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What is Scleroderma?
- “Turning to Stone” d/t excessive production of collagen
- A rare chronic disorder of diffuse fibrosis (thickening and hardening) of the skin, arteries, joints and internal organs including the lungs, and kidneys
- --Lungs usually go first, so Dx is usually done with PFTs and CX.
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What is CREST as it relates to scleroderma?
- C=calcinosis (calcium lumps)
- R=Raynaud’s
- E=Esophagus
- S=sclerodactyly ( tapering deformity of the bones)
- T=Telangiectasias=small red spots on the skin of the fingers, face and inside of mouth
- 80% end up with CREST syndrome
- Diffuse (20%)—rapid progression of visceral organ disease and death within a few years
- Tx is largely supportive and symptomatic.
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Risks of acquiring HIV
- The higher the viral load greater the risk
- Blood and blood products greatest risk when injected
- Mucosal exposure to blood 90% less risky than needle stick
- Dx with ELISA or Western Blog. Blot is more accurate, but more expensive.
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What can nurses do with regard to HIV testing?
- Obtain consent
- Provide pre/post testing information
- Perform Point of care HIV testing
- Assess Hx
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What are some markers for infection of HIV?
- CD4 counts and viral load
- CD4: 200-500 = moderate immunosuppression. <200--> ^opportunistic nfxn.
- Viral load:
- goal is for viral load to be undetectable.
- When it reaches ~10K, time to rethink treatment.
- >100K-->AIDS.
- In HIV/AIDS pts, both markers are check every 4-6 weeks.
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What is nursings' role in managing HIV?
- Centers around keeping the immune system functional
- Assisting the client in coping with a chronic disease, and maintaining emotional and spiritual well-being.
- This requires early assessment and intervention, comfort with asking about high risk behaviors and developing sensitive teaching and counseling skills
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Definition and SnSs of AIDS after HIV.
- Presence of HIV infection and a CD4 count of less than 200 or HIV infection or diagnosis or indicator disease with no other cause of immunodeficiency
- Cancer
- Kaposi’s Sarcoma: Flat, pink turning to dark violet or black
- Pneumocystis carinii
- White out: RAISE head of bed, assess LOC (hypoxia) etc.
- Many unrelated pathologies all present simultaneously or in succession.
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What other non-obvious symptoms will AIDS pts have?
- neuropathy/dementia
- encephalopathy
- lethargy, withdrawal, depression
- limb spasticity
- dysfunctional bladder/bowel
- wasting syndrom (TPN)
- --Not always successful since the body saves fat when it needs protein.
- --Nutritional supplements high in protein and well-balanced meals with multiple vitamin/mineral supplementation (NO IRON) and adequate calories and adequate fluids
- --Recombinant human growth hormone may be helpful
- lymphomas
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Nursing diagnoses are going to be pretty much all of them
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