BELLS PALSY Charles Bell Is a temporary facial paralysis or weakness of the muscle on one side of your face due

ue to peripheral involvement of the seventh cranial nerve. This condition comes on suddenly, often one night and usually gets better on its own within a few weeks. CAUSES Viral Infection Herpes Eipstein barr Influenza Autoimmune Disease Lyme Disease Diabetes Mellitus Pregnant Woman SIGNS AND SYMPTOMS Paresis Pain Restricted muscle of the facial muscle Facial stiffness Drooling Eye problem Alteration in taste Speech difficulty Numbness in the affected side of your face Increase sensitivity to touch DIAGNOSTIC TEST Physical examination and Neurological examination Assessment for cranial nerve function MRI CT Scan X-ray Electromyography (EMG) perform to assess nerve damage test how well the muscles respond to the nerve signal. TREATMENT CORTICOSTEROID (Prednisone) Early treatment within 3 days after the onset Improves recovery at 6 months ANTIVIRALS (Acyclovir) Ineffective in improving recovery beyond steroids alone. They were however commonly prescribed due to a theoretical link between Bell's palsy and the herpes simplex and varicella zoster virus. SURGERY Smile Surgery or Smile Reconstruction is a surgical procedure that restores the smile for the people with facial nerve paralysis. PHYSIOTHERAPY It helps to maintain muscle tone of the affected facial muscles and stimulate the facial nerve Facial massage and exercises may help prevent permanent contractures (shrinkage or shortening of muscles) of the paralyzed muscles before recovery takes place. NURSING MANAGEMENT Provide support and reassurance. Provide soft diet with supplementary feedings as indicated. Instruct to chew on unaffected side, avoid hot fluids/foods, and perform mouth care after each meal.

Assess facial nerve function regularly Administer medications as ordered Corticosteroids: to decrease edema and pain Mild analgesics as necessary Provide special eye care to protect the cornea. Dark glasses (cosmetic and protective reasons) or eye shield Artificial tears to prevent drying of the cornea Ointment and eye patch at night to keep eyelid closed Patients need reassurance that a stroke has not occurred and that spontaneous recovery occurs within 3 to 5 weeks in most patients. Teaching patients with Bells palsy to care for themselves at home is an important nursing priority.

GUILLAIN-BARRE SYNDROME GBS is also known as Acute idiopathic polyneuritis French polio Landry's ascending paralysis and GuillainBarr syndrome. WHAT IS GUILLAIN-BARRE SYNDROME? Guillain-Barre syndrome is a rare disorder that causes your immune system to attack your peripheral nervous system (PNS). This syndrome is characterized by acute neuropathy involving motor and sensory nerves through out the PNS. What causes GBS? Campylobacter jejuni Cytomegalo virus Epstein Barr Mycoplasma pneumonia Hepatitis A and B Who is at risk for developing GBS???? Anyone can develop GBS; however, it is more common among older adults. The incidence of GBS increases with age, and people older than 50 years are at greatest risk for developing GBS. ASSESSMENT AND CLINICAL MANIFESTATION Weakness DTR are weak or absent Sensory impairments of numbness is worse in the toes Pain Respiratory difficulties Paresthesia PHASES OF GUILLAIN Barre syndrome Acute phase which begins when the first definitive symptoms develops and ends 1 to 3 weeks later, when no further deterioration is noted. Plateau phase Which lasts for several days to 2 to 3 weeks. Recovery phase which is believe to coincide with remyelination and axonal process regrowth and can last from 4 months to 3 years. DIAGNOSTIC TESTS Cerebrospinal fluid test Electromyography Nerve conduction studies Planning and implementation Plasmapheresis Monitoring pulmonary function test Cardiac monitoring

 Health teachings Preventing alterations in skin integrity Prevention of DVT and PE Pain relief NURSING DIAGNOSIS Ineffective breathing pattern Impaired gas exchange related to ventilation-perfusion inequality Ineffective coping related to anxiety, lower activity level and the inability to perform normal activities of daily living Knowledge deficit related to self care and risk prevention TRIGEMINAL NEURALGIA (tic douloureux) is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain Epidemiology affects women more than men and generally occurs in middle and later years of life. Etiology Trigeminal Neuralgia is believed to occur from pressure exerted by blood vessels on the fifth cranial nerve. This pressure eventually causes demyelination on the nerve resulting in severe pain. Causes: Triggers A variety of triggers may set off the pain of trigeminal neuralgia, including: Shaving Stroking your face Eating Drinking Brushing your teeth Talking Putting on makeup Encountering a breeze Smiling Washing your face Sign & Symptoms: Occasional twinges of mild pain Episodes of severe, shooting or jabbing pain that may feel like an electric shock Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking and brushing teeth Bouts of pain lasting from a few seconds to several seconds Episodes of several attacks lasting days, weeks, months or longer some people have periods when they experience no pain Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips, or less often the eye and forehead Pain affecting one side of your face at a time Pain focused in one spot or spread in a wider pattern Attacks becoming more frequent and intense over time Diagnostic Test: MRI CT scan Medications: Carbamazepine (Tegetrol) Baclofen

Surgery: Micro vascular decompression Gamma Knife radio surgery Nursing Diagnoses: Acute pain related to neurological impairment Alteration in nutritional status, less than body requirements related to pain associated with eating Social isolation related to pain Risk for loneliness related to pain and discomfort TETANUS Tetanus is a nervous system disorder characterized by muscle spasms that is caused by the exotoxin-producing anaerobic organisms called Clostridium tetani. It is generally found to attract wounds and deep cuts. Tetanus actually means 'stretch' in Greek Also known as LOCKJAW Infectious but not contagious Causes & Transmission Bacterium clostridium tetani can survive for years in a contaminated soil commonly found in the manure of animals, animal feces and in contaminated soil, house dusts, rusty objects Produces exotoxin: tetanospasmin: the neurotoxin and the clinical manifestation of tetanus Found in contaminated heroin Break in skin integrity Wounds contaminated with dirt, feces, or saliva Burns Crush injuries Injuries with dead tissue Types of Tetanus Generalized tetanus is the most common type found in most cases. characteristic feature of this form of the bacterium is the locked jaw condition, followed by a stiff neck and severe head ache, difficulty in swallowing and stiffening of the calf muscles. There is also a rapid rise in body temperature, sweating and increase in the blood pressure and pulse rate Local Tetanus Experiences pain only in the portion of the body where he/she has been hurt or injured with a cut. The bacterium enters only that local spot and is prevented from spreading further into the body, either due to partial immunization or due to decreased strength of the attacking bacterium. Neonatal tetanus is a form of generalized tetanus in the newborn lacking passive immunity from a non-immune mother, infected usually via the umbilical stump through lack of antiseptic practice. It presents with inability to suck, irritability, grimaces, and rigidity. Signs & Symptoms: Tetanus may appear anytime from a few days to several weeks after tetanus bacteria enter your body through a wound. The average incubation period is 3-21 days Spasms and stiffness in jaw muscles Stiffness of neck muscles Difficulty swallowing Stiffness of abdominal muscles

Painful body spasms, lasting for several minutes, typically triggered by minor occurrences, such as loud noise, physical touch or light Fever Sweating Elevated blood pressure Rapid heart rate Lead to seizures & death Uncontrolled urination and defecation Muscle spasms progressive Complications Fractures - sometimes in severe cases the muscle spasms and convulsions may lead to fractures of the bones in the patient's back, as well as some other bones. Pulmonary embolism - a blood vessel in the lung can become blocked and affect breathing and circulation. The patient will urgently need oxygen therapy and anti-clotting medication Respiratory failure and cardiac failure are late life-threatening events. Seizures Laryngospasm - the larynx (voice box) goes into a spasm which can last up to a minute and cause breathing difficulties. In severe cases the patient can suffocate Diagnosis Clinical Observation History & examination Progressive muscle spasms (starting in the facial region, especially lockjaw and progressing outward from the face to include all muscles of the body Neonates show signs of being irritable, muscle spasms, and poor ability to take in liquids usually seen in neonates about 7-10 days old Diagnosing tetanus Spatula test A spatula test can help confirm tetanus if there is any doubt about the diagnosis. It involves inserting a spatula into the back of your throat. If you do not have the infection, the spatula will cause a gag reflex and you will try to push the spatula out of your mouth. However, if the tetanus infection is present, the spatula will cause your throat muscles to spasm and you will bite down onto the spatula Medical Management 1.) Neutralization: Tetanus immune globulin antibodies against tetanus help neutralize the tetanus toxin. This is a protein that helps your body's immune system find and destroy bacteria. TIG boosts your immunity while your body fights the infection. 2.) Kill the microorganism: Penicillin is the drug of choice. Metronidazloe to kill the bacteria 3.) Prevent and Control spasm: Give muscle relaxant *Diazepam *Phenobarbital *Baclofen Nursing Management Protect the client from injury Quite environment with less light. Reduce stimuli precipitating spasms. Catheterization Never leave the patient alone Maintain adequate airway & ventilation Provide comfort measures

Turn the client to prevent respiratory problems Gentle handling of the client Avoid disturbance of the patient. Nursing Diagnosis Breathing pattern disorders related to impaired airway due to spasm of respiratory muscles Risk of injury related to frequent seizures Disturbed interpersonal relationships related to speech difficulties Changes in nutrition, less than body requirements related to the mastication muscle stiffness Lack of knowledge of the client and family about tetanus disease related to lack of information Prevention Tetanus can be prevented by immunization. Immunization of all children is recommended at 2, 4, 6 and 18 months of age with a booster dose at 4 to 6 years of age. Teenagers and adults should receive a tetanus booster every 10 years (recommended at 15, 25, 35, 45 years, etc.). In cases where an individual has been injured and suspected of not having sufficient immunity to the bacteria, a vaccine and antitoxin can be administered. POLIOMYELITIS (Polio; Infantile paralysis; Post-polio syndrome) Poliomyelitis is a viral disease that can affect nerves and can lead to partial or full paralysis. Causes, incidence, and risk factors Poliomyelitis is a disease caused by infection with the poliovirus. The virus spreads by: Direct person-to-person contact Contact with infected mucus or phlegm from the nose or mouth Contact with infected feces The virus enters through the mouth and nose, multiplies in the throat and intestinal tract, and then is absorbed and spread through the blood and lymph system. The time from being infected with the virus to developing symptoms of disease (incubation) ranges from 5 - 35 days (average 7 - 14 days). Most people do not develop symptoms. Risks include: Lack of immunization against polio Travel to an area that has experienced a polio outbreak Outbreaks can still occur in the developed world, usually in groups of people who have not been vaccinated. Polio often occurs after someone travels to a region where the disease is common. As a result of a massive, global vaccination campaign over the past 20 years, polio exists only in a few countries in Africa and Asia. Symptoms There are three basic patterns of polio infection: subclinical infections, nonparalytic, and paralytic. Most people have subclinical infection, and may not have symptoms. SUBCLINICAL INFECTION SYMPTOMS General discomfort or uneasiness (malaise) Headache Red throat Slight fever Sore throat Vomiting People with subclinical polio infection might not have symptoms, or mild symptoms may last 72 hours or less. Clinical poliomyelitis affects the central nervous system (brain and spinal cord), and is divided into nonparalytic and paralytic forms. It may occur after recovery from a subclinical infection. Signs and tests The health care provider may find:

Abnormal reflexes Back stiffness Difficulty lifting the head or legs when lying flat on the back Stiff neck Trouble bending the neck Tests include: Cultures of throat washings, stools, or spinal fluid Spinal tap and examination of the spinal fluid (CSF examination ) Test for levels of antibodies to the polio virus Treatment The goal of treatment is to control symptoms while the infection runs its course. People with severe cases may need lifesaving measures, especially breathing help. Symptoms are treated based on their severity. Treatment may include: Antibiotics for urinary tract infections Moist heat (heating pads, warm towels) to reduce muscle pain and spasms Painkillers to reduce headache, muscle pain, and spasms (narcotics are not usually given because they increase the risk of breathing trouble) Physical therapy, braces or corrective shoes, or orthopedic surgery to help recover muscle strength and function Expectations (prognosis) The outlook depends on the form of the disease (subclinical, or paralytic) and the body area affected. Most of the time, complete recovery is likely if the spinal cord and brain are not involved. Brain or spinal cord involvement is a medical emergency that may result in paralysis or death (usually from respiratoryproblems). Disability is more common than death. Infection that is located high in the spinal cord or in the brain increases the risk of breathing problems. Complications Aspiration pneumonia Cor pulmonale (a form of heart failure found on the right side of the circulation system) Lack of movement Lung problems Myocarditis Paralytic ileus (loss of intestinal function) Permanent muscle paralysis, disability, deformity Pulmonary edema Shock Urinary tract infections Post-polio syndrome is a complication that develops in some patients, usually 30 or more years after they are first infected. Muscles that were already weak may get weaker. Weakness may also develop in muscles that were not affected before. Calling your health care provide Call your health care provider if: Someone close to you has developed poliomyelitis and you haven't been vaccinated You develop symptoms of poliomyelitis Your child's polio immunization (vaccine) is not up to date Prevention Polio immunization (vaccine) effectively prevents poliomyelitis in most people (immunization is over 90% effective).

RABIES is a viral disease that causes acute encephalitis in warmblooded animals . The disease is zoonotic. For a human, rabies is almost invariably fatal if postexposure prophylaxis is not administered prior to the onset of severe symptoms. The rabies virus infects the central nervous system, ultimately causing disease in the brain and death. The rabies virus travels to the brain by following the peripheral nerves. The incubation period of the disease is usually a few months in humans, depending on the distance the virus must travel to reach the central nervous system. According to CD manual the incubation period in human is 10 days to 21 years The patient may experience periods of mania and lethargy eventually leading to coma. The primary cause of death is usually respiratory insufficiency CAUSATIVE AGENT: (RHABDOVIRUS) STAGES OF RABIES INFECTION SIGN AND SYMPTOMS Early-stage symptoms of rabies malaise headache fever acutepain violent movements uncontrolled excitement depression hydrophobia Soon after the symptoms paralysis anxiety insomnia Confusion abnormal behavior agitation paranoia terror hallucinations progressing to delirium DIAGNOSTIC TEST PCR (Polymerase chain reaction) or viral culture - on brain samples taken after death Saliva urine cerebrospinal fluid samples Cerebral inclusion bodies called Negri bodies The differential diagnosis in a case of suspected human rabies may initially include any cause of encephalitis, in particular infection with viruses such as herpesviruses, enteroviruses, and arboviruses such as West Nile virus. Before patient manifests sign & symptoms Brain biopsy of the animal To identifies presense of negri bodies Direct flourescent Antibody Test(DFA test) Confirmatory test for rabies. PREVENTION Vaccine/vaccination Vaccinating dogs, cats, rabbits, and ferrets against rabies Keeping pets under supervision Not handling wild animals or strays Contacting an animal control officer upon observing a wild animal or a stray, especially if the animal is acting strangely Washing the wound with soap and water for 10 to 15 minutes, if bitten by an animal, and contacting a healthcare

provider to determine if postexposure prophylaxis is required TREATMENT Treatment after exposure is highly successful in preventing the disease if administered promptly, in general within 10 days of infection. washing the wound as soon as possible with soap and water virucidal antiseptic (povidone-iodine, iodine tincture) aqueous iodine solution, or alcohol (ethanol) should be applied after washing. MEDICAL MANAGEMENT POST-EXPOSURE PROPHYLAXIS VACCINES Active form of vaccine Made up of microorganisms VACCINE FIRST!!! NURSING CARE Place patient in a dim and quiet environment. Keep patient away in sub-utility room. Restrain the patient before he exhibits maniacal behavior. Wear all Personal protective equipment when you enter the room because patient continues to spit.

HERPES ZOSTER (Shingles) Shingles (herpes zoster) is a painful, blistering skin rash due to the varicella-zoster virus, the virus that causes chickenpox. Causes, incidence, and risk factors After you get chickenpox, the virus remains inactive (becomes dormant) in certain nerves in the body. Shingles occurs after the virus becomes active again in these nerves years later. The reason the virus suddenly becomes active again is not clear. Often only one attack occurs. Shingles may develop in any age group, but you are more likely to develop the condition if: You are older than 60 You had chickenpox before age 1 Your immune system is weakened by medications or disease If an adult or child has direct contact with the shingles rash and did not have chickenpox as a child or a chickenpox vaccine, they can develop chickenpox, not shingles. Symptoms The first symptom is usually one-sided pain, tingling, or burning. The pain and burning may be severe and is usually present before any rash appears. Red patches on the skin, followed by small blisters, form in most people. The blisters break, forming small sores that begin to dry and form crusts. The crusts fall off in 2 to 3 weeks. Scarring is rare. The rash usually involves a narrow area from the spine around to the front of the belly area or chest. The rash may involve the face, eyes, mouth, and ears. Other symptoms may include: Abdominal pain Fever and chills General ill feeling Genital sores Headache Joint pain Swollen glands (lymph nodes) You may also have pain, muscle weakness, and a rash involving different parts of your face if shingles affects a nerve in your face. The symptoms may include: Difficulty moving some of the muscles in the face Drooping eyelid (ptosis) Hearing loss Loss of eye motion

Taste problems Vision problems Signs and tests Your health care provider can make the diagnosis by looking at your skin and asking questions about your medical history. Tests are rarely needed, but may include taking a skin sample to see if the skin is infected with the virus that causes shingles. Blood tests may show an increase in white blood cells and antibodies to the chickenpox virus, but they cannot confirm that the rash is due to shingles. Treatment Your health care provider may prescribe a medicine that fights the virus, called an antiviral drug. This drug helps reduce pain, prevent complications, and shorten the course of the disease. Acyclovir, famciclovir, and valacyclovir may be used. The medications should be started within 72 hours of when you first feel pain or burning. It is best to start taking them before the blisters appear. The drugs are usually given in pill form, and in high doses. Some people may need to receive the medicine through a vein (by IV). Strong anti-inflammatory medicines called corticosteroids, such as prednisone, may be used to reduce swelling and pain. These drugs do not work in all patients. Other medicines may include: Antihistamines to reduce itching (taken by mouth or applied to the skin) Pain medicines Zostrix, a cream containing capsaicin (an extract of pepper) that may reduce the risk of postherpetic neuralgia Cool wet compresses can be used to reduce pain. Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, or calamine lotion, may help to relieve itching and discomfort. Resting in bed until the fever goes down is recommended. Keep the skin clean. Do not reuse contaminated items. Wash nondisposable items in boiling water or disinfect them before using them again You may need to stay away from people while the sores are oozing to avoid infecting those who have never had chickenpox -- especially pregnant women. Expectations (prognosis) Herpes zoster usually clears up in 2 to 3 weeks and rarely returns. If the virus affects the nerves that control movement (the motor nerves), you may have temporary or permanent weakness or paralysis. Sometimes, the pain in the area where the shingles occurred may last from months to years. This pain is called postherpetic neuralgia. Postherpetic neuralgia is more likely to occur in people over age 60. It occurs when the nerves have been damaged after an outbreak of shingles. Pain ranges from mild to very severe. Complications Complications may include: Another attack of shingles Bacterial skin infections Blindness (if shingles occurs in the eye) Deafness Infection, including encephalitis or sepsis (blood infection) in persons with a weakened immune system Ramsay Hunt syndrome if shingles affects the nerves in the face

Prevention Avoid touching the rash and blisters on persons with shingles or chickenpox if you have never had chickenpox or the chickenpox vaccine. A herpes zoster vaccine is available. It is different than the chickenpox vaccine. Older adults who receive the herpes zoster vaccine are less likely to have complications from shingles. The United States Advisory Committee on Immunization Practices (ACIP) has recommended that adults older than 60 receive the herpes zoster vaccine as part of routine medical care LEPTOSPIROSIS Leptospirosis is a rare and severe infection that occurs when you come in contact with Leptospirabacteria. Causes The Leptospira bacteria can be found in fresh water that has been contaminated by animal urine. The infection occurs in warmer climates. It is not spread from person to person, except in vary rare cases when it is spread through breast milk or from a mother to her unborn child. Risk factors include: Occupational exposure -- farmers, ranchers, slaughterhouse workers, trappers, veterinarians, loggers, sewer workers, rice field workers, and military personnel Recreational activities -- fresh water swimming, canoeing, kayaking, and trail biking in warm areas Household exposure -- pet dogs, domesticated livestock, rainwater catchment systems, and infected rodents Leptospirosis is rare in the continental United States. Hawaii has the highest number of cases in the United States. Symptoms Symptoms can take 2 - 26 days (average 10 days) to develop, and may include: Dry cough Fever Headache Muscle pain Nausea, vomiting, and diarrhea Shaking chills Less common symptoms include: Abdominal pain Abnormal lung sounds Bone pain Conjunctivitis Enlarged lymph glands Enlarged spleen or liver Joint aches Muscle rigidity Muscle tenderness Skin rash Sore throat Exams and Tests The blood is tested for antibodies to the bacteria. Other tests that may be done: Complete blood count (CBC) Creatine kinase Liver enzymes Urinalysis Treatment Medications to treat leptospirosis include: Ampicillin Azithromycin Ceftriaxone Doxycycline Penicillin

Complicated or serious cases may need supportive care or treatment in a hospital intensive care unit (ICU). Outlook (Prognosis) The outlook is generally good. However, a complicated case can be life-threatening if it is not treated promptly. Possible Complications Jarisch-Herxheimer reaction when penicillin is given Meningitis Severe bleeding When to Contact a Medical Professional Contact your health care provider if you have any symptoms of, or risk factors for, leptospirosis. Prevention Avoid areas of stagnant water, especially in tropical climates. If you are exposed to a high risk area, taking doxycycline or amoxicillin may decrease your risk of developing this disease. Alternative Names Weil disease; Icterohemorrhagic fever; Swineherd's disease; Rice-field fever; Cane-cutter fever; Swamp fever; Mud fever; Hemorrhagic jaundice; Stuttgart disease; Canicola fever

AIDS

or acquired immune deficiency syndrome final stage of the infection caused by the virus called HIV or Human Immunodeficiency Virus. Causative Agent Human Immunodeficiency Virus a retrovirus a very fragile virus can easily destroyed by: Seventy percent (70%) alcohol a temperature of fifty-six degree celsus Chlorine Preventable, managable but not curable. MODE OF TRANSMISSION Through Sex (Unprotected Intercourse) o Oral o Anal o Vaginal IntraVenous Drug Abuse o Sharing Needles o Unsterilized blades Mother-to-Baby o Placenta o breastmilk Stages of HIV Disease PRIMARY INFECTION Is the period from infection with HIV to the development of antibodies to HIV there is intense viral replication and widespread dissemination throughout the body Severe flu-like symptoms occur, individuals may display fever, enlarged lymph nodes, rash, muscle aches, and headaches. Window period occurs HIV ASYMPTOMATIC (CDC CATEGORY A: >500 CD4+ T LYMPHOCYTES/MM3 individuals are free from any symptoms of HIV. Levels of HIV in the blood are very low, but are detectable. may last 8-10 years. HIV SYMPTOMATIC (CDC CATEGORY B: 200 499 CD4+ T LYMPHOCYTES/MM3)

Consists of symptomatic condition in HIV-infected patients that are not included in in the conditions listed in Category C These conditions must also meet one of the following criteria: The condition is due to HIV infection or a defect in a cellular immunity The condition must be considered to have a clinical course or require management that is complicated by HIV infection AIDS (CDC CATEGORY C: <200 CD4+ T LYMPHOCYTES/MM3 When CD4+ T-cell levels drop below 200 cells/mm3, patients are said to have AIDS. Once a patient has had a category C condition, he/she remains in category C. DIAGNOSTIC TESTS HIV ANTIBODY TESTS Enzyme-linked Immunosorbent Assay identifies antibodies directed specifically against HIV has 99.5% or higher sensitivity when performed at least 13 weeks after infection Western Blot Assay used to confirm seropositivity test when the EIA/ELISA is positive. Viral Load Tests measures HIV RNA in the plasma used to tract viral load and response to treatment for HIV infection the lower the viral load, the longer time to AIDS diagnosis and the longer the survival time. TREATMENT ANTIRETROVIRAL AGENTS Nucleoside Reverse Transcriptase (NRTIs) act by becoming part of HIVs DNA and derail its building process. as a result, the damaged viral DNA cannot take control of the host cells DNA. Zidovudine ( AZT, Retrovir) Lamivudine (3TC, Epivir) Stavudine (d4T, Zerit) ddi (Videx, didanosine) abacavir (Ziagen) Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs) attached to the reverse transcriptase enzyme, preventing it from converting HIV RNA into HIV DNA. nevirapine (Viramune) delavirdine (Rescriptor) efavirenz (Sustiva) tenofovir (Viread) Protease Inhibitors work in the later stage in HIV replication process by preventing the protease enzyme from cutting HIV viral proteins into the viral particles that infect new CD4 Tcells nelfinavir (Viracept) Ritonavir (Norvir) Saquinavir (Invirase, Fortovase) indinavir (Crixivan) amprenavir (Agenerase) STRUCTURED INTERMITTENT THERAPY a form of reduced treatment for patients with HIV. HIV+ patients took anti-HIV drugs for seven days, and then took no drugs for seven days. PREVENTION OPPORTUNISTIC INFECTIONS

RESPIRATORY MANIFESTATIONS Pneumocystis carinii pneumonia (PCP) 80% of HIV patients may develop PCP manifestations are nonspecific such as nonproductive cough, fever, chills, SOB, dyspnea, and ocassionally chest pain. can be diagnosed through: sputum induction bronchial-alveolar lavage Transbronchial biopsy Mycobacterium avium Complex MAC disease is a leading OI in people with AIDS. organisms include M. Avium, M. Intracellulare, and M. Scrofulaceum causes respiratory infections commonly found in the GI tract, lymph nodes and bone marrow Tuberculosis the number one OI in the Philippines Mycobacterium tuberculosis tends to occur early in the course of HIV infection unlike other OI, usually preceding the diagnosis of AIDS associated with the development of caseating granulomas (dry, cheeselike masses of granulation tissue) TB that occurs late in HIV infection is characterized by absence of an immune response to a tuberculin skin test response known as anergy. GI MANIFESTATIONS Oral Candidiasis Candidiasis, a fungal infection, occurs in nearly all patients with AIDS, characterized by creamy white patches in the oral cavity. progresses to involve esophagus and stomach S/S: difficult and painful swallowing Retrosternal pain Wasting Syndrome diagnostic criteria: Profound involuntary weight loss exceeding 10% of baseline body weight chronic diarrhea for more than 30 days or chronic weakness and documented intermittent or constant fever in the absence of concurrent illness anorexia, diarrhea, GI malabsorption, and lack of nutrition in chronic disease all contribute to wasting syndrome Tumor necrosis factor (TNF) and IL-1 are cytokines that play important roles in AIDS-related wasting syndrome. ONCOLOGIC MANIFESTATIONS Kaposis Sarcoma most common cancer associated with AIDS caused by a virus called Kaposi sarcoma-associated herpesvirus a tumor of the endothelial cells lining small blood vessels, presents as vascular macules, papules, or a violent lesions affecting the skin and viscera. indicator of late-stage HIV disease survival time: 18 mos after diagnosis. B-cell Lymphomas second most common malignancy occurring with AIDS AIDS-related lymphomas develop outside the lymph nodes, most commonly in the brain, bone marrow, and GI tract NEUROLOGIC MANIFESTATIONS HIV ENCEPHALOPHATY formerly referred to as AIDS dementia complex a clinical syndrome characterized by progressive cognitive, behavioral, and motor functions

early manifestations: memory deficits headache Difficulty concentrating Progressive confusion psychomotor slowing Apathy ataxia Late manifestations: global cognitive impairments delay in verbal responses a vacant stare spastic paraparesis hyperreflexia psychosis Hallucinations Tremor seizure Mutism death Cryptococcus neoformans fungal infection S/S fever Headache Malaise stiff neck Nausea and vomiting Seizures Diagnostic test CSF analysis Progressive Multifocal Leukoncephalophaty a demyelinating CNS disorder that affects the oligodendroglia. S/S mental confusion blindness Aphasia paresis death GYNECOLOGIC MANIFESTATIONS Persistent, recurrent vaginal candidiasis may be the first sign of HIV infection in women Human papillomavirus causes venereal warts and is a risk factor for cervical intraepithelial neoplasia a cellular change that is frequently a precursor to cervical cancer. MEDICAL MANAGEMENT Treatment of Infections General Infection Trimethoprim-sulfamethoxazole (TMP-SMZ; Bactrim, Septra) PCP DOC is TMP-SMZ Pentamidine (Pentacarinat, Pentam 300, NebuPent) MAC clarithromycin (Biaxin) or azithromycin (Zithromax) ANTIDIARRHEAL THERAPY octreotide acetate (Sandostatin) CHEMOTHERAPY Kaposis Sarcoma Lymphoma Antidepressant Therapy Tofranil Prozac Nursing Diagnosis Diarrhea r/t enteric pathogens or HIV infection Risk for infection r/t immunodeficiency

Ineffective airway clearance r/t Pneumocystis carinii pneumonia Deficient knowledge r/t means of preventing HIV transmission Social isolation r/t stigma of the disease, withdrawal of support system and fear of infecting others

CATARACT Lens opacity; Age-related cataract A cataract is a clouding of the lens of the eye. Causes, incidence, and risk factors The lens of the eye is normally clear. It acts like the lens on a camera, focusing light as it passes to the back of the eye Until a person is around age 45, the shape of the lens is able to change. This allows the lens to focus on an object, whether it is close or far away. As we age, proteins in the lens begin to break down and the lens becomes cloudy. What the eye sees may appear blurry. This condition is known as a cataract. Factors that may speed up cataract formation are: Diabetes Eye inflammation Eye injury Family history of cataracts Long-term use of corticosteroids (taken by mouth) or certain other medications Radiation exposure Smoking Surgery for another eye problem Too much exposure to ultraviolet light (sunlight) In many cases, the cause of cataract is unknown. Symptoms Adult cataracts develop slowly and painlessly. Vision in the affected eye or eyes slowly gets worse. Mild clouding of the lens often occurs after age 60, but it may not cause any vision problems. By age 75, most people have cataracts that affect their vision. Visual problems may include the following changes: Being sensitive to glare Cloudy, fuzzy, foggy, or filmy vision Difficulty seeing at night or in dim light Double vision Loss of color intensity Problems seeing shapes against a background or the difference between shades of colors Seeing halos around lights Other symptoms may include: Frequent changes in eyeglass prescription Signs and tests A standard eye exam and slit-lamp examination are used to diagnose cataracts. Other diagnostic tests are rarely needed, except to rule out other possible causes of poor vision. Treatment The following may help people who have an early cataract: Better eyeglasses Better lighting Magnifying lenses Sunglasses The only treatment for a cataract is surgery to remove it. Surgery is done if you cannot perform normal activities, such as driving, reading, or looking at computer or video screens, even with glasses. Expectations (prognosis)

Vision may not improve to 20/20 after cataract surgery if other eye diseases, such as macular degeneration, are present. Ophthalmologists can usually, but not always, determine this in advance. Complications Early diagnosis and treatment are key to preventing permanent vision problems. Although rare, a cataract that goes on to an advanced stage (called a hypermature cataract) can begin to leak into other parts of the eye. This may cause a painful form of glaucoma and inflammation inside the eye. Calling your health care provider Call for an appointment with your health care provider if you have: Decreased night vision Problems with glare Vision loss Prevention The best prevention involves controlling diseases that increase the risk of a cataract, and avoiding exposure to factors known to promote cataract formation. Wearing sunglasses when you are outside during the day can reduce the amount of ultraviolet (UV) light your eyes are exposed to. For patients who smoke cigarettes, quitting will decrease the risk of cataracts.

Eventually, scar tissue stimulated by the growth of new blood vessels may cause the retina to detach from the back of your eye. If the new blood vessels interfere with the normal flow of fluid out of the eye, pressure may build up in the eyeball, causing glaucoma. This can damage the nerve that carries images from your eye to your brain (optic nerve).

Causes

DIABETIC RETINOPATHY retinopathy (damage to the retina) caused by complications of diabetes, which can eventually lead to blindness. Diabetic retinopathy, the most common diabetic eye disease, occurs when blood vessels in the retina change. it affects up to 80 percent of all patients who have had diabetes for 10 years or more. Anatomy of the eye Symptoms Spots or dark strings floating in your vision (floaters) Blurred vision Fluctuating vision Dark or empty areas in your vision Vision loss Difficulty with color perception Classification of diabetic retinopathy Early diabetic retinopathy. nonproliferative diabetic retinopathy (NPDR). new blood vessels aren't growing (proliferating). NPDR can be described as mild, moderate or severe. When you have NPDR, the walls of the blood vessels in your retina weaken. Tiny bulges (called microaneurysms) protrude from the vessel walls, sometimes leaking or oozing fluid and blood into the retina. As the condition progresses, the smaller vessels may close and the larger retinal vessels may begin to dilate and become irregular in diameter. Nerve fibers in the retina may begin to swell. Sometimes the central part of the retina (macula) begins to swell, too. This is known as macular edema. Advanced diabetic retinopathy proliferative diabetic retinopathy (PDR). is the most severe type of diabetic retinopathy. It's called proliferative because at this stage, new blood vessels begin to grow in the retina. These new blood vessels are abnormal. They may grow or leak into the clear, jelly-like substance that fills the center of your eye (vitreous).

Too much sugar in your blood can damage the tiny blood vessels that nourish the retina. It may even block them completely. As more and more blood vessels become blocked, the blood supply to more of the retina is cutoff. This can result in vision loss. Elevated blood sugar levels can also affect the eyes' lenses. With high levels of sugar over long periods of time, the lenses can swell, providing another cause of blurred vision. Rick factors All people with diabetes mellitus are at risk Duration of diabetes Poor control of your blood sugar level High blood pressure High cholesterol Pregnancy Tobacco use Tests and diagnosis Diabetic retinopathy is best diagnosed with a dilated eye exam. For this exam, your eye doctor will place drops in your eyes that make your pupils open widely. This allows your doctor to get a better view inside your eye. The drops may cause your close vision to be blurry until they wear off several hours later. During the exam, your eye doctor will look for: Presence or absence of a cataract Abnormal blood vessels Swelling, blood or fatty deposits in the retina Growth of new blood vessels and scar tissue Bleeding in the clear, jelly-like substance that fills the center of the eye (vitreous) Retinal detachment Abnormalities in your optic nerve In addition, your eye doctor may: Test your vision Measure your eye pressure to test for glaucoma. As part of the eye exam, your doctor may do a retinal photography test called fluorescein angiography. First, your doctor will dilate your pupils and take pictures of the inside of your eyes. Then your doctor will inject a special dye into your arm. More pictures will be taken as the dye circulates through your eyes. Your doctor can use the images to pinpoint blood vessels that are closed, broken down or leaking fluid. Optical coherence tomography This imaging test provides cross-sectional images of the retina that show the thickness of the retina, which will help determine whether fluid has leaked into retinal tissue. Later, OCT exams can be used to monitor how treatment is working. Treatments and drugs Early diabetic retinopathy If you have nonproliferative diabetic retinopathy, you may not need treatment right away. However, your eye doctor will closely monitor your eyes to determine if you need treatment. Advanced diabetic retinopathy If you have proliferative diabetic retinopathy, you'll need prompt surgical treatment. Sometimes surgery is also recommended for severe nonproliferative diabetic retinopathy

 Focal laser treatment This laser treatment, also known as photocoagulation, can stop or slow the leakage of blood and fluid in the eye. It's done in your doctor's office or eye clinic. During the procedure, leaks from abnormal blood vessels are treated with laser burns. Focal laser treatment is usually done in a single session. Your vision will be blurry for about a day after the procedure. Sometimes you will be aware of small spots in your visual field that are related to the laser treatment. These usually disappear within weeks. If you had blurred vision from swelling of the central macula before surgery, however, you may not recover completely normal vision. But, in some cases, vision does improve. Scatter laser treatment This laser treatment, also known as panretinal photocoagulation. It's also done in your doctor's office or eye clinic. During the procedure, the areas of the retina away from the macula are treated with scattered laser burns. The burns cause the abnormal new blood vessels to shrink and scar. Scatter laser treatment is usually done in two or more sessions. Your vision will be blurry for about a day after the procedure. Some loss of peripheral vision or night vision after the procedure is possible. Vitrectomy This procedure can be used to remove blood from the middle of the eye (vitreous) as well as any scar tissue that's tugging on the retina. It's done in a surgery center or hospital using local or general anesthesia. During the procedure, the doctor makes a tiny incision in your eye. Scar tissue and blood in the eye are removed with delicate instruments and replaced with a salt solution, which helps maintain your eye's normal shape. Sometimes a gas bubble must be placed in the cavity of the eye to help reattach the retina. If a gas bubble was placed in your eye, you may need to remain in a facedown position until the gas bubble dissipates often several days. You'll need to wear an eye patch and use medicated eye drops for a few days or weeks. Vitrectomy may be followed or accompanied by laser treatment. Prevention Make a commitment to managing your diabetes. Monitor your blood sugar level. Ask your doctor about a glycosylated hemoglobin test. Keep your blood pressure and cholesterol under control. If you smoke or use other types of tobacco, ask your doctor to help you quit. Pay attention to vision changes. Complications Vitreous hemorrhage Retinal detachment Glaucoma Blindness

GLAUCOMA refers to certain eye diseases that affect the optic nerve and cause vision loss. Most, but not all, of these diseases typically produce elevated pressure inside the eye, called intraocular pressure (IOP). Normal IOP is 10-21 mm Hg. Glaucoma is a silent thief of vision. Client typically experiences no manifestations other than narrowing of the visual field. Open- Angle Glaucoma Also called chronic simple glaucoma, is the most common form in adults, accounting for approximately 90% of all glaucoma. Its cause is unknown The anterior chamber angle between the iris and cornea is normal , hence the term open-angle. Initially has no symptoms. Manifestations Open- angle glaucoma is vague Loss of peripheral vision Mild headaches Difficulty adapting to the dark Difficulty focusing on near objects Intraocular pressure continues to increase, visual acuity is reduced. See halos around lights Angle-Closure Glaucoma Also called (narrow-angle or closed-angle) less common form of primary glaucoma in adults. Narrowing of the anterior chamber angle occurs. When the lens thickens during accommodation or the iris thickens during pupil dilation, this angle can closed completely. Closure of the angle blocks the outflow of aqueous humor through the trabecular meshwork and canal of schlemm , and the intraocular pressure rises abruptly. Clients who have had angle-glaucoma of one eye, the other eye is at increased risk in the future. Clients may have intermittent episodes lasting several hours before having a more typical prolonged attack of angle-closure glaucoma. Manifestations Severe eye and face pain General malaise Nausea and vomiting Seeing colored halos around light comparison of open-angle and angle-closure glaucoma

Diagnostic test Tonometry Fundoscopy Gonioscopy Visual field testing Medications Cholinergics (MIOTICS) ex: Acetylcholine (Miochol) Carbachol (Isopto carbachol) Pilocarpine (Isopto carpine, Ocusert-pilo) Adrenergic Agonists ex: Epinephrine (Epitrate, Mytrate/Epifrin) Beta-Adrenergic Blockers ex: Betaxolol (Betoptic) Levobunolol (Betagan) Surgery Trabeculectomy

 Laser trabeculoplasty Laser Iridotomy Nursing diagnoses and interventions Risk for Disturbed Sensory Perception: Visual Risk for Injury Anxiety COMPARISON

Planning and Implementations Antibiotic eye ointment A course of oral antibiotics o Cephalexin (Keflex, Biocef, Keftab) o Erythromycin base (E-Mycin) Hygiene o Apply a warm compress such as a washcloth to the outer eyelids. o Cleanse the eyelids with a commercial lid scrub or other recommended product. o Gently massage the outer eyelids. To use a warm compress: o Wash your hands, then dampen a clean washcloth with warm water. o Place the washcloth over your closed eyes for several minutes. o Open your eyes, and then use fingers to rub gently around the outer eyelids in a circular motion. Don't press too hard on the eyeball. o Follow your doctor's recommendations on how often to use a compress and how long it should be kept in place. To clean eyelids: o Wash your hands, then dip a clean washcloth, cotton swab or gauze pad into your cleaning solution. o Make sure you squeeze out any excess moisture. o Gently wipe across your lashes and lid margin. o Rinse with cool water. o Repeat the process for your other eye, but use a different washcloth, swab or pad. o Your eye doctor may have you clean your lids several times daily to start, and then once daily thereafter Is there any surgical care? o Incision and drainage is indicated if the hordeolum is large or if it is refractory to medical therapy. MNIRES DISEASE The Inner Ear A complex system of communicating chambers and tubes called a labyrinth Each ear has the following part of the labyrinth o Osseous labyrinth-the bony canal in the temporal bone o Membranous labyrinth-a tube that lies within the Osseous labyrinth o Perilymph-a fluid between Osseous and Membranous labyrinth, which is secreted by cells in the wall of the bony canal o Endolymph- a fluid within the Membranous labyrinth Labyrinth includes three parts: o Semicircular canals-provides the sense of equilibrium o Cochlea- provides the sense of hearing, it has a bony shelf that winds around the core like threads of a screws WHAT IS MNIRES DISEASE???? It is a disorder that affects the inner part of the ear causing damage in the function of the vestibulocochlear ( CN VIII ) It is thought to be caused by a range of inflammation, traumatic event, autoimmune diseases The disease is named after the French physician Prosper Mnire The condition affects people differently: it can range in intensity from being mild annoyance to a chronic, lifelong disability. In united states, 2.4 million people are affected by mnires disease. CAUSES

BLEPHARITIS HORDEOLUM Blepharitis inflammation of the hair follicles (cilia) along the edges of the eyelids. Hordeolum inflammation of the sweat glands in and around the eyelids. Parasitic Blepharitis Ulcerative Blepharitis Angular Blepharitis Stye Blepharitis has two basic form: Anterior blepharitis, affecting the outside front of the eyelid where eyelashes are attached. Posterior blepharitis, linked to dysfunction of meibomian glands within the eyelids that secrete oils to help lubricate the eye. Two affected area of Hordeolum Glands of Zeis (external hordeola, or styes) Meibomian glands (internal hordeola) Signs and Symptoms Eyelids appear red and irritated, with scales that stick to the base of the eyelashes. The eyelids may be: Burning Crusty Itching Reddened Swollen Dryness

Unknown Ear infection Upper respiratory tract infection Smoking and drinking alcohol In some research: Herpes Simplex Virus , autoimmune disorders and syphilis People who have history of head accidents has high incidence of having the disease. About 20% of patients have a positive family history. PEOPLE AFFECTED Incidence are higher in Women than men Adults o Ranging from 40yrs-old and above o Symptoms usually appears between ages 20 and 60 o In some cases symptoms can appear in children's as young as 4years old SIGN AND SYMPTOMS Low frequency sensorineural loss Tinnitus Sensation of fullness or pressure in one or both ear Attacks of vertigo accompanied by nausea and vomiting Nystagmus Diaphoresis

Requires overnight stay in the hospital Intraotologic catheters Catheter is used to deliver medications. Treatment for sudden hearing loss and various disorders catheters. Vestibular Nerve section o Provides the greatest success (98%) o Performed by a translabyrinthine approach o Cutting the nerve prevents the brain from receiving input from the semisecular canals. o Requires a brief hospital stay. NURSING CARE The primary concern is risk for injury from falls. Teaching regarding safe activity and the need for bed rest. Health teaching about the patients condition also includes the family. Assessment or Monitoring medication intake Providing Emotional support.

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SEMI-FINALS!!!!!!! DIAGNOSTIC EXAMINATION Physical assessment o History taking o Hearing test- to identify neural etiology: hearing loss indicates CN VIII is damage Weber's test Rinnes test Caloric test o Irrigating the ear with cold water o A test of the vestibulo-ocular reflex that involves irrigating cold or warm water or air into the external auditory canal. o To assess Nystagmus MRI o To rule out tumor as the cause of symptoms Electrocochleograpy o To assess electrical activity of the inner ear TREATMENT Most patient are treated with diet and medication therapy Low sodium diet is recommended Drugs administered: o Antihistamine e.g. meclizine (antivert) o Tranquilizers e.g. diazepam (valium) o Antiemetics e.g. promethazine ( Phenergan) o Diuretics e.g. hydrochlorothiazide o Vasodilators e.g. nicotinic acid o Steroids - e.g. dexamethasone o Antibiotics - e.g. gentamicin SURGICAL MANAGEMENT Endolymphatic Sac Decompression o Equalizes the pressure in the endolymphatic space o A shunt or a drain is inserted in the endolymphatic sac through a postauriular incision. o First line surgical approach to treat the vertigo o Simple and safe and can be performed on an outpatient basis Middle And Inner Ear Perfusion o Medications are given by infusion in the middle or inner ear. o To decrease vestibular function and decrease vertigo. o Success rate is about 85% but the risk of hearing loss is higher.