Kaposi's Sarcoma And Lyme Disease

KAPOSI’S SARCOMA

-most common AIDS-related cancer

-causes structural and functional damage.

-when associated with AIDS, it progresses aggressively, involving the lymph nodes, the viscera and, possibly, GI structures.

Causes:

1.     Idiopathic = unknown

2.     Maybe related to immunosuppression.

3.     Genetic factors

Signs and Symptoms

ü  Obvious lesions in various shapes, sizes and colors (ranging from red-brown to dark purple) appearing most commonly on the skin, buccal mucosa, hard and soft palates, lips, gums, tongue, tonsils, conjunctiva, and sclera. – initial sign

ü  Lesions may become one large plaque if left untreated.

ü  A health history of AIDS

ü  Pain

ü  Edema from lymphatic obstruction

ü  Dyspnea, wheezing, hypoventilation, and respiratory distress from bronchial blockage. (in cases of pulmonary involvement)

*most common extracutaneous sites are the lungs and metastasis include sever pulmonary involvement and GI involvement leading to digestive problems.

Diagnosis

1.     Tissue biopsy

2.     CT scan

Treatment

*Indications: Cosmetically offensive, painful or obstructive lesions of rapidly progressing disease.

1. Radiation therapy – alleviates symptoms of pain from obstructing lesions in the oral cavity or extremities and edema caused by lymphatic blockage. It may also be used for cosmetic improvement.

2. Chemotherapy – includes combinations of doxorubicin, vinblastine, vincristine and etoposide (VP-16)

3. Biotherapy – with interferon alfa-2b may be administered for AIDS-related Kaposi’s sarcoma.

Nursing Management

1.     Allow and encourage patient to participate in self-care decisions.

2.     Inspect the patient’s skin every shift.

3.     Follow universal precautions when caring for the patient

4.     Administer pain medications

5.     Teach diversion activities and relaxation techniques.

6.     Allow to express feelings and provide encouragement.

7.     Monitor patient’s weight daily.

8.     DIET: High-calorie , high-protein meals.

9.     Small frequent feedings.

10.   WOF side effects of radiation therapy or chemotherapy such as anorexia, nausea, vomiting and diarrhea.

11.   Of course, monitor V/S.

LYME DISEASE

-A multisystemic disorder.

-causative agent : Borrelia burgdorferi which is carried by the minute tick Ixodes dammini.

-it often begins in the summer with classic skin lesion called erythema chronicum migrans (ECM)

Signs and Symptoms (3 Stages)

Stage 1

-          ECM heralds

-          Lesion feels hot and itchy

-          Malar rash

-          Conjunctivitis

-          Diffuse urticaria

-          Lesions are replaced by small red blotches in 3 to 4 weeks

-          Malaise

-          Fatigue

-          Headache, fever, chills, achiness and regional lymphadenopathy

-          Less common

o   Meningeal irritation, mild encephalopathy, migrating musculoskeletal pain and hepatitis

o   Sore throat and dry cough may appear sever days before ECM.

Stage 2 (weeks to months later)

-          Fluctuating meningoencephalitis with peripheral and cranial neuropathy.

-          Facial palsy

-          Cardiac abnormalities such as a brief, fluctuatin AV heart block, may also develop.

Stage 3 (weeks to years later)

-          Musculoskeletal pain

-          Frank arthritis with marked swelling

Diagnosis.

Ø  Indirect immunofluorescent antibody test but are marginally sensitive.

Ø  Clinical assessment especially on EMC characteristics.

Treatment

ü  DOC : Tetracycline

ü  Penicillin and erythromycin are alternates.

Nursing Management

o    Help with ROM exercises but avoid overexertion

o    Assess for patient’s neurologic function and level of consciousness frequently.

o    Watch for signs of increased ICP and cranial nerve involvement such as ptosis, strabismus and diplopia

o    Check for cardiac abnormalities such as arrhythmias and heart block.

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