Infections common in the older adult can include pna

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Infections common in the older adult can include: PNA, UTI, & TB. Infection in the older adult can have atypical manifestations such as cognitive & behavioral changes before the emergence of fever, pain, 0r alterations in lab values. – stupor, combative, ALOC, usually 1 st manifestation
Human Immunodeficiency Virus (HIV) HIV is a RNA virus (retrovirus) because it replicates “backward” going from RNA to DNA *HIV cannot replicate unless it is inside a living cell. Retrovirus that causes immunosuppression Targets T-cells (CD4+) or T-lymphocytes – immune cells Managed as a chronic disease Transmitted through contact with infected blood, semen, vaginal secretions, or breast milk. – must educate the patient NOT spread by tears, saliva, urine, emesis, sputum, feces, sweat, respiratory droplets. – standard isolation (gloves) – if WBC is low, then neutropenic/reverse isolation Risk Factors Unprotected sex (vaginal, anal, & oral) Multiple sex partners Occupational Exposure – including health care provider Perinatal Exposure Blood Transfusions IV drug use with contaminated needle Diagnostic Studies HIV progression is monitored by CD4+ (T-cell counts) – decreases CD4+ T-cell count provides a marker of immune function Viral load The lower the viral load the less active the disease Abnormal blood tests are common Caused by HIV, opportunistic diseases, or complications of therapy Decreased WBC counts Low platelet counts Anemia is associated with ART Altered liver function ELISA (screening for it), Western Blot (confirmation and tells what stage they are in), & Indirect Immunofluorescence Assay HIV Stage 1 Stage 1 Acute Infection Manifestations can occur within 2-4 wks of infection S/S similar to flu, can cause rash, muscle & joint pain, nausea, malaise, and sore throat Neurologic complications can occur such as peripheral neuropathy, facial palsy, or Guillian-Barre syndrome. Marked by rapid rise in HIV viral load, decreased CD4+ cells and increased CD8 cells Lymphadenopathy persists throughout disease ***CD4+ count =/> 500 HIV Stage 2 Stage 2 Chronic HIV Infection Asymptomatic Infection This stage can be prolonged and asymptomatic for up to 10 years or more Anti-HIV antibodies are produced (HIV +) After time the virus will begin replication using host’s genetic machinery CD4+ cells destroyed Viral load increases Dramatic loss of immunity begins Asymptomatic phase will go into symptomatic phase when CD4 count is close to 200 – the more pt closer to 200, the more symptoms they are going to have ***CD4+ count 200-499 HIV Clinical Manifestations Chills Fever
Rash Anorexia, nausea, weight loss Weakness, fatigue, malaise Headache, sore throat Frequent Night sweats Often mistaken for the FLU – and similar TB s/s – night sweats HIV Stage 2 Stage 2 Chronic HIV Infection Symptomatic Infection As the CD4+ T cell count declines closer to 200 and the viral load increases, HIV advances to a more active stage.

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