Discharge And Home Healthcare Guidelines

MEDICATIONS. Instruct the patient on all medications, including the dosage, route, action, and adverse effects.

COMPLICATIONS OF SURGERY. Instruct the patient to notify the physician if signs of infection or increased vaginal bleeding are noted. If patient is discharged with a catheter, assure that they understand that the catheter must remain patent and to notify physician if the catheter fails to drain urine.

Cytomegalovirus Infection 271

PATIENT TEACHING. Instruct the patient to avoid enemas, heavy lifting, prolonged standing, and sexual intercourse for approximately 6 weeks. Note that it is normal to have some loss of vaginal sensation for several months. Emphasize the importance of keeping follow-up visits.

Cytomegalovirus (CMV) is a member of the herpes simplex virus group. The virus, transmitted by human contact, results in an infection so mild that it is usually overlooked because no symptoms are present. Approximately 80% of the general population experience a CMV infection by the time they reach middle age. Imunosuppressed patients, however, particularly patients who have received transplanted organs, are highly susceptible to CMV, with estimates as high as 90% of such patients contracting CMV infection. Generally the CMV infection occurs 4 to 6 weeks after the implementation of increased doses of immunosuppressive drugs to treat rejection. CMV infection is also present in at least 80% of patients with acquired immunodeficiency syndrome (AIDS), causing serious problems such as encephalitis, retinitis, pneumonia, and esophagitis in 30% of them.

The virus generally inhabits the salivary glands in a latent infection that is reactivated by pregnancy, blood transfusions, or immunosuppressive medications. Benign in people with normal immune systems, the virus can be devastating to an unborn fetus or a person with immuno-suppression. The virus is spread throughout the body by the white blood cells (lymphocytes and mononuclear cells) to organs such as the liver, lungs, gastrointestinal (GI) tract, and central nervous system (CNS), leading to cellular inflammation and possibly organ dysfunction.

CMV is transmitted by contact with the fluids that contain the virus, such as saliva, urine, breast milk, cervical mucus, and semen. It can be transmitted during pregnancy from a primary or reactivated CMV infection. It can be transmitted during delivery from contact with cervical secretions or after delivery in the breast milk. The virus may be present for years after the primary infection.

Fetuses and infants are at particular risk because intrauterine CMV infection is the most common congenital infection; it occurs in 0.5% to 3% of all live births. Infection of the fetus by CMV may not be recognized until birth or several years after birth because pregnant women with CMV infections may not have clinical symptoms. Infants who have been infected with CMV during gestation may have intrauterine growth retardation, microcephaly (small head size), or hydrocephaly (increased cerebrospinal fluid in the brain).

In adults, CMV may be serious and can cause blindness or a mononucleosis-type infection. CMV mononucleosis is the most common form of CMV infection, and it occurs at about 25 to 30 years of age. In adults with no immunosuppression difficulties, the risk of infection increases with age. Of adults over the age of 40, 50% have antibodies to CMV, but most do not

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