NCM 234

Care of Client with

Sexually Transmitted
Diseases
SEXUALLY TRANSMITTED
DISEASES
 COMMON CAUSES OF GENITAL
DISCHARGE

• Gonorrhea
• Non – Gonococcal Urethritis or NGU

• Trichomoniasis

• Candidiasis
• Bacterial Vaginitis
CAUSATIVE AGENT Neisseria gonorrheae
•Direct staining of urethral or cervical secretions
• Fragile organism

INCUBATION PERIOD
2-5 days post coitus
• as early as 1 day
• as late as 12 days
 MAIN SYMPTOMS GONORRHEA in
MALES
Urethral discharge
Dysuria
Thick pus usually in the
morning Pain/burning on urination, sometimes
with increased frequency
. Anal discharge/rectal pain
“ Dysuria in a young man always suggests
Sore throat STD until proven OTHERWISE.”

Often asymptomatic Cloudy or bloodstained urine

1. Urethral stricture
- scarring

2. Prostatitis

3. Epididymitis
• Inflammation of the epididymis
- almost always unilateral
- pain and swelling
- most cases are infectious
• Precedes urethritis
- can be a complication of gonococcal or chlamydial
urethritis and other non-sexually transmitted agents
- in men under 45 years old, commonly associated with STDs
 CLINICAL MANIFESTATIONS
• History of urethral discharge or recent sexual exposure
• Scrotal pain is rapid in 1/3 patients, more gradual in 2/3
patients
• Inguinal pain
• Flank pain (massively swollen spermatic cord)
• Scrotal swelling and tenderness
• Chills, fever, pyuria, bacteriuria
• Elevated WBC
 NURSING CARE FOR CLIENTS WITH
EPIDIDYMITIS
• Obtain urethral and/or urine specimen for culture.
• Maintain client in a restful state.
• Explain the importance of good hygiene practices.
• Encourage fluid intake.
• Apply cold compress or administer sitz bath as ordered.
• Advise to avoid heavy lifting, straining, or sexual activity
until infection subsides.
• Ascertain contacts and treat them.
• Teach to protect self from STD by using condom.
MAIN SYMPTOMS

Vaginal discharge
Cervix: pus, swelling, reddening
Discharges: Yellowish, purulent, usually odorless
Dysuria SIGNS OF EARLY INFECTION IN WOMEN
Gonococcal urethritis
Vaginal Discharge
Pain
Dysuria
1. Pelvic Inflammatory
Disease (PID)

• Frequently associated with pre-

existing or concomitant gonococcal or Complications of
chlamydial infection ascending genital
tract
• Clinical syndrome found in women
resulting from infection of the uterus,
NOTE: 50% OF WOMEN WITH
fallopian tubes, peritoneal structures and GONORRHEA ARE
other surrounding structures. GENERALLY
ASYMPTOMATIC
• If untreated, can lead to adhesions,
sterility, and peritonitis.
 COMPLICATIONS OF GONORRHEA
3. ENDOMETRITIS IN WOMEN
(MENORRHAGIA
OR ETRORRHAGIA) 2. SALPHINGITIS
• Localized PID
•Mainly in fallopian tubes
4. ARTHRITIS/REITER’S • Lower abdominal pain/tenderness
SYNDROME • Fever/ill
• Abnormal period
• TOTAL BLOCK – INFERTILITY
• PARTIAL BLOCK –
ECTOPIC PREGNANCY
• Retarded intrauterine GONORRHEA IN PREGNANCY
growth of fetus
• Same symptoms as
• Premature rupture of in
membranes (PROM) non-pregnant
with premature delivery women
• PID less common
• Eye infection from
pus in the cervix
opthalmia neonatorum • Risk of membrane
infection
pneumonitis/pneumonia
1. ARTHRITIS
• Often affects the knee
• Most common in young people
• More common in females during
pregnancy
• Joint destruction : urgent treatment

2. SEPTICEMIA/BLOOD INFECTION

3. EYE INFECTION (CONJUNCTIVITIS)

 • SEXUAL ABUSE

•
•SWELLING/REDNESS OF VULVA
THERAPEUTIC INTERVENTIONS

•
•
PENICILLIN Tetracycline
drug of choice
•
• Doxycycline
Ceftriaxone •
(Rocephin) Amoxicillin
(Augmenti
n)
 NURSING CARE FOR CLIENTS WITH GONORRHEA
•

•Provide a supportive nonjudgmental environment.

• Encourage the use of early screening and educational programs such
as STD clinics, hotlines and workshops.
• Instruct to use condom to prevent transmission of STD.
• Teach about the disease and its transmission.
• Instruct client to wash hands to prevent conjunctivitis.
 NURSING CARE FOR CLIENTS WITH GONORRHEA

•Make arrangements for follow-up culture 2 weeks after therapy is

initiated.
• Monitor bowel and urinary elimination.
• Allow client to verbalize concerns about potential infertility.
• Continue to encourage to identify prior contacts.
 NURSING CARE FOR CLIENTS WITH GONORRHEA

•Inform client to report the disease to HEALTH DEPARTMENT, assure

confidentiality will be maintained.
• Reinforce teaching regarding medication compliance.
• Avoid sexual activity until tests are negative.
• Reinforce safe sex practices. (monogamous relationship, avoid
multiple sex partners, those with known STDs)
SIGNS AND SYMPTOMS

• Severe cramping pain in • If associated with

lower abdomen Chlamydia- milder and
tolerated
for longer periods
• If associated with
Gonorrhea-less than 3 days
• Elevated temperature, elevated WBC
SIGNS AND SYMPTOMS

• Dysuria

• Associated with endometritis-

• Dyspareunia, dysmenorrhea
metrorrhagia/menorrhagia

• Foul-smelling, purulent • Nausea and malaise

vaginal discharge
ADDITIONAL CRITERIA

1. ROUTINE

- Fever (Temp. >38 degrees C) MINIMUM CRITERIA

- Abnormal vaginal bleeding - Lower abdominal pain

- Endocervical evidence of N. gonorrhea and C. - Bilateral adnexal mass

trichomatis
- Cervical motion tenderness
2. EXTENSIVE
- (-) Pregnancy test
- Laparoscopy
RISK FACTORS
• Sexual activity: Increased
with multiple sex partners and DIFFERENTIAL DIAGNOSIS
number of coitus
• Acute Appendicitis
• Age

• Contraceptive use • Ectopic Pregnancy

• Vaginal douching • Urinary tract infection

• Postpartum infection
 THERAPEUTIC
INTERVENTIONS OF P.I.D.
• Medications to control pain and fever.
• Culture vaginal discharge to reveal causative organism.

• Identification and notification of sexual contacts and the

department of health if STD is present.
• Specific antibiotics depending on the organism.
NURSING CARE OF CLIENTS WITH
P.I.D.

• Monitor temperature, WBC count, and culture reports.

• Explain the importance of completing prescribed meds.
• Maintain on bedrest in semi-Fowler’s position.
• Apply heat if ordered to the abdomen or via douche.
• Observe and record the amount and character of
vaginal discharge.
• Change perineal pads frequently using gloves.
• Never use tampons.
• Abstain from intercourse during acute period.
• Practice safe sex to prevent reinfection.
• Allow to verbalize feelings about illness and the
possibility of complication of sterility.
 NURSING CARE OF CLIENTS WITH P.I.D.

• Monitor temperature, WBC count, and culture reports.

• Explain the importance of completing prescribed meds.

• Maintain on bedrest in semi-Fowler’s position.

• Apply heat if ordered to the abdomen or via douche.

• Observe and record the amount and character of vaginal discharge.

MOST COMMON CAUSES:
NON-GONOCOCCAL
URETHRITIS (NGU)
1. CHLAMYDIA Also known as Non-specific
2. MYCOPLASMA urethritis (NSU) or cervicitis
3. TRICHOMONAS
4. GENITAL HERPIS - discharges/dysuria

- no gonococci cultured
 CHLAMYDIA
ETIOLOGY
• Caused by Chlamydia
trichomatis
• Most prevalent STD in the INCUBATION PERIOD
USA 1-12 days
• Same symptoms as GC.
• Watery/mucopurulent urethral discharge
• Dysuria/frequency
• Epididymitis
• Arthritis/Reiter’s syndrome-uncommon
• Most are asymptomatic
• Initial signs and symptoms are:
- Cervical inflammation
- Vaginal discharge (thin, mucoid or white vaginal or urethral discharge)
- Pelvic discomfort
- Dysuria/Urgency/Frequency
MALES
• Epididymitis
• Prostatitis (Infertility)
• Arthritis
FEMALES
• PID
• Endometritis
• Dysuria
• DOXYCYCLINE (VIBRAMYCIN)

• ERYTHROMYCIN

• TETRACYCLINE
 NURSING CARE FOR CLIENTS WITH CHLAMYDIA

• Provide a nonjudgmental environment.

• Instruct to use condom to prevent transmission of disease.
• Teach about the disease and its transmission.
• Identify and treat contacts.
• Report the disease to HEALTH DEPARTMENT,but assure
confidentiality.
 NURSING CARE FOR CLIENTS WITH CHLAMYDIA

• Reinforce strict medication compliance of antibiotics.

• Avoid sexual activity until tests are negative.
• Encourage monogamous relationships.
• Avoid having multiple sexual partners and illicit sex from
unknown individuals and those with known STD’s.
ETIOLOGY
• Caused by
Trichomonas vaginalis

MODE OF TRANSMISSION
NOTE: 10X more • Sexual contact – primary
common in women • Mother to newborn
than in men.
1. Vaginal discharge
Profuse, frothy, greenish-yellow and malodorous
2. Severe vaginal itching
Vulva may be thickened or reddened
3. Dysuria due to vulvar inflammation
4. Dyspareunia

NOTE:
SYMPTOMS WORSEN: DURING MENSTRUATION, PREGNANCY, IN DIABETICS,
POSTMENOPAUSAL WOMEN
COMPLICATION: ASSOCIATED WITH PID
LABORATORY DIAGNOSIS OF
TRICHOMONIASIS
• Fresh wet smears with
NSS SIGNS AND SYMPTOMS:
• Culture
• Largely asymptomatic
TREATMENT OF • Itching, dysuria,
TRICHOMONIASIS frequency
• METRONIDAZOLE (Flagyl)
tablet p.o.
FACTORS LEADING TO INFECTION: CANDIDIASIS/ MONILIASIS
1. Diabetics
2. Oral contraceptives
3. Oral antibiotics
4. Anemia ETIOLOGY
5. Immunocompromised • Caused by Candida albicans
patients (HIV,AIDS) - yeast organism common in the vagina
6. Poor anal/perianal hygiene
NOTE: HOT, HUMID WEATHER AND
TIGHT CLOTHES FAVOR INFECTION.
CANDIDIASIS in
WOMEN
• 50 % are asymptomatic
• Vaginal discharge
thick, curdy, cheesy discharge with an
offensive odor
whitish plaque on vaginal walls upon
speculum exam
• Irresistible itching in the vulvar or anal
region
•Painful sexual intercourse
DIAGNOSIS OF CANDIDIASIS
KOH- DIRECT VISUALIZATION
VAGINAL/URETHRAL CULTURE CANDIDIA
(Partner) SIS in MEN
• Less common
TREATMENT OF CANDIDIASIS • Itching especially in
• NSYSTATIN (Mycostatin) vaginal uncircumcised
suppositories
or cream
• MICONAZOLE NITRATE ( Monistat)
• CLOTRIMAZOLE (Gynelotrimen)
• CAUSATIVE AGENTS
- Gardenella vaginalis
- Anaerobes
- Streptococus viridans
- Mycoplasma hominis
• Causes non-specific vaginitis
• Vaginal discharge
- grayish-white discharge
with characteristic offensive
“fishy” odor
- very little or no vaginal
inflammation
COMPLICATIONS:
• PID
• Premature rupture of DIAGNOSIS:
membranes in • Characteristic smooth gray-or
pregnant women white discharge
TREATMENT: • Vaginal pH > 4.5
• METRONIDAZOLE • Presence of Clue cells
(Flagyl) p.o.
NURSING CARE FOR CLIENTS with TRICHOMONIASIS,
CANDIDIASIS and VAGINITIS
• Use condom during coitus until vaginitis is resolved.

• Identify sexual contacts and treat them as well.

• Avoid frequent douching (alter normal pH of vagina).

• Instruct to use tampons to prevent vulvar area irritation but

remind to change frequently.
NURSING CARE FOR CLIENTS with TRICHOMONIASIS,
CANDIDIASIS and VAGINITIS

• Teach importance of wearing cotton underwear, loose-fitting

clothes and to avoid wearing pantyhose and tight pants.

• Administer douche if ordered.

Solution at 110 F (45 C); 30 ml vinegar:1 L of H20
Alkaline solutions never utilized.

• Instruct client with recurrent infections or with antibiotics to

include yogurt in the diet or foods containing Lactobacillus
acidophilus in the diet.
 GENITAL ULCER DISEASE

GENITAL ULCERS
• Characterized by a defect in the epithelium of the skin or mucosa; has
several etiologies
• Clinical presentation is diverse, multiple infections are common and
etiological diagnosis is difficult in most clinical settings.
DISEASES THAT PRESENT WITH GENITAL ULCERS :
• Genital herpes
• Syphilis
ETIOLOGY
Caused by Human herpes virus or Herpes GENITAL
simplex virus (HSV) HERPES
• HSV type 1
• HSV type 2
INCUBATION PERIOD
4 days ( 2 – 14 days )
NOTE:
Laboratory tests are not readily
available;
thus diagnosis is usually done on clinical
grounds.
 SIGNS AND SYPMTOMS
of GENITAL HERPES
• Half of the infections are asymptomatic or cause
mild symptoms.
• Pain and itching in the genital area ( vesicular rash
or blister).
• Blister erode and form shallow sores that merge to
form large sores.
 SIGNS AND SYPMTOMS
of GENITAL HERPES
• Affects the external genitalia (vulva or penis) cause
vaginal bleeding

• Dysuria and urinary retention

• Produces clear and mucoid discharge. (Leukorrhea)

• Anorexia
 CLINICAL COURSE OF HERPES GENITALIS

1. INITIAL INFECTION

Fever, headache, and general malaise

Painful, multiple bilateral lesions

2. RESOLUTION OF THE LESION (blister or sore)

AFTER 10 – 20 DAYS
 CLINICAL COURSE OF HERPES GENITALIS

3. RECURRENCE

Usually unilateral lesion recurs ( 2-6X/year )

Lasts for 3-7 days with no systemic symptoms
Usually limited to the genitalia
Episodes are less severe and shorter ranging from 8-12 days
Can recur due to “trigger factors” (menstruation, stress,
immunocompromised, sexual intercourse)
THERAPEUTIC INTERVENTIONS
No cure known.

ACYCLOVIR (Zovirax)
reduces healing time and severity of symptoms.
Sedation for severe pain.

Alcohol may be used to dry lesions.

Wash with soap and water to avoid

Secondary infections
 NURSING CARE FOR HERPES
GENITALIS

Provide emotional support to deal with incurable nature of disease

Relieve local discomfort as ordered.

- Prescribed analgesics. - Topical anesthetics.
- Sitz baths. - Application of heat or cold compress.
- Stress avoidance in sexual activity when lesions exist.
 NURSING CARE FOR HERPES
GENITALIS

Assist in developing stress reduction strategies.

Encourage increased fluid intake.

Advise annual Pap smears.

ETIOLOGY
SYPHILIS
A chronic STD caused by Treponema pallidum (Spirochete) bacteria

Episodes of active clinical disease interrupted by a period of

latent infection.
Early manifestation primarily involve skin and
mucosal surface.
Late syphilis virtually affects any organ.

INCUBATION PERIOD
9-90 days
SEXUAL CONTACT
MODE OF TRANSMISSON

BLOOD TRANSFUSION

PERINATAL
 CLINICAL COURSE OF SYPHILIS
1. EARLY
SYPHILI
A. PRIMARY
S SYPHILIS
- First manifestation is a hard sore (chancre) at the site of
- Chancreinoculation.
is usually single, painless, firm to touch, with slightly
elevated edges and often appears cleanly punched out (3
-
mm
Found in thetoglans
1 cm)penis, prepuce and penile shaft in men

- Found in the vulva, specifically the labia, fourchette or clitoris,

vagina or on the cervix
- Can also be found in mouth and anus If untreated, syphilis runs a
- Painless enlargement of regional lymph nodes
lifetime affecting any part of the
organ
PRIMARY SYPHILIS
PRIMARY SYPHILIS
1. EARLY SYPHILIS
CLINICAL COURSE OF SYPHILIS
B. SECONDARY SYPHILIS (SYSTEMIC)

- Starts from 3-6 weeks or 1-6 months

after the appearance of the chancre
- Associated with fever and body malaise
C. EARLY LATENT SYPHILIS (ASYMPTOMATIC)
- Alopecia
- Skin rash on palms and soles of feet Detected serogically (+) on the following Syphilis tests
- Enlarged lymph nodes - RPR-CT (Rapid Plasma Reagin Circle Card Test)
-- Condylomata lata (papules that
- ART (Automated Reagin Test)
thickened and looked warty)
FTA-ABS (Flourescent Treponemal Antibody
-

Absorption Test)
- VDRL – Venereal Disease Research Laboratory)
SECONDARY
SYPHILIS
II. LATE SYPHILIS
A. TERTIARY SYPHILIS (CARDIOVASCULAR
SYPHILIS and NEUROSYPHILIS)

- Develops 10-30 years after the primary stage

- Personality changes
- Cardiovascular changes
- Ataxia
- Stroke
- Blindness
- GUMMA is a typical lesion which can affect any
organ.
B. LATE SYPHILIS
(ASYMPTOMATIC)
Detected serogically (+) on the following Syphilis tests

-VDRL (Venereal Disease Research Laboratory)

- RPR-CT (Rapid Plasma Reagin Circle Card Test)
- ART (Automated Reagin Test)
-FTA-ABS (Flourescent Treponemal Antibody
Absorption Test)
NEUROSYPHILIS
GUMMA in
TERTIARY
SYPHILIS
•PENICILLIN THERAPEUTIC
INTERVENTIONS
•PROBENICID
– delay excretion
• TETRACYCLINE
AND of penicillin
ERYTHROMYCIN
NURSING CARE FOR CLIENTS with SYPHILIS
Provide a nonjudgmental environment.

Encourage the use of early screening and education

programs.

Explain the careful cleaning of the genital, as well as the use

of condoms.

Teach about the disease and its transmission.

NURSING CARE FOR CLIENTS with SYPHILIS

Identify contacts and treat them.

Inform client to tell the HEALTH DEPARTMENT.

Abstain from sex until tests are negative

Always practice SAFE SEX

 SYPHILIS HERPES
Incubation period 9-90 Days 2-7 Days
Primary lesion Papule Blister CLINICAL
No. of lesions Usually single Multiple FEATURES of
Diameter (mm) 5-15 mm 1-2 mm GENITAL
Edges Raised, round, Erythematous ULCER
Clearly defined DISEASE
Depth Varies Superficial
Base Smooth, clean Serous, Erythematous

Induration Firm, rubbery None

Pain Unusual Common
Lymph glands Firm, bilateral, Firm, often
Non-tender Bilateral, tender
ETIOLOGIC AGENT PUBIC LICE
Phythirus pubis (PEDICULOSIS PUBIS)
(Like a tiny crab or turtle)
MODE OF TRANSMISSION
Sexual intercourse

Close physical contact through clothing and bedding

SIGNS AND SYMPTOMS

Severe itchiness

Elevated red and pink spots

FACTORS THAT AFFECT INCIDENCE OF PUBIC LICE:

• Poor personal hygiene

• Overcrowding
• Poor environmental sanitation

PUBIC LICE INFESTATION MAY CAUSE:

• Psychological depression
• Irritability
• Mild fever
 PUBIC LICE
MANAGEMENT
(PEDICULOSIS PUBIS)

• Disinfection of clothing and

bedding
DIAGNOSIS

• Personal hygiene • Presence of light grayish, oval-shaped

nits on the hair shafts
• Environmental sanitation
• Crab-like adult lice can be seen clinging
to the hair shaft
PUBIC LICE
(PEDICULOSIS PUBIS)
TREATMENT PUBIC LICE
(PEDICULOSIS PUBIS)

• Gamma benzene hexachloride 0.3% gel (Lindane 0.3%)

apply for 3 days on pubis, lower abdomen, buttocks, top of
thighs for 12 hours, then wash out.
• Benzyl benzoate 25% suspension apply for 3 days on
pubis, lower abdomen, buttocks, top of the thighs for
12 hours, then wash out.
ETILOGIC AGENT
VENEREAVL WART
Human papilloma virus (HPV) (CONDYLOMA
CLINICAL FEATURES ACUMINATA)

Small fingerlike growth with spiny projections

“Cauliflower” appearance
Bleed when impaired
SITES
Genital areas
Anal areas
Palms and fingers
Soles of feet
DIAGNOSIS
PAP smear and clinical features
VENEREAL WART
(CONDYLOMA
ACUMINATA)
VENEREAL WART
(CONDYLOMA
ACUMINATA)
CAUSATIVE AGENT
- Sarcoptes scabiei (a tiny female burrowing
mite to lay eggs usually in the folds of the skin
)
SIGNS AND SYMPTOMS
Intense itching specially at night
Rash or scratch mark in between the fingers, toes, forearms and
genitals

MODE OF TRANSMISSION
Close personal contact
Sexual intercourse
 TREATMENT
Gamma benzene hexachloride 0.3% gel
(Lindane 0.3%) apply for 3 days all over the body
and extremities for 12 hours, then wash out.

Benzyl benzoate 25% suspension apply for 3 days

all over the body and extremities.
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
Found in the body fluids such as:
- blood
- semen
- vaginal/cervical secretions
- breast milk
HIV INFECTION
- The patient may be asymptomatic for as long as 5-10 years.

- It is a life-long infection.
ACQUIRED IMMUNODEFICIENCY VIRUS
✓ Terminal and fatal stage of HIV infection.
✓ Person becomes ill from opportunistic infections that set in as
a result of weak immune system.
TRANSMISSION OF HIV
 Sexual contact (oral, vaginal, anal intercourse) with an
infected person.
 Transfusion of infected blood and blood products.
 Contaminated needles and syringes.
 From infected mother during pregnancy, childbirth and
breastfeeding.
 EXPOSURE NATURAL HISTORY of
HIV/AIDS INFECTION
DETECTION (WITHIN 6 WEEKS - 6 MONTHS)
“WINDOW PERIOD”

ASYMPTOMATIC (5 - 10 YEARS)
COMMON MYTHS and MISCONCEPTIONS about HIV INFECTION

Mosquitoes can transmit HIV.

HIV can be transmitted through kissing.

HIV can be transmitted through casual contact.

HIV can be transmitted through sharing of utensils.

PREVENTION METHODS of HIV/AIDS INFECTION
Abstinence

Mutual monogamy

Safer sex activities including correct

and consistent use of condoms
No sharing of contaminated needles
and syringes

Use of screened blood

 SUBJECTIVE CLINICAL FINDINGS

Anorexia /Fatigue /Dyspnea

OBJECTIVE
 ( +) HIV Antibody test – blood test that detects the
presence and absence of HIV antibody
 ELISA (Enzyme - Linked Immunosorbent Assay) - screening test
 Western Blot - confirmatory test
 T - cell count for lymphocytopenia
ELISA TEST
OBJECTIVE
• PCR (Polymerase chain reaction)
- (+) test for the presence of HIV itself CLINICAL FINDINGS

• Night sweats, fever, recurrent diarrhea, thrush,

lymphadenopathy for up to 1 yr. duration
• HIV wasting syndrome (emaciation)
• HIV encephalopathy - memory loss, lack of coordination,
partial paralysis, mental deterioration

• Presence of opportunistic infections - Pneumocystis carinii

pneumonia, Fungal (Oral thrush, histoplasmosis); Viral
(Cytomegalovirus, Herpes I and II); Bacterial (PTB)
• Kaposi’s sarcoma
 SIGNS AND SYMPTOMS OPPORTUNISTIC INFECTIONS
 Lassitude
 Chest pain that increases
with inspiration PNEUMOCYSTIS CARINII PNEUMONIA
 tachypnea, dyspnea with
severe air hunger, hypoxemia,
- a rare protozoan infection seen in
cyanosis patients with impaired immune
 High fever
function such as AIDS
 Chest x-ray reveals
pulmonary infiltrates
 Non-productive cough
B. MANAGEMENT OF
PNEUMOCYSTIS CARINII
SYMPTOMS PNEUMONIA
1. Oxygen therapy via nasal cannula.
2. Inhalation therapy and use
of incentive spirometry. THERAPEUTIC INTERVENTIONS
3. Increase fluid intake.
4. Monitor vital signs. A. MEDICATIONS
5. Observe for signs of 1. Trimethoprim
respiratory distress. sulfamethoxazole
6. Frequent rest periods.
7. Cover nose and mouth when (Bactrim and Septra)
coughing. 2. Pentamidine (Pentam)
8. Strict antibiotic compliance.
 CLASSIFICATIONS OF LESIONS:
KAPOSI’S SARCOMA
NODULAR:
Found in extremities and slow
growing. ETIOLOGY
FLORID: Cause is unknown - occurs primarily in
Very rapid growing and ulcerated. individuals with compromised immune
INFILTRATE: system (AIDS)
Penetrating into deeper
structures, including bone. Lesions generally begin in the
epidermis and extend into dermis
LYMPADENOPATHIC:
Disseminated type, rare, Involvement of GI, bone and lungs
generally found in children.

SUBJECTIVE
Pain (may/may not be
present)
Depend on organs involved.
CLINICAL FINDINGS of KAPOSI’S
SARCOMA
OBJECTIVE
Purplish lesions on skin and
mucous membrane
(+) identification thru biopsy
KAPOSI’S SARCOMA
 THERAPEUTIC INTERVENTIONS
Radiation therapy alone or in conjunction with
chemotherapy.

Chemotherapy (IV, Intraarterial, Intralesion)

Immunotherapy to stabilize and boost the immune

system
 SPECIFIC CARE for CHEMOTHERAPY
• Monitor IV site for infiltration. (tissue necrosis)
• Institute for protective isolation especially if WBC is low.
• Observe for bleeding and avoid use of anticoagulants.
• Avoid contact of drugs during preparation of meds. ( use gloves;
if with contact, rinse with water)
• Avoid use of rectal thermometer, enemas, IM injections and razor
blades.
• Monitor renal function. (Neprotoxicity)
• Monitor V/S (cardiotoxicity)
• Avoid using OTC drugs without doctor’s knowledge (aspirin and
alcohol).
SPECIFIC CARE FOR RADIATION THERAPY

• Avoid washing off marks placed by radiologist.

• Instruct client to avoid creams, soaps, powders and deodorants
during the treatment period.
• Assess skin for erythema.
• Instruct client to wear cotton, loose fitting clothing.
• Protect skin from sunlight.
•Apply a non-adherent dressing to areas of breakdown.
 NURSING CARE of KAPSOSI’S SARCOMA

• Provide emotional support.

• Provide pain relief.

• Use precautions to maximize skin integrity.

- Diet high in Vitamin A and foods with high nutrient density

• Aseptic technique in applying dressing over open lesions.

• Institute protective isolation and use fluid precautions.

• Specific treatment of opportunistic
infections: THERAPEUTIC INTERVENTIONS
A. PNEUMOCYSTIS CARINII
PNEUMONIA
for HIV/AIDS
- Pentamidine (Pentam),
Trimethroprim sulfamethroxazole •There is no CURE; PREVENTION is the
(Bactrim or Septra)
B. PULMONARY TUBERCULOSIS key to control.
- Isoniazid (INH), Rifamficin • Zidovudine (ZDV)/Azidothymidine (AZT)
(Rifadin), Ethambutol (Myambutol) (Retrovir) – antiretroviral medication
C. FUNGAL INFECTIONS • Didanosine (ddl, DDI) – (Videx) - highly
- Nystatin (Mycostatin),
Amphotericin B (Fungizone), active antiretroviral therapy (HAART)
Ketoconazole (Nizoral) • Dideoxyinosine – inhibits the replication
D. VIRAL INFECTIONS of HIV combined with ZDV
- Acyclovir (Zovirax)
GENERAL NURSING CARE for CLIENTS with AIDS INFECTION

Use UNIVERSAL PRECAUTIONS regardless of diagnosis (Virus can be

transmitted before client shows any signs of infection).

1. Wear gloves when touching any blood or body fluids, handling soiled
items, performing venipuncture. Change gloves after every contact.

2. Wear gowns, masks and protective eye wear for any procedure that may
result in splashes of blood or body fluids.
GENERAL NURSING CARE for CLIENTS with AIDS INFECTION

3. Wash contaminated hands immediately; wash hands immediately after

removing gloves.

4. Use only disposable needles; DON”T RECAP, purposely bend, break or

remove needles from syringes.

5. Keep puncture-proof containers for used needles and syringes close to

location of use.
 GENERAL NURSING CARE for
CLIENTS with AIDS

Use UNIVERSAL PRECAUTIONS

6. Wear mouthpiece or use resuscitation bag for emergency mouth-to-mouth

resuscitation.
7. Avoid client contact if giver has open skin lesions.
8. Use household bleach in 1:10 – 1:100 concentration or approved hospital
disinfectants to clean contaminated surfaces.
 GENERAL NURSING CARE
for CLIENTS with AIDS

9. Bag soiled linen at client’s bedside and place contaminated linen in leak-
proof bags.
10. Teach IV substance abusers importance of safely discarding needles and not
to share needles.
11. Discourage sharing razors, toothbrushes, etc. that might be contaminated
with blood or other body fluids.
12. Discourage donating blood for transfusions, organs for transplant or semen
for artificial inseminations.
GENERAL NURSING CARE for CLIENTS with AIDS

• Refer to counselor or support group.

• Provide emotional support; client must deal with social rejection and death .

• Protect the client from secondary infection. Carefully assess for early signs.

• Monitor client receiving Zidovudine for blood dyscrasias.

• Frequent rest periods.

 GENERAL NURSING CARE for CLIENTS with AIDS

• Teach the client the importance of :

- informing sexual contacts of diagnosis.

- avoiding sexual contact unless a condom is used
.

continue medical supervision.

-

•Provide a high-caloric, high protein diet.

• Encourage intake of foods rich in immune-stimulating nutrients, especially
vitamins A, C, and E and the mineral Selenium.
• Provide skin care.
 Everyone is at risk. ABOUT HIV/AIDS INFECTION
 We cannot tell if a person is infected.
 Infected persons are capable of infecting others.
 There is no CURE for AIDS.
 AIDS is incurable and fatal.
 There is no vaccine for AIDS.
 HIV is lifelong.
 HIV transmission can be prevented.
RESPONSE DEPENDS ON: DURATION OF HIV
• Route of infection
to DEVELOP
• Dose of the virus
• Response of the infected
Duration for someone who is
person
infected with HIV to develop HIV
• Frequency of the antibodies:
exposure to the virus
6 weeks to 6 months
 MEANING OF HIV ANTIBODY-POSITIVE and
ANTIBODY-NEGATIVE TEST RESULTS
A (+) HIV ANTIBODY TEST MEANS:
• the blood sample was tested twice with screening and confirmatory tests
and found antibodies at both times.
• a person has been infected with HIV and there are HIV antibodies in
his/her system.
• one should assume that he/she is infectious and capable of
transmitting the virus to others through high-risk activities.
NOTE: A positive HIV antibody test does not mean one has AIDS or
will get AIDS.
 MEANING OF HIV ANTIBODY-POSITIVE and
ANTIBODY-NEGATIVE TEST RESULTS
A negative HIV antibody test means that no antibodies were found in the
blood at a specific time.
A negative HIV antibody test does not mean:
• one has resistance to the infection.
• one will never get HIV (a person must continue avoiding unsafe activities
to protect him/herself).

NOTE: There is no immunity to HIV.

PREREQUISITES to HIV ANTIBODY
TESTING
1. All information regarding the test will be kept confidential.

2. A written informed consent must be signed by the person to

be tested.

3. Pre- and post-test counseling should be provided before

blood extraction and after releasing the result.
 STD CASE MANAGEMENT
Refers to the treatment of patients with STD-related syndromes
and their sexual partners through early recognition, effective
drug therapy, education on risk reduction and prevention of
further infection.

INVOLVES 4 C’S
• Counseling
• Compliance to treatment
• Condom use
• Partner notification (Contact tracing)
EDUCATION and COUNSELING with SEXUALLY TRANSMITTED
DISEASES
There are common beliefs on protecting oneself from STD/HIV infection that needs
to be corrected through education. Some of them are:
• Physical appearance will show if a person is free from infection.

• Married women are safe.

• Young people are likely to be free from infection.

• Taking medication before and after sex.

• Urinating, washing, or douching after sex prevents STDs.

• Only high-risk groups like commercial sex workers or gay men will get infected.
 IMPORTANT REMINDERS WHEN TAKING STD DRUGS

• Drink drugs with plain water.

• Tetracyclines should be taken 1 hour before and after meals. Avoid dairy
products, antacids, iron or other mineral containing preparation and
sunlight.

• Avoid alcohol for 24 hours following completion of Metronidazole therapy.

• Continue to use vaginal suppositories despite menses.

 EXAMPLES ARE NON-
SAFE SEX and CONDOMS
PENETRATIVE SEX LIKE:

• Hugging
• Massaging Safe sex refers to activities that prevent
• Kissing the transfer of body fluids (semen,
• Necking vaginal/cervical fluids and blood) from
• Petting one person to another during sex.
• Masturbation and others
NOTE: Unsafe sexual activities are unprotected (no condom)
vaginal, anal and oral sex.
 CONDOMS

•Condoms serve as mechanical barriers that prevent

the transfer of body fluids.
•To achieve maximum effectiveness, condoms must
be used correctly and consistently.
• Condoms are made of very thin latex rubber.
•It is used as protection against STDs/HIV.

•Condoms are also used as a contraceptive device.

STEPS IN USING CONDOMS

☺ Check expiry date. Condoms

are good for 3 years from date of
manufacture.

☺ Open the packet carefully.

STEPS IN USING CONDOMS

☺ Pinch nipple-end of condom to

release air.
STEPS IN USING CONDOMS

☺ Unroll the condom over the

entire length of erect penis.
STEPS IN USING CONDOMS

☺ Use only water based lubricants

like saliva or KY jelly. Do not use
lotions or oils.
STEPS IN USING CONDOMS

☺ The man should hold onto the

condom at the base of the penis
and withdraw while still hard.
STEPS IN USING CONDOMS

☺ Remove the condom. Don’t let

semen spill or leak from the
condom.
 STEPS IN USING CONDOMS

☺ Dispose of the used condom safely.

Throw it in the garbage or other safe
place.

☺ Do not reuse used

condom.
Care of Client with Sexually
Transmitted Diseases

Please watch the video:

https://www.youtube.com/
watch?v=vYtV_Hf29RE