Summary medical surgical nursing 12th edition

ia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 616 Thyroiditis, Acute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 617 Thyroiditis, Chronic (Hashimoto’s Thyroiditis) . . . . . . . . 619 Thyroid Storm (Thyrotoxic Crisis) . . . . . . . . . . . . . . . . . . 619 Toxic Epidermal Necrolysis and Stevens–Johnson Syndrome . . . . . . . . . . . . . . . . . . . .621 Trigeminal Neuralgia (Tic Douloureux) . . . . . . . . . . . . . . 626 Tuberculosis, Pulmonary . . . . . . . . . . . . . . . . . . . . . . . . . . 628 U Ulcerative Colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 632 Unconscious Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 639 Urolithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 646 V Vein Disorders: Venous Thrombosis, Thrombophlebitis, Phlebothrombosis, and Deep Vein Thrombosis . . . . 653 Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 659 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 685 x Contents 1 A Acquired Immunodeficiency Syndrome (HIV Infection) Acquired immunodeficiency syndrome (AIDS) is defined as the most severe form of a continuum of illnesses associated with human immunodeficiency virus (HIV) infection. HIV belongs to a group of viruses known as retroviruses. These viruses carry their genetic material in the form of ribonucleic acid (RNA) rather than deoxyribonucleic acid (DNA). Infection with HIV occurs when it enters the host CD4 (T) cell and causes this cell to replicate viral RNA and viral proteins, which in turn invade other CD4 cells. The stage of HIV disease is based on clinical history, physical examination, laboratory evidence of immune dysfunction, signs and symptoms, and infections and malignancies. The Centers for Disease Control and Prevention (CDC) standard case definition of AIDS categorizes HIV infection and AIDS in adults and adolescents on the basis of clinical conditions associated with HIV infection and CD4 T-cell counts. Four categories of infected states have been denoted: • Primary infection (acute/recent HIV infection, acute HIV syndrome: dramatic drops in CD4 T-cell counts, which are normally between 500 and 1,500 cells/mm3 ) • HIV asymptomatic (CDC Category A: more than 500 CD4 T lymphocytes/mm3 ) • HIV symptomatic (CDC Category B: 200 to 499 CD4 T lymphocytes/mm3 ) • AIDS (CDC Category C: fewer than 200 CD4 T lymphocytes/mm3 ) Risk Factors HIV is transmitted through bodily fluids by high-risk behaviors such as heterosexual intercourse with an HIV-infected LWBK partner, injection drug use, and male homosexual relations. People who received transfusions of blood or blood products contaminated with HIV, children born to mothers with HIV infection, breast-fed infants of HIV-infected mothers, and health care workers exposed to needle-stick injury associated with an infected patient are also at risk. Clinical Manifestations Symptoms are widespread and may affect any organ system. Manifestations range from mild abnormalities in immune response without overt signs and symptoms to profound immunosuppression, life-threatening infection, malignancy, and the direct effect of HIV on body tissues. Respiratory • Shortness of breath, dyspnea, cough, chest pain, and fever are associated with opportunistic infections, such as those caused by Pneumocystis jiroveci (Pneumocystis pneumonia [PCP], the most common infection), Mycobacterium avium-intracellulare, cytomegalovirus (CMV), and Legionella species. • HIV-associated tuberculosis occurs early in the course of HIV infection, often preceding a diagnosis of AIDS. Gastrointestinal • Loss of appetite • Nausea and vomiting • Oral and esophageal candidiasis (white patches, painful swallowing, retrosternal pain, and possibly oral lesions) • Chronic diarrhea, possibly with devastating effects (eg, profound weight loss, fluid and electrolyte imbalances, perianal skin excoriation, weakness, and inability to perform activities of daily living) Wasting Syndrome (Cachexia) • Multifactorial protein-energy malnutrition • Profound involuntary weight loss exceeding 10% of baseline body weight • Either chronic diarrhea (for more than 30 days) or chronic weakness and documented intermittent or constant fever with no concurrent illness 2