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Barbara Weis MS, RN, CCRN Fall 2007 HIV/AIDS
History of HIV/AIDS <ul><li>1981 </li></ul><ul><li>1985 </li></ul><ul><li>1987 </li></ul><ul><li>1994 </li></ul><ul><li>19...
 
Ribonucleic Acid Virus
HIV Replication
CD4+ T Cells <ul><li>CD4 Receptors </li></ul><ul><ul><li>lymphocytes </li></ul></ul><ul><ul><li>monocytes/macrophages  Hel...
Transmission of HIV <ul><li>Contact with infected body fluids </li></ul><ul><ul><ul><li>Blood </li></ul></ul></ul><ul><ul>...
Factors Affecting Transmission <ul><li>Duration of contact </li></ul><ul><li>Frequency of contact </li></ul><ul><li>Volume...
Sexual Transmission <ul><li>Sexual contact with an HIV-infected partner </li></ul><ul><ul><li>Contact with semen, vaginal ...
Injection Equipment <ul><li>Accidental or intended sharing </li></ul><ul><ul><li>Illegal drugs </li></ul></ul><ul><ul><li>...
Healthcare Workers <ul><li>Occupational exposure </li></ul><ul><li>57 heath care workers (24 nurses)137 more cases of acci...
Diagnosis of HIV <ul><li>Window period after infection </li></ul><ul><ul><li>Will not test antibody positive </li></ul></u...
Blood Testing <ul><li>Standard blood test </li></ul><ul><li>First to be developed </li></ul><ul><ul><li>Most widely used <...
Urine HIV Antibody Test <ul><li>Painless and Noninvasive </li></ul><ul><li>Not as sensitive or specific as blood testing <...
Rapid HIV Antibody Test <ul><li>Results in 5 to 60 minutes </li></ul><ul><li>Collection </li></ul><ul><ul><li>Fingertip la...
Home Testing Kits <ul><li>Do-it-yourself </li></ul><ul><ul><li>Finger-prick </li></ul></ul><ul><ul><li>Mailed to laborator...
Perinatal and Newborn Testing <ul><li>HIV-infected Mother identified during pregnancy </li></ul><ul><ul><li>Medications hi...
Laboratory Studies <ul><li>Decreased white blood cell count (WBC) </li></ul><ul><ul><li>Low neutrophil count (neutropenia)...
HIV Staging <ul><li>Category 1 </li></ul><ul><ul><li>CD4 count >500 </li></ul></ul><ul><li>Category A </li></ul><ul><ul><l...
Timeline: Untreated HIV
Acute HIV Infection <ul><li>Acute retroviral syndrome </li></ul><ul><ul><li>Seroconversion </li></ul></ul><ul><ul><li>Occu...
Early Chronic HIV Infection <ul><li>10 years </li></ul><ul><li>CD4+ T lymphocyte cells remain above 500 cells/ µ/l </li></...
Intermediate Chronic Infection <ul><li>CD4+ T cell count to 200 - 499  µl </li></ul><ul><li>Viral load rises </li></ul><ul...
Opportunistic Infections <ul><li>Oropharyngeal candidiasis (thrush) </li></ul><ul><li>Varicella zoster virus (shingles) </...
Late Chronic Infection (AIDS) <ul><li>CD4+ count below 200 </li></ul><ul><ul><li>CD4 (helper) to CD8 (suppressor) ratio re...
Collaborative Management <ul><li>Monitoring disease progression </li></ul><ul><li>Monitoring immune function </li></ul><ul...
Tests for Resistance <ul><li>Tests for resistance to antiretroviral drugs </li></ul><ul><ul><li>Genotype assay </li></ul><...
Starting ART <ul><li>Old guidelines: “Hit early, hit hard” </li></ul><ul><li>New guidelines: Wait for viral load to go up ...
Drug Therapy for HIV Infection <ul><li>Goals: </li></ul><ul><ul><li>Decreases HIV RNA levels to less than 50 copies/ µl </...
Disease and Drug Side Effects <ul><li>Anxiety, fear, depression </li></ul><ul><li>Diarrhea </li></ul><ul><li>Peripheral ne...
Nursing Assessment <ul><li>Focus on behaviors:  </li></ul><ul><ul><li>Have you ever had a blood transfusion or used clotti...
Nursing Diagnosis <ul><li>Nursing Outcomes </li></ul>
Patient Education <ul><ul><li>Adhere to drug regimens </li></ul></ul><ul><ul><li>Promote a healthy lifestyle </li></ul></u...
Illicit Drug Use <ul><li>Sharing injecting equipment </li></ul><ul><li>Unsafe sexual experiences while under influence of ...
Initial Response to Diagnosis <ul><li>Empowerment </li></ul><ul><ul><li>Education </li></ul></ul><ul><ul><li>Honest discus...
Health Promotion <ul><li>Promote healthy immune system </li></ul><ul><ul><li>Nutritional Support </li></ul></ul><ul><ul><u...
Pneumocystis Carinii Pneumonia <ul><li>CD4 counts < 200 </li></ul><ul><li>Prevent with antibiotics </li></ul><ul><li>S/S: ...
Cryptococcus Neoformans <ul><li>6 to 10% of all HIV-infected clients </li></ul><ul><li>Meningitis </li></ul><ul><ul><li>Pr...
Cytomegalovirus Retinitis <ul><li>Retinitis </li></ul><ul><ul><li>Decreased vision </li></ul></ul><ul><ul><li>floaters </l...
Kaposi's sarcoma <ul><li>Skin </li></ul><ul><ul><li>Lesions flat or raised </li></ul></ul><ul><ul><li>Variety in color and...
Mycobacterium Avium complex <ul><li>Gastrointestinal tract problems </li></ul><ul><li>Can also infect blood, spleen, lymph...
Metabolic Disorders <ul><li>Changes in body shape </li></ul><ul><ul><li>Fat redistribution to abdomen, upper back, breasts...
AIDS-Dementia Complex <ul><li>Cognitive, behavioral motor abnormalities </li></ul><ul><ul><li>Decreased ability to concent...
Terminal phase <ul><li>Disease progresses toward disability and death </li></ul><ul><ul><li>Calculated decision to forego ...
Suicide Rates  <ul><li>66  times greater </li></ul><ul><li>than that of others </li></ul><ul><li>Art from:  </li></ul><ul>...
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Hivaids Fa07

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  • Transcript of "Hivaids Fa07"

    1. 1. Barbara Weis MS, RN, CCRN Fall 2007 HIV/AIDS
    2. 2. History of HIV/AIDS <ul><li>1981 </li></ul><ul><li>1985 </li></ul><ul><li>1987 </li></ul><ul><li>1994 </li></ul><ul><li>1995-1999 </li></ul><ul><li>2000-present </li></ul><ul><li>Documented presence of new disease </li></ul><ul><li>Causative agent identified (HIV) </li></ul><ul><li>AIDS determined to be end stage </li></ul><ul><li>Antibody test developed </li></ul><ul><li>Routes of transmission determined </li></ul><ul><li>Drug therapy available </li></ul><ul><li>OK first state to mandate AIDS education </li></ul><ul><li>Other advances </li></ul><ul><li>Development of lab tests </li></ul><ul><li>Production of new drugs </li></ul><ul><li>Combination drug therapy </li></ul><ul><li>Test for antiretroviral drug resistance </li></ul><ul><li>Treatment to decrease risk of transmission from mother to baby </li></ul><ul><li>Protease inhibitors approved </li></ul><ul><li>Home testing available; Antigen testing & viral load testing available </li></ul><ul><li>New drug formulas approved; 1 st generic drug approved </li></ul><ul><li>Rapid HIV testing available </li></ul><ul><li>HIV genotyping approved to begin </li></ul>
    3. 4. Ribonucleic Acid Virus
    4. 5. HIV Replication
    5. 6. CD4+ T Cells <ul><li>CD4 Receptors </li></ul><ul><ul><li>lymphocytes </li></ul></ul><ul><ul><li>monocytes/macrophages Helper T cells </li></ul></ul><ul><ul><li>astrocytes </li></ul></ul><ul><ul><li>Oligodendrocytes </li></ul></ul><ul><li>Adults normal </li></ul><ul><ul><li>800 to 1200 per microliter ( µl) of blood </li></ul></ul><ul><ul><li>Normal life span: 100 days </li></ul></ul><ul><li>Healthy until 500 CD4+ T cells/ µl </li></ul><ul><li>Problems start at 200 to 499 CD4+ T cells/ µl </li></ul><ul><li>Severe problems start at < 200 CD4+ T cells/ µl </li></ul>
    6. 7. Transmission of HIV <ul><li>Contact with infected body fluids </li></ul><ul><ul><ul><li>Blood </li></ul></ul></ul><ul><ul><ul><li>Semen </li></ul></ul></ul><ul><ul><ul><li>Vaginal secretions </li></ul></ul></ul><ul><ul><ul><li>Breast milk </li></ul></ul></ul><ul><li>One of three ways: </li></ul><ul><ul><li>Sexual intercourse with infected partner </li></ul></ul><ul><ul><li>Exposure to HIV-infected blood or blood products </li></ul></ul><ul><ul><li>Perinatal transmission </li></ul></ul><ul><ul><ul><li>During pregnancy </li></ul></ul></ul><ul><ul><ul><li>At time of delivery </li></ul></ul></ul><ul><ul><ul><li>Breastfeeding </li></ul></ul></ul>
    7. 8. Factors Affecting Transmission <ul><li>Duration of contact </li></ul><ul><li>Frequency of contact </li></ul><ul><li>Volume of fluid </li></ul><ul><li>Virulence of virus </li></ul><ul><li>Concentration of virus </li></ul><ul><li>Host immune status </li></ul>
    8. 9. Sexual Transmission <ul><li>Sexual contact with an HIV-infected partner </li></ul><ul><ul><li>Contact with semen, vaginal secretions, and/or blood </li></ul></ul><ul><ul><ul><li>Lymphocytes containing HIV </li></ul></ul></ul><ul><li>MSM account for most cases of sexual </li></ul><ul><li>transmission </li></ul><ul><li>MSW most common method of infection </li></ul><ul><li>for women </li></ul><ul><li>Unprotected anal intercourse most risky </li></ul><ul><li>Greatest risk for partner who receives </li></ul><ul><li>the semen </li></ul><ul><ul><li>Receiver has prolonged contact with </li></ul></ul><ul><ul><li>semen </li></ul></ul><ul><ul><li>Can be transmitted to inserting partner </li></ul></ul><ul><li>Most risky when blood involved </li></ul><ul><ul><li>Menstruation </li></ul></ul><ul><ul><li>Trauma </li></ul></ul><ul><ul><li>Genital lesions from other STDs </li></ul></ul>
    9. 10. Injection Equipment <ul><li>Accidental or intended sharing </li></ul><ul><ul><li>Illegal drugs </li></ul></ul><ul><ul><li>All used equipment is potentially contaminated </li></ul></ul><ul><ul><li>Only 1% of adult AIDS cases </li></ul></ul><ul><li>Blood donation </li></ul><ul><ul><li>Routine screening not until 1985 </li></ul></ul><ul><ul><li>Still possible during first few </li></ul></ul><ul><ul><li>months after infection </li></ul></ul><ul><li>Clotting Factors </li></ul><ul><ul><li>Heat and chemical treated </li></ul></ul>
    10. 11. Healthcare Workers <ul><li>Occupational exposure </li></ul><ul><li>57 heath care workers (24 nurses)137 more cases of accidental exposure </li></ul><ul><li>Risk of infection after needle-stick </li></ul><ul><ul><ul><li>0.3% to 0.4% </li></ul></ul></ul><ul><ul><ul><li>Deep puncture wound </li></ul></ul></ul><ul><ul><ul><li>Hollow bore needle </li></ul></ul></ul><ul><ul><ul><li>Visible blood </li></ul></ul></ul><ul><ul><ul><li>Higher if patient has high viral load </li></ul></ul></ul><ul><ul><ul><li>Patient dies within 60 days </li></ul></ul></ul><ul><ul><li>Risk of infection after splash exposure </li></ul></ul><ul><ul><ul><li>Risk much lower </li></ul></ul></ul><ul><ul><ul><li>On skin with open lesion </li></ul></ul></ul><ul><li>Employer Requirements </li></ul><ul><li>Protect workers from exposure to blood and other potentially infectious materials </li></ul><ul><li>Postexposure prophylaxis (PEP) </li></ul><ul><ul><li>Combination ART </li></ul></ul><ul><ul><ul><li>Type of exposure </li></ul></ul></ul><ul><ul><ul><li>Volume of exposure </li></ul></ul></ul><ul><ul><ul><li>Status of source patient </li></ul></ul></ul><ul><li>Report exposures </li></ul><ul><li>OSHA requirements </li></ul><ul><li> Isolation needs </li></ul>
    11. 12. Diagnosis of HIV <ul><li>Window period after infection </li></ul><ul><ul><li>Will not test antibody positive </li></ul></ul><ul><ul><li>Median delay of 2 months before antibodies can be detected </li></ul></ul><ul><li>Testing is highly accurate if proper sequence followed (Lewis Table 14-3) </li></ul><ul><li>Locations offering free testing </li></ul><ul><li>Not all tests available everywhere </li></ul><ul><ul><li>Sample: Oral mucosa, urine and blood </li></ul></ul><ul><ul><li>Time: Standard or rapid (20 minutes) </li></ul></ul><ul><ul><li>Method: EIA, Western Blot </li></ul></ul><ul><ul><li>FDA approval and availability </li></ul></ul>
    12. 13. Blood Testing <ul><li>Standard blood test </li></ul><ul><li>First to be developed </li></ul><ul><ul><li>Most widely used </li></ul></ul><ul><ul><li>May take 2 weeks </li></ul></ul><ul><ul><li>Initial assay used (EIA, ELISA) </li></ul></ul><ul><ul><li>Confirmed with Western Blot </li></ul></ul><ul><li>OMT HIV Antibody Test </li></ul><ul><li>Alternative to standard blood test </li></ul><ul><li>Specially treated pad placed in mouth and gently rubbed between lower cheek and gum </li></ul><ul><li>Collect oral fluid called oral mucosal transudate (OMT) </li></ul><ul><li>Must be confirmed with Western Blot </li></ul><ul><li>Does not test saliva! </li></ul><ul><li>FDA approved </li></ul><ul><li>Rapid Report </li></ul><ul><ul><li>Orrasure© </li></ul></ul><ul><ul><li>OraQuick Advance HIV ½ © </li></ul></ul>
    13. 14. Urine HIV Antibody Test <ul><li>Painless and Noninvasive </li></ul><ul><li>Not as sensitive or specific as blood testing </li></ul><ul><ul><li>Urine EIA (ELISA) </li></ul></ul><ul><ul><li>Confirmed with Western Blot technique </li></ul></ul><ul><li>FDA-licensed as alternative to blood test </li></ul><ul><li>Eliminates needle sticks and exposure-related dangers </li></ul><ul><ul><li>Protects patient and healthcare worker </li></ul></ul>
    14. 15. Rapid HIV Antibody Test <ul><li>Results in 5 to 60 minutes </li></ul><ul><li>Collection </li></ul><ul><ul><li>Fingertip lanced for small drop of blood </li></ul></ul><ul><ul><li>Oral fluid swabbed </li></ul></ul><ul><ul><li>Reactive test result </li></ul></ul><ul><li>Must still be confirmed with Western Blot </li></ul><ul><li>FDA Approved </li></ul><ul><ul><li>Reveal G2 HIV-Antibody Tests, manufactured by MedMira, Inc. </li></ul></ul><ul><ul><li>Multispot, manufactured by Bio-Rad Laboratories </li></ul></ul><ul><ul><li>Uni-Gold Recombigen, manufactured by Trinity Biotech </li></ul></ul>
    15. 16. Home Testing Kits <ul><li>Do-it-yourself </li></ul><ul><ul><li>Finger-prick </li></ul></ul><ul><ul><li>Mailed to laboratory on card </li></ul></ul><ul><ul><li>Test results provided over phone </li></ul></ul><ul><ul><li>Available at drug stores </li></ul></ul><ul><ul><li>FDA approved </li></ul></ul><ul><ul><ul><li>Home Access Kit </li></ul></ul></ul><ul><ul><li>Rapid tests not accurate </li></ul></ul>
    16. 17. Perinatal and Newborn Testing <ul><li>HIV-infected Mother identified during pregnancy </li></ul><ul><ul><li>Medications highly effective if initiated </li></ul></ul><ul><ul><li>Reduces risk to 1-2 percent </li></ul></ul><ul><li>HIV-infected Mother identified at labor and delivery </li></ul><ul><ul><li>Medications initiated at labor and delivery </li></ul></ul><ul><ul><li>Reduces risk to 9 to 13 percent </li></ul></ul><ul><li>HIV-infected Mother not identified </li></ul><ul><ul><li>Risk of transmission at 25 percent </li></ul></ul><ul><ul><li>All babies born to HIV –infected mothers will be positive </li></ul></ul><ul><ul><li>Antibodies remain present for up to 18 months </li></ul></ul><ul><ul><li>HIV DNA polymerase chair reaction (PCR),, HIV RNA PCR, or viral culture </li></ul></ul>
    17. 18. Laboratory Studies <ul><li>Decreased white blood cell count (WBC) </li></ul><ul><ul><li>Low neutrophil count (neutropenia) </li></ul></ul><ul><li>Low platelet counts (thrombocytopenia) </li></ul><ul><ul><li>Anitiplatelet antibodies </li></ul></ul><ul><ul><li>Drug therapy </li></ul></ul><ul><li>Anemia </li></ul><ul><ul><li>Chronic disease process </li></ul></ul><ul><ul><li>Adverse effect of antiretroviral agents </li></ul></ul><ul><li>Altered liver function tests </li></ul><ul><ul><li>Disease Process </li></ul></ul><ul><ul><li>Drug therapy </li></ul></ul><ul><li>Co infection </li></ul><ul><ul><li>Hepatitis B virus (HBV) </li></ul></ul><ul><ul><li>Hepatitis C virus (HBC) </li></ul></ul>
    18. 19. HIV Staging <ul><li>Category 1 </li></ul><ul><ul><li>CD4 count >500 </li></ul></ul><ul><li>Category A </li></ul><ul><ul><li>Asymptomatic or acute </li></ul></ul><ul><ul><li>HIV infection </li></ul></ul><ul><ul><li>Early Chronic Infection </li></ul></ul><ul><li>Category 2 </li></ul><ul><ul><li>CD4 count 200 – 499 </li></ul></ul><ul><li>Category B </li></ul><ul><ul><li>Symptomatic disease </li></ul></ul><ul><ul><li>Intermediate Chronic </li></ul></ul><ul><ul><li>Infection </li></ul></ul><ul><li>Category 3 </li></ul><ul><ul><li>CD4 count <200 </li></ul></ul><ul><li>Category C </li></ul><ul><ul><li>AIDS Conditions </li></ul></ul><ul><ul><li>Late Chronic Infection </li></ul></ul><ul><ul><li>Once at C, always at C </li></ul></ul>
    19. 20. Timeline: Untreated HIV
    20. 21. Acute HIV Infection <ul><li>Acute retroviral syndrome </li></ul><ul><ul><li>Seroconversion </li></ul></ul><ul><ul><li>Occurs in 1 to 3 weeks </li></ul></ul><ul><ul><li>Lasts 1 to 2 weeks, to months </li></ul></ul><ul><ul><li>High viral load </li></ul></ul><ul><ul><li>CD4+ T Cells fall temporarily </li></ul></ul><ul><ul><li>Symptoms may be mistaken for flu </li></ul></ul><ul><ul><ul><li>Fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, diffuse rash </li></ul></ul></ul><ul><ul><li>Neurologic complications </li></ul></ul><ul><ul><ul><li>Aseptic meningitis, peripheral neuropathy, facial palsy, Guillian-Barre syndrome </li></ul></ul></ul>
    21. 22. Early Chronic HIV Infection <ul><li>10 years </li></ul><ul><li>CD4+ T lymphocyte cells remain above 500 cells/ µ/l </li></ul><ul><li>Viral load in blood will be low </li></ul><ul><li>Asymptomatic disease or </li></ul><ul><ul><li>Fatigue, headache, low-grade fever, night sweats, persistent generalized lymphadenopathy (PGL) </li></ul></ul><ul><li>May not be aware of infection </li></ul>
    22. 23. Intermediate Chronic Infection <ul><li>CD4+ T cell count to 200 - 499 µl </li></ul><ul><li>Viral load rises </li></ul><ul><li>Early phase symptoms become worse </li></ul><ul><ul><li>persistent fever, frequent drenching night sweats, chronic diarrhea, recurrent headaches, and fatigue severe enough to interrupt normal routines </li></ul></ul><ul><li>New symptoms </li></ul><ul><ul><li>localized infections, lymphadenopathy, nervous system manifestations, and opportunistic infections begin </li></ul></ul>
    23. 24. Opportunistic Infections <ul><li>Oropharyngeal candidiasis (thrush) </li></ul><ul><li>Varicella zoster virus (shingles) </li></ul><ul><li>Vaginal candidal infections </li></ul><ul><li>Oral or genital herpes </li></ul><ul><li>Oral hairy leukoplakia </li></ul><ul><ul><li>Epstein-Barr virus </li></ul></ul><ul><li>See Lewis Table 14-1 for lists of other infections </li></ul>
    24. 25. Late Chronic Infection (AIDS) <ul><li>CD4+ count below 200 </li></ul><ul><ul><li>CD4 (helper) to CD8 (suppressor) ratio reverses </li></ul></ul><ul><ul><li>Absolute number of lymphocytes increase </li></ul></ul><ul><ul><li>Percentage of lymphocytes increases </li></ul></ul><ul><li>Development of opportunistic infection (OI) </li></ul><ul><li>Development of opportunistic cancer </li></ul><ul><li>Wasting Syndrome </li></ul><ul><ul><li>loss of 10% or more of body weight </li></ul></ul><ul><li>Dementia </li></ul>
    25. 26. Collaborative Management <ul><li>Monitoring disease progression </li></ul><ul><li>Monitoring immune function </li></ul><ul><li>Initiating and monitoring ART (antiretroviral drug therapy) </li></ul><ul><li>Preventing development of opportunistic diseases </li></ul><ul><li>Detecting and treating opportunistic diseases </li></ul><ul><li>Managing symptoms </li></ul><ul><li>Preventing or decreasing complications of treatment </li></ul>
    26. 27. Tests for Resistance <ul><li>Tests for resistance to antiretroviral drugs </li></ul><ul><ul><li>Genotype assay </li></ul></ul><ul><ul><ul><li>Detects drug-resistant viral mutations that are present in the reverse transcriptase and protease genes </li></ul></ul></ul><ul><ul><li>Phenotype assay </li></ul></ul><ul><ul><ul><li>Measures the growth of the virus in various concentrations of antiretroviral drugs </li></ul></ul></ul>
    27. 28. Starting ART <ul><li>Old guidelines: “Hit early, hit hard” </li></ul><ul><li>New guidelines: Wait for viral load to go up </li></ul><ul><li>Consider: </li></ul><ul><ul><li>Client readiness </li></ul></ul><ul><ul><li>Client ability to adhere to regimen </li></ul></ul><ul><ul><ul><li>95% adherence rate required to prevent disease progression, opportunistic disease, viral drug resistance. </li></ul></ul></ul><ul><ul><ul><li>Electronic reminders, beepers, timers on pillboxes </li></ul></ul></ul>
    28. 29. Drug Therapy for HIV Infection <ul><li>Goals: </li></ul><ul><ul><li>Decreases HIV RNA levels to less than 50 copies/ µl </li></ul></ul><ul><ul><li>Maintain or raise CD4+ T cell counts to greater than 200 cells/µl </li></ul></ul><ul><ul><ul><li>Also known as Immune reconstitution </li></ul></ul></ul><ul><ul><li>Delay development of HIV-related symptoms </li></ul></ul><ul><ul><ul><li>Opportunistic diseases </li></ul></ul></ul><ul><li>Lewis Table 14-4 Principles of Therapy </li></ul><ul><ul><li>National Institutes of Health website </li></ul></ul>
    29. 30. Disease and Drug Side Effects <ul><li>Anxiety, fear, depression </li></ul><ul><li>Diarrhea </li></ul><ul><li>Peripheral neuropathy </li></ul><ul><li>Pain, n & v </li></ul><ul><li>Fatigue </li></ul><ul><li>Skin breakdown </li></ul>
    30. 31. Nursing Assessment <ul><li>Focus on behaviors: </li></ul><ul><ul><li>Have you ever had a blood transfusion or used clotting factors? If so, was it before 1985? </li></ul></ul><ul><ul><li>Have you ever shared needles, syringes, or other injecting equipment with another person? </li></ul></ul><ul><ul><li>Have you ever had a sexual experience in which your penis, vagina, rectum, or mouth came into contact with another person's penis, vagina, rectum, or mouth? </li></ul></ul><ul><ul><li>Have you ever had an STD? </li></ul></ul><ul><li>Positive response requires in-depth exploration! </li></ul>
    31. 32. Nursing Diagnosis <ul><li>Nursing Outcomes </li></ul>
    32. 33. Patient Education <ul><ul><li>Adhere to drug regimens </li></ul></ul><ul><ul><li>Promote a healthy lifestyle </li></ul></ul><ul><ul><li>Prevent opportunistic disease </li></ul></ul><ul><ul><li>Protect others from HIV </li></ul></ul><ul><ul><li>Maintain or develop healthy, supportive relationships </li></ul></ul><ul><ul><li>Maintain activities and productivity </li></ul></ul><ul><ul><li>Come to terms with issues related to disease, death, and spirituality </li></ul></ul>
    33. 34. Illicit Drug Use <ul><li>Sharing injecting equipment </li></ul><ul><li>Unsafe sexual experiences while under influence of drugs </li></ul><ul><li>The basic rules are as follows: </li></ul><ul><ul><li>Do not use drugs </li></ul></ul><ul><ul><li>If you use drugs, do not share equipment; </li></ul></ul><ul><ul><ul><li>Use alternatives (smoking, snorting, ingesting) </li></ul></ul></ul><ul><ul><ul><li>Needles, syringes, cookers (spoons or bottle caps used to mix drugs), cotton, rinse water </li></ul></ul></ul><ul><ul><ul><li>Community Needle and Syringe Exchange Programs </li></ul></ul></ul><ul><ul><li>Do not have sexual intercourse when under the influence of any drug (including alcohol) that impairs decision-making ability </li></ul></ul>
    34. 35. Initial Response to Diagnosis <ul><li>Empowerment </li></ul><ul><ul><li>Education </li></ul></ul><ul><ul><li>Honest discussions </li></ul></ul><ul><ul><ul><li>Health status </li></ul></ul></ul><ul><ul><ul><li>Treatment Options </li></ul></ul></ul><ul><ul><li>Referrals </li></ul></ul><ul><ul><ul><li>Local agencies </li></ul></ul></ul><ul><ul><ul><li>Web resources </li></ul></ul></ul><ul><ul><ul><li>Literature </li></ul></ul></ul><ul><ul><ul><li>Groups </li></ul></ul></ul>
    35. 36. Health Promotion <ul><li>Promote healthy immune system </li></ul><ul><ul><li>Nutritional Support </li></ul></ul><ul><ul><ul><li>Maintain lean body mass </li></ul></ul></ul><ul><ul><ul><li>Ensure appropriate levels of vitamins and micronutrients </li></ul></ul></ul><ul><ul><li>Moderation or elimination of alcohol, nicotine, and drug use </li></ul></ul><ul><ul><li>Adequate rest and exercise </li></ul></ul><ul><ul><li>Stress reduction </li></ul></ul><ul><ul><li>Avoidance of exposure to new infectious agents </li></ul></ul><ul><ul><li>Mental Health counseling </li></ul></ul><ul><ul><li>Involvement in support groups and community activities </li></ul></ul>
    36. 37. Pneumocystis Carinii Pneumonia <ul><li>CD4 counts < 200 </li></ul><ul><li>Prevent with antibiotics </li></ul><ul><li>S/S: </li></ul><ul><ul><li>SOB, fever, night sweats, fatigue, weight loss, non-productive cough </li></ul></ul><ul><li>May require intensive therapy </li></ul>
    37. 38. Cryptococcus Neoformans <ul><li>6 to 10% of all HIV-infected clients </li></ul><ul><li>Meningitis </li></ul><ul><ul><li>Prolonged waxing and waning period of fever Headache and malaise Nausea & vomiting </li></ul></ul><ul><ul><li>Altered Mental Status Stiff neck </li></ul></ul><ul><ul><li>Visual disturbances, papilledema </li></ul></ul><ul><ul><li>Light sensitivity </li></ul></ul><ul><ul><li>Seizures </li></ul></ul><ul><ul><li>Aphasia </li></ul></ul><ul><ul><li>Ataxia </li></ul></ul><ul><li>Relapse rate: 50-75% </li></ul><ul><ul><li>Maintenance therapy </li></ul></ul>
    38. 39. Cytomegalovirus Retinitis <ul><li>Retinitis </li></ul><ul><ul><li>Decreased vision </li></ul></ul><ul><ul><li>floaters </li></ul></ul><ul><ul><li>One-sided visual field loss </li></ul></ul><ul><ul><li>blindness </li></ul></ul>&quot;Blue Yonder,&quot; Elliott Linwood
    39. 40. Kaposi's sarcoma <ul><li>Skin </li></ul><ul><ul><li>Lesions flat or raised </li></ul></ul><ul><ul><li>Variety in color and shape </li></ul></ul><ul><li>Lungs and GI Tract </li></ul><ul><ul><li>Bleeding </li></ul></ul><ul><ul><li>Respiratory distress </li></ul></ul><ul><li>Palliative care </li></ul><ul><li>Lesions resolved with ART </li></ul>
    40. 41. Mycobacterium Avium complex <ul><li>Gastrointestinal tract problems </li></ul><ul><li>Can also infect blood, spleen, lymph nodes, bone marrow, liver. </li></ul><ul><li>Chronic diarrhea, abdominal pain, fever, malaise, weight loss, anemia, neutropenia, malabsorption syndrome, obstructive jaundice </li></ul><ul><li>Teach about drug therapy </li></ul><ul><li>Teach how to deal with diarrhea, n & v </li></ul>
    41. 42. Metabolic Disorders <ul><li>Changes in body shape </li></ul><ul><ul><li>Fat redistribution to abdomen, upper back, breasts </li></ul></ul><ul><ul><li>Wasting in arms, legs and face </li></ul></ul><ul><ul><li>Hyperlipidemia </li></ul></ul><ul><ul><ul><li>Elevated triglycerides </li></ul></ul></ul><ul><ul><ul><li>Decreases in high-density lipoproteins </li></ul></ul></ul><ul><ul><li>Insulin resistance and Hyperglycemia </li></ul></ul><ul><ul><li>Bone disease </li></ul></ul><ul><ul><ul><li>osteoporosis, osteopenia, avascular necrosis </li></ul></ul></ul><ul><ul><li>Lactic Acidosis </li></ul></ul><ul><ul><li>Cardiovascular disease </li></ul></ul>
    42. 43. AIDS-Dementia Complex <ul><li>Cognitive, behavioral motor abnormalities </li></ul><ul><ul><li>Decreased ability to concentrate, apathy, depression, inattention, forgetfulness, social withdrawal, personality change, insomnia, confusion, hallucinations, slowed response rates, clumsiness, ataxias </li></ul></ul><ul><li>HIV-Associated Cognitive Motor Complex </li></ul><ul><ul><li>Lymphoma, toxoplasmosis, CMV, herpes virus, Cryptococcus, Progressive multifocal leukoencephalopathy, dehydration, drug side effects </li></ul></ul><ul><ul><li>Reversible if treatable cause identified </li></ul></ul><ul><li>Interventions: Safety, maintaining meaningful environment, frequent reorientation, stress reduction, family support </li></ul>
    43. 44. Terminal phase <ul><li>Disease progresses toward disability and death </li></ul><ul><ul><li>Calculated decision to forego further treatment </li></ul></ul><ul><li>Comfort care, facilitate emotional and spiritual acceptance of finite nature of life </li></ul><ul><li>Help SO’s deal with grief and loss </li></ul><ul><li>Hospice </li></ul>
    44. 45. Suicide Rates <ul><li>66 times greater </li></ul><ul><li>than that of others </li></ul><ul><li>Art from: </li></ul><ul><li>thebody.com </li></ul><ul><ul><li>Untitled (self-portrait), c. 1993-96, Nelson Edwin Rodriguez </li></ul></ul>
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