Chapter 37 HIV/AIDS Flashcards
How is HIV transmitted?
Sexually transmitted (semen and vaginal fluid) - latex condoms protect, nonlatex dont, circumcision also has shown to reduce risk, even if taking oral contraceptives use condoms
Exposure to infected blood - needle exchange program reduces risk, clean drug equipment, dont share needles,
Sharing infected injection drug use equipment • Having sexual relations with infected individuals (both male and female) • Infants born to mothers with HIV infection and/or who are breast-fed by HIV-infected mothers • People who received organ transplants, HIV-infected blood, or blood products (especially between 1978 and 1985)
What are standard precaution recommendations?
Hand hygiene - after touching blood, bodyfluids, secretions, excretions, contaminated items, after removing gloves, between patient contacts.
PPE - gloves (all times), gown (contact of clothing/exposed skin with blood or body fluids, secretions, and excretions is anticipated), mask/eye protection (goggles)/face shield (splashes of blood, body fluids, secretions, especially suctioning or ET intubation)
Soiled patient care equipment - gloves if visibly contaminated, perform hand hygiene, Handle in a manner that prevents transmission of microorganisms to others and environment
Environmental control - procedures for routine care, cleaning, and disinfection of environmental surfaces, especially frequently touched surfaces in patient care areas
Textiles and laundry - Handle in a manner that prevents transmission of microorganisms to others and environment
Needles and other sharps - Dont recap, break, bend, or hand manipulate needles; if recapping is required use the one handed scoop technique, use safety features when available, place used sharps in puncture resistant container
patient resuscitation - use mouthpiece, resuscitation bag, and other ventilation devices to prevent contact with mouth and oral secretions
patient placement - single-patient room if patient is at an increased risk for transmission, is likely to contaminate environment, does not maintain appropriate hygiene, or is at an increased risk for acquiring infection or developing adverse outcomes following infection
Respiratory hygiene/cough etiquette - beginning at initial encounter, cover mouth and nose when coughing or sneezing, use tissues and dispose in no-touch receptacle, observe hand-hygiene after soiling of hands with respiratory secretions, wear surgical mask if tolerated
Postexposure prophylaxis?
The average risk for HIV transmission to health care providers after a percutaneous exposure to HIV-infected blood is estimated to be approximately 0.3%; after a mucous membrane exposure, the risk is approximately 0.09%. If you sustain an occupational exposure to HIV, take the following actions immediately:
- Alert your supervisor/nursing faculty, and initiate the injuryreporting system used in the setting.
- Identify the source patient, who may need to be tested for HIV, hepatitis B, and hepatitis C. State laws will determine whether written informed consent must be obtained from the source patient before his or her testing. OraQuick® rapid testing should be used if possible if the HIV status of the source patient is unknown, because results can be available within 20 minutes.
- Report as quickly as possible to the employee health services, the emergency department, or other designated treatment facility. This visit should be documented in the health care worker’s confidential medical record.
- Give consent for baseline testing for HIV, hepatitis B, and hepatitis C. Confidential HIV testing can be performed up to 72 hours after the exposure but should be performed as soon as the health care worker can give informed consent for baseline testing.
- Get postexposure prophylaxis for HIV in accordance with Centers for Disease Control and Prevention guidelines. Start the prophylaxis medications within 2 hours after exposure. Make sure that you are being monitored for symptoms of toxicity. Practice safer sex until follow-up testing is complete. Continue the HIV medications for the full 4 weeks after exposure. The majority of HIV exposures will warrant a combination of antiretroviral agents. Combinations that may be prescribed for postexposure prophylaxis include zidovudine (ZDV) and lamivudine (3TC) or emtricitabine (FTC); stavudine (d4T) and 3TC or FTC; and tenofovir (TDF) and 3TC or FTC.
- Follow up with postexposure testing at 1 month, 3 months, and 6 months, and perhaps 1 year.
- Document the exposure in detail for your own records as well as for the employer.
- Take the psychosocial support offered or seek support outside of the employment setting.
Information for patients who are positive for HIV?
All patients should be advised to:
- Abstain from sharing sexual fluids (semen and vaginal fluid).
- Reduce the number of sexual partners to one.
- Always use latex condoms. If the patient is allergic to latex, nonlatex condoms should be used; however, they will not protect against HIV infection.
- Not reuse condoms.
- Avoid using cervical caps or diaphragms without using a condom as well.
- Always use dental dams for oral-genital or anal stimulation.
- Avoid anal intercourse, because this practice may injure tissues.
- Avoid manual-anal intercourse (“fisting”).
- Not ingest urine or semen.
- Avoid sharing needles, razors, toothbrushes, sex toys, or blood-contaminated articles.
All patients should be educated about nonpenetrative sexual activities, such as body massage, social kissing (dry), mutual masturbation, fantasy, and sex films.
Patients who are HIV seropositive should also be advised to:
- Inform previous, present, and prospective sexual and drugusing partners of their HIV-positive status. If the patient is concerned for his or her safety, advise the patient that many states have established mechanisms through the public health department in which professionals are available to notify exposed people.
- Avoid having unprotected sex with another HIV-seropositive person. Cross-infection with that person’s HIV can increase the severity of infection.
- Avoid donating blood, plasma, body organs, or sperm.
Information for patients who are HIV negative?
All patients should be advised to:
- Abstain from sharing sexual fluids (semen and vaginal fluid).
- Reduce the number of sexual partners to one.
- Always use latex condoms. If the patient is allergic to latex, nonlatex condoms should be used; however, they will not protect against HIV infection.
- Not reuse condoms.
- Avoid using cervical caps or diaphragms without using a condom as well.
- Always use dental dams for oral-genital or anal stimulation.
- Avoid anal intercourse, because this practice may injure tissues.
- Avoid manual-anal intercourse (“fisting”).
- Not ingest urine or semen.
- Avoid sharing needles, razors, toothbrushes, sex toys, or blood-contaminated articles.
All patients should be educated about nonpenetrative sexual activities, such as body massage, social kissing (dry), mutual masturbation, fantasy, and sex films.
What are the lab tests that diagnose HIV/AIDS?
EIA or ELISA - antibodies are detected, resulting in a positive results which marks the end of window period
Western blot - also detects antibodies, used to confirm EIA
Viral load - measures HIV RNA in the plasma, reverse transcriptae polymerase chain reaction can also detect HIV in high-risk seronegative people before antibodies are measureable, to confirm EIA result, and to screen neonates. better predictor for risk of HIV than CD4 count
CD4/CD8 - markers found on lymphocytes, HIV kills CD4 cells, which significantly impairs the immune system
Oraquick - in-home HIV test, uses less than a drop of blood, takes approximately 20 minutes.. used when a delay in testing could effect treatment, like L&D or in ED when HIV status of sexual abuser is unknown
BLOOD THAT CONTAINS HIV ANTIBODIES IS INFECTED
What is the action of NRTIs (nucleuside/nucleotide reverse transcriptase inhibitors) and NNRTIs (nonnucleoside reverse transcritase inhibitors)?
These prevent the change or viral RNA into DNA.
What is the action of protease inhibitors (PIs)?
Inhibits the function of protease, which is an enzyme needed for HIV replication.
What is the action of integrate inhibitors?
Inhibits integrase, which stops the integration of HIV DNA into the hosts DNA.
Fusion inhibitors action?
Stops HIV from entering the CD4 cell.
Adverse effects for ART therapy?
ALL - hepatotoxicity, nephrotoxicity, osteopenia, increased risk for MI, Increased risk for CVD, fat redistribution syndrome (buffalo hump),
NNRTI - rash/steven-johnson syndrome
PI - hepatotoxicity
NRTI - bone marrow suppression, lactic acidosis.
Describe methods to improve adherence to ART therapy.
- Verbalize knowledge of each medication name. ✓ ✓
- State the action of each medication. ✓ ✓
- State the correct times that medications are to be taken. ✓ ✓
- Identify special guidelines to follow when taking medications (e.g., with meals, on an empty stomach, medications that are not to be taken together). ✓ ✓
- Demonstrate methods of keeping track of the medication regimen and storage of the prescribed medications, and use reminders such as beepers and/or pillboxes. ✓ ✓
- Identify specific laboratory tests, such as viral load, that are necessary to monitor the effectiveness of the prescribed medication regimen. ✓ ✓
- List expected side effects of each medication. ✓ ✓
- Identify side effects that should be reported to health care providers. ✓ ✓
- Explain the importance of and necessity for adherence with prescribed medication regimen. ✓ ✓
- Demonstrate correct administration of intramuscular, subcutaneous, or IV medications. ✓ ✓
- Demonstrate correct use and safe disposal of needles, syringes, and other IV equipment. ✓ ✓
- Discuss with health care providers any problems that the patient is having with side effects and adherence. ✓ ✓
- Discuss episodes of nonadherence to the medication regimen.
Clinical manifestations of HIV/AIDS?
1009-1015
Nursing process for HIV/AIDS?
p. 1016-1025
