Immunity

Live vaccines

MMR, varicella, H1N1, nasal flu, rotavirus, bacille calmette-guérin (BCG), yellow fever or typhoid vaccines

What is the combination of Tenofovir/Emtricitabine indicated for?

Pre-exposure prophylaxis of HIV for men who have sex with other men or are at high risk of HIV

HIV meds

Zidovudine, Efavirenz, raltegravir, enfuvirtide

Sepsis criteria

· A documented or suspected infection with one or more of the following: - Fever (core temperature >38.3 C) - Hypothermia (core temperature <36 C) - Heart rate >90 beats/min Tachypnea - Altered mental status (sign in elderly people) - Significant edema or positive fluid balance (>20 mL/kg over 24 hours) - Hyperglycemia (plasma glucose >120 mg/dL) in the absence of diabetes (cortisol released from adrenal glands) - Leukocytosis ( WBC count >12,000/mL) - Leukopenia (WBC count <4000/mL): isolate pt from flowers and fresh foods - Normal WBC count with >10% immature forms - Plasma C-reactive protein increased (inflammatory process) - Plasma procalcitonin increased

A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, "I feel obsessed with thoughts about dying. Do you think I am just being morbid?" Which response by the nurse is best?

"Can you tell me more about the kind of thoughts that you are having?" (More assessment of the patient's psychosocial status is needed before taking any other action.)

A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/mL. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct?

"The patient has developed acquired immunodeficiency syndrome (AIDS)." (Development of PCP meets the diagnostic criterion for AIDS.)

Risk factors of HIV

- Vaginal candida (1st sign of HIV), herpes, PID, cervical cancer (She said this 5 times!!!)

Serum lactate for sepsis

> 2.2

To evaluate the effectiveness of the pantoprazole (Protonix) ordered for a patient with systemic inflammatory response syndrome (SIRS), which assessment will the nurse perform?

Check stools for occult blood. (Proton pump inhibitors are given to decrease the risk for stress ulcers in critically ill patients.)

Lab values with HIV

HIV/AIDS Lab Values: · Viremia: large amounts of HIV in blood for 2-3 weeks after initial infection. Then followed by low levels of HIV level (even without tx); then slowly increases while CD4 decreases (chronic); then AIDS (CD4 <200) - Transmission is more likely when the viral load is high; if low less likely to infect others - Window period takes several weeks after the infection before antibodies can be detected on a screening test - Teach to pt that they will have to report back after a week to get results - If both spouses have HIV, they still need to use protection to avoid infection with different strains of HIV. USE LATEX CONDOMS ONLY (No natural membrane)!!!! (Test question here!!!) · Rapid HIV antibody is recommended bc results are given in 20 minutes; no need to wait a week; treatment & counseling can begin - HIV determination - ELISA gives positive result confirmed by western blot or immunofluorescence assay test - Positive result from virologic (viral load): RT-PCR, bDNA, NASBA - Liver, biopsy, Stoll, MRI, CT - If patient is undetectable for viral load, it means that the viral load is lower than the test can detect; DOES NOT mean the virus is gone or can no longer be transmitted · Low WBC (lymphocytes and neutrophils) · low platelets, anemia, Plt <150,000= anemia, thrombocytopenia, leukopenia · Altered liver function 1. Progression (>500 CD4 cells) - S/S (fever, night sweats, anorexia, weakness, H/A, sore throat, chills, flulike) start 2-4 wks after infection - Rapid rise in HIV viral load, decrease in CD4+ cells, increase in CD8 cells - Then decline in viral HIV copies - Lymphadenopathy (high con of lymphocytes in lymph nodes); hard, swollen, more than 1 cm - Fatigue, headache, low-grade fever, night sweats, PGL (swollen lymph nodes), and other symptoms, joint pain, Guillain-Barre syndrome (AMS; keep pt safe!) - Teach pt about adequate nutrition, exercise, sleep, & infection prevention 2. Chronic asymptomatic infection (200-499 CD4 cells) - Immune problems tend to start (opportunistic infections start) - Asymptomatic for about 10 yrs. - Fever, frequent drenching night sweats chronic diarrhea, recurrent headaches, and fatigue severe enough to interrupt normal routines, - oral thrush, shingles, herpes outbreaks, Kaposi sarcoma (cancer), and oral hair leukoplakia all may develop - CD4 cells destroyed, HIV viral load increases, loss of immunity overtime 3. AIDS (<200 CD4 cells) - Severe immune problems begin to start - Life-threatening opportunistic infection - End of HIV stage, death 5 yrs. Later (death from Opportunistic diseases; PNA, UTI, CMV, cancers) - AIDS have HIV; HIV not has AIDS - pneumocystis jirovecii pneumonia (PCP), candidiasis, Kaposi's sarcoma(Skin cancer: was on the exam!!!), Burkitt's lymphoma, malengies - cryptococcal meningitis: Kernig and Brudzinski and seizure - (PCP): fatal; tx is Trimethoprim plus sulfamethoxazole (Bactrim)

A patient with septic shock comes into the ED. What order should the RN, that is caring for the patient, care form more priority concern?

O2, IV, lab work, IVBP (antibiotics)

The nurse prepares to administer the following medications to a hospitalized patient with human immunodeficiency (HIV). Which medication is most important to administer at the right time?

Oral saquinavir (Invirase). (It is important that antiretroviral be taken at the prescribed time every day to avoid developing drug-resistant HIV.)

After change-of-shift report in the progressive care unit, who should the nurse care for first?

Patient with suspected urosepsis who has new orders for urine and blood cultures and antibiotics. (Antibiotics should be administered within the first hour for patients who have sepsis or suspected sepsis in order to prevent progression to systemic inflammatory response syndrome (SIRS) and septic shock.)

After reviewing the information shown in the accompanying figure for a patient with pneumonia and sepsis, which information is most important to report to the health care provider?

Platelet count and presence of petechiae. (The low platelet count and presence of petechiae suggest that the patient may have disseminated intravascular coagulation and that multiple organ dysfunction syndrome (MODS) is developing.)

The nurse designs a program to decrease the incidence of human immunodeficiency virus (HIV) infection in the adolescent and young adult populations. Which information should the nurse assign as the highest priority?

Prevention of HIV transmission between sexual partners. (Sexual transmission is the most common way that HIV is transmitted.)

The nurse is caring for a patient who has septic shock. Which assessment finding is most important for the nurse to report to the health care provider?

Skin cool and clammy. (Because patients in the early stage of septic shock have warm and dry skin, the patient's cool and clammy skin indicates that shock is progressing.)

What herbal medication should be avoided on ART?

St. Johns wort

Which finding about a patient who is receiving vasopressin (Pitressin) to treat septic shock is most important for the nurse to communicate to the health care provider?

The patient is complaining of chest pain. (Because vasopressin is a potent vasoconstrictor, it may decrease coronary artery perfusion.)

Which data collected by the nurse caring for a patient who has cardiogenic shock indicate that the patient may be developing multiple organ dysfunction syndrome (MODS)?

The patient's serum creatinine level is elevated. (The elevated serum creatinine level indicates that the patient has renal failure as well as heart failure. The crackles, chest pressure, and cool extremities are all consistent with the patient's diagnosis of cardiogenic shock.)

The health care provider orders the following interventions for a 67-kg patient who has septic shock with a BP of 70/42 mm Hg and oxygen saturation of 90% on room air. In which order will the nurse implement the actions?

Titrate oxygen administration to keep O2 saturation >95%, Infuse normal saline 2000 mL over 30 minutes, Start norepinephrine (Levophed) 0.5 mcg/min, Obtain blood and urine cultures, Give vancomycin (Vancocin) 1 g IV. (The initial action for this hypotensive and hypoxemic patient should be to improve the oxygen saturation, followed by infusion of IV fluids and vasopressors to improve perfusion. Cultures should be obtained before administration of antibiotics.)

HIV

a retrovirus that causes immunosuppression. transmitted by blood, breast milk, and body fluids (WET SEX!!!!!); normal CD4 (800-1500) lives about 100 days. If HIV+, CD4 cells live for 2 days

Sepsis drugs

dopamine, norepinephrine, phenylephrine, corticosteroids, epinephrine, insulin

After receiving 2 L of normal saline, the central venous pressure for a patient who has septic shock is 10 mm Hg, but the blood pressure is still 82/40 mm Hg. The nurse will anticipate an order for...

norepinephrine (Levophed). (When fluid resuscitation is unsuccessful, vasopressor drugs are administered to increase the systemic vascular resistance (SVR) and blood pressure, and improve tissue perfusion.)

SIRS

· Defined by the presence of 2 or more of the following (temp, resp, HR): - Temperature greater than 38.0°C or less than 36.0° - Heart rate higher than 90 beats/min - Respiratory rate higher than 20 breaths/min or arterial carbon dioxide tension below 32 mm Hg - White blood cell (WBC) count higher than 12,000/µL, or lower than 4000/µL, or including more than 10% bands (baby WBC taking over the mature neutrophils)

Sepsis

· Systemic response to an infection (virus, fungal, bacteria). Results specifically to the infection - SIRS with a confirmed or presumed infection

Assessment findings of HIV

· Targets CD4 lymphocytes (T-helper cells) (these cells important for adaptive immunity) · No cure, rest of life, progress to AIDS (<200 CD4 cells), then to death (like 5 yrs later) - Support groups highly recommended!!! · Teach supportive care about opportunistic diseases · Swollen lymph nodes, painful, on neck (This was a test question!!!) · Albumin is the key for nutrition and hgb for pt. Test for protein; Keep it stable · Stigma occurs (discrimination, low self-esteem, economic pressure; thus can lead to more risky behaviors) · All pregnant women should be screen for HIV!!! Pregnant women untreated transmission is 25%; if on ART, it's 2%!!! - HIV women: no breast feeding!!!! · If exposed to HIV (needle stick), prophylaxis is given · Oropharyngeal candidiasis (thrush): most common infection with symptomatic HIV · HIV is on the rise in the old people and young people. Get tested while in High School · Healthcare worker gets stuck by a needle from a possible HIV infected pt - Post exposure prophylaxis: Start 2 NRTIs for at least 28 days within 1-2 hours of exposure need to be tested for HIV antibodies at time of exposure, 6 weeks, 12 weeks, & 6 months after · Seroconversion: When HIV specific antibodies develop during initial infection · If asymptomatic, give vaccinations for Hep B, PNA, and influenza · Candidiasis, PNA, CMV, Tuberculosis (wear N95 mask) are most common opportunistic infections · Night sweats mean there is not active immune response · Cryptosporidiosis- parasite in the GI causing inflammation. Pt can lose up to 20L of fluid per day