Unit 2 - Management of Patients with Immune Deficiency Disorders (Ch. 32) Flashcards
Candidiasis
Fungal infection, usually of the skin or mucous membranes, caused by Candida species
Enzyme immunoassay (EIA)
A blood test that can determine the presence of antibodies to HIV in the blood or saliva; a variant of this test is called enzyme-linked immunosorbent assay (ELISA)
HIV-1
Retrovirus isolated and recognized as the etiologic agent of HIV disease
HIV encephalopathy
Clinical syndrome characterized by a progressive decline in cognitive, behavioral and motor functions
Immune reconstitution inflammatory syndrome (IRIS)
a syndrome that results from rapid restoration of pathogen-specific immune responses to opportunistic infections
Kaposi sarcoma
Malignancy that involved the epithelial layer of blood and lymphatic vessels
Latent reservoir
The integrated HIV provirus within the CD4+T cell during the resting memory state; does not express viral proteins and is invisible to the immune system and medications
Mycobacterium avium complex (MAC)
opportunistic infection caused by mycobacterial organisms that commonly causes a respiratory illness but can also infect other body systems
Opportunistic infection
Illness caused by various organisms, some of which typically do not cause disease in people with normal immune systems
Peripheral neuropathy
Disorder characterized by sensory loss, pain, muscle weakness, and wasting of muscles in the hands or legs and feet
Pneumocystis pneumonia (PCP)
Common opportunistic lung infection; pathogen implicated is pneumocystis jirovecii
Polymerase chain reaction (PCR)
A sensitive laboratory technique that can detect and quantify HIV in a person’s blood or lymph nodes
Post-exposure prophylaxis (PEP)
Taking antiretroviral medicines as soon as possible, but no more than 72 hours (3 days) after possible HIV exposure; two to three drugs are usually prescribed which must be taken for 28 days
Pre-exposure prophylaxis (PrEP)
Prevention method for HIV-negative people who are at high risk of HIV infection; involves taking a specific combination of HIV medicines daily; use condoms and other prevention tools
Primary immune deficiency diseases (PIDDs)
Rare, genetic disorders that impair the immune system
Retrovirus
A virus that carries genetic material in ribonucleic acid (RNA) instead of DNA and contains reverse transcriptase
Viral load test
Measures the quantity of HIV RNA or DNA in the blood
Viral set point
Amount of virus in the blood after the initial burst of viremia and the immune response that follows
Wasting syndrome
Involuntary weight loss consisting of both lean and fat body mass
What are primary immune deficiency disorders (PIDDs)
- Rare inherited disorders that impair the immune system
- These rare inherited disorders not only lead to frequent infections, but also to increased risk of autoimmune disorders
When are the majority of primary immune deficiency disorders (PIDDs) diagnosed?
Majority diagnosed in infancy
List some clinical manifestations of primary immune deficiency disorders (PIDDs)
- Multiple infection despite treatment
- Infection with unusual or opportunistic organisms
- Failure to thrive or poor growth
- Positive family history
Name some things a nurse could do to help manage a patient with a PIDD
- Be meticulous in the type of care they are giving
- Appropriate hand hygiene and infection precautions
- Continual monitoring of a patient’s condition, looking for early signs of infection
- Teach patients, family, caregivers how to administer medications and therapy at home
- Provide ongoing support and education and support for the patient and the a family
True or False: Immune deficiency can be acquired?
FALSE; Immune deficiency can be acquired due to medical treatment such as chemotherapy OR infection from pathogens such as human immune deficiency virus (HIV)
PLWHA?
Persons living with HIV/AIDS
Important aspects of care for PLWHA?
- Prevention
- Early detection
- Ongoing treatment
HIV-1 is transmitted in ______ ______ that contain ______ ______?
body fluids; infected cells
Name some modes of transmission for HIV-1
- Blood and blood products
- Seminal fluids
- Vaginal secretions
- Mother to child: Amniotic fluid, breast milk
- HIV-1 is not transmitted through casual contact
Risks associated with HIV infection (chart 32-2)?
- Sharing infected injection drug use equipment
- Having sexual relations with infected persons (both genders)
- Infants born to mothers with HIV infection or who are breast-fed by HIV-infected mothers
- People who receive organ transplants, HIV-infected blood, or blood products (especially between 1978 and1985)
Prevention of HIV infection in achieved via?
- Behavioral interventions
- HIV testing
- Linkage to treatment and care
How do behavioral interventions promote HIV infection prevention?
By ensuring that people have the information, motivation, and skill necessary to reduce their risks
How does HIV testing promote HIV infection prevention?
Most people change behaviors to protect their partners if they know they are infected with HIV
How does linkage to treatment and care promote HIV infection prevention?
Enables individuals with HIV to live longer, healthier lives and reduce their risk of transmitting HIV
Name some preventive educational considerations to protect against HIV infection
- Consistent and correct use of condoms
- Medical male circumcision
- Female condoms
- Dental dams
- Harm reduction framework for people who inject drugs
- Reproductive education
- LGTB communities
What is the idea behind harm reduction framework?
- Uses practical strategies and ideas aimed at reducing negative consequences associated with drug use
- Using harm reduction framework, the nurse works with people who inject drugs to assist them to increase their healthy behaviors
Topics for the nurse to consider when using harm reduction framework?
- Needle exchange programs
- The use of bleach to clean used needles and syringes
- Avoidance of sharing needles and syringes with others
Topics for the nurse to consider when providing reproduction education?
- The use of artificial insemination in some cases
- The benefits of taking ART to reduce perinatal HIV transmission
- Refrain from breastfeeding infants, because HIV is transmitted through breast milk
Topics for the nurse to consider when providing preventive education to the LGTB community?
- LGTB youth are at high risk for HIV infection
- Take into consideration that many of these people have no/limited social support, are stigmatized, are isolated, have increased stressors, and may have been abused/harassed
- Remain nonjudgmental in educating about HIV prevention
True or False: Lambskin condoms are available as an alternative for people with a latex allergy and protect against HIV infection?
False; Lambskin condoms do not protect against HIV infection
What type of precaution is used to prevent the risk of HIV transmission to health care providers?
Standard precaution
What is post-exposure prophylaxis (PEP)?
- PEP includes taking antiretroviral medicines as soon as possible, but no more than 72 hours (3 days) after possible HIV exposure
- 2 to 3 drugs are prescribe for 28 days
What type of virus is HIV?
HIV is in the subfamily of lentiviruses and is a RETROVIRUS because it carries its genetic material in the form of ribonucleic acid (RNA) rather than deoxyribonucleic acid (DNA)
What type of cells does HIV target
HIV targets cells with CD4+ receptors, which are expressed on the surface of T lymphocytes, monocytes, dendritic cells, and brain microglia
List the steps in the life cycle of HIV
- Attachment/Binding
- Fusion/Uncoating
- DNA synthesis (reverse transcription)
- Integration
- Transcription (DNA –> RNA)
- Translation (RNA –> proteins)
- Cleavage (protein modification)
- Assembly
- Budding
Describe the binding/attachment phase of the HIV life cycle and list the class of drugs used to stop infection at this stage
- HIV binds (attaches itself ) to the receptors on the surface of a CD4+ cell
Drugs: CCR5 antagonists, Post-attachment inhibitors
Describe the Fusion phase of the HIV life cycle and list the class of drugs used to stop infection at this stage
- The HIV envelope and the CD4+ cell membrane fuse (join together), which allows HIV to enter the cell
Drugs: fusion inhibitors
Describe the DNA synthesis (reverse transcription) phase of the HIV life cycle and list the class of drugs used to stop infection at this stage
- Inside the CD4+ cell, HIV releases and uses reverse transcriptase (an HIV enzyme) to convert its genetic material — HIV RNA — into HIV DNA. The conversion of HIV DNA allows HIV to enter the CD4+ cell nucleus an combine with the cell’s genetic material
Drugs: Non-nucleoside reverse transcriptase inhibitors (NNRTIs), Nucleoside reverse transcriptase inhibitors (NRTIs)
Describe the integration phase of the HIV life cycle and list the class of drugs used to stop infection at this stage
- Inside the CD4+ cell nucleus, HIV releases integrase (an HIV enzyme). HIV uses integrase to insert (integrate) its viral DNA into the DNA of the CD4+ cell
Drugs: Integrase inhibitors
Describe the replication (transcription/translation) phase of the HIV life cycle and list the class of drugs used to stop infection at this stage
- Once integrated into the CD4+ cell DNA, HIV begins to use the machinery of the CD4+ cell to make long chains of HIV proteins. The proteins chains are the building blocks for more HIV
Describe the assembly phase of the HIV life cycle and list the class of drugs used to stop infection at this stage
- New HIV proteins and HIV RNA move to the surface of the cell and assemble into immature (noninfectious) HIV
Describe the budding phase of the HIV life cycle and list the class of drugs used to stop infection at this stage
- Newly formed immature (noninfectious) HIV pushes itself out of the host CD4+ cell. The new HIV releases protease (an HIV enzyme). Protease breaks up the long protein chains in the immature virus, creating the mature (infectious) virus
Drugs: Protease inhibitors (PIs)
Normal CD4+ T-cell count
500-1500 cells/mm^3 of blood
HIV infection - Stage 0
Early HIV infection; inferred from laboratory testing
HIV infection - Stage 1
- Primary/acute
- Period of infection with HIV to the development of HIV-specific antibodies
- Dramatic drops in CD4+ T-cell counts (normally 500 to 1500 cells/mm^3 of blood)
HIV infection - Stage 2
Occurs when the CD4+ T-cell counts are between 200 and 499 cells/mm^3
HIV infection - Stage 3
- CD4+ T-cell count drops below 200 cells/mm^3 of blood
- Considered to have Aids for surveillance purposes
HIV infection - Stage unknown
No information on CD4+ T-cell count or percentage
