COMMUNICABLE DISEASES

DISEASES ACQUIRED MAINLY THROUGH THE RESPIRATORY TRACT CHICKEN POX OTHER NAMES: VARICELLA,SHINGLES AGENT: HERPES VIRUS VARICELLA note: same virus that causes herpes zoster SOURCE : respiratory secretions of infected persons MODE OF TRANSMISSION: DIRECT CONTACT, RESPIRATORY,RARELY THRU SKIN LESIONS Airborne Contact with contaminated linen and fomites Severe small pox skin lesions Period of communicability

1 day before the appearance of lesions and 6 days after the last scab formation Most contagious in the early satges of eruption of skin lesions
Incubation period 2-3 weeks or 13 to 17 days NOTE: Neonatal infection is rare An attack confers long immunity VACCINES Varicella zoster Immune Globulin (VZIG) - effective in modifying or preventing disease if given within 96 hours after exposure. Live attenuated varicella virus vaccine-shown to protect children with leukemia exposed to siblings exposed with Congenital varicella results to: Hypoplastic deformities and scarring of limb Retarded growth CNS and ophthalmic manifestations DIAGNOSTIC EVALUATION Isolation of the virus from the vesicular fluid Giemsa stain Serum antibodies is present in 7 days after onset Nursing considerations Strict isolation until all vesicles and most scabs disappear (usually 1 week after appearance of rash )

Exclude children from school for at least 5 days after eruption first appears or until
vesicles becomes dry DIPTHERIA Toxin mediated disease with formation of pseudomembranes on faucial areas and tonsils Toxin affects heart, kidneys,and peripheral nervous system KLEBS-LOEFFLER BACILLUS Immunity of the baby disappears at 6 mos with mothers who have vaccinations High prevalence is during cooler month of December and February Does not confer immunity Prolonged active immunity can be induced by vaccination Source of infection Discharges and secretions mucus membrane of nose, pharynx and other lesions of infected persons Reservoir of infection is MAN Incubation period : 2-5 days LARYNGOTRACHEAL INVOLVEMENT: Hoarseness and barking cough Noisy breathing Inspiratory stridor Progressive suffocation Death NASAL INVOLVEMENT Persistent serous nasal discharge Bloody and foul Nasal obstruction Excoriation of external nares MEDS : ERYTHROMYCIN PENICILLIN Administration of diptheria AT DIAGNOSTIC EVALUATION: Schick test for immunity to diphtheria

LEPROSY
OTHER NAMES: Lepra, Leontiasis,Hansenosis,Hansens disease ETIOLOGIC AGENT: Mycobacyerium leprae
or Hansen's bacillus an acid fast bacilli MODE OF TRANSMISSION: Prolonged skin contact, droplet infection

Children below 12 years old are more susceptible CARDINAL SIGNS

1. peripheral nerve enlargement 2. loss of sensation 3. positive smear test

EARLY MANIFESTATIONS Color changes in the skin which does not disappear even with treatment Skin ulcers which does not heal with treatment Pain and redness of the eyes Nasal obstruction and nose bleeding Muscle weakness and paralysis Loss of sensation on the affected area Loss of hair growth Anhydrosis- loss of sweating

LATE MANIFESTATIONS: Lagopthalmos- inability to close the eyelids Madarosis- loss or absence of eyebrows Sinking of bridge of the nose Leonine face Natural amputation-toes,fingers,ear,nose Contractures clawing of fingers and toes Chronic skin ulcers Gynecomastia DIAGNOSTIC EXAMINATIONS Skin smear test Skin lesion biopsy Lepromine test MANAGEMENT Ambulatory, multi drug therapy Domicilary treatment as embodied in R.A. 4073 which advocated home treatment The MULTI DRUG THERAPY RECOMMENDED BY WHO Rifampicin Dapsone-photosensistivity Ofloxacin Minocycline Clofazimine (lamprene)- discoloration of skin which is reversible, discolors body fluids from pink to brownish black

NOTE: once the treatment has been complied with, the patient is considered cured and
no longer infective even if he displays the sequela of the disease. MEASLES URT symptoms KOPLIKS spot Not associated with congenital abnormalities but can cause abortion, induced labor ,stillbirth 3

AGENT: PARAMYXOVIRIDAE SOURCE OF INFECTION: MAN MODE OF TRANSMISSION:

1.Droplet infection 2. Direct contact with infected persons 3. Indirectly freshly contaminated articles 4. In some instances,airborne
INCUBATION PERIOD: 10 days,

varying from 7-18 days from exposure to onset of fever. Usually 14 days after rash appears MANIFESTATIONS PRODROMAL PHASE: Lasting 4-5 days Catarrhal appears Respiratory symptoms usually appears At the end of the prodrome: Koplik spots appear About 5 days after the appearance of the Koplik spots: Temperature rises sharply Spots slough off Rash appears behind the ears, neck and cheeks Macules becomes papular and erythematous spreading on the entire face ,neck, arms,chest,back , abdomen and thighs About 2-3 days later when the rashes reaches the feet, it begins to fade in the same sequence it appeared , leaving brownish discoloration that disappears in 7-10 days. The climax of measles occurs 2-3 days after the rash appears and is marked by : a. temperature of 39.4-40.6 degree C b. severe cough c. Puffy red eye d. rhinorrhea
At about 5 days after the rash appears , other symptoms disappear and

communicability ends SOME REMINDERS ON MEASLES VACCINE Defer vaccination of persons who are having fever ,severe acute illness Do not give to people allergic to eggs Vaccine should be given 14 days before or 3 months after IG and blood transfusions Isolation of patients from diagnosis until 5-7 days onset of rash MUMPS OTHER NAMES: Epidemmic parotitis, Infectious Parotitis ETIOLOGIC AGENT: Paramyxoviruses 4

SOURCE OF INFECTION: mouth and nose, saliva Mode of transmission: Direct contact, contact with freshly contaminated secretions
from the respiratory tract of the patient (Fomites) Occurrence of immunity Basically a childhood disease Prevalent in children older than age 5 but younger age 9 One attack if unilateral always confers lifelong immunity

INCUBATION PERIOD:12 to 26 days usually 18 days CLINICAL MANIFESTATIONS:

myalgia anorexia malaise headache low grade fever earache parotid gland swelling

Inform patient that common complication of mumps is orchitis, rarely sterility

RUBELLA OTHER NAMES: German Measles Mild febrile Self-limiting ETIOLOGIC AGENT: Rubella Virus (TOGAVIRIDAE) RESERVOIR: MAN FORSCHEIMERS SPOTS-Small red petechial macules on soft palate CONGENITAL RUBELLA SYNDROME st Acquired the disease during 1 trimester of pregnancy Fetuses infected early are at risk of: a. Intrauterine death b. spontaneous abortion c. Congenital malformations DEFECTS MAY INCLUDE: Deafness Cataracts Micropthalmia Congenital glaucoma Microcephaly Meningoencephalitis Mental retardation PDA Atrial Ventricular septal defects Purpura 5

Hepatosplenomegaly Jaundice Radiolucent

bone disease ROSEOLA INFANTUM Other names: Roseola subitum,The sixth disease, exanthem subitum,exanthem criticum,rose rash of infants Common among 4 years old and below Benign self limiting Etiologic agent: Human Herpes virus Mode of Transmission: Unknown Incubation period: 10-15 days
AVIAN INFLUENZA Bird Flu

CA: Type A Influenza virus H5N1 MOT: fecal-oral s/sx: typical influenza like;
eye infection pneumonia FMD/ Foot and Mouth Disease

CA: Coxsackie virus MOT: direct contact with nose/throat discharges, blisters and feces
Droplet

IP: 2-5 days PC: 1st sx to disappearance of blisters s/sx: Blisterlike rashes, fever Tx: symptomatic, fever control, oral hygiene

TUBERCULOSIS

Phthisis/Consumption/Kochs CA; Mycobacterium tuberculosis

hominis bovine avis

MOT: droplet Tubercle lesions hardening calcification - necrosis PRIMARY COMPLEX: non-contagious because children swallow phlegm S/sx: afternoon fever, night sweats, fatiguability, back pain, chest pain MILLIARY TB: very ill, e.g. Pots disease Tuberculin Tests:
Vollmerpatch Von Parquet 6

Mantoux test NI: Diet, Drugs, Rest Anti-TB drugs R Rifampicin (Rifadine/Rimactane) 600mg once a day I Isoniazid (Laniazid) 300 mg once a day P Pyrazinamide (Zinamide) 500 mg/tablet E Ethambutol (Myambutol) 1.5mg/kg once a day S Streptomycin 1 g/day RIFAMPICIN Empty stomach Body fluid discoloration Hepatotoxic (metabolism) Nephrotoxic (elimination) Permanent discoloration of contact lenses

ISONIAZID Empty stomach Peripheral neuropathy Avoid alcohol Hepatotoxic Nephrotoxic

PYRAZINAMIDE Before meals Monitor s/sx of liver impairment anorexia fatigue dark urine photosensitivity Liver function studies ETHAMBUTOL Not affected by food Report visual disturbances Hepatotoxic Not recommended for children STREPTOMYCIN
After meals Report Oliguria nephrotoxic

Ototoxic Neurotoxic

MALARIA CA: Plasmodium STAGES: cold - chilling; 10-15min -hot water bath on soles Hot - 410C fever; TSB, antipyretics Diaphoretic stage - increase fluids; rest Dx: Malarial smear (peak of fever) Tx: CHLOROQUINE; QUININE DENGUE FEVER Grade I: (+) tourniquet test Fever Abdominal sign Hermans sign Grade II: Grade 1 + bleeding Petechiae Epistaxis Melena Gingival bleeding Coffee ground vomitus Grade III: Grade II + circulatory collapse hypotension Cold clammy skin Weak thready pulse Grade IV: Grade III + shock Grade I: Dengue fever Grade II to IV: Dengue Hemorrhagic Fever Diagnostic Tourniquet test/ Rumpel Lead Test BP cuff: S + D 2 Hematocrit decreased Clotting & Bleeding time (3 series in 8 hours) Platelet count : decreased Dengue Blot test Nursing Mgt Monitor bleeding cold compress epistaxis: lean forward gingival bleeding: ice chips hematemesis: NPO 8

FILARIASIS Helminthic infestation CA: Wuchereria bancrofti; Brugia Malayi Vector: Aedes albopictus; Culex fatigans, Anopheles s/sx: Acute: fever, malaise, chills Chronic: lymphadenitis, swelling of scrotum; elephantiasis Lymphatic channel affected

Dx: Blood smear

Bentonite flocculation test

Tx: Diethylcarbamazepine citrate

KAWASAKI UNKNOWN cause Associated with autoimmune response r/t viral infections Lesions and desquamation: palms, soles of the feet Strawberry tongue DOC : ASPIRIN HELMINTHS Ascaris lumbricoides roundworm Trichinella spiralis trichinosis Trichuris trichuria - whipworm Enterobius vermicularis pinworm Strongyloides stercoralis (Cochin-china diarrhea) Ancylostoma duodenale and Necator Americanus (hookworms) SARS

Atypical pneumonia CA: Corona Virus MOT: close contact/ droplet IP: 2-7 days s/sx:

high fever >380C, dry cough dyspnea, malaise, myalgia, Thrombocytopenia, respiratory distress

DX: Chest X-ray NDx: Impaired Gas Exchange

Mgt: Strict respiratory and mucosal barrier isolation Tx/NI:

symptomatic; no meds 9

Case: Ans.

1ST: Hanoi, Guandong, China

SURVEILLANCE & CASE FINDING

DISEASES MAINLY ACQUIRED THROUGH THE DIGESTIVE SYSTEM TYPHOID FEVER OTHER NAMES: Enteric Fever, Typhus Abdominalis ETIOLOGIC AGENT: Salmonella Typhi,Typhoid bacillus, Salmonella typhosa SOURCE: Man,family contacts become carriers Characterized by ladder like fever Involves ulceration of the Peyers Patches MODE OF TRANSMISSION: 5 Fs fingers food feces fomites flies Fecal-Oral contamination Oral-anal

INCUBATION PERIOD: 2 weeks Susceptibility is general but more prevalent for those with Achlorhydria
DIAGNOSIS

ISOLATION OF THE ORGANISM

a. Blood Culture- positive for the organism after a week b. Urine Culture- positive during the first 2 weeks c. Stool Culture- positive for the organism after the first week or throughout the course of treatment

WIDAL TEST or Blood serum agglutination test nd

-Usually becomes positive by the end of the 2 week -Time recommended on 8th or 10th and repeat by 4th week MEDS CHLORAMPHENICOL TMP SMZ PARAGOMNIASIS Lung dwelling trematode, from eating fresh or half cooked crabs 10

Closely resembles signs and symptoms of PTB ETIOLOGIC AGENT:

paragonimus westermani-ASIA paragonimus siamenses paragonimus heterotrema

RESERVOIR: man , dog, cat and pig Incubation period is 6 weeks Eggs may be discharged by infected persons up to 20 years Not directly transmitted from person to person

PATHOLOGY AND MANIFESTATIONS Flukes and eggs elicit inflammatory response Formation of fibrous capsule Cyst ruptures into the bronchioles and lung parenchyma Blood,eggs and inflammatory exudates are extruded result Pleural-based lesions causes eosinophilic empyemas Long standing lesions shows fibrosis and decreased inflammatory response Flukes can reach distant locations ( brain,abdominal wall, viscera) Signs and symptoms Pleuritic pain Cough Rusty blood tinged sputum Hemoptysis Dyspnea Chest pain fever MEDS Praziquantrel

DISEASES MAINLY ACQUIRED THROUGH THE GENITO URINARY TRACT CHLAMYDIA TRACHOMATIS Uretheritis Mucopurolent cervicitis Man is the reservoir Relapses are possible Incubation : 1-2 weeks MANIFESTATIONS MALE Uretheritis Urethral itching Dysuria Some case are asymptomatic Scrotal swelling Infertility 11

Proctitis-from anorectal intercourse( diarrhea, tsenesmus,bloody discharge)

females Breakthrough bleeding Bleeding after intercourse Vaginal discharge Dysuria dyspareunia GONORRHEA GC,DRIP,CLAP,DOSE,GLEET,STRAIN,GONOCOCCAL CERVICITIS,G.BARTHOLINITIS,G.VULVOVAGINITIS Urethra,cervix ,rectum,pharynx Opthalmia neonatorum ETIOLOGIC AGENT Nisseria gonorrhea RESERVOIR: MAN MOT: contact exudates from mucus membranes,sexual activity Communicability end within hours if with effective treatment males Purulent discharge after 2-7 days of exposure Rectal infection- tsenesmus , pruritus and discharge females Initially uretheritis and cervicitis Endometritis Salphyngitis Pelvic peritonitis infertility diagnosis Gram staining Oxidase reaction meds Non complicated Ceftriaxone Cefixime Ciprofloxacin ofloxacin Concurrent with chlamydia Doxycycline Azithromycin PO SD Pregnant and allergic to penicillin Ceftriaxone erythromycin SYPHILIS SY,LUES,THE POX,BAD BLOOD,LUES VENEREA,MORBUS GALLICUS SPIROCHETE-TREPONEMA PALLIDUM SALIVA , SEMEN, blood, VAGINAL discharges 12

Contaminated articles are theoretically possible source

Primary CHANCRE -painless at 2-6 week on penis, anal canal,rectum,mouth secondary alopecia areata- patchy alopecia,affects eyebrows and beard(due to follicular syphilides) involving hair follicles Condylomata lata- highly infectious lesions at perianal, vulva,scrotum,inner thighs,axilla,undersides of breasts latent GUMMA-diffuse solitary lesions,skin ,skeletal, URT,liver,stomach Meningeal syphilis-brain and spinal cord Most common is stroke syndrome in young adult
P- personality changes A-affect disturbance R-reflexes hyperactive E-eye disturbance S-sensorium disturbsnces I-intellect disturbance S-speech disturbance

congenital Rhinitis desquamation PARALYTIC SHELLFISH POISONING OTHER NAME: RED TIDE ETIOLOGIC AGENT Pyrodinium Bahamense- a plankton SOURCES: bivavalve mollusks sea fishes crustaceans DESCRIPTION A syndrome occurring due to the effect of saxitoxin a toxin released by dinoflagellate (algae ) ingested by seashells and other aquatic animals during filter feeding. SAXITOXIN Is a derivative of tetrahydropurine which is one of the most lethal poison known ( 0.1mg is lethal to man) It is water soluble , acid base stable and heat stable exotoxin Toxicity is dose related Clinical Manifestations Symptoms occurs within 15 min up to 12 hours after eating contaminated sea products. 13

Circumoral tingling, numbness, on the face neck to upper and lower extremities,

generalized body weakness and respiratory paralysis Treatment Lavage with activated charcoal Sodium Bicarbonate Diuretics Rabies: P.R.O. Pinoy Responsible Owner of Dog DOH primer

350-400 Filipinos die of rabies every year. WHAT TO DO IF BITTEN BY A DOG

Wash wound immediately with soap & water. Consult a health worker at the nearest health center. Observe the dog for 14 days for any change in behavior.

If the dog cannot be observed (stray) or if suspected to be rabid, consult your physician
immediately for immunization. If dog shows s/sx of rabies, it usually dies within 3-7 days. Pinoy Responsible Pet Owner P.R.O. Have your pet immunized against rabies at 3 months old & every year thereafter Current WHO Guide for Rabies Pre & Post Exposure Tx General considerations in Post-exposure Tx: WHO advocates the use of modern vaccines for PET Abandon the production of BRAIN-TISSUE VACCINES Immediate washing/flushing & disinfection of the wound Disinfecting with ETHANOL (700ml) or Iodine tincture Rapid administration of purified Ig TREATMENT MODALITIES Administration of RIG Infiltrate into the depth of the wound & around the wound Any remaining amount, administer IM to distal part (e.g. anterior thigh) Quantities/vol. Of RIG 20 IU/kg for Human RIG 40 IU/kg for Equine RIG If the calculated dose is insufficient to infiltrate all wounds, sterile saline may be used to dilute it 2 to 3 fold to permit thorough infiltration. Post exposure Tx IM TWO IM schedule for modern vaccine Vaccine shouldnt be injected into the gluteal region CLASSICAL 5 DOSE IM (Essen regimen) 1 dose: days 0, 3, 7, 14 & 28 Deltoid 14

antero-lateral thigh: children Post exposure Tx IM ALTERNATIVE: the 2-1-1 regimen 2 doses: day 0 deltoid, R & L 1 dose : deltoid on day 7 1 dose : on day 21 Post exposure Tx Intradermal Economical: use 1 ml syringe & short hypodermic needles 3 vaccines: HDCV (Human Diploid Cell Vaccine) RABIVAC PVRV (Purified Verocell Vaccine) VERORAB, IMOVAX, Rabies vero PCECV (Purified Chick Embryo Cell Vaccine) RABIPUR

8 SITE ID METHOD: 8-0-4-0-1-1 for use with HDC (Rabivac); PCECV (Rabipur)
When no RIG is available in emergency For use: Rabivac & Rabipur 0.1ml per ID site

2 SITE ID:

2-2-2-0-1-1 for use with: PVRV (Verorab, Imovax, Rabies Vero, TRC verorab) 0.1ml PCECV (Rabipur) 0.2ml ID minimum value of 2.5IU/ampule CHOLERA OTHER NAMES: El Tor, Asiatic cholera, Epidemic cholera ETIOLOGIC AGENT: Vibrio Cholerae-a motile aerobic microbe Vibrio El Tor- includes Ogawa and Inaba stereotypes, has the ability to hemolyze human, sheep red blood cells
SOURCE OF INFECTION: Humans are the only HOST and VICTIMS

Fecal oral route or ingestion of contaminated food or water

INCUBATION PERIOD: few hours to 5 days PERIOD OF COMMUNICABILITY:

7-14 days
STOOL CHARACTERISTICS

watery and without fecal material contains white flecks of mucus ( rice water stools ) Fishy odor MEDS Tetracyclines

15

Laboratory Studies 1. Antinuclear antibodies - A blood test used in the differential diagnosis of rheumatic diseases, and to detect anti- nucleoprotein factors and patterns associated with certain autoimmune diseases - Positive at a titer of 1:20 or 1:40, depending on the laboratory - A positive result does not necessarily confirm a disease 2. Anti-dsDNA antibody test - A blood test done specifically to identify or differentiate DNA antibodies found in systemic lupus erythematosus (SLE) or other rheumatic diseases - Supports a diagnosis, monitors disease activity and response to therapy, and establishes a prognosis for systemic lupus erythematosus (SLE) Values negative less than 70 units by ELISA Borderline 70 to 200 units Positive more than 200 units

3. Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) Testing - Detects HIV types 1 and 2,which causes AIDS - Tests used to determine the presence of antibodies to HIV-1 include ELISA, Western Blot (WB) - A single reactive ELISA test by itself cannot be used to diagnose AIDS and should be repeated in duplicate with the same blood sample; if the result is repeatedly reactive, follow-up tests using WB should be done - A positive WB - A positive ELISA that fails to be confirmed by WB should not be considered negative, and repeat testing should take place in 3 to 6 months - Nursing Considerations 1. Maintain issues of confidentiality surrounding HIV and AIDS testing 2. Follow prescribed state regulations and protocols related to reporting positive test results

Immune Deficiency absence or inadequate production of immune bodies can be congenital (primary) or acquired (secondary) treatment depends on the inadequacy of immune bodies and its primary cause Assessment factors that decrease immune function 16

frequent infections nutritional status medication history such as corticosteroids history of alcohol or drug abuse

Implementation protect from infection promote balanced, adequate nutrition use strict aseptic technique for all procedures instruct the client in measures to prevent infection

Autoimmune Disease - body is unable to recognize its own cells as a part of itself can affect collagenous tissue Systemic Lupus erythematosus (SLE) - a chronic progressive systemic inflammatory disease that can cause major organs and systems to fail - leads to necrosis and/or inflammation of blood vessels, lymph nodes, gastrointestinal (GI) tract, pleura - there is no cure for the disease Cause the cause is unknown, although the disease is thought to be due to a defect in the immunological mechanisms or to have a genetic origin precipitating factors include medications, stress, genetic factors, sunlight or ultraviolet light, and pregnancy Assessment 1. precipitating factors such as sunlight, stress, and medications 2. dry scaly raised rash on the face or upper body 3. fever 4. weakness, malaise, and fatigue Anorexia weight loss Photosensitivity joint pain erythema of the palms butterfly erythema of the face Anemia positive antinuclear antibodies (ANA) and LE prep Elevated sedimentation rate Implementation a. monitor skin integrity and provide frequent oral care

17

b. instruct the client to clean skin with a mild soap, avoiding harsh and perfumed substances c. assist with the use of ointments and creams for rash as prescribed d. identify factors contributing to fatigue e. administer iron, folic acid, or vitamin supplements as prescribed if anemia occurs f. provide a high-vitamin and high-iron diet g. Provide a high-protein diet if there is no evidence of kidney disease h. instruct in measures to conserve energy, such as pacing activities and balancing rest with exercise i. administer topical or systemic corticosteroids, salicylates, and nonsteroidal antiinflammatory drugs (NSAIDs) as prescribed for pain and inflammation j. administer hydroxychloroquine (Plaquenil) as prescribed to decrease the inflammatory response k. Instruct the client to avoid exposure to sunlight and ultraviolet light l. Monitor for proteinuria and red cells casts in the urine m. Monitor for bruising, bleeding, and injury n. Assist with plasmapheresis as prescribed to remove autoantibodies and immune complexes from the blood before organ damage occurs o. Monitor for signs of organ involvement, such as pleuritis, nephritis, pericarditis, neuritis, anemia, and peritonitis p. Note that lupus nephritis occurs early in the disease process q. q. provide supportive therapy as major organs become affected Sclerodema (Progressive systemic sclerosis) a chronic connective tissue disease, similar to SLE, characterized by inflammation, fibrosis, and sclerosis affects the connective tissue throughout the body causes fibrotic changes involving the skin, synovial membranes, esophagus, heart, lungs, kidneys, and GI tract Assessment pain stiffness and muscle weakness pitting edema of the hands and fingers, which progresses to the rest of the body taut and shiny skin that is free from wrinkles skin tissue is tight, hard, and thick, and loses its elasticity mask- like hard skin that adheres to underlying structures dysphagia decreased range of motion joint contractures inability to perform activities of daily living Implementation 18

encourage activity as tolerated maintain a constant room temperature provide small frequent meals, eliminating foods that stimulate gastric secretions, such as spicy foods, caffeine, and alcohol Advise the client to sit up for 1 to 2 hours after meals if esophageal involvement exists Administer corticosteroids as prescribed for inflammation

Polyarteritis nodosa a collagen disease that causes inflammation of the arteries and thickening and impairment of the circulation treatment is similar to treatment for SLE affects middle-aged men and involves every body system the cause is unknown and the prognosis is poor renal disorders and cardiac involvement are the most frequent causes of death Assessment malaise and weakness low-grade fever severe abdominal pain bloody diarrhea weight loss Elevated sedimentation rate Acquired Immunodeficiency Syndrome (AIDS) an infectious disease characterized by severe deficits in cellular function manifested clinically by opportunistic infection and/or unusual neoplasms etiology : human immunodeficiency virus (HIV the disease has a long incubation period, sometimes up to 10 years or more manifestations may not appear until late in the infection AIDS-related complex (ARC) similar to AIDS two or more symptoms or two or more laboratory findings characteristic of immunodeficiency client is not as ill as the AIDS client may lead to AIDS High-risk groups male homosexuals or bisexuals intravenous drug abusers persons receiving blood transfusions (hemophiliacs, surgical clients) those individuals with frequent exposure to blood and body fluids 19

heterosexual contact with high-risk individuals babies born to infected mothers

Assessment malaise, weight loss lymphadenopathy of at least 3 months leukopenia diarrhea fatigue night sweats presence of opportunistic infections Pneumocystis carinii pneumonia (major source of mortality) Kaposiss sarcoma: purplish red lesions on internal organs and skin candidiasis fungal infections cytomegalovirus (CMV) Implementation provide respiratory support administer respiratory treatments as prescribed administer oxygen as prescribed maintain fluid and electrolyte balance monitor for signs of infections prevent the spread of infection initiate standard (universal) precautions provide comfort as necessary Provide meticulous skin care Provide adequate nutritional support as prescribed Medications for Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) Antiinflammatory medications Sulfasalazine (Azulfidine) used to treat toxoplasmosis or nocardiasis administered orally can cause renal toxicity suppresses bone marrow function increase photosensitivity monitor urine output and complete blood count (CBC) monitor the client for sore throat, pallor, purpura, jaundice, and weakness encourage fluid intake advise the client to avoid exposure to the sun 20

Anti-infective medications Pentamidine isethionate (Pentam 300) used to treat Pneumocystis carinii pneumonia administered by intramuscular (IM) or intravenous (IV) route can cause nephrotoxicity monitor blood pressure and heart rate (may cause hypotension) monitor for hypoglycemia is hepatotoxic and immunosuppressive monitor liver function tests and CBC Metronidazole (Flagyl) used to treat cryptosporidiosis and giardiasis administered orally or by the IV route administer with food or milk monitor for dry mouth, dizziness, or fungal infection instruct the client to avoid alcohol during treatment Antifungal medications 1. Ketoconazole ( Nizoral) - used in the treatment of candidiasis, coccidioidomycosis, or histoplasmosis - administered orally -administer with food or milk instruct client to avoid antacids for 2 hours after taking the medication because gastric acid is needed to activate the medication - is hepatotoxic - monitor hepatic function - instruct client to avoid exposure to the sun because the medication increases photosensitivity - instruct the client to avoid alcohol during treatment 2. Fluconazole (Dilfulcan) - used to treat candidiasis - administered orally - is hepatotoxic - monitor for abdominal pain, fever, and diarrhea - monitor for hepatic function 3. Amphotecerin B (Fungizone) - used to treat candidiasis and other fungal infections -administered by the IV route - is nephrotoxic - can cause thrombophlebitis - suppresses bone marrow function - monitor renal function - monitor infusion site - monitor CBC 21

Antivirals 1. Ganciclovir (Cytovene) - used to treat cytomegalovirus retinitis - administered orally or by the IV route - suppresses bone marrow function - monitor neutrophil and platelet count - administer food 2. Acyclovir (Zovirax) - used to treat herpes simplex, herpes zoster, or varicella zoster - may be administered orally or by the IV route - is nephrotoxic - monitor renal function - encourage fluid intake - is irritating to a blood vessel when administered by the IV route 3. Foscarnet (Foscavir) - used in the treatment of cytomegalovirus retinitis in human immunodeficiency virus (HIV)- infected clients - administered by the IV route - is nephrotoxic - monitor renal function 4. Zidovudine (Retrovir, AZT) - antiretroviral (nucleoside reverse transcriptase inhibitor) - indicated for clients with HIV seropositivity - administered orally -suppresses bone marrow function - is hepatotoxic and nephrotoxic - monitor CBC and hepatic and renal function studies - monitor for dizziness because the medication crosses the blood-brain barrier - instruct the client that medication must be administered around the clock 5. Didanosine (Videx) - antiretroviral (nucleoside reverse transcriptase inhibitor) - indicated for clients with HIV seropositivity - administered orally - administer on an empty stomach to enhance absorption - instruct the client to chew or crush tablet - monitor for dizziness, neuropathy, and pancreatitis 6. Lamivudine (Epivir) - antiretroviral (nucleoside reverse transcriptase inhibitor) - indicated for clients with HIV seropositivity - used as prophylaxis for occupational exposure - administered orally - can cause severe pancreatitis - instruct the client to avoid fatty foods 7. Zalcitabine (ddC) - antiretroviral (nucleoside reverse transcriptase inhibitor)

22

- used in the management of HIV infection with other antiretrovirals, such as AZT, because of the synergistic effect - it has also been used as a single agent in clients who are intolerant of other regimens - administered orally (with AZT) - can cause serious liver damage - monitor liver function studies 8. Saquinavir (Invirase) - antiretroviral (protease inhibitor) - used in combination with other antiretroviral medications in the management of HIV infection - administered orally - administered with meals -is best absorbed if the client consumes high-calorie, high-fat meals - if can cause photosensitivity, and the client is instructed to avoid sun exposure 9. Ritonavir (Norvir) - antiretroviral (protease inhibitor) - used in combination with other antiretroviral medications in the management of HIV infection - administered orally - administered 1 hour before or 2 hours after meals because it is best absorbed in a fasting state - can increase triglyceride levels - monitor triglyceride levels 10. Stavudine (d4T, Zerit) - antiretroviral (protease inhibitor) - used in the management of HIV infection in clients who do not respond to or cannot tolerate conventional therapy - administered orally - can cause peripheral neuropathy - monitor the clients gait - ask the client about paresthesias Others Dapsone (Avlosulfon, DDS) - antifungal, antiinfective, antiprotozoal - used for the treatment of toxoplasmosis - administered orally - suppresses bone marrow activity - can cause anemia, peripheral motor weakness, liver damage - monitor the CBC - monitor for fever, sore throat, purpura, or jaundice Pyrimethamine (Daraprim) - antimalarial, antiprotozoal - used in the treatment of toxoplasmosis or Pneumocystis carinii pneumonia - administered orally 23

- suppresses bone marrow function - monitor complete blood count (CBC) and platelet count - administer with food or milk Systemic Lupus Erythematosus - medications are used to control symptoms and to prevent or control serious complications that occur as a result of organ damage by the inflammatory process A. Azathioprine (Imuran) - glucocorticoid-sparing effect - potentiates the immunosuppressive action of glucocorticoids and thereby allows a lower dosage of glucocorticoid to have a greater immunosuppressive action - monitor CBC and liver function tests B. Cyclophosphamide (Cytoxan) - immunosuppressive treatment of diffuse proliferative nephritis and other organ inflammation unresponsive to glucocorticoids - reserved for use in severe cases because of the adverse effects C. Hydroxychloroquine sulfate (Plaquenil) - an antimalarial used to prevent the recurrence of an exacerbation - an eye examination should be performed initially and 6 months after treatment - administer with meals or glass of milk D. Prednisone (Deltasone) - used at high doses to treat exacerbations and at low doses to control symptoms when other medications do not work E. Nonsteroidal anti-inflammatory drugs (NSAIDs) - used to control fever and arthralgia

24