RTRMF – BSN LEVEL III MARINURSE AND FRIENDS F#1

NCM 112: MEDICAL-SURGICAL NURSING LECTURER: MR. ANDRE CARLO DE VEYRA

3 LAYERS OF THE LESION

SEXUALLY TRANSMITTED 1. The shallow surface which contains polymorphonuclear cells,

DISEASES Red Blood Cells, and the debris.

2. The white middle zone which is edematous and shows
endothelial proliferation of blood vessels but lacks
1
CHANCROID fibroblastic repair
3. The Deep zone that is dense infiltration of plasma cells and
Soft chancre/Soft Sore/ Sulcus
ALSO KNOWN AS: lymphocytes.
Mole
CAUSATIVE AGENT: Haemophilus ducreyi
1-14 days; With average of three CLINICAL MANIFESTATIONS
INCUBATION PERIOD:
to five days  Small lesions on groin or inner thigh; (males- penis, Females-

SOURCE OF INFECTION: ----------------------- vulva, vagina, cervix).

-----
 Lesions may erupt on the lips, tongue, breast, navel.
MODE OF
Sexual Contact  Papule rapidly ulcerates, become painful; soft compared to
TRANSMISSION:
PERIOD OF syphilis & malodorous.
---------------------------------------------------
COMMUNICABILITY:  Papules bleed easily & produce pus. That is why we say there
PATHOGNOMONIC
--------------------------------------------------- are exudates on it.
SIGN:
Gram stain of ulcer exudates  2-3 weeks, inguinal adenitis may develop, creating suppurated,
Biopsy inflamed nodes that may rupture into large ulcers or buboes.
DIAGNOSTICS:
Darkfield examination & serologic
 At the healing stage if the penis is affected, it may lead to
exam
phimosis. It is only common among people that are
Azithromycin- 500 mg
TREATMENT: Erythromycin 500 mg x 7 uncircumcised.
Ceftriaxone 250 mg IM  Healing stage - phimosis may develop
 “Buboes”- swollen lymph nodes & abscess; are found
- also known as Soft on soft chancre
chancre/Soft Sore/ Sulcus
Mole. It is characterized by COMPLICATIONS
painful genital ulcers &
 Phimosis - Narrowing of foreskin, inflammation of the glans
inguinal adenitis. It affects
penis (this occurs upon healing).
both male and female, but it
affects the males more.

PATHOPHYSIOLOGY
Lesions are usually confined only to the genital sites most
commonly traumatized during sexual contact. A lesion will start
to form as a small papule surrounded by zones of erythema
(redness) and soon erodes to produce a sharply circumscribed,
non-indurated ulcer with a granulating base. Circumscribed
meaning there are clear borders to the ulcer. Multiple lesions
may develop rapidly by autoinoculation and suppurative adenitis TREATMENT
 Azithromycin- 500 mg  Ceftriaxone 250 mg IM
is evident.
 Erythromycin 500 mg x 7 days
 The initial ulcers however may be mistaken as a hard
chancre, the typical sore of primary syphilis, but remember
that in Chancroid it is soft ulcer. NURSING MANAGEMENT
 Standard precaution – consider all secretions coming from
 In women the most common location of this ulcers is in the
the px infectious.
labia majora, called as “Kissing Ulcer”. It is called “kissing
ulcer” because the 2 labia would touch each other, and the  Check for drug allergy
ulcers are kissing. Kissing ulcers are ulcers that are occurring  Lotion, cream or oil should be applied on lesions
on opposing surfaces of the labia. The ulcers might also  Abstain sexual contacts until healing is complete (2 weeks)
occur at different places, it can occur in the labia minora, it
 Wash genitalia daily
can occur in the perineal area, in the inner thighs etc.
 Approximately 1/3 of individuals develop enlargement of the
PREVENTION
inguinal lymph node. (bagat nagkakamayada hin bulugan)
1. Avoid sexual contact with infected persons
 The causative agent Haemophilus ducreyi, a Gram-
2. Use condom
Negative, non-spore-forming streptobacilli
3. Wash genitalia after sexual contact.
 For the males it is commonly found in the penis not on the
scrotum

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NCM 112: MEDICAL-SURGICAL NURSING LECTURER: MR. ANDRE CARLO DE VEYRA

2
CHLAMYDIAL INFECTIONS tubes have already swollen and have healed afterwards
there are instances that scar formation develops
ALSO KNOWN AS: ------------------------------------------------ (scarring and scar formation).If there are scarring or scar
CAUSATIVE AGENT: Chlamydia trachomatis formation the tendency is that the fallopian tube is very
NCUBATION slender there will be strictures in the fallopian tube that
1-3 weeks
PERIOD: may lead to infertility or if the sperm cell can pass
SOURCE OF through where in they meet with the egg cell at the distal
-------------------------------------- third of the fallopian tube at the ampulla region. When
INFECTION:
MODE OF Vaginal/rectal intercourse, oral-genital the sperm cell and egg cell meet it is still okay, the zygote
TRANSMISSION: contact. will develop. Normally from the fallopian tube it will
PERIOD OF travel for 3-4 days to the uterus, it should be propelled to
--------------------------------------------------- the uterus where the zygote would attach to the upper
COMMUNICABILITY:
PATHOGNOMONIC posterior portion of the uterus where the blood flow is
--------------------------------------------------- very sufficient, the problem is if there are scars and there
SIGN:
Swab from the site of infection are strictures it could not easily pass through and migrate

Culture of aspirated materials to the uterus, so the effect would be ectopic pregnancy.
DIAGNOSTICS:
ELISA o Signs & symptoms of PID such as pain & tenderness of
Direct fluorescent antibody test the abdomen, cervix, & lymph nodes.
Doxycycline- orally for 7 days o Chills o Breakthrough bleeding
TREATMENT:
Azithromycin o Fever o Bleeding during intercourse

- Chlamydia is a sexually transmitted infection caused by the  WOMEN WITH URETHRAL SYNDROME
bacterium Chlamydia trachomatis. This is bacterial in nature o Dysuria – painful urination
and can infect the urinary and reproductive organs. o Pyuria – presence of pus in the urine
- The term chlamydia refers to chlamydia trachomatis which is the o Increased Urinary frequency
STD. Do not confuse yourself because there are 2 other types of
bacteria which can lead to illness such as the Chlamydia  MEN WITH URETHRITIS
Pneumoniae which can spread through coughing/sneezing, and o Dysuria o Urinary Frequency
Chlamydia Psittaci which can be spread by birds to humans. o Erythema o Pruritus
- Chlamydial infection can be treated with antibiotic. Untreated o Tenderness of the urethral meatus o Urethral discharge
chlamydia would result to the complications below and would
also lead to sterility. Since this is bacterial in nature this is  MEN WITH EPIDIDYMITIS
treated with antibiotics. But in many cases, it causes no o Painful scrotal swelling
symptoms, so people can be infected with it without them o Urethral discharge
knowing, but they are already spreading the disease. o Diarrhea
o Tenesmus – painful and straining during defecation
- If the chlamydial infections go untreated it can lead to a more
o Pruritus
serious health problem such as infertility, so it is important to
o Bloody mucopurulent discharge
undergo testing if sexually active and promiscuous (multiple
o Diffuse or discrete ulceration in the rectosigmoid colon
sexual partner). In addition, conjunctivitis, otitis media, and
pneumonia may develop in children born to mothers with
TREATMENT
chlamydial infection passed through the birth canal.
 Doxycycline- orally for 7 days – prophylaxis and treatment for
the communicable disease: leptospirosis
CLINICAL MANIFESTATIONS
 Azithromycin in single dose
 WOMEN WITH CERVICITIS
o Cervical erosion NURSING MANAGEMENT
o Mucopurulent discharges  Universal precaution
(whitish in discharge and  Submit to HIV testing (couple)
usually soft itis protein.)  Assess newborn for signs of chlamydial infection.
o Pelvic pain
o Dyspareunia painful sexual PREVENTION
intercourse  Sex education
o Severe vulvar pruritus  Case Finding, Contact tracing
 Report cases
 WOMEN WITH ENDOMETRITIS OR SALPINGITIS  ABC- ABSTINENCE, BE FAITHFUL, CONDOM
- STDs which causes salpingitis or the inflammation of the
fallopian tube may cause infertility, or if it may not cause
infertility there is a danger in the future that the patient
will get pregnant in the future there will be higher
chances of ectopic pregnancy because if the fallopian

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NCM 112: MEDICAL-SURGICAL NURSING LECTURER: MR. ANDRE CARLO DE VEYRA

3
GONORRHEA  Bacteria are transmitted through direct contact with
contaminated vaginal secretions of the mother as the baby
ALSO KNOWN
CLAP/ FLORES BLANCAS/ GLEET comes out of the birth canal.
AS:
 It may be acquired through sexual contact (orogenital,
CAUSATIVE
Neisseria gonorrhoeae anogenital) between opposite sexes, as well as the same sex.
AGENT:
INCUBATION  Bacteria may also be transmitted through fomites.
3-21 days; average 3-5 days
PERIOD:
SOURCE OF
--------------------------------------------------- PATHOPHYSIOLOGY
INFECTION:
1. After infection, gonococci become adherent to the urethral
Direct contact with exudates, Occurs in utero
MODE OF epithelium.
(upon rupture of membrane), Sexual contact,
TRANSMISSION:
Fomites 2. Penetration of the mucosa usually elicits an acute
PERIOD OF inflammatory response consisting mainly of
as long as the organism is present in
COMMUNICABI polymorphonuclear leukocytes in the submucosa.
discharges it is considered communicable
LITY: 3. Inflammatory edema of the gland ducts or plugs of debris
PATHOGNOMO
--------------------------------------------------- obstruct drainage to form micro abscesses that may coalesce
NIC SIGN:
to form large abscess.
Female – Thayer- Martin medium
DIAGNOSTICS: 4. Infection tends to spread along mucosal surfaces and may
Male – gram stain
involve the fallopian tube and the endometrium and
Uncomplicated
eventually enter the peritoneal cavity of women.
1. Ceftriaxone 125-250 mg IM single dose
5. Scarring from this abscess formation or tubal involvement
2. Doxycycline 100 mg orally BID for 7 days.
may lead to strictures and sterility.
Pregnant
6. A similar mechanism, epididymitis, and, therefore, possible
1. Ceftriaxone 125-150 mg IM single dose
sterility may occur in men.
plus Erythromycin 500 mg orally for 7
days
CLINICAL MANIFESTATIONS
TREATMENT: Aqueous procaine PCN 4M units IM ANST
 FEMALES
(Initial regimen)
 May lead to infertility
1. Disseminated gonococcal; infection 1 g
 Pain during urination
Ceftriaxone IM or IV every 24 hours
 Redness and swelling of genitals
2. 2 g spectinomycin IM every 12 hours for  Yellowish purulent vaginal drainage
those allergic beta-lactam  Burning sensation and frequent urination
o Gonococcal conjunctivitis- 1g single  Burning sensation and itching on vaginal area
dose ceftriaxone IM & irrigation of  Urethritis or cervicitis (few days post exposure)
infected eye with NSS.  Endometritis, salpingitis, pelvic peritonitis which
 Signs of pelvic infection (fever. N&V, abdominal pain &
- Gonorrhea is a sexually transmitted bacterial disease involving
tenderness)
the mucosal lining of the genitourinary tract, the rectum, and
 Pregnant woman may infect the eye of the newborn
pharynx.
(gonorrheal conjunctivitis)

CAUSATIVE AGENT
 MALES
 Neisseria gonorrhoeae or gonococcus  Urethritis
o This is a gram-negative coccus found in pairs.  Epididymitis
o This coccus is non-spore former and non-motile.  Rectal infection
o It is fragile and does not survive long outside the body.  Prostatitis (pelvic pain & fever)
o It is readily killed by drying, sunlight, and ultraviolet light.  Dysuria with purulent discharge (fleet) 2-7 days post
o It may be killed by ordinary disinfectants. exposure “tulo”

MODE OF TRANSMISSION COMPLICATION

 If the mother has gonorrhea the baby is delivered through  Sterility & pelvic infection
cesarean section. in women
 Sometimes if we don’t know if the mother has gonorrhea, it  Epididymitis would
can cause blindness that is why we have Crede’s prophylaxis. eventually lead to sterility
 Bacteria is transmitted by contact with exudates from the amongst males
mucous membranes of infected persons, usually as a result of  Arthritis
a sexual activity.  Endocarditis
 Transmission may occur in utero upon the rupture of  Conjunctivitis
membranes, as observed in infants delivered by cesarean  Meningitis
section after the membrane ruptures.

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RTRMF – BSN LEVEL III MARINURSE AND FRIENDS F#1
NCM 112: MEDICAL-SURGICAL NURSING LECTURER: MR. ANDRE CARLO DE VEYRA

TREATMENT CLINICAL MANIFESTATIONS

UNCOMPLICATED  Female
 Ceftriaxone 125-250 mg IM single dose; o Genital warts (inside and outside the vagina, anus & cervix)
 Doxycycline 100 mg orally BID for 7 days.
 Male
o Genital warts (scrotum, anus, groin, thighs)
PREGNANT
 Ceftriaxone 125-150 mg IM single dose plus Erythromycin  Other manifestations
500 mg orally for 7 days o Vaginal discharge, vaginal bleeding, genital itch, increased
dampness
AQUEOUS PROCAINE PCN 4M UNITS IM ANST (INITIAL
REGIMEN) COMPLICATIONS
 Disseminated gonococcal; infection 1 g Ceftriaxone IM or IV  Cervical cancer
every 24 hours  Penile cancer
 2 g spectinomycin IM every 12 hours for those allergic
beta-lactam NURSING MANAGEMENT
 Universal precaution
o Gonococcal conjunctivitis - 1g single dose ceftriaxone IM &
irrigation of infected eye with NSS.
PREVENTION
 Avoiding sexual contact
NURSING MANAGEMENT
 HPV vaccine- Gardasil (given at 9-25 years old)
 Check for drug sensitivities prior to tx
 Standard precautions 5
SYPHILIS
 Respect client privacy
 Isolate pt until recovery
ALSO KNOWN AS Morbus Gallicus or Lues Venereal
 Gonococcal arthritis – moist heat to affected areas INCUBATION PERIOD 10-90 days
 Infants- 1% silver nitrate or other ophthalmic prophylaxis CAUSATIVE AGENT Trepanoma pallidum
 Contact trace and report cases PERIOD OF Variable and indefinite
COMMUNICABILITY
SIGNS OF GONOCOCCAL OPHTHALMIA NEONATORUM SOURCE OF INFECTION Discharge from infected persons
 Lid edema (semen; blood; urine)
 Bilateral conjunctival edema MODE OF TRANSMISSION Transplacental
 Abundant purulent discharge 2-3 days after birth Indirect contact with contaminated
 May progress to corneal ulceration & blindness articles
Direct contact with infected persons
PREVENTION DIAGNOSTIC Dark field illumination
 Sex education Fluorescent treponemal antibody
 Case finding & contact tracing absorption test
 Reporting of cases Venereal Disease Research
Laboratory (VDRL)
4
HUMAN PAPILLOMAVIRUS (HPV) CSF analysis
TREATMENT
ALSO KNOWN AS

INCUBATION PERIOD 2-3 MONTHS CLINICAL MANIFESTATIONS

CAUSATIVE AGENT  Primary Syphilis
o Starts with one or more chancre that erupt in the genitalia,
PERIOD OF
anus, nipple, tonsils, or eyelids.
COMMUNICABILITY
o Painful chancres: start as papule that erode.
SOURCE OF INFECTION -----------------------------------------
MODE OF TRANSMISSION Sexual contact o Chancres disappears after 3-6 weeks without treatment.

DIAGNOSTIC Pap smear o Unilateral or bilateral lymphadenopathy may be present.

HPV DNA test o In women, chancres are often overlooked because they often
Biopsy develop in the internal surfaces such as the vaginal wall or the
Colposcopy cervix.
TREATMENT Trichloroacetic acid
 Secondary Syphilis
Podophyllin
o Development of mucocutaneous lesions & generalized
Imiquimod
lymphadenopathy.
Surgery: Cryosurgery,
Electrocauterization, Laser o Rash (macular, popular, pustular, or nodular)

Surgery o Lesions, uniform in size well defined & generalized.

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NCM 112: MEDICAL-SURGICAL NURSING LECTURER: MR. ANDRE CARLO DE VEYRA

o Macules erupt between rolls of fat on the trunk, arms, 2. Late Congenital Syphilis
palms, sole, face & scalp. - Interstitial keratitis – late lesion
o In moist areas of the body such as the perineum, the vulva - Circumcorneal vascularization of the sclera
and rolls of fat in the scrotum, the lesions would enlarge - Corneal opacities which may cause slight impairment of
and erode forming a highly contaminated pink to grayish- vision and would lead to blindness.
white lesion called Condylomata lata
o Mild constitutional symptoms (headache, anorexia, COMPLICATIONS
malaise, weight loss, nausea, vomiting, sore throat, slight  Insanity and brain damage  Heart Disease

fever)  Severe illness or death in infants  Severe damage to organs

o Alopecia (temporary)
TREATMENT
o Nails become brittle and pitted
 Penicillin G 2.4 million units
 Latent Syphilis  Oral tetracycline or doxycycline
o Serologic test proves to be reactive.  Syphilis of more than a year’s duration is treated usually with
o Remains asymptomatic until death. Penicillin Benzathine 2.4 million units per week for 3 weeks.
 Not pregnant patients who develop allergy to Penicillin may be
 Late Syphilis
treated with Oral tetracycline or doxycycline for 15 days for
o Destructive but non-infectious stage
early syphilis and 30 days for late syphilis.

3 SUBTYPES OF LATE SYPHILIS  Tetracycline is contraindicated for pregnant women which can
cause congenital anomalies and damage to the teeth of the
1. Late Benign
fetus.
- Develop 1-10 years after infection.
 Patient receiving treatment must abstain from sexual contact
- Appear on skin, bones, upper respiratory tract, mucus
until infection is completely healed.
membranes, liver and stomach.
- Typical lesion called Gumma, a chronic superficial nodule,
NURSING MANAGEMENT
solitary asymmetric, painless, indurated & can be found in
 Stress importance of completing treatment to prevent resistant
any bone.
to drug.
2. Late Syphilis  Instruct partner that they should be tested.
- Involves the liver that leads to epigastric pain, tenderness,  Universal precaution
enlarged spleen, anemia  Keep lesions as dry as possible
- Affects URT, cause perforation of the nasal septum or  Check for signs of decreased cardiac output which can indicate
palate. cardiovascular syphilis
- Destruction of other organs.
 Check the level of consciousness, mood, and coherence
- Death
 Check for signs of ataxia which may indicate brain or CNS
3. Cardiovascular Syphilis affectation
- Develops about 10 years after initial infection.  Encourage to undergo VDRL testing after 3, 6, 12, and 24
- Pt may appear asymptomatic but may suffer from aortic months to detect any relapse.
regurgitation and aneurysm.  Report cases.

CONGENITAL SYPHILIS PREVENTION

 which would affect the baby. The fetus may be overwhelmed with  Report cases to DOH
the infection and may die. The fetus then may be expelled by the  Control prostitution
uterus leading to miscarriage, stillbirth depending on the stage of  Require sex workers to have regular check-up
the pregnancy. A syphilitic stillborn may have a lacerated  Proper sex education
appearance and collapsed skull, protuberant abdomen, the skin
is livid color and, on its surface, it may be seen a number of bullae
filled with hemorrhagic fluid. Spleen and liver are also enlarged,
pancreatitis and thickening of the intestine is also found in severe
cases.

1. Early Congenital Syphilis

- Bullous rash (syphilis pemphigus) may be present at birth
- Old man look because of weight loss
- Syphilis nonychia which involves the nails
- Mucus patch found on the lips, mouth, throat, nasal
passages.
- Mucopurulent discharge
- Hepatosplenomegaly
- Impaired protein metabolism

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6
HERPES SIMPLEX CLINICAL CHARACTERISTICS
MILD TO MODERATE
ALSO KNOWN AS The virus of love
1. Oral Herpes
INCUBATION 2-20 days
- Gingivostomatitis in young children is the most common
PERIOD
clinical manifestation of the initial infection with HSV.
CAUSATIVE AGENT Epstein-Barr virus
- Vesicular and ulcerative lesions occur in the buccal
PERIOD OF mucosa and may involve the tongue.
COMMUNICABILITY - Inflammation of the gums, cervical adenopathy and fever
SOURCE OF
are present.
INFECTION
- Excessive salivation results from pain on swallowing in
MODE OF Type 1- transmitted via kissing, sharing of
infants and young children.
TRANSMISSION kitchen utensils and sharing of towels.
- Feeding is painful and fluid intake is poor.
Type 2- transmitted via sexual contact.
DIAGNOSTIC Viral culture 2. Labial Herpes
Polymerase chain reaction test - Lips may occasionally be involved in the primary infection.
Blood test - Commonly known as cold sores or fever blisters
TREATMENT Antiviral - The lesions then crust and heal within 3-10 days.
Acyclovir - Subsequent recurrences are usually close to the original
Famciclovir site.
Valacyclovir
3. Ocular Herpes
- A viral disease characterized by an appearance of sores and - Herpetic keratitis is a major medical problem that
blisters anywhere on the skin. These sores usually occur either potentially lead to loss of vision.
around the mouth, nose, genitals and the buttocks. Also known - Primary keratitis may be accompanied by conjunctivitis
as the virus of love. and preauricular lymphadenopathy.
- Conjunctivitis alone may also be a manifestation of
TYPE 1 HERPES SIMPLEX primary infection.
 In type 1 virus this can cause cold sores that usually affects - Recurrent keratitis is usually unilateral but 2% to 6% of
during infancy or childhood. cases may be bilateral.
 The sore is characterized to be tiny, clear, fluid-filled blisters. - More serious disease may occur if the stroma is involved
 The sores commonly affect the lips, mouth, nose, chin, cheeks or if iridocyclitis occurs.
and occurs shortly after exposure.
 Patient may barely notice the symptoms or the need for 4. Cutaneous Herpes
medical attention for relief of pain. - HSV may affect the skin on any part of the body.
- May be accompanied by deep burning pain, fever, skin
TYPE 2 HERPES SIMPLEX edema, ascending lymphangitis and regional
 In type 2 virus it causes genital sores affecting the buttocks, lymphadenopathy.
penis, vagina, cervix and it would last for 2-20 days. - Majority of samples isolated from above the waistline is
 It affects 20% of sexually active individuals and the virus can be type 1 and those isolated from below the waistline is type
spread by touching an unaffected part of the body after 2.
touching the herpes lesion.
5. Erythema Multiforme
PATHOGENESIS - Allergic reaction of the skin is sometimes a complication of
 Before blisters appear, the skin would be itchy and very HSV infections.
sensitive. - HSV lesions sometimes appear as a zosteriform
distribution that mimics herpes zoster.
 The lesions are limited to the epidermis source superficial
mucus membrane. The blisters may break as a result of injury 6. Genital Herpes
allowing the fluid of the blister to ooze and crust (whitish to - One of the most common sexually transmitted diseases.
yellow in color) around the area.
 The crust falls off leaving slightly red healing skin however the SEVERE TO FATAL DISEASE
virus remains in the body, but it doesn’t mean that once the 1. Newborns
crusts fall it is fully healed. It would then infect the nerve cells - Neonatal herpetic infection is usually acquired from
and remain there in a resting state. maternal infection at the time of delivery.
 The infection may recur in either the same location or nearby
2. Eczema varicelliform eruption
site. Subsequent infections tend to be milder than the primary
- Occurs most commonly in individuals with atopic
infection.
dermatitis.

CLINICAL MANIFESTATION 3. Encephalitis

 Minor rash  Muscular Pain  Fever - Considered as one of the most common non-epidemic
 Painful sore  Burning sensation on urination forms of herpes infection.

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NURSING MANAGEMENT  The HIV attacks the immune system, the organism attaches to
 Restoration of fluid and electrolyte balance a protein molecule called CD4, which is found on the surface
 Proper nutrition of T4 cells. Once the virus enters the T4, it inserts its genetic
 Isolation of clients (eczema herpeticum or neonatal herpes) materials into the T4 cell’s nucleus, taking over the cell to
 Universal precaution such as handwashing replicate itself. The T4 cell would die after having been used to
replicate HIV.
PREVENTION  The virus mutates rapidly, and it is more difficult for the body’s
 Health and sex education immune system to “recognize” the invaders. HIV infection
 Use of condoms progresses through several stages
 All types of virus needs a cell for it to survive and replicate.
7
ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)
The virus could not replicate or multiply without invading a
ALSO KNOWN AS: AIDS cell. ALL VIRUSES.
CAUSATIVE AGENT Human Immunodeficiency Virus (HIV)  HIV affects the CD4 cells and B-lymphocytes (heralds in the
INCUBATION 7-12 years, some patients - 3 years development of immunoglobulin). Immunoglobulin and
PERIOD: antibody production is affected which results to patient being
PERIOD OF --------------------------------------------------------- immunocompromised.
COMMUNICABILITY:
MODE OF Sexual intercourse DIAGNOSTIC TESTS
TRANSMISSION Perinatal transmission  ELISA (enzyme-linked immunosorbent assay) – antigen
Blood transfusion antibody
Sharing/injury of infected needle  Particle agglutination test
DIAGNOSTICS: ELISA,  Western blot analysis – CONFRIMATORY
Particle agglutination test  Immunofluorescent test
Western blot analysis  Radio-immune perception test
Immunofluorescent test  Skin biopsy
Radio-immune perception test o Normal CD4 count – 500 to 1,500
Skin biopsy o Viral load less than 10,000 is low
TREATMENT: Reverse transcriptase inhibitors o CD4 count of 230 with viral load of 350,000 – considered
Protease inhibitors serious and needed treatment.
Viral load – amount of virus present.
ETIOLOGIC AGENT
 Human Immunodeficiency Virus (HIV)
MODIFIED CLASSIFICATION (STAGES OF HIV INFECTION)

INCUBATION PERIOD:  CLINICAL STAGE 1: Asymptomatic

 7-12 years - Characterized by general lymphadenopathy

 Nowadays there are some patients, the incubation period is 3

years.  CLINICAL STAGE 2: Early (Mild)
- Weight loss greater than 10% of body weight

MODE OF TRANSMISSION - Minor mucocutaneous manifestation:

 Sexual intercourse  Blood Transfusion a) Seborrheic dermatitis

 Sharing/injury of infected needle  Perinatal transmission

Question: Can a mother with HIV breastfeed a baby?

Answer: Yes, transmission of HIV is 1:1000. The advantage of
breastfeeding outweighs the risk of contracting HIV. Mixed feeding
is NOT ALLOWED because the resistance of the baby will be lower.

PATHOPHYSIOLOGY
 Human beings produce antibodies against specific infections.
When HIV infection takes place, anti-HIV antibodies are b) Fungal nail infection
produced but they do not become detectable immediately.
This is called the “window effect”. In some cases, the
antibodies to HIV become detectable 4 to 6 weeks after
infection.
 Window effect – the body is just starting to produce
antibodies.
 The HIV is in circulation, it invades several types of cells – the
lymphocytes, macrophages, the Langerhans cells, and
neurons within the CNS.

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c) Recurrent oral ulceration MAJOR SIGNS

 Weight loss 10% of body weight
 Chronic diarrhea for >1 month
 Prolonged fever for 1 month

TOP 10 SYNDROMS OF HIV

 Depression
 Diarrhea
 Thrush
d) Angular cheilitis  Weight loss
 Lipodystrophy (fat redistribution syndrome)
 Sinus infection
 Fatigue
 Nausea and vomiting
 Lactic acidosis (due to the damaged mitochondria)
 Peripheral neuropathy (burning and tingling sensation

COMMON OPPORTUNISTIC INFECTIONS

BACTERIAL
e) Recurrent respiratory infection  MAC / mycobacterium avium complex  Salmonellosis
 Tuberculosis

 CLINICAL STAGE 3: Intermediate (Moderate)

VIRAL
- Weight loss greater than 10%
 Herpes
- Chronic unexplained diarrhea (more than a month)
 Hepatitis
- Oral thrush
 Genital warts
- Oral hairy leukoplakia  Cytomegalovirus (CMV)
o causes pain on swallowing, numbness of the legs. This
can be transmitted through semen, vaginal secretions,
blood and breastmilk.
 Molluscum contangiosum
o dome-shaped papules (face, trunk & extremities)

FUNGAL
 Candidiasis
- Severe bacterial infection (pneumonia)
 Cryptococcal meningitis
 Histoplasmosis
o small lesions that appear on the skin. Usually transmitted
by direct contact and it is autoinoculable. The organism
is resistant to treatment. When the CD4 count fall below
200, lesions tend to proliferate and start to spread.

PNEUMONIAS
 Bacterial
 CLINICAL STAGE 4: Late (Severe)
 Pneumocystis carinii pneumonia (PCP)
- HIV wasting syndrome
o Atypical type of pneumonia. For HIV patients.
- Pneumocystis carinii pneumonia
- Toxoplasmosis of the brain
CANCERS
- Cryptosporidiosis with diarrhea for more than a month
 Kaposi’s sarcoma
- Herpes simplex virus infection
o cancerous lesion, overgrowth
- Progressive Multifocal Leukoencephalopathy. Affects only
of blood vessels. Found on
the brain. Hallucinations and delirium
the surfaces of the skin, oral
- (PML) Disseminated endemic mycosis
cavity, internally on the
intestines, lymph nodes and
MINOR SIGNS
lungs, and can attack eyes
1. Persistent cough for 1 month
2. Generalized pruritic dermatitis
 Cervical dysplasia and cancer
3. Recurrent herpes zoster infection
o associated with HPV
4. Oropharyngeal candidiasis
5. Chronic disseminated herpes simplex infection
 Non-Hodgkin’s lymphoma
6. Generalized lymphadenopathy
o cancerous tumors in the lymph nodes

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RTRMF – BSN LEVEL III MARINURSE AND FRIENDS F#1
NCM 112: MEDICAL-SURGICAL NURSING LECTURER: MR. ANDRE CARLO DE VEYRA

PARASITIC 8
TRICHOMONIASIS
 Toxoplasmosis
o Parasitic disease that causes neurologic symptoms. ALSO KNOWN AS: --------------------------------------------------------
o Acquired by eating raw meat and from cat litter. CAUSATIVE AGENT Trichomonas Vaginalis

 Cryptosporidiosis INCUBATION PERIOD: 4-28 days

o Microscopic parasite cryptosporidium - Can cause PERIOD OF
--------------------------------------------------------
serious illness in people with HIV, especially if CD4 COMMUNICABILITY:
count below 200. If CD4 count is above 200, symptoms MODE OF Sexual intercourse
may appear 1-3 weeks. TRANSMISSION Perinatal transmission
o Acquired by having contact with feces. It is not blood Blood transfusion
borne. There is no drug for this. Sharing/injury of infected needle

TREATMENT DIAGNOSTICS: --------------------------------------------------------

 Reverse transcriptase inhibitors
 Zedovudine (ZDV) - Retrovir
 Zalcitabine – Hivid
 Lamivudine - Epivir
TREATMENT: One megadose of Metronidazole
 Stavudine – Zerit (Flagyl), Tinidazole
 Nevirapine – Viramune
 Didanosine - Videx
ETIOLOGIC AGENT

 Protease inhibitors  Trichomonas Vaginalis

 Saquinavir – Invarase  Indinavir - Crixivan

 Ritonavir – Norvir INCUBATION PERIOD
 4-28 days

NURSING MANAGEMENT
CLINICAL MANIFESTATION
 Health Education
o Be consistent, concise, use positive statement, and give  Female

practical advice. o Foul smelling vaginal discharge (white frothy discharge,

o When you talk to the patient, remove the biases, prejudice, gray, yellow or green discharge)

be accepting, and remove unnecessary judgment. o Genital itching

o Painful urination

 Standard Precaution
 Male
o Hand washing
o Irritation of the penis
o Use of PPE (cap, mask, gloves, CD gown, face
o Discharge from the penis
shield/goggles, is very necessary)
o But typically, does not exhibit symptoms as compared to
women
 Republic Act 8504 – Aids Prevention & Control Act of 1998

COMPLICATIONS
PREVENTION
 Premature delivery (pregnant clients)
 Avoid pricks from sharp instruments
 Low birth weight baby
 Wear gloves when handling blood specimens and other body
secretions. TREATMENT
 “AIDS precaution”  One megadose of metronidazole (Flagyl)
 Disinfectants such as “chlorox”  Tinidazole

 Personal articles should not be shared such as razors and

toothbrush END

 Isolation of active cases

 Practice monogamous relationships

4 C’s
 COMPLIANCE – ensuring patient sticks with the program.

 COUNSELLING – give instruction about treatment,

disseminating information about the disease, provide guidance
on how to avoid contacting STD and HIV.

 CONTRACT TRACING- tracing and proving treatment of the

partners.

 CONDOMS – practicing safe sex.

In general, all STDs, condoms help in protecting yourself.

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