Strategies in early HIV and role of a nurse. Nurses should know a strategies to identify diagnosis. based on this they can be able to provide effective nursing care strategies in alleviating the symptoms of HIV .Nurses are the front line care givers before somebody could provide care. Hence it is important for nurses to learn early strategies and nurses role in caring HIV patients.

1. Prof. M. Chinna Devi
MSN, (PhD)
Principal, SBBSIN, Jalandhar
Former Dean, FON, SGT University, Gurugram

2. Introduction
 HIV is a virus that attacks the immune system. It weakens
the immunity to the point where the body struggles to fight
infections and disease.
What is HIV/AIDS?
 In 1983 the virus that caused AIDS was discovered by
scientists in France and the routes of transmission were
confirmed. The virus eventually known as the human
immunodeficiency virus (HIV). There are 2 different types of
HIV:
 HIV-1 the most common type found worldwide, and
 HIV-2 found mostly in West Africa.

3. CAUSES
People transmit HIV in bodily fluids, including:
 blood
 semen
 vaginal secretions
 anal fluids
 breast milk
 Sharing infected needles.
 Having sexual relations with infected individuals (both
male and female).

4. Early symptoms of HIV infection
 Some people with HIV do not show symptoms until
months or even years after contracting the virus.
 Around 80 percent of people may develop a set of flu-
like symptoms known as acute retroviral syndrome
around 2–6 weeks after the virus enters the body.

5. Early symptoms of HIV infection
con..
The early symptoms of HIV infection may include
1. Fever: Fever is when a human's body temperature goes
above the normal range of 36–37° Centigrade (98–100°
Fahrenheit). It is a common medical sign.

6. Early symptoms of HIV infection
con..
Symptoms of Fever:
 feeling cold when nobody else does
 shivering
 lack of appetite
 dehydration — preventable if the person drinks plenty of
fluids
 depression
 hyperalgesia, or increased sensitivity to pain
 Lethargy, Sleepiness, sweating
 If the fever is high, there may also be extreme irritability,
confusion, delirium, and seizures.

7. Early symptoms of HIV infection
con..
2. Strep throat :
 Referred as a Streptococcal pharyngitis or
streptococcal sore throat; it is only ever caused by
bacteria.
 Sore throats are more common among children and
adolescents.

8. Early symptoms of HIV infection
con..
The symptoms of strep throat are similar to a sore throat;
these include:
 Pain in the throat.
 Difficulty swallowing.
 Loss of appetite.
 Tonsils are painful and/or swollen; sometimes with white
patches and/or streaks of pus.
 Very small red spots may appear on the soft part of the
palate (roof of the mouth).
 Nodes (lymph glands) of the neck are swollen and tender.
 Fever.

9. Early symptoms of HIV infection
con..
3. Fatigue
There are different types of fatigue.
 Physical fatigue: A person finds it physically hard to do
the things they normally do or used to do, for example,
climbing stairs. It includes muscle weakness. Diagnosis
may involve a strength test.
 Mental fatigue: A person finds it harder to concentrate on
things and stay on task. The person may feel sleepy, or
have difficulty staying awake while working.

10. Early symptoms of HIV infection
con..
The signs and symptoms of fatigue may be physical, mental, or
emotional.
Common signs and symptoms associated with fatigue can include:
 aching or sore muscles
 apathy and lack of motivation
 daytime drowsiness
 difficulty in concentrating or learning new tasks
 gastrointestinal problems such as bloating, abdominal
pain, constipation, and diarrhea
 Headache, irritability and moodiness
 slowed response time
 vision problems, such as blurriness

11. DIAGNOSTIC STRATERGIES
 diagnosis of acute HIV-1 infection, especially in high-
prevalence areas (areas where ≥1% of people have HIV
infection).
 One strategy is a “public health approach” that
incorporates routine screening of all HIV antibody.
 A second strategy is a “medical approach” based on
clinical signs and symptoms combined with a history of
possible recent exposure.

12. DIAGNOSTIC STRATERGIES
Con..
 A persons with acute or recent HIV infection will report
symptoms consistent with the acute retroviral syndrome.
These symptoms include “flu-like” illness characterized
by fever, headache, muscle aches, joint pain, swollen
lymph nodes, sore throat, diarrhea, and/or rash.

13. DIAGNOSTIC STRATERGIES
Con..
Several screening tests are used to diagnose HIV infection.
 CBC: anemia and idiopathic thrombocytopenia ,
Leukopenia may be present;
 PPD: Determines exposure and/or active TB disease. HIV
patients, 100% of those exposed to active Mycobacterium
tuberculosis will develop the disease.
 Serologic: Serum antibody test: HIV screen by ELISA. A
positive test result may be indicative of exposure to HIV.
 Western blot test: Confirms diagnosis of HIV in blood and
urine.

14. DIAGNOSTIC STRATERGIES
Con..
 Viral load test:
 RT-PCR:( Real Time Polymerase Chain
Reaction) The most widely used test currently can
detect viral RNA levels as low as 50 copies/ml of
plasma with an upper limit of 75,000 copies/ml.
(An HIV viral load test measures the number of HIV
particles in a milliliter (ml) of blood.

15. DIAGNOSTIC STRATERGIES
Con..
• bDNA ( Branched DNA)assay: Has a wider range of
50–500,000 copies/ml. Therapy can be initiated, or
changes made in treatment approaches, based on rise of
viral load or maintenance of a low viral load. This is
currently the leading indicator of effectiveness of therapy.

16. Strategies in HIV Treatment
 Antiretroviral therapy (ART) is recommended for all
individuals with HIV-1 infection (AI), including those with
early HIV-1 infection.
 Patients starting ART should be willing and able to commit
to life-long treatment and should understand the
importance of adherence
 Treatment of opportunistic infections
 dermatological , pulmonary , gastrointestinal , oral
neurological .
 OIs are caused by organisms (such as bacteria, viruses,
fungi, or protozoa) that would not cause a disease in a
person with a well-functioning immune system

17. Strategies in HIV Treatment con..
 Antidepressant therapy. Treatment for depression in
patients with HIV infection involves psychotherapy
integrated with imipramine, desipramine or fluoxetine.
 Nutrition therapy. For all AIDS patients who experience
unexplained weight loss, calorie counts should be
obtained, and appetite stimulants and oral supplements are
also appropriate.

18. Role of a Nurse

19. Role of a Nurse
 The nurse is seen as the primary link to the patient in any
given health care facility. The nurse must therefore be
fully competent.
 Nurses provide life-saving and life-enriching care
throughout the world. Often they are the first provider
or even the primary provider for patients with HIV.

20. Role of a Nurse con…
Nursing Assessment
Nursing assessment includes identification of
potential risk factors, including a history of
risky sexual practices or IV/injection drug use
Nutritional status. Nutritional status is
assessed by obtaining a diet history and
identifying factors that may affect the oral
intake.

21. Role of a Nurse con…
 Neurologic status. Neurologic status is determined by
assessing the level of consciousness; orientation to person,
place, and time; and memory lapses.
 Fluid and electrolyte balance. F&E status is assessed by
examining the skin and mucous membranes for turgor and
dryness.
 Knowledge level. The patient’s level of knowledge about
the disease and the modes of disease transmission is
evaluated.

22. Nursing Diagnosis
 Disturbed thought process related to shortened attention
span, impaired memory, confusion, and disorientation
associated with HIV encephalopathy.
 Ineffective airway clearance assessed by, increased
bronchial secretions, and decreased ability to cough
related to weakness and fatigue.
 Pain related to impaired peri anal skin integrity secondary
to diarrhea, and peripheral neuropathy
 Imbalanced nutrition status, less than body
requirements related to decreased oral intake

23. Nursing Interventions
 Promote skin integrity. Patients are encouraged
1. to avoid scratching;
2. to use nonabrasive, nondrying soaps and apply
nonperfumed moisturizers;
3. to perform regular oral care; and
4. to clean the peri anal area after each bowel movement
with nonabrasive soap and water.
 Promote usual bowel patterns. The nurse should monitor
for frequency and consistency of stools and the patient’s
reports of abdominal pain or cramps.

24. Nursing Interventions con..
 Prevent infection. The patient and the caregivers should
monitor for signs of infection and laboratory test results that
indicate infection. Nurse has to identify the opportunistic
infections which are common and provide care.
 Improve activity intolerance. Assist the patient in planning
daily routines that maintain a balance between activity and rest.
 Maintain thought processes. Family and support network
members are instructed to speak to the patient in simple, clear
language and give the patient sufficient time to respond to
questions.

25. Nursing Interventions con..
 Improve airway clearance. Coughing, deep breathing,
postural drainage, percussion and vibration is provided for
every 2 hours to prevent stasis of secretions and to
promote airway clearance.
 Relieve pain and discomfort. Use of soft cushions and
foam pads may increase comfort as well as administration
of NSAIDS and opioids.
 Improve nutritional status. The patient is encouraged to
eat foods that are easy to swallow and to avoid rough,
spicy, and sticky food items.

26. Nursing Interventions con…
. Promote a well-balanced diet that includes sufficient
calories, protein, fat, vitamins, and minerals.
 Teach good hygiene and safe food handling.
 Manage symptoms that interfere with food intake.
 Provide nutritional supplements as needed

27. Education on HIV prevention
Safer sex
 The most common way for HIV to spread is through anal or
vaginal sex without a condom. This risk can’t be completely
eliminated unless sex is avoided entirely, but the risk can
be lowered considerably by taking a few precautions. A
person concerned about their risk of HIV should:
Get tested for HIV. It’s important they learn their status and
that of their partner.
Get tested for other sexually transmitted infections
(STIs). If they test positive for one, they should get it
treated, because having an STI increases the risk of
contracting HIV.

28.  Use condoms. They should learn the correct way to
use condoms and use them every time they have sex,
whether it’s through vaginal or anal intercourse.
 Limit their sexual partners. They should have one
sexual partner with whom they have an exclusive
sexual relationship.
 Take their medications as directed if they have
HIV. This lowers the risk of transmitting the virus to
their sexual partner

29.  Avoid sharing needles . HIV is transmitted through blood and
can be contracted by using contaminated materials.
 Consider PEP. A person who has been exposed to HIV should
contact their healthcare provider about obtaining post-exposure
prophylaxis (PEP). PEP can reduce the risk of contracting HIV. It
consists of three antiretroviral medications given for 28 days.
PEP should be started as soon as possible after exposure, but
before 36 to 72 hours have passed.
 Consider PrEP. A person at a high risk of HIV should talk to
their healthcare provider about pre-exposure prophylaxis (PrEP).
If taken consistently, it can lower the risk of contracting HIV.
PrEP is a combination of two drugs available in pill form.

30. Discharge and Home Care
Guidelines
 Patients and their families or caregivers should receive
instructions about how to prevent disease transmission,
including hand-washing techniques and methods for
safely handling and disposing of items soiled with body
fluids.
 Patients are advised to avoid exposure to others who are
sick or who have been recently vaccinated

31. Discharge and Home Care
Guidelines
 Medication administration. Caregivers in the home
are taught how to administer medications, including
IV preparations.
 The patient’s adherence to the therapeutic regimen is
assessed and strategies are suggested to assist with
adherence.

32.  Pain/discomfort alleviated or controlled.
 Patient dealing with current situation realistically.
 Diagnosis, prognosis, and therapeutic regimen
understood.
 Plan in place to meet needs after discharge.

33.  Ivan Gitachu (2017) conducted a study on
“ KEY CMPETENCIES ESSENTIAL FOR NURSES IN HIV/AIDS
CARE.” The researcher mentioned that Role of a nurse in
HIV/AIDS is mainly are testing, prevention and care.
 Testing HIV/AIDS should be encouraged among patients to ensure
early treatment. Late diagnosis may prove to be more expensive and
the patient may experience worse suffering or worsely spread the
virus unknowingly.
 Prevention methods minimizes HIV infection rates
 When dealing with people living with HIV/AIDS, the nurse must be
able to take the patient step by step into the care plan that will enable
the patient to live a full life. The nurse impacts greatly on the
physical and mental health of such patients through counseling.

34. Testing
 Nurses should be trained to identify the main groups of people
who are more prone to contracting the disease in order to be
able to train their patients about proper HIV/AIDS
management. This will go a long way in curbing infection rates
and ensuring that more people are aware of their status.
 People who are more prone to contracting the disease include
the following: Sex workers, patients that are diagnosed with a
sexually transmitted infection, patients who have sexual
partners that are already diagnosed with the virus, gay and
bisexual men and patients who use injected drugs. (Doyal &
Doyal 2013.).

35.  Key factors that would help nurses care better for
HIV/AIDS patients need to be put in place in health care
facilities.
 For example, it should be a routine procedure to test
patients for HIV if they suffer from a sexually transmitted
infection.
 Nurses should be able to advise these patients on the
importance of proper sexual habits and the importance of
testing to get rid of doubt and ensure early treatment, if it
is needed.

36. Prevention
 When it comes to prevention of contracting HIV/AIDS,
nurses play a key role. As discussed earlier, the nurse is
the primary contact of patients. One of the key
competencies of nurses is identifying and educating these
patients.

37. Care
 After patients are newly diagnosed with the virus, a lot of
counseling and education will be necessary to ensure that
the patient understands and copes with the disease.
 People newly diagnosed with the HIV/AIDS have been
reported to undergo HIV stigma at first.
 At this point, new patients are in need of unbiased support
and nurses are required to show them the way forward.

38. Nursing Competence in HIV
 General competencies in nursing include:
great communication skills, empathy, flexibility, stability
and attention to detail.
 HIV/AIDS nurses are required to go an extra mile and be
problem-solvers in the fight against the spread of
HIV/AIDS.
 Nurses should employ the code of ethics, education and
knowledge of HIV/AIDS gained through studies and in
practical situations as well as ethical and cultural
competencies in administering HIV/AIDS care. (Harmon
& Relf 2016).

39.  Nurses advocate for patients every day and are viewed
as trustworthy, compassionate and knowledgeable
heath care professionals in communities. The nursing
profession was founded in public health advocacy and
leadership. Nurses were on the front lines of early
AIDS activism.

40. THANK YOU