Adverse reactions: rash, fever, headache, nausea, diarrhea, elevated liver enzymes Candidiasis Oral candidia: clotrimazole troches

10 mg, dissolved orally, 5 times daily or nystatin 100,000 swish and swallow, four times a day, or ketoconazole 200 to 400 mg, three times a week, or fluconazole 100 mg, three times weekly. Esophageal candidia: fluconazole 100 to 200 mg, daily or ketaconazole 200 mg, twice a ay for 14 to 21 days.Adverse reactions: (clotrimazole) nausea, vomiting; icity, nausea, vomiting, diarrhea, abdominal pain, headache; (fluconazole) nausea, vomiting, diarrhea, abdominal pain, rash, increased liver enzymes, headache. Cryptococcus Amphotericin, 0,5 to 1,0 mg/kg/day, IV, for 2 to 3 weeks, the fluconazole, 400 mg, dail fo 8 to 12 weeks. adverse reactions: (amphotericin) nephrotoxicity, fever, chills, nausea, vomiting, anorexia, headache, joint pain. Cryptosporidium Paromomycin, 500 to 750 mg, four times a ay, for 15 to 30 days, then 500 mg, twice a day. Adverse reactions: (ganciclovir) granulocytopenia. Thrombocytopenia, skin rash, phlebitis, fatigue, nervousness: (foscarnet) nausea, diarrhea, anemia, thrombocytopenia, fever, acute renal failure. Seizures, hyper/hypocalcemia, hypokalemia, hypomagnesemia, hyper/hypophosphatemia, genital ulcers. Herpes simplex Acyclovir 200 mg, five times a day for 10 to 14 days. Adverse reactions: arthralgias, diarrhea, headache, nausea, vomiting, dizziness Mycobacterium avium complex Clarithromycin, 500 mg, twice a day and clofazamine, 100 to 200 mg, daily with or without ethambutol 15 to 25 mg/kg/day. Adverse reactions: (clarithromycin) headache, diarrhea, nausea, abnormal taste sensation, otoxicity; (clofazamine) reversible discoloration of the skin, urine, sweat, and feces; abnominal pain, nausea, increased liver enzymes, skin dryness, rash, itching, diarrhea; (ethambutol) increased uric acid levels, increased liver enzymes, optic neuritis, peripheral neuritis, headache, dizziness, nausea, vomiting.

Toxoplasmosis Sulfadiazine 75 mg/kg loading dose followed by 100 mg/kg/day plus pyrimethamine 100 mg daily for 2 days (loading dose) followed by 50 to 100 mg daily, plus folinic acid, 10 to 20 mg, daily for at least 6 to 9 weeks. Adverse reactions: (sulfadiazine) nausea, anorexia, diarrhea, headache, peripheral neuropathy, impaired folic acid absorption, leucopenia, thrombocytopenia, methemoglobinemia, crystalluri, photosensitivity; (pyrimethamine) megaloblasti anemia, thrombocytopenia, leucopenia, anorexia, vomiting, ataxia, tremors, increased liver enzymes, hypersensitivity reactions; (foiinic acid ) allergic sensitization

General management Chest physiotherapy, postural drainage, positioning, and oxygen therapy in conjunction with antimicrobial therapy if needed for pulmonary infections. Reduction of risk factors for in injection: malnutrition, exposure to infectious sources or invasive procedures such as contaminated equipment, frequent venipuncture, or foley catheterization Maintenance of adequate hydration, particularly during acute febrile episodes and with administration of nephrotoxic medication or with individuals who have chronic diarrhea. Maintenance of optimal nutritional status with high-calorie, high-protein iet, use of supplements feedings such as osmolite an Ensure if needed: total parenteral nutrition if necessary. Physical thrapy for immobilized patients: regular program of rest and exercise for ambulatory patients Administration of analgesics as needed to minimize discomfort an pain: assistance with alternative therapies and selection of distracting measures. Supports services appropriate: social workers, clergy, psychologist, psychiatrist, clinical nurse specialist, support groups, involvement of significant others (partner and family) in care. NURSING CARE Nuring Assessment As noted earlier, the signs and symptoms of AIDS vary greatly. Clinical manifestations depend on the degree of immunosuppression and the opportunistic infections and neoplasms that develop secondarily. Nonspecific complains may also occur and are usually exacerbated as the disease progresses. Assessment The multiple problems associated with AIDS are included

Pulmonary Cough SOB dyspnea Wheezing Tachypnea Cyanosis Hemoptysis Intercostals retraction

Neurologic AIDS dementia complex Cognitive Memory impairment Poor concentration Slowed thought processes Confusion Motor Unsteady gait Weakness, especially lower extremities Decreased hand coordination Tremors Seizures Behavioral

Decreased animation Withdrawal Depression Emotional liability Psychosis Other Parenthesias Paralysis Headache Nuchal rigidity Altered consciousness Coma

Ophthalmological Cotton wool exudates Photophobia Blurred vision Papilledema Diplopia Prostosis Visual field deficits Blindness

Skin and Mucous Membranes Oral/esophageal White to gray/white patches may appear hairy if dried Red to purple/brown lesions macular, nodular, or plaque-like gingitivitis

Perioral or lips Concerns of mouth; red fissures; crusted Hepatic vesicles Skin Pink/purple to brown lesions May appear as bright red subconjunctival mass Vesicles Diaphoresis Rash Dryness Delayed wound healing Lymphadenopathy: nodes no fixed or hand

Gastrointestinal Loss of appetite Difficulty chewing or swallowing: retrosternal pain Nausea, vomiting Unintentional weight loss, 10 %in 1 to 2 months Abdominal cramping/pain

Diarrhea, at least 2 stools/ day for 1 month intractable Rectal: bleeding, fissures, itching, pain

Hematological Splenomegaly Petechiae Purpura Easy bruising Epistaxis Gingival bleeding Systemic Night sweats Severe fatigue Elevated temperature History Hepatitis Sexually transmitted diseases Frequent viral illnesses Amebiasis Exposure to contaminated needles IV drug use Recipient of blood or blood product (1978- 1984) Multiple sex patterns Sexual preference

Alcohol use Support system Work/productive activities Fatigue Stress factors Previous loses Coping patterns Self-concept Conceptualization of illness

Nursing Dx and intervention Impaired gas exchange related to altered alveolocapillary membrane changes caused by pneumocytis carinii Assess respiratory status: rate, rhythm, and regularity of respirations; use of accessory muscles; adventitious breath sounds on auscultation, cough, and cyanosis.