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NUR 334: exam 3 > HIV + labs/dx tests > Flashcards

HIV + labs/dx tests Flashcards

1
Q

HIV/AIDs

A

human immunodeficiency virus
acquired immunodeficiency syndrome

same disease/virus

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2
Q

when are you considered to have AIDs?

A

final stage of viral infection (before death)
CD4: <200
OR specific opportunistic infection occurs –>
-Burkitt’s lymphoma
-pneumocystis jirovecii
-HIV-related encephalopathy
-kaposi’s sarcoma
-disseminated histoplasmosis
-candidiasis of esophagus/bronchi

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3
Q

collaborative management of HIV patient?

A

-manage symptoms
-monitor progression and immune fxn
-initiate/monitor anti-retroviral therapy (ART)
-prevent opportunistic infections
-prevent complications
-prevent spreading disease

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4
Q

preventative measures for a person with HIV

A

-avoid/modify risk factors
-safer sex (handouts - male & female condoms)
-decrease risk r/t drug use (stop or needle exchange programs)
-decrease risk of perinatal transmission
-encourage routine HIV testing
-decrease risk at work

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5
Q

potentially infectious substances from HIV patient

A

blood
cerebral spinal fluid (CSF)
synovial fluid
pleural fluid
amniotic fluid

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6
Q

what is considered exposure?

A

needle stick or cut with sharp object
mucous membrane contact
non-intact skin contact

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7
Q

post-exposure prophylaxis

A

initiate drug therapy ASAP –> within 1-2 hours, especially within 72 hours
undergo HIV testing

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8
Q

patient education on ART

A

advantages and disadvantages
dangers of non-adherence
how and when to take drugs
drug interactions to avoid
side effects to report to HCP

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9
Q

strategies to promote adherence and improve outcomes

A

-ensure motivation before 1st prescription
-social support
-negotiate a treatment plan
-devise a simpler regimen
-anticipate side effects
-establish trust

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10
Q

candidates for Pre-Exposure Prophylaxis (PrEP)

A

-anal or vaginal sex in last 6 months
-sexual partner with HIV
-not consistently using condoms
-been diagnosed with an STD in past 6 months

-inject drugs
-injection partner with HIV
-share needles, syringes, etc.

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11
Q

PrEP

A

daily meds to lower chance of getting HIV (Truvada and Descovy) –> highly effective if used as prescribed

reduces risk of getting HIV through sexual contact by 99% when taken consistently –> 74% if using IV drugs

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12
Q

what should you teach PrEP candidates?

A

continue to use condoms
often covered by insurance and medicaid, free medication programs available and co-pay assistance

does NOT protect against other STIs

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13
Q

education for patient with AIDS

A

-avoid crowded areas or traveling to countries with poor sanitation
-avoid raw foods (uncooked fruits and vegetables) and undercooked foods
-avoid cleaning pet litter boxes
-keep home environment clean, don’t allow sick friends or family to visit
-continue ART
-frequent monitoring of CD4 and viral load labs

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14
Q

HIV screening is recommended for

A

13-75 years old
pregnant
if at risk, all ages

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15
Q

routine screening

A

one time

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16
Q

yearly screening for high risk patients includes

A

-men who have sex with men
-injection drug users
-people who exchange sex for drugs/money
-sex partners of people who are HIV infected, bisexual,, or injection drug users
-person who has sex w partner who HIV status is unknown

17
Q

Implications of HIV screening

A

-consent: voluntary, ensure they understand, offer to opt out –> document if they opt out

-confidentiality: scrupulous attention to this

-counseling: available to educate reducing likelihood of exposure

-referral to care: have the option of where to go if positive

18
Q

CDC estimates

A

85% aware of HIV status
62% linked to HIV care
41% stay in HIV care
36% get ART
28% are able to adhere to their treatment and sustain undetectable viral loads

19
Q

types of HIV testing

A

*HIV antibody only
*combination - HIV antibody AND HIV antigen (4th gen)
*HIV RNA

20
Q

HIV antibody only test

A

ELISAs: enzyme-linked immunosorbent assays
HIV-1/HIV-2 differentiation assays
*western blot: confirmatory follow up testing

older

21
Q

combination test

A

antibody AND antigen
almost 100% specificity and sensitivity
able to identify early/acute infections in up to 80% of pt.
2 available combo rapid tests

22
Q

HIV RNA test

A

actual viral load level
*qualitative: used as a screener to identify HIV-infected individuals (ex: blood donors)
*quantitative: used to manage/monitor those who are infected; can also be used to diagnose

23
Q

if the initial test is positive, what are the next steps?

A

all initial positive tests are confirmed with another test

the newer generation of tests –> the earlier the possibility of detection

24
Q

positive result

A

positive ELISA or combination assay followed by a positive confirmatory test

25
Q

negative result

A

negative screening ELISA or combination assay

26
Q

indeterminate result

A

when ELISA or combination assay is positive but confirmatory test is indeterminate or negative

27
Q

window period

A

time between potential exposure to HIV infection and the point when the test will give an accurate result

during window period–> VERY infectious but tests are negative

28
Q

time it takes to develop antibodies

A

95% by wk 4
>99.9% by wk 12

2-3 weeks most infectious

29
Q

what do you want the CD4 count and viral load to be?

A

CD4: HIGHER (>500)
viral load: LOWER (<50)

30
Q

CD4 count indicates

A

how healthy the immune system is

31
Q

CD4 count monitors

A

progression of AIDS
risk for opportunistic infections –> helps determine when it’s time for prophylactic treatment

*check every 3-4 months – with stable untreated patients and patients on ART therapy

32
Q

CD4 count normal range

A

800-1200 cells
reported in actual numbers or “copies”

33
Q

CD4 count < 200

A

infected person becomes vulnerable to any of ~26 opportunistic infections and rare cancers

34
Q

viral load testing indicates

A

how active HIV is in the body

35
Q

viral load and HIV infection

A

untreated –> replication usually produces billions of new viral copies daily

plasma HIV RNA (viral load) quantifies viral burden in plasma

helps monitor response to ART (along with CD4 ct)

check q 3-4 months

**lowest level of detection differs with each test

36
Q

what does an “undetectable viral load” mean?

A

GOAL –> unable to detect HIV in plasma

does NOT indicate absence of clearance of virus from body

recommendation: check twice at baseline before starting ART - when stable, q 3-4 months

37
Q

labs worth monitoring with HIV

A

WBC
platelets
H&H
LFTs (liver function tests) - early detection of co-infection with HBV or HCV impt

can also test for resistance to ART drugs

NUR 334: exam 3 (11 decks)

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