early strategies in HIV infection and nurses role. In this the nurses should understand the strategies in diagnosing HIV and management along with nursing care. So that nurses can alleviate the patients problems and relieve the problems based on different strategies

1. EARLY STRATEGIES IN HIV INFECTION AND NURSES ROLE
Abstract: HIV infection is spread through blood, semen, anal and oral sexual intercourse, IV
drugs and infected needles. HIV infection weakens the immunity system and leads to expose
many opportunistic infections. The nurses are the primary care givers in health care facility. So
it is important that the nurses get acquainted with the causes, symptoms, diagnosis, treatment
etc.
Key words: HIV, infection, immunity, symptoms, diagnosis
Introduction
HIV is a virusthat attacks the immune system.Itweakensthe immunitytothe pointwhere the body
strugglestofightinfectionsanddisease.
What is HIV/AIDS?
 In 1983 the virusthat causedAIDSwas discoveredbyscientistsinFrance andthe routesof
transmissionwere confirmed.The viruseventuallyknownasthe humanimmunodeficiencyvirus
(HIV).There are 2 differenttypesof HIV:
 HIV-1 the most common type found worldwide,and
 HIV-2 found mostlyin WestAfrica.
CAUSES
People transmitHIV inbodilyfluids,including:
 blood
 semen
 vaginal secretions
 anal fluids
 breastmilk
 Sharinginfectedneedles.
 Havingsexual relationswithinfectedindividuals(bothmale andfemale).

2. Early symptoms of HIV infection
 Some people withHIV donotshow symptomsuntil monthsoreven yearsaftercontractingthe
virus.
 Around 80 percentof people maydevelopasetof flu-like symptomsknownasacute retroviral
syndrome around2–6 weeksafterthe virusentersthe body.The earlysymptomsof HIV
infectionmayinclude
hyperalgesia,orincreasedsensitivitytopain 1. Fever:Feveriswhenahuman'sbodytemperature
goesabove the normal range of 36–37° Centigrade (98–100° Fahrenheit).Itisa commonmedical
sign.
Symptomsof Fever:
 feelingcold, shivering,lackof appetite,dehydration,depression,Lethargy,Sleepiness,sweating
when feverishigh,there mayalsobe extreme irritability,confusion,delirium,andseizures.
2. Strep throat:
 Known as a Streptococcal pharyngitisorstreptococcal sore throat;it isonlyevercausedby
bacteria.
The symptomsof strepthroat are similartoa sore throat; these include:
 Paininthe throat.
 Difficultyswallowing.
 Loss of appetite.
 Tonsilsare painful and/orswollen;sometimeswithwhite patchesand/orstreaksof pus.
 Verysmall redspotsmay appearon the softpart of the palate.
 Cervical lymphnodes are swollenandtender,Fever
3. Fatigue
The signsand symptomsof fatigue maybe physical,mental,oremotional.
Commonsignsandsymptomsassociatedwithfatiguecaninclude:
 achingor sore muscles
 apathyand lack of motivation
 daytime drowsiness

3.  difficultyinconcentratingorlearningnew tasks
 gastrointestinal problemssuchasbloating,abdominal pain, constipation,anddiarrhea
 Headache,irritabilityandmoodiness
 slowedresponsetime
 vision problems,suchasblurriness
DIAGNOSTICSTRATERGIES
 diagnosisof acute HIV-1infection,especiallyinhigh-prevalence areas(areaswhere≥1% of
people have HIV infection).
 A persons givesahistory include the symptomsinclude “flu-like”illnesscharacterizedbyfever,
headache,muscle aches,jointpain,swollenlymphnodes,sore throat,diarrhea,and/orrash.
Several screeningtestsare usedtodiagnose HIV infection.
 CBC: The findingsmaybe anemiaandidiopathicthrombocytopenia,Leukopenia.
 PPD: Determinesexposureand/oractive TBdisease.
 Serologic:Serumantibodytest: HIV screenbyELISA.A positive testresultmaybe indicative of
exposure toHIV.
 Westernblottest: Confirmsdiagnosisof HIV inbloodandurine.
 Viral load test:
RT-PCR:( Real Time Polymerase ChainReaction) Widelyusedtestcurrentlycandetectviral RNA levels
as lowas 50 copies/ml of plasmawithanupperlimitof 75,000 copies/ml.(An HIV viral load
testmeasuresthe numberof HIV particlesina milliliter(ml) of blood
bDNA ( Branched DNA)assay: Has a widerrange of 50–500,000 copies/ml.
StrategiesinHIV Treatment
 Antiretroviraltherapy(ART) isrecommendedforall individualswithHIV-1infection (AI),
includingthose withearly HIV-1infection.
 PatientsstartingARTshouldbe willingandable tocommitto life-longtreatmentandshould
understandthe importance of adherence
 Treatment of opportunisticinfections
 dermatological ,pulmonary,gastrointestinal ,oral neurological.

4.  OIs are causedbyorganisms(suchas bacteria,viruses,fungi,orprotozoa) thatwouldnotcause
a disease ina personwithawell-functioningimmunesystem
 Antidepressanttherapy. TreatmentfordepressioninpatientswithHIV infectioninvolves
psychotherapyintegratedwithimipramine,desipramine orfluoxetine.
 Nutritiontherapy. For all AIDSpatientswhoexperience unexplainedweightloss,caloriecounts
shouldbe obtained,andappetitestimulantsandoral supplementsare alsoappropriate.
Role of a Nurse
 The nurse is seenasthe primary linktothe patientinany givenhealthcare facility.The nurse
musttherefore be fullycompetent.
 Nursesprovide life-savingandlife-enrichingcare throughout the world.Often theyare the
first provideror eventhe primary provider for patientswith HIV.
NursingAssessment
 Nursingassessmentincludesidentificationof potentialriskfactors,includingahistoryof risky
sexual practicesorIV/injectiondruguse
 Nutritional status. Nutritional statusisassessedbycollecting adiethistoryand identifying
factors thatmay affectthe oral intake.
 Neurologicstatus. Neurologicstatusisdeterminedbyassessingthe level of consciousness;
orientationtoperson,place,andtime;andmemorylapses.
 Fluidand electrolyte balance. F&E status isassessedbyexaminingthe skinandmucous
membranesforturgorand dryness.
 Knowledge level. The patient’slevel of knowledge aboutthe disease andthe modesof disease
transmissionisevaluated.
Nursing Diagnosis
 Disturbedthought process relatedtoshortenedattentionspan,impairedmemory,confusion,
and disorientationassociatedwithHIV encephalopathy.
 Ineffective airwayclearance assessedby, increasedbronchial secretions,anddecreasedability
to cough relatedtoweaknessandfatigue.
 Pain relatedtoimpairedperi anal skinintegritysecondarytodiarrhea,andperipheral
neuropathy
 Imbalancednutrition status, lessthan body requirements relatedtodecreasedoral intake

5. Nursing Interventions
 Promote skinintegrity. Patientsare encouraged to
1. Avoidscratching;
2. Use nonabrasive,nondrying soaps and apply nonperfumedmoisturizers;
3. Performregularoral care; and
4. Cleanthe peri anal area aftereachbowel movementwithnonabrasive soapandwater.
Promote usual bowel patterns. The nurse shouldmonitorforfrequencyandconsistencyof stoolsand
assessforabdominal painorcramps
 Preventinfection. Nurse hasto identifythe opportunisticinfectionswhichare commonand
provide care.
 Improve activity intolerance. Assistthe patientinplanningdailyroutinesthatmaintainabalance
betweenactivityandrest.
 Maintain thought processes. Familyandsupportnetworkmembersare instructedtospeakto
the patientinsimple,clearlanguage andgive the patientsufficienttime torespondtoquestions.
 Improve airway clearance. Teach Coughing,deepbreathingexercises,2nd
hourlyprovide
postural drainage,percussionandvibration topreventstasisof secretionsandtopromote
airwayclearance.
 Relieve painand discomfort. By using softcushionsandfoam pads increase comfortas well as
administrationof NSAIDSandopioidsas perorders.
 Improve nutritional status. The patientisencouragedtoeat foodsthatare easyto swallowand
to avoidrough,spicy,andstickyfooditems.
 . Promote a well-balanceddietthatincludessufficientcalories,protein,fat,vitamins,and
minerals.
 Teach goodhygiene andsafe foodhandling.
 Manage symptomsthatinterfere withfoodintake.
 Provide nutritionalsupplementsasneeded
Education on HIV prevention
Safer sex

6.  The most commonway forHIV to spreadisthroughanal or vaginal sex withoutacondom.This
riskcan’t be completelyeliminatedunlesssex isavoidedentirely,butthe riskcanbe lowered
considerablybytakingafewprecautions.A personconcernedabouttheirriskof HIV should:
Gettestedfor HIV. It’s importanttheylearntheirstatusandthat of theirpartner.
Gettestedfor other sexuallytransmittedinfections(STIs). If theytestpositive forone,theyshouldget
it treated,because havinganSTIincreasesthe riskof contractingHIV.
 Use condoms. Theyshouldlearnthe correctway to use condomsanduse themeverytime they
have sex,whetherit’sthroughvaginal oranal intercourse.
 Limit theirsexual partners. Theyshouldhave one sexual partnerwithwhomtheyhave an
exclusivesexual relationship.
 Take medicationsas directed. Thislowersthe riskof transmittingthe virustotheirsexual
partner.
 Avoid sharingneedles. HIV istransmittedthroughbloodand can be contractedby using
contaminatedmaterials.
 ConsiderPEP. A personwhohasbeenexposedtoHIV shouldcontacttheirhealthcare provider
aboutobtainingpost-exposure prophylaxis(PEP).PEPcanreduce the riskof contractingHIV.It
consistsof three antiretroviral medicationsgivenfor28 days.PEP shouldbe startedassoon as
possible afterexposure,butbefore 36to 72 hourshave passed.
ConsiderPrEP. A personat a highriskof HIV shouldtalkto theirhealthcare providerabout pre-
exposure prophylaxis(PrEP).If takenconsistently,itcanlowerthe riskof contracting HIV.PrEPis
a combinationof twodrugsavailable inpill form.
Discharge andHome Care Guidelines
 Patientsandtheirfamiliesorcaregiversshouldreceive instructionsabouthow to prevent
disease transmission,includinghand-washingtechniquesandmethodsforsafelyhandlingand
disposingof itemssoiledwithbodyfluids.
 Patientsare advisedtoavoidexposuretootherswhoare sick or whohave beenrecently
vaccinated.
 Medicationadministration.Caregiversinthe home are taughthow to administermedications,
includingIV preparations.
 The patient’sadherence tothe therapeuticregimenisassessedandstrategiesare suggestedto
assistwithadherence.
Summary

7.  HIV infectionweakensthe immunesysteminthe body.There are twotypesof HIV infections.
Theyare HIV 1 seenworldwide andHIV2seeninWestAfrica.EarlyHIV symptomsare fever,
strepthroat and fatigue. Nursesprovide life-savingandlife-enrichingcare throughoutthe world.
Oftentheyare the firstprovideroreventhe primaryproviderforpatientswithHIV. Hence
nursesplaya vital role inprovidingcare tothe HIV patients.