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NURSING 3 > Week 11 HIV-AIDS > Flashcards

Week 11 HIV-AIDS Flashcards

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1
Q

What is a primary immunodeficiency

A

Genetic in origin
Predominately X-linked
Manifest in infancy and childhood

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2
Q

What are the characteristics of a secondary immunodeficiency

A

Affects the normal immune function

Extrinsic and intrinsic factors impair the immune response

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3
Q

18% of newly diagnosed HIV infections consist of what group of people?

A

people greater than 50 years old

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4
Q

HIV - gero considerations

A

a. older adults recently widowed or divorced are dating again and may not be aware of HIV
b. Many older adults are sexually active but do not use condoms, viewing them only as a means of unneeded birth control.
c. Older adults may be IV/injection drug users.
d. Older adults may have received HIV-infected blood through transfusions before 1985.
e. Normal age-related changes include a reduction in immune system function, which puts the older adult at greater risk for infections, cancers, and autoimmune disorders. Many older adults also experience the loss of loved ones, resulting in depression and bereavement, factors that are associated with depressed immune function

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5
Q

HIV is what?

A

A virus whose genetic data is organized into dingle strands called RNA

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6
Q

HIV - survival requires what

A

HIV virus can not survived without a host - it needs a host/living cell to survive and replicate

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7
Q

HIV - what happens with the T cells

A

A T cell called CD4+ Helper cell helps destroy abnormal cells by signaling to its homeboys that there’s an intruder on the block

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8
Q

HIV seeks out what kind of cells?

A

CD4+ cells, infects them and takes over the way they function

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9
Q

What can HIV do once it seeks out CD4+ cells

A

HIV can now turn its RNA into DNA strands using enzyme reverse transcriptase (they fancy…)

HIV DNA is now infused into CD4+ cells’ nuclei…”new phone, who dis”?

CD4+ cells are now like robots – instead of them being the “look out boys” their purpose now is to rapidly produce more HIV inside their cells

CD4+ cells are stripped of all their street cred (dishonorable discharge) – these cells eventually have a shorter lifespan and are destroyed…dying without any honorable mentions

HIV virions are like little gremlins, once that CD4+ cell is dead, they push themselves out of that cell and look for more CD4+ to attack and the cycle repeats itself

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10
Q

What group has the biggest population that is most affected by HIV?

A

Gay and bisexual men

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11
Q

What kind of virus is HIV

A

blood borne, sexually transmission virus

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12
Q

What can transmit HIV to recipients?

A

Blood and blood products

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13
Q

How can HIV be transmitted?

A

Blood, blood products, vaginal secretions, seminal fluid, amniotic fluid, breast milk

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14
Q

What did the emergence of HIV prompt?

A

The implementation of standard precautions and the need for post-exposure prophylaxis

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15
Q

HIV risk factors:

A
  1. Sharing infected IV drug use equipment (needles)
  2. Sexual contact with HIV infected persons
  3. Infants born to HIV+ mothers who are breastfed by HIV+ mothers
  4. People who received organ transplants or HIV infected blood primarily between 1978-85
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16
Q

HIV prevention and education: safe sex practices

A

Abstinence usually not realistic

Education on safe sex practices - condoms, limiting partners, etc.

Early access to testing - most people will change behaviors to protect partners if they know they are infected

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17
Q

HIV prevention and education

A

Safe sex
Needle exchange programs
HIV women and pregnancy
PrEP: Pre-exposure prophylaxis

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18
Q

HIV prevention and education: Women and pregnancy

A

Education on risks of HIV exposure and transmission to baby

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19
Q

HIV prevention and education: PrEP (Pre-exposure prophylaxis)

A

One pill that contains two different HIV medications
Taken daily in order to reduce the risk of sexual HIV acquisition
Patient should be tested for HIV ever 3 months

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20
Q

HIV: Prevention measures for HCP

A

Implementation of standard precautions

Healthcare workers who are exposed to a needle stick involving HIV-infected blood have a 0.23% risk of becoming HIV infected

PEP: Post-exposure prophylaxis

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21
Q

HIV prevention for HCP: PEP (Post-exposure prophylaxis)

A

Includes taking antiretroviral medicines as soon as possible, but not more than 72 hours (3 days) after possible HIV exposure

2 to 3 drugs are usually prescribed which must be taken for 28 days

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22
Q

Post-exposure prophylaxis for HCP - if you sustain a puncture, take the following actions immediately:

A
  1. Wash area thoroughly with soap and water
  2. Alert supervisor/nursing facility and initiate the injury-reporting system used in that setting
  3. Identify the source patient who may need to be tested for HIV, hepatitis B, and hepatitis C. State laws will determine whether written informed consent must be obtained from the source patient before his or her testing. Rapid testing should be used, if possible, if the HIV status of the source patient is unknown because results can be available within 20 minutes
  4. Report as quickly as possible to employee health services, the emergency department, or other designated treatment facility. This visit should be documented in the health care worker’s confidential medical record.
  5. Give consent for baseline testing for HIV, hepatitis B, and hepatitis C. Confidential HIV testing can be performed up to 72 hours after the exposure but should be performed as soon as the health care worker can give informed consent for baseline testing.
  6. Get postexposure prophylaxis for HIV in accordance with CDC guidelines. Start the prophylaxis medications within 2 hours after exposure. Postexposure prophylaxis must be initiated within 72 hours of exposure to be effective. Make sure that you are being monitored for symptoms of toxicity. Practice safer sex until follow-up testing is complete. Continue the HIV medications for 4 weeks.
  7. Follow up with postexposure testing at 1 month, 3 months, and 6 months.
  8. Document the exposure in detail for your own records, as well as for the employer.
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23
Q

What are examples of diagnostic tests for HIV?

A

HIV antibody test
Antigen and RNA testing specifically detect HIV
STARHS
Viral blood test

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24
Q

HIV diagnostics: HIV antibody test

A

Screens for bodies development of antibodies to HIV, not virus itself

Enzyme immunoassay (EIA) test

Nucleic Acid Testing (NAC)

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25
Q

HIV diagnostics: STARHS

A

Serologic Testing Algorithm for Recent HIV Seroconversion

– analyzes HIV+ blood to determine if infection is recent or has been ongoing

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26
Q

HIV diagnostics: Viral blood load

A

Better predictor of disease progression than CD4+ counts

Lower viral load usually correlates to longer time until AIDS diagnosis and longer survival time

27
Q

What are the stages of HIV?

A

Acute infection
HIV asymptomatic
HIV symptomatic/AIDS

28
Q

Stages of HIV: Acute infection

A

1st stage
Period of infection to development of HIV antibodies (Time of infection to 2-4 weeks)

High levels of viral replication, widespread dissemination of HIV throughout body, and destruction of CD4+ cells

Patient may have vague, flu-like symptoms

Person may be unaware of infection, high risk of transmission

29
Q

Stages of HIV: HIV asymptomatic

A

2nd stage - “clinical latency stage” - virus slowly developing but does not cause s/s

Patient appears in good health - still have enough CD4+ cells to preserve immune defense

CD4+ counts: 500-1500

Without treatment, can last up to 10 years; with treatment, several decade

30
Q

Stages of HIV: HIV symptomatic/AIDS

A

3rd stage - CD4+ count less than 200 or presence of opportunistic infection(s)

High viral load, high risk of transmission

Survival without treatment averages 3 years

31
Q

HIV Asymptomatic - body develops “viral set point”, which is what?

A

a balance between HIV levels and the immune response that is elicited

– higher set point = poorer prognosis

32
Q

HIV manifestations: Respiratory

A 
SOB
Dyspnea (labored breathing)
Cough
Chest pain
Fever

All associated with various opportunistic infections

33
Q

HIV manifestations: GI

A

Decrease appetite, n/v, oral and esophageal candidiasis, chronic diarrhea

Symptoms may be related to the direct inflammatory effect of HIV on the cells lining the intestines or infection with various bacteria- Cryptosporidium, Salmonella, Giardia, CMV, C Diff

Effects of diarrhea can be devastating in terms of profound weight loss (more than 10% of body weight), fluid and electrolyte imbalances, perianal skin excoriation, weakness, and inability to perform the usual activities of daily living

34
Q

HIV manifestations: neuro

A 
Immune response to HIV infection in the CNS includes: inflammation
atrophy 
demyelination
degeneration
opportunistic infections
primary or metastatic neoplasms
metabolic encephalopathies
35
Q

What neuro condition do we give IgG

A

Guillan barre (this is immunology but putting it in this set so i dont forget)

36
Q

What are complications of HIV

A 
HIV encephalopathy 
Depression 
Opportunistic infection
Wasting syndrome 
B-cell lymphoma
37
Q

What are common opportunistic infections someone with HIV is prone to?

A 
Pneumocystic pneumonia (PCP)
Tuberculosis
Kaposi Sarcoma
Cytomegalovirus (CMV)
Candidiasis
Cryptococcus Neoformans
Mycobacterium Avium Complex (MAC)
38
Q

What is Wasting syndrome?

A

Involuntary loss of >10% of one’s body weight while having experienced diarrhea, weakness or fever for more than 30 days

Loss of muscle mass in addition to fat

39
Q

Complication of HIV: B-cell lymphomas

A

Higher incidence of Hodgkin’s and Non-Hodgkin’s Lymphoma

40
Q

Complication of HIV: HIV encephalopathy

A

Progressive decline in cognitive, behavioral, and motor functions as a direct result of HIV infection

HIV infection is thought to trigger the release of toxins or lymphokines that result in cellular dysfunction, inflammation, or interference with neurotransmitter function

41
Q

What are early manifestations of HIV encephalopathy

A

memory deficits, headache, difficulty concentrating, progressive confusion, psychomotor slowing, apathy, and ataxia.

42
Q

What are later manifestations of HIV encephalopathy

A

global cognitive impairments, delay in verbal responses, a vacant stare, spastic paraparesis, hyperreflexia, psychosis, hallucinations, tremor, incontinence, seizures, mutism, and death.

43
Q

Complication of HIV: Depression

A

30-40% of patients, generalized apathy is common

Correlates with decreased compliance with ART

44
Q

What is HIV treatment?

A

Antiretroviral therapy (ART)

45
Q

What is the goal of ART?

A

To suppress HIV replication to a level below which drug-resistance mutations do not emerge

46
Q

What are related ART goals?

A

Reduce HIV-associated morbidity and prolong the duration and quality of survival

Restore and preserve immunologic function

Maximally and durably suppress plasma HIV viral load

Prevent HIV transmission

47
Q

How many approved antiretroviral meds are there?

A

more than 20 approved antiretroviral medications

48
Q

how many meds will an HIV patient on ART be taking

A

patients will be on at least 3 different medications from 2 different classes

49
Q

ART - what is essential?

A

Adherence - many meds have horrible sfx

50
Q

What are barriers to adherence to ART?

A

Psychosocial barriers such as depression and other mental illnesses
Neurocognitive impairment
Low health literacy
Low levels of social support
Stressful life events
High levels of alcohol consumption and active substance use
Homelessness/poverty
Denial/poor coping mechanisms
Fear from associated stigma
Inconsistent access to medications affect adherence to ART
Drug side effects

51
Q

How can the nurse promote adherence to ART?

A
  1. Simplifying treatment regiments
  2. Decreasing number of medications needing to be taken
  3. Linking medication taking to daily activities or using a medication reminder system or a pill organizer
  4. Positive relationship between the patient and health care provider
  5. Individualized plans of care that consider housing and social support issues
52
Q

Nursing assessment and interventions: HIV / AIDS nutritional status

A

Obtaining a dietary history and identifying factors that may interfere with oral intake, such as anorexia, nausea, vomiting, oral pain, or difficulty swallowing.

Socioeconomic factors: patient’s ability to purchase, prepare, and store food safely

Weight history (changes over time)

53
Q

What are labs that are monitored with someone how has HIV/AIDS in regard to nutrition

A

blood urea nitrogen (BUN), serum protein, albumin, and transferrin levels provide objective measurements of nutritional status.

54
Q

HIV/AIDS: nutrition interventions

A

a. Daily weight / dietary intake log
b. encourage high calorie, high protein foods that do not stimulate intestinal motility
c. antiemetics prior to meals
d. treat oral thrush
e. dietician consult, nutritional supplements/shakes
f. enteral or parenteral nutrition

55
Q

HIV Skin integrity assessment

A

Inspect daily for breakdown, ulceration or infection

Assess oral cavity for redness, ulcerations, and presence of creamy-white patches (yeast)

Peri area: assess for excoriation and infection in patients with profuse diarrhea

Wounds are cultured to ID infectious agents

56
Q

HIV skin interventions

A

Skin and oral mucosa are monitored routinely for changes in appearance, location, and size of lesions and evidence of infection and breakdown

Q2turn, low air loss mattress

Adhesive tape - avoided

Skin surfaces are protected from friction and rubbing by keeping free of wrinkles and avoiding tight or restrictive clothing

57
Q

HIV respiratory assessment

A

Assess for cough, sputum production (amount and color), SOB, orthopnea, tachypnea, chest pain

Presence and quality of breath sounds

CXRay results, ABG, pulse oximetry, pulmonary function test results

58
Q

HIV respiratory interventions

A

Pulmonary therapy (cough, deep breathing, postural drainage, percussion, vibration) Q2 hours to prevent stasis of secretions and to promote airway clearance

Adequate hydration to facilitation mucous clearance

Humidified o2

Suctioning

59
Q

HIV neuro assessment

A

LOC, orientation (person, place, time, and memory lapses)

Assess mental status ASAP to establish baseline

Sensory deficits (visual changes, headache, numbness, tingling) and/or motor involvement (altered gait, paresis, or paralysis) and seizure activity

60
Q

HIV neuro interventions

A

Speak in simple, clear language and give the patient sufficient time to respond to questions

Reorientation to surroundings and location as needed

Post schedule to prominent area (ex. fridge)

Provide night lights for bedroom and bathroom

Maintain routine

Incorporate patient preferred activities to maintain sense of normalcy

61
Q

HIV - imbalanced fluid and electrolyte status

A

Examining the skin and mucous membranes for turgor and dryness

Increased thirst, decrease UOP, postural hypotension, weak/rapid pulse, urine specific gravity of 1.025 or more

62
Q

What are common electrolyte imbalances for someone with HIV/AIDS

A

decreased Na, K, Ca, Mg, Chl., - typically result from the profuse diarrhea

63
Q

What are the s/s of electrolyte deficits with someone with HIV/AIDS

A 
decreased mental status
muscle twitching
muscle cramps
irregular pulse
nausea and vomiting
shallow respirations

NURSING 3 (16 decks)

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