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Nursing IV Exam 3 > HIV/AIDS > Flashcards

HIV/AIDS Flashcards

0
Q

Pathophysiology of HIV

A
  1. HIV destroys the body’s ability to fight infection.
  2. The virus infects cells that have the CD4 antigen. Once inside the cell, the virus sheds its protein coat and uses reverse transcriptase to convert the viral RNA to DNA. The viral DNA is then integrated into host cell DNA and duplicated during normal processes of cell division. The virus may remain latent or become activated to produce new RNA and to form virions. The virus then buds from the cell surface, disrupting the cell membrane and leading to destruction of the host cell.
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1
Q

Human Immunodeficiency Virus

A

A retrovirus (meaning that it carries its genetic information in RNA) that is transmitted by direct contact with infected blood and body fluids.

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2
Q

Virions

A

Virus able to grow and reproduce outside a host

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3
Q

Seroconversion

A

Antibodies are produced against the viral proteins. These antibodies usually are detectable 6 weeks - 6 months after the initial infection.

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4
Q

Children can acquire HIV by Vertical transmission:

A

Perinatal transmission- transplacentally or during delivery

  1. transmission can occur during birth from blood, amniotic fluid, and exposure to genital tract secretions and after birth from breast milk.
  2. Risk is significantly reduced when mothers receive Retrovir, AZT during pregnancy, and when deliveries are by cesarean section at 38 weeks gestation before rupture of membranes, and babies are given therapy after birth.
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5
Q

HIV is present in:

A
  1. Blood
  2. Semen
  3. Vaginal and Cervical secretions
  4. cerebrospinal fluid
  5. Breast milk
  6. Saliva
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6
Q

Etiology of HIV

A
  1. Men make up majority of cases
  2. Women account for 26%
  3. Higher incidence in African Americans and Hispanics
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7
Q

Risk Factors for HIV

A

Primarily behavioral

  1. Behavior- unprotected anal intercourse, injection drug use, heterosexual intercourse
  2. Hemophilia and blood transfusions- Those in the window period 6 weeks- 6 months are able to transmit HIV to others even though they do not yet test positive
  3. Health Care as an occupation
  4. Poverty- less access to preventive health care& education, increased illiteracy, less likely to have internet as a health tool
  5. Pregnancy and Breast feeding- smoking, illicit drug use, genital tract infections, and unprotected sexual intercourse
  6. Older Age- declining immune system, belief that they cannot be affected. fail to use condoms in non-child bearing years
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8
Q

Clinical Manifestations of HIV

A

Range from no symptoms at all to severe immunodeficiency with multiple opportunistic infections and cancers.

  1. Most develop acute, mononucleosis- type illness within days to weeks after contracting the virus.
    a. Fever, sore throat, arthralgias, myalgias, headache, Rash, Nausea vomiting, abdominal cramping, and lymphadenopathy.
  2. Many attribute this initial manifestations to a common viral illness such as influenza.
  3. After acute illness, clients enter a long-lasting asymptomatic period, which can last from 8-10 years.
  4. Some develop persistent generalized lymphadenopathy (enlargement of 2 or more lymph nodes for more than 3 months)
  5. Client then experiences: General malaise, fatigue, low-grade fever, night sweats, involuntary weight loss, dry skin, rashes, diarrhea, oral lesions
  6. Development of advanced HIV occurs around 10-11 years after initial infection
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9
Q

Classification System for HIV Infection

CD4 Counts

A

(1) = 500/mm3
(2) = 200-400/mm3
(3) = <200/mm3

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10
Q

Classification System for HIV Infection

Category A

A
  1. Asymptomatic HIV infection
  2. Persistent generalized lymphadenopathy
  3. Acute HIV infection w/ illness or history of acute HIV infection
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11
Q

Classification System for HIV Infection

Category B

A
  1. Symptomatic
  2. Candidiasis, oral thrush
  3. cervical dysplasia/ cervical carcinoma in situ
  4. Fever, diarrhea exceeding 1 month
  5. Hairy leukoplakia
  6. Herpes zoster involving at least 2 distinct episodes
  7. Peripheral neuropathy & Pelvic inflammatory disease
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12
Q

Classification System for HIV Infection

Category C

A

AIDS-Indicator Categories

  1. Candidiasis of bronchi, trachea, lungs, or esophagus
  2. Kaposi’s sarcoma
  3. Cryptococcosis
  4. HIV encephalopathy
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13
Q

Antiretroviral Therapies

A

stop or suppress activity of retrovirus, preventing further weakening of the immune system and thereby minimizing opportunistic infections

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14
Q

Pneumocystis carinii pneumonia (PCP)

A
  1. An opportunistic infection that is not pathogenic in those with intact immune systems
  2. CD4 count is < 200/mm3
  3. most commonly in those who are undiagnosed, have a late HIV infection, or fail to take prophylactic antibiotics.
  4. S/S fever, cough, dyspnea, tachypnea, & tachycardia
  5. Cause of death in 20% of clients w/ AIDS
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15
Q

AIDS Dementia complex

A
  1. Most common cause of mental status change for clients with HIV infection.
  2. results from direct effect of the virus on the brain and impacts cognitive, motor,and behavioral functioning. Fluctuating memory loss, confusion, difficult concentrating, lethargy, and diminished motor speed are typical manifestations.
  3. clients become apathetic, losing interest in work, social and recreational activities.
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16
Q

Toxoplasmosis

A

Toxoplasmosis and non-Hodgkin’s lymphoma are space-occupying lesions that may cause headache, altered mental status, and neurologic deficits.

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17
Q

Opportunistic Infections

A
  1. most common manifestations of AIDS and often occur simultaneously
  2. Risk is predictable by T4 or CD4 cell count.
  3. Normal CD4 is > 1000/mm3.
  4. When CD4 falls below 500/mm3 immunodeficiency s/s develop
  5. When CD4 is less than 200/mm3 opportunistic infections & cancers are likely.
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18
Q

Tuberculosis

A
  1. active TB results from reactivation of a previous infection, or a new primary disease facilitated by impaired immune function
  2. Rapid progression, diffuse pulmonary infiltrates, and disseminated disease occur more commonly in clients with AIDs
19
Q

Candidiasis

A
  1. opportunistic fungal infection
  2. usually manifests as oral thrush or esophagitis
  3. Often is 1st indication of progression to AIDS
  4. Esophagitis-> difficulty swallowing, substernal pain or burning
  5. In women vaginal candidiasis is frequent and often recurrent
20
Q

Mycobacterium Avium complex

A
  1. Typically occurs late in course of disease, when CD4 cell counts are less than 50/mm3
  2. More common in women than men
  3. caused by organisms found in food, water, and soil
  4. Major cause of “wasting syndrome”
  5. S/S: chills, fever, weakness, night sweats, abd pain, diarrhea, weight loss
21
Q

CDC classification of AIDS currently includes 4 Cancers:

A
  1. Kaposi’s Sarcoma
  2. Two lymphomas: non-Hodgkin’s & Primary lymphoma of the brain
  3. invasive cervical carcinoma
22
Q

Kaposi’s Sarcoma

A
  1. Often the presenting symptom of AIDS
  2. Most common cancer associated with the disease
  3. virus called KS-associated herpes virus aka human herpesvirus 8
  4. Survival time after diagnosis is 18 months
  5. A tumor of the endothelial cells lining small blood vessels, KP presents as vascular macules, papules, or violet lesions affecting the skin and viscera.
23
Q

Lymphomas

A
  1. Malignancies of the lymphoid tissue, including lymphocytes, lymph nodes, and lymphoid organs, such as the spleen and bone marrow.
  2. CNS is usual site for lymphoma, but also found in bone marrow, GI tract, liver, skin, and mucous membranes.
  3. headache & change in mental status- early s/s
24
Q

Cervical Cancer

A
  1. Of women infected with HIV 40% have cervical dysplasia
  2. tends to be aggressive
  3. women with concurrent HIV infection and cervical cancer usually die of cervical cancer not AIDS
  4. Recommended women with HIV have Pap smears ever 6 months
25
Q

Goals of care for HIV

A
  1. Early identification of the infection
  2. Promoting health maintenance activities to prolong the asymptomatic period
  3. Prevention of opportunistic infections
  4. Treatment of disease complications, such as cancers
  5. Providing emotional and psychosocial support
26
Q

HIV Test Trends:

A

False positive HIV test results are more likely in settings where the tested population prevalence is lower than in settings where the tested population prevalence is higher.

27
Q

Rapid Diagnostic Tests

A
  1. Enzyme-linked immunosorbent assay (ELISA)
  2. Western blot antibody testing
  3. HIV viral load tests
  4. CBC- anemia, leukopenia, thrombocytopenia
  5. CD4 count
28
Q

Enzyme-linked immunosorbent assay (ELISA)

A
  1. most widely used
  2. tests for HIV antibodies not the virus itself, client may be negative early in course of infection, before detectable antibodies have developed.
  3. 99.5 sensitivity when preformed 13 weeks after infection
  4. Initial (+) is always tested repeatedly and confirmed using a different method, usually Western Blot
29
Q

Western blot antibody testing:

A
  1. more reliable than ELISA, more time consuming, and expensive
  2. when combined with ELISA a specificity of 99.9%
  3. Client’s serum is mixed with HIV proteins to detect a reaction. If antibodies are present a detectable antigen-antibody response will occur
30
Q

HIV viral load tests:

A
  1. Measure amount of actively replicating HIV
  2. levels correlate with disease progression
  3. levels greater than 5,000-10,000 indicated need for treatment
31
Q

CBC

A
  1. to detect anemia, leukopenia, and thrombocytopenia often present in HIV infection
32
Q

CD4 Cell count:

A
  1. most widely used test to monitor progress of disease and to guide therapy
  2. correlates closely with immunodeficiency disorders seen in clients with AIDS
  3. AIDS is defined not only by presence of opportunistic infections and other diseases but also by HIV seropositive status and CD4 count less than 200/mm3
  4. Recommended every 3-6 months for HIV clients
33
Q

Other Diagnostics:

A
  1. Blood culture for HIV- most specific, expensive, cumbersome
  2. Immune-complex-dissociated p24 assay- test for p24 (HIV) antigen in the blod
  3. TB skin testing
  4. MRI of brain
  5. Pap smears every 6 months
34
Q

Pediatric Testing:

A
  1. ELISA and Western Blot cannot distinguish between maternal and infant antibodies. May take up to 18 months for infected infants to form their own antibodies to HIV.
  2. Testing By HIV DNA polymerase chain reaction (PCR) is the preferred test.
  3. Test at 1-2 months then again at 2-4 months, considered infected if 2 separate samples are positive
35
Q

Highly active antiretroviral therapy (HAART)

A
  1. uses a minimum of 3 antiretroviral agents
  2. generally includes: zidovudine (Retrovir, AZT), an NRTI, plus a second NRTI, such as didanosine or lamivudine, combined with a nonnucleoside reverse transcriptase inhibitor (NNRTI), such as nevirapine, or a protease inhibitor (PI) such as indinavir, ritonavir, or saquinavir
36
Q

4 classes of drugs used in antiretroviral treatment:

A
  1. Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
  2. Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)
  3. Protease Inhibitor (PI)
  4. Entry Inhibitors
    HAART combines 3 out of 4 to reduce the incidence of drug resistance.
37
Q

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

A
  1. inhibit action of viral reverse transcriptase, a retroviral enzyme that catalyzes the substrates for conversion and copying of viral RNA to DNA sequences
  2. Zidovudine (AZT)-1st antiretroviral agent approved for use with HIV infection. often is given to clients with a CD4 <500/mm3 because it slows progression to severe disease
38
Q

Protease Inhibitors

A
  1. bond chemically with protease to block the function of the enzyme and result in the production of immature, noninfectious viral particles
  2. PIs may inhibit metabolism of other meds, and cause them to circulate longer.
  3. elevated cholesterol, triglycerides, insulin resistance, and diabetes, changes in body fat composition.
  4. Saquinavir (Invirase), Ritonavir (Norvir),
39
Q

Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)

A
  1. Nevirapine
  2. high incidence of cross resistance to NRTIs
  3. risk of liver toxicity and Stevens-Johnson syndrome
40
Q

Entry Inhibitors

A
  1. efuvirtide (Fuzeon)

2. prevent HIV from entering target cells by binding to protein envelope that surrounds the virus.

41
Q

Vaccines for HIV clients

A
  1. Pneumococcal, influenza, Hep. B,
  2. Persons w/ positive PPD and negative chest x-ray are given prophylactic isoniazid
  3. CD4 <100/mm3= prophylactic for MAC
42
Q

Complementary Therapies

A
  1. warnings against use of garlic supplements w/HIV meds

2. St. John’s wort also contraindicated for clients receiving antiretroviral therapy.

43
Q

Nursing Diagnosis for HIV

A
  1. Ineffective coping
  2. Impaired Skin Integrity
  3. Imbalanced nutrition: less than body requirements
  4. Risk for deficient fluid volume
  5. risk for infection
  6. anxiety
  7. fear
  8. deficient knowledge
44
Q

Safe Sex practices:

A
  1. Use latex condoms

2. nonoxynol-9 a spermicide, may cause genital ulcers

45
Q

Cleaning paraphernalia

A

use a fresh solution of houshold bleach and water 1:10 ratio

Nursing IV Exam 3 (4 decks)

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