HIV and AIDS

Question 1

Pathophysiology of HIV Infection and AIDS

Answer 1

HIV is a retrovirus that causes a chronic disorder of impaired immunity; HIV can progress to AIDS; Individuals with AIDS are profoundly immunocompromised

Question 2

Stage 1 of HIV

Answer 2

1. Begins with onset of acute infection responses after an initial invasion by the virus causes overt symptom
2. This stage is relatively short and in most infected adults can progress over time to the HIV disease chronic stage of HIV-II

Question 3

Stage 2 of HIV

Answer 3

Stage HIV- II is considered as the chronic HIV illness

May last for years due to current medications

First, intermittent acute infections followed by periods or relative wellness

Secondly, chronic progressive debilitation occurs

Question 4

Stage 3 of HIV

Answer 4

Stage HIV-III is the final, most serious form of HIV known as AIDS.

Severe reduction of immunity and increased risk for cancer

May live for years before dying

Question 5

Signs and Symptoms

Answer 5

1. Fever
2. Sore throat
3. Rash
4. Night Sweats
5. Chills
6. Headache
7. Muscle Ache

Question 6

Classification of HIV

Answer 6

Class 0: Patient develops a first positive HIV test result within 6 months after a negative HIV test result. CD4+ T-cell counts are usually in the normal range and no AIDS-defining condition is present.

Class 1: Patient has a CD4+ T-cell count of greater than 500 cells/mm3 (0.5 X 109/L) or a percentage of 29% or greater. No AIDS-defining illnesses are present. (HIV-I)

Class 2: Patient has a CD4+ T-cell count between 200 and 499 cells/mm3 (0.2 to 0.499 X 109/L) or a percentage between 14% and 28%. No AIDS-defining illnesses are present. (HIV-II)

Stage HIV-III

Class 3: Patient has a CD4+ T-cell count of less than 200 cells/mm3 (0.2 X 109/L) or a percentage of less than 14%. Any patient, regardless of CD4+ T-cell counts or percentages who has an AIDS-defining illness. AIDS diagnosis.

Unknown:
> Patient has a confirmed HIV infection but no information regarding CD4+ T-cell counts, CD4+ T-cell percentages, and AIDS-defining illnesses is available.

Question 7

HIV Infectious Process

Answer 7

Stage 1:
> Develop an acute infection within 4 weeks of being infected (Flu-like symptoms)

Stage 2:
> Infected adults are diagnosed
> Appropriate drug therapy suppress viral reproduction, allowing the patient to maintain a relatively level of immunity for protection
> Because drug therapy only suppress viral reproduction and does not kill the organism, eventually many patients progress to stage 3
> Poor CD4+ T-Cell function leads too:
> Leukopenia (decreased number of circulating WBC)
> Lymphocytopenia (decreased number of lymphocytes)
> Production of incomplete and non functional antibodies
> Abnormally functioning macrophages
> At risk for bacterial, fungal, viral infections and opportunistic cancers

Stage 3:
> CD4+ T-Cell of less than 200 cells/mm3 or an opportunistic infection

Question 8

HIV Progression

Answer 8

1. The time from the beginning of HIV-I infection to HIV-III ranges from months to years depending on how HIV is acquired, other health problems, personal factors, and interventions
2. When HIV results from a single sexual encounter, progression takes longer
3. Personal Factors influencing time to progression include:
   > Frequency of Re-exposure
   > Presence of other STIs
   > Nutrition status
   > Stress
4. Infection within first four weeks of infection
   > May not even consider they have HIV- just think they have a cold
   > Will begin to feel better when symptom relieve, but the disease is only starting
   > When viral numbers are in the bloodstream and genital tract, sexual transmission is possible
5. May have a few symptoms, but as progression occurs, more health problems occur
   > Coughing, SOB
   > Diarrhea, weight loss, N/V
   > Dry skin or lesions, poor wound healing, night sweats
   > Confusion, dementia, memory loss, HA, fever, visual changes, personality changes, seizures

Question 9

Health Promotion and Maintenance

Answer 9

• HIV and AIDS cannot be cured, the continued use of antiretroviral therapy allows patients to live longer, healthier lives*
• Teach all adults about the transmission routes and ways to reduce their exposure*
• Stress that HIV is not transmitted through casual contact in the home, school, or workplace
• Sharing household utensils, towels and linens, and toilet facilities does not transmit HIV
• HIV is not spread by mosquitos or other insects

Question 10

Infected Fluids with Highest HIV Concentrations

Answer 10

1. Blood
2. Semen
3. Breast Milk
4. Vaginal Secretions

Question 11

Infected Fluids with Lowest HIV Concentration

Answer 11

1. Tears
2. Saliva
3. Sweat

*Low risk for transmission unless obvious blood is present

Question 12

HIV is Transmitted in Three Ways

Answer 12

1. Sexual
2. Parenteral
3. Perinatal

Question 13

HIV Staus

Answer 13

1. Early diagnosis allows for early treatment and prevention, a concept known as Treatment As Prevention (TAP)
2. Recommendations for HIV Screening:
   > One-time screening between ages 15-65
   > An annual screening for those who are at greater risk for HIV infection
   > Prenatal screening
   > Frequent testing in adults with repeated high-risk exposures
3. Testing help prevention because test can diagnose HIV infection before immunity changes or disease symptoms develop
4. ALL SEXUALLY ACTIVE ADULTS SHOULD KNOW THEIR HIV STATUS

Question 14

Recommendations for Annual HIV Testing and One-Time Screening

Answer 14

You should be tested annually for HIV if you:

1. Have a sexually transmitted disease
2. Use injection drugs
3. Consider yourself a risk
4. Are a women of child bearing age with identifiable risks including
   > Used injection drugs
   > Engaged in sex work
   > Had sexual partners who were infected or at risk
   > Had sexual contact with men from countries with high HIV prevalence
5. Received a blood product transfusion between 1978 and 1985
6. Plan to get married
7. Are undergoing medical evaluation or treatment for symptoms that may be HIV related
8. Have been or are in a correctional institution such as jail and prison
9. Are a sex worker or have had sex with a sex worker
10. Between the age of 18-65
11. As part of routine prenatal screening when you are pregnant

Question 15

Sexual Tranmission

Answer 15

• Genital, anal, or oral sexual contact with exposure of mucous membranes to infected semen or vaginal secretions

1. Abstinence or mutually monogamous sex with a noninfected partner is ONLY absolute way of preventing infection
2. The risk for becoming infected from a partner with HIV positive and has a detectable viral load is always present
3. Sexual Acts of Practices in which infected seminal fluid come is contact with mucous membranes or non intact skin are the most risky for sexual transmission of HIV
4. Viral Load, the amount of virus present in blood and other body fluids, affects transmission
5. Safe Sex Practice
   - reduce instances where non-intact skin or mucous membranes come in contact with HIV-infected blood/body fluids
   • use latex or polyurethane condoms for both genital and anal intercourse
   • use water-based lubricant with a latex condom
   • use a condom or other latex barrier (dental dam) during oral-genital or oral-anal contact
   • use latex gloves for finger/hand contact with a vagina or rectum

Question 16

Safe Sex Practices

Answer 16

• Reduce instances where non-intact skin or mucous membranes come in contact with HIV-infected blood/body fluids

1. Use latex or polyurethane condoms for both genital and anal intercourse
2. Use water-based lubricant with a latex condom
3. Use a condom or other latex barrier (dental dam) during oral-genital or oral-anal contact
4. Use latex gloves for finger/hand contact with a vagina or rectum

Question 17

Pre-Exposure Prophylaxis (PrEP)

Answer 17

• Use of HIV antiretroviral drugs by an HIV-UNINFECTED adult to prevent HIV infection

1. Used for people who are at high risk for acquiring HIV infection such as:
   > Men who have sex with men
   > Nonmonogamous heterosexually active men and women
   > Injection drug users
   > Relationship in which one partner is HIV positive and one partner is HIV negative
2. Important to ensure the adult is HIV negative using a HIV antigen/antibody test
   > Other tests include: kidney function, other test for STI, liver function, and Hep. A,B,C
3. After starting PrEP, ongoing testing of kidney function and HIV infection is performed q3 months because both drugs can be toxic to kidney and liver
4. PrEP is not protected until 7 days of consistent dosing allows a steady-state blood drug level to be achieved
5. When the initial period is completed, one dose can be missed and protection is still adequate
6. If two consecutively missed doses greatly reduce protection and the patient needs to start over with another 7-day lead in period until the new steady state is achieved before being sexually active.

Question 18

Postexposture Prophylaxis (PEP)

Answer 18

• PEP with cART is used for adults who have had:
  > Occupational Exposure (sharps injury)
  > Non-occupational Exposure (consensual sexual exposure with a person of unknown HIV status)
  > Those who suffered a sexual assault

1. Starting cART as soon as possible (within 36 hours) is critical to preventing HIV infection
2. Occupational Exposure: contact between blood, tissue or selected bodily fluids from a patient who is positive for HIV and the blood, broken skin, or mucus membranes of a health care professional
   > Most cases of occupational exposure requiring PEP involve a percutaneous needle stick with a needle
   > STEPS:
   1. Washing the wound carefully for 1 full minute
   2. Immediately contact employee health to begin documentation, testing and prophylaxis
   3. cART with 2 hours of exposure has the best outcome in preventing HIV infection
   4. Return for HIV testing every 1, 3 and 6 months
   5. Electrolytes, CBC, Creatine checked 2 weeks after starting cART
3. Nonoccupational Exposure
   > Consensual and nonconsensual sexual exposures, involving insertive and receptive types of sex with oral, vaginal or anal contact
   > Other types include sharing of needles and inadvertent percutaneous or mucosal contact in the home
4. Exposure to HIV as a result of sexual assault also includes testing for other STIs. For women of child-bearing age, emergency contraception is offered

Question 19

Parenteral Transmission

Answer 19

• Sharing of needles (sharps) or equipment contaminated with infected blood or receiving contaminated blood products*

1. Preventive Practices
   > Proper cleaning of needles, syringes and other drug paraphernalia
   > Clean a used needle and syringe by first filling and flushing them with clear water
   > Teach them to fill the syringe with ordinary household bleach and shake it for 30-60 seconds
   > Advise IDU to carry a small container with this solution whenever sharing needles or to participate in community needle exchange programs
2. Transmission of HIV through blood transfusion is very low
   > All blood is screened

Question 20

Perinatal Transmission

Answer 20

• From the placenta, from contact with maternal blood and body fluids during birth, or from breast milk from an infected mother to child*

1. Inform women of child-bearing age with HIV infection about the risks for perinatal transmission
2. Encourage HIV-positive women who are pregnant to continue the therapy or, if they are not on antiviral therapy, to start the therapy as soon as possible

Question 21

Transmission and Health Care Workers

Answer 21

1. Needlestick and “sharps” injuries are the main means of occupation-related HIV infection for health care workers
2. Can also be infected through exposure of non intact skin and mucous membranes to blood and body fluid
3. To prevent HIV transmission to patients, health care workers must wear gloves when in contact with patients’ mucous membranes or non intact skin
4. Infected workers with weeping dermatitis must wear gloves or not perform direct patient care

Question 22

Nursing Assessment: Health History

Answer 22

Ask About:
1. Gender, Age, Occupation and Home Environment
2. Assess current illness (when it started, severity of symptoms, associated problems and interventions)
3. When was HIV infection diagnosed and which symptoms led to that diagnosis
4. Give chronologic history of infections and problems since diagnosis
5. Ask about sex practices, STIs, and infectious diseases
6. Ask whether they have engaged in past or present injection drug use
7. Assess cognitive function and knowledge level of the diagnosis, symptom management, diagnostic tests, treatments, community resources and modes of HIV transmission
8. Assess safer sex practices and provide appropriate teaching

Question 23

Physical Assessment/Sign and Symptoms

Answer 23

Immunologic:
1. Low white blood cell count (<200 cells/mm3)
2. High blood immunoglobulin levels
3. Opportunistic Infections
4. Lymphadenopathy

Integumentary:
1. Dry skin, lesions
2. Poor wound healing
3. Night Sweats

Respiratory:
1. Cough, shortness of breath

GI:
1. Diarrhea
2. Weight loss
3. Nausea and Vomiting

CNS:
1. Confusion, dementia, memory loss
2. Headache
3. Fever
4. Visual change
5. Personality changes
6. Seizures

Viral Infection:
1. Cytomegalovirus

Bacterial Infection:
1. Tuberculosis

Fungal Infection:
1. Candidiasis
2. Pneumocystis jiroveci pneumonia

Malignancies:
1. Kaposi’s sarcoma

Protozoal Infection:
1. Cryptosporidiosis

Question 24

Nursing Assessment: Psychosocial Assessment

Answer 24

1. Assess baseline neurologic and mental status
2. Evaluate the patient for subtle changes in memory, ability to concentrate, affect and behavior
3. Ask about social support system (family, friends, significant other)
4. Assess patient’s feelings, thoughts and behaviors (anxiety, mood, cognition, energy, and activity level)

• The patient with HIV disease HIV-III has less energy as the disease progresses. Pace interviews, assessments and interventions to match his or her energy levels*

Question 25

Nursing Assessment: Laboratory Assessment

Answer 25

Lymphocytes Counts:
> Normal WBC is 5000-10,000 cells
> Patients with AIDS are often leukopenic with a WBC count of less than 3500 cells or lymphopenic less than 1,500
> Lower CD4+ T-Cells

Anti-body Antigen Tests
>Measure the pts response to the virus
> Indirect test for HIV
> If a positive result for HIV antibodies, it does not indicate severity or
disease progression- only that the virus is infected

Viral Loading Test
> Measures the amount of HIV viral RNA particles present in 1 mL of blood and used to measure therapy effectiveness
> The higher the viral load, the greater the risk for transmission
> Unaffected adult has no viral load

HIV Home Screening:
> Can you use blood or oral transmucosal exudate- not saliva
> Patient privacy is maintained when specimens have code numbers for test
results
> Positive results equals a need for additional testing

HIV genotype
>Used before starting antiretroviral drugs to determine whether any mutations cause drug resistance in the strain of HIV the pt has

Test to Detect Infection
> Blood Chemistries
> Urinalysis
> CBC with differential
> Toxoplasmosis antibody titer
> Liver Function Test
> STI testing
> Hep A,B,C
> Lipid profile
> QuantiFERON TB testing
> Cervical and anal PAP testing

Diagnostics:
> Stool for ova and parasites
> Biopsies of the skin, lymph nodes, lungs, liver, GI tract, or brain
> Chest X-ray
> Gallium Scan
> Bronchoscopy
> Endoscopy
> Colonoscopy
> Liver and Spleen Exams
> CT
> Pulmonary Function Test
> Arterial Blood Gas Analysis

Question 26

Opportunistic Infection: Tuberculosis

Answer 26

1. Caused by Mycobacterium tuberculosis
2. Patients who have TB have extra pulmonary (beyond the lungs) disease
3. Can affect the LUNGS, kidneys and brain
4. Signs and Symptoms:
   > Cough
   > Dyspnea
   > Chest Pain
   > Fever
   > Chills
   > Night Sweats
   > Weight Loss
   > Anorexia
5. The adult with TB and a CD4+ T-Cell Count below 200 cells/mm3 may not have a positive TB skin test because of an inability to mount to an immune response to the antigen (anergy)
6. Blood analysis (nucleic acid application test) for TB with result available in less than 2 hours is the most sensitive rapid test
7. Other diagnostic test:
   > Chest X-ray
   > Acid-fast sputum smear
   > Sputum Culture
8. Spread by airborne precautions (DROPLET PRECAUTION)
9. Aerosolized Treatments: Pentamidine isethionate (those who administer must get screen every 6 months to determine if they have been infected)
10. Nursing Interventions:
    > Antibiotics (INH, Rifarmphin, Purazinamide, Ethambutol)
    > 6-12 months antibiotic regimen
    > Respiratory Therapist Collaboration
    > Infection disease consult
    > Chest X-ray (monitor for TB growth)

Question 27

Opportunistic Infection: Pneumocystis jiroveci pneumonia

Answer 27

1. Fungal Infection with Pneumocystis jiroveci in lungs
2. Signs and Symptoms:
   > Shortness of Breath
   > Tachypnea
   > Persistent Dry Cough
   > Persistent Low grade Fever
3. Assess breath sounds for crackles
4. Patient may report fatigue and weight loss
5. Nursing Interventions:
   > Optimal Positioning for Breathing (semi-fowler, Fowlers)
   > Applied Humidified Air
   > Trach Care if on ventilator (pulmonary hygiene and suctioning)
   > Collaborate with RT/pulmonary
   > Corticosteroids (reduce inflammation)
   > Trimethoprim w/ sulfamethoxazole (Bactrim; first line of defense)
   > Pentamidine isethiomate (aerosol prophylaxis)

Question 28

Opportunistic Infection: Kaposi’s sarcoma

Answer 28

1. Most common AIDS-related malignancy
2. The risk for KS is related to co-infection of HIV and human herpesvirus 8
3. Develops small, purplish-brown, raised lesions on skin and mucus membranes that are not painful or itchy
4. In some patients lesions develop in the lymph nodes, mouth or throat, intestinal tract or lungs
5. Assess KS lesions for:
   > Number
   > Size
   > Location
   > Intact
   > Monitor for progression
6. Signs and Symptoms:
   > Purplish-brown lesions
   > Lymphedema
   > Difficulty Breathing
   > Blood in stool
   > Diarrhea
   > Constipation or Vomiting
   > Mouth Pain
7. Nursing Interventions:
   > Topical Medications
   > Target therapy
   > Radiation therapy
   > Chemotherapy
   > Surgery
   
   • Determine by type of KS, number of lesions, location of lesion and overall health

• Think KAPOSI KILLS SOFT TISSUE*

Question 29

Opportunistic Infection: Cryptosporidiosis

Answer 29

1. Intestinal infection caused by Cryptosporidium organism
2. Ranges from mild diarrhea to severe wasting with electrolyte imbalance
3. Diarrhea may result in significant fluid loss
4. Ask the patient about diarrhea and whether they had unplanned weight loss of 5 lbs or more
5. Nursing Interventions
   > IV hydration
   > Nitazoxanide treatment
   > Drink plenty of fluids

Question 30

Opportunistic Infection: Candidiasis

Answer 30

1. Fungal Infection
2. Overgrowth of the Candida albicans fungus occurs because the reduced immunity can no longer control fungal growth
3. Candida stomatitis or esophagitis occurs often
4. Patient may report food tasting funny, mouth pain, difficulty swallowing, and pain behind the sternum
5. When examining the throat, you may see cottage cheese like, yellowish white plaques and inflammation
6. Women may have persistent vaginal candidiasis with severe pruritic (itching), perineal irritation, and a thick, white vaginal discharge

Question 31

Opportunistic Infection: Cytomegalovirus

Answer 31

1. Viral infection affecting:
   > The eye (retinitis) (ranges from slight impairment to total blindness)
   > Respiratory
   > GI tract
   > CNS
2. Transmitted through saliva, urine, sex, breast milk
3. Signs and Symptoms:
   > Fever
   > Malaise
   > Weight loss
   > Fatigue
   > Swollen Lymph Nodes
   > Diarrhea
   > Abdominal bloating
   > Discomfort and weight loss
4. Complications:
   > Encephalitis
   > Pneumonitis
   > Adrenalitis
   > Hepatitis
   > Disseminated infection
5. Nursing Interventions
   > Standard Precaution
   > Daily Weights
   > Small, frequent balance meals
   > Monitor Temp
   > Increase fluid intake (strict I&O)
   > Promote comfort and rest
   > Encourage coughing and deep breathing
   > Vision: promote safe environment
   > Administer antivirals

Question 32

Endocrine Complications

Answer 32

1. Problems:
   > Gonadal dysfunction
   > Body shape changes
   > Adrenal insufficiency
   > Diabetes
   > Elevated triglycerides and Cholesterol
   2.Gonadal Dysfunction
   > HIV-positive men- low testosterone levels
   > HIV-positive women- irregular menstrual cycles
   > Changes in gonadal function decreases muscle mass, weight loss, decreased libido, decreased energy and increased fatigue
2. Body Changes
   > Changes from fat redistribution or fat deposition
   > Common from antiretroviral drug therapies
   > Signs and Symptoms
   > Buffalo hump
   > Neck fat development
   > Large belly fat accumulation
3. Adrenal Insufficiency
   > Results when the adrenal glands are infected by opportunistic organisms, causing adrenal insufficiency
   > Life-threatening problem can cause
   > Fatigue
   > Weight loss
   > Nausea/Vomiting
   > Low Blood Pressure
   > Electrolyte disturbances
4. Patients taking older protease inhibitors have a high-than-expected incidence of type 2 diabetes and hyperlipidemia

Question 33

Cardiovascular Complication

Answer 33

1. Leading cause of death for PLWH
2. Fat metabolism is disordered and the common problem of diabetes mellitus adds to the risk for hypertension and atherosclerosis
3. Sedentary lifestyle increases the risk
4. Regular physical activities of at least 150 mins per week can lower the risk

Question 34

Other Symptoms

Answer 34

1. Neurologic Problems
   > Peripheral neuropathy
   > Myopathy
2. Assess for peripheral neuropathy:
   > paresthesias and burning sensation
   > reduced sensory perception
   > pain
   > gait changes
3. Myopathy is accompanied by leg weakness, ataxia and muscle pain
4. Assess for ICP
5. Diarrhea, malabsorption, anorexia and oral and esophageal lesions can contribute to persistent weight loss
6. Skin changes include:
   > Dry, itchy skin
   > Irritated skin
   > Folliculitis, eczema, or psoriasis may occur
   > When platelet count is low, petechiae or bleeding gums may be present
7. Kidney Problems:
   > HIV-associated nephropathy
   > Patients with HIV have a far higher risk for requiring renal replacement intervention

Question 35

Nursing Interventions: Preventing Infection

Answer 35

1. Avoid exposure to infectious agents
2. Continually assess the patient for the presence of infection
3. Monitor daily CBC with differential, WBC count and Neutrophil count
4. Inspect the mouth qshift for lesion and mucosa breakdown
5. Assess lung sounds q8 hours for crackles, wheezes and reduced breath sounds that indicate impaired gas exchange
6. Assess urine for odor and cloudiness (ask about urgency, burning or pain)
7. Assess any areas for loss of tissue integrity and open sores (look at perirectal region)
8. Drug therapy: cART
   > The most important factor leading to development of drug resistance to cART is missed drug doses

Question 36

Preventing Infection

Answer 36

1. Avoid crowds and other large gathering of people
2. Do not share personal articles such as toothbrushes, toothpaste, washcloths or deodorant sticks
3. Bathe daily, using an antimicrobial soap
   > If total bathing is not possible, wash armpits, groin, genitals, and anal area twice a day with antimicrobial soap
4. Clean toothbrush at least weekly by either running it through the dishwasher or rinsing it in liquid laundry bleach
5. Wash Hands:
   > Before eating or drinking
   > After touching a pet
   > After shaking hands
   > As soon as you come home from an outing
   > After using the bathroom
6. Avoid eating undercook meat, fish and eggs
7. Wash dishes between use with hot, sudsy water or use a dishwasher
8. Do not change pet liter boxes
9. Avoid turtle and reptiles as pets
10. Do not feed pets raw or undercooked meats
11. Take temp at least once a day and whenever you do not feel well
12. Report Indications to PCP:
    > Temp >100
    > Persistent cough (with or without sputum)
    > Pus or foul-smelling drainage from any open skin are or normal body opening
    > Presence of a boil or abscess
    > Urine that is cloudy or foul-smelling or that burns on urination
13. Take all prescribed drugs
14. Do not dig in the garden or work with houseplants
15. Avoid travel to area with poor sanitation or primitive health care facilities

Question 37

Nursing Intervention: Enhancing Gas Exchange

Answer 37

1. Drug therapy – medications used to treat associated infections like PCP; bronchodilators to improve airflow; glucocorticoids for inflammation
2. Respiratory support – frequent respiratory assessment oxygen, humidification, mechanical ventilation if needed, suctioning and pulmonary hygiene if needed, ABGs
3. Comfort – elevate HOB for ease of breathing, pace activities
4. Rest and activity changes – conserve energy, appropriate schedules for ADLs

Question 38

Nursing Intervention: Managing Pain

Answer 38

1. Comfort measures – special mattresses/mattress pads, warm baths/other hydrotherapies, massage, heat/cold to help reduce pain, use of lift sheets, frequent position changes
2. Drug therapy: NSAIDs (inflammation), acetaminophen (pain), pregabalin (muscle and joint pain), tricyclic antidepressants (neuropathic pain), anticonvulsants (neuropathic pain)
   -Careful use with opioids, depends upon pain intensity and pain quality

Question 39

Nursing Intervention: Enhancing Nutrition

Answer 39

1. Drug therapy – to manage issues with the mouth for ease of eating, antiemetics for nausea/vomiting
2. Nutrition therapy – monitor weight, monitor calorie counts, monitor I&O, know client’s food preferences, collaborate with dietician/nutritionist for appropriate diet (High-calorie, high protein), encourage small but frequent meals, use of supplemental vitamins, encourage fluid intake, TPN/PNN may be needed
3. Mouth Care- can help to improve appetite, use mouth rinses, use of soft toothbrushes, drink plenty of fluids, analgesics and oral anesthetic gel for soothing, avoid alcohol-based mouthwashes

Question 40

Nursing Intervention: Managing Diarrhea

Answer 40

1. Symptom management:
   -Antidiarrheal medication
   -Appropriate foods (collaborate with dietician)
   - less roughage, less sweets, alcohol, no caffeine, dairy can be questionable
   -IV fluids may be needed for hydration
2. Assess perinatal area often, keep it clean and dry; watch for open area, blisters, redness, or rashes and report those immediately-would care collaboration may be needed
3. Offer BSC or bedpan, advocate for privacy

Question 41

Nursing Intervention: Restoring Skin Integrity

Answer 41

Lesions r/t OIs need to be addressed
- For Kaposi’s sarcoma: cART, local radiation, local or systemic chemotherapy interferon, cryotherapy, or topical retinoid
- For pain r/t KS lesions: analgesics and comfort measures, keep open and weeping lesions clean and dressed to prevent infection, special dermatologist-approved makeup for closed lesion, long-sleeved shirts, hats
- For herpes simplex virus: good skin care, keep area clean and dry, keep abscesses clean with normal saline and allow to air-dry, analgesics for pain, comfortable position, drug therapy

Question 42

Infection Control for Home Care of the Patient with HIV-III (AIDS)

Answer 42

1. Direct Care
   > Follow Standard Precaution and good handwashing technique
   > Do NOT share toothbrushes or razors
2. Housekeeping
   > Wipe up feces, vomit, sputum, urine or blood or other bodily fluids and the area with soap and water. Dispose of solid waste and solutions used for cleaning by flushing them down the toilet. Disinfect the area by wiping with a 1:10 solution of household bleach. Wear gloves when cleaning
   > Wash dishes in hot water and dishwashing soap or detergent
   > Clean bathroom surfaces with regular household cleaner and then disinfect them with a 1:10 solution of household bleach
3. Laundry
   > Rinse clothes, towels and bedclothes if they become soiled with feces, vomit, sputum, urine, or blood. Dispose of the soiled water by flushing it down the toilet. Launder these clothes with hot water and detergent with 1 cup of bleach added per load of laundry
   > Keep soiled clothes in a plastic bag
4. Waste Disposal
   > Dispose of needles and sharps in a labeled puncture-proof container (coffee can with a lid or empty liquid bleach bottle)
   > Remove solid waste from contaminated trash; then flush the solid waste down the toilet. Place the contaminated trash items in tied plastic bag and dispose of them in the regular trash

Question 43

Self-Management Education

Answer 43

• Teach the patient, family, and friends is a HIGH PRIORITY when preparing for discharge*

1. Instruct about modes of transmission and preventative behaviors
2. Teach how to protect the patient from infection, identify an infection and what to do if they appear
3. Teach self-care strategies (good hygiene, balance rest and exercise, skin care, mouth care)
4. Stress good nutrition (avoid raw or rare fish, fowl or meat); wash fruits and vegetable and proper food refrigeration
5. Avoid crowds and do not travel to areas with poor sanitation
6. Avoid cleaning pet litter boxes