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HANDBOOK FOR BRUNNER & SUDDARTH’S Textbook of Medical-Surgical Nursing TWELFTH EDITION

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HANDBOOK FOR BRUNNER & SUDDARTH’S Textbook of Medical-Surgical Nursing TWELFTH EDITION Acquisitions Editor: Hilarie Surrena Product Director: Renee Gagliardi Vendor Manager: Cindy Rudy De... sign Coordinator: Joan Wendt Senior Manufacturing Manager: William Alberti Compositor: Aptara, Inc. 12th Edition Copyright © 2010 by Wolters Kluwer Health / Lippincott Williams & Wilkins. Copyright © 2008, 2004, 2000 by Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means—electronic, mechanical, photocopy, recording, or otherwise—without prior written permission of the publisher, except for brief quotations embodied in critical articles and reviews and testing and evaluation materials provided by publisher to instructors whose schools have adopted its accompanying textbook. Printed in the United States of America. For information write Wolters Kluwer Health/Lippincott Williams & Wilkins, 530 Walnut Street, Philadelphia, PA 19106. Materials appearing in this book prepared by individuals as part of their official duties as U.S. Government employees are not covered by the above-mentioned copyright. 987654321 Library of Congress Cataloging-in-Publication Data Handbook for Brunner & Suddarth’s textbook of medical-surgical nursing. —12th ed. p. ; cm. Rev. ed. of: Handbook for Brunner & Suddarth’s textbook of medical-surgical nursing / Joyce Young Johnson. 11th ed. c2008. Includes index. ISBN 978-0-7817-8592-1 1. Nursing—Handbooks, manuals, etc. 2. Surgical nursing—Handbooks, manuals, etc. I. Johnson, Joyce Young. Handbook for Brunner & Suddarth’s textbook of medical-surgical nursing. II. Title: Textbook of medical-surgical nursing. III. Title: Handbook for Brunner and Suddarth’s textbook of medical-surgical nursing. [DNLM: 1. Nursing Care—Handbooks. 2. Perioperative Nursing— Handbooks. WY 49 H2326 2010] RT41.J56 2010 617'.0231—dc22 2009028731 ISBN-13: 978-0-7817-8592-1 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, express or implied, with respect to the content of the publication. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in his or her clinical practice. LWW.com iii Preface This Handbook for Brunner & Suddarth’s Textbook of MedicalSurgical Nursing, 12th edition, is a comprehensive yet concise clinical reference designed for use by nursing students and professionals. Perfect for use across multiple health care settings, the Handbook presents need-to-know information on nearly 200 commonly encountered diseases and disorders. The easyto-use, colorful, consistent, and alphabetized outline format enables readers to gain quick access to vital information on • Disease (Pathophysiology) • Clinical Manifestations • Assessment and Diagnostic Methods • Medical, Surgical, and Pharmacologic Management • Nursing Management according to the Nursing Process For readers requiring more in-depth information, the Handbook is completely cross-referenced to chapters in Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition. Special Features The Handbook places special emphasis on home- and community-based nursing practice, patient education, and expected outcomes of care. Additional features include the following: Gerontologic Considerations—Thumbnail descriptions and interventions related to the care of the older adult population, whose health care needs continue to expand at a rapid rate. Nursing Alerts—Instant notes focused on priority care issues and hazardous or potentially life-threatening situations. Selected tables and boxes—At-a-glance presentations of additional diseases, disorders, measurements, and the like. Up-to-date appendices for use in clinicals, on the unit, and at home or in the community. These include the following: • Important lab values • Current nursing diagnoses • Acronyms and abbreviations iv Preface v Contents A Acquired Immunodeficiency Syndrome (HIV Infection) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Acute Coronary Syndrome and Myocardial Infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Acute Respiratory Distress Syndrome . . . . . . . . . . . . . . . . . 22 Addison’s Disease (Adrenocortical Insufficiency) . . . . . . . 25 Alzheimer’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Amyotrophic Lateral Sclerosis . . . . . . . . . . . . . . . . . . . . . . 33 Anaphylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Anemia, Aplastic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Anemia, Iron Deficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Anemia, Megaloblastic (Vitamin B12 and Folic Acid Deficiency) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Anemia, Sickle Cell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Aneurysm, Aortic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Aneurysm, Intracranial . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Angina Pectoris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Aortic Insufficiency (Regurgitation) . . . . . . . . . . . . . . . . . . 66 Aortic Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Appendicitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Arterial Embolism and Arterial Thrombosis . . . . . . . . . . . 71 Arteriosclerosis and Atherosclerosis . . . . . . . . . . . . . . . . . . 73 Arthritis, Rheumatoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Asthma: Status Asthmaticus . . . . . . . . . . . . . . . . . . . . . . . . 82 B Back Pain, Low . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Bell’s Palsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Benign Prostatic Hyperplasia and Prostatectomy . . . . . . . . 90 Bone Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Bowel Obstruction, Large . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Bowel Obstruction, Small . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Brain Abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Brain Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Bronchiectasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Bronchitis, Chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Buerger’s Disease (Thromboangiitis Obliterans) . . . . . . . . 106 Burn Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 C Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Cancer of the Bladder . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Cancer of the Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Cancer of the Cervix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Cancer of the Colon and Rectum (Colorectal Cancer) . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Cancer of the Endometrium . . . . . . . . . . . . . . . . . . . . . . . 158 Cancer of the Esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Cancer of the Kidneys (Renal Tumors) . . . . . . . . . . . . . . 161 Cancer of the Larynx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Cancer of the Liver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Cancer of the Lung (Bronchogenic Carcinoma) . . . . . . . 175 Cancer of the Oral Cavity and Pharynx . . . . . . . . . . . . . . 178 Cancer of the Ovary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Cancer of the Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Cancer of the Prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 Cancer of the Skin (Malignant Melanoma) . . . . . . . . . . 191 Cancer of the Stomach (Gastric Cancer) . . . . . . . . . . . . 196 Cancer of the Testis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 Cancer of the Thyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 Cancer of the Vagina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Cancer of the Vulva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Cardiomyopathies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Cerebral Vascular Accident (Ischemic Stroke) . . . . . . . . 214 Cholelithiasis (and Cholecystitis) . . . . . . . . . . . . . . . . . . 225 Chronic Obstructive Pulmonary Disease (COPD) . . . . . 231 Cirrhosis, Hepatic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 Constipation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238 Contact Dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240 Coronary Atherosclerosis and CAD . . . . . . . . . . . . . . . . . 241 vi Contents Contents vii Cushing Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 Cystitis (Lower UTI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249 D Diabetes Insipidus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 Diabetic Ketoacidosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264 Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269 Disseminated Intravascular Coagulation . . . . . . . . . . . . . . 272 Diverticular Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275 E Emphysema, Pulmonary . . . . . . . . . . . . . . . . . . . . . . . . . . . 280 Empyema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281 Endocarditis, Infective . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282 Endocarditis, Rheumatic . . . . . . . . . . . . . . . . . . . . . . . . . . 285 Endometriosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286 Epididymitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288 Epilepsies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290 Epistaxis (Nosebleed) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296 Esophageal Varices, Bleeding . . . . . . . . . . . . . . . . . . . . . . . 297 Exfoliative Dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300 F Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302 G Gastritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313 Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316 Glomerulonephritis, Chronic . . . . . . . . . . . . . . . . . . . . . . 319 Gout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321 Guillain–Barré Syndrome (Polyradiculoneuritis) . . . . . . . 324 H Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330 Head Injury (Brain Injury) . . . . . . . . . . . . . . . . . . . . . . . . 335 Heart Failure (Cor Pulmonale) . . . . . . . . . . . . . . . . . . . . . 346 Hemophilia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 354 Hepatic Encephalopathy and Hepatic Coma . . . . . . . . . . 356 Hepatic Failure, Fulminant . . . . . . . . . . . . . . . . . . . . . . . . 359 Hepatitis, Viral: Types A, B, C, D, E, and G . . . . . . . . . . 360 Hiatal Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365 Hodgkin’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368 Huntington Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371 Hyperglycemic Hyperosmolar Nonketotic Syndrome . . . 373 Hypertension (and Hypertensive Crisis) . . . . . . . . . . . . . . 375 Hyperthyroidism (Graves’ Disease) . . . . . . . . . . . . . . . . . . 381 Hypoglycemia (Insulin Reaction) . . . . . . . . . . . . . . . . . . . 387 Hypoparathyroidism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390 Hypopituitarism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392 Hypothyroidism and Myxedema . . . . . . . . . . . . . . . . . . . . 392 I Idiopathic Thrombocytopenic Purpura . . . . . . . . . . . . . . . 397 Impetigo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399 Increased Intracranial Pressure . . . . . . . . . . . . . . . . . . . . . 401 Influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406 K Kaposi’s Sarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408 L Leukemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 Leukemia, Lymphocytic, Acute . . . . . . . . . . . . . . . . . . . . . 416 Leukemia, Lymphocytic, Chronic . . . . . . . . . . . . . . . . . . . 417 Leukemia, Myeloid, Acute . . . . . . . . . . . . . . . . . . . . . . . . 419 Leukemia, Myeloid, Chronic . . . . . . . . . . . . . . . . . . . . . . . 421 Lung Abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422 Lymphedema and Elephantiasis . . . . . . . . . . . . . . . . . . . . . 424 M Mastoiditis and Mastoid Surgery . . . . . . . . . . . . . . . . . . . . 427 Ménière’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431 Meningitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 434 Mitral Regurgitation (Insufficiency) . . . . . . . . . . . . . . . . . 437 Mitral Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 438 Mitral Valve Prolapse . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439 Multiple Myeloma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 440 Multiple Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 442 Muscular Dystrophies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449 Musculoskeletal Trauma (Contusions, Strains, Sprains, and Joint Dislocations) . . . . . . . . . . . . . . . . 451 Myasthenia Gravis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454 Myocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457 viii Contents Contents ix N Nephritic Syndrome, Acute . . . . . . . . . . . . . . . . . . . . . . . 460 Nephrotic Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462 O Obesity, Morbid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464 Osteoarthritis (Degenerative Joint Disease) . . . . . . . . . . . 466 Osteomalacia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 468 Osteomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469 Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473 Otitis Media, Acute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477 Otitis Media, Chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . 479 P Pancreatitis, Acute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 481 Pancreatitis, Chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 486 Parkinson’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 488 Pelvic Infection (Pelvic Inflammatory Disease) . . . . . . . . 494 Pemphigus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 497 Peptic Ulcer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501 Pericarditis (Cardiac Tamponade) . . . . . . . . . . . . . . . . . . . 507 Perioperative Nursing Management . . . . . . . . . . . . . . . . . 511 Peripheral Arterial Occlusive Disease . . . . . . . . . . . . . . . . 536 Peritonitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 538 Pharyngitis, Acute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541 Pharyngitis, Chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 543 Pheochromocytoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 544 Pituitary Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 546 Pleural Effusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 547 Pleurisy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 549 Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 Pneumothorax and Hemothorax . . . . . . . . . . . . . . . . . . . . 556 Polycythemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 559 Prostatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 561 Pruritus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 563 Psoriasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 565 Pulmonary Edema, Acute . . . . . . . . . . . . . . . . . . . . . . . . . 570 Pulmonary Embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 572 Pulmonary Heart Disease (Cor Pulmonale) . . . . . . . . . . . 577 Pulmonary Arterial Hypertension . . . . . . . . . . . . . . . . . . . 579 Pyelonephritis, Acute . . . . . . . . . . . . . . . . . . . . . . . . . . . . 581 Pyelonephritis, Chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . 582 R Raynaud’s Phenomenon . . . . . . . . . . . . . . . . . . . . . . . . . . . 584 Regional Enteritis (Crohn’s Disease) . . . . . . . . . . . . . . . . 585 Renal Failure, Acute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 587 Renal Failure, Chronic (End-Stage Renal Disease) . . . . . 591 S Seborrheic Dermatoses . . . . . . . . . . . . . . . . . . . . . . . . . . . 595 Shock, Cardiogenic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 596 Shock, Hypovolemic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 598 Shock, Septic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 600 Spinal Cord Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 602 Syndrome of Inappropriate Antidiuretic Hormone Secretion . . . . . . . . . . . . . . . . . . . . . . . . . . 612 Systemic Lupus Erythematosus . . . . . . . . . . . . . . . . . . . . . 613 T Thrombocytopenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 616 Thyroiditis, Acute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 617 Thyroiditis, Chronic (Hashimoto’s Thyroiditis) . . . . . . . . 619 Thyroid Storm (Thyrotoxic Crisis) . . . . . . . . . . . . . . . . . . 619 Toxic Epidermal Necrolysis and Stevens–Johnson Syndrome . . . . . . . . . . . . . . . . . . . .621 Trigeminal Neuralgia (Tic Douloureux) . . . . . . . . . . . . . . 626 Tuberculosis, Pulmonary . . . . . . . . . . . . . . . . . . . . . . . . . . 628 U Ulcerative Colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 632 Unconscious Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 639 Urolithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 646 V Vein Disorders: Venous Thrombosis, Thrombophlebitis, Phlebothrombosis, and Deep Vein Thrombosis . . . . 653 Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 659 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 685 x Contents 1 A Acquired Immunodeficiency Syndrome (HIV Infection) Acquired immunodeficiency syndrome (AIDS) is defined as the most severe form of a continuum of illnesses associated with human immunodeficiency virus (HIV) infection. HIV belongs to a group of viruses known as retroviruses. These viruses carry their genetic material in the form of ribonucleic acid (RNA) rather than deoxyribonucleic acid (DNA). Infection with HIV occurs when it enters the host CD4 (T) cell and causes this cell to replicate viral RNA and viral proteins, which in turn invade other CD4 cells. The stage of HIV disease is based on clinical history, physical examination, laboratory evidence of immune dysfunction, signs and symptoms, and infections and malignancies. The Centers for Disease Control and Prevention (CDC) standard case definition of AIDS categorizes HIV infection and AIDS in adults and adolescents on the basis of clinical conditions associated with HIV infection and CD4 T-cell counts. Four categories of infected states have been denoted: • Primary infection (acute/recent HIV infection, acute HIV syndrome: dramatic drops in CD4 T-cell counts, which are normally between 500 and 1,500 cells/mm3 ) • HIV asymptomatic (CDC Category A: more than 500 CD4 T lymphocytes/mm3 ) • HIV symptomatic (CDC Category B: 200 to 499 CD4 T lymphocytes/mm3 ) • AIDS (CDC Category C: fewer than 200 CD4 T lymphocytes/mm3 ) Risk Factors HIV is transmitted through bodily fluids by high-risk behaviors such as heterosexual intercourse with an HIV-infected LWBK partner, injection drug use, and male homosexual relations. People who received transfusions of blood or blood products contaminated with HIV, children born to mothers with HIV infection, breast-fed infants of HIV-infected mothers, and health care workers exposed to needle-stick injury associated with an infected patient are also at risk. Clinical Manifestations Symptoms are widespread and may affect any organ system. Manifestations range from mild abnormalities in immune response without overt signs and symptoms to profound immunosuppression, life-threatening infection, malignancy, and the direct effect of HIV on body tissues. Respiratory • Shortness of breath, dyspnea, cough, chest pain, and fever are associated with opportunistic infections, such as those caused by Pneumocystis jiroveci (Pneumocystis pneumonia [PCP], the most common infection), Mycobacterium avium-intracellulare, cytomegalovirus (CMV), and Legionella species. • HIV-associated tuberculosis occurs early in the course of HIV infection, often preceding a diagnosis of AIDS. Gastrointestinal • Loss of appetite • Nausea and vomiting • Oral and esophageal candidiasis (white patches, painful swallowing, retrosternal pain, and possibly oral lesions) • Chronic diarrhea, possibly with devastating effects (eg, profound weight loss, fluid and electrolyte imbalances, perianal skin excoriation, weakness, and inability to perform activities of daily living) Wasting Syndrome (Cachexia) • Multifactorial protein-energy malnutrition • Profound involuntary weight loss exceeding 10% of baseline body weight • Either chronic diarrhea (for more than 30 days) or chronic weakness and documented intermittent or constant fever with no concurrent illness 2 Acquired Immunodeficiency Syndrome (HIV Infection) A Acquired Immunodeficiency Syndrome (HIV Infection) 3 A • Anorexia, diarrhea, gastrointestinal (GI) malabsorption, lack of nutrition, and for some patients a hypermetabolic state Oncologic Certain types of cancer occur often in people with AIDS and are considered AIDS-defining conditions: • Kaposi’s sarcoma (KS) is the most common HIV-related malignancy and involves the endothelial layer of blood and lymphatic vessels (exhibits a variable and aggressive course, ranging from localized cutaneous lesions to disseminated disease involving multiple organ systems). • B-cell lymphomas are the second most common malignancy; they tend to develop outside the lymph nodes, most commonly in the brain, bone marrow, and GI tract. These types of lymphomas are characteristically of a higher grade, indicating aggressive growth and resistance to treatment. • Invasive cervical cancer. Neurologic HIV-associated neurocognitive disorders consist of cognitive impairment that is often accompanied by motor dysfunction and behavioral change. • HIV-related peripheral neuropathy is common across the trajectory of HIV infection and may occur in a variety of patterns, with distal sensory polyneuropathy (DSPN) or distal symmetrical polyneuropathy the most frequently occurring type. DSPN can lead to significant pain and decreased function. • HIV encephalopathy (formerly referred to as AIDS dementia complex [ADC]) is a clinical syndrome that is characterized by a progressive decline in cognitive, behavioral, and motor functions. Symptoms include memory deficits, headache, difficulty concentrating, progressive confusion, psychomotor slowing, apathy, and ataxia, and in later stages global cognitive impairments, delayed verbal responses, a vacant stare, spastic paraparesis, hyperreflexia, psychosis, hallucinations, tremor, incontinence, seizures, mutism, and death. • Cryptococcus neoformans, a fungal infection (fever, headache, malaise, stiff neck, na [Show More]

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