Unit 4

Which STIs are curable ?

Chlamydia , Gonorrhea and Syphilis

Which STIs are not curable but can be treated ?

HSV I , HSV II and HPV

Which STI is being described ?

• most commonly reported

• patients can be asymptomatic

• curable

• thin white or clear discharge (penile or vaginal ) is observed

• dysuria

Chlamydia

A pregnant woman can give which STD to her baby during childbirth ?

Gonorrhea

What STI is being described ?

• thick green or yellow discharge (penile or vaginal )

• dysuria

• swollen testicles

Gonorrhea

What complications of Chlamydia ?

Ectopic pregnancies , PID , infertility

What is Pelvic Inflammatory Disease (PID ) ?

caused by untreated chlamydia or gonorrhea - sx : pelvic pain , fever , chills

What are factors associated with an increased risk of developing chlamydia ?

• being under the age of 25

• having a new sex partner

• having multiple sex partners

• having a partner who is having sex with other people at the same time

• having a sex partner with an STI

What are sx that are seen in women with chlamydia ?

• Dysuria

• abnormal / irregular menstrual cycles

• spotting

• PID

• watery , clear or white vaginal discharge

what sx are seen in males with chlamydia ?

• white watery or clear penile discharge

• dysuria

• penile pain

• swelling of testicles (rare )

What tx and education is indicated for chlamydia ?

• no sexual contact until 7 days after ABX are completed and sx go away

• being tested for HIV and syphilis

what sx are seen in women with gonorrhea ?

• painful or burning urination

• thick green , yellow discharge

• vaginal bleeding between periods

• PID

what sx are seen in males with gonorrhea ?

• burning when urinating

• white , yellow or green discharge

• painful or swollen testicles

HSV 1

• presents as a round and irritated sore near the mouth

• dx : with culture or lab test

• lifelong viral infection ; not curable

• transmitted through oral contact

HSV 2

• presents as a round and irritated sore on the genital area

• dx : culture or lab test

• life long viral infection ; not curable

• transmitted through sexual contact

Patient education on genital herpes

• can be treated with daily immunosuppressants

• condom use to prevent asymptomatic spreading since it is a virus

• will be able to have children

What is the preventative vaccine for HPV ?

Gardasil 9

• can be started at age 9 through 45

• protects against cancers caused by HPV and genital warts

HPV

a non-curable virus with 80 different types that can cause cervical , anal , penile , vaginal or throat cancer

what is are the sx primary syphilis ?

starts with Chancre sores (large blisters) which heal on their own and virus becomes dormant

what are the sx of secondary syphilis ?

non-itchy rash on hands and feet with a fever

what is different in a child’s eustachian tube vs an adult’s ?

A child’s eustachian tube is shorter and flatter which makes it hard for any infectious fluid to drain

Why is bottle propping not ideal ?

• Increases the risk of aspiration

• Increased risk for ear infections bc milk can reflux into the eustachian tubes

• decreases bonding with caregiver

what is acute otitis media (AOM)

acute infectious process of the middle ear that may produce a rapid onset of ear pain and possibly fever

• also otalgia (ear pain )

• toddlers will tug at their ears

what is otitis media with effusion (OME)

fluid in the middle ear space without signs and symptoms of infection

what is chronic otitis media with effusion

OME lasting longer than 3 months with perforation of the tympanic membrane (fluid escape through small hole)

what is otitis externa

inflammation of the external ear canal

what are the risk factors for otitis media ?

Eustachian tube dysfunction , recurrent upper respiratory infections , passive smoke (tobacco ) , # of previous ear infections , day care attendance

clinical cues of otitis media

• fussiness or inconsolable crying (especially when lying down )

• pulling at ears

• verbalized ear pain (otalgia )

• fever up to 104 or higher

• rolling head from side to side

• loss of appetite ; refusal to feed

• lethargy

• fluid draining from ear

• swollen lymph nodes

Diagnostic evaluation of Otitis media

• fast onset of sx

• visual inspection of tympanic membrane

  • may look dull , bulging or red with visible pus

• immobile eardrum of inspection of canal

what are complications of otitis media ?

• most common is hearing loss —> gradual decline or deficit

• expressive speech delay

• tympanosclerosis (ear drum scarring )

• perforation of ear drum

• intracranial infections (meningitis )

sx management of Otitis media

• kids under 6 mo will be given abx doesn’t matter if its bacterial or viral at this age

• over 2 mo w/o severe sx will be monitored

sx of uncomplicated lower uti ( bladder or urethra)

fever , vomiting , diarrhea , nocturia , hesitancy , frequency and dysuria

sx of complicated upper uti (kidneys or ureters)

can be asymptomatic or be septic

• high fever

• cold , clammy or pole skim

• disorientation or difficult to arose

what can be a key sx of a UTI in an infant ?

jaundice

sx of uti in infants and children

• fever , irritability , tachypnea , vomiting , poor po intake , grabbing diaper , bed wetting , blood in urine

What are some risk factors for a UTI

• female

• diabetic

• pregnancy

• gout

• any condition that can cause obstruction , urine stasis or foreign body insertion

what are factors that contribute to UTI in older adults

cognitive impairments , frequent use of antimicrobial agents , multiple chronic medical conditions , immunocompromised , low fluid intake or excessive fluid loss

what are risk factors for pyelonephritis?

recurrent utis and urine back flow

What does acute pyelonephritis lead to and what is the tx

leads to inflammation of kidneys and possible abscesses . it causes atrophy and destruction of glomeruli

• Tx : two week course of abx

what does chronic pyelonephritis lead to and what is the tx

leads to kidney scarring and progressively lowers kidney function

• Tx: long term IV abx

what are potential complications of pyelonephritis ?

end stage renal disease , HTN or renal calculi

What class is amoxicillin ?

penicillin

what are adverse effects of amoxicillin ?

anaphylaxis and furry tongue

what are nursing considerations for amoxicillin?

• check for allergies to cephalosporins as there is a high cross sensitivity between both classes

what class is ceftriaxone ?

cephalosporin

what are the adverse effects of ceftriaxone ?

disulfiram - like reaction with alcohol

• causes pt to become nauseous , vomit or experience a HA after alcohol consumption

what are nursing considerations for ceftriaxone ?

• Do not give if pt is allergic to penicillin , these drugs have a high cross sensitivity as they are both beta lactams

what education should be given to a patient taking ceftriaxone ?

do not drink alcohol during the entire course of abx and for 12 hrs after the last dose

what class is doxycycline ?

tetracycline

what are adverse effects of doxycycline ?

bicycle in sun

• photosensitivity (severe sunburn risk )

• tooth discoloration ( permanent yellow/brown stains in kids )

what are nursing considerations for doxycycline ?

• do not give to pregnant women or kids under 8

• do not give with dairy , antacids or iron

  • these bind to drug and stop absorption

what class is gentamicin ?

aminoglycoside

what are adverse effects of gentamicin ?

• ototoxicity (irreversible hearing loss or tinnitus)

• nephrotoxicity ( kidney damage )

what are nursing considerations for gentamicin ?

• check peak and trough levels : narrow therapeutic window , trough needs to be drawn 30 min before next dose

• monitor urine output : let provider know if under 30 ml/hr

• monitor BUN and CR

Red man syndrome

Red rash from rapid IV administration of gentamicin or vancomycin

• sx : hypotension , flushing and itching

what class is vancomycin ?

glycopeptide

what are the adverse effects of vancomycin ?

• otoxicity : irreversible tinnitus and hearing loss

• nephrotoxicity : kidney damage

• red man syndrome

what are nursing considerations for vancomycin ?

• narrow therapeutic window → check peaks and troughs

• closely follow infusion rate instructions

what class is ciprofloxacin ?

fluoroquinolone

what are adverse effects for ciprofloxacin ?

• BLACK box warning : achilles tendon rupture

• QT prolongation : can cause cardiac arrhythmias

what are nursing considerations for ciprofloxacin ?

• monitor pt for tendon pain / inflammation

• ask if hx of myasthenia graves (can worse muscle weakness)

• take any multivitamins , antacids (tums ) or dairy products 2 hrs before or after this med

what class is azithromycin ?

macrolide

what are the adverse effects of azithromycin ?

• hepatotoxicity (liver damage )

• contraindicated in pts that are lactating

what are nursing considerations for azithromycin ?

• monitor liver function tests (LFT)

• do not give to patients that are lactating

what is clotrimazole ?

a topical anti-fungal

what is nystatin ?

a topical or oral anti-fungal

what are three main priorities of abx administration ?

• culture before first dose of abx

• monitor for allergies

• monitor for s/s of secondary infections like c. diff or oral candidacies

what is the peak level

highest concentration of abx in blood

• too high kidney will die

• is drawn 1 ½ hr after administration

what is the trough level

lowest concentration of abx in blood

• too low bacteria grows

• is drawn 30 min b4 next dose

Healthcare associated MRSA

• associated with invasive procedures or devices like surgeries , IV tubing or artificial joints

• spread by HCW touching ppl with unclean hands or by ppl touching unclean surfaces

Community associated MRSA

• starts as a painful skin boil

• spread by skin to skin contact

• ppl at risk are high school wrestlers , childcare workers or ppl that live in crowded conditions

what are s/s of MRSA

• Starts as swollen, painful red bumps that may resemble pimples or spider bites.

• Lesions can feel warm and may contain pus.

• fever

• progresses to deep, painful boils.

what is the cause of bacterial meningitis?

caused by bacteria (meningococci and pneumococci )

what is the cause of viral (aseptic )meningitis ?

caused by viruses such as

• enteroviruses (echovirus or coxsackievirus )

• measles , mumps , herpes virus , HIV , varicella or influenza

Bacterial meningitis pathophysiology

• Bacteria enter CSF → multiply

• Release toxins → inflammation

• ↑ Blood brain barrier permeability

• WBCs + bacteria → pus

• Brain swelling + ↑ ICP → headache

• brain is covered with a layer of pus

• commonly seen in school age children to adults

viral meningitis pathophysiology

• Virus infects meninges

• Mild inflammation

• No pus

• ↓ ICP compared to bacterial

• Symptoms less severe

s/s of meningitis

Will be the same regardless if viral or bacterial

• fever , HA , drowsiness, nuchal rigidity , photophobia , poor feeding , n/v , neck pain

• positive kernig and brudzinski signs

• seizures , weak cries

• flat / bulging fontanels

• rash → late stage

how do you differentiate between the manifestations of viral and bacterial meningitis ?

• Patients with viral meningitis will appear less ill

• sx appear suddenly with bacterial

• sx come on gradually in viral

How is meningitis treated in babies if we are unable to obtain a CSF sample ?

Will need to be treated as if it were bacterial meningitis

what cues of mengitis are not typically present in children under 12-18 months

nuchal rigidity , brudzinski , kernig

What is a positive brudzinski sign

Severe neck stiffness that causes pt’s hips and knees to flex when their neck is flexed

what is a positive kernig sign

severe stiffness of hamstrings causes an inability to straighten the legs when the hip is flexed to 90 degree’s

What will children do as meningitis progresses and what is that position called ?

• Opisthonos postion to avoid flexing the neck

• The child will hyperextended their neck to relieve pain

what CSF results should we except in bacterial meningitis ?

• elevated —→ csf pressure , wbc ,neutrophils

• decreased → glucose

• positive bacterial culture

• cloudy color

what is a definite diagnostic test to distinguish between viral or bacterial meningitis ?

Lumbar tap

what CSF results should we expect in viral meningitis

• normal → CSF pressure , Glucose

• normal / slightly elevated → wbc , protein

• negative bacterial culture

• clear or slightly cloudy color

Nursing management for bacterial meningitis

medical emergency

• contact and droplet isolation

• IV abx (7-21 days )

• control temp

• control or prevent seizures

• hydration (over hydration can increase output and positon changes )

• dark room

• corticosteroids to lower inflammation

Nursing management for viral meningitis

Symptom management

• antipyretics

• hydration

• side lying in dark quiet room

• can be managed at home

• tx is 3-10 days

What is sepsis ?

A life-threatening organ dysfunction caused by infection

what is SIRS (systemic inflammatory response syndrome ) ?

a body wide inflammatory response that can be infectious or non infectious

SIRS criteria

• Temp: > 38 or < 36 celsius

• HR : > 90

• RR : > 20

• WBC

• AMS