HIV Flashcards
All the ways HIV is transmitted
Blood ** Semen ** Urine Feces Saliva Tears Cerebral spinal fluid Brain tissue Breast Milk ** Vaginal Secretions ** Amniotic Fluid
would have to have A LOT of exposure to contract HIV from non * ones
Primary ways HIV is spread
- sexual contact: genital, anal, oral
- Parenteral: IV drug use, blood transfusion (1978-1985)
- perinatal: placenta/maternal blood/breastmilk/fluids
3 ways to reduce risk of transmitting HIV to baby from mom
- -> risk reduced if mother being treated w/ antivirals
- -> C Section
- -> don’t breastfeed baby
The higher the viral load, the higher….
the risk of transmission
penis + vagina = sex - which one is more likely to infect the other if positive?
penis more likely give the vagina HIV then vagina giving the penis HIV
highest risk sexual behavior for HIV transmission?
Anal intercourse
what are the ABCD’s of safe sex
Abstinence
Being faithful
Condom use
Drugs (PREP)
risk of getting HIV from blood products today?
< 0.2% = low risK!
1978-1985 - higher risk
Babies born to mothers with HIV should be treated with HIV medications for _________ after delivery
4-6 weeks
As a nurse what do you do if you have a dirty needle stick?
If stuck: wash area, squeeze the area, report it, get labs
-24 hours to make decision about starting post exposure treatment after stick
What is 4th generation testing for HIV?
Detects HIV antibodies (HIV IgM and IgG) within 21 days
Detects p24 antigen (HIV capsid protein) within 14 days
(looking at ANTIBODIES and ANTIGENS)
If test positive need to determine if you have ____ or ____.
HIV 1 or HIV2
What is nucleic acid test for HIV?
tell if a person has HIV or tell how much virus is present in the blood (known as an HIV viral load test).
-detect HIV sooner than other types of tests, this test is very expensive and not routinely used for screening individuals unless they recently had a high-risk exposure or a possible exposure and have early symptoms of HIV infection.
what is a transmucosal exudate test for HIV?
(results in 20 minutes) only looking for antibodies
-If test is positive, results should be verified with further testing
what does viral load measure? why do i care?
amount of HIV viral RNA particles in the blood
-Test for HIV infectivity and therapy effectiveness
normal vs AIDS cd4 count
normal = 500-1500 aids = <200
other labs to look at with HIV
- Lymphocyte counts- low with AIDS
- CD4 count normal 500-1500, indicator of HIV –> AIDS = <200
- Viral Load testing/ Quantitative RNA assays
- CBC- infection
- CMP- infection
- Toxoplasmosis antibody titer
- LFT
- Hepatitis A, B, C
- Lipid profile
- Syphilis - test yearly for HIV
4 stages of HIV infection
- acute
- chronic
- aids
- Unknown
Acute HIV infection stage - when do sxs start? CD4 count? contagious?
- Flu like sxs 2-4 weeks after initial contact
- VERY contagious –> high viral load
- CD4 T-cell count > 500 cells/mm3 (no AIDS defining illness)
chronic HIV infection- cd4 t cell count? how long stay here? contagious?
- HIV active and reproducing slowly
- Lasts about 10 years untreated –> stay here indefinitely if treated with retrovirals
- can transmit HIV to others
- T-cell count between 200 and 499 cells/mm3 (no AIDS defining illness)
AIDs- cd4 count? how long stay here?
- Immune system severely damaged and impaired
- CD4+ count is below 200 cells/mm OR develop opportunistic infection
- W/O treatment = death w/in 3 years
stage unknown HIV
Confirmed HIV with no further information regarding CD4 status/ illnesses
HIV –> AIDS = ?
-CD4 T-cell count < 200 cells/mm3 is indicative of AIDS
OR
-HIV positive and presence of Opportunistic Infections
(remember: CD4 T cell count Normal is 500-1500 cells/mm3)`
who is getting screened for HIV
All adults between the ages of 13 and 65 (at least one test)
Annual screening for those at higher risk for HIV
Prenatal screening
Frequent testing for people with repeated high-risk exposure :sex workers, IV drug user
assessment for HIV
- History
- Infections *
- Malignancies
- Endocrine problems
- Neurological problems
- Protein wasting
- Skin problems
- Kidney problems
- Support
- Current level of function
priority assessment for HIV?
infections!
- Should be monitored on a routine basis for immune function and presence of infections/ disease progression
- At risk for opportunistic and pathogenic infections
pathogenic vs opportunistic infections
Pathogenic Infection = Virulent organisms all people are susceptible to regardless of immune response
Opportunistic Infections =Organisms that take advantage of a weakened immune system
-Do not typically cause infections in people with healthy immune systems
what accounts for many of the clinical signs of HIV?
opportunistic Protozoan, viral, bacterial or fungal infections
nurse role in managing opportunistic infections?
- assess for s/s
- monitor patient response to treatment
- report appropriately
Most common opportunistic infection in patients with HIV?
what kind of infection is it? what we gonna do about it?
Pneumocystis Pneumonia: PCP, (Pneumocystis jiroveci)
- -Fungal infection
- Give support and Bactrim –> @ risk for hospital acquired infections from vent/central line
Pneumocystis Pneumonia/ PCP presents with
- Persistent cough
- Low grade fever
- Tachypnea
- Dyspnea
- Crackles in lungs
- Wheezing
- Fatigue
how do we diagnose Pneumocystis Pneumonia: PCP?
Presentation
Sputum Culture
Bronchial Lavage
Transbronchial or open lung biopsy
treatment forPneumocystis Pneumonia: PCP
- Trimethoprim Sulfamethoxazole (Bactrim)
- Support (O2, Positive pressure)
which OI is present in cat feces and undercooked meat?
Toxoplasmosis encephalitis
how does Toxoplasmosis encephalitis manifest?
- Neurological changes
- Fever
- Lethargy
- Headaches
how do we treat Toxoplasmosis encephalitis?
-Treated with pyrimethamine and sulfadiazine
what is Disseminated MAC?
-Mycobacterium avium complex
when do you get Disseminated MAC
- **-CD4 T lymphocyte < 50 cells/mm3
* -Occurs in patients who are not on Antiretroviral treatment (ART) - never seen w/ someone on retrovirals!
s/s of Disseminated multi-organ infection (MAC)
Anemia, fever, night sweats, fatigue, diarrhea, abdominal pain, weight loss
treatment for Disseminated MAC
- Support
- Clarithromycin, ethambutol and rifabutin
s/s of TB in HIV patient
Cough, dyspnea, chest pain, night sweats, weight loss, anorexia, dyspnea, fever, chills
considerations for testing HIV+ patient for TB?
- If CD4+ T-cell count is below 200 cells/mm3, TB skin test may not be positive
- Diagnosed by Nucleic acid amplification test (NAAT), chest xray, sputum smear or culture
OI’s in HIV pateints
TB
Disseminated MAC
PCP Pneumonia
Toxoplasmosis encephalitis
+
Cryptosporidiosis (Intestinal Infection) Candida stomatitis or esophagitis Cryptococcosis Histoplasmosis Cytomegalovirus Herpes simplex Shingles
Malignancies with HIV+
Kaposi’s Sarcoma: but them on ART Lymphomas Cervical Cancer Lung cancer Anal Cancer GI Cancer
Malignant Lymphomas - types and s/s
S/s: Swollen lymph nodes, fever, night sweats, fatigue
disease that causes anal cancer? how we test?
HPV- anal PAP test
how often should HIV + get cervical pap?
every 6 months
Other Assessment findings related to retroviral therapy
- Gonadal dysfunction
- Body shape changes
- Lipid abnormalities
- Lipodystrophy (buffalo neck)
- Lipoatrophy
- Type I DM
- AIDS Dementia Complex
- AIDS Wasting Syndrome
key to managing OI’s?
early assessment/detection and management!
interventions to prevent infections in HIV+
Education Monitor VS’s and temperature No fresh plants of flowers No visitors who are sick Hand washing Inspect patient’s mouth, skin and genitals for breakdown Avoid catheters
what kind of precautions for we put on HIV patients?
reverse = caution taking things in the room
How often should HIV patients bathe?
daily with antibacterial soap
what things should HIV + patients avoid
- sharing personal items
- contact w/ sick people
- changing cat litter
-Highly Active Antiretroviral Therapy (HAART)
Drugs should be taken correctly 90% of the time
nutrition interventions for HIV+
- Determine the cause of deficits, then make adjustments
- Monitor weight, I’s & O’s,
- High calorie, high protein/ Low fat
- Small frequent meals
- Mouth care (sodium bicarbonate, soft toothbrush)
- Avoid foods that can cause infections
- cannot leave water out for a few hours, avoid tap water
diarrhea interventions for HIV+
- Symptom Management
- Drug therapy
- Food choices
- Avoid alcohol and caffeine
- Avoid dairy products
- Small, frequent meals
- Fluid intake
- Skin assessment
Skin integrity interventions for HIV+
- **Kaposi’s sarcoma often responds to Anti Retroviral Therapy
- Analgesics
- Prevent infections
- Herpes simplex- clean with NS
- Assess, assess, assess
