Question

Define, Risk factor, patho, sign and symptoms; What do we went to prevent? Nursing management; Asess, Do Treatments, medication for Torch

Define, Risk factor, patho, sign and symptoms; What do we went to prevent? Nursing management; Asess, Do Treatments, medication for DIC

Define, Risk factor, patho, sign and symptoms; What do we went to prevent? Nursing management; Asess, Do Treatments, medication for D&C

Define, Risk factor, patho, sign and symptoms; What do we went to prevent? Nursing management; Asess, Do Treatments, medication for Gestation Diabetes

Answer 1

1.TORCH stands for Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes

Toxoplasmosis:

A disease that results from infection with the Toxoplasma gondii parasite.Toxoplasmosis results from infection with a common parasite found in cat feces and contaminated food(undercooked contaminated meat).

#Pathophysiology:

*Toxoplasma gondii has 2 distinct life cycles:

i) The sexual cycle occurs only in cats, the definitive host.

ii) The asexual cycle occurs in other mammals (including humans) and various strains of birds.

*It consists of 2 forms:

i )Tachyzoites (the rapidly dividing form observed in the acute phase of infection)

ii) Bradyzoites (the slowly growing form observed in tissue cysts).

By eating contaminated raw meat, wild birds, or mice, a cat becomes infected with Toxoplasma gondii $\small \rightarrow$ The organism’s sexual cycle then begins in the cat’s gastrointestinal (GI) tract (Tachyzoites) $\small \rightarrow$ Macrogametocytes and microgametocytes develop from ingested bradyzoites $\small \rightarrow$ They fuse to form zygotes $\small \rightarrow$ The zygote sporulates and divides to form sporozoites within the oocyst $\small \rightarrow$ Sporozoites become infectious 24 hours or more after the cat sheds the oocyst via feces.

-Infection can occur by ingestion of oocysts following the handling of contaminated soil or through the consumption of contaminated water or contaminated food.

-Following primary maternal infection $\small \rightarrow$ Transmission of tachyzoites to the fetus can occur via the placenta

-Ingestion of tissue cysts (bradyzoites) in undercooked or uncooked meat $\small \rightarrow$ Transmission

-It can be transmitted through transplantation of an organ that contains tissue cysts.

It can cause serious complications for pregnant women and people with weakened immune systems.
*Symptoms include mild flu-like syndrome or fever, and headache, malaise, myalgia all of which can last for weeks.

*Neonates may exhibit jaundice, rash, hepatosplenomegaly (swollen liver and spleen)

Prevention :

-Wear disposable gloves when handling litter boxes or working in soil or sand that is possibly contaminated with cat feces

-Wash hands after removing gloves

-Do not feed cats raw meat.

-Wear appropriate gloves when in contact with raw meat

-Pregnant women should avoid cleaning litter pans and contact with cats of unknown feeding history

-Feed pet cats only dry, canned or cooked food. Try to keep pet cats indoors to discourage scavenging for food.

-Cover children’s sandboxes to keep cats from using it as a litter box.

-Eat meat that has been thoroughly smoked, cured or cooked.

-Wash fruit and vegetables before eating.

-Do not eat raw eggs. Do not drink unpasteurized milk or other dairy products.

Treatment:

• Pyrimethamine, an antimalarial drug considered the most effective agent in treating an acute toxo infection
• Sulfadiazine, an antibiotic drug used in combination with pyrimethamine
• Clindamycin, an alternative antibiotic used alongside pyrimethamine
• Minocycline, an antibiotic used only when a person is resistant to both sulfadiazine and clindamycin
• Folinic acid used as a supplement to reduce the risk of thrombocytopenia(low platelets)

Rubella:

A contagious viral infection caused by rubella virus, preventable by vaccine and best known by its distinctive red rash.

*Risk factor:

-human transmission only
-droplets
-vaccine use decreased incidence by 99%

*Rubella Pathogenesis:

-humans are the only host and are transmitted by droplets
-incubation: 14-21 days
- infects upper respiratory tract and spreads to lymph nodes causing lymphadenopathy and dissemination to the target organs
- the prodromal period lasts about 2 weeks
- the virus is shed in respiratory droplets during the prodromal period and after the onset of the rash
- congenital infection is transmitted transplacentally
- prodromal period: period without symptoms, lasts about 2 weeks, a detectable virus in the pharynx
- contagious if the virus is in the pharynx

*Signs and symptoms:

-mild symptoms
-slight fever
-erythematous maculopapular rash
-generalized lymphadenopathy (post auricular)
-transient joint symptoms
- after incubation (14-21 days), symptoms consist of a 3 day maculopapular or macular rash
- infections in adults can be severe and cause arthralgia, arthritis and rarely thrombocytopenia or post-infectious encephalitis
- however, congenital rubella may cause a number of abnormalities depending on the organ systems involved and gestational age
- mortality in utero and within the first year after birth is high for affected babies

Prevention:

-vaccine after exposure affords no protection

- effective live attenuated vaccine RA 27/3 (Meruvax II) administered as a single antigen or together with mumps and measles (MMR) to children at 15 months of age
- immunity is lifelong
- serological screening is available for women planning to conceive

-Vaccination 90 days prior to conception; Non-immune- vaccinate postpartum;

-vaccine contraindicated in pregnancy (live virus)

Treatment:

There is no cure for rubella, only supportive treatment, such as bed rest, fluids, and fever reduction. and analgesics

Cytomegalovirus

Cytomegalovirus is also called CMV.

Cytomegalovirus (CMV) is a member of the herpes family. Related viruses include Epstein-Barr (causes glandular fever), varicella-zoster (causes chickenpox) and herpes simplex (causes cold sores).

*Risk factor:

-Transmission transplacentally and through blood transfusion, sexual intercourse, transplanted organs, and other direct contact with secretions and excretions (saliva, urine, blood, breast milk, or semen),
-Infections of the epithelial cells of the salivary gland, leading to persistent infection and shedding of the virus.
-CMV carried for life once a person is infected

*Pathogenesis:

CMV is found in the saliva, urine, semen, breast milk, feces, blood, and vaginal and cervical secretions of infected people. It can be detected in body fluids for weeks or months after infection.
CMV usually remains latent, but when T-lymphocyte-mediated immunity is compromised (as in organ transplantation, lymphoid neoplasms, and certain acquired immunodeficiencies), CMV is reactivated.
CMV spreads through the body in lymphocytes or mononuclear cells to the lungs, liver, GI tract, eyes, and central nervous system (CNS), typically producing inflammatory reactions.

Signs and symptoms:

Possibly asymptomatic in persons who are immunocompetent

-Fever common
-Lethargy
-In immunocompetent patients with CMV mononucleosis, 3 or more weeks of irregular high fever possibly the only finding

• Tachypnea
• Dyspnea
• Cyanosis
• Cough
• Jaundice
• Spider angiomas
• Hepatomegaly
• Splenomegaly

Prevention:

.1. Ganciclovir
2. Screen blood transfusion + tissue transplants!

Treatment:

The drug of choice for treatment of CMV disease is intravenous ganciclovir,

Herpes simplex:

Herpes simplex is a viral infection caused by the herpes simplex virus. A virus causing contagious sores, most often around the mouth or on the genitals.

*Risk factors:

There are of two types :

HSV 1: transmission through DIRECT person-to-person contact from saliva, mucosal linings of mouths, cold sores
-> cause Ocular Herpes manifestation

HSV 2: transmission through SEXUAL contact
-> cause Genital Herpes infection

*Pathophysiology:

Herpes simplex virus enters through the mucosal linings of mouth, nose, labia (vagina) & fuse with cell membrane & replicate in cell causing blisters/lesions
-Reside in GANGLIA cell body

*Prevention:

Avoid contact with vesicles (direct or indirect)

C-section if active HSV lesion present within 7 days of labor to prevent transmission; Both HSV I and II may be transmitted to the baby so observe contact precautions; Acyclovir/Valtrex to suppress the outbreak of HSV - start at 36 weeks; Vaccinate for varicella prenatally if non-immune to varicella.

Treatment:

Although there is no cure for herpes, treatments can relieve the symptoms. Medication can decrease the pain related to an outbreak and can shorten healing time. They can also decrease the total number of outbreaks. Drugs including Famvir, Zovirax, and Valtrex are among the drugs used to treat the symptoms of herpes. Warm baths may relieve the pain associated with genital sores.

Others:

Others may include Hepatitis B, HIV, group B streptococcus, chlamydia, Gonorrhoea, syphilis, and Human papillomavirus etc

Nursing management of TORCH infection:

*Assess for the signs and symptoms of the particular TORCHinfection

*Assess for screening as per doctors orders

*Administer medications as per doctors orders

*Give health education regarding care during the antenatal period to prevent the complications

*Give health education to the spouse and family members regarding the care and importance of taking medications

2.DIC:

DIC stands for Disseminated intravascular coagulation is a condition in which blood clots form throughout the body's small blood vessels.,With fewer platelets and clotting factors in the blood, serious bleeding can occur. DIC can cause internal and external bleeding. The clots may lead to blocking of small blood vessels  As clotting factors and platelets are used up, results in bleeding

Risk factors:

• Blood transfusion reaction
• Cancer, especially certain types of leukemia
• Inflammation of the pancreas (pancreatitis)
• Infection in the blood, especially by bacteria or fungus
• Liver disease
• Pregnancy complications (such as placenta that is left behind after delivery)
• Recent surgery or anesthesia
• Severe tissue injury (as in burns and head injury)
• Large hemangioma (a blood vessel that is not formed properly)

Pathogenesis:

DIC occurs because of aberrant activation of the clotting cascade, leading to fibrin deposition in small vessels, combined with activation of fibrinolytic mechanisms, leading to bleeding.

DIC is usually a common final hemostatic disorder caused by other conditions such as sepsis, pancreatitis, or trauma. Because they are consumed by the ongoing prothrombotic and fibrinolytic processes, coagulation proteins and platelets can become depleted, leading to bleeding.

Thus, in DIC, hemorrhage, and thrombosis can occur simultaneously. DIC can be an acute or a chronic disorder, and the latter is seen mostly in obstetric and oncology patients. Hereafter, the discussion will focus primarily on acute DIC, the form most likely to be encountered in the critical care setting.

Signs and symptoms:

-sudden onset of bleeding disorder without a prior history of bleeding or blood coagulation abnormalities
- spontaneous bleeding for no reason
- purple toes and gums bleeding
- IV bleeding continuously
-petechiae, bruising, ecchymosis, hematomas
- conjunctival bleeding
- tubes, veins, lines, incisions, wounds
- overt bleeding or oozing
- occult bleeding
- changes in mental status
- infarction of tissues in digits and nose

Prevention:

Prevention of cause- prevent sepsis, prevent placenta abruptio,

Management of DIC:

-Administer oxygen
-Will need blood product transfusions because bleeding out, fresh frozen, platelets
-infusion of an anticoagulation agent like heparin to release those clogged up clotting factors.

Nursing Management:

*Assess for the signs and symptoms

*Frequent monitoring of the patient

*Administer the blood products or anticoagulants as needed

*Monitor vital signs frequently

D & C:

D and C stand for dilation and curettage.

A dilation and curettage procedure is a surgical procedure in which the cervix (lower, narrow part of the uterus) is dilated (expanded) so that the uterine lining (endometrium) can be scraped with a curette (spoon-shaped instrument) to remove abnormal tissues.

Indication:

The curettage procedure (D&C) involves dilating the uterine cervix so that the lining tissue (endometrium) of the uterus can be removed by scraping or suction. The D&C is a safe procedure that is done for a variety of reasons. A D&C is often done as an adjunct procedure to a hysteroscopy and/or polypectomy.

Possible risks for Dand C;

• Risks associated with anesthesia such as an adverse reaction to medication and breathing problems.
• Hemorrhage or heavy bleeding.
• Infection in the uterus or other pelvic organs.
• Perforation or puncture to the uterus.
• Laceration or weakening of the cervix.

The Possible side effects of Dand C:

• Heavy bleeding.
• Foul-smelling vaginal discharge.
• Severe abdominal pain.
• Fever and/or chills.

The D&C can be done in the doctor's office, or an outpatient clinic, or the hospital. It usually takes only 10 to 15 minutes, but the patient may stay in the office, clinic, or hospital for up to five hours to become stable.

Nursing assessment and management:

• Nurses have to record your vital signs such as temperature, pulse, and blood pressure.
• observed for any vaginal bleeding.
• If any complicated signs occur inform to the physician

Gestational Diabetes mellitus:

Gestational diabetes mellitus (GDM) defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy.

Risk factor:

• an unidentified preexisting disease
• the unmasking of a compensated metabolic abnormality be the added stress of pregnancy
• a direct consequence of the altered maternal metabolism stemming from changing hormonal levels
• spontaneous abortion, which is related to poor glycemic control
• infections (urinary and vaginal) which are related to increased glucose in the urine and decreased resistance because of altered carbohydrate metabolism
• Hydramnios, which can cause overdistention of the uterus, premature rupture of membranes, preterm labor, and hemorrhage.
• Ketoacidosis from the diabetogenic effect of pregnancy (increased insulin resistance), untreated hyperglycemia or inappropriate insulin dosing
• hypoglycemia which is caused by overdosing in insulin skipped or late meals, or increased exercise
• hyperglycemia, which causes excessive fetal growth (macrosomia)
• over the age of 35
• . obesity
• multiple gestations
• the family history of DM

Pathophysiology:

In pregnancy, there is an increased need for insulin
2. There is an increase in human placental lactogen and growth hormone, causing insulin resistance
3. Insulin needs inc to overcome the resistance caused by the two hormones
4. Insulin resistance peaks in late pregnancy to provide more nutrients to the fetus.

signs and symptoms:

-weight loss
-blurred vision
-recurrent UTI and yeast infections
-signs of gestational hypertension
-large fetus for gestational age

Prevention:

-keep blood glucose between 65 and 130, diet, exercise, insulin as needed
-monitor weight
-monitor for s/s of infection
-assess fetal status

Management :

• Planning the diet and following a balanced meal plan
• Exercising regularly
• Taking medication, if prescribed, and closely following the guidelines on how and when to take it
• Monitoring your blood glucose and blood pressure levels at home
• Keeping appointments with the healthcare providers and having laboratory tests completed as ordered by your doctor.

Medications:

Administer insulin as prescribed
-most oral hypoglycemic agents are contraindicated for gestational diabetes mellitus, but there is limited use of glyburide (DiaBeta) at this time. The provider will need to make the determination if these medications may be used.

Nursing management:

• monitor the client's blood glucose
• monitor the fetus
• instruct the client to perform daily kick counts
• educate the client about diet and exercise
• instruct the client about self-administration of insulin
• educate the client about the need for postpartum laboratory testing to include OGTT and blood glucose levels.