Chapter 16: Communicable and Infectious Disease Risks

NUR 436: Comm in Population Health; MCUSON; Dr. Hall and Dr. Watts

first cases of _____ identified in 1981

AIDS

worldwide ___ million people live with HIV infection

35.3

Sub-Saharan Africa accounts for more than ___ of all HIV infections. epidemic also growing in central Asia, the Middle East, and Eastern Europe

50%

treatment for _____ infection has been given higher priority

HIV

prevalence of _____ has increased

AIDS

HIV is not transmitted through casual contact (hugging, touching, kitchen utensils), or through mosquitos or other insects. HIV has been found in some _____ and tear samples but has not been transmitted via these secretions

saliva; tear

_____ are screened for bloodborne illnesses, blood or tissues from high-risk individuals or HIV positive individuals is not used, these screenings have helped reduce the numbers of transmissions through blood and organ donation

donors

_____ testing involves reporting to the state health departments by identifying the person’s name and other identifying information; this information is considered protected by confidentiality. With anonymous testing, the client is given an identification code number that is attached to all records of the test results and is not linked to the person’s name and address (CDC, 2018p).

confidential

The _____ _____ test is the most commonly used screening test for determining infection. This test does just as its name implies: it does not reveal whether an individual has symptomatic AIDS, nor does it isolate the virus. It does indicate the presence of the antibody to HIV

HIV antibody

The most commonly used form of this test is the _____-_____ _____ _____. The EIA effectively screens blood and other donor products. To minimize false-positive results, a confirmatory test, the Western blot, is used to verify the results. False-negative results may also occur after infection and before antibodies are produced. Sometimes referred to as the window period, this can last from 6 weeks to 3 months.

enzyme-linked immunosorbent assay (EIA)

Rapid HIV antibody testing using oral fluid samples (e.g., OraQuick, Home Access HIV-1 Test System) is 99.5% accurate and provides results within ___ minutes, allowing immediate results to be given (CDC, 2018p). In addition to the rapid results, this test may appeal to persons who fear having their blood drawn. If the test is positive, it requires a second specific confirmatory test

20

The nurse should counsel _____ with HIV about importance of regular medical evaluations and follow-ups, the risk of prenatal transmission as well as inform Health Care providers about the HIV infections

females

_____ testing is recommended for all clients attending health department STD clinics, family planning clinics, community health centers, and primary care offices

routine

_____ screening programs for HIV may be either confidential or anonymous: the process for each is unique

voluntary

_____ infection state may go unrecognized; person may experience mononucleosis-like syndrome, so they might have enlarged lymph nodes, myalgia, sore throat, lethargy, rash, and a fever, which is self-limiting. If a person seeks treatment for their illness during this early stage, the antibodies may not show up yet, and their illness will not be recognized as HIV

primary

Within ___ weeks - ___ months, the antibodies will begin to appear. HIV antibodies are not there as a protection, like many other antibodies

6; 3

list 5 AIDS-related opportunistic infections

• Pneumocystis jiroveci carinii pneumonia

• Oral candidiasis

• Pulmonary tuberculosis (should get a TST if positive for HIV)

• Invasive cervical cancer

• Recurrent pneumonia

The effectiveness of _____ therapy in pregnant women and newborns in preventing transmission from mother to fetus or infant has made pediatric HIV rates decline sharply

antiretroviral

The Americans with Disabilities Act of 1990 and other laws protect persons with _____ HIV infection and AIDS against discrimination in housing, at work, and in other public situations

asymptomatic

_____ health issues, such as depression, substance abuse, and bipolar disorder, are often present in someone newly diagnosed with HIV. These conditions must be addressed prior to or simultaneously with HIV treatment to be effective

mental

***HIV-infected children should attend school because the benefit of attendance outweighs the risk of transmitting or acquiring infections

***Nurses collaborate with workers from community-based organizations in the client's home and may advise these groups in their supportive work

***The Ryan White HIV/AIDS Program, through the Ryan White HIV/AIDS Treatment Extension Act of 2009, provides care for persons with HIV infection (USDHHS, 2019). This program provides funds for health care in the geographic areas with the largest number of AIDS cases. Health services that are covered include emergency services, services for early intervention and care (sometimes including coverage of health insurance), and drug reimbursement programs for HIV-infected individuals. The AIDS Drug Assistance Programs (ADAPs) are awards that pay for medications on the basis of the estimated number of persons living with AIDS in the individual state (USDHHS, 2019).

sexually transmitted diseases: The number of new cases (the _____) of STDs, such as gonorrhea, herpes simplex virus, human papillomavirus (HPV), and chlamydia continues to increase

incidence

sexually transmitted diseases: _____ is the most commonly reported infectious disease

chlamydia

sexually transmitted diseases: _____ is the second most common

gonorrhea

sexually transmitted diseases: Because of the impact of _____ on long-term health and the emergence of eight new ones since 1980, continued attention to their prevention and treatment is vital

STDs

_____ gonorrhea refers to limited cervical or urethral infection

uncomplicated

_____ gonorrhea includes salpingitis (inflammation of fallopian tubes), epididymitis (inflammation of the tube at the back of the testicle that carries sperm), systemic gonococcal infection, and gonococcal meningitis

complicated

Increase of antibiotic-resistant gonorrhea in the United States: _____-resistant gonorrhea first identified in 1976

penicillin

***Increase of antibiotic-resistant gonorrhea in the United States: By 1990, 64,972 resistant cases reported

Increase of antibiotic-resistant gonorrhea in the United States: _____-resistance N. gonorrhoeae has continued to develop exponentially, with gonorrhea becoming resistant to every antibiotic used for treatment.

antibiotic

Increase of antibiotic-resistant gonorrhea in the United States: In 2012, the CDC revised its treatment guidelines and no longer recommended oral _____ as a recommended first-line treatment for gonorrhea, in an effort to preserve the last remaining treatment option (CDC, 2013a).

cephalosporins

Increase of antibiotic-resistant gonorrhea in the United States: At this time, combination therapy of _____ IM along with either oral doxycycline or azithromycin is the most reliably effective treatment for uncomplicated gonorrhea (CDC, 2012g).

ceftriaxone

Increase of antibiotic-resistant gonorrhea in the United States: The injection route versus the previously recommended oral _____ may make treatment more challenging due to patient fear of injection and health care facilities having to stock injectable medication (CDC, 2013a).

cefixime

Increase of antibiotic-resistant gonorrhea in the United States: Increase in cases attributed in part to indiscriminate or illicit use of _____ as prophylactic by persons with multiple sexual partners

antibiotics

_____ syphilis - When syphilis is acquired sexually, the bacteria produce infection in the form of a chancre at the site of entry. The lesion begins as a macula, progresses to a papule, and later ulcerates. If left untreated, this chancre persists for 3 to 6 weeks and then in most cases disappears (Heymann, 2014).

primary

_____ syphilis occurs when the organism enters the lymph system and spreads throughout the body. Signs include rash, lymphadenopathy, and mucosal ulceration. Symptoms of secondary syphilis may include skin rash, lymphadenopathy, and lesions of the mucous membranes (Heymann, 2014).

secondary

About one-third of untreated syphilis patients will demonstrate signs and symptoms of _____ syphilis (Heymann, 2014). Tertiary syphilis can lead to blindness, congenital damage, cardiovascular damage, or syphilitic psychoses. A further complication can be the development of lesions of the bones, skin, and mucous membranes, known as gummatous lesions. Tertiary syphilis usually occurs several years after initial infection and is rare in the United States because the disease is usually cured in its early stages with antibiotics. Tertiary syphilis is a major problem in developing countries.

tertiary

_____ syphilis is transmitted transplacentally and, if untreated, can cause premature stillbirth, blindness, deafness, facial abnormalities, crippling, or death.

congenital

If left untreated, _____ can result in pelvic inflammatory disease (PID).

chlamydia

***Signs and symptoms of herpes simplex virus (HSV) infection include the presence of painful lesions that begin as vesicles and ulcerate and crust within 1 to 4 days. The first episode is typically longer and is usually characterized by more lesions than seen in subsequent infections. Lesions may occur on the vulva, vagina, upper thighs, buttocks, and penis and have an average duration of 11 days (Fig. 15.3). The vesicles can cause itching and pain and may be accompanied by dysuria or rectal pain. Although the ability to pass the infection to others is higher with active lesions, some individuals can spread the virus even when they are asymptomatic. Prodromal phase is when there are no visible lesions yet, but there may be a tingling sensation in the affected area. HSV is not a nationally reportable disease, and many people do not know they have it.

***Two specific types of HPV (HPV 16 and HPV 18) cause cervical cancer, accounting for 70% of cervical cancer cases (Heymann, 2014).

_____ is the most common STD in the United States, although it is not reportable (CDC, 2017e).

HPV

High-risk groups:

• Travelers to countries with high rates of the disease

• Children living in areas with high rates of HAV infection

• Injection drug users

• MSM

• Persons with clotting disorders or chronic liver disease

_____-_____ groups: Users of injection drugs; persons with STDs or multiple sex partners; immigrants/refugees and their descendants who came from areas with a high endemic rate of HBV; health care workers; clients on hemodialysis; inmates of long-term correctional institutions.

high-risk

The _____ infection is self-limited: individuals develop an antibody to the virus and successfully eliminate the virus from the body. They subsequently have lifelong immunity against the virus.

acute

_____ infected individuals are unable to rid their bodies of the virus and remain lifelong carriers of the hepatitis B surface antigen (HBsAg). As carriers, they can transmit HBV to others. They may develop hepatic carcinoma or chronic active hepatitis.

chronically

OSHA regulations

•Mandates specific activities to protect workers from HBV and other bloodborne pathogens

•Requires employers to identify the risk of blood exposure to various employees

•If employees perform work that involves a potential exposure to others’ body fluids, employers are mandated to offer the HBV vaccine to employee at the employer’s expense and to offer annual educational programs on preventing HBV and HIV exposure in the workplace. Employees have the right to refuse the vaccine.

High-risk groups:

• Health care workers and emergency personnel who are accidentally exposed

• Infants who are born to infected mothers

• Injection drug users, particularly those who share needles or other drug use equipment

• Those born between 1945 and 1965

_____ usually occurs through exposure to the tubercle bacilli in airborne droplets from persons with pulmonary tuberculosis who talk, cough, or sneeze

transmission

Epidemiology (2012)

•Southeast Asia and Western Pacific region account for 58%.

•Africa accounts for 25% of cases.

•In United States, half of new cases are in New York, Florida, Texas, and California.

Drug-resistant TB

•Multidrug-resistant TB (MDRTB): resistant to rifampin and isoniazid (know side effects of rifampin)

•Extremely drug-resistant TB (XDRTB): MDRTB plus added resistance to fluoroquinolones and at least three injectable second-line drugs (e.g. amikacin, kanamycin, and capreomycin)

U.S. drug regimens include _____ and sometimes rifampin.

isoniazid

Primary prevention

•Assessment: client’s risk level, sexual history, partner notification

•Interventions: client education and other actions aimed at prevention

•Sexual behavior: abstinence, condom use, female condoms (Fig. 14.4)

•Drug use: IV drug use, danger of using shared needles and syringes

•Community outreach: to reach those who do not seek care on their own

•Community education: spreading information about modes of transmission, testing, vaccine availability, early symptoms

•Evaluation: to determine whether adequate vaccination occurs, whether risky behavior changes to safe behavior, whether illness is prevented

Secondary prevention—screening for disease to ensure early identification, treatment, and follow-up with contacts

Tertiary prevention—managing symptoms, maintaining psychosocial support

•Directly observed therapy (DOT) programs for TB medication—nurses observe and document individual clients taking their TB drugs  ***

Standard precautions

•Client and family education about infection control in the home

•Dispelling myths and fears about transmission of HIV

•

•If the nurse does not have the conversations about sexual behaviors and sexual orientation the potential risk and risky behaviors will not be identified. ***