HIV Flashcards
What is the Main Focus for HIV?
PREVENTION!
Treatment IS Prevention!
-Keeping the Viral Load LOW!
How is HIV Transmitted?
- Sexual Contact (Genital, Anal, Oral)
- Anal has the highest risk!
- “passive” partner (lol) at higher risk - Parenteral (IV drug use, Bld transfusions, needlesticks)
- Perinatal (placenta, delivery, breast milk)
What Bodily fluids is HIV most likely to spread thru?
- Blood
- Semen
- Vaginal Secretions
- Breast Milk
Other bodily fluids would require drinking an entire bucket to pass it on…
Prevention of HIV transmission via Sexual Contact:
(1) ABCD’s of safe sex
1. Abstinence (HAHA-yeah f’in right)
2. Being faithful
3. Condom use
4. Drugs… Pre-Exposure Prophylaxis (PrEP)
- BEFORE coming into contact with HIV
(2) Post-Exposure Prophylaxis (PEP)
- after coming into contact with HIV
Prevention of HIV transmission via Parenteral Route: (4)
- Cleaning method for IV needles
- Needle Exchange programs
- PrEP –> Treatment is Prevention
- Blood donation screening (1978-1985)
Prevention of HIV transmission via Perinatal (3)
- Drug therapy during pregnancy (25% to 8% risk)
- Cesarean delivery
- NO BREASTFEEDING!!
Babies born to HIV+ mothers should be treated with HIV medications for
4-6 weeks after delivery
Prevention of HIV Transmission for Healthcare Workers (3)
When should testing be performed post-needlestick?
- Use of Standard Precautions
- Sharps Injury Prevention Programs
- Post-Exposure Prophylaxis (PEP)
- TEST WITHIN 24 HOURS!!
What is the Gold Standard test for HIV SCREENING?
4th Generation HIV Assay Testing
- detects antibodies within 21 days
- detects p24 antigen within 14 days
Who Should be Screened for HIV?
- ALL ADULTS at least once ages 13-65
- Prenatal screening
- ANNUAL screening for High-risk groups
- sex workers, IV drug users, etc. - More frequent testing with repeated high-risk exposure
What’s the next step in testing if 4th Gen. HIV Assay Test is Positive or Negative?
HIV+ –> Differentiate HIV-1 vs. HIV-2 then Viral load
HIV- –> NAT RNA Testing for an ACUTE HIV Infection
HIV Home Testing Kits only test for what?
If Positive, what’s the next step?
ANTIBODIES
NEED to follow up with another test for confirmation!
What does HIV Viral Load testing help us with? (2)
- HIV infectivity risk
HIGHER THE LOAD –> HIGHER THE TRANSMISSION RISK - Effectiveness of Treatment
What does CD4 Count testing tell us?
Determines transition from HIV to AIDs (CD4 <200)
How often should someone with HIV be tested for Syphilis?
Annually
What are the 3 Stages of HIV?
1) Acute HIV Infection (Symptomatic; flu-like Sxs)
- 2-4 wks post-exposure
2) Chronic HIV Infection (Asymptomatic)
- can last up to 10 years or indefinitely with medications
3) AaaaaaaIDS
- CD4 <200 and/or presence of opportunistic infection
Which stage is a person MOST infective?
Stage I –> Acute HIV infection
-most contagious due to a high viral load!
HIV Stages based on CD4 counts:
Stage I: CD4 count <500
Stage II: CD4 count b/t 200-499
Stage III: CD4 count <200 OR +AIDS-defining illness
Assessment related to HIV
just a catch-all, don’t fret
- Infections *
- Malignancies
- Endocrine problems
- Neurological problems
- Protein-wasting
- AIDs specific; multi-factorial
- GI issues, difficulty eating
- Skin problems
- Kidney problems
- High risk of Kidney failure
- Support
- Current level of function
- ADLs, etc.
What is the main priority of care for HIV/AIDs patients?
Patients should be monitored on a routine basis for: (2)
Early detection (& subsequent) Management of Infections
Should be monitored on a routine basis for:
- immune function
- presence of infections/disease progression
Nurse’s Role R/T Opportunistic Infections (OI’s):
- Assess for S/S of OI’s
- Assess how pt is responding to treatments of OI’s
- Report Appropriately!
What’s the #1 Intervention for preventing OI’s?
HANDWASHING
What is the most common OI related to HIV?
Pneumocystis Jiroveci pneumonia (PCP/PJP)
-fungal infection
Treatment for PCP?
- Antibiotics (Bactrim DS)
2. Support–OXYGEN**, Positive pressure, etc.
What patient teaching can we provide to prevent Toxoplasmosis encephalitis OI?
- Avoid cat litter
- Fully cook meats
- Neurologic S/S
TB infection is associated with a CD4 count of ___, and cause a negative ___ test.
CD4 count <200; PPD test
Confirm with NAAT, CXR, sputum cultures, etc.
Disseminated Mycobacterium Avium Complex (MAC) is associated with a CD4 count of ___ and occurs in patients who aren’t on ____ ___.
CD4 count <50 Antiretroviral treatment (ART)
Malignancies associated with HIV Infection
Kaposi’s Sarcoma Lymphomas -Hodgkin’s B-cell, Immunoblastic, & Brain lymphoma Cervical Cancer Lung cancer Anal Cancer (HPV) GI Cancer
What can we do to treat Kaposi’s Sarcoma?
Treat with ANTIRETROVIRALS
How often should an HIV+ be screened for HPV?
Every 6 months via a Pap smear (vaginal or anal)
Nursing Interventions for HIV:
- Education on how to prevent infections
- No fresh plants or flowers
- No visitors who are sick
- Monitor VS’s (especially temperature)
- Hand washing
- Inspect mouth, skin, & genitals for skin breakdown
- Avoid catheters
Patient Education for HIV patients:
- Avoid contact with sick people
- Bathe daily with antibacterial soap
- Avoid sharing personal items
- Dietary changes (raw foods, etc.)
- Avoid pet litter
- Report S/S of infections EARLY to a provider
Oxygenation Interventions
- Apply oxygen as needed/ prescribed
- Positioning (upright)
- Rest/Limiting activities
Causes of Nutritional deficits related to HIV
fatigue anorexia diarrhea N/V mucosal lesions/thrush
Nutrition Interventions
- Determine the cause of nutritional deficits, then make adjustments
- Monitor weight and I&O
- Dietary changes
- High calorie & protein diet
- Low fat - Provide small, frequent meals
- Mouth care
- Sodium bicarbonate mouthwash
- Soft toothbrush - AVOID foods that can cause infections
- raw veggies, meat, cheeses, etc.
Diarrhea Interventions
“Diarrhea, here I go again”
IDENTIFY CAUSE!
- Symptom Management
- Drug therapy (Imodium)
- Food choices
- Avoid alcohol and caffeine
- Avoid dairy products
- Implement Small, frequent meals
- Adequate Fluid intake
- Skin assessment (mouth)
- Monitor I/O and weight daily
Skin Integrity Interventions
- ART for Kaposi’s sarcoma (often responds)
- Topical Analgesics
- Prevent infections –MONITOR for skin breakdown
- Herpes simplex- clean with Normal Saline
Assess, assess, assess!
Other Priority Nursing Interventions related to ADLs and Psychosocial:
- Identify the level of assistance needed
- Social support
- Patient and family education
- Dealing with social stigma
- “Peer-to-Peer” education on prevention
