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Targeted tuberculin testing and treatment of latent tuberculosis in- Zeind cheap lithium 300mg free shipping, C order 300mg lithium mastercard. Discuss difficulties in developing and using and nursing process implications. Identify clients at risk for development of drugs in treating HIV infection. Teach clients techniques to prevent viral virus (HIV) infections, influenza A, and respira- infections. Critical Thinking Scenario Mark, a 32-year-old bisexual man, was recently diagnosed with human immunodeficiency virus (HIV) infection with a CD4+ cell count of less than 200. He is started on aggressive drug therapy with Combivir, a reverse transcriptase inhibitor combination, and nelfinavir, a protease inhibitor. Reflect on: What is the expected outcome of antiviral therapy in a person infected with HIV? Is the HIV-infected person still able to spread the infection to others while on antiviral treatment? Who should be responsible for the cost of treatment if private insurance lapses when Mark is no longer able to work? OVERVIEW characteristics of viruses and viral infections are described in the following paragraphs; selected infections are de- Viruses produce many diseases, including acquired immuno- scribed in Box 39–1. Viruses are intracellular parasites that can live and re- other disorders that affect almost every body system. For example, more entry to human host cells by binding to receptors on than 150 viruses infect the human respiratory tract, includ- cell membranes. All human cells do not have receptors ing approximately 100 types of rhinovirus that cause the for all viruses; cells that lack receptors for a particular common cold. Viruses can be spread by secretions from in- virus are resistant to infection by that virus. Thus, the fected people, ingestion of contaminated food or water, locations and numbers of the receptors determine which breaks in skin or mucous membrane, blood transfusions, host cells can be infected by a virus. For example, the sexual contact, pregnancy, breast-feeding, and organ trans- mucous membranes lining the tracheobronchial tree plantation. Viral infections vary from mild, localized dis- have receptors for the influenza A virus, and certain ease with few symptoms to severe systemic illness and death. Re- Cytomegalovirus Disease and Retinitis covery from the primary infection leaves latent infection in nerve Cytomegalovirus (CMV) infection is extremely common, and most cells. Reactivation of the latent infection (usually later in life) people become infected by adulthood. Infection is usually causes herpes zoster (more commonly known as shingles), a lo- asymptomatic in healthy, immunocompetent adults. Like other her- calized cluster of painful, blister-like skin eruptions. The skin le- pesviruses, CMV can cause a primary infection, then remain latent sions have the same appearance as those of chickenpox and in body tissues, probably for life. Over several days, the vesicles become pustules, in secretions of an asymptomatic host and spread to others by con- then rupture and heal. Because the virus remains in sensory nerve tact with infected saliva, blood, urine, semen, breast milk, and cer- cells, pain can persist for months after the skin lesions heal.

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Pe- These drugs are contraindicated in clients with severe hy- ripherally purchase 150 mg lithium overnight delivery, cough receptors in the pharynx discount lithium 300 mg with amex, larynx, tra- pertension or coronary artery disease because of their cardiac chea, or lungs may be stimulated by air, dryness of stimulating and vasoconstricting effects. A cough is traindicated for clients with narrow-angle glaucoma and productive when secretions are expectorated; it is non- those taking tricyclic or monoamine oxidase inhibitor anti- productive when it is dry and no sputum is expectorated. They must be used with caution in the presence Cough is a prominent symptom of respiratory tract of cardiac dysrhythmias, hyperthyroidism, diabetes mellitus, infections (eg, the common cold, influenza, bronchitis, glaucoma, and prostatic hypertrophy. Fell, an elderly man with a history of hypertension and dia- Many cold remedies are over-the-counter (OTC) formula- betes, has a cold. Commonly used ingredients include chlorpheniramine scribes pseudoephedrine (Sudafed) to relieve nasal congestion. Discuss the error and gestant), acetaminophen (analgesic and antipyretic), dextro- the impact it will have on Mr. Although antihistamines are popular OTC drugs because they dry nasal secretions, they are not recommended because they Antitussives can also dry lower respiratory secretions and worsen secre- tion retention and cough. Antitussive agents suppress cough by depressing the cough Many products come in several formulations, with differ- center in the medulla oblongata or the cough receptors in the ent ingredients, and are advertised for different purposes throat, trachea, or lungs. Centrally acting antitussives include (eg, allergy, sinus disorders, multisymptom cold and flu reme- narcotics (eg, codeine, hydrocodone) and non-narcotics dies). For example, allergy remedies contain an antihistamine; (eg, dextromethorphan). Locally acting agents (eg, throat nondrowsy or daytime formulas contain a nasal decon- lozenges, cough drops) may suppress cough by increasing the gestant, but do not contain an antihistamine; PM or night flow of saliva and by containing demulcents or local anes- formulas contain a sedating antihistamine to promote sleep; thetics to decrease irritation of pharyngeal mucosa. Flavored pain, fever, and multisymptom formulas usually contain acet- syrups are often used as vehicles for other drugs. It is not desirable to suppress a productive cough because products list ingredients by generic name, without identifying the secretions need to be removed. As a result of these bewildering products, tinue to be used and some people report beneficial effects, consumers, including nurses and other health care providers, some research studies indicate that cough medicines are no may not know what medications they are taking or whether more effective than placebos in children or adults. INDIVIDUAL DRUGS Expectorants Individual decongestants, antitussives, expectorants, and mu- Expectorants are agents given orally to liquefy respiratory se- colytics are listed in Drugs at a Glance: Nasal Decongestants, cretions and allow for their easier removal. Guaifenesin is the Antitussives, and Expectorants; selected combination prod- most commonly used expectorant. Several supplements are commonly used to prevent or treat Mucolytics symptoms of the common cold. Mucolytics are administered by inhalation to liquefy mucus in Echinacea preparations differ in chemical composition the respiratory tract. Solutions of mucolytic drugs may be neb- depending on which of the nine species or parts of the plant ulized into a face mask or mouthpiece or instilled directly into (eg, leaves, roots, whole plants) are used, as well as the sea- the respiratory tract through a tracheostomy. Sodium chloride solution and acetylcysteine (Mucomyst) are the only agents recommended for use as mucolytics. Acetylcysteine is effec- tive within 1 minute after inhalation, and maximal effects Nursing Notes: Apply Your Knowledge occur within 5 to 10 minutes. Oral acetylcysteine is widely used in the treatment of acetaminophen overdosage (see Chap.

Iodine excess (iodism) produces tion buy 300 mg lithium with amex, 200 mcg iodine in soil where grown discount 300mg lithium visa. Iodism is unlikely Other Children: 1–10 y, 10 mg; present in animal feed. Essential component of he- Adults (RDAs): males 19–51+, Liver and other organ meats, globin in red blood cells; approxi- moglobin, myoglobin, and 10 mg; females 19–50, 15 lean meat, shellfish, dried mately 25% is stored in the liver, several enzymes mg; 51+, 10 mg; pregnancy, beans and vegetables, egg bone marrow, and spleen as ferritin 2. Hemoglobin is required for 30 mg; lactation, 15 mg yolks, dried fruits, mo- and hemosiderin; the remaining transport and use of oxygen Infants: 0–6 mo, 6 mg; 6–12 lasses, whole grain and en- small amount is in myoglobin and by body cells; myoglobin mo, 10 mg riched breads. Milk and milk enzymes or bound to transferrin in aids oxygen transport and Other Children: 1–10 y, 10 products contain essentially plasma. Absorption from foods is approxi- zymes are important for females 11–18 y, 15 mg mately 10%. Factors that increase absorption: (1) Presence of dietary ascorbic acid (2) Acidity of gastric fluids in- creases solubility of dietary iron. If this reaction does not occur, iron combines with these sub- stances and produces non- absorbable compounds. Factors that decrease absorption: (1) Lack of hydrochloric acid in the stomach or adminis- tration of antacids, which produces an alkaline environment (2) Combination of iron with phosphates, oxalates, or phytates in the intestine. Has antioxidant properties similar Important for function of Adults (RDAs): males and Fish, meat, breads, and cereals to those of vitamin E myocardium and probably females, 19–>70 y, 55 mcg; 2. Deficiency most likely with long- other muscles pregnancy 60 mcg; lactation term IV therapy. Signs and symp- 70 mcg toms include myocardial Infants (AIs): 0-6 mo, 15 mcg; abnormalities and other muscle 7-12 mo, 20 mcg discomfort and weakness. A component of many en- Adults (RDAs): males 19–51+ y, Animal proteins, such as sis, hepatitis, nephrosis, malabsorp- zymes that are essential 15 mg; females, 19–51+ y, meat, liver, eggs, and tion syndromes, chronic infections, for normal metabolism (eg, 12 mg; pregnancy 15 mg; seafood. Wheat germ is also malignant diseases, myocardial carbonic anhydrase, lactic lactation, 16–19 mg a good source. Necessary for normal Other children: 1–10 y, 10 mg; and symptoms are most evident cell growth, synthesis males, 11–18 y, 12 mg; in growing children and include of nucleic acids (RNA and females 11–18 y, 15 mg impaired growth, hypogonadism in DNA), and synthesis boys, anorexia, and sensory impair- of carbohydrates and pro- ment (loss of taste and smell). Zinc excess is unlikely with dietary intake but may develop with exces- sive ingestion or inhalation of zinc. Ingestion may cause nausea, vom- iting, and diarrhea; inhalation may cause vomiting, headache, and fever. It also can be used prophylactically, before clini- periods of increased requirements (eg, childhood, preg- cal manifestations occur, in clients in whom this heredi- nancy). Oral ferrous salts (sulfate, gluconate, fumarate) are tary condition is likely to develop. Action starts in used to treat cystinuria, a hereditary metabolic disorder about 4 days, peaks in 7 to 10 days, and lasts 2 to 4 months. Otherwise, the iron content is recycled and severe rheumatoid arthritis that does not respond to con- its half-life is unknown.

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