Ch, 20 Nursing Care of Patients w/ HIV Disease and AIDs

Acquired immunodeficiency syndrome(AIDS)

- (AIDS) Acquired Immunodeficiency Syndrome - Final Phase of HIV Infection - No Cure - Can Be Fatal

How can a nurse help an AIDS client with wasting syndrome

- AIDS wasting syndrome is challenging. - Do not give up! - Be creative in developing interventions to help increase the patient's appetite and calorie intake. - Small, frequent meals are usually helpful. - A registered dietitian can be a helpful member on the care team for HIV patients.

Safer Sex Practices and rationales

- Abstinence >> only sure way - Monogamous Sexual Relationship >> must be mutual >> considered safest when both partners are tested and HIV-negative - Limit Sexual Partners >> obvious benifits - Condoms >> correctly and regularly - Dental Dams >> latex sheets, for mouth, genitals, or anus - Latex Gloves >> during genital and anus

HIV

- Human Immunodeficiency Virus (HIV) - Chronic Infection - Sometimes Progressive Immune Disorder - HIV can Cause AIDS in Time

Therapeutic Interventions overview

- No Cure - Begin HAART - Goal of Therapy >> Prevent/Delay Opportunistic Diseases

General Testing overview

- Syphilis - Hepatitis A, B, C - Liver Chemistry Panels

What is the average number of years reported for the latency stage?

- This period,from infection to the beginning of the symptomatic stage,varies for each person and averages 8 to 12 years. - During this stage individual are considered HIV infected.

Complications: Cytomegalovirus (CMV)

- an infection can be serious for those with HIV/AIDS, - especially when CD4+ T-lymphocyte counts fall below 100/mm3. - can cause retinitis, which can result in blindness. - Other symptoms can include: >> fever >> fatigue >> diarrhea >> GI upset >> hepatitis

Planning and Implementation Impaired Gas Exchange

- goal: to maintain oxygenation within normal limits and reduce dyspnea - PCP is a potential respiratory infection with AIDS - Monitoring the patient's vital signs, including >> respiratory rate >> depth >> rhythm >> oxygen saturation - Medications and oxygen therapy are given as ordered. - Positioning the patient for comfort is often done by raising the head of the bed - Assisting with activities helps reduce fatigue.

How is HIV transmitted from person to person?

- infected blood - vaginal secretions - semen - breastmilk - body fluids containing blood

The nurse would recognize the need for further teaching about HIV if the patient stated which of the following about HIV? 1. "HIV is an Acute Infection". 2. "It Can be a Progressive Immune Disorder." 3. "Over time, HIV Can Cause AIDS." 4. "HIV Results in Death."

1. "HIV is an Acute Infection".

What is the only sure way to prevent sexual exposure to HIV?

Abstaining from sexual intercourse Abstinence

At what stage does HIV greatly impair the immune system?

After an extended asymptomatic phase, untreated HIV infection usually progresses to a symptomatic stage when the virus has greatly impaired the immune system.

What is the safest type of blood transfusion to prevent HIV infection?

Autologous (one's own) blood transfusion. - There is a reported 1 in 1.8 million units chance of HIV transmission from donated blood that is infected but has not yet had time to develop antibodies.

Does testing positive for HIV mean the client has AIDS?

Being HIV-positive means that the person has been infected with the HIV virus. It does not mean that the person has AIDS.

Pt Education: Condom use to prevent HIV Transmission

Condoms should be >> New for each sex act. >> Made of latex, because other materials have large pores that allow HIV to pass >> Undamaged and used before expiration date >> Applied before partner is touched. (Tip of condom is held while unrolling over erect penis, allowing room at tip for semen collection.) >> Used with adequate amounts of only water- soluble lubricant. (Petroleum or oil-based lubricants such as petroleum jelly, cooking oil, shortening, or lotions can damage latex condoms.) >> Replaced if broken. (If ejaculation occurs before replacement, immediate use of a spermicide can give some protection.) >> Withdrawn from partner by holding condom against base of erect penis to avoid semen leakage.

DIARRHEA

Diarrhea can be caused by: >> HIV infection >> opportunistic infections >> ARTs - antimotility agent can be prescribed. - Consult dietitian for dietary changes that reduce diarrhea (e.g., low-residue diet, no dairy products, no spicy foods, no caffeine or alcohol). - Sitz baths can be soothing. Thorough cleansing of the anal area after each stool is a must. - Ointments can be applied to protect and soothe the anal area from excoriation.

What are the best ways to manage the HIV/AIDS epidemic

Education and prevention. - Education regarding the disease and its transmission should begin with the older school-age child and include the general population, including older adults

When can HIV be transmitted to others

HIV can be transmitted to others within a few days of initial infection and throughout all phases of the HIV and AIDS infection.

What type of virus is HIV?

HIV is a retrovirus (which only has ribonucleic acid[RNA] for genetic material).

What type of immune cells is HIV attracted to?

HIV is attracted to immune cells that have a surface-attaching site referred to as a CD4 receptor.

What are the two strains of HIV that have been identified?

HIV-1 and HIV-2. - HIV-1 is found around the world - HIV-2 is found mainly in a small area in W. Africa. - it IS possible to become infected with both strains of HIV.

What is needed for HIV to enter the body?

PORTAL OF ENTRY - HIV is not spread casually and does not live long when outside the body. - It needs a portal of entry into the body, such as a tear in a mucous membrane or nonintact skin, or access to the bloodstream or lymphatic tissue.

How effective is starting early ARV therapies for HIV-infected individuals in reducing HIV transmission rates to the uninfected sexual partners?

Research has shown 96% effectiveness

How effective is PrEP with an ARV for non-HIV-infected people who inject drugs in reducing HIV exposure?

Research showed 49%. This is another option for reducing HIV transmission risk.

Best way to prevent parenteral transmission of HIV?

avoid or stop injecting drugs and enroll in a substance abuse treatment program

Final stage of HIV Infection

- AIDS Diagnosis >> CD4+T Lymphocyte Count Below 200 OR >> Opportunistic Infections and Diseases

HIV/AIDS Summary for complications

- AIDS wasting syndrome - Opportunistic infections and cancer - AIDS dementia complex

What is the window period and why is it important?

- After a person has been infected with HIV, other immune system components form antibodies to fight HIV. - These HIV antibodies typically become present within 3 to 6 months after infection. - The time between infection and developing antibodies is called the window period. - Testing for these antibodies can be done to diagnose HIV. - Laboratory tests are available that detect the virus directly, but these are more costly for routine HIV testing.

Nursing Interventions: Fatigue

- Alternate Activity and Rest - Prioritize Activity Timing >> tasks that use more energy should be planned at times when the patient is most energetic.

HIV Antibody Tests: Explain the traditional HIV-1 antibody testing pattern

- An enzyme-linked immunosorbent assay (ELISA) test is done to detect antibodies to HIV antigen in the patient's blood using test plates. - If positive, the ELISA test is repeated because false positives can occur (0.1%). - If the ELISA test is again positive, the Western blot test is done to detect the presence of antibodies to four major HIV antigens. The test is positive if two antibodies are present. - If all test results are positive, the patient is HIV-antibody positive. - If the test is negative, the patient is said to be in the window period or HIV negative. - Other tests can be used, especially if initial test results are not conclusive. Testing directly for the virus is available but more costly.

What is done for the pregnant woman who have not been tested for HIV at the time of labor?

- At the time of labor, pregnant women who have not been tested for HIV should be offered rapid HIV tests, and therapy should be started if HIV is confirmed. - After delivery,the infant of a mother with HIV is given AZT for 6 weeks.

What questions should be asked of the older population (50+) as well as information provided?

- Be sure to ask about: >> sexual history >> drug history - Give preventive education and information about products that reduce transmission of HIV and sexually transmitted infections(STIs). >> less likely to use condoms ( thought of as a birth control measure) >> less likely to be tested for HIV.

Why are the number of older adults living with HIV increasing?

- Because older adults are not usually taught HIV prevention, the rise in HIV infection among older adults is expected to continue. - With AIDS death rates dropping as a result of more effective treatments, the number of older adults living with HIV will increase.

Complete Blood Cell Count/Lymphocyte Count

- Because patients with HIV are susceptible to leukopenia,lymphopenia, anemia, and thrombocytopenia related to HIV infection and as a complication of antiretroviral therapy, acomplete blood cell count (CBC) including a lymphocytecount should be obtained. - The CBC should be repeated at 3-to 4-month intervals or more often if there is a change in therapy or the patient's clinical course is unstable.

Complications: Opportunistic Infection/ Cancer

- Candida Albicans - Cytomegalovirus - Pneumocystis Jiroveci Pneumonia - Tuberculosis - Viral Infections - Kaposi's Sarcoma

What interactions with an HIV client would not result in being infected?

- Casual contact such as hugging, closed-mouth kissing, shaking hands, or sharing eating utensils, towels, or bathroom fixtures with an HIV-positive person does not transmit HIV. - It is not transmitted in the air, water, food,or by insects.

Complications: Tuberculosis

- Causes: >> a bacterial infection caused by the mycobacterium tuberculosis. - Symptoms include >> dyspnea >> cough >> chest pain >> fever >> night sweats >> weight loss.

Therapeutic Intervention Antiretroviral Therapy (ART) overview

- Early, Aggressive Treatment - Multiple-drug Therapy >> Three Drugs in at Least Two Classes of Treatment Categories - Reduces Viral Load to Undetectable Level - Prolongs Survival

Pre-exposure prophylaxis (PrEP) overview

- Effective Prevention for those at High Risk - Antiretroviral Drug - Daily Pill - Used with Other transmission Precautions

HIV Antibody Testing Pattern overview

- Enzyme-linked Immunosorbent Assay - If Positive, Repeat Test - If Again Positive, Western Blot Test - If All Positive, HIV-antibody Positive

Post HIV Infection Signs and symptoms

- Fatigue - Headache - Fever - Lymphadenopathy - Diarrhea - Sore throat

Which gender has the greater risk for becoming infected with HIV and why? Is it the same gender that has the greater chance at giving the infections?

- Females have a greater risk for becoming infected because the vagina has a greater area of mucous membranes than the penis, and there is a greater amount of HIV found in semen compared with vaginal secretions. - The presence of a STI can increase the risk of transmission through an STI-related lesion.

Dx testing

- HIV Antibody Tests - CBC - Lymphocyte Count - CD4+/CD8+ T-lymphocyte Count - Viral Load Testing - Genotyping

HIV Pathophysiology overview

- HIV Viral Particle Taken into Human Cell - Reverse Transcriptase Forces Human Cell to Produce New DNA from Viral RNA - HIV Particles Spread via Lymphoid System - HIV Attracted to CD4+ T-lymphocytes - CD4+ T-lymphocytes Function Abnormally >> Busy Replicating More HIV Impairment of Immune System Results

HIV/AIDS Summary for Dx test

- HIV antibody tests - RNA Tests - Complete blood cell ct / lymphocyte count - CD4+/CD8+ T-lymphocyte count - Viral load testing - Genotyping

what cells are the primary targets for HIV infections. How does HIV infections begin ( pathologically speaking)?

- HIV begins its infection by binding to the CD4 receptor of the host cell. - The CD4+ T lymphocytes are the primary targets for HIV infection. >>Because CD4+ T lymphocytes orchestrate all immune functions, HIV's attack on these cells results in progressive impairment of the body's immune response. The CD4+ T lymphocytes do not function normally and are too busy replicating more HIV to perform their intended immune functions. >> After fusion occurs with a host cell, the HIV viral particle is taken into the cell and its covering is destroyed to expose its viral RNA. >> The retrovirus then uses an enzyme called reverse transcriptase to force the human cell to produce a new piece of DNA from the viral RNA. >> The new DNA is then integrated into the person's cellular DNA. As a result, the human cell creates more viral particles, which spread through the lymphoid system.

Health Care Providers and HIV Prevention overview

- Hand Hygiene - Personal Protective Equipment - Standard Precautions - Needlesticks >> No Recapping >> Needleles Systems >> Needle Safety Devices

Nursing Interventions: Ineffective Protection

- Hand Hygiene/Bathing - Avoid Sharing Grooming Items - Wash Toothbrush - Clean Dishes - Report Infection Symptoms

Prophylactic Intervention overview

- Hepatitis A, B - Herpes Simplex - Microbacterium Avium Complex - Pneumocystis jiroveci Pneumonia

Nursing Interventions: Pain

- Identify Cause - Medications >> Timing medication administration before planned activities is helpful in increasing ability to function - Complementary Therapy >> Heat/Cold >> Massage >> Positioning

Nursing Interventions: Imbalanced Nutrition: Less Than Body Requirements and exercise

- Identify Interfering Factors - Weigh - Monitor Caloric Intake - Dietary Consult - High calorie, high protein - Small, Frequent Meals - Antiemetics - exercise helps: >> maintain muscle mass >> promotes relaxation >> aids sleep >> gives the person a sense of control and well-being. - An effective exercise program includes exercises that increase strength, flexibility, and endurance. - For many, becoming physically fit is a lifestyle change that requires dedication.

HIV infection in the brain or other parts of the central nervous system (CNS) results in CNS conditions with varying degrees of severity. How do CNS changes affect the individuals?

- In advanced AIDS, with HAART, AIDS dementia complex is less common than before and minor cognitive motor disorder has become more common. - When CNS changes occur, safety is an important consideration for the patient and caregiver.

HIV mode of transmission overview

- Infected >>Blood >>Semen >>Vaginal Secretions >>Breast Milk - Not Spread Casually

HIV progression overview

- Initial Infection - Clinical Latency: Symptom-free Period - CD4+ T-lymphocytes Decreasing - Varies: 8 to 12 Years Until Symptoms of HIV - Symptoms of Weakening Immune System - AIDS = Opportunistic Infections/Cancers

HIV/AIDS Summary for Signs and Symptoms

- Initially vary; none or acute retro-viral syndrome - - Asymptomatic phase - - Immune system impairment: >> dyspnea >> fever >> weight loss >> fatigue >> night sweats >> persistent diarrhea >> oral or vaginal candidiasis ulcers >> dry skin >> skin lesions >> peripheral neuropathy >> shingles >> dementia - AIDS diagnosed when CD4+ T-lymphocyte count BELOW 200 or opportunistic infections and diseases occur.

Parenteral Transmission overview

- Injection Drug Use >> Avoid >> Do Not Share Drug Injection Equipment >> Clean Equipment if Won't Stop Sharing >> PrEP Reduces Transmission Risk - Autologous Blood Transfusions >> Reduces Risk

What ultimately causes death from HIV/AIDS and how has ARTs affected this?

- It is not the HIV that ultimately causes death; it is compromised immunity and the invasion of an opportunistic infection or disease that the patient's body is unable to successfully fight off, even with medical intervention. - With today's successful ARTs, HIV has changed from being a life-ending infection to a chronic disease requiring constant management.

Why are side effects so important when teaching HIV patients about interactions?

- Many anti-HIV drugs have side effects. If they occur, the drug regimen can be changed or interventions can be used to help control the side effects. - The patient should be taught about side effects and instructed always to report them immediately, >> especially rashes (such as with trimethoprim-sulfamethoxazole) >> abdominal pain (such as with AZT[Retrovir]) - they could be serious or even life threatening.

Vital Load Testing overview

- Measures Amount of HIV RNA in Plasma - Shows Response to Antiretroviral Therapy - 1-Month After New Treatment - Then 3-Month Intervals - Goal: Ultra-sensitive Undetectable Viral Load

Genotyping overview

- Measures Resistance to Current Antiviral Tx - Guides Treatment Regimens

IMPAIRED SKIN INTEGRITY

- Medications can cause skin infections that can be life threatening and must be reported immediately. dermatologist consult

Complications: Symptoms associated with HIV-Associated Neurocognitive Disorders Such as: HIV-associated dementia [HIV encephalopathy or AIDS dementia complex (ADC)]

- Memory Impairment - Personality Changes - Hallucinations - Leg Weakness - Loss of Balance - Slow Responses - Safety Importance

HIV sexual transmission overview

- Most Easily to Women - Risky Acts >>Anal Sex >>Oral Sex - Reduced with PrEP

In 2013 what was the percentage of older adults living with HIV/AIDS?

- Nearly 1/4 (24%) of all persons living with HIV/AIDS are over age 50. - HIV infection can occur at any age.

Therapeutic Intervention

- Non-nucleoside Reverse Transcriptase Inhibitors >> Block HIV Reverse Transcriptase - Nucleoside Reverse Transcriptase Inhibitors >> Inhibits Reverse Transcriptase/Viral Replication - Protease Inhibitors >> Bind to Active Site of HIV Protease Enzyme >>Interrupt Formation of Viral Particles - Fusion Inhibitors >> Block HIV Fusion with CD4+ Cell Membrane - Cellular chemokine receptor antagonists >> Blocks CCR5 receptor preventing HIV-1 entry into CD4+ cells. - Integrase inhibitors >> Blocks HIV from combining w its genetic code

HIV/AIDS Summary for Therapeutic Measures

- Nonnucleoside reverse transcriptase inhibitors (NRTIs) - Nucleoside reverse transcriptase inhibitors (NNRTIs) - Protease inhibitors (PIs) - Fusion inhibitors - Cellular chemokine receptor (CCR5) antagonists - Integrase inhibitors

Nourishing the Patient With HIV or AIDS

- Nutrition has preventive and therapeutic functions - Well-nourished people infected with the HIV virus are better able to resist opportunistic infections and tolerate the side effects of treatment. - Multiple studies have found that the use of a nutritional supplement delayed the onset of advanced disease in HIV-positive people - The person infected with HIV displays reduced appetite possibly due to oral infections and diarrhea from damage to intestinal cells that interferes with absorption of nutrients. - Coupled with nausea and vomiting related to medications, the clinical picture often leads to loss of weight and lean body mass. - Malnutrition adds fuel to the fire by accelerating the progress of HIV infection to AIDS. - An HIV-infected adult requires 10% to 15% more energy per day and approximately 50% to 100% more protein than someone not infected - Diet should be integral to the treatment plan. Every effort should be made to feed the patient orally. - Strategies that can be helpful are as follows: >> Offer small, frequent feedings >> Serve food cold or at room temperature >> Alter seasonings >> Add powdered milk to mashed potatoes or puddings to increase calories and protein >> Modify texture to accommodate chewing difficulty or oral lesions >> Provide nutritional supplements (e.g., Boost or Ensure)

What type of sexual contact carries a higher rate of HIV transmission?

- Oral and anal sex have high rates of transmission for both males and females. - Anal sex has the highest risk because it often results in tearing of the mucous membrane, allowing for exposure to infected semen.

IMPAIRED ORAL MUCOUS MEMBRANE.

- Oral or esophageal candidiasis is more common in the late stage of AIDS. - The painful lesions interfere with swallowing and nutrition. - smoking increases incidence of oral thrush (candidiasis). Therefore, patients should be encouraged to quit smoking. - Antifungal medication is given. - Mouth care is important. - soft toothbrush promotes comfort. - Xylocaine viscous (Lidocaine viscous) can be given to decrease pain during eating.

HIV counseling /testing overview

- Per CDC Guidelines - Routine testing 13 - 64 yrs old, pregnant females or after sexual assault -Confidentially/Anonymously >> Permission is needed to release one's test results - Post Test Counseling by Trained Personnel >> Explain Test Results >> Assist With Informing Sexual Partners/Drug Needle Sharers >> Risk Factor Reduction >> Care Options

HIV Prevention overview

- Prevention/Education Best - CDC Recommendation: >> Teach Older Children Through Older Adults

How long does it take to get test results after HIV testing? How quickly after exposure can a test pick up the antibodies?

- Results can be available in less than 20 minutes with the Multispot HIV-1/HIV-2 Rapid Test - 1 hour for immunoassay (IA) testing. - Consumer-controlled test kits (home sample collection devices) can be purchased at drug stores; the blood sample is sent in for HIV testing, with the individual anonymously calling for results,counseling, and referral if needed. - After HIV infection, antibodies cannot be formed for 3 weeks to 3 months or longer in some cases. - Early detection HIV tests are available for detection as soon as 1 week after potential exposure.

Perinatal Transmission Prevention overview

- Routine Testing During Prenatal Care - Repeat - Third Trimester for High Risk - If HIV Positive, Antiretroviral Therapy can reduce risk of HIV transmission to less than 1% by taking ARV therapy (including zidovudine [AZT]) during pregnancy, labor,and delivery. - Infant Given Zidovudine for 6 Weeks

what are the symptoms during late HIV?

- Shortness of Breath - Fever - Weight Loss - Fatigue - Night Sweats - Persistent Diarrhea - Oral/Vaginal Candidiasis ulcers - Dry Skin - Skin Lesions - Peripheral Neuropathy - Shingles (varicella zoster virus reactivation) - Seizures - Dementia

General Tests - syphilis, hepatitis A B C, Liver chem

- Standard serological testing for syphilis is recommended annually in patients who are sexually active. - Hepatitis A, B, and C serologies and liver chemistry panels are indicated in the early evaluation because of the high incidence of concurrent hepatitis coinfection for HIV-positive patients. - Coinfections can influence the course of either the patient's HIV or the coinfection. It can also affect the HIV treatment options.

How quickly after HIV transmission are symptoms of acute retroviral syndrome present? The symptoms typically last for what period of time?

- Symptoms typically develop 6 to 12 wks after HIV transmission and can last a few days to wks. - These symptoms are usually mild and noT attributed to the HIV infection.

What happens if the HIV infection goes untreated during the clinical latency stage?

- The HIV virus remains in the lymph nodes, liver, and spleen and reproduces. If the infection is untreated CD4+ T lymphocytes gradually decrease. B lymphocytes also become dysfunctional and dysregulated by the events of HIV progression. >> B and T cells work together for a normal healthy immune system,so this can further impair the immune system.

CD4+/CD8+ T-Lymphocyte Count

- The count of CD4+ and CD8+ (cytotoxic cells) T lymphocytes is essential for evaluating the status of the immune system. - In healthy adults, CD4+ levels average 500 to 1600 cells per mm3. - In HIV/AIDS, CD4+ cell levels drop but CD8+ cell levels do not. - A low ratio of CD4+ cells to CD8+ cells is seen as HIV/AIDS progresses. - It is recommended that CD4+/CD8+ T-lymphocyte counts be performed at 3-month intervals for most patients, especially those on ARV therapy.

What causes drug resistance in HIV/AIDS patients?

- The major cause of drug resistance occurs when medications are not taken as directed so teaching is important. Adherence is the word used to describe taking medications exactly as directed. - Another increasing potential cause of drug resistance is when an infected person with resistant virus exposes another infected person to the resistant virus through unprotected sexual exposure or injected drug use

What is ARV Therapy?

- There are six drug classes of HIV treatment available. - Each class affects the virus in a different stage of its life cycle. - Use of these drugs in combination is referred to as antiretroviral therapy (ART). - Usually at least three medications in at least two classes of treatment categories are used

Postexposure Prophylaxis Guidelines

- Urgent Medical Condition - Wash Exposure Site with Soap/Water - Mucous Membrane Exposure, Flush with Water - Consider Risk - Test Source - Treatment for 4 Weeks - Begin Within Hours of Exposure

How do you assess the results of a TST what is considered positive for an AIDS patient?

- When assessing the results of a TST, only the induration (palpable, raised, hardened area or swelling) is measured across the forearm and recorded in millimeters. If there is no induration,it is recorded as 0 mm. - A Mantoux tuberculin skin test (TST) with tuberculin purified protein derivative should be performed at least yearly in patients with HIV infection. Induration of 5 mm or more is defined as a positive result in patients with HIV infection and so defines the development of AIDS

Home Health Hints For AIDS patients

- When providing patient care, perform hand hygiene and wash hands frequently, follow standard precautions, and use plastic bags to contain soiled items or clothing. - Teach patients how to properly clean and disinfect the home to prevent infections. >> Least expensive solution: diluted bleach mixture that contains 1 part household bleach to 10 parts water. >> this solution must be mixed daily to be effective. - Wearing gloves, clean body fluid spills with soap and water. - Flush body fluids, solid waste, and contaminated solutions down toilet - Use disinfectant to: >> disinfect spill areas >> clean toilet seats and bathroom fixtures >> clean inside the refrigerator to avoid mold growth >> Rinse clothing and then wash separately from other clothes with 1 cup of bleach if soiled with blood, urine, feces, or semen. - Patients with HIV/AIDS do not require separate sets of dishes or silverware. Dishes and silverware are washed in hot, soapy water and rinsed thoroughly or placed in dishwasher. - Dispose of sharps (e.g., needles, lancets, ra-zors) >> provide a red biohazard container if available. >> use a rigid labeled container such as a tin can with a sealable lid. Add 1:10 bleach solution to disinfect the sharps. Tape the lid. Place in a bag and dispose of in the trash. - Contaminated articles are disposed by bagging and sealing in plastic and placing in the trash. - Teach the family of a patient with AIDS which signs and symptoms to report to the physician or nurse immediately: >> fever >> increased dyspnea >> pain >> change in sputum production >> upper respiratory tract infection >>pneumonia >> respiratory distress syndrome >> diarrhea five times a day or more for 5 days >> uncontrolled weight loss greater than 10 pounds in the past month >> persistent headaches >> falling >> seizures >> mental status changes >> including memory loss >> personality changes >> rashes and skin changes >> difficulty swallowing >> problems with urination.

What is immune reconstructive syndrome

- When someone with a suppressed immune system (very low CD4/T-cell count) is started on ART, the person can experience immune reconstitution syndrome. - The patient's immune system can be greatly improving, but the patient is feeling worse. >> This is because, when the patient's immune system was severely damaged, immune responses can have been too weak or absent to show the signs of infection. When immune function improves and the immune system begins to fight off infections that were already present in the body, such as Pneumocystis jiroveci pneumonia, symptoms can arise. - This can be a serious, sometimes fatal condition that can occur a few weeks after antiretroviral therapy starts. - Educating the patient to report immediately any symptoms of opportunistic infections after starting therapy can allow for prompt diagnosis and treatment of the infection—and can save the person's life.

Why would a person with HIV/AIDS have increased risk for cancer and opportunistic infections?

- With an impaired immune system, the incidence of certain kinds of cancer rises because the immune system is not able to destroy the abnormal cells. - Opportunistic infections, which a healthy immune system could fight, are also a complication of HIV/AIDS. Infections that develop even with a healthy immune system, such as tuberculosis, can also occur. >>Opportunistic infections can be viral, bacterial, mycobacterial,fungal, protozoal, or parasitic. >> They can affect many areas of the body. Some opportunistic infections can now be prevented with prophylactic treatments.

Complications: Mycobacterium Avium Complex (MAC)

- a serious bacterial infection - can occur in those with AIDS when CD4+ T-lymphocyte counts drop below 50. - MAC is found in water,food, and soil, so avoidance is difficult. - Prophylactic drugs when CD4 counts fall below 50 include >> azithromycin >> clarithromycin >> rifabutin. - With infection, symptoms can include >> fever >> night sweats >> weight loss >> abdominal pain >> tiredness >> diarrhea. - Treatment includes a combination of clarithromycin and ethambutol, and possibly rifabutin.

Complications: Pneumocystis pneumonia (PCP)

- caused by >> the fungus Pneumocystis jiroveciin immunocompromised persons. - Signs and symptoms: >> PCP develops slowly and produces >>> shortness of breath >>> fever >>> dry cough - Prophylactic: >> When CD4+ T-lymphocyte counts fall BELOW 350/mm3, prophylactic oral trimethoprim-sulfamethoxazole (TMP-SMX [Bactrim, Septra, Cotrim])is recommended. - PCP is less likely to occur than in the past with TMP-SMX but remains a concern for those with HIV/AIDS. - Treatment: >> PCP can be treated with >>> oxygen >>> TMP-SMX >>> pentamidine isethionate >>> Steroids can help reduce lung inflammation.

what are the symptoms of acute retroviral syndrome?

- extreme fatigue - headache - fever - lymphadenopathy (enlarged lymph nodes in two sites other than inguinal nodes) - diarrhea - sore throat

What is the recommendation for HIV screening?

- from 15 to 65 years of age at least once - Those with increased risk outside of this age range should also be screened. - For those at high risk, screening should occur more frequently.

Complications: Candida Albicans

- fungus normally found in the GI tract that does not infect a person with a healthy immune system. >> In AIDS, overgrowth of this fungus occurs. - Candidiasis of mouth or esophagus is common. - Signs & symptoms of candidiasis include: >> oral or esophageal pain >> dysphagia >> yellow-white plaques looks like cottage cheese in the mouth and throat. - Nutrition can be affected by oral or esophageal candidiasis. - Recurrent vaginal candidiasis, w severe itching & white discharge, is common in women with AIDS.

What should be done if exposure occurs to a HCP?

- if an exposure occurs: - wash the exposure site with soap and water immediately. - For mucous membrane exposure, flush with water and then report to the closest emergency room immediately for further assessment and possible treatment.

What should be recommended If a person who injects drugs is unable or unwilling to stop for prevention of HIV?

- it is recommended that a new sterile syringe and needle, obtained from pharmacies, is used each time along with new sterile water and new or disinfected preparation equipment, and alcohol swabs to clean the injection site. - Afterward, the syringe should be safely disposed of. Drug injection equipment should never be shared or reused. Syringe exchange program availability varies by location, although these programs have been shown to decrease the risk of trans-mission of HIV and other blood borne pathogens. - If injection equipment is reused, it should be boiled or cleansed with bleach.

What cells include CD4 receptors?

- lymphocytes >> CD4+ T lymphocytes T4 lymphocytes helper T lymphocytes - macrophages >> where HIV hides

Genotyping

- measures resistance to currently available ARV treatments. - This information guides HCPs in choosing treatment regimens that will most likely be effective against that person's virus.

Viral Load Testing

- measures the amount of HIV RNA in plasma and is extremely important for determining: >> risk of disease progression if left untreated >> risk of opportunistic infections >> response to ARV therapy. - Combination ARV regimens usually produce a 50% decrease in total-body HIV levels within just a few days. - Viral loads should be performed 1 month after starting new treatments and at 3-month intervals thereafter. - The goal on ARV therapy is to obtain and maintain an ultra sensitive undetectable viral load.

Why is there an increased rate of transmission of the HIV virus during the latency stage?

- the person is considered to be HIV infected. - 1 in 6 persons (15.8%) do not know they are infected with the virus, causing increased rates of transmission related to uncontrolled viral loads from lack of HAART. - During the early symptomatic stage of HIV disease, symptoms of the weakening immune system are seen. - When the immune system is severely weakened, opportunistic infections and cancers can occur

Contributing factors that increase the older (50+) populations risk/susceptibility to HIV/AIDS.

- tx options for ED >> increases the sexual activity >> lack of protection >> multiple sexual partners - same-sex contact. - decline in immune system - Increased vaginal dryness and friability - Lack of preventive education

How can health care providers protect themselves from exposure and transmission of HIV?

- using standard precautions - perform hand hygiene p contact w body fluids - using safety devices to prevent needlesticks >> needles systems >> protective covers >> no recapping - using safety devices to prevent other injuries - ** it is essential to understand and use these practices with all patients to protect yourself from exposure and transmission of HIV

The nurse is contributing to the teaching plan for a patient with HIV on reducing infection risks. Which of the following should the patient with HIV be taught to do to decrease risk of infections? Select all that apply. 1. Wash hands before eating. 2. Wash toothbrush. 3. Reuse dishes. 4. Buy prepared deli foods. 5. Report signs of infection. 6. Share razor if no visible blood.

1, 2, 5. Preventing infection risk is done with good hygiene (hand washing, toothbrush washing, not reusing dishes, not sharing grooming items), avoiding deli foods that may harbor bacteria, and promptly reporting infection signs.

The nurse is assisting with education at a health fair. Which of these would the nurse include as ways for exposure to HIV? Select all that apply. 1. Blood 2. Semen 3. Tears 4. Vaginal Secretions 5. Breast Milk

1. Blood 2. Semen 4. Vaginal Secretions 5. Breast Milk

What are the methods used for HIV testing?

1. Finger stick blood 2. oral fluid (OraQuick Rapid HIV test—swab of complete upper and lower outer gums) 3. serum specimens 4. Urine can also be tested but is slightly less accurate.

The nurse would recognize that the patient is having are action to abacavir sulfate (Ziagen) if which of the following occurred? 1. Flu-like symptoms 2. Edema 3. Abdominal pain 4. Blurred vision

1. Flulike symptoms indicate a reaction to abacavir sulfate (Ziagen) can be occurring.

The nurse is assisting with education at a health fair. Which of these would the nurse include as ways for exposure to HIV? Select all that apply. 1. Men Who Have Sex with Men 2. Heterosexual Contact 3. Handshaking 4. Injection Drug Use 5. Sharing dishes and eating utensils.

1. Men Who Have Sex with Men 2. Heterosexual Contact 4. Injection Drug Use

Which of the following would the nurse include for teaching about PrEP? Select all that apply. 1. Prevention for Those at High Risk 2. Antiretroviral Drug 3. Weekly Injection 4. Other Transmission precautions Not Needed 5. Daily Pill

1. Prevention for High Risk 2. Antiretroviral Drug 5. Daily Pill

The nurse experiences a needlestick. Which of these actions should the nurse take? Select all that apply 1. Wash Exposure Site with Soap/Water 2. Seek Urgent Medical Care 3. Flush Mucous Membranes with Water 4. Begin Ordered Therapy Within Hours After Exposure 5. Follow Treatment for 1 Week 6. Test Source

1. Wash Exposure Site with Soap/Water 2. Seek Urgent Medical Care 4. Begin Ordered Therapy Within Hours After Exposure

The nurse is teaching a patient about HIV testing. Place traditional HIV-1 diagnostic tests in the sequential order in which they are performed. 1. Western blot test 2. Enzyme-linked immunosorbent assay (ELISA) test 3. Repeated ELISA test

2, 3, 1. ELISA detects antibodies to the HIV antigen. If positive,the test is repeated. If positive again, the Western blot test detects antibodies to four major HIV antigens and is positive if two antibodies are present.

The nurse is planning to teach a patient about HIV prevention. What should the nurse include in a teaching plan to prevent HIV infection? Select all that apply. 1. Recapping of used needles by caregiver permitted 2. Abstain from sexual intercourse 3. Avoid injection drug use 4. Avoid use of male or female condoms 5. Plan for autologous blood transfusion 6. Test for HIV at time of labor

2, 3, 5, 6. Ways to prevent HIV infection include abstinence,avoiding injection drug use, autologous (self) blood transfusion,and testing for HIV at the time of labor to begin treatment.

The nurse would recognize that the patient needs further reinforcement of knowledge if the patient stated that one of the goals of antiretroviral therapy is which of the following? 1. Reduce the viral load. 2. Improve survival rates. 3. Decrease CD4+ T lymphocytes. 4. Delay the progression of HIV disease.

3. HIV causes decreased CD4+ T lymphocytes, so the goal of antiretroviral therapy is to control the virus so CD4+ T lymphocytes will increase.

A patient who is newly diagnosed with HIV infection asks what to expect for future health status. The best response for the nurse to give is based on the understanding that HIV disease and AIDS are characterized as which of the following? 1. An acute disease 2. A life-ending disease 3. A chronically managed disease 4. A disease with remissions and exacerbations

3. HIV is a chronically managed disease with treatment.

The nurse would evaluate the patient as understanding modes of HIV transmission if the patient stated that the modes of HIV transmission include which of the following? 1. Saliva, tears, fecal-oral contamination 2. Close physical contact involving skin surfaces, mosquito bites 3. Sharing towels, sharing eating utensils, skin contact 4. Unprotected sex with HIV-infected partner, contact with infected blood products

4. HIV is transmitted from human to human only through infected blood, through sexual secretions, and from an infected mother to her unborn baby or to her infant via breast milk.

Safer Sex Practices overview

>> Abstinence >> Monogamous Sexual Relationship >> Limit Sexual Partners >> Condoms >> Dental Dams >> Latex Gloves

FOOD AND WATER SAFETY. Symptoms of food-borne or waterborne infections

>> diarrhea >> nausea >> vomiting >> abdominal cramps >> headache >> fever

Which of the symptoms of HIV in older adults can be confused with commonly perceived problems of aging?

>> fatigue >> decreased endurance >> altered cognitive status -The effect of HIV on the brain can be mistaken for Alzheimer's disease, delaying proper treatment.

Complication: Define AIDS Wasting Syndrome

AIDS wasting syndrome is defined by 1. involuntary loss of more than 10% of baseline body weight plus chronic weakness or fever or 2. chronic diarrhea for more than 30 days.

why dont all HIV-infected people develope AIDS?

Not all HIV-infected people develop AIDS, largely because current treatments help to improve immune function and reduce the risk of Opportunistic infections, which can be life threatening in these patients.

What factors contribute to AIDS wasting syndrome?

Several factors contribute to this syndrome: >> decreased appetite >>oral lesions >>altered metabolism >>malabsorption >>gastrointestinal (GI) infections >>diarrhea >>medication side effects >>cognitive impairment.

What is HAART

Stands for highly active antiretroviral therapy. Treatment with a very potent drug "cocktail" to suppress the growth of HIV, the retrovirus responsible for AIDS.

Signs and Symptoms of Opportunistic Infections to Report

Teach patient to monitor temperature and to report the fol-lowing symptoms to a health care provider immediately: >> New fever higher than 100°F (38.5°C) or a change in fever pattern if low-grade fevers are common >> Cough, shortness of breath, fever, or chest tightness,which can be signs of early pneumonia >> Signs of central nervous system infection, such as severe headache; stiff neck; visual changes; problems with balance, walking, or speech; weakness of an arm or leg; or changes in moods or memory >> Foul-smelling drainage or pus >> Cloudy or foul-smelling urine >> Signs of dehydration, such as a dry mouth, dark concentrated urine, or dizziness when standing >> Diarrhea lasting longer than 48 hours; more than six stools a day; watery, mucousy, or bloody stools >> Rashes (possible side effect of medication) >> Sore mouth or tongue, difficulty swallowing, white patches on tongue or back of mouth >> Worsening fatigue >> Change in vision and if floaters develop >> Unintended weight loss

Medication Adherence Teaching

Teach patients that it is essential to take all medications as ordered. Missing just 10% of medication doses (1 of 10) decreases effectiveness to about 80%, depending on the drug. This means that if a patient is taking three to seven pills each day, missing one to two pills a week will decrease the medications' effectiveness by 20%.

What is the clinical latency stage?

The initial HIV infection is followed by a relatively symptom-free period called the clinical latency stage. The virus remains in the lymph nodes, liver, and spleen and reproduces