HIV Flashcards
HIV is a
Retrovirus causes immunosuppression making persons more susceptible to infections
errors during replication making different strains of HIV
HIV stands for
Human Immunodeficiency Virus
AIDS stands for
acquired immunodeficiency syndrome
1 (US) and 2 (Africa)
HIV targets what cells
CD4 (helps immune cells communicate esp. when foreign cells )
dendritic
T helper
monocytes
Macrophages
HIV Transmission
through contact with blood, semen, vaginal secretions, and breast milk
not from casual contact
The most common transmission of HIV?
sexual transmission
- tissue trauma receiver (anal sex)
Can you transfer HIV through breast milk?
yes, vaginal or breast milk
Sexual Transmission of HIV
Unprotected sex with an HIV-infected partner
-RECEIVER has the most risk
prolonged contact with infected fluids
women high risk
trauma (tearing) increases likelihood
Contact with Blood HIV +
Sharing drug-using paraphernalia
Puncture wounds (deep)
Accidental needle sticks
Splash exposures
- screening needs to be done for blood donors
Perinatal Transmission of HIV
Can occur during pregnancy, delivery, or breastfeeding will contract HIV
25% of infants born to women with untreated HIV tested HIV+
Treatment can rate of transmission to < 2%
-DRUGS can be taken during pregnancy
Pathophysiology of HIV
RNA virus
-replicate backward manner going from RNA - DNA
once integrated inside of the cell’s DNA directs to make new HIV cells
What cell is targeted in HIV?
CD4+T
-lymphocyte
- binds through fusion and replicate
Lower the T cell count =
more symptomatic
destroy 1 billion T cells every day
Immune problems start when the CD4+T cell count raises greater than
500
CD4+T cell normal ranges
800-1200
Severe problems develop when CD4+T cells are lower than
200
What ultimately kills HIV patients?
Insufficient immune response allows for opportunistic diseases
How many years does it take HIV pts to develop AIDS?
8-10
What are the phases of HIV?
Acute infection (1-3 weeks)
HIV antibody test + (3 weeks to 3 months)
Asymptomatic (up to 8 years)
Symptomatic (8-10 years)
AIDs (10+)
Acute Infection s/s
flu-like symptoms
**fever, swollen lymph nodes, sore throat, HA, malaise, nausea, muscle and joint pain, diarrhea, diffuse rash
- 2-4 weeks after infection
highly infectious
What phase is the highest infectious?
acute infection
Asymptomatic infection s/s
generally absent
high-risk behaviors may continue
Untreated to AIDs
Asymptomatic infection lab
CD4+T greater than 500 with low viral load
Symptomatic infection lab values
CD4+T 200-500
High viral load
Symptomatic infection s/s
Persistent fevers
shingles
Night sweats
vaginal yeast infection and herpes
bacterial infections
Chronic diarrhea
Frequent HA
fatigue
HIV advances to a more active stage
Candida
oral thrush
persistent and down the esophagus
difficulty eating (swish and swallow meds)
Kaposi Sarcoma
LOOKS LIKE BRUISE INITIALLY DARK VIOLET/BLACK
invades skin on torsos and extremities and organ surfaces
-possible pain
Kaposi Sarcoma is caused by
herpes virus
Oral Hairy Leukoplakia
caused by Epstein-Barre virus
not painful
Vertical stripes on the side of the tongue
during active phase
AIDs defined by and lab value
CD4+ T-cell < 200cell/uL and or AIDS-defining condition
1+ opportunistic infections
HIV wasting syndrome
loss of weight by at least 10% along with diarrhea, chronic weakness, and documented fevers lasting up to a month which can only be accounted for by HIV. - more in the face
- decrease in fat and lean body
Pneumocysitis jirovecii pneumonia
caused by yeast fungus PJ
in lungs of healthy but opportunistic with weak immune system
S/S of PJP
fever
dry cough or wheezing
SOB
fatigue
chest pain or tightness
Tx of PJP
trimethoprim/sulfamethoxazole (TMP/SMX), the brand names are (Bactrim or Septra). Given PO or IV for 3 weeks.
Dx of HIV
HIV-specific antibodies and/or antigens
May take several weeks to detect antibodies (window period)
Performed using blood or saliva
Combination (4th generation) tests can detect HIV earlier
Negative results – retest in 6 wks
What is the window period?
several weeks after initial infection to detect antibodies
-false
If you get a negative HIV test during the window period, then you should come back when?
in 6 weeks
In HIV pts we want the T cell count to be ________ and the viral load to be _______
T = high
Load = low (less active immune system)
HIV progression is monitored by
CD4T
Viral Load
Dx abnormal blood tests are common due to
HIV, opportunistic infections and complications of therapy
low WBC, platelets, anemia (ART), and alter LFT
Resistance tests can help determine if a pt is resisant to
ART
What helps HCPs know which med is effective?
Assay (geno and pheno)
Genotype Assay
about the infection itself
Phenotype Assay
which drugs might be the most effective for the pt
Hep B and C is possible for the pt to be at risk if they are a
drug user
Interprofessional Care of the HIV pt
Monitor disease progression, immune function & manage symptoms
Initiate and monitor ART
Prevent, detect and/or treat opportunistic infections
Prevent or decrease complications of therapies
Prevent further transmission of HIV
Initial pt visit of an HIV pt
baseline data
rapport and input for the care plan
teaching of HIV, Tx, Prevention of transmission, improve health, and family planning
Main Goals of Drug Therapies
lower viral load
increase T cells
prevent HIV symptoms and opportunistic diseases
delay progression
prevent transmission
OTC drug interactions for HIV pt
Antacids
Proton pump inhibitors
supplements
DRUG INTERACTION TO ARTs
St. John’s wort and OTC
avoid or not at the same time
The main thing about drug therapies before the start on an HIV pt is
are they going to take the medicine regimen as prescribed
if not drug resistance might develop and go to a different medicine
For opportunistic disease on an HIV pt what is the best mgmt?
prevention
onset delayed with adequate measures
increased life expectancy if preventative
Pre-exposure prophylaxis of HIV
reduce risk of sex-acquired infection in adults at high risk
with prevention interventions
Should an autoimmune pt take a live virus vaccine?
no
When asking questions for at high risk of HIV, the nurse should be
blunt and candid
use their language
What questions should you ask at-risk patients?
Received a blood transfusion or clotting factors before 1985?
Shared needles with another person?
Had a sexual experience with your penis, vagina, rectum, or mouth in contact with these areas of another person?
Had a sexually transmitted infection?
What needs to be assessed in dx pts thoroughly?
pst health hx
med
functional health patterns
s/s
Goals for HIV pts
Compliance with drug regimens
Adopting a healthy lifestyle
Beneficial relationships
Spiritual well-being regarding life and death
Coping with the disease and its treatment
Health Promotion of HIV
infection is preventable
avoid risky behaviors
modify risk behaviors
culture sensitive, age specific
What are some ways to prevent HIV through sexual intercourse?
abstinence (not realistic)
noncontact safe sex
barriers
What are some ways to prevent HIV through decreased drug use?
don’t
no sharing equipment
no sex under the influence of impairing substances
help with substance abuse
What are some ways to prevent HIV through decreased perinatal trans.?
family planning (esp. younger)
prevent for women
appropriate medication for pregnant women (ART)
What are some ways to prevent HIV through decreased work?
adhere to precautions and safety from exposure
report all exposures for tx and counseling
prophylaxis after exposure with ARTs and decrease risk of infection
REactions to postive HIV tests
similar to life-threatening or chronic illness
panic
anxiety
fear, guilt
depression
denial
anger
hopeless
ART means
Antiretroviral Therapy
ART can significantly slow HIV progression, but
complex regimen
side effects
not for everyone
expensive
When do you start ART?
pt readiness
recommended when immune suppression is excellent to avoid burnout and non-adherence
What happens when ART is not taken as prescribed?
mutation of HIV
and can pass on to already-positive HIV
Adherence to ART is critical to prevent
disease progression
opportunistic disease
drug resistance
mutations
How can an HIV pt support a healthy immune system?
adequate nutrition (bc of diarrhea, electrolyte imbalance and wasting syndrome)
vaccinations
habits
avoid risks
supportive relationships
Acute Exacerbations of HIV
NO CURE
CONTINUES FOR LIFE
physical disability
impairs social, emotional, economic,a nd spiritual wellbeing
ultimately leads to death
What can lead to discrimination and result in social isolation, dependence, frustration, low self-image, loss of control, and economic pressures?
Stigma
and further involvement in risky behaviors
Can your employer ask if you have AIDS?
no
Common side effects of disease and drug for HIV
Anxiety, fear, depression
Diarrhea
Peripheral neuropathy
Pain
Nausea/vomiting
Fatigue
malaise
Metabolic disorders
lipodystrophy
hyperlipidemia
DM: insulin resistance AND hyperglycemia
bone disease
lactic acidosis
renal disease
CV disease
What PPE is used with HIV pts?
Gloves
Gerontologic Considerations
increase risk of HIV of older
death from opportunistic
60+ more frisky and in denial
comorbidities
polypharmacy
Transmission of HIV from an infected individual to another most commonly occurs as a result of which of the following?
Unprotected anal or vaginal sexual intercourse
Low levels of virus in the blood and high levels of CD4+T cells
Transmission from mother to infant during labor and delivery and breastfeeding
Sharing of drug-using equipment, including needles, syringes, pipes, and straws
Unprotected anal or vaginal sexual intercourse
A diagnosis of AIDS can be made for a patient with HIV when which of the following are present?
CD4+ T-cell count <500/µL
WBC count <3000/µL (3 × 109/L)
Development of oral candidiasis (thrush)
Onset of Pneumocystis jiroveci pneumonia
Onset of Pneumocystis jiroveci pneumonia
The nurse is teaching a newly diagnosed 34-year-old male about his HIV infection. Which statement by the patient indicates the need for additional education?
“I will need to take my HIV medication daily for the rest of my life.”
“Although I only take one pill, it has multiple medications combined into a single tablet.”
“I should notify my HIV provider if I get fevers that do not go away with Tylenol or aspirin.”
“Once my viral load is undetectable, I don’t have to worry about taking my medication every day.”
“Once my viral load is undetectable, I don’t have to worry about taking my medication every day.”
The nurse is caring for a patient who is receiving antiretroviral therapy (ART) for the treatment of HIV. Which assessment best indicates that the patient’s condition is improving?
Decreased viral load
Increased drug resistance
Decreased CD4+ T-cell count
Increased aminotransferase levels
Decreased viral load
