The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

More documents

Recommendations

Info

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 8: Oral ProblemsTable 8-1: Medications for Oral Conditions26 picasCondition Problem Medication DosageCaries “Dry mouth” Sugar-free lemon drops or artificial salivaAbscess Penicillin VK 500mg q6H for 28 dosesOral candidiasis Oral infection Clotrimazole troches Slowly allow to dissolve in mouth, one q4H whileawake, for 14 daysFluconazole 100mg 1 tablet/day for 14 daysAngular cheilitis Clotrimazole 1% cream Apply two to three times/day until condition clearsRecurrent aphthous Minor lesion Fluocinonide (Lidex Cream) or Apply to lesion four times a daystomatitis Triamcinolone acetonide (Kenalog until condition clearsin Orabase)Major lesion Same medication as above; if no effect, consider systemic prednisone, tapering dosesRecurrent herpes simplex Prodromal stage Acyclovir ointment Apply q3H for 7 daysLesion present Acyclovir 200mg 1q4H while awake for 10 daysPeriodontal disease Linear erythemetous Chlorhexidine gluconate rinse Rinse with 1/2 oz, bid for 2 weeksgingivitisNecrotizing ulcerative Chlorhexidine rinses and either Both 250 mg, q6H for metronidazole,periodontitis metronidazole or Augmentin 1 q8H forAugmentin, for 7 days1Amoxicillin/clavulanate potassium168U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau
A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 8: Oral ProblemsCARIES■ Caries, or dental decay, is a common problem for everyone. Medical providers do not need tobe concerned with a few carious lesions (cavities). However, rampant decay in an HIV-positive26 picaspatient’s teeth frequently lead to pulpal infection, followed rapidly by abscess formation, whichis important to either prevent or treat promptly.Some antiretroviral medications (e.g., indinavir) can cause decreased salivary flow, which isknown to result in rampant caries; it is not uncommon for patients with decreased salivary flowto have multiple carious lesions. These lesions frequently are at the cervical area, the part of thetooth where the crown meets the roots. The tooth surface at this area is cementum, not enamel,and more likely to decay at a faster rate. Further, this can lead to an abscess formation whichcan be debilitating. A photo showing rampant decay in the cervical area can be seen in ColorPlate 8-1 at the end of this chapter.In cases of rampant decay, treatment should be expedited, which may mean that the dentistuses the technique called scoop and fill. As quickly as possible, and usually without anesthesia,the bulk of the decay is scooped out, using hand instruments, and then filled with a temporaryfilling or medium that contains fluoride, so that further decay is inhibited. The filling material ofchoice is glass ionomer. Once the teeth are temporized by the scoop and fill, the dentist canthen go back and restore each tooth in a traditional manner.Until the patient can be treated by a dentist, several steps can be taken by medical providers. Thefirst, and clearly most important, is to determine if there are any cavities that have extended intothe pulp, causing an infection. This is recognizable by swelling, and would be noticed by medicalproviders during a routine examination of the oral cavity. Infections should be treated with antibiotics,preferably penicillin. Treatment should be immediately implemented, and a referral to adentist should occur within days. The treatment for an abscess is the same for both HIV-positiveand HIV-negative patients.If there are no obvious infections, but decay is present, particularly if the decay is extensive, palliativecare consists of fluoride mouth rinses, which can be prescribed by the medical provider priorto referring the patient to a dentist. Referral should occur as soon as possible, but this is not anurgent problem.There are artificial saliva products that can be used with patients who have active decay, resultingin part from xerostomia (dry mouth) that can be caused by medications or even HIV infectionitself. However, the frequency with which these artificial saliva products have to be usedmay be unrealistic, and patients may prefer to use sugar-free lemon drops, which stimulatesaliva, another palliative treatment that is effective. Medical providers can suggest the use ofeither sugar-free lemon drops or over-the-counter saliva substitutes.VIIIORAL CANDIDIASIS■ Oral candidiasis is a relatively frequent problem for people who are HIV-positive. This conditionhas several different forms, the most common being pseudomembranous candidiasis. Candidiasis,which presents with small white patches any place in the mouth, can be mistaken for materia alba,or food particles. A photo showing pseudomembranous candidiasis is seen in Color Plate 8-2.Pseudomembranous candidiasis is generally white, and can easily be wiped off. There may be anerythematous area or bleeding under the white patch. The patient usually notices a change intaste, with food becoming undesirable. Further, there may be pain or a burning sensation associatedwith this lesion.U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 169
Page 4 and 5:
DedicationA Clinical Guide to Suppo
Page 6 and 7:
Lynn A Jansen, RN, PhDAssistant Res
Page 9 and 10:
TABLE OF CONTENTSPart IChapter 1Cha
Page 11 and 12:
IChapter 1.26 picasHIV and Palliati
Page 13:
IA Clinical Guide to Supportive and
Page 16 and 17:
A Clinical Guide to Supportive and
Page 18 and 19:
Page 20 and 21:
Page 22 and 23:
Page 24 and 25:
Page 26 and 27:
Page 28 and 29:
Page 30 and 31:
Page 32 and 33:
Page 34 and 35:
Page 36 and 37:
Page 38 and 39:
Page 40 and 41:
Page 42 and 43:
Page 44 and 45:
Page 47 and 48:
IIIChapter 3.Assessment of Physical
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93:
Page 96 and 97:
Page 98 and 99:
Page 100 and 101:
Page 102 and 103:
Page 104 and 105:
Page 106 and 107:
Page 108 and 109:
Page 110 and 111:
Page 112 and 113:
Page 114 and 115:
Page 116 and 117:
Page 118 and 119:
Page 120 and 121:
Page 122 and 123:
Page 124 and 125:
Page 126 and 127:
Page 128 and 129: A Clinical Guide to Supportive and
Page 145 and 146: Chapter 6.26 picasPulmonary Symptom
Page 165: A Clinical Guide to Supportive and
Page 177: Chapter 8.26 picasOral ProblemsDavi
Page 187 and 188: Chapter 9.26 picasDermatologic Prob
Page 217 and 218: Chapter 10.26 picasPsychiatric Prob
Page 229 and 230:
Page 231 and 232:
Page 233 and 234:
Page 235 and 236:
Page 237 and 238:
Page 239 and 240:
Page 241 and 242:
Page 243 and 244:
Page 245 and 246:
Page 247 and 248:
Page 249 and 250:
Page 251 and 252:
Page 253 and 254:
Page 255 and 256:
Page 257 and 258:
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
Chapter 11.26 picas Substance Use P
Page 265 and 266:
Page 267 and 268:
Page 269 and 270:
Page 271 and 272:
Page 273 and 274:
Page 275:
Page 278 and 279:
Page 280 and 281:
Page 282 and 283:
Page 284 and 285:
Page 286 and 287:
Page 288 and 289:
Page 290 and 291:
Page 292 and 293:
Page 294 and 295:
Page 296 and 297:
Page 298 and 299:
Page 300 and 301:
Page 302 and 303:
Page 304 and 305:
Page 306 and 307:
Page 308 and 309:
Page 311 and 312:
Chapter 14.26 picasCulture and Care
Page 313 and 314:
Page 315 and 316:
Page 317 and 318:
Page 319 and 320:
Page 321 and 322:
Page 323 and 324:
Page 325 and 326:
Chapter 15.26 picasSpecial Populati
Page 327 and 328:
Page 329 and 330:
Page 331 and 332:
Page 333 and 334:
Page 335 and 336:
Page 337:
Page 340 and 341:
Page 342 and 343:
Page 344 and 345:
Page 346 and 347:
Page 348 and 349:
Page 350 and 351:
Page 352 and 353:
Page 354 and 355:
Page 356 and 357:
Page 359 and 360:
Chapter 17.26 picasEthical IssuesLy
Page 361 and 362:
Page 363 and 364:
Page 365 and 366:
Page 367 and 368:
Page 369 and 370:
Page 371 and 372:
Page 373 and 374:
Page 375 and 376:
Chapter 18.26 picasLegal and Financ
Page 377 and 378:
Page 379 and 380:
Page 381 and 382:
Page 383 and 384:
Page 385 and 386:
Page 387 and 388:
Page 389 and 390:
Page 391 and 392:
Page 393 and 394:
Page 395 and 396:
Page 397 and 398:
Chapter 19.Palliative 26 picas Care
Page 399 and 400:
Page 401 and 402:
Page 403 and 404:
Page 405 and 406:
Page 407 and 408:
Page 409 and 410:
Page 411 and 412:
Page 413 and 414:
Page 415 and 416:
Page 417:
Page 420 and 421:
Page 422 and 423:
Page 424 and 425:
Page 426 and 427:
Page 428 and 429:
Page 430 and 431:
Page 432 and 433:
Page 434 and 435:
Page 436 and 437:
Page 438 and 439:
Page 441 and 442:
Chapter 21.26 picas Patient-Clinici
Page 443 and 444:
Page 445 and 446:
Page 447 and 448:
Page 449 and 450:
Page 451 and 452:
Page 453 and 454:
Page 455:
Page 458 and 459:
Page 460 and 461:
Page 462 and 463:
Page 464 and 465:
Page 466 and 467:
Page 468 and 469:
Page 470 and 471:
Page 472 and 473:
Page 474 and 475:
Page 476 and 477:
Page 478 and 479:
Page 480 and 481:
Page 482 and 483:
Page 484 and 485:
Page 486 and 487:
Page 489 and 490:
Chapter 23.26 picas Medical Care in
Page 491 and 492:
Page 493 and 494:
Page 495 and 496:
Page 497 and 498:
Page 499 and 500:
Page 501:
Page 504 and 505:
Page 506 and 507:
Page 508 and 509:
Page 510 and 511:
Page 512 and 513:
Page 515 and 516:
Chapter 25.26 picas Prevention of S
Page 517 and 518:
Page 519 and 520:
Page 521 and 522:
Page 523 and 524:
Page 525 and 526:
Chapter 26.26 picasResourcesMagda B
Page 527 and 528:
Page 529 and 530:
Page 531 and 532:
Page 533 and 534:
Page 535 and 536:
Page 537 and 538:
Page 539 and 540:
Page 541 and 542:
Page 543 and 544:
Page 545 and 546:
Page 547 and 548:
Page 549 and 550:
Page 551 and 552:
Page 553 and 554:
Page 555 and 556:
Page 557:
Page 560 and 561:
Page 562 and 563:
Page 564 and 565:
Page 566 and 567:
Page 568 and 569:
Page 570 and 571:
Page 572 and 573:
Page 574 and 575:
Page 576 and 577:
Page 578 and 579:
Page 580 and 581:
Page 582 and 583:
Page 584 and 585:
Page 586 and 587:
Page 588 and 589:
Page 590 and 591:
Page 592 and 593:
Page 594 and 595:
Page 596 and 597:
Page 598 and 599:
Page 600 and 601:
Page 602 and 603:
Page 604 and 605:
Page 606 and 607:
DRUGS AND THERAPIES INDEXNOTES: Ent
Page 608 and 609:
Page 610 and 611:
Page 612:
show all

The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

Create successful ePaper yourself

Delete template?

Save as template?