HIV/ AIDS Flashcards by Jessica Maleport

Origin of HIV/ AIDS

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

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How is the virus transmitted

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

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what is the bodys response to the HIV virus

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

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Initial stage

with s/s

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

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Latent stage

with s/s

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

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Third stage

with s/s

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

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complications and causes

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

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leading cause of death with aids

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

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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

Cryptosporidiosis and isosporiasis

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Toxoplasmosis

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.

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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

Microsporidiosis

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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

Pneumocystis jiroveci pneumonia

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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

Aspergillosis

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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

Candidiasis

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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

Coccidioidomycosis

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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

Cryptococcosis

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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

Histoplasmosis

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

Cytomegalovirus (CMV)

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

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

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

Oral hairy leukoplakia (OHL)

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

Progressive multifocal leukoencephalopathy

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

Bacillary angiomatosis (BA)

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

Mycobacterium avium complex (MAC)

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

Mycobacterium tuberculosis (TB)

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

Kaposi’s Sarcoma

Lymphomas types cause diagnosis

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

Medical Diagnosis of HIV

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

AIDS diagnosis

CD4 count of <200 cells/mm³; with category B symptoms | Category C symptoms regardless of CD4 count

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

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

Signs and symptoms of infection

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

Assessment

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

Health History

``` 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 ```

physical

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

interventions

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

anxiety intervention

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

infections intervention

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

Impaired Oral Mucous Membrane | intervention

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

Imbalanced Nutrition: Less Than Body Requirements | intervention

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)

Disturbed Thought Processes | intervention

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

pain intervention

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