Nurb Test 3: Aids Flashcards by katie boone

Teaching about anti-biotic infections, what should be included in teaching- hand washing to prevent infections, want to take all the drugs to prevent resistance , follow directions for the antibiotics, do not request for flu or colds, finish whole dose, don’t take left over later on, and don’t take to prevent illness

infections

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The virus is very fragile so you have to have contact with the virus through blood, semen, vaginal secretions, or breast milk
Healthcare have a low risk from a needle risk 3 out of 100 get it maybe
The life of a virus is very short outside the body because so fragile
perinatally can occur during pregnancy, delivery, or breastfeeding

Transmission of HIV

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unprotected sex with an infected partner

- sharing needles with infected person

Most common methods of transmission

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If pregnant women receive ART <1% because of all the testing

Almost eliminated as a risk

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Can transmit in a few days after becoming affected. The viral load is a very important factor- when higher, have a higher risk for transmission
Pt would be in standard precautions, not contact, droplet, or airborne isolation, not through casual contact

Conditions Necessary for Infection

Susceptible Host

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has to have large amount of virus to get infected

susceptible host

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Duration/frequency of contact
Volume of fluid
Viral load- how much virus in the blood
Host immune status

Whether or not you get affected:

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Is a retrovirus- starts from RNA then goes to DNA instead of DNA to RNA like other viruses
Gets in from the knobs (glycoproteins) outside of its body
Gets in the cell and creates a single strand of viral DNA through reverse transcriptase
Copies itself to form a double stranded viral DNA
Makes its way to the nucleus, gets in there using integrase and splices into genome, which makes it a permanent part of the cell
When it is a permanent part of the cell, any cell replicated from this cell will be infected

HIV Replication

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large amounts of virus in the blood
B and T cells respond- start to respond and decrease the virus load in the blood. Can last 10-12 years and have very little or no signs and symptoms

Viral Load in the Blood
A. Initial infection
Viremia (first 6 months)

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which increases the risk of transmission again

Riskier when large amounts in the blood

Viral Load in the Blood Late Stages

Viremia returns

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-Immune problems start when CD4+ T-cell counts drop to below 500 cells/μL.
Normal range is 800 to 1200 cells/μL.
-Allows for opportunistic diseases
Attacks T-helper cells- very important to immune system. Usually lives for 100 days and when infected only lives 2 days. When the t-helper cells become damaged they decrease in amount and then opportunistic diseases occur because immune system dysfunction
-Opportunistic diseases lead to disease, disability and death in most HIV patients

Pathophysiology of HIV

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This displays the typical course of untreated HIV infection. However, it is important to remember that disease progression is highly individualized, and that treatment can significantly alter this pattern. The information depicted in this figure represents data from large groups of people and should not be used to predict an individual’s prognosis.

Timeline for Untreated HIV Infection

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-Viral load high

Phases of HIV

1. Acute Infection

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HIV specific antibodies develop

Seroconversion

Phases of HIV acute infection

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flu-like fever, headache, nausea and vomiting- wouldn’t think infected

Symptoms-

acute infection phases of hiv

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acute infection phases of hiv

CD4+T cell counts-

counts start to fall but rebound quickly

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acute infection phases of hiv

Onset-

2-4 weeks after initial infection

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acute infection phases of hiv

Duration

1-2 weeks

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Early Chronic Infection

CD4+T cell counts-

usually normal or slightly decreased

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11 years- time between having HIV and being diagnosed with AIDS

Duration-

early chronic infection HIV

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asymptomatic or have generalized fatigue, low-grade fever, headache- wouldn’t think have HIV. Can be in stage for a long time so can spread it without knowing

Symptoms

early chronic infection HIV

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Early chronic infection hiv

Viral Load-

low because B and T cells responded

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Intermediate Chronic Infection

CD4+T cell counts-

dropped to 200-500

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Viral Load-

intermediate chronic infection

going back up

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- worsening localized infections, nervous system symptoms

Symptoms | intermediate chronic infection

Most common infection in this stage

1. thrush kaposi asrcoma oral hairy leukoplakia

- white lesions on side of tongue, painless, don’t look pretty epistein barr

oral hairy leukoplakia

- by HPV, red splotches

Kaposi sarcoma

Late Chronic Infection | - get diagnosed with

aids

- T-helper cell count is below 200 - Have an opportunistic disease present or opportunistic cancer - Wasting is present-loss of 10% or more of body mass - AIDS dementia is present

Leads to diagnosis of AIDS:

late chronic infection Viral load-

still increasing

late chronic infection CD4+T cell counts- opens door for opportunistic diseases

less than 200,

- malignancies, wasting, dementia

Symptoms late chronic infection

- time period between infection and the development of anti-bodies. Can be delayed or last for 2 months between infection and anti-bodies, can still transmit HIV during this time

Diagnostic Studies | 1. Window Period

``` antibody test- standard HIV test, detects the anti-bodies that bind to HIV, if it comes back positive then retake it, if it is positive again move to western blot Western Blot (WB) and Immunofluorescence assay (IFA)- definitive dx test ```

Dx. Enzyme immunoassay (EIA)-

``` -antibody screen- get results in 20 min, expensive. If get positive still need Western Blot, starting to be recommended as first test Western Blot (WB) and Immunofluorescence assay (IFA) ```

Dx. Rapid HIV

- the virus is still present and can transmit to others | Undetectable means too low for the test to record, virus not eliminated from body

If the viral load has decreased

CD4 T cell counts | Viral load

Progression of HIV dx tests

- decrease viral load, increase or maintain T cell helper counts, decrease onset of signs and symptoms and opportunistic diseases

Drug Therapy | Goals

- individualized by progression and pts desire for therapy

Guidelines | drug therapy goals

- used with caution. St. Johns Wart can affect the therapy

Herbals | drug therapy

- Decrease viral replication - Delay the progression of the disease - Reduce the viral load by 90-99% - If pregnant should receive anti-viral therapy

Antiretroviral drugs

resistance-develops pretty rapidly. Want ot use a combination. Want to use 3 different meds in two different classes

issues antiretroviral drugs

. Reverse Transcriptase Inhibitors

Nucleoside reverse transcriptase inhibitors (NRTIs)- Nucleotide Reverse Transciptase Inhibitors (NtRTI)- . Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)

-zidovudine (AZT, Retrovir), stavudine (Zerit), lamivudine (Epvir), didanosine (Videx), emtricitabine (Emtriva)

Nucleoside reverse transcriptase inhibitors (NRTIs)

Nucleotide Reverse Transciptase Inhibitors (NtRTI)

tenofovir (Viread)

: nevirapine (Viramune), delavirdine (Rescriptor), efavirenz (Sustiva)

Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)-

saquinavir (Fortovase, Invirase), ritonavir (Norvir), nelfinavir (Viracept), amprenavir (Agenerase)

Protease Inhibitors (PIs)

. Entry Inhibitor

enfuvirtide (Fuzeon)

Integrase Inhibitors

raltegravir (Isentress)

- Lipodystrophy - Hyperlipidemia - Insulin resistance and hyperglycemia - Bone disease - Cardiovascular disease

Disease and Drug Side Effects-Long term use of Anti-retroviral therapy causes these metabolic diseases:

-Identify risk factors- avoiding or modifying behaviors that put them at risk

Nursing Management Prior to infection 1. Health Promotion: A. Prevention of HIV Infection

Nursing Management Prior to infection

1. Health Promotion: A. Prevention of HIV Infection B. Education

- safe sexual practices - drug use- alcohol and tobacco can cause immune suppression, don’t share equipment - perinatal transmission- ART for moms - Caution and safety at work - ob related exposure

Education | health promotion nursing management prior to infection

- Monitoring the HIV progression and immune function - Initiating and monitoring ART - Preventing opportunistic diseases - Detecting and treating opportunistic diseases - Managing symptoms - Preventing or decreasing complications from treatment - Preventing further transmission of HIV

Nursing Management After Diagnosed with HIV | 1. Focus of management:

- focus on early detection of symptoms, opportunistic diseases, and psychosocial problems

Nursing Management | 1. Early Intervention

- ART start and adherence (stick to it) and psychosocial support

Acute Intervention

- psychosocial support, disease management- side effects of treatment, chronic terminal care, and opportunistic diseases

Chronic Intervention

abnormal or degenerative condition of adipose tissue lose or build up fat men are more likely to lose- arms, legs, face, and butt women are more likely to build up- abd, breasts, back of neck and shoulders

lipodustrophy | se of antiretroviral therapy

- pt comfort, emotional and spiritual comfort on what is going to come, helping families deal with loss, and maintaining a safe

End of Life Care

must be reactive to all three tests to be hiv positive -intermediate see if they are at risk for dev=risky behavior no risky behavior= retest in 3 months yes risky behavior= test for HIV antigen

dx hivwe, ifa, rapid hi or eia