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NURS 425 > Exam 3: HIV > Flashcards

Exam 3: HIV Flashcards

1
Q

What is HIV?

A

Retrovirus that causes immunosuppression making persons more susceptible to infections.

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2
Q

How can HIV be transmitted?

A
  • Through contact with certain body fluids: blood, semen, vaginal secretions and breast milk.
  • HIV is not spread through casual contact.
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3
Q

What is the most common mode of transmission for HIV?

A
  • Unprotected sex with an HIV-infected partner.

- Greatest risk is for partner who receives semen, prolonged contact with infected fluids.

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4
Q

HIV Modes of Transmission: Contact with blood

A
  • Sharing drug-using paraphernalia is highly risky
  • Screening measures have improved blood supply safety
  • Puncture wounds are most common means of work-related HIV transmission
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5
Q

HIV Modes of Transmission: Perinatal Transmission

A

-Can occur during pregnancy, delivery or breastfeeding

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6
Q

Pathophysiology of HIV

A
  • CD4+T cell is the target cell for HIV: type of lymphocyte that HIV binds to through fusion.
  • Once HIV is attached and fused with specific protein receptors on the outside of the CD4+ T cell, HIV RNA enters the cell.
  • This triggers the release of reverse transcriptase, an enzyme that transforms HIV RNA into a single strand of DNA
  • This strand copies itself, becoming double-stranded viral DNA.
  • Another enzyme, called integrase, allows the newly formed double-stranded DNA to integrate itself into the host’s genetic structure.
  • HIV destroys about 1 billion CD4+ T cells every day.
  • For many years the body can produce new CD4+ T cells to replace the destroyed cells.
  • However, over time the ability of HIV to destroy CD4+ T cells exceeds the body’s ability to replace the cells.
  • The decline in the CD4+ T cell count impairs immune function.
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7
Q

Viral Load

A

The amount of HIV circulating in the blood

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8
Q

Pathophysiology of HIV: Immune problems start when

A
  • When CD4+T cell counts drop < 500 cells/uL
  • Severe problems develop when <200 CD4+T cells/uL
  • Insufficient immune response allows for opportunistic diseases
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9
Q

What is the normal range of CD4+T cells?

A

800-1200 cells/uL

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10
Q

Timeline for Untreated HIV Infection

A
  1. Disease progression is highly individualized
  2. Treatment can significantly alter this pattern
  3. An individual’s prognosis is unpredictable
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11
Q

What are clinical manifestations/complications of HIV?

A
  • Acute infection
  • Asymptomatic infection
  • Symptomatic infection
  • AIDS
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12
Q

Clinical Manifestations/Complications of HIV: Acute infection

A
  • Flulike symptoms: Fever, swollen lymph nodes, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea or diffuse rash
  • Occurs about 2-4 weeks after infection
  • Highly infectious
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13
Q

Clinical Manifestations/Complications of HIV: How can asymptomatic infection cause problems in patients with HIV?

A
  • Symptoms are generally absent or vague, therefore patients may be unaware they are infected.
  • High risk behaviors may continue.
  • If left untreated, a diagnosis of AIDS is made about 10 years after initial HIV infection.
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14
Q

Clinical Manifestations/Complications of HIV: What happens during a symptomatic Infection?

A
  • CD4+T cells decline closer to 200 cells/uL
  • Symptoms become worse
  • HIV advances to a more active stage.
  • As viral load increases, symptoms such as persistent fever, frequent night sweats, chronic diarrhea, recurrent headaches and severe fatigue may develop.
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15
Q

What are common infections associated with symptomatic infection of HIV?

A
  • Oropharyngeal candidiasis (thrush)
  • Shingles
  • Persistent vaginal candidal infections
  • Herpes
  • Bacterial infections
  • Oral hairy leukoplakia (Epstein-Barr virus infection)
  • Pneumocystis jiroveci pneumonia
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16
Q

Kaposi Sarcoma

A
  • Malignant vascular lesions that can appear anywhere on the skin surface or on internal organs.
  • Caused by human herpesvirus 8
  • Lesions vary in size and may appear in a variety of shades.
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17
Q

Oral hairy leukoplakia

A

An Epstein-Barr virus infection that causes painless, white, raised lesions on the lateral aspect of the tongue, can occur at this phase of the infection and is another indicator of disease progression.

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18
Q

Complications of HIV: AIDS

A
  • Diagnostic criteria is established by CDC

- Immune system is severely compromised: infections, malignancies, wasting and HIV-related cognitive changes

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19
Q

Pneumocystis jiroveci pneumonia

A

A type of pneumonia that can appear as an opportunistic disease associated with HIV infection

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20
Q

HIV Diagnostic Studies

A
  • Most useful screening tests detect HIV-specific antibodies and/or antigens
  • May take several weeks to detect antibodies (window period)
  • Performed using blood or saliva.
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21
Q

What kind of test can detect HIV earlier?

A

Combination (4th generation) tests

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22
Q

HIV Progression is monitored by what?

A
  1. CD4+ T-cell counts: provides a marker of immune function

2. Viral load: the lower the viral load, the less active the disease

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23
Q

The goal of HIV treatment is to…

A

Suppress the viral load to the lowest level possible, which is below the level of detection on a commercial assay. (Referred to as undetectable)

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24
Q

When a viral load is undetectable, what does it mean?

A
  • Does not mean that the virus has been eliminated from the body or that the individual can no longer transmit HIV to others.
  • Rather it refers to the fact that the amount of circulating HIV in the blood is below the level of detection of the test.
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25
Q

HIV Diagnostic Studies: Abnormal blood tests are common including

A
  • Decreased WBC counts
  • Low platelet counts
  • Anemia is associated with ART
  • Altered liver function
26
Q

What causes abnormal blood tests in HIV patients?

A
  • HIV
  • Opportunistic diseases
  • Complications of therapy
27
Q

HIV Diagnostic Studies: Resistance Test

A

Can determine if a patient’s HIV is resistant to drugs used for ART

28
Q

HIV Diagnostic Studies: Assays

A
  • Help HCP’s know which medications may be effective.

- Include genotype and phenotype assay

29
Q

Interprofessional care of the HIV-infected patient focuses on

A
  1. Monitor disease progression, immune function, and manage symptoms
  2. Initiate and monitor ART
  3. Prevent, detect and/or treat opportunistic infections
  4. Prevent or decrease complications of therapies
  5. Prevent further transmission of HIV
30
Q

HIV Interprofessional Care: What must be done during the initial patient visit?

A
  • Gather baseline data
  • Begin to establish rapport and use patient input to develop a plan of care
  • Initiate teaching about spectrum of HIV, treatment, preventing transmission, improving health, and family planning
31
Q

What are the main goals of HIV drug therapy?

A
  • Decrease viral load
  • Maintain/increase CD4+T counts
  • Prevent HIV-related symptoms and opportunistic diseases
  • Delay disease progression
  • Prevent HIV transmission
32
Q

HIV Drugs: Drug Interactions include

A
  • Herbal therapies: St. John’s Wort
  • Commonly used drugs
  • OTC drugs: Antacids, PPI’s, supplements
33
Q

Drug therapy for HIV: Opportunistic diseases complicate management of HIV infection, therefore

A
  • Prevention is key
  • Onset can be delayed with adequate measures (i.e vaccines or adequate ART)
  • Effective management has significantly increased life expectancy
34
Q

Preventing Transmission of HIV: Pre-exposure prophylaxis

A
  • Comprehensive strategy to reduce risk of sexually-acquired infection in adults at high risk
  • Used in conjunction with proven prevention interventions
35
Q

Pre-exposure prophylaxis includes

A
  • Tenofovir in combination with emtricitabine, also known as Truvada, is used to reduce the risk of HIV infection in uninfected individuals who are at significant risk of acquiring HIV.
  • Tenofovir/emtricitabine is also currently used in combination with other antiretroviral agents for the treatment of HIV-infected people.
36
Q

HIV: Nursing Assessment

A
  • Do not make assumptions about who may be at risk
  • Candid conversation is important for effective management of HIV
  • Ask at-risk patients:
    1) Received blood transfusion or clotting factors before 1985?
    2) Shared needles with another person?
    3) Had a sexual experience with your penis, vagina, rectum, or mouth in contact with these areas of another person?
    4) Had a sexually transmitted infection?
37
Q

HIV Nursing Assessment: Assess diagnosed patient thoroughly including

A
  • Past health history
  • Medications
  • Functional health patterns
  • Presence of symptoms using a systems review
38
Q

HIV: Goals for care are aimed at

A
  • Compliance with drug regimens
  • Adopting a healthy lifestyle
  • Beneficial relationships
  • Spiritual well-being in regard to life and death
  • Coping with the disease and its treatment
39
Q

HIV: Health promotion includes

A
  • Avoid/modify risky behaviors

- Candid, culturally sensitive, language appropriate, age-specific information and behavior change counseling

40
Q

Decreasing Risk for HIV: Sexual Intercourse

A
  • Abstinence
  • Noncontact safe sex (can include masturbation, mutual masturbation (i.e handjob))
  • Use of barriers
41
Q

Decreasing Risk for HIV: Drug use

A
  • Do not use drugs (can cause immunosuppression, poor nutrition and a host of psychosocial problems)
  • Do not share equipment
  • Do not have sexual intercourse under the influence of any impairing substance
  • Refer for help with substance use
42
Q

Decreasing Risk of HIV: Perinatal Transmission

A
  • Family planning (need info on abortion, how to maintain pregnancy and using ART to decrease risk of transmission)
  • Preventing HIV in women
  • Appropriately medicate HIV-infected pregnant women
43
Q

Decreasing Risk of HIV: Work

A
  • Adhere to precautions and safety measures to avoid exposure
  • Report all exposures for timely treatment and counseling
  • Post-exposure prophylaxis with combination ART can significantly decrease risk of infection
44
Q

HIV Testing

A
  • Testing is the only sure method of determining HIV infection
  • CDC recommends universal, voluntary testing as part of routine medical care
45
Q

HIV: Acute Interaction

A
  • Early intervention promotes health and delays disability
  • Reactions to positive HIV test is similar to any life-threatening, chronic illness: panic, anxiety, fear, guilt, depression, denial, anger and hopelessness
46
Q

ART can significantly slow HIV progression, but it

A
  • Is complex
  • Has side effects
  • Does not work for everyone
  • Is expensive
47
Q

ART: When to start therapy

A
  • Patient readiness is most important concern

- To avoid burnout and non-adherence, treatment is recommended when immune suppression is great

48
Q

ART: Adherence to drug regimens

A
  • Is critical to prevent disease progression, opportunistic disease and viral drug resistance.
  • An individual approach is best.
49
Q

Drug Therapy for HIV includes

A
  • Nucleoside, non-nucleoside and nucleotide reverse transcriptase inhibitors
  • Protease inhibitors
  • Fusion inhibitors
50
Q

How do nucleoside, non-nucleoside and nucleotide reverse transcriptase inhibitors treat HIV?

A

Inhibits the ability of HIV to make a DNA copy early in replication

51
Q

How does protease inhibitors treat HIV?

A

Interfere with activity of enzyme protease

52
Q

How do fusion inhibitors treat HIV?

A

-Interfere with HIV CD4 receptor site binding and entry into cells

53
Q

Delaying HIV Disease Progression: Supporting a healthy immune system through

A
  • Adequate nutrition
  • Current vaccinations
  • Health habits (adequate rest, exercise, reducing stress)
  • Avoiding risky behaviors
  • Supportive relationships (i.e HCP’s)
54
Q

Acute Exacerbations of HIV Infection

A
  • Has no cure
  • Continues for life
  • Causes physical disability
  • Impairs social, emotional, economic, and spiritual wellbeing
  • Ultimately leads to death
55
Q

Stigmas that surround HIV

A
  • Can lead to discrimination and result in social isolation, dependence, frustration, low self-image, loss of control, and economic pressures
  • This, in turn, could lead to further involvement in risky behaviors
56
Q

What are common physical problems related to HIV and/or its treatment?

A
  • Anxiety, fear, depression
  • Diarrhea
  • Peripheral neuropathy
  • Pain
  • Nausea/vomiting
  • Fatigue
57
Q

Some HIV-infected patients, especially those who have been infected and on ART for a long time, may develop a set of metabolic disorders including

A
  • Lipodystrophy
  • Hyperlipidemia: (elevated triglycerides, elevated LDLs and decreased HDL’s) treated with lipid lowering drugs, dietary changes and exercise
  • Insulin resistance: treated with hypoglycemic drugs and weight loss
  • Hyperglycemia
  • Bone disease (osteoporosis, osteopenia, avascular necrosis): treated with exercise, dietary changes, calcium and vitamin D supplements.
  • Lactic acidosis
  • Renal disease
  • Cardiovascular disease
58
Q

Lipodystrophy

A

changes in body shape caused by a redistribution of fat in the abdomen, upper back, and breasts along with fat loss in the arms, legs, and face.

59
Q

Management of metabolic disorders associated with HIV focuses on

A
  • Early detection
  • Symptom management
  • Helping patients cope with emerging problems
  • Changing treatment regimens (especially to avoid potentially fatal complications)
60
Q

A frequent first intervention when managing metabolic disorders associated with HIV is

A

Change to ART medications because some drugs are more often associated with these disorders.

61
Q

End of Life Care: The focus of nursing intervention is

A
  • Patient comfort
  • Promoting acceptance of finite nature of life
  • Helping significant others deal with loss
  • Maintaining safe environment

NURS 425 (19 decks)

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