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Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
Nrsg 200 hiv
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Nrsg 200 hiv


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  • Four rapid tests approved by the FDA are currently commercially available: The Uni-Gold, Multispot, Reveal, and OraQuick Advance.
  • Kaposi’s sarcoma
  • Transcript

    • 1. HIV and AIDS
    • 2. Epidemiology
      • CDC issued case definition of AIDS in 1982
      • Number of people living with AIDS more than doubled between 1998 and 2003
      • AIDS kills more than 8000 people daily around the world
        • Unsafe sex predominate mode of transmission; also infected drug injection equipment
        • Racial & ethnic minorities have disproportionately high rates of HIV in US, especially African-American & Hispanics
    • 3. Transmission of HIV
      • Body fluids: Blood, semen, vaginal secretions, amniotic fluid, breast milk
      • Not transmitted via casual contact
      • Risk of transmission via transfusion virtually eliminated due to extensive testing, heat treatment & virus inactivation methods
    • 4. Transmission to health care workers
      • Standard precautions used on ALL patients
      • Post-exposure treatment reduces risk of HIV infection
        • Immediately cleanse exposed area; report it!
        • Begin tx immediately after exposure, no longer than 72 hours after
        • Baseline testing for HIV, hep. B & C for you & pt
        • Follow-up testing done at 1 month, 3 & 6 mo.
        • Antiretroviral therapy x 4 weeks
          • Can cost $500-$1000; may develop future resistance; S/E
    • 5. Pathophysiology
      • HIV is a retrovirus
        • Carry genetic material in RNA instead of DNA
        • Consists of viral core containing the RNA surrounded by an envelope of glycoproteins
        • HIV has complex life cycle of 8 steps
          • HIV attaches to an uninfected CD4 or CD8 cell surface
          • Enzyme “reverse transcriptase” copies the viral genetic material from RNA into DNA
          • Mutates quickly; now 12 sub-types identified
    • 6. Stages of HIV Disease
      • CDC classification system:
      • 3 groups (A, B, C) based on history, physical exam, lab values, S&S, and infections and malignancies
      • See Table 52-1 on page 1823
    • 7. Primary Infection (A)
      • Defined as the period from infection with HIV to the development of antibodies to HIV
        • Intense viral replication
        • Symptoms vary from none to flu-like or “mono”
          • Fever, enlarged lymph nodes, rash, muscle aches, H/A
        • “ Window” period exists where infection has occurred but no antibodies are detected (lasts 3 months up to 1 year)
    • 8. CDC Category A: HIV Asymptomatic
      • By about 6 months, viral replication reaches lower but steady state
      • CD4+ T-cell count greater than 500
      • Few, if any, symptoms
      • 8-10 years can pass before major HIV-related complication occurs
    • 9. CDC Category B: HIV Symptomatic
      • CD4+ T-cells drop to 200 to 499
      • Has developed a condition related to defect in cellular immunity
        • Candidiasis
        • Cervical dysplasia
        • Fever or diarrhea lasting more than 1 month
        • Hairy leukoplakia of the mouth
        • Herpes zoster
        • Idiopathic thrombocytopenic purpura
        • PID
        • Peripheral neuropathy
    • 10. CDC Category C: AIDS
      • CD4+ T-cell count drops below 200
      • Once classified as category C, patient remains in Category C (May qualify for entitlements)
        • Candidiasis of esophagus or trachea
        • Coccidioidomycosis
        • Cryptosporidiosis
        • Cytomegalovirus
        • HIV-related encephalopathy
        • Kaposi’s sarcoma
        • Lymphoma
        • Toxoplasmosis
        • Pneumocystis pneumonia
        • Wasting syndrome
    • 11. Lab Tests
      • EIA (enzyme immunoassay)
        • Antibodies are detected (end of window period)
      • Western blot
        • Also detects antibodies; confirms EIA
      • Viral load
        • Measures HIV RNA in the plasma
        • Better predictor of disease progression than CD4 count
      • CD4/CD8 ratio
    • 12. Uni-Gold Recombigen Multispot HIV-1/HIV-2 Reveal G2 OraQuick Advance
    • 13. Treatment of HIV
      • Protocols change frequently
      • CD4 count most important consideration in starting therapy (less than 350)
      • Treatment should be offered to all patients with primary infection
      • Tx regimens are complex, have major side-effects & require adherence to avoid resistance
      • Viral load/ CD4 counts checked every 3 months
        • Viral load should drop to less than 50 copies by 16-20 weeks; CD4 count should increase by 100-150 within 3 months
    • 14. Antiretrovial Agents
      • NRTIs (nucleoside reverse transcriptase inhibitors): Retrovir, AZT
      • NNRTIs (non-nucleoside reverse transcriptase inhibitors): Sustiva
      • Protease inhibitors: Agenerase, Kaletra
      • Fusion inhibitors: Fuzeon
      • See Table 52-3 on pages 1827-28
    • 15. HAART
      • Highly active antiretroviral therapy
      • More than one antiretroviral medication taken in order to achieve sustained viral suppression
    • 16. Medication S/E
      • Nausea, vomiting, diarrhea, rash, pancreatitis, peripheral neuropathy
      • Many cause lipodystrophy syndrome
        • Pseudo-Cushing’s appearance: fat loss in arms & legs, with build-up of fat in abdomen & neck
        • At risk for early-onset hypercholesterolemia, heart disease & diabetes
    • 17. Video Clip
      • Watch “HIV Case Study” Video
    • 18. Manifestations of HIV Infection
      • Sx are widespread and can involve any organ system
      • Fatigue very common
      • Opportunistic infections
      • Immune Reconstitution Syndromes
        • Fever & worsening of the opportunistic infection symptoms
        • Develops weeks after starting antiretroviral therapy
          • Tx with NSAIDs to alleviate inflammatory reaction
    • 19. Respiratory Infections
      • Most common infection in AIDS patients is Pneumocystis pneumonia (PCP)
        • Non-productive cough, fever & chills, SOB, dyspnea, crackles, decreased O2 sats.
        • Will lead to resp. failure without tx
      • Mycobacterium avium complex
      • TB which can disseminate to CNS, bone, stomach, peritoneum & scrotum
    • 20. GI Symptoms
      • Loss of appetite, N/V
      • Diarrhea occurs in 50-90% of AIDS pts.
        • Cryptosporidium, Salmonella, Giardia,
      • C. diff.
      • May develop profound weight loss, fluid & electrolyte imbalances, weakness, perianal excoriation
    • 21. Oral Candidiasis
      • Occurs in almost all AIDS pts
      • May precede life-threatening infections
      • Creamy white patches in the mouth
      • Can spread to esophagus
      • Difficulty swallowing
      • May also have oral lesions
    • 22. Mucocutaneous Candidiasis: Clinical Manifestations Erythematous candidiasis Credit: D. Greenspan, DSC, BDS, HIV InSite Pseudomembranous candidiasis Credit: Pediatric AIDS Pictorial Atlas, Baylor International Pediatric AIDS Initiative
    • 23. Skin Manifestations
      • Herpes zoster & simplex
      • Molluscum contagiosum (viral infection)
      • Generalized folliculitis
    • 24. Wasting Syndrome
      • Weight loss of more than 10%
      • Chronic diarrhea more than 1 month
      • Chronic weakness
      • Fever
      • Hypermetabolic state with protein-energy malnutrition
      • Elevated triglycerides
    • 25. Oncologic Manifestations
      • Kaposi’s sarcoma is most common HIV related malignancy
        • Skin lesions can occur anywhere on body
        • Brownish-pink to deep purple; flat or raised
        • Diagnosis confirmed by skin biopsy
      • B-cell lymphomas are second most common; resistant to tx
      • Invasive cervical CA in females
      • Also can get CA in stomach, skin, pancreas, rectum, bladder
    • 26.  
    • 27. Neurologic Manifestations
      • 80% of AIDS patients will have neurologic involvement resulting from direct effects of HIV, opportunistic infections or neoplasms
      • Cryptococcus meningitis
      • Leukoencephalopathy
      • Peripheral neuropathy R/T demyelination
      • Depression
    • 28. HIV Encephalopathy
      • Formerly called “AIDS dementia complex”
      • Progressive decline in cognitive, behavioral and motor functions
      • Memory deficits, headache, difficulty concentrating, confusion, apathy, ataxia
      • Later stages include global cognitive impairment, delayed verbal response, vacant stare, spastic paraparesis, hyperreflexia, psychosis, tremor, hallucinations, incontinence, seizures
      • CT shows diffuse cerebral atrophy & ventricular enlargement
    • 29. Additional Medical Management
      • Treatment of infections
        • T-cell count less than 200 should receive prophylaxis against PCP with Bactrim or Septra (TMP-SMZ)
        • PCP treated with Septra; pentamidine used if Septra ineffective
          • Aerosolized pentamidine no longer used
        • Prophylaxis against Mycobacterium avium with Biaxin or azithromycin, for T-cell counts less than 50
    • 30. Additional Medical Management
      • Tx of cryptococcal meningitis with amphotericin B, with or without Diflucan
        • Diflucan also used for suppressive therapy
      • Retinitis due to Cytomegalovirus (leading cause of blindness in AIDS patients): tx prophylactically with ganciclovir for T-cell counts less than 50
        • Tx for retinitis must be taken for life
        • Common adverse reaction is neutropenia
          • May be given intravitreally
    • 31. Additional Medical Management
      • Herpes infections treated with acyclovir or famciclovir
      • Oral or esophageal Candidiasis treated with Mycelex, nystatin, Nizoral or Diflucan
      • Chronic diarrhea treated with Sandostatin
      • Kaposi’s sarcoma treated with alpha-interferon, surgical excision, liquid nitrogen, radiation
      • Lymphoma treated may be treated with chemo & radiation but usually has limited effect
    • 32. Additional Medical Management
      • Depression treated with Tofranil, Prozac
        • ECT used for severe cases not responsive to meds
      • Appetite stimulants such as Megace
      • Dronabinol (synthetic THC) used to control N/V
      • Nutritional supplements usually lactose-free: Advera specifically for AIDS
        • Parenteral nutrition is final option due to risk of infections
    • 33. Nursing Assessment
      • Potential risk factors: IV drug use, risky sexual behavior
      • Nutritional status: anorexia, N/V, oral pain, diarrhea, weight pattern, serum protein & albumin levels
      • Skin & mucous membranes: Look for breakdown, ulcerations, peri-anal excoriation
      • Fluid & electrolyte status: Turgor, V/S, urine output, electrolyte values
    • 34. Nursing Assessment
      • Respiratory Status: cough, sputum, SOB, chest pain, pulse-ox, breath sounds, CXR
      • Neuro Status: LOC, orientation, memory, H/A, neuropathy, seizures, visual changes, depression
      • Knowledge level: transmission, psychological reaction, ability to manage treatments
    • 35. Nursing Diagnoses for HIV/AIDS
      • Risk for infection
      • Diarrhea
      • Ineffective airway clearance
      • Imbalanced nutrition
      • Deficient knowledge
      • Social isolation
      • *See Care Plan pages 1838-44
    • 36. Nursing Interventions
      • Monitor for S&S of infection
      • Balance activities with rest
      • Prevent skin breakdown; administer treatments as ordered
      • Promote usual bowel patterns
        • Avoid bowel irritants; small frequent meals
        • Anti-diarrheals on routine basis
      • Improve airway clearance
        • Cough/ deep breathe, postural drainage
    • 37. Nursing Interventions
      • Nutritional support
        • Anti-emetics, soft foods, topical Lidocaine
        • Supplements & high-cal foods
      • Pain management
        • NSAIDs, opioids, tricyclics for neuropathy
      • Social isolation: Many feel guilt, shame, suffer loss normal roles, anger
        • Offer accepting attitude
        • Reassure that HIV not transmitted casually
    • 38. Nursing Interventions
      • Monitoring for medication side-effects
      • Teaching self-care: preventing transmission of HIV & other infections (safe sexual practices, handling soiled items, handwashing, personal and environmental hygiene)
        • Avoid exposure to sick people
        • Avoid alcohol, tobacco
        • Avoid cleaning bird cages & cat litter boxes
        • Medication administration
        • Nutrition
        • Importance of keeping follow-up appointments
        • Community resource referrals
    • 39. Ethical Considerations
      • Must protect patient’s right to privacy
      • This sometimes conflicts with sexual or drug partners’ right to know about their exposure
      • State laws vary as to whether contacts are notified & who is responsible for notification
      • Indiana law requires that persons infected with HIV who know their status, warn past & present sexual or needle-sharing partners of their HIV status & need to seek testing
        • Court can order restrictive limitations on person who presents a danger to public health