Infections Chapter 8 PDF

- HIV/AIDS - Effects on Pregnancy and Newborn - Risk Factors - IV drug use - Multiple sexual partners - History of STIs - Findings - Fatigue, diarrhea, influenza like findings - Laboratory Testing - Blood and urine...

- HIV/AIDS - Effects on Pregnancy and Newborn - Risk Factors - IV drug use - Multiple sexual partners - History of STIs - Findings - Fatigue, diarrhea, influenza like findings - Laboratory Testing - Blood and urine before birth - Viral load levels - Nursing Care - Antepartum - Keep CD4 cell count greater than 500 - Intrapartum - Administer IV zidovudine (except those with CD4 less than 1000 - Postpartum - Specialist for birth - Avoid breastfeeding - Wear gloves - Bath the baby's early - - Medications -- decreases transmission to child - Antiretroviral Therapy (ART) - Oral and cont. through pregnancy - Highly Active Antiretroviral Therapy (HAART) - Triple antiretroviral (PO) - Client Education - TORCH Infections - Infections, Risk Factors, and Findings - Toxoplasmosis - Don't fool with cat litter - Other (Hepatitis A and B, Syphilis, Mumps, Parvovirus, Varicella-Zoster,...) - Rubella (German Measles) - Stay away from kids with rashes. - Cytomegalovirus - Droplet infection - Through breast milk, semen, feces and blood. - May be dormant until pregnancy. - Herpes Simplex Virus (HSV) - Direct contact (oral) - Nursing Care - Medications - Toxoplasmosis - Rubella - Vaccination received postpartum. Should avoid pregnancy for at least 1 month. - HSV - Acyclovir PO - Valacyclovir PO - Client Education - Toxoplasmosis - Prevention - Washing hands - Cook food properly - Stay away from cat litter - Rubella - Immunization of client that are pregnant is contraindicated. - Avoid crowds and young children - Clients with low titers prior to pregnancy should receive immunizations. - Cytomegalovirus - Reinforce about condition - Hand washing before and after food, and diapers. - HSV - Cesarean birth is recommended - Refrain from sexual intercourse during 3^rd^ trimester. - Routine screening for HSV is not recommended - Prior to birth ask client about history of HSV - **Group B Streptococcus** - Findings - Laboratory Tests - Nursing Care - Education - **Chlamydia (Most common)** - Complications if untreated - PID - Premature rupture of membranes - Preterm labor - Postpartum endometritis - If transmitted to the neonate, it can cause conjunctivitis, ophthalmia neonatorum and pneumonia. - Findings - Dysuria - Urinary frequency - Spotting or postcoital bleeding - Vulvar itching - Gray-white discharge. - Laboratory Tests - Endocervical swap culture of cervical discharge. - Urine culture - Nursing Care - Instruct the client to take medications - ID and treat all exposed sex partners. - Repeat test in 3-4 weeks - Be aware of sexually transmitted infections status - Medications - Antibiotics - Safe during pregnancy and breast feeding. - Azithromycin PO (Single Dose) - Amoxicillin PO up to 7 days - Doxycycline and levofloxacin is contraindicated during pregnancy. - Erythromycin ointment. (admin to all newborns following birth.) - **Gonorrhea** - Findings - PID - Salpingitis - PROM - Preterm birth - Chorioamnionitis - Postpartum sepsis, endometritis - If transmitted to the neonate it can cause neonatal sepsis, intrauterine growth restriction and ophthalmia neonatorum (can cause blindness) - Laboratory Tests - Endocervical culture - Urine cultures - Anal or oral cultures - Nursing Care - Client education for disease transmission. - ID and treat sex partners - Admin erythromycin to all newborns, - Take all meds - Should be retested in 3 -- 4 weeks - Adhere to safe sex - **Syphilis** - Findings - Stages - Primary - Notice of chancre (painless popular lesion - Secondary - Skin rashes on palmar surface on hands and soles of feet. - Latent phase -- client does not have any expected finding of syphilis present - Tertiary - Damage to internal organs can occur - Difficulty coordinating muscle movement - blindness - Laboratory Tests - Nontreponemal (VDRL and rapid plasma regain) and treponemal - Darkfield -- examination of the primary lesion. - Nursing Care - Education - Complications - **HPV** - Findings - Spread through vaginal or anal sex - Small warts or a group of warts in the genital area - Abnormal changes to the cervix that can be detected by Pap test. - Laboratory/Diagnostic Tests - Pap - Genital warts are diagnosed by provider based on appearance. - Nursing Care - May need cesarean birth - Lesion care -- use oatmeal baths, keep lesions clean and dry, wear loose fitting cloths. - Medications - Trichloroacetic acid (TCA) - Podophyllin, podofilox, sinecatechins, imiquimod - Contraindicated during pregnancy - Cryotherapy (Cold therapy that freezes) Recommended during pregnancy. - **Tricholoniasis** - Findings - Yellow-green, frothy vaginal discharge with foul odor - Dyspareunia and vaginal itching - Dysuria - Discharge in the vaginal vault during speculum examination - Strawberry spots on the cervix - A cervix that bleeds easily - Laboratory/Diagnostic Tests - Wet mount saline prep microscopically detected. - Cultures, urine specimens (NAAT, POC, Molecular testing, Rapid testing) - Nursing Care - Avoid ETOH while taking medications for 3 days after treatment - Take all medications as prescribed - Safe sex - Treat all sex partners - Encourage retesting in 3 months - Medications - Metronidazole PO safe during pregnancy (can cross placenta and enters the breast milk) - Do not give during 1^st^ trimester. - Contraindicated during pregnancy (intravaginal) - **Bacterial Vaginosis (BV)** - Finding - Vaginal pruritus, milky (gray, white) discharge, fishy older. - Laboratory/Diagnostic Tests - WHIFF TEST POSITIVE FOR FISHY ODOR - Nursing Care - Clindamycin PO (safe during pregnancy) - Metronidazole PO (safe during pregnancy and can cross placenta and enters the breast milk) - Do not give during 1^st^ trimester. - Contraindicated during pregnancy (intravaginal) - No ETOH - Treatment is not indicated for sexual partners. - Use condoms - Refrain from sex - **Candidiasis (Yeast Infection)** - Findings - Speculum exam - Thick, creamy, white, cottage cheese-like vaginal discharge. - Vulvar and vaginal erythema and inflammation - White patches on vaginal wall - Laboratory/Diagnostic Tests - Sample of discharge (Used on pH paper) - Saline and potassium chloride wet mount smear - pH less than 4.5 - Wet mount potassium hydroxide prep - Nursing Care - Avoid tight fitting clothing - Remove damp clothing as soon as possible - Avoid douching - Increase dietary intake of yogurt with active cultures. - Diabetes should be ruled out of recurrent infections.