4092 7 HIV Flashcards
vertical transmission means
perinatal transmission
A _____ is created when the viral DNA integrates itself into the cellular DNA or genome of the cell
provirus
HIV causes significant changes in the ____ ratio
CD4+/CD8+
HIV causes absent or decreased skin
test reactivity (anergy)
HIV causes increased ____ levels
immunoglobulin
Antiretroviral drugs play a key role in interrupting the HIV disease process by
inhibiting the ability of the virus to replicate
Most antiretroviral drugs cannot cross the blood-brain barrier, so the drugs
do not have an effect on CNS problems caused by HIV infection
Course of HIV illness can be affected by a__
age
Course of HIV illness can be affected by s_____ ____
substance abuse
Course of HIV illness can be affected by m_____
malnutrition
Course of HIV illness can be affected by g____s
genetics
Course of HIV illness can be affected by g_____r
gender
Course of HIV illness can be affected by p_____
pregnancy
Course of HIV illness can be affected by other i_____
infections
Primary infection (Stage I) the initial period after a person has acquired HIV varies from
several weeks to a few months
In which stage might the person be asymptomatic
Stage 2
Viral destruction is taking place in which phase
Stage 2
Which phase: Persistent fever, involuntary weight loss, chronic diarrhea, fatigue, night sweats, thrush
Stage 3
Stage 4 manifestations
Neuro disease (dementia etc)
Opportunistic infection
secondary cancer
Classification A
Has HIV and is asymptomatic, can last for many years
Classification B
Have respiratory or other illnesses more frequently than in the past.
Thrush or candidiasis may appear, and clients may seek HIV testing
Classification C
Have HIV and an AIDS defining illness
Viral loads—10,000 copies/ml ___ risk for AIDS
low
Viral load– 10,000—100,000 copies/ml ___ risk for AIDS
doubles the
Viral load >100,000 copies/ml ___ risk for AIDS
high
AIDs Defining Illnesses: PCP stands for
Pneumocystic Carinii Pneumonia
AIDs Defining Illnesses: Chronic ____ Diarrhea
Cryptosporidial
AIDs Defining Illnesses: Cerebral ____
Toxoplasmosis
AIDs Defining Illnesses: Oral, Esophageal, Pulmonary
Candidiasis
AIDs Defining Illnesses: Chronic Herpes ____
Simplex
AIDs Defining Illnesses: Kaposi’s ____ and other cancers
Sarcoma
Elisa: May be negative if
exposure was within last three months
___ ___ test may detect presence of HIV in blood of CSF before seroconversion
P24 antigen
P24 antigen test may detect presence of HIV in blood of CSF before
seroconversion
Polymerase chain reaction (PCR) test is used
to check patients that have a false negative with Elisa/Western
Oraquick: how does it work
Specimen may be obtained by fingerstick or venipuncture;
results can be read in 20 minutes
HIV testing requires ___ consent
written
What should you do for: Asymptomatic clients with CD4+ count
treat
What should you do for: Asymptomatic clients with CD4+ counts 200-350
therapy should be offered
What should you do for: Asymptomatic clients with CD4+ counts > 350
Defer treatment or consider if viral load is high
HAART Therapy: Multiple drugs are used because they reduce the likelihood of
developing resistance
Drugs to treat HIV/AIDS are categorized based on which part of the
viral replication cycle they are effective against
types of drug: Genotype resistance
—the virus mutates
types of drug: Phenotype resistance
—virus shows a decrease in sensitivity to the drug
types of drug: Cross-resistance
—the virus develops resistance to one drug, and becomes resistant to other drugs in that class
A group of meds that binds directly to the enzyme and prevent the conversion of RNA to DNA
Non-nucleoside Reverse Transcriptase Inhibitors
A group of meds that incorporate themselves into viral DNA and cause it’s construction to be terminated
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors
Combivir, Epivir, Retrovir, Zerit are examples of
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors
Rescriptor, Sustiva, Viramune are example of
Non-nucleoside Reverse Transcriptase Inhibitors
meds that prevent the successful assembly and release of new virus particles
Protease Inhibitors
Protease Inhibitors have the following problems: _____ to drug
intolerance
Protease Inhibitors have the following problems: ___ burden
pill
Agenerase, Crixivan, Kaletra, Norvir, Viracept are examples of
Protease Inhibitors
group of meds that prevent HIV from entering healthy T cells
Entry Inhibitors
Entry Inhibitors drugs are reserved for use in people who have become resistant to
PI’s, NRTI’s and NNRTI’s
Fuzeon is an examples of
Entry Inhibitors
Patients should use antimicrobials (ciprofloxacin) when
traveling to prevent traveler’s diarrhea
alcohol consumption should be
limited
diet should be high in ___ and low in ___
high cal, low fat
Benefits of HAART Therapy: Control of HIV replication and mutation, with reduction in
viral load
Benefits of HAART Therapy: Prevention of destruction of the immune system and loss of CD4+ T-helper cells
CD4 cells
Benefits of HAART Therapy: Decreased risk of
drug toxicity (drugs are started when the person is healthier)
Risks of HAART Therapy: Reduced quality of life from
adverse drug effects and the inconvenience of a complex regimen
Risks of HAART Therapy: Earlier development of
drug resistance
Risks of HAART Therapy: A limited number of
drugs available to respond to drug resistance
Risks of HAART Therapy: Unknown ___ ___ effects
long-term effects
Risks of HAART Therapy: Unknown duration of the
effectiveness of the drugs
Maintaining skin and mucous membrane integrity with good skin and mouth hygiene (can reduce _____)
candidiasis
How often should they get tested for TB
annually
Salmonella Prevention: do not eat
raw things or cold cuts
Pneumocystosis carinii mode of transmission
airborne
Toxoplasmosis is spread by cats and certain
foods
Symptoms include: headache, impaired cognition, hemiparesis, aphasia, ataxia, vision loss, cranial nerve palsies, motor problems, and seizures
Toxoplasmosis
Toxoplasmosis: Potential for development when the CD4 count falls below
100
A second line drug tx for dyspnea is
Anxiolytics (if anxiety exists)
____ cough suggests gastroesophageal reflux disease or congestive heart failure
Nocturnal
Cough with hemoptysis suggests ____ or ____ ____
pneumonia or pulmonary embolism
Cough with dark green or yellow sputum suggests ___ or ____ infection
viral or bacterial
Cough with fever or night sweats indicated ____ or ____ ____
TB or bacterial pneumonia
avoid stimuli that may induce coughing: smoke, cold air, and
exercise
For treatment of P. carinii clients should receive
albuterol to relieve cough
When there is no therapeutic reason to induce cough, then use cough suppressants, such as
OTC suppressants, opiods
HAART and dementia
In some patients HAART may reduce the dementia, but in many patients it is ineffective
Current research states that Haldol is
ineffective in treating AIDS Dementia
methyphenidate should not be taken after
2pm
Apathy and social withdrawal in patients with mild-to-moderate impairment can be treating with
methyphenidate
Delirium: Use of neuroleptics is controversial but ___ and ___ have been shown to have some effectiveness
Haldol and Chlorpro
Benzodiazepines may aggravate
delirium
In patients with severe or persistent dementia, there is no need to
orient to time and place. Instead use comments such as “ you are safe”
Early initiation of oral anti-retroviral agents can both enhance outcomes and
reduce HIV transmission
