NURS 444 week 8 Flashcards
HIV
acute infection
mononucleosis like symptoms:
fever, swollen lymph nodes, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and or diffuse rash
occurs 2 to 4 weeks after infection
highly infectious
HIV
asymptomatic infection
left untreated, a diagnosis of AIDS is made about 10 years after HIV infection
high risk behaviors may continue
HIV stages
Stage 1:
acute phase
Stage 2:
Kaposi sarcoma-cancer (specific to HIV)
Stage 3:
AIDS- waisting syndrome
HIV: symptomatic infection
immune problems happen when CD4 T cells drop < 500 cells
- severe problems when < 200 CD4 T cells
- normal range is 800-1200
symptomatic infection
- CD4 T cells decline closer to 200 cells
- HIV advances to more active stage
- symptoms become worse
insufficient immune response allows for opportunistic infections
HIV progression monitored by;
CD4 cell count-
Viral load- if lower, then the disease is less active (Nucleic Acid Test)
Resistance tests (determine if HIV strain is resistant to ART drug)
AIDS
CD4 T call count < 200
immune system severely compromised
great risk for opportunistic infections
possible malignancies, wasting syndrome, HIV related cognitive changes
Drug Therapy Goals for HIV
> decrease viral load
maintain/ increase CD4 counts
prevent HIV related symptoms and opportunistic diseases
delay disease progression
prevent HIV transmission
drug therapy has significantly increased life expectancy
ART drugs
Attachment inhibitors, entry inhibitors
integrase inhibitors
# nucleoside, non-nucleoside, and nucleotide reverse transcriptase inhibitors
# protease inhibitors
# fusion inhibitors
# combination antiretroviral therapy
PrEP: preexposure prophylaxis
preventing transmission of HIV
involves taking part of an HIV antiretroviral regimen daily
used in conjunction with other proven interventions
Integrase inhibitors
prevents HIV from incorporating genetic material into host cell
nucleoside, non-nucleoside and nucleotide reverse transcriptase inhibitors
inhibit the ability of HIV to make a DNA copy early in replication
protease inhibitors
interfere with activity of enzyme protease
fusion inhibitors
interfere with HIV CD4 receptor site binding and entry into cells
combination antiretroviral therapy
three or more drugs from different groups are prescribed at full strengths
ART drug interactions
herbal: St. John’s wort
OTC: antacids, PPI, supplements
Disease and ART side effects
- anxiety, fear, depression
- nausea, vomiting, diarrhea
- insomnia, nightmares
- neuropathy, headache, seizures
- pain
- fatigue
- rashes
- oral ulcers
- fetal defects (first 12 weeks especially)
Disease and ART potential disorders
^ renal disease
^ CVD
^ hyperlipidemia
^ insulin resistance
^ hyperglycemia
^ bone disease
^ liver disease
^ lactic acidosis
^ lipodystrophy
Stages 1 Liver Disease
Stage 1: any damage to the liver; toxins, immune system, NAFLD (non-alcoholic fatty liver disease), alcohol, hepatitis, biliary duct disease
Stage 2 Liver Disease
Stage 2: chronic and hepatocyte start to change into fibrous tissue
Stage 3 Liver Disease
continuation of change plus nodules
Stage 4 Liver Disease
Cirrhosis
sufficient amount of liver has been damaged
Type 1= compensated
Type 2= decompensated
Types of Cirrhosis
Alcoholic (previously Laennec’s)
Post-necrotic- a complication of viral, toxic, or idiopathic hepatitis
Biliary- associated w/ chronic biliary obstruction and infection
Cardiac- resulting from long-standing, severe right-sided HF
Cirrhosis risk factors
- alcohol
- malnutrition
- hepatitis
- biliary obstruction
- Right-sided HF
Early liver disease manifestations
fatigue
enlarged liver
dyspepsia
flatulence
N&V
change in bowel habits
abd pain (RUQ or epigastric)
Later manifestations of liver failure
Result from liver failure and portal hypertension
- jaundice
- skin lesions (spider angiomas, palmer erythema)
- hematological problems
- endocrine problems
- peripheral neuropathy
Decompensated Cirrhosis
! portal htn
! varices
! peripheral edema
! abdominal ascites
! hepatic encephalopathy
! hepatorenal syndrome
Hepatic Encephalopathy
!!! terminal comp. in liver disease
!!! liver unable to convert ammonia into urea
!!! toxic changes in neurologic function and mental responsiveness (sleep disturbance, lethargy, coma)
!!! Asterixis- characteristic symptom. Flapping tremors
!!! Fetor hepaticus- musty sweet odor in breath, digestive byproducts
Hepatorenal syndrome
- serious complication of cirrhosis
- functional renal failure with; azotemia, oliguria, intractable ascites
- no structural abnormality of kidney
- splanchnic and systemic vasodilation and decrease arterial blood vol.; renal vasoconstriction occurs with renal failure
Liver: Diagnostic studies
** liver biopsy (other tests can be done first)
* liver US
* differential analysis of ascitic fluid
* labs
Goals for liver disease
slow progression of disease
- rest
- B-complex vitamins
- avoidance of alcohol, aspirin, acetaminophen, NSAIDs
- prevention of variceal bleeding
- management of encephalopathy
Managing Hepatic encephalopathy
GOAL: decrease ammonia formation
- sterilization of GI tract w/ antibiotics
- lactulose
- cathartics/ enemas
Tx of precipitating cause
- control GI bleed
- treat electrolyte imbalances (hypokalemia), acid-base imbalances, infections
Contraindications for Liver Transplant
- advanced hepatocellular carcinoma
- severe extrahepatic disease: cancers, advanced heart/ lung/ renal disease
- ongoing drug/ alcohol abuse
- inability to understand or follow post-transplant treatment regimen
