MED2052-Exam2

Nursing considerations when administering metronidazole (Flagyl)

1) Advise clients that adverse effects of nausea and diarrhea are common 2) Remind clients to take the full course of prescribed medications

Teaching for the client prescribed amoxicillin and clavulanate (Augmentin)

1) Amoxicillin may be taken with meals. 2) instruct the client to take the full course of medication

Nursing considerations when administering ceftriaxone (Rocephin)

1) Antibiotics given until culture and sensitivity results are available. Effective for bacterial infections. 2) Prophylactic antibiotics given to individuals in close contact with the client.

List the types of opportunistic infections observed in the AIDS client

1) Bacterial diseases, such as tuberculosis, bacterial pneumonia, and septicemia (blood poisoning) 2) HIV-associated malignancies, such as Kaposi's sarcoma, lymphoma, and squamous cell carcinoma 3) Viral diseases, such as those caused by cytomegalovirus, herpes simplex, and herpes zoster virus 4) Fungal diseases, such as PCP, candidiasis, cryptococcosis, and penicilliosis 5) Protozoal diseases, such as pneumocystis jiroveci pneumonia (PCP), toxoplasmosis, microsporidiosis, cryptosporidiosis, isosporiasis, and leishmaniasis

Nursing considerations for the client taking zidovudine (Retrovir)/Labs to monitor

1) CBC with differential 2) if neutropenia, Discontinuation of the medication

How do you know when the HIV client has AIDS?

1) CD4+ T-lymphocyte count and percentage or AIDS-defining illnesses 2) Less than 200 cells/mm3 3) Less than 14%

Describe the HIV retrovirus

1) Contact with infected blood or body fluids o Homosexual or bisexual men o lntravenous drug users o Neonates of infected women (perinatal) o Breast feeding infants of infected women o Recipients of contaminated blood or blood products; healthcare workers, surgery o Heterosexual partners

Nursing considerations for client taking tetracycline

1) Contraindicated during pregnancy because of possibility of toxic effects to the developing fetus 2) Contraindicated in lactation and in children younger than 9; may cause permanent yellow-gray-brown discoloration of the teeth

Superinfection and antibiotic therapy

1) Diarrhea, bloody diarrhea, rectal bleeding, fever, abdominal cramping, candidiasis, pseudomembranous colitis, stomatitis 2) May cause antibiotic associated pseudomembranous colitis (superinfection);

Teaching for client treated with acyclovir (Zovirax) for genital herpes

1) For topical administration, advise clients to put on rubber gloves to avoid transfer of virus to other areas of the body. 2) Inform clients to expect symptom relief but not cure. 3) Instruct clients to wash affected area with soap and water three to four times/day and to keep the lesions dry after washing. 4) Advise clients to refrain from sexual contact while lesions are present. 5) Clients who have healed herpetic lesions should continue to use condoms to prevent transmission of the virus.

Adverse effects of sulfonamides

1) Gastrointestinal system adverse reactions: nausea, vomiting, anorexia, diarrhea, abdominal pain, stomatitis 2) chills, fever, crystaNuria, photosensitivity

Adverse effects of aminoglycosides

1) General system adverse reactions: nausea, vomiting, anorexia, rash, urticaria 2) May cause nephrotoxicity: monitor l&O, hematuria, BUN and creatinine; have client report j in urine output 3) May cause ototoxicity: monitor tinnitus, headache, hearing loss, nausea, dizziness, and vertigo 4) May cause neurotoxicity: monitor for peripheral neuritis, optic nerve dysfunction, numbness and tingling

Discuss HAART for HIV client

1) Highly active antiretroviral therapy (HAART) involves using three or four HIV medications in combination with other antiretroviral medications 2) Infusion inhibitors - enfuvirtide (Fuzeon) 3) Entry inhibitors - maraviroc (Selzentry) 4) Nucleoside reverse transcriptase inhibitors (NRTIs) - zidovudine (Retrovir) 5) Non-nucleoside reverse transcriptase inhibitors (NNRTIs) - delavirdine (Rescriptor) and efavirenz (Sustiva) 6) Protease inhibitors - atazanavir (Reyataz), nelfinavir (Viracept), saquinavir (Invirase), and indinavir (Crixivan) 7) Integrase inhibitors - raltegravir (Isentress) 8) Antineoplastic medication - interleukin (Interferon)

Discuss Kaposi's sarcoma

1) Painless purplish or brown skin lesions 2) immune deficiencies, such as HIV or AIDS 3) Treatment may include radiation or chemotherapy.

Transmission precautions for the AIDS client/Ways HIV transmitted

1) Providers should use standard precautions when caring for the client 2) "HIV enters the body through breaks in the skin or mucous membranes." 3) HIV has been shown to be present in very low concentrations but not been shown to be transmitted via urine, saliva, tears, cerebrospinal fluid

Psychosocial interventions for the client diagnosed with AIDS

1) Test neurological status (confusion, dementia, visual changes) 2) Encourage activity alternated with rest periods.

Discuss the actions of oral NRTIs (abacavir, lamivudine, and zidovudine (Trizivir)

1) These medications inhibit enzymes to prevent HIV replication 2) given during pregnancy to prevent transmission of the virus to the fetus.

toxoplasmosis

1) treated with sulfadiazine. 2) Pregnant people should not empty litter boxes 3) organism found in rare pork 4) may cause a severe inflammatory response

Pneumocystitis carinii pneumonia (PCP)

A serious respiratory complication of AIDS

Priority of care for the client with HIV

A. Perform a physical assessment B. Determine when current symptoms began. E. Obtain a sexual history.

Risk factors associated with HIV

A. Perinatal exposure D. Older adult woman E. Occupational exposure

Describe the screening tests for HIV

A. Western blot B. Indirect immunofluorescence assay

diagnostic tests and laboratory values are used to confirm HIV infection

A. Western blot B. Indirect immunofluorescence assay C. enzyme-linked immunosorbent assay [ELISA]

pemphigus

An autoimmune disease that causes blistering in the epidermis

Discuss the cells involved when the client has HIV

CD4+ lymphocytes T-cells T-lymphocytes.

fluconazole (Diflucan)

Candidiasis

Pregnancy and HIV/AIDS

Condoms made from latex are the best at preventing pregnancy

Indinavir (Crixivan)

"I need to take the medication with water but on an empty stomach."

Discuss culture and sensitivity tests

Culture and sensitivity should be performed prior to the administration of Penicillins drugs

Most important thing to prevent HIV

Education

Pneumocystis jiroveci pneumonia

Fungal disease, common defining condition of HIV Stage III-AIDS, symptoms: non-productive cough, crackles, SOB, fever, tachypnea

Nursing diagnoses for the AIDS client

HIV enters the body through breaks in the skin or mucous membranes

Define HIV

Human immunodeficiency virus (HIV) is a retrovirus that is transmitted through blood and body fluids (semen, vaginal secretions).

Important labs for the client taking ritonavir (Norvir)

Hyperlipidemia with increased cholesterol and triglyceride levels can occur as an adverse effect of ritonavir

night fever and night sweats. The nurse advises the client to do which action to increase comfort while minimizing symptoms?

Keep liquids on the nightstand at home.

Stage 4 human immunodeficiency virus (HIV) infection?

Lymphoma Kaposi sarcoma Candidiasis of the esophagus

Viral Load

Measurement of the number of copies of HIV virus in blood to monitor progression of HIV and AIDS

Most rapidly growing AIDS group

Men sex with other men (MSM)

zalcitabine (Hivid)

Numbness in the legs

Candida albicans

Opportunistic fungal infection causing red bleeding gums and oral mucous membranes with cheesy white patches

Cytomegalovirus

Opportunistic viral infection in client with AIDS, causing lung inflammation, colitis, retinitis and blindness

Enzyme linked immunosorbent assay (ELISA)

Primary screening test for HIV, requiring two positive results for preliminary diagnosis.

Kaposi's sarcoma diagnosis

Punch biopsy of the cutaneous lesions

Medication for the pregnant HIV client

Ribavarin is pregnancy category X

Discuss "peak and trough" levels; Give an example of a drug that requires this

Samples for peak levels should be collected 30 minutes after administration of drug IM or IV; trough levels for the client should be collected prior to the next dose

Discuss care after an accidental needle stick

Scrub the area vigorously when soap and water for 5 minutes

increase the risk of HIV transmission

• intravenous drug use • perinatal exposure • unprotected vaginal or anal sex • unprotected oral sex

Discuss HIV encephalopathy

■■ Maintain client safety. ■■ Implement seizure precautions.

Discuss symptoms for AIDS

◯ Chills ◯ Rash ◯ Anorexia, nausea, weight loss ◯ Weakness and fatigue ◯ Headache and sore throat ◯ Night sweats ◯ Flu like symptoms

Data collection for the client at risk for HIV

◯ Unprotected sex (vaginal, anal, oral) ◯ Multiple sex partners ◯ Occupational exposure (health care workers) ◯ Perinatal exposure ◯ Blood transfusions ◯ Intravenous drug use with a contaminated needle ◯ Older adult ◯ Older women experience vaginal dryness and thinning of the vaginal wall

Most common use of sulfonamides

UTI

Manifestations of wasting syndrome

anorexia, vomiting, diarrhea

Not recommend for HIV mother

breast feeding

Penicillin

effective to treat all organism except viral and fungal infections

Describe manifestations of Pneumocystis jiroveci (carinii) pneumonia

fungal pneumonia with nonproductive cough, crackle, dyspnea, shortness of breath, fever, tachypnea, cyanosis

Discuss standard precautions

gloves, gowns, eye protection, face masks, and shoe covers - must be worn to prevent contamination with bodily fluids

Discuss cytomegalovirus (CMV)

lung inflammation, colitis, retinitis and blindness (visual changes)

Aminoglycosides can cause

ototoxicity

Vancomycin

peak blood levels should be collected 1-2 hours after completion of IV infusion, trough 1 hour before IV infusion

Discuss ways to prevent sexual transmission of HIV

use of condoms, abstinence