Med Surg Final Exam PDF

Arterial blood gas analysis  Balance between acids and bases in body  Slight imbalance can affect essential body functions  Must understand pH to assess acid/base balance  Indicator of hydrogen ion concentration (H+)  pH maintained in ratio  20 parts bicarbonate: 1 part carbonic acid ...

Arterial blood gas analysis  Balance between acids and bases in body  Slight imbalance can affect essential body functions  Must understand pH to assess acid/base balance  Indicator of hydrogen ion concentration (H+)  pH maintained in ratio  20 parts bicarbonate: 1 part carbonic acid  Acidosis: pH less than 7.35  Alkalosis: pH greater than 7.45  response very quickly Respiratory system-----look at carbon dioxide (paCO2) on ABG  paCO2  Increased paCO2  Decreased paCO2  Responds quickly Other buffers----phosphates and protein buffers  Slawly may respcned days take Bicarbonate Kidneys-----look at bicarbonate (HCO3) on ABG  HCO3 is metabolic component of acid base balance  Increased HCO3-metabolic alkalosis  Decreased HCO3-metabolic acidosis  Respond slowly  Assesses bicarbonate-carbonic acid buffer system  Proper analysis essential need an avery  Obtained via radial, brachial, or femoral artery  pH---------7.35-7.45  PaCO2---35-45 mmHg  HCO3----22-26 mEq/L  PaO2 ----- 80-100 mmHg  SaO2------95-100% COPD Changes this range  Causes  Hypoventilation  Pulmonary disorders COPD  CNS depression medication (opiates)  Impaired respiratory muscle function  Other-pain, chest wall injury, abdominal distension Pregnacy use pain management  Clinical Manifestations  Shallow respirations  Dyspnea  Respiratory distress of  Headache Brain not getting  Restlessness  Confusion/decreased LOC  Tachycardia/dysrhythmias  always goes oppisive Heph pH pCO2  Causes  Hyperventilation  Pain  Anxiety/fear  Increased metabolic demands  Early salicylate intoxication  Clinical Manifestations  Tachypnea  Light-headedness  Numbness and tingling  Confusion  Blurred vision  Palpitations  Diaphoresis  Dry mouth  oppisic pH pCO2  Causes  Renal failure  Diabetic ketoacidosis  Sepsis  Fever burning through cal  Starvation Signs of Diabetic Ketoacidosis  Clinical Manifestations  Headache  Lethargy  Confusion  Sluggishness  Dysrhythmias  Nausea and vomiting  Decreased BP  Kussmaul’s respirations very labor breathing can lead to hyperventilation pH HCO3  Causes  Prolonged vomiting  Gastric suctioning  Hypochloremia always eating  Excess use of bicarbonate antacids  Diuretics  Cushing’s disease  Clinical Manifestations  Tingling in extremities  Muscle twitching/muscle cramps  Dizziness  Hypertonic muscles overmouments  Respiratory depression pH HCO3 Aimed at correcting pH, not correcting underlying problem  Fully compensated-------normal pH  Partially compensated----abnormal pH; CO2 and HCO3 both abnormal  Uncompensated-----abnormal pH; only one value abnormal  Review paO2  Hypoxemia defined as < 60 mmHg  Worry when it is 40  LDL < 100  CRP  Think inflammation   Cardiac Biomarkers or Cardiac Enzymes- released when myocardial cells are injured cercise in we see ter e CK/CK-MB If is blood something heart happing to  Enzyme within heart muscle  Myoglobin you will see this first  Similar to hemoglobin  Troponin most common has had or having  Protein found in heart muscle MF  Level >0.3ng/mL indicates elevated troponin  ST elevation look for Electrocardiogram Stemi of  electrical activity for MF Inoracic live X-ray heart F (PO) Casea Fageal cardio for esongeal its invasi need  Echocardiogram/Transesophageal ejection fraction Echocardiogram  Stress Testing sometimes treadmill to see how medication heart response  Cardiac catheterization view of cornary artery give radial ! /semorl assess latflat 24hr  or right while over fire smole gras our nal snow  Control cholesterol levels  Manage hypertension  Manage diabetes  Morphine for Pain -  Oxygen administration for - heart  Nitrates vasodilate -  Aspirin-antiplatelet medication - Plaklet agivation  Beta blockers  Calcium channel blockers  Anticoagulants  Surgical intervention  Medications include aspirin, nitroglycerin, morphine, beta blockers, ACE inhibitors, and statins  Thrombolytics break up clot  Analgesics  Reperfusion therapy  Cardiac rehabilitation  Nursing care focuses on relieving pain, promoting respiratory function, promoting tissue perfusion, reducing anxiety, and monitoring for complications   The nurse caring for a patient with an MI knows that the top priority in the care of this patient is what? A. Balancing intake and output B. Decreasing energy expenditure of the myocardium C. Balancing myocardial oxygen supply with ⑧ demand D. Decreasing nutritional need of myocardial muscle  movement Stability, made by box marran real issue fix  like fluid marrow to State harder invectionde to por wear circulation  Saddle Hinge , Balland Socult ,  can on also be organs Don't always leave on ice also trying to promote Really important for surgical activity  4-8 weeks to heal normally takes use may Calcium and VitP metal rods Promote Sui of alignment out Open Brown infection risk  ski brown not hair live looks like chieped shards thy cracked Bullet common it twisted  Big to look - at thy are well make sue medicated  wase with extermity SwellingVascular squeres naurons even a fur and surgent moument sou decrease mobile want tem to be Some cannot be surgical fixeda make a in mator a Swelling slife Of sections of leg to reduce extremies compresses swelling use wandra Gnvschecks - Pulse Color sensation Caprefill movement Temp only used for to much swelling s brace figue used for collarbor fractic  by a Pancursed e krm Chronic long Verve/Pandamage rapid Bone Granthatcarenerg  as nevesgetDitch de  happens time over weavers Bor loss or estrogen/calcium/Vitp  accrease height caused by something else Control calcium levis can tall calcitonin Fromand lear Common in knee do to injury ↳Rom Sounds are more distal Heberden are more protimal Borchards swelling joint  treatment watch medical sue tuy con do make  and round more smooth live looks finger malignent Diabetic T risk in let de to increase inkers lives on sun goes in with break no Pick lines for drug user at home educat dificult Deep mae in Poor circulation Bol may see Absess swelling Pitching of heres athers popular is it tingliy ↑ uricle acid What’s wrong with this picture?  10/30/2024 CANCER Med-Surg I Fall 2024  Define cancer  Differentiate between healthy cells and cancerous cells OBJECTIVES  Understand classifications  Discuss treatment modalities  Discuss nursing considerations related to care of an individual with a cancer diagnosis o A term for diseases in which abnormal cells divide without control and can invade nearby tissues o can spread to other parts of the body through the blood and lymph systems o r direct transfer , o Also called malignancy, neoplasm o Six classifications, plus mixed cancers WHAT IS CANCER ? umbulla term 1  10/30/2024 to Heart disease national o Leading cause of death worldwide; 2nd in the US o Most common o US – lung o Globally – breast (US we lend to screen move o Slightly higher, overall prevalence in males, Caucasians, as cells get tired individuals in their late 70 – mid 80s Mutation increase o $21B cancer-related medical costs in 2019 STATISTICS Genetics Epigenetic 5-10% of all cancers Environmental Ex: BRCA gene, PSA marker Chemical Exposure for cancer Oncogenes make Radiation gue causing creation Proto-oncogenes Supress Oncogenes inflammation Tumor suppression gene Lifestyle causing Smoking Egiguehes (change Orgetics) ETOH you aren't bor with Obesity i t buk kid will Chemical intake (dietary) be Infection (HPV) may still remove normal Slow growth Rapid growth Well-defined capsule no border Not encapsulated Non-invasive Invasive harder to difference Well-differentiated see race of replication Poorly differentiated Low mitotic index High mitotic index Does not metastasize Can metastasize contined Slowgravingasells 2  10/30/2024 Normal versus Should kill bad Cancerous cells Cell Division mutated genes replicat faster to Survive Cell Cycle Control Checkpoints Chemical Gatekeepers Chemical response If it doesn't kill badcell its malignant  Hyperplasia  _______________________________ Increase in cellular growth  _______________________________ layer that contains cells is unchanged cause of BPH  _______________________________ respone tocellular stess ,  Dysplasia  _____________________________ cells look different and increase grath  _____________________________ Pushing again wall and cause damage  _____________________________  Carcinoma in situ  ______________________________ cells are n o longer contained  ______________________________ Cancer cells in the tissue hasn't spread 3  10/30/2024 1. Tumor Initiation _________________ Exposure to carcinogen Damage/alteration _______________ in genetic material __________________ Mutation Starts 2. Tumor Promotion Mutated cell proliferates to taa Dependent on a _________________ tumor Promoter (Partof quetic Spefic 3. Malignant Conversion traits ofcancer Preneoplastic cell expresses malignant phenotype If the promoter is removed, this stage is halted genetic tragy 4. Progression get out of control Promoter remains Neoplastic cells become more prolific Neoplastic cells become increasingly aggressive STAGES OF beginng Spread of cancer cells to distant areas of the body Metastasis happens through the blood or lymph How it happens: tisse Breaks through blood to moves through Primary tumor and find new tissue can cause problems cell escapes One Cells do not always survive all do im a trynot may Metastatic tumor Bladder cancer: liver, lungs or bones WHERE Breast cancer: brain, liver, lungs or bones Colon cancer: liver, lungs or peritoneum Kidney cancer: brain, liver, lungs, adrenal glands or bones DOES Lung cancer: brain, liver, bones, adrenal glands Melanoma: brain, liver, skin, lungs or bones Ovarian cancer: liver, lungs or peritoneum Pancreatic cancer: liver, lungs or peritoneum Prostate cancer: liver, lungs, adrenal glands or bones IT GO? Rectal cancer: liver, lungs or peritoneum Stomach cancer: liver, lungs or peritoneum Thyroid cancer: lungs or bones Uterine cancer: liver, lungs, peritoneum, vagina or bones 4  10/30/2024 Staging characteris of tumor T : Tumor size and spread (from site of primary tumor) N : involvement of lymph Nodes? M : Spread? Metastasis much it moved Grading how has Cellular classification of tumor cells I – IV Early to advanced examination of tissue removed from a living body to discover the presence, cause, or extent of a disease Removal of cells lessing for cancer Incisional taking piece Excisional taking whole and grab cells Needle in Put needle Breast and Glvia) Found on tumor cells only Changes in antigens Can facilitate an immune response causing illness Can be targeted for treatment will only kill cancer cells 5  10/30/2024 Biochemical markers. clear recognision EXAMPLES men o u r so for screening give risk for but not 10090 PSA (prostate) Not very “specific,” can may show up with other diseases AFP (ovary, testicle) Not a known tumor marker for all types of cancer ACTH (small cell, renal cell) Hormone, enzyme, gene, antigen, or antibody CA 125 (colon) Beta-2 macroglobulin Found in cancer cells, blood, spinal fluid, urine (multiple myeloma) Screening, diagnosing, assessing, prognosis, treatment, and staging More for screening that diagnosing Carcinoma Sarcoma CANCER Myeloma TYPES Melanoma Leukemia Lymphoma  ADAPT to remove most – covered in MS2 tissue  Epithelial origin Cancer of the internal or external systems know which lining of the body Shald have gotten screening when possible breast trouble swallowing , I SiS-Pain weight , loss screening decrease fuction , of organ colorectal lung and Bose Diagnosis-imaging esophagus pancreatic prostate renal cell Renal cell colorectal prostate 6  10/30/2024  cancers of the bones and soft tissues  7 subtypes  more than 70 types of sarcoma Osteo- bore SIS-first pain Fibro- connta Cartilage Chondro- muscle Rhabdomyo- happening immuno Kaposi's compromise under Kaposi’s P + only Skin Angio- Vessels  Neoplasm of the plasma cells  may be found when a blood or urine test is done for another condition and a higher-than-normal level of protein is found  3 subtypes most common multible myelomas ↑antibodies SIS-immule responses ,  Neoplasm of the skin  most serious type of skin cancer can spead quickly  develops in the melanocytes under finger nail / on scald  Can be hidden  first melanoma signs and symptoms often are: in more Change  Is a normal mole or a melanoma??  Think A-B-C-D-E 7  10/30/2024  Leukemia Acute Lymphocytic Frequent : Ilress fatiace bRBC Bruising  marrow , , ,  Excess, abnormal white blood cells Acute Myelogenous  Previous cancer treatments increase Chronic lymphocytic risk  Diagnosis Chronic Myelogenous  Lymphoma  lymphatic system can go everywhereHinfection  Some viruses linked to lymphoma such Hodgkin's as Epstein Barre, HIV, etc Non-Hodgkin's  Can be very slow growing Similar S/S to leuremia Cutaneous B-cell Cutaneous T-cell  Surgery  Diagnostic our tumor  Primary taking  Prophylactic Prevent from happening to cure but reduceSumtoms  Palliative nor going Cancer  Reconstructive fixes Surgery affects tolemae  Chemotherapy removal size) symtems I get to go  Why? Size reduction (mange Lure Palliative  Nursing considerations: ,  Monitoring lab work, VS central lie car  Education RE: diet, rest, supportive medication, protecting health about side effects  Radiation in tumor cells Place seed  Internal  External lasers shooting at Cancer Scatter radation manage show where laser should be tattoo to will get to treat Burns Stem Cell Treatment  Immunotherapy 8  10/30/2024 Physical Support Psych/Social Support Anti-nausea medications Education Hydration Counseling Monitoring labs Community support referral (CBC, renal function, hepatic function) Monitor depression, anxiety Monitor neuro function Goals of care discussions Central line (portacath) care Plan of care discussions Education Symptom management - Medication side effects - Treatment education - Nutritional needs Infection risk - Plan of care options - Resource availability - Potential for mental health struggles NURSING CONSIDERATIONS Support Before, During, & After Diagnosis and Treatment 9 Care of the Patient with Stroke NUR340  Objectives Understand the signs and symptoms of stroke and which area of the brain is affected. Discuss nursing considerations and interventions for stroke patients. Describe the Joint Commission guidelines for stroke patient care and nursing documentation. Understand the risk factors and complications pre and post stroke.  Just the Facts Fifth leading cause of death Leading cause of chronic disabilities new stroke never effects both sides 800,000 strokes each year – 25% are recurrent Certified Stroke Centers Comprestive Strok center  Get with the Guidelines IV t-PA within 3 hours By discharge: Venous Thrombus embolis break up a VTE prophylaxis Anti-thrombotics clot spaced Early anti-thrombotics Statin order control Cholestral Anticoagulant for Afib Smoking cessation Brain Anatomy Review  Roles of the Lobes Judgement Frontal lobe Personality you are Parietal lobe Position speech where Temporal lobe hearing Speech Occipital lobe Sight Cerebellum balare cornation Brain stem Breathing HR  Brain perfusion If brain & a cooltur has ↓ clot on they will gush blood up and around  Anterior Cerebral Artery Fed by carotid arteries Supplies blood to frontal lobe Symptoms exhibited Problems with Frontal lobe than weakness in legs greater arms personality changes is okay function Gait apraxia-leg but difficult walking  Middle Cerebral Artery Parietal lobe, portion of frontal lobe Iscemic Largest artery, most common for stroke A Symptoms exhibited arm reckness greater than leg Feild Cut (Perplerial vision) thik of eye as one Broca’s vs Wernicke’s aphasia side neglect to right Right reconce not will vision of tild langua lett Broadcast , difficult expressing meaning , expressive aphasic Broca's - understanding - receptive agnasia wernicke's-what-difficulty is both global aphasia  ICA & PCA Internal Carotid Artery Posterior Cerebral Artery Similar to MCA Occipital lobe blood supply Vessel insufficiency Fed by basilar and vertebral Amaurosis fugax lemoraly arteries loss of vision in one or both Visual changes eyes visual nosia as what tell I car front objection is  Types of Stroke Ischemic Hemorrhagicby caused Clot/oclusion 1590 common hypertension more common 8090 older palent he e ten skill brai blood pushes on excected brain and moves it outof midline out of the bottom by uncal hermation Cushing triad - but tissu brain BP6HRbPR tisse is Strokenot dead ↑ see out the bottom PICP pushes on brain su can Shar  Transient Ischemic Attacks g % of strones Not just a “mini stroke” Symptoms resolve 250 Can become severe quickly  Ketones in urine and Late blood Fruity breath  Glucose in urine Rapid, deep breathing  Electrolyte imbalances Nausea & vomiting Dry fatigue Special Circumstances It sick call Doctor  Take insulin or oral antidiabetic medications as usual unless vomiting occurs frequently  Attempt to consume frequent small meals  Drink fluids every hour  Check blood glucose and urine ketones q3-4 hours  Know when to notify health care provider Complications in Diabetes Chronic hyperglycemia Vascular damage atherosclerotic changes narrowed lumen mores normal hyperglycemia 6  9/24/2024 Diabetic Ulcers A major complication Usually on feet a tum meropath well Do not heal well hard to treat Often lead to osteomyelitis a andcan # I cause of tem High potential for amputation Patient education is paramount es a much ba 7 ENDOCRINE DISEASE NUR 340 What is the endocrine system and how does it work? hormones release control body functions  land g master Oxytocin-vlerire contraction ACTH TSH Some key terms…… ◦ Hormones ◦ Endocrine glands thyroid, Parathyroid , Adrenal ◦ Hypothalamus ◦ Pituitary gland  Hypothalamus Regulation of Endocrine function: TRH “Negative Feedback System” Anterior Pituitary TSH When T3 & T4 levels increase, TSH release is suppressed. Thyroid Thyroid Hormones T3 & T4 Pituitary Disorders change arginine vasopressive deficiency ◦ Diabetes insipidus name ◦ Syndrome of Inappropriate Antidiuretic hormone (SIADH) Hormae affected ADH PossirorPituitary  holds enter Harmove fluid Diabetes Insipidus ◦ A deficiency of ______________________ ADH is characterized by excessive thirst (polydipsia) and large volumes of dilute urine. ◦ Three types: tumor damage * ◦ Neurogenic (central): Brain/gland right ◦ Nephrogenic: Kidneys not woming ◦ Psychogenic: Drinking to much water Surgrey through nosed packed not just should sneeze ◦ Who’s at Risk? Head trama , Surgery math closed with Diabetes insipidus-Clinical Findings lab work ◦ R/T decrease of ADH test with an hr ◦ Polyuria, nocturia, polydipsia -oomt diluk more ◦ Low urine specific gravity and low urine osmolality urgire for apart ◦ High plasma (blood) osmolality (300 mOsm or more) Blood Cell ◦ Plasma sodium: elevated less fluid closer ◦ Dehydration!! Diabetes Insipidus: Treatment ◦ Treatment goals: Keep hydration ◦ Nursing management includes: ◦ Maintaining adequate fluid volume ◦ Monitoring patient’s weight ◦ Administering vasopressin ned form of APH THR ◦ Monitoring VS Change in JBP ◦ Monitoring patient’s I/O DI-Medical Management ◦ FLUID REPLACEMENT ◦ Replace ADH ◦ DDAVP (desmopressin) – nasal spray or IV ◦ Vasopressin tannate in oil- IM ◦ Other: ◦ Thiazide diuretics itwas nechrogenic ◦ Prostaglandin inhibitors: e.g. ibuprofen Promote flow Blood Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Holds on to ◦ Cannot excrete diluted urine fluid ◦ Develop dilutional hyponatremia low Sodium consentrad Urin Vrimosmo Blood osmo ◦ Medical management: SIADH ◦ Excess of ADH ◦ Water retention and dilutional hyponatremia ◦ Plasma sodium: decreased secondary to fluid retention salt tablet) 135-145 less than 120 very Concern (congre ◦ Normal Na = ◦ Decreased serum osmolality women Occurs in a single node Causes enlargement of node starts and then spreads rese are tumor cells Reed-Sternberg cells – malignant, large tumor cell Presence aid in diagnosis mono get after Cause unknown, relation to EBV ↓ = chemo , limen removal Non-Hodgkin Lymphoma Involve malignant B lymphocytes Largely infiltrate lymphoid tissue Low grade: Ex: CLL and follicular lymphoma Longer survival rate Delayed treatment not as aggressive High grade: Ex: B-cell & T-cell lymphomas, Burkitt’s lymphoma Require aggressive chemotherapy myelo suppression Blood Transfusions Common blood product transfusions RBCs, platelets, FFPs Table 20-6, p. 612 (blood transfusion therapy) Follow the process for transfusions Monitor for adverse effects or reaction Usually occurs within first 15 minutes Pts can refuse transfusion – Jehovah’s Witness Transfusion Reactions an/15 Vitals Transfusion-Related Acute Lung Injury (TRALI) New lung injury within 6 hours of transfusion S/s: dyspnea, fever, chills, hypoxia, cyanosis, hypotension Transfusion-Associated Circulatory Overload (TACO) Hypervolemia – blood infused too quickly S/s: tachycardia, JVD, crackles, HTN, dyspnea watch F Allergic Reaction Rash, pruritis, wheezing Benadryl/steroids given prophylactically  Requires dual nurse sign-off Check off: Blood product Product number Blood ID band Patient ID band Expiration date Blood type Requires blood IV tubing and saline flush bag Questions?  atlab look Do value or a can HYPERTENSION NUR 334 thyer eoints UTIS Hypo , power prevent Chronic SBAPBundleplacement Adult a is Fory N9 to know be rig you in EPIDEMIOLOGY CDC Statistics 46% of Americans affected ↑ risk of myocardial infarc on, CVA, ARF 1 in 3 adults have pre-hypertension About 50% have controlled HTN Primary/contributing factor of death in 410,000 Americans in 2014 Healthy People 2030 goals  ranges know NEW AHA GUIDELINES HOW IS BP DETERMINED? Cardiac Output (CO) SUCHR Diastolic Peripheral Vascular Resistance (PVR) placed on the AmountOf Pressure being vessels HTN RESULTS FROM: ↑ PVR ↑ CO ↑ vasoconstric on ↑ blood volume harder for Blood to get through ↑ blood viscosity ↑ sympathe c s mula on ↓ vessel elas city ↓ parasympathe c s mula on PRIMARY VS SECONDARY HTN Primary (Essential or idiopathic) 95% of cases No identifiable cause Secondary renal disease (Aldosterone) 5% of cases Secondary to identifiable cause RISK FACTORS Multifactorial not just ore RF include: Family history O Obesity · - nonmodifiable Sleep Apnea Ethnicity/Race 6 Smoking Sedentary lifestyle Advanced age ⑧ · Gender. OLDER ADULTS Why dose prevalence of HTN increase with age? Decrease elasity risk Bursting (Hemmerage Stroke) increase of Vessels Treatment Lifestyle modifications first Start with low doses and increase slowly Brain Shrinks especily for elderly Kidney not as good when Compliance watch side effects issues – why? OlderSostStress more more meds space to leak Can't drive to get it Forget , wrong , CLINICAL MANIFESTATIONS & ASSESSMENT Typically asymptomatic Flushing May experience HA, fatigue, visual changes Its be happen for awhile Proper technique Automatic vs auscultation lends to be check weird a little higher BPS TARGET ORGAN DAMAGE Happens our time unless unreasonale high Structure & function impaired Effects major organs Brain, Kidneys, Retina tiny die to caps Burst Caused by elevated BP Leads to: DIAGNOSTICS Urinalysis Bloodwith Kidney in wireproblem Blood chemistry Sodium BUN, Cr, electrolytes Kidney function Fasting glucose HLD gohand Choles/BP and a HDL levels - EKG, ECHO, Chest XR Eye Exam target organ Neuro exam damage  BP dawn get it causes before GOALS OF TREATMENT damage Decrease peripheral resistance ↑ Decrease blood volume Decrease strength, force, and rate of myocardial contraction LIFESTYLE MODIFICATIONS Smoking cessation Weight loss Dietary changes Daily physical activity Stress management Pain management DASH DIET Dietary Approaches to Stop Hypertension Increase grains Increase fruit/vegetables Decreased sodium/salt Lean meats/proteins Monitor dairy intake PHARMACOLOGICAL TREATMENT anyone over 50 Diuretics – Thiazides as 1st line treatment ACE inhibitors women / child Bearing age no Pregnant ARBs Calcium channel blockers Beta-blockers, aldosterone antagonists # under so COMPLICATIONS OF HTN HYPERTENSIVE CRISIS to give IV meds going Definition: BP >180/120 Hypertensive emergency Hypertensive urgency little more time not as high can adjust info rale Based on Managed with continuous, titratable IV antihypertensive agent IMPORTANCE OF EDUCATION!  4/25/2023 NURSING MANAGEMENT OF PATIENTS WITH IMMUNODEFICIENCY, HIV INFECTION, AND AIDS NUR334 FALL 2022 Deborah Toddes Med-Surg I - Spring 2023 1 OBJECTIVE  Define immunodeficiency  Discuss patients who are susceptible to immunodeficient disease processes  Distinguish between HIV Infection and AIDS  Identify how to diagnose and treat.  Discuss nursing management and diagnoses related to caring for individuals with immunodeficient disease processes 2 s IMMUNODEFICIENCY DISORDERS sumrobn immune  Part of the immune system is missing or defective  Reduces the ability to fight infection  Primary or Secondary 3 1  4/25/2023 Primary Immune Deficiency uncommon missing low B-cell T-cell  Manifestations: PRIMARY more infections than normal IMMUNODEFICIENCY can go unnoticed Combination haveng of B & T Defective  Complications: insections are real bad phagocytes need t deficiencies  Examples maks a Complement Idiopathic ALPS-essymphocytes deficiencies weda't know why chemicalsa re nto signals 4 Secondary Immune Deficiency more common  Extrinsic causation not caused by genes  SECONDARY Manifestations: Chemocaner/radation , totns , organ damage IMMUNODEFICIENCY  Treatment: resolve underlying process, if possible issue or supress underlying  Examples: Most well-known example: HIV/AIDS -not going away chemo-canbefixed 5 HIV & AIDS o re a  HIV - human immunodeficiency virus thisisthevinethat So can't spread getting undetected it  1.2M in the US (2022) – holding steady better at  38.8M globally (2021) – growing  1.5M new cases  650K HIV-related deaths  AIDS – acquired immune deficiency syndrome  Bloodborne any bodilyGlvid  Transmittable in pregnancy mom to baby 6 2  4/25/2023 HIV PATHOLOGY Big part of immure sysum  Targets CD4 T-cell, easy know its this whinecan't  Retrovirus it a res only has RNA no DNA So to replicat  New viral particles bud from the cell 7 HIV DIAGNOSIS looking for antibodies earkit Catch the Separated untibodies sees things better looks for viral DNA only definitie way Diagnoeslo a b test viral load it see how much Progresses as anyshawsexposea -2 8 STAGES OF HIV INFECTION vins Primary infection: competes fir resources Stage 1 – Acute, Asymptomatic Starts by rapidly  By about 6 months, the rate of viral replication reaches a lower going but relatively steady state n and virus Stage 2 – Chronic/ symptomatic: insected levelsoff  The number of CD4+ T cells gradually falls amounter Stage 3 - conversion to AIDS ist recour Without  The CD4+ T-cell level drops treatment below 200 cells/mm3 9 3  4/25/2023 MANIFESTATIONS OF HIV  Pulmonary - infections curon : niu , trush diarrhea  GI bappitere , - , Cytonegolovirus  Immune - KoposkiScorcama , geteasily foughtvirusthatadangersa  Integumentary rushes  Musculoskeletal vaginal yeast muscle pain flactic acid) and UTIS weightloss  Psycholgical 10 MANIFESTATIONS (CONT) to acrease Or organs 11 IMMUNE RECONSTITUTION late reaction of sysum immure INFLAMMATORY SYNDROMES (IRIS) a to irestat ~ reacting  Over reaction to previous infection currently have it ac ts as if he  Overwhelming a ummit its once  Paradoxical  Treatment unknown monitor immune respose risk of infection decrease a canshu a 12 4  4/25/2023 HIV TREATMENT  Based on number of factors viral load , health , bodies responde  At least 3 active drugs from at least 2 classes combo to kill many virus with He lowest does  Strict adherence imperative don't give virus a chance  Treatment side effects can affect plan Cy repatictox : mylo suppression  PreP treatments 13 TREATMENT OF OPPORTUNISTIC INFECTIONS tak advantage of bad immune sysum  Pneumocystis Pneumonia Respritory fa i l s fungu insection langterm to f i x use bactrim Can Sit in lung for awhile beare h e see i n  Mycobacterium avium complex (MAC) Reseirtert illness Hard with erthroymucin  Cytomegalovirus adding antivirals ↑ liver renal disease  Kaposi Sarcoma no heatrent can on ly see it on ce i t get to the Skin 14 NURSING CONSIDERATIONS FOR CARE OF PATIENTS WITH HIV/AIDS  Challenging infection can being an ongoing issue cause of around the issue Stigma  Assessment Head to toe everytime  Physical and psychosocial Social worker for loss (very Frail) fall risk weight cost of drugs EBC issue bleeding visu 15 5  4/25/2023 POTENTIAL NURSING DIAGNOSES Physical Related Psych-Social Related  Imbalanced Nutrition: Less Than Body  Social Isolation Requirements  Powerlessness  Fatigue  Deficient Knowledge  Acute/Chronic Pain  Disturbed Thought Process  Impaired Skin Integrity  Anxiety/Fear  Impaired Oral Mucous Membrane  Impaired health maintenance (risk or  Risk for Injury actual)  Risk for Infection 16 NURSING INTERVENTIONS  Pain relief  Support nutritional status  Evaluate for infection  Education 17 6