LARYNGITIS

Laryngitis is an inflammation of the larynx. It causes hoarse voice or the complete loss of the voice because of irritation to the vocal folds (vocal cords). Dysphonia is the medical term for a vocal disorder, of which laryngitis is one cause. Laryngitis is categorized as acute if it lasts less than a few days. Otherwise it is categorized as chronic, and may last over 3 weeks. The chronic form occurs mostly in middle age and is much more common in men than women.

Causes
Laryngitis can be infectious as well as non-infectious in origin. Non-infectious causes

Acid reflux disease, resulting in laryngitis gastrica. Allergies. Excessive coughing, smoking, or alcohol consumption. Inflammation due to overuse of the vocal cords.[1][2][3][4][5] Prolonged use of inhaled corticosteroids for asthma treatment. Thermal or chemical burns. Laryngeal trauma, including iatrogenic one caused by endotracheal intubation.

Infectious causes

Viral infection, including those caused by rhinovirus, influenza virus, parainfluenza virus, adenovirus, coxsackievirus, coronavirus, and RSV Bacterial infections, including those caused by group A streptococcus, C. diphtheriae, M. catarrhalis, andM. tuberculosis. Bacterial infections usually follow pre-existent viral infection. Fungal infection, including those caused by Histoplasma, Blastomyces, Candida (especially in immunocompromised persons), and rarely by Cryptococcus and Coccidioides.

Symptoms

Dysphonia (hoarseness) or aphonia (inability to speak). Dry, sore, burning throat. Coughing, which can be a symptom of as well as a factor in causing laryngitis. Dysphagia (difficulty in swallowing). Sensation of swelling in the area of the larynx. Cold or flu-like symptoms (which, like a cough, may also be the causal factor for laryngitis). Swollen lymph nodes in the throat, chest, or face. Fever. Hemoptysis (coughing out blood). Dyspnea (difficulty in breathing), predominantly in children.

Increased production of saliva in mouth.

Signs
In early stages, there is erythema (reddening) and edema of epiglottis, aryepiglottic folds, arytenoids and ventricular folds. In late stage, vocal cords and subglottic structures are also involved. There are sticky secretions between cords and in interarytenoid region. Sometimes submucous hemorrhage is seen, especially in case of vocal abuse. In acute membranous laryngitis, a condition resembling acute membraous tonsillitis is caused by pyogenic nonspecific organisms. It has to be differentiated from laryngeal diphtheria.

PATHOPHYSIOLOGY
Injury ( infections, smoking, contact with caustic or acidic substances, allergic reaction or direct trauma) of the laryngeal tissues

Inflammatory response Leakage of fluid fro, blood vessels with edema or swelling, congregation of white blood cells Release of mediator of inflammation and engorgement of blood vessels Inflammation of the vocal epithelium, there is an effect on voice quality and strenght Hoarseness of voice

NURSING MANAGEMENT

General measures: Voice rest is important. Steam inhalations with tincture benzoin or oil of pine or eucalyptus help loosen secretions. Cough sedatives are given to reduce cough. In severely inflammed larynx, humidifier or vaporizer is used to moisten the air inhaled by person. If laryngitis is due to gastroesophageal reflux, an H2-inhibitor (such as ranitidine) or proton-pump inhibitor (such as omeprazole) is used to reduce gastric acid secretions. In laryngitis caused by thermal or chemical burns, steroids are used. In viral laryngitis, drinking sufficient fluids is helpful. If laryngitis is due to a bacterial or fungal infection, appropriate antibiotic or antifungal therapy is given. If persistent hoarseness or loss of voice (dysphonia) is a result of vocal cord nodules, physicians may recommend a course of treatment that may include a surgical procedure and/or speech therapy.

Prognosis

Most cases of laryngitis are viral and resolve without treatment with sufficient voice rest. Laryngitis, hoarseness or breathiness that lasts for more than two weeks may signal a voice disorder and should be followed up with a voice pathologist. This is typically a vocology certified SLP (speech language pathologist) or a laryngologist (voice specialized ENT).

MEDICAL MANAGEMENT:
Resting the voice, avoiding irritants Resting Inhaling cool steam or an aerosol For respiratory infection caused by bacterial infection, severe and appropriate anti bacterial therapy is instituted For chronic laryngitis, the treatment includes: o Resting the voice o Eliminating any primary respiratory tract infection o Eliminating smoking and second hand smoking o Topical corticosteroids, such as beclomethasone dipropionate ( Vanceril) may be given by inhalation o For reflux laryngitis, involves the use of proton pump inhibitors such as omeprazole given once daily.

HIV HIV stands for: Human Immunodeficiency Virus

HIV is a virus. Viruses such as HIV cannot grow or reproduce on their own, they need to infect the cells of a living organism in order to replicate (make new copies of themselves). The human immune system usually finds and kills viruses fairly quickly, but HIV attacks the immune system itself - the very thing that would normally get rid of a virus. Human immunodeficiency virus (HIV) is a lentivirus (a member of the retrovirus family) that causes acquired immunodeficiency syndrome (AIDS), a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive. HIV infects vital cells in the human immune system such as helper T cells (specifically CD4+ T cells), macrophages, and dendritic cells HIV infection leads to low levels of CD4+ T cells through three main mechanisms: First, direct viral killing of infected cells; second, increased rates of apoptosis in infected cells; and third, killing of infected CD4+ T cells by CD8 cytotoxic lymphocytes that recognize infected cells. When CD4+ T cell numbers decline below a critical level, cell-mediated immunity is lost, and the body becomes progressively more susceptible to opportunistic infections. With around 2.7 million people becoming infected with HIV in 2010, there are now an estimated 34 million people around the world who are living with HIV, including millions who have developed AIDS.

PATHOPHYSIOLOGY:
HIV attachment to the uninfected CD4 cell Uncoating of viral core components into the host cell HIV enzyme reverse transcriptase copies the viral genetic material from RNA into doublestranded DNA.

Double stranded DNA is sliced into the cellular DNA by the action of another HIV enzyme integrase

Using the integrated DNA or provirus as a blue print, the cell makes a new viral proteins and viral RNA

HIV protease cleeves the new proteins ( polyproteins)

The new protein joins the viral RNA into the viral particles

New viral particles bud from the cell and start the process all over.

What is the connection between HIV & AIDS? The condition that is referred to as AIDS is caused by HIV damaging the immune system cells until the immune system can no longer fight off other infections that it would usually be able to prevent. If left untreated, it takes around ten years on average for someone with HIV to develop AIDS. However, this average is based on the person with HIV having a reasonable diet, and someone who is malnourished may well progress from HIV to AIDS more rapidly. There are more than 20 antiretroviral drugs approved for the treatment of HIV infection in the US and Europe, as well as many new HIV drugs currently undergoing trials. Although treatment for HIV has become more widely available in recent years, access to antiretroviral treatment is limited.

CAUSES
HIV is found in the blood and the sexual fluids of an infected person, and in the breast milk of an infected woman. HIV transmission occurs when a sufficient quantity of these fluids get into someone else's bloodstream. There are various ways a person can become infected with HIV:

Unprotected sexual intercourse with an infected person: Sexual intercourse without a condom carries the risk of HIV infection. Contact with an infected person's blood: If sufficient blood from somebody who has HIV enters someone else's body, then HIV can be passed on in the blood. Use of infected blood products: Many people in the past have been infected with HIV by the use of blood transfusions and blood products which were contaminated with the virus. In much of the world this is no longer a significant risk, as blood donations are routinely tested for HIV. Injecting drugs: HIV can be passed on when injecting equipment that has been used by an infected person is then used by someone else. In many parts of the world, often because it is illegal to possess them, injecting equipment or works are shared. From mother to child: HIV can be transmitted from an infected woman to her baby during pregnancy, delivery and breastfeeding.

Certain groups of people, such as injecting drug users, sex workers, prisoners, and men who have sex with men have been particularly affected by HIV. However, HIV can infect anybody, and everyone needs to know how they can and can't become infected with HIV.

SIGNS AND SYMPTOMS

Some people experience a flu-like illness, develop a rash, or get swollen glands for a brief period soon after they become infected with HIV. However, these are also common symptoms of other less serious illnesses, and do not necessarily mean that a person has HIV. RESPIRATORY MANIFESTATION: o Shortness of breath, dyspnea, cough, chest pain, and fever are associated with various opportunistic infections, such as those caused by P. jiroveci, Mycobacterium avium- intracellulare, CMV, and Legionella species. GASTROINTESTINAL MANIFESTATION o Loss of appetite, nausea, vomiting, oral and esophageal candidiasis, and chronic diarrhea. ONCOLOGIC MANIFESTATION o AIDS related cancers include Kaposis sarcoma, lymphoma, and invasive cervical cancer. NEUROLOGIC MANIFESTATION o These includes Peripheral Neuropathy, HIV encephalopathy, Cryptococcus neoformans.

DIAGNOSTICS
Enzyme linked immunosorbent assay ( ELISA)- presence of antibodies Western Blot- confirms ELISA positive HIV antibodies T lympocytes and B lympocytes subsets; CD4 counts, CD4 percentages- decreased Viral load: polymerase chain reaction (PCR)- detects multiple copies of HIV RNA

NURSING MANAGEMENT
Health education o Inform the client about the disease process and mode of transmission o Emphasize the AIDS Awareness Program o Avoid judgemental and moralistic messages o Teach patient ROM and Deep breathing exercises o Teach client to watch signs and symptoms of infection. o Encourage to adhere to treatment regimen religiously o Teach the patient strategies to practice safe sex Maintain skin continuity and integrity Maintain clean environment Monitor I and O Collaborate with nutritionist for the patients diet

Assess for pain and give analgesics as prescribed Preventing transmission of HIV through blood

Preventing mother to child transmission of HIV

MEDICAL MANAGEMENT
TREATMENT MODALITIES:

Two group of anti-retroviral drugs: 1. Reverse transcriptase inhibitors- inhibit the enzyme called reverse transcriptase, which is needed to copy informations for the virus to replicate. Zedovudine Zalcitabine Stavudine Lamivudine Nevirapine Didanosine

2. Protease Inhibitors- inhibits the enzymes protease which are needed for the assembly of viral particles. Saquinavir Ritonavir Indinavir

SUPPORTIVE THERAPY IMUNODULATOR AGENTS-to boost the immune system ANTI- INFECTIVE AND ANTI NEOPLASTIC AGENTS- to combat opportunistic infection NUCLEOSIDE ANALOG