NUR 211 Unit 1A/1B: Infection, Tuberculosis, Immunity

NUR 211 UNIT 1A/1B INFECTION TUBERCULOSIS IMMUNITY EXEMPLARS: HIV/AIDS, RHEUMATOID ARTHRITIS Ignatavicius, D. (2021). Chapter 21 (Review). Chapter 28, pp. 575-581. Ignatavicius, D. (2021). Study Guide, Chapter 28 – questions 21-30. Silvestri, L. (2023). pp. 462-46...

NUR 211 UNIT 1A/1B INFECTION TUBERCULOSIS IMMUNITY EXEMPLARS: HIV/AIDS, RHEUMATOID ARTHRITIS Ignatavicius, D. (2021). Chapter 21 (Review). Chapter 28, pp. 575-581. Ignatavicius, D. (2021). Study Guide, Chapter 28 – questions 21-30. Silvestri, L. (2023). pp. 462-463, 693-695. ATI RN Adult Medical Surgical Nursing 11.0 – Chapter 23. Resources INFECTION THE INVASION OF BODY TISSUE BY MICROORGANISMS WITH THE POTENTIAL TO CAUSE ILLNESS OR DISEASE EXEMPLARS TUBERCULOSIS RISK FACTORS LOW SOCIOECONOMIC STATUS IMMUNOCOMPROMISED ADVANCED AGE RECENT TRAVEL OUTSIDE US SUBSTANCE USE IMMIGRATION HEALTH-CARE OCCUPATION LAB TESTS NAAT QUANTIFERON-TB GOLD ACID-FAST BACILLI SMEAR AND CULTURE MANTOUX TEST (PPD) NURSING INTERVENTIONS CONTACT PRECAUTIONS ADMINISTER PRESCRIBED MEDICATIONS EDUCATION EMOTIONAL SUPPORT OXYGEN AS ORDERED/NEEDED PHARMACOLOGICAL THERAPY COMBINATION THERAPY IS INDICATED DUE TO POTENTIAL RESISTANCE MEDICATIONS MUST BE TAKEN FOR 6-12 MONTHS TYPICAL 4 MEDICATION THERAPY ISONIAZID RIFAMPIN PYRAZINAMIDE ETHAMBUTOL IMMUNITY THE NATURAL OR INDUCED RESISTANCE TO INFECTION AND CONDITIONS ASSOCIATED WITH IMPAIRED RESPONSE. RESOURCES Ignatavicius, D. (2021). Chapters 16, 17 & 18 pp. 345-358, 1017-1027. Ignatavicius, D. (2021). Study Guide, Chapters 16, 17, & 18, Chapter 46 (questions 22-30). Silvestri, L. (2023) Chapter 41, pp. 507-508. Chapter 64, pp. 902; 921-924. ATI RN Adult Medical Surgical Nursing 11.0 – Chapters 86, 87, & 88. ATI RN Nursing Care of Children 11.0 – Chapter 38. EXEMPLARS ● HIV/AIDS: ● Rheumatoid Arthritis: RISK FACTORS ● Unprotected sex (vaginal, oral, anal) ● Multiple sex partners ● Occupational exposure ● Perinatal exposure ● Blood transfusions (not in US) ● IV drug use ● Older adult patients OCCUPATIONAL EXPOSURE TO HIV ● Almost 25,000 adults who developed AIDS before 2003 were health care workers. This represents 5% of all AIDS cases among adults who had a known occupation ● Most of the health care workers who have been infected with HIV are nurses ● If a health care worker does have a needlestick resulting in exposure to a known HIV-infected person, transmission risk is at just about 0.3% ● Transmission risk is increased if the health care worker suffers a deep injury at the time of the exposure SPECTRUM OF HIV INFECTION ● Stage 1 - HIV - Acute Infection ● Stage 2 - HIV - Chronic Infection ● Stage 3 - AIDS STAGE 1 - ACUTE INFECTION ● The early symptomatic phase of HIV infection occurs when the CD4+ cell count drops below 500 cells/mm 3 ● Early symptoms include constitutional problems such as persistent unexplained fevers; recurrent, drenching night sweats; chronic diarrhea; headaches; and fatigue ● A physical examination may reveal persistent generalized lymphadenopathy ● One of the most common infections seen in individuals with early symptomatic disease is oral candidiasis ● Neurologic manifestations of HIV disease occur in more than 90% of individuals who are infected STAGE 2 CHRONIC INFECTION ● ASYMPTOMATIC ● SILENT STAGE ● HIV virus levels increase ● CD4 Levels decrease STAGE 3 AIDS AIDS ● AIDS is the acronym used to describe the end stage of the spectrum of HIV infection ● CD4+ count decreases ● The number of viruses detectable in the blood increases rapidly ● Without treatment, the median time from an AIDS diagnosis to death averages 1 1/3 years Pharmacological therapy Nucleoside Reverse Transcriptase Inhibitors (NRTIs) Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) Protease Inhibitors (PI’s) Integrase Inhibitors Fusion Inhibitors/CCR5 Antagonists Combination products PATHOPHYSIOLOGY ● HIV is classified as a “slow” retrovirus ● After infection with these types of viruses, a long time passes before specific signs and symptoms appear ● The virus is incorporated into the host’s genetic material CDC laboratory classification of HIV HIV LABORATORY TESTING ● Viral load monitoring -(HIV RNA Quantification) ● HIV drug resistance testing (HIV genotype or HIV tropism) ● CD4+ cell count monitoring NURSING INTERVENTIONS ● Establish rapport ● Treat in a nonjudgmental manner ● Prevent infection ● Provide patient education ● Encourage adherence to medication regimen ADHERENCE ● Adherence can be difficult due to side effects of medications and cost ● A multidisciplinary approach can help ensure adherence to regimen RHEUMATOID ARTHRITIS Rheumatoid arthritis of hands. (From Kamal, A., Brocklehurst, J.C. [1991]. Color atlas of geriatric medicine. [2 nd ed.]. St. Louis: Mosby.) RHEUMATOID ARTHRITIS (RA) ■ Most serious form of arthritis ■ Chronic, systemic disease ■ Most common in women of childbearing age ■ Autoimmune disorder, but may also be genetic ■ Antibodies are formed against synovial tissues ■ May affect lungs, heart, blood vessels, muscles, eyes, and skin ■ Chronic inflammation of the synovial membrane of the diarthrodial joints (movable) ■ Polyarticular and symmetric ■ Exacerbations and remissions RHEUMATOID ARTHRITIS (RA) Early Disease Late Disease Joint Inflammation Joint Deformities Moderate-to severe pain and morning stiffness Systemic low-grade fever fatigue weakness anorexia paresthesias Systemic Osteoporosis Severe fatigue Anemia Weight loss SQ nodules Peripheral neuropathy Vasculitis Fibrotic lung disease Kidney disease RHEUMATOID ARTHRITIS (RA) Risk Factors ● Female ● Ages 30 to 50 ● Genetic predisposition (Family history of RA) ● Epstein Barr Virus ● Heavy smokers ● Risk can be reduced if stop smoking Diagnosis ● RF (rheumatoid factor) ● Antinuclear Antibody titer (ANA) ● Erythrocyte sedimentation rate (ESR) ● C-reactive Protein (CRP) ● CBC - elevated WBC’s ● Arthrocentesis ● XRAY Medical management/nursing interventions ■ Medications: Salicylates, NSAIDs, slow-acting anti-inflammatory agents (corticosteroids), disease-modifying anti-rheumatoid drugs (DMARDS) ■ Rest: 8-10 hours of sleep a night ■ Exercise: Range of motion 2-3 times per day ■ Heat: Hot packs, heat lamp, and/or hot paraffin ■ Rehabilitation RA MEDICATIONS - DMARDS Nonbiologics ● Methotrexate (po) ● Hydroxychloroquine (Plaquenil, po) Biologics ● Etanercept (Enbrel, Subcu) ● Infliximab (Remicade, IV) ● Adalimumab (Humira, Subcu) ● Gold Salts (Aurolate, IM) RA; CONT. ● Nursing Care ○ Encourage rest/pace activities ○ Assist with and encourage physical activity ○ Apply heat or cold as ordered ○ Maintain proper body alignment ○ Immobilize joints if acutely inflamed ○ Encourage proper use of walking aids ○ Encourage good nutrition ○ Patient education/support groups