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Chapter035
Chapter035
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Chapter035

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  • 1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 35: Caring for Clients with HIV/AIDS Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 2. Human Immunodeficiency Virus • Requires host for survival, duplication • Eventually results in AIDS – Can remain well for several years being HIV+ • Pandemic: 33.2 million people worldwide – 63% live in sub-Saharan Africa • 2 of 3 adults are HIV+ • 90% of children are HIV+ • No longer exclusive: Homosexual men; IV drug users – Increasing numbers of heterosexual women infected; Transmission to newborns Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 3. Human Immunodeficiency Virus • Nurses: Largest group of healthcare workers to occupationally acquire HIV • 2007 Deaths: 2.1 million people (decline) • U.S. Health Problem – African-Americans: HIV infection rate 8 times higher than whites – 2003 • 2nd leading death cause in African-American males, ages 35-44 • 3rd leading death cause in African-American females, ages 35-44 Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 4. Human Immunodeficiency Virus • Subtypes – HIV-1: Mutates easily, frequently • More prevalent in U.S., world – HIV-2: Less transmittable; HIV to AIDS interval longer • Western Africa primary infection site Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 5. Human Immunodeficiency Virus (HIV) •HIV Structural Characteristics Structure of a retrovirus Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 6. Human Immunodeficiency Virus (HIV) Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 7. HIV Replication; Transmission ● Transmission: Body fluids − Blood − Semen − Vaginal secretions − Breast milk ● Specific behaviors increase risk Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 8. Human Immunodeficiency Virus • Pathophysiology and Etiology – Infected CD4 cells are unable to recognize foreign antigens – Viral cells continue parasitic replication, resulting in decreased CD4 cell count • >10 billion viral particles released daily • Frequent mutations complicate drug therapy • Render vaccine development virtually impossible • New strains Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 9. Human Immunodeficiency Virus • Prevention Strategies – Prevention guideline compliance • No sex with strangers; Mutually monogamous sex – uninfected partner • Use condoms effectively • No IV, psychostimulant drug use – Use standard precautions – Immediately report needlesticks • Get prophylactic treatment Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 10. Acquired Immunodeficiency Syndrome • Is End Stage HIV Infection – Immunodeficiency develops – Mortality from opportunistic infection; Cancers • Progression Related to – Viral concentration in blood – Subtype, strain of infecting HIV – CD4 cell status • Few Long-term Survivors Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 11. Acquired Immunodeficiency Syndrome • Assessment Findings: Signs and Symptoms – Acute retroviral syndrome (flu-like) • Fever; Swollen, tender lymph nodes; Rash on face, trunk, pales, soles; Muscle, joint pain; HA; N/V; Diarrhea – Liver, spleen enlargement; Weight loss; Neurologic symptoms; Kaposi’s sarcoma; Abnormal gynecologic problems in women • Assessment Findings: Diagnostic Findings – ELISA test (x2), Western blot test confirms – CD4 (T-cell) count; Viral load tests Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 12. Acquired Immunodeficiency Syndrome Figure 35-4 Kaposi's Sarcoma Left: Single lesion; Right: Multiple lesions Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 13. AIDS Antiretroviral drugs Supportive care Adjunct drug therapy Medical Management Treating anorexia, diarrhea, weight loss Treating side effects of therapy Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 14. Medical Management • Antiretroviral Drug Therapy – Initiation controversy; Very expensive – Reverse transcriptase inhibitors • NRTIs + NNRTIs: Cripple viral copying • Nucleotide analogues: Activate immediately on entering CD4 cell – Protease inhibitors: Interfere with viral copy maturation – Entry inhibitors: Block proteins or surface coreceptors of the CD4 T-cell lymphocyte • HAART Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 15. Highly Active Antiretroviral Therapy (HAART) Combination Therapy Reverse Transcriptase Inhibitors Protease Inhibitors Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Fusion Inhibitors
  • 16. Medical Management • Adjunct Drug Therapy – Hydroxyurea: Interferes with viral replication – IL-2: Boosts immune defenses against HIV • AIDS Vaccines: In clinical trials; Success unlikely due to frequent viral mutations • Drug resistance development due to noncompliance – Medication compliance difficult • Numerous medications taken simultaneously ATC requiring near-perfect compliance • Undesirable GI side effects Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 17. Medical Management Figure 35-7 The effect of noncompliance on drug resistance Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 18. Supportive Care: Opportunistic Infection Pneumocystis Pneumonia Cryptosporidiosis Infectious Conditions Candidiasis Cytomegalovirus Infection Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 19. AIDS-Related Complication Management • AIDS Dementia Complex (ADC) – Antiretroviral therapy – Drug therapy • Distal Sensory Polyneuropathy (DSP) – Side effect of several antiretroviral drugs – Vitamin B12 – Thiamine supplementation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 20. Nursing Management • Maintain client confidentiality • Significant health education; Counseling; Follow-up • Diagnostics – Test result interpretation; Appointments • Medications – Action and side effects of drugs – Schedule for self-administration • Referral to support groups and resources for information Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 21. Nursing Management • Reducing Occupational Risks – Observe standard precautions – Follow guidelines: Nursing; OSHA – Immediately report any blood exposure • Post-exposure HIV testing at regular intervals • Follow sexual precautions post-exposure Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 22. End of Presentation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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