Cystic Fibrosis

cryptosporidiosis

-parasite that is transmitted through the feces -S&S : severe diarrhea, stomach cramps, fever -it's difficult to treat the actual parasite, so treat the symptoms -interventions I&O, assess hydration, record onset, pattern, duration, etc. -encourage increased protein , soluble fiver, bland foods -antidiarrheals which include sandreostatin, octreotide acetate

What level of CD4 Cell Counts indicate HIV?

< 200 is an AIDS indicator value 200-500 cells per mm3 = suppressed immune system 500 -1200 cells per mm3 = competent immune system As the viral load increases the CD4 count decreases

CF meds and teaching

Albuterol - teaching about proper use and monitor for tremors or tachycardia ipratropium (bronchodilator)- will cause dry mouth, suck on hard candies, nebulizer treatment teaching - breaks up mucus antibiotics- screen for allergies, take entire course pancreatic enzymes- take with meals; swallow whole or sprinkle on food Therapeutic vest- use on an empty stomach- coughing spasms can cause vomiting Diet-High calorie, let child choose, ADEK supplements, stool softeners Fluticasone propionate/salmeterol - steroid

diagnosing CF at birth

At birth, some babies have a terminal Ileus that blocks feces from being excreted. This is highly suggestive of cystic fibrosis - s/s abdominal distinction , n/v and inability to pass meconium

How is Tuberculosis associated with AIDS patients?

Because an AIDS patient is opportunistic infected, meaning that they are much more susceptible to getting TB. TB is spread via airborne contact

CD4 cells

CD4 cells are a type of white blood cell that fights infection. Another name for them is T-helper cells. CD4 cells are made in the spleen, lymph nodes, and thymus gland, which are part of the lymph or infection-fighting system. They send signals to activate your body's immune response when they detect "intruders," like viruses or bacteria. In people with HIV, it is the most important laboratory indicator of how well your immune system is working and the strongest predictor of HIV progression.

What type of cell does the HIV virus attack ?

CD4+ Lymhocytes, also known as T-cells or T- Lymphocytes - T- cells are part of the adaptive (acquired) immunity

What is Cryptococcal Meningitis and how associated with AIDS patients?

Cryptococcus is a fungus. It is very common in the soil. It can get into your body when you breathe in dust or dried bird droppings. It does not seem to spread from person to person. Meningitis is the most common illness caused by Cryptococcus. Meningitis is an infection of the lining of the spinal cord and brain. It can cause coma and death. Cryptococcus can also infect the skin, lungs, or other parts of the body. The risk of cryptococcal infection is highest when your CD4 counts are below 100. Cryptococcal meningitis is a major HIV-related opportunistic infection,

how does one test for HIV

Diagnosis - looking for antibodies EIA (former name ELISA) 3, 6 weeks , 3 months, 6 months Western blot (to confirm EIA results) OraQuick Rapid HIV-1 Antibody Test - 10-20 minutes Aptima: FDA approved

S/s cystic fibrosis pink puffer

Fatigue, chronic cough, thick yellow mucous, sob, cyanosis, difficulty in exhaling, hyperinflation of chest, barrel shaped chest, clubbing of fingers, +sputum culture , distended abdomen, thin arms and legs with a bloated belly

What would be the nursing care of a cystic fibrosis child with pulmonary issues

General care of Vitals, in particular lung sounds, IV, get sputum cultures (B. capacia and P. aeruginosa), provide support ot child and family Perform chest physiotherapy (CPT) with posterual drainage (traditional or vest) Administer aerosol therapy Administer IV antibiotics (tobramycin, ticarcillian or gentamicin) Encourage physical exercise Provide Oxygen as necessary

What would be nursing care for gastrointestional complications of a cystic fibrosis patient?

Give multiple small meals a day with snacks Encourage fluid intake Administer pancreatic enzymes as prescribed (with meals or 30 within 30 minutes) Administer vitamin supplements (multivitamin (especially A, D, E, K) Administer polyethylene-glycol electrolyte solution via nasogastric tube for constipation Administer histamine-receptor antagonist and motility medications for GERD Administer possible formula supplements via gastric tube Consult dietitian

What are the Antiretroviral (ART) Therapies ?

HAART/ART - Drugs used to target the HIV replication, entry and release . The goal of ART is to decrease your viral load, ideally down to 45- 75 copies in one sample of your blood Always use 3 drugs from 2 classes - work at different stages of disease development . This will interfere with the viral replication in different stages Reverse Transcriptase Inhibitors NRTIs NNRTIs Protease Inhibitors Entry/fusion Inhibitors Integrase Inhibitors Combination Drugs

EIA test

If your blood contains antibodies to HIV, it will bind with the antigen. The technician will check this by adding an enzyme (a protein that helps speed up chemical reactions) to the petri dish and watching how your blood and the antigen react. If the contents of the dish change color, you may have HIV.

what are opportunistic infections

Infections that normally wouldn't be able to invade a healthy host but can because the host in immuno-compromised such as with AIDS

What happens during the initial HIV infection

Instance of Exposure Acute retroviral infection (flu-like symptoms/non-specific, fever, body-aches, headache, anorexia, swollen glands, sore throat- Seroconversion: 2-6 weeks, maybe 6 months

western blot test

It involves separating the HIV sample into its component proteins using an electrical current. Then, these proteins are transferred to a special kind of paper (blotting) and reacted with your blood sample. An enzyme is used to cause color change and detect antibodies.

what is kaposi sarcoma

Kaposi sarcoma (KS) is a cancer that develops from the cells that line lymph or blood vessels. It usually appears as tumors on the skin or on mucosal surfaces such as inside the mouth, but tumors can also develop in other parts of the body, such as in the lymph nodes (bean-sized collections of immune cells throughout the body), the lungs, or digestive tract. The abnormal cells of KS form purple, red, or brown blotches or tumors on the skin. These affected areas are called lesions. The skin lesions of KS most often appear on the legs or face. They may look bad, but they usually cause no symptoms. Some lesions on the legs or in the groin area may cause the legs and feet to swell painfully. KS can cause serious problems or even become life threatening when the lesions are in the lungs, liver, or digestive tract. KS in the digestive tract, for example, can cause bleeding, while tumors in the lungs may cause trouble breathing.

What is chronic asymptomatic HIV infection ?

Latent period of up to 10+ years (HIV positive but no symptoms ( Anti-HIV antibodies are produced so HIV positive Over time the virus begins active replication using host's machinery and CD4+ cells destroyed, the viral load increases and there is a dramatic loss of immunity

when does HIV turn into AiDS

Must be Infected with HIV and CD4+ T-cell count < 200 and/or Onset of an opportunistic infection (OI)

what is Myobacterium avium complex

Mycobacterium avium complex (MAC) is a group of bacteria that is very common in food, water, and soil. Almost everyone has them in their bodies. If you have a strong immune system, they don't cause problems. s/s include high fevers, chills, diarrhea, weight loss, stomach aches, fatigue, and anemia

Sweat test

Pilocarpine is applied to skin on forearm and covered with electrodes. The electrodes are stimulated (to get sweat) and the test is checked for NaCl levels

what is the most common opportunistic life threatening infection associated with AIDS

Pneumocystis Pneumonia (PCP) - most common life threatening associated with HIV/AIDS - bronchial secretions Tx with Sulfamethoxazole and trimetheprim

Who needs to start ART therapy immediately?

Pregnant women Hep A and Hep C peeps

What are the complications of Cystic Fibrosis

Respiratory Complications - infections, bronchial cysts, emphysema, pneumothorax, nasal polys Gastrointestional complications meconium ileus, prolapse of the rectum, distal intestional obstruction syndrome, GERD Endocrine complications - Diabetes mellitus

What are the diagnostic test for cystic fibrosis ?

Sweat chloride test - normal less than 40 mEq/L DNA testing to isolate mutation Pulmonary Function Tests Chest X-rays Abdominal X-rays

ethambutol

TB med that can have negative vision effects- monitor eye sight while on this medication hepatoxicity is the main side effect with these meds, don't drinks! will be on longer than 9 mos

INH

TB med that can have neuro SE- watch for tingling in the hands and feet, vitamin B6 can be a preventative measure for INH toxicity hepatoxicity is the main side effect with these meds, don't drinks! will be on longer than 9 mos

rifampin

TB med that turns your pee orange hepatoxicity is the main side effect with these meds, don't drinks! will be on longer than 9 mos

pyranzinmamide

TB med- drink a full glass of water with each dose hepatoxicity is the main side effect with these meds, don't drinks! will be on longer than 9 mos

TPN considerations

TPN Considerations I&O; ensure homeostasis and watch for signs of overload FSBG - check for hyperglycemia; @least 1x/shift Vital signs- include temperature - Watch for infection Bicep measurements; 1x/shift, to check for infiltration BMP:TPN can be adjusted to correct electrolyte imbalances Catheter length: check if its still in the right spot, 1X/shift Sterile Dressing changes per protocol - Prevent Sepsis Monitor dressing/insertion site for signs of infection Daily weights: tell us about fluid status 2 RNS hang TPN

s/s of cryptococcal meningitis

The first signs of meningitis include fever, fatigue, a stiff neck, headache, nausea and vomiting, confusion, blurred vision or sensitivity to bright light. The symptoms may come on slowly.

what is the goal of ART THERAPY

The goal is to change the DNA of the virus or it's effect on the cell. They are given in combos to decrease the resistance and decrease side effects. Pregnant mothers should take drugs in the 2/3 trimesters, only. DO NOT BREASTFEED!

tests used to test for cryptococcal meningitis

The tests use blood or spinal fluid. The blood or spinal fluid can be tested for cryptococcus in two ways. A culture can take a week or more to show a positive result. Spinal fluid can also be tested quickly using a stain.

What is Post Exposure Prophylaxis; when used

When someone exposed to Blood or visibly bloody fluids, semen, vaginal secretions, breast milk, CSF, synovial, pleural, peritoneal, pericardial, & amniotic fluids are considered infectious Wash area with soap & water (mm flush with water). Report immediately and go to ED Document details of exposure Counseling Recommended treatment (NYSDOH): Start multi-drug treatment within 2 hours (no later than 36 H) Take meds for 4 weeks Employment institution should have these available for employees (3 day use). If given within 1-2 hours, transmission may be reduced 79%. Check HIV & HBV status in the HCW and the "source" (consent required)

cor pulmonale in CF

an abnormal enlargement of the right side of the heart. result of lung disease or hypertension for a long period of time s/s shortness of breath tiredness an increased heart rate lightheadedness crackles in the lungs JVD S3 heart sound

Drugs used to treat Myobacterium avium complex

antibiotics (per class) Rifampin azithromycin clarithromycin You should know that these drugs can interact with others and cause side effects. For this reason, be sure to tell your doctor about all the medications you are taking. MAC drugs may interact with:Antiretroviral medications: Antifungal medications: Birth control pills: Blood thinning drugs

What med does an HIV negative partner take

emtricitabine/tenofovir reduced the risk of infection by 96% if taken regularly NNRT- common side effects basic, n/v/d

medication treatment for cyrptococcal meningitis

fluconazole and Amphotericin B

candidiasis

fungal infection creamy white patches on the mouth throat, and GI tract. tx- with antifungals- fluconazole

What to hang if TPN is not available yet

hang D10 - a nurse cannot make this decision, call provider. typically people must be weaned off of TPN slowly, so rebound hypoglycemia is a big concern.

wasting

involuntary loss of over 10% of body weight. interventions- small meals, bland food , eat what you can and rest when you can. TPN

amphotericin b

is also a very strong drug. It is given as an injection or a slow intravenous (IV) infusion. Both of these drugs can have serious side effects. Side effects can be reduced by taking Advil or Tylenol a half hour before taking the drug. Monitor for renal toxicity so maintain hydration and provide IV fluid before and after . Given for Crytococcoal meningitis never given with oral candidosis

What is Candida albicans and how associated with AIDS patients?

it is a fungus, can show up as trush or yeast infections, etc Fluconazole (Diflucan tablets): Diflucan is a tablet that must be swallowed.

pancreatic enzyme deficiency in CF

leads to malabsorption and a failure to thrive. These kids will need exogenous pancreatic enzymes. If malabsorption is a serious issue, it may maybe lead to decreased metabolism of protein, low albumin, and generalized edema from leaky vasculature.

CF reproductive and endocrine

men are usually sterile. There is a delay in puberty, viscous cervical mucous - glucose monitoring may be needed because of insulin resistance or deficiency.

ART side effects - top concerns

orthostatic hypotension long term- hepotoxicity nephrotoxicity hyperglycemia hypolipidemia n/v/d fatigue/weakness flu like symptoms

polycythemia in CF

the body tries to compensate for decreased ventilatory capacity by creating more O2, carrying capacity (RBC). This increased hematocrit of the blood can lead to clotting problems

Drug resistance testing

this is a marker of the disease progression. It is a therapeutic response to see if ART is working and if they need to switch it up and try a new string of medications

Sulfamethoxazole

used to treat infections and given to AIDS patients for Pneumocystis pneumonia