Major Diseases: HIV/AIDS and Cancer

HIV/AIDS

Human Immunodeficiency Virus (HIV) is a chronic infectious disease that can progress to Acquired Immunodeficiency Syndrome (AIDS) if untreated. Understanding its diagnosis, management, and prevention is essential for personal and public health.

• Diagnostic Criterion for AIDS: AIDS is diagnosed when a person with HIV has a CD4 cell count < 200 cells/mm3 or develops certain opportunistic infections or cancers.

• Chronic HIV: Refers to the long-term phase of HIV infection, where the virus is present but may not cause symptoms for years.

• Symptomatic and Asymptomatic HIV: Asymptomatic individuals have no symptoms but can transmit the virus. Symptomatic individuals may experience fever, weight loss, and opportunistic infections.

• Antiretroviral Therapy (ART): The main treatment for HIV, involving a combination of drugs to suppress viral replication and preserve immune function.

• Teaching about Antiretroviral Administration: Patients should take medications consistently, be aware of side effects, and understand the importance of adherence to prevent resistance.

• Evaluating Effectiveness: Effectiveness is monitored by measuring viral load (should decrease) and CD4 count (should increase or remain stable).

• HIV Prophylaxis: Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are strategies to prevent HIV infection in high-risk individuals.

• CD4 Cell Count: Normal: 500–1,500 cells/mm3. Abnormal: < 200 cells/mm3 indicates AIDS.

• Neutropenia: A decrease in neutrophils, increasing infection risk. Common in advanced HIV/AIDS.

• Malnutrition: HIV can cause protein-energy malnutrition. Signs/Symptoms: Weight loss, muscle wasting, low serum albumin.

Example: A patient with HIV and a CD4 count of 150 cells/mm3 who develops pneumonia meets the diagnostic criteria for AIDS.

Cancer

Cancer is a group of diseases characterized by uncontrolled cell growth. Management includes chemotherapy, radiation, and supportive care.

• Patient Education for Chemotherapy: Discuss side effects (nausea, hair loss, immunosuppression), infection prevention, and the importance of reporting symptoms.

• Health Promotion: Encourage regular screenings, healthy diet, and avoidance of carcinogens (e.g., tobacco).

• Radiation Therapy Education: Teach about skin care, fatigue management, and avoiding sun exposure to treated areas.

• Preventing Complications of Radiation: Avoid tight clothing, harsh soaps, and scratching the treated area.

• Complications of Chemotherapy: Includes neutropenia, anemia, nausea, and mucositis. Actions: Infection prevention, antiemetics, oral care.

• Interferon and Cyclophosphamide: Interferon can cause flu-like symptoms. Cyclophosphamide may cause hemorrhagic cystitis; encourage hydration.

• Healthy Food Choices: Emphasize protein, vitamins, and minerals to support healing and immune function.

• Signs of Metastasis: Unexplained pain, weight loss, organ dysfunction, or new symptoms in distant sites.

• Staging Cancer: Describes the extent of disease spread (e.g., TNM system: Tumor, Node, Metastasis).

• Biopsy: Removal of tissue for diagnostic examination.

Example: A patient receiving chemotherapy develops a fever and low white blood cell count, indicating neutropenia and risk for infection.

Fluid and Electrolyte Balance

Fluid Volume Disorders

Maintaining proper fluid and electrolyte balance is vital for health. Disorders can result from excess or deficit of fluids or electrolytes.

• Hypovolemia (Fluid Volume Deficit): Signs/Symptoms: Tachycardia, hypotension, dry mucous membranes, decreased urine output.

• Hypervolemia (Fluid Volume Excess): Signs/Symptoms: Edema, hypertension, crackles in lungs, jugular venous distension.

• Dehydration in the Elderly: Confusion, dry skin, poor skin turgor, rapid pulse.

Electrolyte Imbalances

• Hypernatremia: High sodium. Symptoms: Thirst, confusion, muscle twitching.

• Hyponatremia: Low sodium. Symptoms: Nausea, headache, seizures.

• Hyperkalemia: High potassium. Symptoms: Muscle weakness, arrhythmias.

• Hypokalemia: Low potassium. Symptoms: Muscle cramps, arrhythmias.

• Calcium Imbalances: Normal: 8.5–10.5 mg/dL. Treatments: Calcium supplements for low levels; IV fluids and diuretics for high levels.

• Administration of KCl: Maximum IV rate is 10 mEq/hr (peripheral) or 20 mEq/hr (central line). Never give IV push.

• Foods High in Phosphate: Dairy, nuts, beans, meats.

Normal Electrolyte Ranges

Acid-Base Balance: ABG Interpretation

Arterial Blood Gases (ABGs) are used to assess acid-base status. Imbalances can be metabolic or respiratory in origin.

• Metabolic Acidosis: Low pH, low HCO3−. Causes: Renal failure, diabetic ketoacidosis.

• Metabolic Alkalosis: High pH, high HCO3−. Causes: Vomiting, diuretic use.

• Respiratory Acidosis: Low pH, high CO2. Causes: Hypoventilation, COPD.

• Respiratory Alkalosis: High pH, low CO2. Causes: Hyperventilation, anxiety.

Key ABG Values:

Fluid Replacement Solutions

• Isotonic: Same osmolarity as plasma (e.g., 0.9% NaCl). Used for fluid resuscitation.

• Hypotonic: Lower osmolarity than plasma (e.g., 0.45% NaCl). Used for cellular dehydration.

• Hypertonic: Higher osmolarity than plasma (e.g., 3% NaCl). Used for severe hyponatremia.

Priority of Care

• ABC: Airway, Breathing, Circulation—always assess and address in this order.

• LOC: Level of Consciousness—monitor for changes indicating worsening condition.

• Delegation: Assign tasks based on staff qualifications (e.g., UAP can take vital signs, but only nurses can administer IV medications).

Example: A patient with severe hyperkalemia and ECG changes requires immediate intervention to prevent cardiac arrest.

Additional info: Academic context was added to clarify the clinical significance of laboratory values, the rationale for interventions, and the importance of patient education in disease management.