Week 11 HIV-AIDS Flashcards
What is a primary immunodeficiency
Genetic in origin
Predominately X-linked
Manifest in infancy and childhood
What are the characteristics of a secondary immunodeficiency
Affects the normal immune function
Extrinsic and intrinsic factors impair the immune response
18% of newly diagnosed HIV infections consist of what group of people?
people greater than 50 years old
HIV - gero considerations
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
HIV is what?
A virus whose genetic data is organized into dingle strands called RNA
HIV - survival requires what
HIV virus can not survived without a host - it needs a host/living cell to survive and replicate
HIV - what happens with the T cells
A T cell called CD4+ Helper cell helps destroy abnormal cells by signaling to its homeboys that there’s an intruder on the block
HIV seeks out what kind of cells?
CD4+ cells, infects them and takes over the way they function
What can HIV do once it seeks out CD4+ cells
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
What group has the biggest population that is most affected by HIV?
Gay and bisexual men
What kind of virus is HIV
blood borne, sexually transmission virus
What can transmit HIV to recipients?
Blood and blood products
How can HIV be transmitted?
Blood, blood products, vaginal secretions, seminal fluid, amniotic fluid, breast milk
What did the emergence of HIV prompt?
The implementation of standard precautions and the need for post-exposure prophylaxis
HIV risk factors:
- Sharing infected IV drug use equipment (needles)
- Sexual contact with HIV infected persons
- Infants born to HIV+ mothers who are breastfed by HIV+ mothers
- People who received organ transplants or HIV infected blood primarily between 1978-85
HIV prevention and education: safe sex practices
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
HIV prevention and education
Safe sex
Needle exchange programs
HIV women and pregnancy
PrEP: Pre-exposure prophylaxis
HIV prevention and education: Women and pregnancy
Education on risks of HIV exposure and transmission to baby
HIV prevention and education: PrEP (Pre-exposure prophylaxis)
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
HIV: Prevention measures for HCP
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
HIV prevention for HCP: PEP (Post-exposure prophylaxis)
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
Post-exposure prophylaxis for HCP - if you sustain a puncture, take the following actions immediately:
- Wash area thoroughly with soap and water
- Alert supervisor/nursing facility and initiate the injury-reporting system used in that setting
- 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
- 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.
- 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.
- 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.
- Follow up with postexposure testing at 1 month, 3 months, and 6 months.
- Document the exposure in detail for your own records, as well as for the employer.
What are examples of diagnostic tests for HIV?
HIV antibody test
Antigen and RNA testing specifically detect HIV
STARHS
Viral blood test
HIV diagnostics: HIV antibody test
Screens for bodies development of antibodies to HIV, not virus itself
Enzyme immunoassay (EIA) test
Nucleic Acid Testing (NAC)
HIV diagnostics: STARHS
Serologic Testing Algorithm for Recent HIV Seroconversion
– analyzes HIV+ blood to determine if infection is recent or has been ongoing
HIV diagnostics: Viral blood load
Better predictor of disease progression than CD4+ counts
Lower viral load usually correlates to longer time until AIDS diagnosis and longer survival time
What are the stages of HIV?
Acute infection
HIV asymptomatic
HIV symptomatic/AIDS
Stages of HIV: Acute infection
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
Stages of HIV: HIV asymptomatic
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
Stages of HIV: HIV symptomatic/AIDS
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
HIV Asymptomatic - body develops “viral set point”, which is what?
a balance between HIV levels and the immune response that is elicited
– higher set point = poorer prognosis
HIV manifestations: Respiratory
SOB Dyspnea (labored breathing) Cough Chest pain Fever
All associated with various opportunistic infections
HIV manifestations: GI
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
HIV manifestations: neuro
Immune response to HIV infection in the CNS includes: inflammation atrophy demyelination degeneration opportunistic infections primary or metastatic neoplasms metabolic encephalopathies
What neuro condition do we give IgG
Guillan barre (this is immunology but putting it in this set so i dont forget)
What are complications of HIV
HIV encephalopathy Depression Opportunistic infection Wasting syndrome B-cell lymphoma
What are common opportunistic infections someone with HIV is prone to?
Pneumocystic pneumonia (PCP) Tuberculosis Kaposi Sarcoma Cytomegalovirus (CMV) Candidiasis Cryptococcus Neoformans Mycobacterium Avium Complex (MAC)
What is Wasting syndrome?
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
Complication of HIV: B-cell lymphomas
Higher incidence of Hodgkin’s and Non-Hodgkin’s Lymphoma
Complication of HIV: HIV encephalopathy
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
What are early manifestations of HIV encephalopathy
memory deficits, headache, difficulty concentrating, progressive confusion, psychomotor slowing, apathy, and ataxia.
What are later manifestations of HIV encephalopathy
global cognitive impairments, delay in verbal responses, a vacant stare, spastic paraparesis, hyperreflexia, psychosis, hallucinations, tremor, incontinence, seizures, mutism, and death.
Complication of HIV: Depression
30-40% of patients, generalized apathy is common
Correlates with decreased compliance with ART
What is HIV treatment?
Antiretroviral therapy (ART)
What is the goal of ART?
To suppress HIV replication to a level below which drug-resistance mutations do not emerge
What are related ART goals?
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
How many approved antiretroviral meds are there?
more than 20 approved antiretroviral medications
how many meds will an HIV patient on ART be taking
patients will be on at least 3 different medications from 2 different classes
ART - what is essential?
Adherence - many meds have horrible sfx
What are barriers to adherence to ART?
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
How can the nurse promote adherence to ART?
- Simplifying treatment regiments
- Decreasing number of medications needing to be taken
- Linking medication taking to daily activities or using a medication reminder system or a pill organizer
- Positive relationship between the patient and health care provider
- Individualized plans of care that consider housing and social support issues
Nursing assessment and interventions: HIV / AIDS nutritional status
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)
What are labs that are monitored with someone how has HIV/AIDS in regard to nutrition
blood urea nitrogen (BUN), serum protein, albumin, and transferrin levels provide objective measurements of nutritional status.
HIV/AIDS: nutrition interventions
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
HIV Skin integrity assessment
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
HIV skin interventions
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
HIV respiratory assessment
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
HIV respiratory interventions
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
HIV neuro assessment
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
HIV neuro interventions
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
HIV - imbalanced fluid and electrolyte status
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
What are common electrolyte imbalances for someone with HIV/AIDS
decreased Na, K, Ca, Mg, Chl., - typically result from the profuse diarrhea
What are the s/s of electrolyte deficits with someone with HIV/AIDS
decreased mental status muscle twitching muscle cramps irregular pulse nausea and vomiting shallow respirations
