NURP 532 – FNP II: Primary Care Nursing Study Guide

NURP 532 – FNP II: Primary Care Nursing Study Guide NURP 532 – FNP II: Primary Care Nursing Study Guide 1 NURP 532 – FNP II: Primary Care Nursing – TEST 3 BLUEPRINT Answer EVERY exam question based on either: a) A clinical guideline b) A standard of care, or c) Evidence based intervention DON’T answer exam questions based on what you see done in clinical practice…. HIV (1) Highest risk of transmission is in patient male to male sex followed by female heterosexual intercourse. - Ages 20 to 35 - Transmission can occur sexually, parenterally through either IV drug use or blood product transmission, and vertically from mother to child during pregnancy or through breast feeding - Increased risk of transmission in the presence of other active STIs and a high HIV viral load Testing→ fourth generation HIV (HIV antigen plus the HIV 1 and 2 antibody) recommended by the CDC can detect infection early on, antigen rises about 10 to 15 days after a person in exposed. – confirmatory test is Western Blot - Also check for renal function, other STIs, hepatitis B and C - Positive test does not differentiate between antigen and antibody, need the immunoassay test to determine between HIV 1 and 2. - 4 weeks for the antibody to be detected. - CDC recommends at least once over the age of 13. - Attacks the CD4 and T cells and decreases the body’s ability to fight off infection, if left untreated over time, it greatly reduces the number of CD4 cells, and can lead to acquired immune deficiency syndrome-AIDS, no cure for HIV but it is treatable. - Increase rate of infection but death rate has decreased. Symptoms of acute infection→ (most people experience these) fever, sore throat, night sweat, lymphadenopathy, gastrointestinal symptoms, macular skin rash on the trunk of body, non-itchy (morbilliform and maculopapular), genital or oral ulcers, leukopenia or anemia, thrombocytopenia, elevation in liver transaminase. Symptoms in children→ opportunistic infections (candidiasis, recurrent pneumonia, recurrent otitis media), growth delay, anemia, neutropenia, hepatomegaly, splenomegaly - Stage 1/acute infection (2 to 4 weeks), large amount of the virus within the body, targets CD4 count, may develop nonspecific flu like illness and then recover from it. o Lab markers→ leukopenia, anemia, thrombocytopenia, liver transaminase elevation, HIV P24 antigen within 10 to 15 days, antibody takes up to three weeks, HIV RNA - Stage 2 level of virus in the blood decreases, can last many years without knowing that they are infected, high viral load and low CD4 cells. 2 NURP 532 – FNP II: Primary Care Nursing Study Guide NURP 532 – FNP II: Primary Care Nursing Study Guide o Highly contagious when they have developed AIDS, dx when the CD4 count gets below 200, develop opportunistic infections. ▪ HIV 1: Group M, Group N, Group O 3 NURP 532 – FNP II: Primary Care Nursing Study Guide NURP 532 – FNP II: Primary Care Nursing Study Guide ▪ HIV 2: Group P, mostly in Africa Definitive treatment, three antiretroviral medications, two nucleosides and then an integrase strand transfer inhibitor, ask about adherence at every visit, monitor for metabolic side effects (diabetes, hyperlipidemia), renal function, any sort of drug interaction, talk about condom use, have negative partners start taking PREP, give flu shots, pneumococcal vaccine, HPV. - Early treatment! Decrease the risk of transmission, we want to decrease the viral load, and help with complete recovery of CD4 count. - Can be treated during pregnancy, low transmission risk, we want to lower the viral load in mom, babies should be treated after birth, it is transmitted through breast milk. - PREVENTION! o PrEP (two antivirals taken daily to reduce the risk about 99% through sex) ▪ Must confirm they are HIV negative before starting. ▪ Still use condoms, do not miss doses. o PEP (three medications, post exposure, needle sticks, high risk encounters) WITHIN 72 hours for 28 days ▪ Recheck renal functional, liver enzymes and HIV test around 6 weeks. ▪ Screen for STI, osteopenia, cervical cancer o Can give vaccines if the CD4 is greater than 100 (inactive vaccines) live vaccines okay if greater than 200. Live vaccines→ MMR, varicella/zoster, rotavirus, flu o Certain antiretroviral therapies do interact with some hormonal contraceptives. A 26-year-old male reports that he was likely exposed to HIV via sexual activity 4 weeks ago and requests testing. He is given a rapid antibody test (OraQuick HIV test) and the results are negative. The NP recommends: a) No further testing is necessary b) Repeat testing in 2 weeks c) Repeat testing in 2 months d) Repeat testing in 1 year C – it can take 3 to 12 weeks for an HIV positive person to make enough antibodies to be detected by Ab tests – a negative result during this window period requires repeat testing 3 months following possible HIV exposure Lyme Disease (1) Most common tick-borne disease in the US and Europe, caused by Borrelia burgdorferi. - More common during months of April through September, spread through deer ticks, tick attaches to the skin and starts to feed and injects infected saliva while its feeding, takes at least 36 hours, tick normally falls off after 4-5 days. - Prevention→ tick checks, insect repellent with DEET, guidelines for prophylaxis for Lyme disease (doxycycline over the age of 8, single dose (200mg), no prophylaxis Tx for children under the age of 8) - Highest in the Northeast United States→ new England, mid Atlantic, upper Midwest, northern California - Incubation 3 to 30 days Symptoms→ Stage 1/early localized days to weeks (erythema migrans/bull's eye rash (can be more solid), larger than 5mm with central clearing, no pain/not itchy, warm to touch, not everyone develops a rash), 3 to 30 days, fever, fatigue, myalgia, dx based on clinical presentation