Nurb Test 3: Aids Flashcards
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
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
- unprotected sex with an infected partner
- sharing needles with infected person
Most common methods of transmission
If pregnant women receive ART <1% because of all the testing
Almost eliminated as a risk
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
- has to have large amount of virus to get infected
susceptible host
Duration/frequency of contact
Volume of fluid
Viral load- how much virus in the blood
Host immune status
Whether or not you get affected:
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
- 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)
- which increases the risk of transmission again
Riskier when large amounts in the blood
Viral Load in the Blood Late Stages
Viremia returns
-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
- 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
-Viral load high
Phases of HIV
1. Acute Infection
- HIV specific antibodies develop
Seroconversion
Phases of HIV acute infection
flu-like fever, headache, nausea and vomiting- wouldn’t think infected
Symptoms-
acute infection phases of hiv
acute infection phases of hiv
CD4+T cell counts-
counts start to fall but rebound quickly
acute infection phases of hiv
Onset-
2-4 weeks after initial infection
acute infection phases of hiv
Duration
- 1-2 weeks
Early Chronic Infection
CD4+T cell counts-
usually normal or slightly decreased
11 years- time between having HIV and being diagnosed with AIDS
Duration-
early chronic infection HIV
- 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
Early chronic infection hiv
Viral Load-
low because B and T cells responded
Intermediate Chronic Infection
CD4+T cell counts-
dropped to 200-500
Viral Load-
intermediate chronic infection
going back up
- worsening localized infections, nervous system symptoms
Symptoms
intermediate chronic infection
Most common infection in this stage
- 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
- 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
