TOPIC 13 - HIV and Immunity Flashcards
immunity
body’s ability to resist disease
three functions of immunity
Defense
Homeostasis
Surveillance
innate immunity
present at birth
involves a nonspecific response (neutrophils and monocytes)
not antigen specific so it can respond within minutes
active immunity
Natural contact with antigen through actual infection (e.g., chickenpox, measles, mumps)
Immunization with antigen (e.g., vaccines for chickenpox, measles, mumps)
passive immunity
Transplacental and colostrum transfer from mother to child (e.g., maternal immunoglobulins passed to baby)
Injection of serum with antibodies from one person (e.g., injection of hepatitis B immune globulin) to another person who does not have antibodies
effects of aging on immune system
increased incidences of tumors
greater susceptibility to infection
increased autoantibodies
immunocompetence
body’s immune system can identify and inactivate or destroy foreign substances
triggers severe infection, immunodeficiency diseases, and malignancies
anaphylaxis
Mediators are released systemically (e.g., after injection of a drug, after an insect sting).
The reaction occurs within minutes and can be life threatening because of bronchial constriction and subsequent airway obstruction and vascular collapse.
autoimmunity
an immune response against self in which the immune system no longer differentiates self from nonself
examples of autoimmune diseases
Rheumatoid arthritis
Systemic lupus erythematosus
Inflammatory bowel disease
Multiple sclerosis
Type 1 Diabetes
immunosuppressant drugs
a class ofdrugsthat suppress, or reduce, the strength of the body’s immune system.
anti rejection drugs
Some of thesedrugsare used to make the body less likely to reject a transplanted organ, such as a liver, heart, or kidney.
standard precautions
CMV
HIV
Hep B and C
aspergilosis
contact precautions
MRSA
VRE
Adenovirus
Diarrhea
C diff
Rotavirus
E coli
Enterovirus
Salmonella
Shingles
Hep A
Herpes Zoster and Simplex
RSV
Lice
Scabies
Chicken pox
droplet precautions
pertussis
influenza a and b
MRSA
neissera meningitis
coxsackle
bacterial meningitis
RSV
mumps
rubella
airborne precautions
chicken pox
disseminated herpes zoster
measles
TB
SARS
avian influenza
stress
inability to cope with perceived demands or threats to ones mental, emotional, and spiritual well being
examples of stressors
can be physiologic (pain, noise, starvation, infection) or emotional (diagnosis of cancer, death of spouse, caring for disabled child, marital problems)
long term effects of stress
linked to leading cause of death
impaired cognitive function
negative changes in lifestyle behaviors : increase risk of CV diseases, decrease control of metabolic conditions, make us more susceptible to infection
coping strategies for stress
Aromatherapy
Art therapy
Exercise
Humor
Journaling
Pet therapy
Social support
relaxation strategies
Imagery
Massage
Meditation
Muscle relaxation
Music
Relaxing breathing
Yoga
affect of stress on the immune system
decreasing the number and function of natural killer cells
decreasing lymphocyte proliferation
altering production of cytokines
decreasing phagocytosis by neutrophils and monocytes
HIV
causes immunosuppression making persons more susceptible to infections
how can HIV be transmitted
contact and certain body fluids (blood, semen, vaginal secretion, breast milk)
contact with blood for spread of HIV
sharing drug use
needle stick
exposure of non intact skin and mucous membranes to blood and body fluids
what precaution is there for HIV
standard
HIV infectious process
- CD4+ T-cells become “HIV factory” to make new viral particles daily
- Gradually, CD4+ T-cell count falls, viral load rises
- Immune systems weakens
- Everyone with AIDS has HIV; not everyone with HIV has AIDS
when do manifestations present for HIV
2-4 weeks after infection
clinical manifestations of HIV
Mononucleosis-like syndrome (fever, swollen lymph nodes, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and/or a diffuse rash)
Neurologic complications (aseptic meningitis, peripheral neuropathy, facial palsy, or Guillain-Barré syndrome)
Highviral load(the amount of HIV circulating in the blood)
CD4+T cell counts fall temporarily but quickly return to baseline or near-baseline levels
Most infectious time because of the high amounts of circulating HIV.
patho of HIV
Immune problems start when CD4+ T cell counts drop to < 500 cells/μL (Normal range 800-1200 cells/μL)
Severe problems develop when < 200 CD4+ T cells/μL
clinical manifestations and complications for asymptomatic infections
Left untreated, a diagnosis of AIDS is made about 10 years after initial HIV infection
Symptoms are generally absent or vague and people do not change their high risk sexual behaviors
clinical manifestations and complications for symptomatic infections
CD4+ T cells decline closer to 200 cells/μL
Symptoms become worse
HIV advances to a more active stage
general manifestations
Weight loss
Cough
Sore throat
Headache
Swollen lymph nodes
Diarrhea
Vomiting
Muscle pain
Joint pain
Skin rashes
Fevers
chronic symptoms after having AIDS
fever,
frequent night sweats,
chronic diarrhea,
recurrent headaches, and
severe fatigue may develop.
opportunistic infections that occur with AIDS/HIV
Oropharyngeal candidiasis (Thrush)
Varicella – zoster virus (Shingles)
Persistent vaginal candida infections
Herpes (oral and/or genital)
Pneumocystis jiroveci pneumonia
Karposi’s sarcoma
Hepatitis B & C
kaposi sarcoma
Malignant vascular lesions such as Kaposi sarcoma lesions can appear anywhere on skin surface or on internal organs.
what treatment is there for kaposi sarcoma
local : radiation therapy, cryosurgery, or a topical retinoid, may be used if a person has only a few skin lesions
oral hairy luemmoplakia
Epstein-Barr virus infection that causes painless, white, raised lesions on the lateral aspect of the tongue, can occur at this phase of the infection and is another indicator of disease progression.
Pneumocystis jiroveci Pneumonia
Pneumocystis jiroveci is a type of pneumonia that can appear as an opportunistic disease associated with HIV infection.
when would an opportunistic infection NOT occur
in the presence of a functioning immune system
diagnostic criteria for AIDS
patient needs at least one of the following
1.CD4+T cell count drops below 200 cells/µL.
2.One of the following opportunistic infections :
Fungal
Viral
Protozoal
Bacterial
3. One of the following opportunistic cancers:
Invasive cervical cancer
Kaposi sarcoma (KS)
Burkitt’s lymphoma
Immunoblastic lymphoma
Primary lymphoma of the brain
4.Wasting syndrome.Wastingis defined as a loss of 10% or more of ideal body mass.
diagnostic studies for HIV
May take several weeks to detect antibodies (window period)
Performed using blood or saliva
Combination (4th generation) tests can detect HIV earlier
labs for HIV
CD4 T cell counts (marker for immune function)
viral load (lower = less active)
blod chemistry, CBC, stool, biopsy
interprofessional care for HIV
Monitor disease progression, immune function, and manage symptoms
Initiate and monitor ART
Prevent, detect and/or treat opportunistic infections
Prevent or decrease complications of therapies
Prevent further transmission of HIV
goals of drug therapy for HIV
Decrease viral load
Maintain/increase CD4+T counts
Prevent HIV-related symptoms and opportunistic diseases
Delay disease progression
Prevent HIV transmission
HIV cannot be cured but what can delay the disease progression by decreasing viral replication
ART (when taken consistently and correctly)
when is ART therapy started
To avoid burnout and non-adherence, treatment is recommended when immune suppression is great
what is the benefit of using drugs from different classes for HIV
combination therapy can inhibit viral replication in several different ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance.
examples of infections associated with HIV
Infections – Opportunistic, protozoal, fungal, bacterial, viral
examples of malignancies associated with HIV
Malignancies – Kaposi’s sarcoma (KS), malignant lymphomas, invasive cancers, HPV
who are at risk for developing HIV
those who received blood transfusion or clotting factors before 1985
Shared needles with another person
Had a sexual experience with a penis, vagina, rectum, or mouth in contact with these areas of another person
Had a sexually transmitted infection
general nursing assessment of HIV
Lethargy, persistent fever, enlarged lymph nodes, peripheral wasting,
assessment of eyes of HIV patient
Presence of exudates, retinal lesions or hemorrhage, papilledema
assessment of integumentary system of HIV patient
Decreased skin turgor, dry skin, diaphoresis. Pallor, cyanosis. Lesions, eruptions, discolorations, bruises of skin or mucous membranes. Vaginal or perianal excoriation. Alopecia. Delayed wound healing
assessment of respiratory system of HIV patient
Tachypnea, dyspnea, intercostal retractions. Crackles, wheezing, productive or nonproductive cough
assessment of cardiovascular system with HIV patient
Pericardial friction rub, murmur, bradycardia, tachycardia.
assessment of GI in HIV patient
Mouth lesions, including blisters (HSV), white-gray patches (Candidainfection), painless white lesions on lateral aspect of the tongue (hairy leukoplakia), discolorations (KS). Gingivitis, tooth decay or loosening. Redness or white patchy lesions of throat. Vomiting, diarrhea, incontinence, rectal lesions, hyperactive bowel sounds, abdominal masses, hepatosplenomegaly
assessment of musculoskeletal system in HIV patient
Muscle wasting, weakness
assessment of neurologic system in HIV patient
Ataxia, tremors, lack of coordination. Sensory loss, slurred speech, aphasia. Memory loss, peripheral neuropathy, apathy, agitation, depression, inappropriate behavior. Decreasing levels of consciousness, seizures, paralysis, coma
assessment of reproductive system in HIV patient
Genital lesions or discharge, abdominal tenderness secondary to pelvic inflammatory disease (PID)
how to prevent HIV
avoid and modify risky behaviors
abstinence and condoms
downsides to ART
Is complex
Has side effects
Does not work for everyone
Is expensive
what is the role of ART in preventing HIV
Inhibits viral replication but does not kill the virus.
who should not do ART
If an HIV patient can not be compliant they should not be started on therapy.
drug side effects
Anxiety, fear, depression
Diarrhea
Peripheral neuropathy
Pain
Nausea/vomiting
Fatigue
Skin rash
CNS – Dizziness, mood changes
TB precautions
airborne
scabies precautions
contact
shingles precautions
airborne
mumps precautions
droplet
pneumonia precautions
droplet
MRSA precautions
contact
measles precautions
airborne
AIDS precautions
standard
