HIV/ AIDS

Question 1

Origin of HIV/ AIDS

Answer 1

A viral infection that has swept the world and has not cure, only management of symptoms.
First cases might have been as early as the 1940s
But not recognized as disease or a new pathogen until the early 1980s when Immune-deficiency conditions began to show up among primarily urban, gay men in the United States
In 1986, HIV-1 and HIV-2 were isolated as causal viruses of AIDS
Gay men were just the first to be affected

Question 2

How is the virus transmitted

Answer 2

Virus is transmitted by exposure to bodily fluids (blood, semen, breast milk, vaginal secretions

Question 3

what is the bodys response to the HIV virus

Answer 3

Mounts a defense against the HIV virus through antibodies and T cells
About 12 weeks after infection, the body produces enough antibodies to be detected by standard HIV test
HIV viral load begins to drop, indicating partial effectiveness of the body to rid itself of HIV
CD8 cells (a T cell with CD8 receptor that recognizes antigens on the surface of a virus-infected cell and binds to the infected cell and kills it)
CD8 cells drop drastically in the late stages, and CD4 cells slowly decline throughout the whole infection

Question 4

Initial stage

with s/s

Answer 4

Lasts 4 to 8 weeks
High levels of virus in the blood
Generalized flulike symptoms

Question 5

Latent stage

with s/s

Answer 5

Lasts 2 to 12 years
Virus is inactive
Levels are high in the lymph nodes but low in the blood

May have no symptoms initially
Eventually, frequent and persistent infections
Fever, night sweats, swollen lymph nodes, headache, skin lesions, sore throat, dyspnea, burning with urination, or diarrhea
Extreme fatigue and weight loss

Question 6

Third stage

with s/s

Answer 6

Lasts 2 to 3 years
Patient experiences opportunistic infections
TH CD4 cells (found in the lymph nodes) are usually <200 cells/mm³
This stage ends in death, usually within 1 yea

Signs and symptoms are those of the opportunistic infections that present themselves

Question 7

complications and causes

Answer 7

When CD4 cells, CD8 cells, and/or HIV antibodies fall below normal, infections and cancers take advantage and cause infection or cancer in the body
Causes: parasites, fungi, bacteria, viruses

Question 8

leading cause of death with aids

Answer 8

Leading cause of death with AIDS is pneumonia due to unspecified organisms

Question 9

Fairly common in the environment
Watery diarrhea; may be severe/persistent
Nursing care: preventing dehydration and maintaining fluid and electrolyte balance, Antidiarrheal drugs, IV fluids, antimicrobial agents, teach good hand washing and personal hygiene

Answer 9

Cryptosporidiosis and isosporiasis

Question 10

Toxoplasmosis

Answer 10

Cats, mammals, and birds serve as hosts
Humans become infected by ingesting contaminated, undercooked meats or vegetables or by contact with cat feces
Affects any tissue; mainly brain, lungs, eyes
S/S: Dull, constant headache, weakness, seizures
Pulmonary infection
Feverish illness that mimics Pneumocystis jiroveci pneumonia with shortness of breath and nonproductive cough
Eye infection: Loss of visual acuity as well as photophobia
Wash hands, avoid undercooked raw meats, and avoid cat litterboxer
Toxoplasmosis encephalitis the most common in immunosuppressed patients.

Question 11

Source of human infection is unknown
Watery diarrhea with weight loss, malabsorption, abdominal cramps, and flatulence
No curative therapy; treat the symptoms
Low-fat, low-residue, high-protein, high-calorie diet
3 L of fluid per day; avoid milk products
Teach good hand washing and good hygiene; avoid ingestion of food or water contaminated with fecal matter

Answer 11

Microsporidiosis

Question 12

Acquired by inhalation
Second leading cause of death in AIDS patients
Cysts prevent the exchange of gases
Shortness of breath on exertion, fever, and a nonproductive cough
Treated with Bactrim, dapsone, clindamycin, and pentamidine

Answer 12

Pneumocystis jiroveci pneumonia

Question 13

Lives in soil, water, and air
Pulmonary infection can develop when spores are inhaled
Causes fever, cough, dyspnea, chest pain, and hemoptysis
Usually fatal within 8 weeks
Avoid wet, cool places; decreases risk of infection

Answer 13

Aspergillosis

Question 14

Found in most foods, soil, and inanimate objects
Approximately 80% of HIV patients will develop this
Affects the mouth, vagina, and/or anus
Thrush: oral form of this
plaques can be scraped off

Answer 14

Candidiasis

Question 15

Endemic in the southwestern United States and northern Mexico
Particles inhaled into the lungs
Fever, weight loss, fatigue, dry cough, or pleuritic chest pain
Dissemination to other organs may occur
People with HIV should avoid exposure to disturbed soils in endemic areas

Answer 15

Coccidioidomycosis

Question 16

Most common systemic fungal infection in AIDS patients
Symptoms appear approximately 30 days after exposure
Fever, headache, malaise, nausea, vomiting, altered mental status, and a stiff neck

Answer 16

Cryptococcosis

Question 17

Endemic in the central and southern United States
Found in soil and bird droppings
Involves the lungs after spores are inhaled, then can be disseminated to other organs
Fever, night sweats, weight loss, and shortness of breath
Avoid cleaning bird cages to prevent infection

Answer 17

Histoplasmosis

Question 18

Found in semen, cervical secretions, saliva, urine, blood, and organs
Mainly transmitted by blood and body fluids through unprotected sex
Complications include chorioretinitis, radiculopathy, subacute encephalitis, colitis, esophagitis, and pneumonia

Answer 18

Cytomegalovirus (CMV)

Question 19

what is the Herpes simplex (HSV) and herpes zoster (HZV)

Answer 19

Reactivated HSV in HIV patients can cause serious disease and tissue destruction
HSV infection follows a predictable pattern
Primary outbreak, latency, and possible reactivation at some later point in life
Most adults carry HZV because of exposure to chickenpox virus as a child
Reactivation of HZV usually occurs as shingle

Question 20

Thick white patches on the buccal mucosa, soft palate, floor of mouth, and tongue
Associated with Epstein-Barr virus
More common among smokers
The mouth is often painful

Answer 20

Oral hairy leukoplakia (OHL)

Question 21

Caused by the Jamestown Canyon virus
Develops in 2% to 4% of AIDS patients
Progressive degeneration of white matter of the brain
Death within 4-6 months after the onset of symptoms
Symptoms include weakness and progressively impaired speech, vision, and motor function
No effective treatment

Answer 21

Progressive multifocal leukoencephalopathy

Question 22

Causes skin lesions; may affect any organ
Transmitted by cats and their fleas
Due to a bite or scratch
Papules/plaques occur anywhere on the skin
Advise HIV patient to avoid rough play with cats and to make sure cats are treated for fleas

Answer 22

Bacillary angiomatosis (BA)

Question 23

Found everywhere, including most food, animal, and soil sources
May affect any organ of the body
Causes fever, fatigue, weight loss, night sweats, abdominal pain, and diarrhea
Not contagious

Answer 23

Mycobacterium avium complex (MAC)

Question 24

HIV patients much more likely than a healthy person to become infected with this. if exposed, especially when CD4 counts drop below 200 cells/mm³

Answer 24

Mycobacterium tuberculosis (TB)

Question 25

Common neoplasm that develops with AIDS
Affects the skin first, appearing as a macular painless, nonpruritic lesion
Color varies: pink, red, purple, and brown
Tumors may spread to the gastrointestinal system and lungs
Treatment: observation, HAART (highly active antiretroviral therapy), surgical removal, cryotherapy, radiotherapy, chemotherapy

Answer 25

Kaposi’s Sarcoma

Question 26

Lymphomas
types
cause
diagnosis

Answer 26

A type of cancer that originates in lymphoid tissue: bone marrow, spleen, thymus gland

Two types: Hodgkin’s and non-Hodgkin’s

Second most common malignancy in AIDS patients

Causes fever, night sweats, and weight loss

Diagnosis based on a biopsy of lymphoid tissue

Question 27

Medical Diagnosis of HIV

Answer 27

HIV diagnosis
Positive HIV antibody test
ELISA: Done first; 99% reliable
Western blot: Used as a confirmation test; 99.99% reliable

Question 28

AIDS diagnosis

Answer 28

CD4 count of <200 cells/mm³; with category B symptoms

Category C symptoms regardless of CD4 count

Question 29

Medical Treatment: Highly Active Antiretroviral Therapy (HAART) with side effects

Answer 29

Recommended for HIV viral load of 5000-30,000 copies/mL and CD4 counts of 350-500 cells/mm
Viral load is used to describe how much virus is found in the blood.
Usual drug combination: 1 protease inhibitor and 2 nucleoside reverse transcriptase inhibitors
Ability/willingness to comply with therapy
If patient will not be compliant with the medication regimen, better to not even start
GI upset common; most common reason for noncompliance
Many side effects; usually subside in a few weeks

Question 30

Signs and symptoms of infection

Answer 30

Most common sites are lungs, mouth, GI tract, skin, blood, and central nervous system

Question 31

Assessment

Answer 31

Any changes should be reported to a registered nurse or physician
Determine how much patient knows about the disease and treatment
Assess how patient is coping with disease

Question 32

Health History

Answer 32

Sexually transmitted infection history
Surgical history
Medication history and allergies
Immunization history
Family history
Tobacco/alcohol use history and Illegal drug use history
Pet history
Occupational history
Nutritional history
Gynecologic history 
Sexual history
Needle and blood exposure history

Question 33

physical

Answer 33

Height, weight, vital signs
Skin
Head, ears, eyes, nose, and throat
Lymphatic system
Respiratory and Cardiovascular system
Abdominal
Neuro-Musculoskeletal Genitourinary

Question 34

interventions

Answer 34

Ineffective Therapeutic Regimen Management
Patient should receive accurate, consistent information from all members of the health care team
Clinical nurse specialist or other specially trained nurse can provide information about disease and treatment
Excellent sources of information on the Internet

Question 35

anxiety intervention

Answer 35

Dealing with emotions of facing a life-threatening illness
Encourage patients to ask questions and talk about their feelings
Information about disease and treatment may help patient and family deal with their anxiety
May need referral to a social worker, chaplain, or mental health counselor

Question 36

infections intervention

Answer 36

Early detection and prompt treatment are vital
May be on anti-infective drugs prophylactically
Important to take drugs as prescribed
May need intravenous antibiotics
Clinic or home administration

Question 37

Impaired Oral Mucous Membrane

intervention

Answer 37

Encourage regular teeth and mouth cleaning with dental floss and a soft toothbrush
Encourage fluids to maintain hydration to keep mucous membranes moist
Topical anesthetics applied before eating
Regular dental evaluations can help prevent and manage oral disease and infections

Question 38

Imbalanced Nutrition: Less Than Body Requirements

intervention

Answer 38

Refer to dietitian for nutrition counseling as soon as the patient is diagnosed
Oral supplements with Carnation Instant Breakfast, Ensure, Sustacal, or Resource
Administer medications
Improve appetite (megestrol, dronabinol)
Relieve nausea (prochlorperazine, metoclopramide)
Control diarrhea (diphenoxylate hydrochloride with atropine sulfate)

Question 39

Disturbed Thought Processes

intervention

Answer 39

Patients with HIV encephalopathy may experience cognitive and motor impairment
May withdraw from social activities because of embarrassment
May become angry and hostile
Safety constantly reevaluated based on mental and physical capabilities

Question 40

pain intervention

Answer 40

From opportunistic infections, viral invasion into the nerves and muscles, malignant tumors, and diagnostic procedures
Closely monitor pain level and medication use
Flow sheet of pain reports on a 10-point scale
Pain and amount of medication used can guide nurse and physician to the appropriate type and amount of pain medication