1. airborne pcns
2. HIV
   1. A:
      1. 8+ new ear infections/yr
      2. 2+ serious sinus infections/yr
      3. 2+ mo ineffective antibiotics
      4. persistent thrush
      5. failure to gain weight
      6. need antibiotics to clear infections
      7. 1/16 African American males
      8. candida/TB/pneumonia
      9. changes in fat metabolism and distribution
   2. AIDS
      1. A:
         1. CD4 count 200mm3 & symptomatic
         2. progresses to dementia
         3. Kaposi's sarcoma
         4. CMV retinitis -- blindness
         5. labs: hi protein, los cholesterol, hi AST/ALT
   3. TESTS
      1. ELISA rules out HIV
         1. repeat twice w'same sample if positive
      2. Western blot
         1. repeat in 3-6 months
   4. Dx
      1. Impaired Nutrition < requirements
      2. Risk/Actual Infection
      3. Anxiety r/t Fear of diagnosis
      4. noncompliance
   5. P:
      1. Decreased viral load, increased CD4
      2. remain free from infections
   6. I:
      1. MEDS
         1. HARRT
            1. inhibit replication
            2. NRTI ...vudine
            3. cc
            4. malnutrition
            5. infection
            6. bleeds
            7. decr WBC & Platelets
            8. liver toxicity
            9. no OTC meds (liver tox)
            10. NNRTI ...virdine
            11. Protease inhibs ... navir
            12. Fusion inhibs ...virtide, ...virdoc
            13. test for drug resistance
            14. start if CD4 <200mm
            15. effective? decrease viral load, increase CD4
         2. antiretrovirals
            1. stop replication
         3. nutrition
            1. appetite stimulator/ megase
            2. antiemetic/ ondansetron
            3. antidiarrheal/loperamide, lomotil
         4. pregnant people
            1. 2-3 months gestation, zidovudine
            2. no breastmilk
            3. c-section
         5. strict compliance
      2. I:
         1. oral hygeine
         2. educate re:transmission
         3. med compliance
         4. hi protein & calories
         5. low fiber, sugar, fat
         6. may be neutropenic
         7. rest periods
         8. frequent meals
         9. massive hydration
         10. Teaching
   7. E;
      1. Viral load decreased; CD4 count >200
3. RISKS
   1. Immature/Elderly
   2. nutrition/exercise/rest/smoking/toxins
   3. inherited blood disorders
   4. cancers/previous transplants or blood transfusions
   5. second exposure faster and stronger
4. ORGAN REJECTION
   1. A:
      1. VS q15 for 2h
      2. if anaphylaxis VS q5 for 1-2 h
      3. more vascular = more chance of rejection (avascular = no rich blood supply)
      4. Multiple organ transplant better acceptance rate
      5. previous h/o blood transfusion = more risk of rejection b/c 2nd exposure stronger
      6. Hyper acute: hrs or up to 3 days. tissue must be removed
      7. acute: 4 days - 3 months. comm with previous blood transfusions
      8. chronic rejection: 3 mo - 4 yrs. gradual decline, s/s not readily visible
   2. Dx
      1. Infection
   3. P:
      1. reduce risk of rejection
      2. ensure no infection before transplant
   4. I:
      1. !! fluids !!
      2. no fan!
      3. no cold bath
      4. monitor fcn of organ tissue, labs, s/s of infections
      5. immunizations
      6. avoid crawds
      7. hand & oral hygeine
      8. moderate-light exercise
      9. MEDS
         1. ibuprophen q6h
         2. tylenol q4h
         3. antipyretics
         4. cyclosporine/specific
            1. no grapefruit, monitor temp
            2. adverse rxns so severe that HCP usually gives 1st two doses
            3. possible anaphylaxis, VS q15 up to 2h
         5. tacrolimus/specific
         6. steroids/less specific
            1. monitor WBC, platelets,liver,kidney,give w'food & fluids
         7. antilymphocyte globulin for acute/rescue
            1. premedicate w'tylenol, benadryl, hydrocortizone
5. INFECTION
   1. MRSA
      1. Vancomycin: push slowly, central line if >24h, red man
   2. Hepatitis
      1. Ig to family
      2. A,E in stool, Vx 1day 3mo 6mo
      3. B,C,D in blood
      4. low fat, high protein
      5. rest self, rest liver
      6. no OTC
      7. interferon C
      8. report Hep A for food workers
      9. no longer contagious 3 wks into therapy
   3. Tuberculosis/droplet
      1. Mask and door sign if suspected TB
      2. low grade fever
      3. 3rd world travel
      4. long term care/prisons/homeless
      5. immunocompromised can come back negative
      6. PPD test: any positive response indicates a person has had exposure to TB. Does not mean patient is infectious or has active TB. False negatives are common in immunosuppressed patients, so test them again a week later.
      7. Sputum test: may ask patient to step outside to cough sputum, nurse wears PPE, three consecutive early morning samples are needed.
      8. CXR also to visualize lesion
      9. >15 cm induration means positive infection
      10. 5 cm induration for HIV patients
      11. CXR, sputum, cured after 3rd negative test
      12. treatment lasts 6 mo - 1 yr
      13. I: MEDS
          1. INH (isoniazid) peripheral neuropathy
          2. Rifampin: orange urine and saliva
          3. ethambutol: eye changes, red-green color deteection
          4. streptomycin: report hearing and balance changes immediately; ototoxicity
   4. A:
      1. redness, warmth, swelling, pain, hi WBC, loss of function
   5. IgE allergy/anaphylaxis IgG passive immunity to bacterial infections lasts 4-6 wks
   6. Angioedema
      1. CALL A RAPID!
   7. Pneumonia
      1. vaccine works for life, but booster good for people >65 because pneumonia often is a sequela to influenza
   8. Dx:
      1. Ineffective Airway Clearance
      2. Ineffective Breathing Pattern
      3. Activity Intolerance
6. cell-mediated ex: TB skin test
7. Leukocytes
   1. Monocytes : chronic diseases
   2. Basophils : parasites
   3. Neutrophils : bacteria
8. A
   1. Vaccines
   2. skin
   3. social history
   4. mucus membranes
   5. lymph nodes
   6. joints
   7. medications
   8. appearance
9. Dx
   1. Subtopic 1
10. I
    1. increase fluids will reduce fever
    2. Epipen, anterolateral thigh, go to ER immediately, discard pen, store in cool dark place
    3. anaphylaxis: epinephrine, benedryl, albuterol, hi-flow O2, hydrocortisone, sit up unless hypotension