Clinical Manual for Management of the HIV-Infected ... - myCME.com

More documents

Recommendations

Info

1–12 | Clinical Manual for Management of the HIV-Infected Adult/2006 Table 3. Physical Examination Eyes • • • • • • Visual acuity and visual fields by confrontation. Tests of extraocular movements and pupillary size and reaction. Funduscopic examination—with or without mydriatics; especially important if CD4 count is
Genitals/Rectum • Inspect the genitalia and perirectal area; note lesions, warts, etc. • Culture discharges, ulcerative lesions, vesicles, and crusted lesions for herpes simplex virus, chancroid, chlamydia, and/or gonorrhea (GC), as appropriate, and send an RPR (rapid plasma reagin) or VDRL (Venereal Disease Research Laboratory) test. Female Patients • • • • • • Speculum examination–note any lesions on vaginal walls or cervix. Obtain a Papanicolaou smear. (Note: Abnormal or inconclusive Papanicolaou smears require colposcopic follow-up, because invasive cervical cancer may progress rapidly in women with HIV. See chapter Cervical Dysplasia.) Obtain endocervical swab for GC and chlamydia, and a posterior pool swab for wet mount evaluation for trichomoniasis, Candida, and bacterial vaginosis. Bimanual exam–note size of uterus and ovaries, shape, and any tenderness or pelvic pain. Rectal examination for anorectal lesions, warts, etc, and evaluation of uterine abnormalities. Anal Papanicolaou smear.* Male Patients • • • • External genitalia–note whether male is circumcised; note any lesions, discharge, other abnormalities, as above. Testicular examination for masses, tenderness. Rectal exam—digital examination to evaluate rectal tone, discharge or tenderness, masses, lesions; prostate exam if appropriate. Anal Papanicolaou smear.* * Anal Papanicolaou smear: Consider this test if follow-up evaluation of abnormal Papanicolaou test results is available. The suggested approach in HIV-infected women and men for anal dysplasia screening is similar to the cervical Papanicolaou screening guidelines for women: perform anal Papanicolaou test at initial diagnosis and, if normal, repeat at 6 months. If the first 2 anal Papanicolaou smears are normal, repeat annually. If a Papanicolaou test shows ASCUS (atypical squamous cells of undetermined significance) or SIL (squamous intraepithelial lesion), refer for anal colposcopy and biopsy. (See chapter Anal Dysplasia.) Section 1—Testing and Assessment | 1–13 Extremities/ Musculoskeletal • • • • • • Joints—note any enlargement, swelling, or tenderness. Muscles—for the major muscle groups, pay close attention to muscle bulk (normal or decreased), tenderness, or weakness. Look for evidence of peripheral fat atrophy. Consider measuring baseline arm, thigh, and chest circumferences for later comparison. Note nail changes (clubbing, cyanosis, fungal infections). Assess for pedal or leg edema. Habitus • Subcutaneous fat loss (face, extremities, buttocks). • Central fat accumulation (neck, dorsocervical, breasts, abdomen). Neurologic • • • • • • Mental status—including orientation, registration, recent and remote memory, and ability to calculate (serial subtraction) Cranial nerves Peripheral sensory examination should include pinprick, temperature, and vibratory stimuli. Extremity strength and gait to discern myopathy, neuropathy, and cerebellar disease Fine motor skills such as rapid alternating movements (often abnormal in dementia) Deep tendon and plantar reflexes Psychiatric • • • • • Patient’s general mood (depressed, anxious, hypertalkative, etc) Verbal content–answers questions appropriately; discussion of suicide Inappropriate or unusual behavior, such as extremes of denial, hostility, or compulsiveness See Neuropsychiatric Disorders section for more complete information on common pathologies. Emergency situations, such as potential suicide or violence— refer to crisis mental health services for immediate evaluation
Page 1 and 2: Clinical Manual for Management of t
Page 3 and 4: Table of Contents Clinical Manual f
Page 5 and 6: Clinical Manual for Management of t
Page 7 and 8: Preface—About this Manual | Clini
Page 9: Previous Editions Atlanta Contribut
Page 12 and 13: ♦ ♦ ♦ ♦ ♦ | Clinical Manu
Page 14 and 15: 1-2 | Clinical Manual for Managemen
Page 23: Initial Physical Examination Backgr
Page 27 and 28: Initial and Interim Laboratory and
Page 29 and 30: Section 1—Testing and Assessment
Page 31: Patient Education ♦ ♦ ♦ ♦ D
Page 34 and 35: 1-22 | Clinical Manual for Manageme
Page 51 and 52: Section 2—Health Maintenance and
Page 53: References ♦ ♦ ♦ ♦ ♦ ♦
Page 67 and 68: Occupational Postexposure Prophylax
Page 69 and 70: P: Plan Laboratory Testing Provide
Page 71 and 72: For hepatitis C, no recommended pro
Page 73 and 74: Section 2—Health Maintenance and
Page 75 and 76:
as hepatitis C or another sexually
Page 77 and 78:
for treatment is appropriate, and b
Page 79 and 80:
Section 2—Health Maintenance and
Page 81 and 82:
contact with the patient. Patients
Page 83 and 84:
tablet daily of trimethoprim-sulfam
Page 85 and 86:
Opportunistic Infection Prophylaxis
Page 87 and 88:
Discontinuing Primary Prophylaxis P
Page 89 and 90:
Latent Tuberculosis Background Late
Page 91 and 92:
INH may cause liver toxicity and it
Page 93:
Patient Education ♦ ♦ ♦ ♦
Page 96 and 97:
2-46 | Clinical Manual for Manageme
Page 98 and 99:
3-2 | Clinical Manual for Managemen
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 117 and 118:
Reducing Maternal-Infant HIV Transm
Page 119 and 120:
Some states require written informe
Page 121 and 122:
contraindicated during pregnancy be
Page 123 and 124:
Section 3—Antiretroviral Therapy
Page 125 and 126:
Nelfinavir (Viracept) Adequate drug
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133:
♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦
Page 136 and 137:
Page 138 and 139:
Page 140 and 141:
Page 142 and 143:
Page 144 and 145:
Page 146 and 147:
Page 148 and 149:
Page 150 and 151:
Page 152 and 153:
Page 154 and 155:
Page 156 and 157:
Page 158 and 159:
Page 160 and 161:
Page 162 and 163:
Page 165 and 166:
Section 4—Complications of Antire
Page 167 and 168:
♦ ♦ ♦ Toronto General Hospita
Page 169 and 170:
Adverse Reactions to HIV Medication
Page 171 and 172:
♦ ♦ ♦ ♦ ♦ Vital signs: No
Page 173 and 174:
egimen, symptoms of fatigue could i
Page 175 and 176:
Recreational Drugs and Antiretrovir
Page 177 and 178:
Section 4—Complications of Antire
Page 179 and 180:
LSD, Mescaline, Psilocin, and Methy
Page 181 and 182:
Immune Reconstitution Syndrome Back
Page 183 and 184:
A: Assessment In the appropriate cl
Page 185 and 186:
♦ ♦ ♦ ♦ ♦ Navas E, Martin
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 202 and 203:
Eye Problems Background The immunos
Page 204:
of
Page 207 and 208:
Page 210 and 211:
Fever Background Although fever may
Page 212 and 213:
Headache Background Headache may ha
Page 214 and 215:
Lymphadenopathy Background Lymphade
Page 216:
Treatment Treatment will depend on
Page 219 and 220:
Page 222 and 223:
Neurologic Symptoms Background The
Page 224 and 225:
♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦
Page 226 and 227:
Pulmonary Symptoms Background Short
Page 228:
Treatment Once the diagnosis is mad
Page 231 and 232:
Page 233 and 234:
Page 235 and 236:
Page 238 and 239:
Candidiasis, Oral and Esophageal Ba
Page 240:
Maintenance therapy Use caution whe
Page 243 and 244:
Page 246 and 247:
Cervical Dysplasia Background Cervi
Page 248:
Patient Education ♦ ♦ ♦ ♦ P
Page 251 and 252:
Page 254 and 255:
Cryptosporidiosis Background Crypto
Page 256:
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
Page 266 and 267:
Gonorrhea and Chlamydia Background
Page 268 and 269:
Treatment of Gonorrhea Treatment op
Page 270 and 271:
Hepatitis B Infection Background He
Page 272 and 273:
♦ ♦ ♦ ♦ ♦ Some patients t
Page 274 and 275:
Hepatitis C Infection Background He
Page 276 and 277:
pregnancy. Ribavirin is teratogenic
Page 278 and 279:
Herpes Simplex, Mucocutaneous Backg
Page 280:
References ♦ ♦ ♦ ♦ ♦ Cent
Page 283 and 284:
Page 285 and 286:
Page 288 and 289:
Kaposi Sarcoma Background Kaposi sa
Page 290 and 291:
Treatment Treatment of KS is not co
Page 292 and 293:
Molluscum Contagiosum Background Mo
Page 294 and 295:
Mycobacterium avium Complex Backgro
Page 296 and 297:
Table 1. Interactions between Rifab
Page 298 and 299:
Mycobacterium tuberculosis: Treatme
Page 300 and 301:
P: Plan Diagnostic Evaluation Durin
Page 302 and 303:
Table 1. Regimens for Treatment of
Page 304 and 305:
Rifabutin may be substituted for ri
Page 306:
Page 309 and 310:
Page 311 and 312:
Page 314 and 315:
Non-Hodgkin Lymphoma Background Non
Page 316:
Patient Education ♦ ♦ ♦ ♦ S
Page 319 and 320:
Page 321 and 322:
Page 323 and 324:
Page 325 and 326:
Page 327 and 328:
Page 329 and 330:
Page 331 and 332:
Page 333 and 334:
6-100| Clinical Manual for Manageme
Page 335 and 336:
6-102| Clinical Manual for Manageme
Page 338 and 339:
Toxoplasmosis Background Toxoplasma
Page 340 and 341:
♦ Atovaquone 1,500 mg orally twic
Page 342 and 343:
Linear Gingival Erythema Background
Page 344 and 345:
Background Necrotizing ulcerating p
Page 346 and 347:
Oral Health Background Examination
Page 348 and 349:
Maxillary Tori; Mandibular Tori S:
Page 350 and 351:
Periodontal Disease Background The
Page 352 and 353:
Oral Hairy Leukoplakia Background O
Page 354 and 355:
Oral Ulceration Background Oral ulc
Page 356 and 357:
Oral Warts Background Oral warts ar
Page 358 and 359:
Page 360 and 361:
Page 362 and 363:
Page 364 and 365:
Page 366 and 367:
Page 369 and 370:
Anxiety Disorders Background Anxiet
Page 371:
Patient Education ♦ ♦ Behaviora
Page 374 and 375:
Page 376 and 377:
Page 378 and 379:
Page 381 and 382:
Insomnia Background Insomnia is a c
Page 383 and 384:
Suicidal Ideation Background Transi
Page 385 and 386:
Section 8—Neuropsychiatric Disord
Page 387 and 388:
P: Plan ♦ ♦ ♦ ♦ ♦ Check t
Page 389 and 390:
Correctional Settings Background Ca
Page 391 and 392:
Adherence Adherence is one of the m
Page 393:
Karnofsky Performance Scale Backgro
Page 396 and 397:
Page 398 and 399:
Page 400:
show all

Clinical Manual for Management of the HIV-Infected ... - myCME.com

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?