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NUR 201 Week 14 > HIV, AIDS, & Rx's > Flashcards

HIV, AIDS, & Rx's Flashcards

1
Q

HIV disease

> C/b the human immunodeficiency virus (HIV)
Several stages ranging from acute infection to death

HIV-infected individual who does not receive treatment
> Infection to death is nearly 12 yrs

A

HIV infection & acquired immune deficiency syndrome (AIDS)

> ELISA (enzyme-linked immunosorbent assay)
- Details HIV exposure based on presence of human antibodies to the virus in the blood

> Retrovirus

> Transmitted by sexual activity, IV drug use, perinatally from mother to child

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2
Q

HIV Replication

A
  • The lower the viral load the better off the pt is & the higher the CD4 count is most likely to be
  • As viral load inc, CD4 count decreases
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3
Q

When the CD4 count is less than __, is when the dz is considered AIDS

A

200

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4
Q

3 Stages of HIV infection

  1. Acute HIV infection
  2. Chronic HIV infection (aka asymptomatic chronic infection to symptomatic chronic infection)
  3. AIDS
A
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5
Q

Acute HIV infection

  • earliest stage
  • develops within 2-4 wks >a person is infected
  • flu-like sx’s; HIV multiplies rapidly & spreads thru body
  • destroys CD4 cells
  • lvl of HIV in blood is very high; inc risk of transmission
A

Chronic HIV infection

  • HIV cont to multiply in the body but @ very low lvls
  • may not have any HIV-related sx’s, but can still spread
  • w/o rx’s progression to AIDS within 10 yrs or sooner
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6
Q

AIDS

  • final, most severe stage of HIV infection
  • body can’t fight off opportunistic infections
  • w/o treatment, ppl survive ~3 yrs
  • dx’d if CD4 count <200 or have certain opp infect
A
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7
Q

Recognize Cues

  • Diagnostic or screening tests assess for antibodies to HIV virus
  • Rapid tests do not require a lab to perform
  • ELISA screening test
A
  • Negative screening test does not require confirmation (should repeat 3-6 mos)
  • HIV Western blot
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8
Q

?

Is a test that requires a blood sample & is not a rapid test
- Specimen must be sent out to a lab for testing; results avail 24-48 hrs

A

ELISA

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9
Q

A positive screening test requires confirmation by an __ __ __. This confirms the presence of proteins unique to the HIV virus.

If proteins absent, person is not infected w/HIV
A positive screening followed by a confirmatory test is used to dx HIV in all individuals over 12 mos

A

HIV Western blot

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10
Q

Clinical Manifestations

  • Fever
  • Cough
  • Weakness
  • N/V
  • Diarrhea
  • Dysphagia
  • Forgetfulness
A
  • Skin lesions
  • SOB
  • Headache (could be d/t meningitis)
  • Vision changes
  • Pain
  • Night sweats (could be d/t TB)
  • Lymphadenopathy
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11
Q

Opportunistic Infections

  • Protozoal
  • Fungal
  • Viral
  • Bacterial
  • Opportunistic neoplasias
  • HIV wasting syndrome
A
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12
Q

?

Major weight loss, chronic diarrhea & fever

A

HIV wasting syndrome

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13
Q

?

Various mycobacterial infections/others, extrapulmonary TB

A

Bacterial

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14
Q

?

Kaposi’s sarcoma/others

A

Opportunistic neoplasias

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15
Q

?

Toxoplasmosis of the brain/others

A

Protozoal

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16
Q

?

CMV dz, HSV infection/others

A

Viral

17
Q

?

Candidiasis of the lungs, esophagus, trachea
Pneumocystis jirovecii pneumonia/others

A

Fungal

18
Q

Treatment - Drug Therapy

  • Prophylaxis
  • Antiretroviral therapy (ART)
  • Immunizations
    > HIV+ more @ risk for infect d/t compromised immune system
A
  • If an HIV+ person has a CD4+ count of 200 cells/L or less, prophylaxis to reduce the risk of OI’s such as toxoplasmosis & PCP involves Bactrim (TMP/SMX)
  • For TB prevention, antitubercular complement of rx’s
  • Generally per guidelines, pt will receive ART therapy & OI prophylaxis, if possible
  • Helps reduce viral load, inc CD4 count & if that goes above 200 for >3 mos, OIP can be stopped
19
Q

Antiretroviral Drugs

ART and TasP or PrEP
> Formerly HAART - Highly active antiretroviral therapy
> Treatment as Prevention
> Now just ART: Anti Retroviral Therapy
> Incl @ least 3 rx’s (“cocktails”)
> Work in diff ways to reduce viral load

A
  • Aim of therapy is to ensure the suppression of HIV to so-called “undetectable” levels - meaning that the virus is not fully eradicated, but is beneath detection lvls of current testing assays
20
Q
  • As opposed to single-drug or dual-drug therapy, comb of 3 or more active drugs is known to effectively suppress variety of resistant HIV that can exist within a viral population
  • If 1 rx can’t suppress a viral mutation, others might
A
21
Q

?

  • involves taking a 28-day course of anti-HIV rx’s, after poss exposure to HIV
  • risk of HIV infection is assessed 1st
  • is not a “cure” for HIV; not 100% effective
  • may prevent HIV from entering cells in body & stop someone from getting HIV
A

PEP (postexposure prophylaxis)

22
Q
  • PEP usually consists of 3 anti-HIV rx’s, from 2 of the different classes
  • Most recent UK guidelines recommend Truvada (fixed dose tablet of emtricitabine & tenofovir) from NRTI class & raltegravir (Isentress) from integrase inhibitor class
A
23
Q

Antiretroviral Classifications (6 groups)

  • Nucleoside Reverse Transcriptase Inhibitors (NRTI)
  • Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
  • Protease inhibitors (PIs)
  • Fusion inhibitors (FIs)
A
  • Entry inhibitor-CCR5 co-receptor antagonists
  • HIV integrase strand transfer inhibitors
24
Q

! Before any pt starts ART therapy, they must undergo baseline hepatic & renal (liver & kidney) fxn tests b/c the rx’s are metabolized there
> Historically, AZT was the 1st treatment

A
25
Q

?

Are the 1st class of rx’s developed to fight HIV

A

Nucleoside Reverse Transcriptase Inhibitors (NRTI)

26
Q

?

These inhibit the protease retroviral enzyme, preventing viral replication

A

Protease inhibitors (PIs)

27
Q

?

These block activity of the enzyme reverse transcriptase preventing production of new viral DNA

A

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

28
Q

?

These inhibit viral fusion, preventing viral replication

A

Fusion inhibitors (FIs)

29
Q

Antiretroviral Drugs: Adverse Effects

  • Numerous & vary w/ea rx
  • Rx therapy may need to be modified b/c adv effects
  • Goal is to find the regimen that will best control the infect w/a tolerable adv effect profile
  • Rx regimens change during the course of illness
A

Nursing Key Points

  • Viruses are diff to kill & to treat b/c they live inside human cells, & most antiviral rx’s work by inhibiting replication of the virus [only ref HIV antivirals (anti-retrovirals)]
30
Q
  • Admin anti-retroviral rx’s only after the prescriber’s orders are read & understood & after performing a thorough nursing assessment that incl a review of the pt’s nutritional status, wt, baseline VS values, & renal & hepatic func as well as assessment of heart sounds, neurologic status, & GI tract func
A
  • Comfort measures & supportive nursing care are to accompany rx therapy; pts need to drink plenty of fluids & to space rx’s around the clock, as ordered, to maintain steady blood lvls of the rx

NUR 201 Week 14 (1 decks)

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