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Aids Aids Presentation Transcript

  • AIDS (Acquired Immune Deficiency Syndrome) by: Policarpio, Anna Marie Lo BSN 4-0
  • A I D S
    • a chronic infectious disease caused by Human Immuno- defiency Virus (HIV) which destroys helper T-lymphocytes causing loss of the immune response and increased susceptibility to secondary infection and cancer, and eventually lead to death.
    • severe form of continuum of illness associated with HIV
    • CD4 T-helper lymphocytes are < 200 with increased viral load of more than 100,000
    • a NO CURE infection
  • Causative Agent:
    • HIV retrovirus (belongs to lentivirus, which sometimes called “slow virus”
    • Human T-cell lymphotropic virus 3 (HTLV-3)
    • consist of genetic material in the form of RNA (instead of DNA ) surrounded by a lipoprotein envelope.
    • HIV type 1 in Europe and America, HIV type 2 in Africa
  • Mode of Transmission:
    • sexual contact
    • blood transfusion
    • contaminated syringes, needles, nipper, razor blades
    • direct contact of open wound/mucous membrane with contaminated blood, body fluids, semen and vaginal discharges
    • vertical or perinatal transmission (mother to fetus, child delivery, breastfeeding)
    • organ donations with infected blood
  • Persons at Risks:
    • with polygamous relationships
    • gay-lesbian relationships
    • drug addicts
    • sex workers
    • organ transplant recipient
    • receiving blood transfusion
    • healthworkers
  • Incubation Period:
    • Variable – 1 to 3 months (time of infection to the development of detectable antibodies)
    • 1 to 15 years (time from HIV infection to diagnosis of AIDS)
  • Signs and Symptoms: (AIDS-related Complex) ARC
    • a person may remain asymptomatic, feel and appear healthy for years even though he is infected with HIV. The immune system starts to be impaired.
    • AIDS is the active stage of infection
    • CD4 T-helper lymphocytes are < 200 with increased viral load of more than 100,000
  • a. Physical
      • maculo-papular rashes
      • loss of appetite
      • weight loss (10% of body weight)
      • fever of unknown origin
      • body malaise
      • chronic diarrhea (more than one month)
      • persistent cough for one month
      • gaunt-looking, apprehensive (anxious looking)
      • generalized lympadenopathy
      • recurrent herpes zoster
      • tuberculosis (localized and disseminated)
      • esophageal/oropharyngeal candidiasis
      • Kaposi’s sarcoma ( skin cancer)
      • pneumocystis carinii pneumonia
  • b. Mental
    • (Early Stage)
      • forgetfulness
      • loss of concentration
      • loss of libido
      • apathy (lack of interest or feeling)
      • psychomotor-retardation
      • withdrawal (anti-social)
    • (Later Stage)
    • - confusion
    • - disorientation
    • - seizures
    • - mutism (speechlessness)
    • - loss of memory
    • - coma
  • Top 10 Symptoms of HIV/AIDS:
    • depression
    • diarrhea
    • thrush
    • weight loss
    • lipodystrophy (fat redistribution syndrome)
    • sinus infection
    • fatigue
    • nausea and vomiting
    • lactic acidosis ( lactic acid build up in the body due to damage in the mitochondria)
    • peripheral neuropathy (burning and tingling of feet and hands)
  • Stages in the development of AIDS:
      • a. Acute HIV (primary infection)
        • from infection of HIV to development of antibodies to HIV
        • “ window period” (test negative with HIV antibody)
        • viremia stage (flu-like symptoms)
        • viral setpoint (balance between HIV & immune response)
        • mild symptoms
        • 0 to 12 months
      • HIV-positive
        • asymptomatic (CD4 is >500, feeling well)
        • symptomatic (CD4 is 200-499, gradual falling of CD4)
        • more antibodies form
        • small amount of virus in blood
        • 1 to 7 years or more
      • c. AIDS
        • active infection
        • decreasing CD4 count
        • AIDS indicator diseases (opportunistic infections, kaposis sarcoma, wasting syndrome, HIV encephalopathy, pneumonia)
        • 7 to 12 years or more
  • Common Opportunistic Infections:
    • Bacterial - Mycobacterium avium complex MAC (TB –like symptoms)
    • disseminated disease involving lung, bone marrow, liver; CD4 <= 100/ml
        • Tuberculosis
        • Salmonillosis
    • Viral
    • - Herpes
    • - Hepatitis
    • - Genital Warts
    • - Cryptomegalovirus CMV (causes retinitis, pain in swallowing, leg numbness)
    • - malluscum contangiosum (dome- shame papule on face, trunk, extremities)
    • Fungal
    • - Candidiasis (infections of trachea, esophagus, lungs)
    • - Cyrptococcal meningitis
    • - Histoplasmosis
    • Pneumonias
    • - Bacterial
        • Pneucystitis carinii Pneumonia (PCP)
    • Cancers
    • - Kaposi’s sarcoma (tumors in the skin and linings of the internal organs)
    • - Cervical dysplasia and carcinoma
    • - Non-Hodgkin’s lymphoma (usually late manifestation of HIV infection)
    • Parasitic
    • - Toxoplasmosis
    • - Cryptosporidiosis (spreads by contact of feces containing crypto)
  • Pathophysiology:
    • HIV Infection:
    • (sexual contact, blood transfusion,mother-to-fetus,
    • contaminated sharps, organ donation, direct contact with open wounds
    • on contaminated fluids & discharges)
    • HIV particles attaches to receptors on Helper-T4 lymphocyte
    • (CD4) cell surfaces
    • Viral RNA and reverse transcriptase enzyme
    • enter Helper-T4 cell
    • enzyme converts Viral RNA to Viral DNA
    • Drug AZT blocks transcription
    • Viral DNA joins Helper-T4 cell DNA
    • Replication of HIV Helper-T4 cell produces
    • viral components
    • Anti-HIV protease inhibitor
    • drugs block
    • Assemble new virus particles
    • infected Helper-T4cells shed many HIV particles to invade
    • other Helper-T4 cells & lymphoid tissue (VIREMIA)
    • infected Helper-T4 cells are destroyed
    • Phase 1: initial infection usually in 3-6 weeks with mild, non-specific
    • “ flu-like” symptoms
    • self-limiting – initially the immune response limits infection
    • antibodies from in 2-10 wks. (blood test)
    • TEST HIV POSITIVE
    • Phase 2: LATENT – may last years-asymptomatic or lymphadenopathy may be present
    • Helper-T4 cell count decreases & weaker immune response
    • gradually move into active infection
    • Phase 3: ACUTE – AIDS IMMUNODEFICIENCY
    • very low T4 cell count
    • multiple severe opportunistic infections,
    • cancers, wasting syndrome, CNS involvement
  • Diagnosis:
    • Physical Exam
      • evaluate for oral candidiasis, &quot;cottage cheese and ketchup&quot; appearance of retina, adenopathy, skin abnormalities, respiratory symptoms, abdominal tenderness, and signs of dementia
    • Chest X ray
      • for pneumonia, tuberculosis. Brain imaging if neurological symptoms are present.
    • Laboratory Tests:
    • 1. ELISA (Enzyme link immunosorbent assay)
      • screening test/presumptive test
      • produces false positive results in people who have been exposed to parasitic diseases such as malaria
    • 2. Western Blot analysis
      • confirmatory test/positive result
      • to confirm reactive seropositive results obtained by ELISA test
    • 3. Polymerase Chain Reaction test (PCR)
    • - screen for viral RNA and therefore allow detection of the virus after very recent exposure
    • - viral load (measures HIV RNA in the plasma)
    • - better predictor of risk of HIV progression than CD4 count)
    • 4. CD4 count (CD4-CD8 Ratio)
    • - significant lowering of CD4 over CD8
    • 5 . Radio immuno-precipitation assay (RIPA)
    • 6. Immunofluorescent test
    • Particle Agglutination test
    • HIV Antibody tests
    • - negative test (HIVantibodies not detectable in the blood at the time of test)
    • - positive test (HIV antibodies are present in blood, person is considered HIV positive)
  •  
  • Treatment:
    • AIDS drugs are medicines used to treat but not cure HIV infection .
    • These drugs are sometimes referred to as “anteroviral drugs” , work by reducing the replication of the virus.
    • There are 2 groups of anteroviral drugs:
    • Reverse transcriptase inhibitors
    • - inhibits the enzyme “reverse transcriptase” which is needed to “copy” information for the virus to replicate.
          • Zidovudine (ZDV) / Azidothymidine - Retirvir (best known drug)
          • Zalcitabine - Havid
          • Stavudine - Zerit
          • Lamivudine - Epivir
          • Nevirapine - Viramune
          • Didanosine - Videx
    • Protease inhibitors – inhibits the enzyme protease which are needed for the assembly of viral particles.
    • - Saquinavir - Invarase
    • - Ratinovir - Norvir
    • - Indinavir - Crixivan
    • “ Cocktail drugs” (combination of three to five drugs) – are used to prolong the latent phase
    • - as well as reduce the viral load during the final phase
    • HARRT (Highly Active Anti-Retrovirus Therapy) - very effective at controlling the virus by reducing the viral load in the blood and returning CD4 cell counts to near normal levels
    • PRIMARY FOCUS:
    • - minimize the effects of complications such as infections or malignancy by prophylactic medications and immediate treatment.
  • Nursing Management:
  • 1. Health Education.
      • inform client of the disease process and mode of transmission
      • emphasize “AIDS awareness Program”
      • give practical advice
      • avoid judgemental and moralistic messages
      • be consistent & concise in giving instructions especially in taking medication
      • use positive statement
      • encourage client to trace or identify previous contact for proper management
  • 2. Practice universal/standard precautions.
      • thorough medical handwashing after every contact with patient and after removing the gown & gloves, and before leaving the room of an AIDS suspect or known AIDS patient.
      • use of universal barrier or personal protective equipment is very necessary
  • 3. Prevention .
      • avoid accidental pricks from sharp instruments contaminated with potentially infectious materials from AIDS patient
      • gloves should be worn when handling blood specimens & other body secretions as well as surfaces, materials and objects exposed to them
      • blood and other specimens should be labeled with special warning “AIDS Precaution”
      • blood spills should be cleaned immediately, like using chlorox
      • needles should not be bent after use, but are disposed to sharps-container
      • personal articles like toothbrush and razors should not be shared with other family members
      • patients with active AIDS should be isolated
      • clients considered at risk should not be allowed to donate blood or any organ of the body
      • encourage monogamous relationship
      • HIV-infected pregnant women should go into regular prenatal, interpartal, postpartal care
      • speak openly with partners about safer sex techniques and HIV status
    • 4 C’s in HIV/AIDS Management:
      • Compliance
      • Counseling/Education
      • Contact tracing
      • Condoms
    • Nursing Diagnosis:
    • Knowledge deficit
    • Strict isolation
    • Risk for infection
    • Anxiety
    • Self-esteem disturbance
    • Altered role performance
  • Prognosis:
    • at present, persons living with HIV/AIDS infection are living longer with improved drug treatment...
    • References:
        • Public Health Nursing (DOH Book) , 2nd Edition
        • Contemporary Medical-Surgical Nursing, J. Tazbir
        • Handbook of Common Communicable & Infectious Diseases, D. Navales
        • Pathophysiology for the Health Professions, B. Gould
        • E-Encyclopedia Britannica 2007