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Human Immunodeficiency Virus Peggy D. Johndrow 2009
Pathophysiology   <ul><li>Retroviruses carry genetic Information in genetic material RNA instead of DNA </li></ul><ul><li>...
 
Incubation <ul><li>Latent period: infected persons (80-90%) develop symptoms of HIV disease or AIDS within 10 years; howev...
Modes of Transmission <ul><li>Sexual </li></ul><ul><ul><li>Genital, anal or oral sexual contact with exposure of mucous me...
CDC Guidelines for Testing <ul><li>People with STI’s </li></ul><ul><li>IV drug users </li></ul><ul><li>People who: conside...
Diagnostic Testing   <ul><li>Need informed consent to perform </li></ul><ul><li>Several tests; repeat to confirm   </li></ul>
Antibody Testing   <ul><li>Antibodies develop within 3-12 weeks of exposure; can take 6-14 months (may not test positive i...
Enzyme Linked Immunosorbent Assay (ELISA) <ul><li>Identifies antibodies directed specifically against HIV; not establish d...
Western Blot Assay <ul><li>Identify HIV antibodies </li></ul><ul><ul><li>Used to confirm seropositive </li></ul></ul><ul><...
Indirect Immunofluorescence Assay (IFA) <ul><li>Used instead of Western Blot faster & easier to perform </li></ul>
Radioimmunoprecipitation Assay (RIPA) <ul><li>Detects HIV protein </li></ul>
Client Implication   <ul><li>Positive test antibodies present, HIV probably active, transmit, HIV + (not AIDS), not immune...
Diagnostic Studies <ul><li>Lymphocyte Count </li></ul><ul><ul><li>Leukcopenia =  WBC <3500cells/mm ³ </li></ul></ul><ul><u...
Viral Load Testing <ul><li>Measures presence of HIV RNA in blood </li></ul><ul><ul><li>Gives quantitative number  </li></u...
HIV Tracking   <ul><li>P24 antigen </li></ul><ul><li>Quantitative cell culture – viral load </li></ul>
Immune Status   <ul><li>CD4 cells </li></ul><ul><li>CD4 cell function test   </li></ul><ul><li>T cells decreased ability t...
Basis of Clinical Manifestations  <ul><li>Result from infections, malignancies, or direct effect of HIV in body tissue   <...
Clinical Manifestations <ul><li>Initial s/s: </li></ul><ul><ul><li>Fever </li></ul></ul><ul><ul><li>Night sweats  </li></u...
Respiratory Problems   <ul><li>Most common Pneumocystis Carinni pneumonia (PCP), mycobacterium avium,  intracellular; legi...
GI Symptoms   <ul><li>Anorexia, nausea, vomiting, diarrhea, oral esophageal candidiasis, chronic diarrhea </li></ul><ul><l...
GI Disorders <ul><li>Effects of diarrhea   </li></ul><ul><ul><li>Profound weight loss >10% body weight, fluid & electrolyt...
Oncology Problems   <ul><li>High incidence of cancer </li></ul><ul><li>Kaposi’s sarcoma </li></ul><ul><ul><li>Malignancy i...
Neurological  Problems <ul><li>80% have neurological involvement </li></ul><ul><li>Central, peripheral, autonomic function...
Integumentary Problems   <ul><li>Kaposi’s Sarcoma </li></ul><ul><li>Molluscum contagiosium: viral infection with plague fo...
Problems Specific to Women <ul><li>Recurrent vaginal candidiasis  </li></ul><ul><li>Genital warts & ulcers </li></ul><ul><...
Gerontologic Considerations   <ul><li>10% AIDS occurs in people >50  </li></ul><ul><li>Under diagnosed; need education for...
HIV Classifications <ul><li>Clinical category A HIV positive </li></ul><ul><li>Clinical category B infected with HIV </li>...
Category A <ul><li>Positive HIV </li></ul><ul><li>May or may not be symptomatic </li></ul><ul><li>Lymphadnopathy or “flu-l...
Category B <ul><li>One or more problems from column Table 25-1 present </li></ul><ul><li>Caused by HIV infection or indica...
Category C <ul><li>Any single problem from column C in Table 25-1  </li></ul><ul><li>Meet criteria for diagnosis of AIDS p...
Important Facts <ul><li>Everyone who has AIDS has HIV infection  ;  not everyone who has HIV infection has AIDS </li></ul>...
Health Promotion & Prevention <ul><li>Education  most important aspect of prevention </li></ul><ul><li>HIV: not transmitte...
Sexual Transmission <ul><li>Abstinence & mutually monogamous sex;  only absolute safe methods of preventing HIV through se...
Parental Transmission <ul><li>Do Not share needles or equipment (aka “works”) </li></ul><ul><li>Use full strength househol...
Perinatal Transmission <ul><li>All women who are pregnant or contemplating pregnancy should be counseled about HIV, inform...
Health care Providers Transmission   <ul><li>Needle sticks primary means of HIV infection for healthcare workers </li></ul...
Medical Management   <ul><li>Medications : a ntiretroviral therapy with CD4+ T-cell count< 500/mm3 </li></ul><ul><li>Measu...
Treatment <ul><li>Post exposure prophylaxis (PEP) </li></ul><ul><li>Preferred regime </li></ul><ul><li>Reverse transcripta...
Treatment Regimen  <ul><li>Dosage BID for 4 weeks </li></ul><ul><li>Must start within 72 hours of exposure </li></ul><ul><...
Medications <ul><li>Nucleoside Analog Reverse Transcriptase Inhibitors (NRTI’s): suppress production of RT & inhibit viral...
Other Therapies <ul><li>Immune enhancement </li></ul><ul><ul><li>In research stages </li></ul></ul><ul><ul><ul><li>Hypothe...
Immunomodulator Therapy <ul><li>Alfa-interferon (stimulate macrophages, lymphocytes & T cells) </li></ul><ul><li>Colony st...
Other Medications   <ul><li>General infections </li></ul><ul><li>Bactrim/Septra </li></ul><ul><li>PCP pentamidine (antipro...
Medications for Specific Disorders  <ul><li>Mycobacterium avium: Biaxin, Zithromax, Rifampin, mycobutin, lamprene, Ethambu...
Nursing Implications <ul><li>See Chart 25-8 for side effects & nursing considerations </li></ul><ul><li>Antiretroviral the...
Problems r/t Therapy <ul><li>Expense of medications </li></ul><ul><li>Distressing side effects </li></ul><ul><li>Food & ti...
Nursing  <ul><li>Assessment </li></ul><ul><li>History sexual practices, IV drug use, physical status, psychological status...
Nutritional <ul><li>Balanced nutrition required for proper immune function </li></ul><ul><li>Diet history </li></ul><ul><l...
Skin integrity <ul><li>Inspect daily for breakdown, excoriation and infection   </li></ul><ul><li>Keep clean and dry </li>...
Respiratory <ul><li>Monitor cough, sputum, dyspnea, tachypnea, chest pain </li></ul><ul><li>Evaluate CXR, PFT’s, ABG’s, O2...
Neurological <ul><li>LOC, orientation </li></ul><ul><li>Mental status exam </li></ul><ul><li>Motor and sensory deficits   ...
Fluid and Electrolytes   <ul><li>Monitor labs, hydration, vital signs, signs and symptoms of electrolyte imbalance   </li>...
Health Teaching <ul><li>Client, family, and support systems </li></ul><ul><li>About disease and transmission   </li></ul><...
Integumentary   Nursing Interventions   <ul><li>Turn q 2hrs </li></ul><ul><li>Use nonabrasive, non-drying soaps, non-perfu...
Promote Usual Bowel Habits   <ul><li>Monitor frequency & consistency of stools </li></ul><ul><li>Measure quantity & volume...
Prevent Infections   <ul><li>Monitor symptoms for infection </li></ul><ul><li>Monitor labs and cultures </li></ul><ul><li>...
Improve Activity Tolerance   <ul><li>Assist clients to plan daily routine that maintain a balance between activity and res...
Maintain Thought Processes   <ul><li>Teach family to speak in simple terms, clear language and give client time to respond...
Improve Airway Clearance   <ul><li>Respiratory assessment </li></ul><ul><li>Postural drainage </li></ul><ul><li>Cough and ...
Relieve Pain and Discomfort   <ul><li>Assess </li></ul><ul><li>Provide skin care </li></ul><ul><li>Assistive devices for c...
Improve Nutrition Status  <ul><li>Oral care </li></ul><ul><li>Monitor daily weight  & dietary intake </li></ul><ul><li>Mon...
Decrease Sense of Isolation <ul><li>Acceptance and understanding </li></ul><ul><li>AIDS support groups and family support ...
Medications <ul><li>Teach side effects of medication </li></ul><ul><li>Instruct on importance of taking medications as ord...
Home and Community Based   <ul><li>Safe sexual practices </li></ul><ul><li>Avoid infections & infectious people </li></ul>...
Ethical <ul><li>With appropriate techniques minimal transmission in providing care </li></ul><ul><li>Confidential informat...
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Transcript of "Hiv Concepts Pptvo"

  1. 1. Human Immunodeficiency Virus Peggy D. Johndrow 2009
  2. 2. Pathophysiology <ul><li>Retroviruses carry genetic Information in genetic material RNA instead of DNA </li></ul><ul><li>HIV uses enzyme reverse transcriptase to insert itself into cells & reprogram genetic structure; creates HIV </li></ul>
  3. 4. Incubation <ul><li>Latent period: infected persons (80-90%) develop symptoms of HIV disease or AIDS within 10 years; however varies greatly individually </li></ul>
  4. 5. Modes of Transmission <ul><li>Sexual </li></ul><ul><ul><li>Genital, anal or oral sexual contact with exposure of mucous membranes to infected semen or vaginal secretions </li></ul></ul><ul><li>Parenteral </li></ul><ul><ul><li>Sharing needles or equipment contaminated with infected blood products </li></ul></ul><ul><ul><li>Needle sticks acquired in healthcare settings </li></ul></ul><ul><li>Perinatal </li></ul><ul><ul><li>Through placenta from contact with maternal blood & body fluids during birth or from breast milk from infected mother to child </li></ul></ul>
  5. 6. CDC Guidelines for Testing <ul><li>People with STI’s </li></ul><ul><li>IV drug users </li></ul><ul><li>People who: consider themselves at risk; received a blood transfusion between 1978-1985; planning to marry; undergoing evaluation or treatment for manifestations that may be HIV related; admitted to hospitals; are in correctional institutions </li></ul><ul><li>Prostitutes and their customers </li></ul><ul><li>Women of childbearing age with identifiable risk factors </li></ul><ul><ul><li>IV drug use, engaged in prostitution or had sexual partners who were infected, at risk or from countries with high HIV rates </li></ul></ul>
  6. 7. Diagnostic Testing <ul><li>Need informed consent to perform </li></ul><ul><li>Several tests; repeat to confirm </li></ul>
  7. 8. Antibody Testing <ul><li>Antibodies develop within 3-12 weeks of exposure; can take 6-14 months (may not test positive initially) </li></ul><ul><li>Important point, may take time to test positive does not mean client is immune </li></ul>
  8. 9. Enzyme Linked Immunosorbent Assay (ELISA) <ul><li>Identifies antibodies directed specifically against HIV; not establish diagnosis, indicates exposure; blood contains antibodies called seropositive </li></ul><ul><li>Window period” means that test can be negative even if person has HIV if test is performed too soon (i.e. testing one week after unprotected sex w/ith HIV + partner) </li></ul><ul><li>False (+) results can occasionally occur </li></ul>
  9. 10. Western Blot Assay <ul><li>Identify HIV antibodies </li></ul><ul><ul><li>Used to confirm seropositive </li></ul></ul><ul><ul><li>Positive ELISA confirmed with Western Blot Analysis </li></ul></ul><ul><ul><li>Detects serum antibodies to four specific HIV antigens </li></ul></ul>
  10. 11. Indirect Immunofluorescence Assay (IFA) <ul><li>Used instead of Western Blot faster & easier to perform </li></ul>
  11. 12. Radioimmunoprecipitation Assay (RIPA) <ul><li>Detects HIV protein </li></ul>
  12. 13. Client Implication <ul><li>Positive test antibodies present, HIV probably active, transmit, HIV + (not AIDS), not immune to AIDS </li></ul><ul><li>Negative (may not have pronounced antibodies at present); continue precautions body hasn’t produced antibodies yet; continuing present behaviors likely to result in infection with HIV </li></ul>
  13. 14. Diagnostic Studies <ul><li>Lymphocyte Count </li></ul><ul><ul><li>Leukcopenia = WBC <3500cells/mm ³ </li></ul></ul><ul><ul><li>Lymphopenia = <1500 lymphocytes/mm³ </li></ul></ul><ul><li>CD4+ and CD8+ Counts </li></ul><ul><ul><li>Decreased CD4+ counts & decreased CD4/CD8 ratios associated with increased manifestations of disease </li></ul></ul><ul><ul><li>T-helper cells = 800-1000 cells/microL </li></ul></ul><ul><ul><li>T-suppressor cells = 300-1000 cells/microL </li></ul></ul><ul><ul><li>CD4/CD8 ratio: >1 </li></ul></ul>
  14. 15. Viral Load Testing <ul><li>Measures presence of HIV RNA in blood </li></ul><ul><ul><li>Gives quantitative number </li></ul></ul><ul><ul><li>Indicates level of viral burden </li></ul></ul><ul><ul><li>Useful in monitoring disease progression & effectiveness of treatment </li></ul></ul><ul><ul><li>Quantitative RNA Assays </li></ul></ul><ul><ul><li>RT-PCR, bDNA, & NASBA: 100% specificity </li></ul></ul><ul><ul><li>p24 Antigen Assay </li></ul></ul><ul><li>Higher viral load the greater risk for transmission; HAART therapy can cause viral load to decrease to undetectable levels, disease transmission risk still present </li></ul>
  15. 16. HIV Tracking <ul><li>P24 antigen </li></ul><ul><li>Quantitative cell culture – viral load </li></ul>
  16. 17. Immune Status <ul><li>CD4 cells </li></ul><ul><li>CD4 cell function test </li></ul><ul><li>T cells decreased ability to respond </li></ul>
  17. 18. Basis of Clinical Manifestations <ul><li>Result from infections, malignancies, or direct effect of HIV in body tissue </li></ul>
  18. 19. Clinical Manifestations <ul><li>Initial s/s: </li></ul><ul><ul><li>Fever </li></ul></ul><ul><ul><li>Night sweats </li></ul></ul><ul><ul><li>Chills </li></ul></ul><ul><ul><li>H/A </li></ul></ul><ul><ul><li>Muscle aches </li></ul></ul><ul><li>Decreased CD4+ function r/t HIV infection leads to: </li></ul><ul><ul><li>Lymphocytopenia </li></ul></ul><ul><ul><li>Increased production incomplete & nonfunctional antibodies </li></ul></ul><ul><ul><li>Abnormally functioning macrophages </li></ul></ul>
  19. 20. Respiratory Problems <ul><li>Most common Pneumocystis Carinni pneumonia (PCP), mycobacterium avium, intracellular; legionella species </li></ul>
  20. 21. GI Symptoms <ul><li>Anorexia, nausea, vomiting, diarrhea, oral esophageal candidiasis, chronic diarrhea </li></ul><ul><li>Stool cultures positive for Cryptosporidium muris, Salmonella, Isopora belli, Giardia lamblia, Clostridium difficile </li></ul>
  21. 22. GI Disorders <ul><li>Effects of diarrhea </li></ul><ul><ul><li>Profound weight loss >10% body weight, fluid & electrolyte imbalance, perianal skin excoriation, weakness, inability to perform ADL’s </li></ul></ul><ul><li>Candidiasis </li></ul><ul><ul><li>Creamy white patches on oral membranes, difficulty swallowing, ulcerations, dissemination to other body systems </li></ul></ul><ul><li>Wasting syndrome </li></ul><ul><ul><li>Defined as wt loss>10% body wt & either chronic diarrhea > 30days, chronic weakness & intermittent or constant fever & absence of disease process </li></ul></ul><ul><li>Hypermetabolic state </li></ul><ul><ul><li>Excessive calories burned & lean body mass lost </li></ul></ul>
  22. 23. Oncology Problems <ul><li>High incidence of cancer </li></ul><ul><li>Kaposi’s sarcoma </li></ul><ul><ul><li>Malignancy involving blood & lymphatic vessels; cutaneous lesions on body brownish pink to deep purple lesions; confirm with biopsy </li></ul></ul><ul><li>B cell lymphomas </li></ul><ul><ul><li>Commonly brain, bone marrow & GI tract; aggressive growth & resistance to treatment; poor prognosis </li></ul></ul>
  23. 24. Neurological Problems <ul><li>80% have neurological involvement </li></ul><ul><li>Central, peripheral, autonomic function </li></ul><ul><li>HIV encephalopathy: ADC(AIDS dementia complex) decline in cognitive, behavioral & motor function ; d iagnose with CT Scan or MRI, analysis of CSF, brain biopsy </li></ul><ul><li>Cryptococcus neoformans: fungal infection; meningitis; diagnose with CSF analysis </li></ul><ul><li>Demyelinating CNS disorders </li></ul><ul><li>Central & Peripheral Neuropathy Depressive disorders </li></ul>
  24. 25. Integumentary Problems <ul><li>Kaposi’s Sarcoma </li></ul><ul><li>Molluscum contagiosium: viral infection with plague formation (wart like, skin tags) </li></ul><ul><li>Seborrheic dermatitis, folliculitis, eczema, psoriasis </li></ul>
  25. 26. Problems Specific to Women <ul><li>Recurrent vaginal candidiasis </li></ul><ul><li>Genital warts & ulcers </li></ul><ul><li>Human papilloma virus (HPV) </li></ul><ul><li>Cervical intraepithelial neoplasia (CIN) cellular change precursor to cervical cancer </li></ul><ul><li>Women with HIV 10x more likely to develop CIN </li></ul><ul><li>Strong correlation between abnormal papanicolaou smear & HIV seropositive </li></ul><ul><li>Higher incidence of PID </li></ul><ul><li>Higher incidence of menstrual abnormalities </li></ul>
  26. 27. Gerontologic Considerations <ul><li>10% AIDS occurs in people >50 </li></ul><ul><li>Under diagnosed; need education for prevention </li></ul>
  27. 28. HIV Classifications <ul><li>Clinical category A HIV positive </li></ul><ul><li>Clinical category B infected with HIV </li></ul><ul><li>Clinical category C has AIDS </li></ul>
  28. 29. Category A <ul><li>Positive HIV </li></ul><ul><li>May or may not be symptomatic </li></ul><ul><li>Lymphadnopathy or “flu-like” complaints </li></ul><ul><li>Sub categories </li></ul><ul><ul><li>A1 = CD4+ ≥500/microL </li></ul></ul><ul><ul><li>A2 = CD4+ 200-499/microL </li></ul></ul><ul><ul><li>A3 = CD4+ <200/microL </li></ul></ul>
  29. 30. Category B <ul><li>One or more problems from column Table 25-1 present </li></ul><ul><li>Caused by HIV infection or indicates deficiency cell mediated immunity; complicated by HIV infection </li></ul><ul><li>Sub categories </li></ul><ul><ul><ul><li>B1, B2, B3 </li></ul></ul></ul><ul><ul><ul><li>CD4+ counts as before </li></ul></ul></ul>
  30. 31. Category C <ul><li>Any single problem from column C in Table 25-1 </li></ul><ul><li>Meet criteria for diagnosis of AIDS per CDC guidelines </li></ul><ul><li>Sub categories </li></ul><ul><ul><ul><li>C1, C2, C3 </li></ul></ul></ul><ul><ul><ul><li>CD4+ counts as in A&B </li></ul></ul></ul>
  31. 32. Important Facts <ul><li>Everyone who has AIDS has HIV infection ; not everyone who has HIV infection has AIDS </li></ul><ul><li>Person with HIV infection can transmit virus to others at all stages of disease </li></ul><ul><li>Progression from HIV to AIDS range from months to years </li></ul><ul><li>Diagnosis of AIDS requires person be HIV (+) & have either a CD4 count <200 cells/microL or an opportunistic infection </li></ul><ul><li>Once AIDS diagnosed, even if CD4 count goes above 200 or infection is successfully treated, AIDS diagnosis remains & client does not return to just being HIV (+) </li></ul>
  32. 33. Health Promotion & Prevention <ul><li>Education most important aspect of prevention </li></ul><ul><li>HIV: not transmitted by casual contact; easily transmitted when infected body fluids in contact with mucous membranes or non-intact skin </li></ul>
  33. 34. Sexual Transmission <ul><li>Abstinence & mutually monogamous sex; only absolute safe methods of preventing HIV through sexual contact </li></ul><ul><li>Outercourse: no direct contact with blood, semen or vaginal secretions </li></ul><ul><li>Male/Female condom use </li></ul><ul><li>See Client Teaching Guidelines </li></ul>
  34. 35. Parental Transmission <ul><li>Do Not share needles or equipment (aka “works”) </li></ul><ul><li>Use full strength household bleach to clean the “works” </li></ul><ul><li>Needle exchange programs </li></ul><ul><li>See Teaching Guidelines Needle exchange programs </li></ul>
  35. 36. Perinatal Transmission <ul><li>All women who are pregnant or contemplating pregnancy should be counseled about HIV, informed of their choices, offered HIV testing & provided HAART </li></ul><ul><li>Refer to maternal-child course content </li></ul>
  36. 37. Health care Providers Transmission <ul><li>Needle sticks primary means of HIV infection for healthcare workers </li></ul><ul><ul><li>If needle stick occurs notify supervisor immediately </li></ul></ul><ul><ul><li>See Best Practice Guideline for HIV exposure </li></ul></ul><ul><li>Contact with infected body fluids </li></ul><ul><ul><li>Best prevention is consistent use of standard precautions </li></ul></ul><ul><ul><li>See prevention guidelines for healthcare workers </li></ul></ul>
  37. 38. Medical Management <ul><li>Medications : a ntiretroviral therapy with CD4+ T-cell count< 500/mm3 </li></ul><ul><li>Measure CD4+ count & viral load 2x before initiating </li></ul><ul><li>HAART triple medication regimen </li></ul><ul><ul><li>1 protease inhibitor </li></ul></ul><ul><ul><li>2 reverse transcriptase inhibitors </li></ul></ul><ul><li>Combination therapies use 3 to 4 medications combinations </li></ul>
  38. 39. Treatment <ul><li>Post exposure prophylaxis (PEP) </li></ul><ul><li>Preferred regime </li></ul><ul><li>Reverse transcriptase inhibitors zidovudine (AZT) and lamivudine (Edvir) </li></ul><ul><li>Alternate </li></ul><ul><li>Stavudine (ZERIT) and didanosine (Videx) </li></ul><ul><li>If client has a high viral load or advanced HIV add a Protease inhibitors either </li></ul><ul><li>Nelfinavir (Viracept) or indinavir (Crixivan) </li></ul>
  39. 40. Treatment Regimen <ul><li>Dosage BID for 4 weeks </li></ul><ul><li>Must start within 72 hours of exposure </li></ul><ul><li>If not started renders no benefit after 72 hours </li></ul>
  40. 41. Medications <ul><li>Nucleoside Analog Reverse Transcriptase Inhibitors (NRTI’s): suppress production of RT & inhibit viral DNA synthesis/replication; Retrovir, AZT (zidovudine ) </li></ul><ul><li>Non-Nucleoside Analog Reverse Transcriptase Inhibitors (NNRTI’s): inhibits synthesis of RT & suppresses viral replication; Suvista (efavirenz ) </li></ul><ul><ul><ul><li>Protease Inhibitors: block protease enzyme preventing viral replication & release of viral particles; Invirase (saquinavir) </li></ul></ul></ul><ul><li>Fusion Inhibitors: b lock ability of gp41 to fuse with CD4+ cell: Fuzeon( enfuvirtide); approved treatment advanced, resistant HIV infection </li></ul>
  41. 42. Other Therapies <ul><li>Immune enhancement </li></ul><ul><ul><li>In research stages </li></ul></ul><ul><ul><ul><li>Hypothesis: immune system may be enhanced or replenished </li></ul></ul></ul><ul><ul><ul><ul><li>Bone marrow transplant </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Lymphocyte transfusion </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Interleukin-2 infusion </li></ul></ul></ul></ul><ul><li>Complementary/Alternative therapies </li></ul><ul><ul><li>Usefulness not yet established; however, used by many clients with HIV/AIDS </li></ul></ul><ul><ul><ul><li>Vitamins, shark cartilage, botanicals </li></ul></ul></ul>
  42. 43. Immunomodulator Therapy <ul><li>Alfa-interferon (stimulate macrophages, lymphocytes & T cells) </li></ul><ul><li>Colony stimulating factor </li></ul><ul><ul><li>Epoetin alfa recombinant/Epogen </li></ul></ul><ul><ul><li>Filgrastim/Neupogen </li></ul></ul>
  43. 44. Other Medications <ul><li>General infections </li></ul><ul><li>Bactrim/Septra </li></ul><ul><li>PCP pentamidine (antiprotozoal) IV slow infusion </li></ul><ul><li>Steroid </li></ul>
  44. 45. Medications for Specific Disorders <ul><li>Mycobacterium avium: Biaxin, Zithromax, Rifampin, mycobutin, lamprene, Ethambutal, Cipro & Amikacin </li></ul><ul><li>Meningitis: Amphotericin B, Diflucan </li></ul><ul><li>Other infections </li></ul><ul><ul><li>Acyclovir & Foscarent for herpes encephalitis </li></ul></ul><ul><ul><li>Daraprim, Sulfadiazine, Clindamycin for toxoplasmosis </li></ul></ul><ul><ul><li>Myclex, Nystatin for candidiasis </li></ul></ul><ul><ul><li>Ketoconazole, fluconazole for chronic candidiasis </li></ul></ul>
  45. 46. Nursing Implications <ul><li>See Chart 25-8 for side effects & nursing considerations </li></ul><ul><li>Antiretroviral therapy only inhibits viral replication; it does not kill virus </li></ul><ul><li>Combination therapy uses; monotherapy promotes resistance , not improve duration or quality of life </li></ul><ul><li>“ Cocktails” combination of different types of antiretroviral medications </li></ul><ul><li>HAART (highly active antiretroviral therapy) shows good results as evidenced by decreased viral load & increased CD4+ counts </li></ul>
  46. 47. Problems r/t Therapy <ul><li>Expense of medications </li></ul><ul><li>Distressing side effects </li></ul><ul><li>Food & timing requirements </li></ul><ul><li>Amount of pills that must be taken daily </li></ul><ul><li>Treatment is lifelong & burdensome </li></ul>
  47. 48. Nursing <ul><li>Assessment </li></ul><ul><li>History sexual practices, IV drug use, physical status, psychological status & all factors affecting immune system </li></ul><ul><li>Teaching </li></ul>
  48. 49. Nutritional <ul><li>Balanced nutrition required for proper immune function </li></ul><ul><li>Diet history </li></ul><ul><li>Assess factors interfering with intake </li></ul><ul><li>Weight, BUN, serum protein, albumin, and transferrin levels </li></ul>
  49. 50. Skin integrity <ul><li>Inspect daily for breakdown, excoriation and infection </li></ul><ul><li>Keep clean and dry </li></ul>
  50. 51. Respiratory <ul><li>Monitor cough, sputum, dyspnea, tachypnea, chest pain </li></ul><ul><li>Evaluate CXR, PFT’s, ABG’s, O2 saturation </li></ul>
  51. 52. Neurological <ul><li>LOC, orientation </li></ul><ul><li>Mental status exam </li></ul><ul><li>Motor and sensory deficits </li></ul>
  52. 53. Fluid and Electrolytes <ul><li>Monitor labs, hydration, vital signs, signs and symptoms of electrolyte imbalance </li></ul><ul><li>I&O </li></ul><ul><li>Skin turgor </li></ul><ul><li>Mucus membranes </li></ul>
  53. 54. Health Teaching <ul><li>Client, family, and support systems </li></ul><ul><li>About disease and transmission </li></ul><ul><li>Use of alternative therapies </li></ul><ul><li>Prevention </li></ul>
  54. 55. Integumentary Nursing Interventions <ul><li>Turn q 2hrs </li></ul><ul><li>Use nonabrasive, non-drying soaps, non-perfumed moisturizers </li></ul><ul><li>Avoid adhesive tape </li></ul><ul><li>Cleanse after BM with soap and water </li></ul><ul><li>Sitz bath for comfort </li></ul>
  55. 56. Promote Usual Bowel Habits <ul><li>Monitor frequency & consistency of stools </li></ul><ul><li>Measure quantity & volume of liquid stools to document fluid loss </li></ul><ul><li>Avoid bowel irritants raw fruits & vegetables, popcorn, carbonated beverages, spicy foods, extreme temperatures of foods </li></ul><ul><li>Small frequent meals </li></ul><ul><li>Anti diarrheal agents administered on regular schedule </li></ul><ul><li>  </li></ul>
  56. 57. Prevent Infections <ul><li>Monitor symptoms for infection </li></ul><ul><li>Monitor labs and cultures </li></ul><ul><li>Screen visitors; avoid others with infections </li></ul><ul><li>No live plants; fresh fruits </li></ul><ul><li>All use good handwashing </li></ul><ul><li>Promote client hygiene </li></ul>
  57. 58. Improve Activity Tolerance <ul><li>Assist clients to plan daily routine that maintain a balance between activity and rest </li></ul><ul><li>Teach techniques of energy conservation </li></ul><ul><li>Cluster nursing actions </li></ul>
  58. 59. Maintain Thought Processes <ul><li>Teach family to speak in simple terms, clear language and give client time to respond </li></ul><ul><li>Orient to daily routine </li></ul><ul><li>Provide a regular schedule / routine </li></ul>
  59. 60. Improve Airway Clearance <ul><li>Respiratory assessment </li></ul><ul><li>Postural drainage </li></ul><ul><li>Cough and deep breathe q 2hrs </li></ul><ul><li>Place HOB in semi or high fowlers </li></ul><ul><li>Adequate hydration (3L/fluid per day) </li></ul><ul><li>Suction as needed </li></ul>
  60. 61. Relieve Pain and Discomfort <ul><li>Assess </li></ul><ul><li>Provide skin care </li></ul><ul><li>Assistive devices for comfort </li></ul><ul><li>Medications NSAIDS, Opioid, tricyclic antidepressants </li></ul>
  61. 62. Improve Nutrition Status <ul><li>Oral care </li></ul><ul><li>Monitor daily weight & dietary intake </li></ul><ul><li>Monitor labs </li></ul><ul><li>Control nausea & vomiting with </li></ul><ul><li>anti-emetics on regular basis </li></ul><ul><li>Oral soreness opioids, viscous lidocaine </li></ul><ul><li>Bland diet, avoid temperature extremes in foods </li></ul><ul><li>Rest before meals </li></ul><ul><li>Dietary teaching, </li></ul><ul><li>supplements </li></ul>
  62. 63. Decrease Sense of Isolation <ul><li>Acceptance and understanding </li></ul><ul><li>AIDS support groups and family support </li></ul><ul><li>Educate client’s families, friends and staff </li></ul>
  63. 64. Medications <ul><li>Teach side effects of medication </li></ul><ul><li>Instruct on importance of taking medications as ordered </li></ul><ul><li>Explain what to report </li></ul>
  64. 65. Home and Community Based <ul><li>Safe sexual practices </li></ul><ul><li>Avoid infections & infectious people </li></ul><ul><li>Kitchens & bathrooms surfaces cleansed with disinfectants </li></ul><ul><li>Avoid contact with pet waste, if necessary client must use gloves </li></ul>
  65. 66. Ethical <ul><li>With appropriate techniques minimal transmission in providing care </li></ul><ul><li>Confidential information disclosure issues </li></ul><ul><li>Privacy </li></ul><ul><li>High mortality rate </li></ul><ul><li>Self-assessment & awareness of personal value & belief system regarding HIV & AIDS </li></ul>
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