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HIV/infection
Lewis Chapter 15
| Question | Answer |
|---|---|
| Give 4 reasons that explain the reemergence of some infectious diseases like TB and measles. | Increase in HIV/Lowered immune defense, Cutbacks in public health funds, Drug resistant pathogens, International travel |
| When a pathogen changes in ways that decrease the ability of drugs to treat it the pathogen has become…? | resistant |
| Name the 3 most troublesome resistant bacteria. | Methicillin Resistant Staphylococcus aureus, Vancomycin-resistant enterococci, penicillin resistant Streptococcus pneumonia |
| Name two ways that bacteria adapt in order to resist antimicrobrial treatments. | 1. Genetic –mutating and acquisition of new DNA 2. Biochemical – making enzymes that destroy or inactivate antimicrobial drugs |
| How long can MRSA survive on our nursing uniform? | days |
| How long can VRE live on the tops of our shoes? | weeks |
| Which patients are most susceptible to nosocomial infections(3)? | immunosuppressed (receiving chemotherapy), invasive device (catheter), breaks in the skin (surgical wound) |
| Why do we love Chlorhexidine for cleaning? | it can kill MRSA and VRE bacteria |
| If a gram negative bacteria has b-lactamase name some antibiotics that won’t work. | third generation cephalosporins- ceftraxone (Rocephin), cefixime (Suprax) |
| Name several actions that contribute to the growing problem of drug resistant pathogens. | Prescribing antibiotics for viral infections or other disorders that they don’t treat, inadequate drug regimen for infections, using big gun antibiotics when little guns will do, not taking full course of antibiotics |
| How many nosocomial infections per year in the US? | about 2 million |
| How many nosocomial infections are caused by antibiotic resistant organisms? | 50% |
| Nosocomial infections occur within ________ of hospitalization. | 72 hours |
| Up to __% of hospital patients will acquire nosocomial infections. Risk is higher for surgical patients. | 10% |
| Name 4 common culprits in nosocomial infections. | Eschericia coli, Staphylococcus aureus, Enterobacter aerogenes, various types of Streptococci |
| Why is it important to change gloves when changing from one task to another even when working with the same patient? | because isolated infections can be caused when bacteria that are normally present in one area are introduced into another area |
| How does the rate of nosocomial infections in older adults compare to that of younger patients? | It is 2-3 times higher. |
| What is the most common type of nosocomial infection among older adults who reside in long term care facilities? | Urinary tract infections |
| What symptoms of infections are unique to older adults and may show up before laboratory values indicate infection? | Cognitive and behavioral changes |
| Why can’t we count on fever as an indicator of infection with older adults? | because they have a lower core temperatures and decreased immune responses |
| Name 3 things that would complicate the treatment of older adults with an infection. | Underlying diseases, increased frequency of drug reactions, and institutionalization |
| Name 6 things we need to teach patients to prevent the development of drug resistant pathogens. | 1. Don’t take antibiotics to prevent illness. 2. Wash hands. 3. Follow directions – how much and when. 4. Finish full course. 5. No antibiotics for cold or flu. 6. Don’t take leftover antibiotics |
| What is the federal agency that protects workers from injury and illness? | Occupational Safety and Health Administration – OSHA |
| What is the difference in standard precautions and transmission precautions? | We use standard precautions with everyone to prevent spread of infection. We use transmission precautions with patients who are or suspected of being infected with epidemiologically important pathogens. |
| According to standard precautions name four things that we avoid direct contact with. | blood, body fluid (secretions, excretions), non-intact skin, mucous membranes |
| What method do we utilize to avoid the transmission of microorganism by treating everyone (including ourselves) as if they had an infectious condition whether they actually do or not? | standard precautions |
| What kind of PPE protects mucous membranes and eyes against splashes, sprays, spatters, or droplets of blood or other potentially infectious materials? | Mask, Eye protection, Face Sheild |
| What kind of precautions do we use with a patient who has TB, measles, or varicella? | Airborne precautions – Infection can be spread by airborne droplet |
| What kind of precautions do we use with a patient diagnosed with Haemophilus influenza, Neisseria meningitides, Strpetococcus pneumonia, or Mycoplasma pneumoniae? | Droplet precaution |
| What kind of precaution do we use with a patient diagnosed with Staphylococcus aureus, Clostridium difficile, or herpes simplex? | contact precautions |
| Under what kind of precautions would we wear gloves when entering the patient’s room, providing direct patient care, or handling potentially contaminated surfaces or items in the patient’s room along with a gown if substantial contact is anticipated? | contact precautions |
| For which type of precaution would we wear a mask whenever working within 3 ft. of the patient? | Droplet precautions |
| What year was the cause of AIDS discovered? | 1985 |
| When we say viral load in regards to HIV what are we talking about? | the number of HIV particles in the plasma |
| Name several factors that have contributed to the decrease in HIV related deaths, improved quality of life, and decreased numbers of babies born with HIV (developed countries). | Laboratory test for viral load, ability to test for antiretroviral drug resistance, treatments that reduce transmission from mother to child |
| What typical sign of a waning epidemic has not yet taken place with HIV? | leveling off |
| How many people in North America were living with HIV at the end of 2004? | About one million |
| About how many new infections and HIV related deaths each year? | 44, 000 new infections, 16,000 HIV related deaths |
| What is meant by the term marginalized individuals in the statement, “HIV remains a disease of marginalized individuals.”? | Those who are disenfranchised by virtue of gender, race, sexual orientation, poverty, drug use, or lack of access to health care. |
| What body fluids can carry HIV? | blood, semen, vaginal secretions, breast milk |
| Name 5 ways that HIV can be transmitted. | Through sexual intercourse with an infected partner, Exposure to HIV infected blood or blood products, Mother to child through pregnancy, birth, or breastfeeding |
| During which two periods of HIV infection is the viral load the highest? | during the first 6 months and during the late stages of the disease |
| Name 7 body fluids that do not transmit HIV. | saliva, urine, emesis, sputum, feces, sweat, or tears |
| What is the most common mode of HIV transmission? | Sex with an infected partner |
| What is the riskiest sexual activity for HIV transmission? | unprotected anal intercourse |
| In untreated HIV infected women what percentage of babies are born with HIV? | 25% |
| Why is HIV called a retrovirus? | Because it replicates backward, going from RNA to DNA |
| What does HIV need in order to replicate? | A living cell |
| What is the normal adult range of CD4 cells per microliter of blood? | 800 to 1200 |
| How long do healthy CD4 cells normally live? | about 100 days |
| How long do CD4 cells infected with HIV live? | about 2 days |
| About how many CD4 cells are destroyed each day by HIV? | About 1 billion |
| If HIV is destroying 1 billion CD4 cells each day why doesn’t an infected person get really sick really fast? | Because the bone marrow and thymus can produce CD4 cells fast enough to compensate for many years |
| What amount of CD4 cells is generally enough to keep the body healthy? | > 500 CD4 per microliter |
| What CD4 count indicates our patient is really in trouble? | below 200 |
| How long will a person live once they have contracted HIV? | We cannot tell because disease progression is highly individualized and treatment can have a huge effect. |
| What is seroconversion? | the development of HIV antibodies |
| What signs and symptoms often accompany the initial acute infection with HIV? | Flulike syndrome: Nausea, fever, swollen lymph glands, sore throat, headache, malaise, muscle and joint pain, diarrhea and/ or diffuse rash. |
| What are the initial flulike symptoms of initial HIV infection called? | Acute HIV infection |
| When does acute HIV infection generally occur and how long does it last? | It occurs 1-3 weeks after the initial infection and last for 1-2 weeks although symptoms may last for several months |
| When would a high viral load exist along with decreased CD4 count that quickly return to baseline? | During acute HIV infection |
| Why would healthcare workers miss an acute HIV infection? | because it looks like the flu and HIV antibody test don’t work for 3 weeks to 3 months after initial infection |
| What is the median interval between untreated HIV infection and the development of AIDS? | about 11 years |
| What is oral hairy leukoplakia? | an Epstein-Barr virus infection that causes painless, white, raised lesions on the lateral aspect of the tongue |
| As the CD4 count drps to 200 to 500 cells per microliter and the viral load increases HIV advances to what? | Intermediate Chronic Infection |
| What is the most common ailment during intermediate chronic infection? | Oropharyngeal candidiasis or thrush |
| What is the median delay before HIV specific antibody test will work? | 2 months after infection |
| What is a window period? | the period of time when a HIV infected person may not test positive |
| Name 5 things we talk to our patients on ART about. | pros and cons of new treatment, how and when to take each drug, dangers of non-adherence, drug interactions to avoid, side effects to report |
| Why has the treatment strategy for HIV change from “Hit it early. Hit it hard.”? | because side effects and treatment “burn out” lead to non-adherence and drug resistance |
| Current federal guidelines suggest that treatment can be delayed until when? | until greater immune suppression is observed |
| What is the most important consideration for initiating therapy? | patient readiness |
| What is the nurse’s role in patient readiness to initiate therapy? | to provide in-depth education and counseling for patients as they struggle to make this decision |
| Why is adherence especially important in HIV treatment? | because missing even a few doses can lead to viral mutations that allow HIV to become resistant to the drug |
| Why is adherence especially problematic in HIV treatment? | because patients have to take 2-20 pills at precise times each day, every day for the rest of their lives |
| Give 7 useful health promotion interventions to help HIV patients maintain a healthy immune system whether or not they are on ART. | 1-Nutritional support for lean body mass 2-reduce/eliminate alcohol, tobacco, drug use 3-Up to date vaccines 4-Avoid exposure to new infections 5-Adequate rest/exercise/stress reduction 6-Mental health counseling 7-Involvement in support group/community |
| All HIV testing should be accompanied by what? | pretest and posttest counseling |
| What kind of test is done initially for HIV? | A highly sensitive enzyme immunoassay (EIA) is done to detect serum antibodies that bind to HIV antigens on test plates |
| If during posttest counseling we find that our patient has been or will be involved in risky behavior what will we encourage? | retesting starting at 3 weeks, 6 weeks, and 3 months |
| What happens if the EIA result is positive? | the test is repeated |
| What if the EIA test is repeated and the result is positive? | Then a more specific confirming test is done, like the western blot or immunoflourescence assay |
| What testing method uses purified HIV antigens electrophoresed on gels and then incubated with serum samples? | Western Blot |
| What testing method treats blood with a fluorescent antibody? | immunoflourescence assay |
| What if HIV testing is indeterminate? | risky behavior - no, reassure patient that infection is extremely unlikely and suggest retesting in 3 months. Risky behavior - yes, advise retesting at 1, 2, and 6 months. Discuss risk reduction measures to protect partners from infection |
| What is the major advantage of the rapid test? | results in 20 minutes, patient does not have to return to get results |
| What is Lipodystrophy? | condition caused by antiretrovirals. It causes loss of fat tissue in certain areas of the body and fat accumulation in others. |
| What is a disturbance of fat METABOLISM that involves the absence of fat and/or the abnormal distribution of fat in the body? | Lipodystrophy |
| Name several metabolic disorders that are side effects of ART. | lipodystrophy, hyperlipidemia, insulin resistance, hyperglycemia, bone diseases, lactic acidosis, and cardiovascular disease |
| What condition is a result of anaerobic metabolism of glucose and therefore a possible indication of hypoxia? | lactic acidosis |
| Name two potentially fatal side effects to ART? | cardiovascular disease and lactic acidosis |
| What is lactic acidosis? | Acidosis due to the buildup of lactic acid (from glucose) when it is created faster than it can be metabolized. |
| When are opportunistic diseases most likely to occur? | When CD4 counts are low and viral load is high |
| What does a genotype assay tell us? | if there drug resistance due viral mutations present in reverse transcriptase or protease genes |
| What does a phenotype assay work? | various concentrations of antiretroviral drugs are used to grow HIV to see which concentrations are most effective |
Created by:
Perseverandovercome
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