HIV Quiz

Medication classes used during fusion

1. Fusion inhibitors - prevents HIV from entering when it attaches to a CD4 cell 2. Early inhibitors - block proteins on the CD4 cell so that HIV can't enter

Medication classes used during reverse transcriptase

1. Non-nucleoside reverse transcriptase inhibitors (NNRTIs) - bind to and alter reverse trancriptase 2. Nucleoside reverse transcriptase inhibitors (NRTIs) - blocks reverse transcriptase so the HIV can't create DNA from RNA

Normal CD4 count

500-1400

CD4 count indicating AIDS

< 200

Predictors of poor adherence

Active drug use Alcoholism Mental illness

(Book) Which snack choice does the nurse recommend to the client with AIDS to help improve nutritional status? A. An ice-cream sandwich B. Two soft-cooked eggs C. A wand of cotton candy D. A serving of french fries

B

Special considerations for IV drug users

Don't adhere to treatment until addiction is resolved

HIV Capsid

HIV's bullet shaped core that contains HIV RNA

HIV RNA

HIV's genetic material

Medication class used during assembly

None

Medication class used during replication

None

Most common cause of hospitalization with HIV patients

Opportunistic infections

Medication class used during budding

Protease inhibitors (PIx) - blocks HIV protease so that HIV can't make copies of itself

Special considerations for adults over 50

Stigma May avoid condoms as they can't get pregnant

Optimal viral load

Undetectable

Teaching priorities for drug therapy

-Antiretrovirals inhibits viral replication but does not kill the virus -Monothearpy: treatment with one retroviral; promotes drug resistance and doesn't improve duration or quality of life -Multiple drugs are used together in regimens called "cocktails" and consist of combinations of different types of antiretrovirals -Also called Highly active antiretroviral therapy (HAART) helps reduce viral load and improve CD4+ counts -Educate about side effects and ways to decrease severity of side effects -Educate client about the need to take medications on a regular schedule and to not miss doses; missed doses can cause drug resistance

AIDS and impaired gas exchange

-Drug therapy to prevent infections, bronchodilators to improve airflow, steroids to reduce inflammation -Respiratory support and maintenance: assess RR, rhythm, depth, breath sounds, and vital signs and assess for cyanosis every 8 hours; apply O2 and humidify the room as prescribed; monitor mechanical ventilation; suction and chest PT, evaluate blood gas results -Comfort can improve gas exchange; assess comfort; elevate HOB; pace activities; provide psychological support during periods of breathing difficulty -Rest and activity changes needed when gas exchange is impaired; pace activities to conserve energy; guide patient in active and passive range of motion exercise; schedule non-time-critical activities such as bathing so that they are not fatigued at mealtime

Ways to improve adherence

-Get the patient up to speed -Treat substance abuse, alcoholism, and depression prior to starting -Health literacy assessment -Review side effects -Caution not to take drug holidays -Simplify the regimen as much as possible -Let them know you support them and they can tell you if they slip

Non-occupational high risk groups

-Men who have sex with men -Men who have sex with men and women -Injection drug users -Commercial sex workers -Victim of a sexual assault -Incarceration -Exposed in a country where seroprevalence is > 1%

Reorientation techniques for patient's with HIV

-Neuro changes with disturbed thought processes are major areas of concern -Assess baseline neuro and mental status to compare changes -Evaluate for subtle changes in memory, ability to concentrate, affect, and behavior -Reorient the patient to person, time, and place as needed -Coordinate with all health team members to ensure reorientation methods are preformed by everyone who interacts with the patient -Remind the patient of your identity -Explain what is to be done at any given time -Give simple direction -use short, uncomplicated sentences -explain activities in simple language -Ask relatives to bring in familiar items from home -arrange items in the patient's environment in the same location as at home -Use calendars, clocks, and radios -Put the bed close to a window to help keep day/night cycles

Prevention

-Teaching -History of STD's (marker of risky sexual activity) -Risk reduction counseling -Partner discordance/referral/notification -Pre-exposure prophylaxis: for those with risky behaviors -Address prevention fatigue -Post-exposure prophylaxis for health care workers

HIV Life Cycle

1. Binding (Attachment): HIV binds to receptors on the surface of a CD4 cell 2. Fusion: HIV envelope and the CD4 cell membrane fuse, allows HIV to enter the CD4 cell 3. Reverse Transcription: inside the CD4 cell, HIV releases and uses reverse transcriptase to convert its genetic material - HIV RNA - into HIV DNA. This conversion allows the HIV to enter the CD4 cell nucleus and combine with the cell's genetic material - cell DNA. 4. Integration: Inside the CD4 cell nucleus, HIV releases integrase and uses it to insert (integrate) its viral DNA into the DNA of the CD4 cell 5. Replication: 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 protein chains are the building blocks for more HIV 6. Assembly: new HIV proteins and HIV RNA move to the surface of the cell and assemble into immature (noninfectious) HIV 7. Budding: newly formed immature (noninfectious) HIV pushes itself out of the host CD4 cell. The new HIV releases protease that breaks up the long protein chains that form the immature virus. The smaller HIV proteins combine to form mature (infectious) HIV

(Saunders) The nurse is reviewing the results of the serum laboratory studies drawn on a client with acquired immunodeficiency syndrome who is receiving didanosine (Videx). The nurse interprets that the client may have the medication discontinued by the health care provider if which elevated result is noted? A. Serum protein level B. Blood glucose level C. Serum amylase level D. Serum creatinine level

3. Didanosine can cause pancreatitis and is hapatotoxic

(Book) Which finding in the client with HIV disease who is receiving antiretroviral therapy indicates to the nurse that the treatment is effective? A. CD4+ cells 700/m3 B. CD4+ cells 200/m3 C. CD8+ cells 700/m3 D. CD8+ cells 200/m3

A The HIV selectively infects and causes the destruction of the CD4 cells (T-helper cells). The normal CD4+ cell number is 600 to 1500/mm3. An increase in this population of cells in a client with HIV disease above 500 indicates the medication regimen is effective in suppressing viral replication.

(Saunders) The nurse is assisting in planning care for a client with a diagnosis of immunodeficiency and should incorporate which action as a priority in the plan? A. Protecting the client from infection B. Providing emotional support to decrease fear C. Encouraging discussion about lifestyle changes D. Identifying factors that decreased the immune function

A. Client has inadequate or absence of immune bodies and is at risk for infection Other options are components but not priority

(ATI) A nurse working in an outpatient clinic is assessing a client who reports night sweats and fatigue. He states he has had a cough along with nausea and diarrhea. His temperature is 31.1 C (100.6 F) orally. The client is afraid he has HIV. Which of the following actions should the nurse take? (Select All) A. Perform a physical assessment B. Determine when current symptoms began C. Teach client about HIV transmission D. Draw blood for HIV testing E. Obtain a sexual history

A. Perform physical assessment to gather data about client's condition B. Determine if clinical manifestations are acute or chronic E. Obtain sexual history to determine how the virus was transmitted C. Incorrect - not a priority at this time D. Incorrect - Not a priority at this time

(ATI) A nurse caring for a client who is suspected of having HIV. Which of the following diagnostic tests and laboratory values are used to confirm HIV infection? (Select All) A. Western blot B. Indirect immunofluorescence assay C. CD4+ T-Lymphocyte count D. CD4+ T-lymphocyte percentage of total lymphocytes E. Cerebrospinal fluid (CSF) analysis

A. Positive western blot confirms HIV B. Positive Indirect immunofluorescence assay confirms HIV C. Incorrect - this indicates the stage of HIV D. Incorrect - this indicates the stage of HIV E. Incorrect - this would confirm meningitis

(ATI) A nurse is assessing a client for HIV. Which of the following are risk factors associated with this virus? (Select All) A. Perinatal exposure B. Pregnancy C. Monogamous sex partner D. Older adult women E. Occupational exposure

A. Yes, women who are pregnant should take cautionary measures to prevent HIV exposure D. Yes, due to vaginal dryness and thinning of vaginal wall E. Yes, example - health care worker B. Incorrect - Women who are pregnant should be tested but pregnancy is not a risk factor C. Incorrect - non-monogamous would be a risk factor

(PPT) Highly activated antiretroviral therapy (HAART) causes what effect? A. Reversal of a patient's antibody status B. Decrease of viral load C. Increase of the viral load D. More detectable HIV

B

(PPT) What is the most important means of preventing HIV spread or transmission? A. Engineering B. Education C. Isolation D. Counseling

B

(PPT) HIV can be transmitted by which routes? (Select all that apply.) A.Viral B. Sexual C. Parenteral D. Airborne E. Perinatal

B, C, E

(PPT) Which statements about immunodeficiency are true? (Select all that apply.) A. It causes a decrease in the patient's risk for infection. B. It may be acquired or congenital. C. It occurs when a person's body cannot recognize antigens. D. It is the same as autoimmunity. E. It may cause varied reactions from mild, localized health problems to total immune system failure.

B, C, E

(PPT) Which immune function abnormalities are a result of HIV infection? (Select all that apply.) A. Lymphocytosis B. CD4 + cell depletion C. Increased CD8 + cell activity D. Long macrophage life span E. Lymphocytopenia

B, E

(Book) The client who is prescribed highly active antiretroviral therapy (HAART) is flying to a wedding and will be gone 1 day. He asks if he can skip his drugs that day so he doesn't have to show them all at the airport. What is the nurse's best response? A. "Yes, just 1 day off your drugs will not make any difference." B. "Yes, as long as you avoid direct contact with anyone who is ill." C. "No, even 1 day off the drugs can help the virus become drug resistant." D. "No, even 1 day off the drugs increases the chances that you can spread the disease."

C

(Book) Which activity is most appropriate for the nurse to eliminate or modify to prevent excessive fatigue in the client with reduced oxygenation as a result of respiratory infections and AIDS? A. Mouth care B. Meal times C. Complete bath D. Dressing changes

C A. Mouth care and meal times are too important to eliminate because the client is at high risk for oral infections and nutritional deficiencies. B. Mouth care and meal times are too important to eliminate because the client is at high risk for oral infections and nutritional deficiencies. C. A complete bath can be very tiring, as well as drying to fragile skin. Keeping skinfold areas clean and dry and keeping the perineal area clean are critical. The rest of the bath can be skipped to prevent excessive fatigue. D. Dressing changes are also needed as scheduled to prevent a superficial infection from becoming deeper or leading to sepsis.

(ATI) A nurse caring for a client who has HIV and has been newly diagnosed with Burkitt's lymphoma. Which of the following HIV stages is the client in? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4

C. Stage 3 - there are one or more defining conditions present. These can include candidiasis of the esophagus, bronchi, trachea, or lungs; chronic ulcers of herpes simplex; HIV-related encephalopathy; disseminated or extrapulmonary histoplasmosis; Kaposi's sarcoma; and Burkitt's lymphoma A. Incorrect: no defining conditions B. Incorrect: no defining conditions D. Incorrect: no information available

Medication class used during binding

CCR5 Antagonist

As the ____ count goes down, the chance of an ____ goes up

CD4 Opportunistic infection

Urgent care for HIV patients needed for what symptoms

Chest pain Moderate to severe abdominal pain Persistent vomiting (> 3 days) Persistent bloody diarrhea (> 3 days) Moderate to severe dehydration Severe headache with neck stiffness Seizures Profound weakness (inability to stand/walk) Suicidal thoughts/severe depression

(PPT) For each lab test, indicate whether the presence of HIV will increase (I), decrease (D), or cause no change (NC) in the levels. ____ a. CD4+ ____ b. CD8+ ____ c. WBC ____ d. Lymphocytes

D, ND, D, D

(ATI) A nurse is completing discharge instructions with a client who has AIDS. Which of the following statements by the client indicates an understanding of the teaching? A. "I will wear gloves while changing the pet litter box." B. "I will rinse raw fruits with water before eating them." C. "I will wear a mask when around family members who are ill." D. "I will cook vegetables before eating them."

D. Cook vegetables before eating them to kill bacteria that causes opportunistic infections A. Incorrect - avoid changing litter box all together B. Incorrect - Avoid consuming raw fruits due to the presence of bacteria that could cause opportunistic infections C. Incorrect - Due to compromised immune response, a client who has AIDS should avoid contact with ill family members

Medical issues related to HIV infection

Diagnosed late in illness, medications, health care engagement

HIV vs AIDS

HIV infection is one continuous disease process with 3 stages 1. Progression of HIV infection: flu-like symptoms within 2-4 weeks of infection; rapid rise in HIV viral load, decreased CD4+ cells, increased CD8 cells; resolution of clinical manifestations coincides with decline in HIV copies; lymphadenopathy 2. Chronic asymptomatic infection: may be a prolonged stage; may be asymptomatic for 10+ years; anti-HIV antibodies are produces making the patient HIV positive; over time the virus begins active replication destroying CD4+ cells, increasing viral load, and decreasing immunity 3. AIDS: life-threatening opportunistic infection; end stage of HIV infection; without treatment death occurs in 5 years 4. no considerable data All people with AIDS have HIV, but not all people with HIV have AIDS.

Medication class used during integration

Integratase inhibitors - blocks HIV integrase so the HIV can't make copies of itself

Special considerations for mentally ill

Must get good mental health services first so they can adhere to treatment

Most common early symptoms

Oral thrush Enlarged lymph nodes Flu-like symptoms Weight loss

Care for a patient with a pathogenic infection vs an opportunistic infection

Pathogenic infection: caused by virulent organisms and occur even among people whose immune systems are functioning normally -Infection may be spread to the health care worker -- requires precautions depending on the pathogen Opportunistic infections: caused by organisms that are present as part of the body's natural environment and are kept in check by normal immune function; only when immune function is depressed are such organisms capable of causing infection -Occur because of the profound immunosuppression of the person with HIV infection -May result from a primary infection or reactivation of a latent infection -Account for many of the clinical symptoms observed in HIV infection -Can be protozoan, fungal, bacterial, or viral -Presence may represent disease progression or temporary further reduction of immune status -Can quickly result in death without treatment -Priority nursing action is assess for presence of an opportunistic infection and monitoring the patient's response to therapy -Do not pose a threat to the immunocompetent health care worker when working with the patient

Primary vs secondary immune deficiencies

Primary deficiencies: congenital -person is born with a defect in the development or function of one or more immune components therefore the immune response doesn't adequately protect him/her from infection, cancer, or other disease -May be X-link inherited or recessive, or an unidentified genetic defect/inheritance pattern -Classified according to the type of immune function that is impaired (antibody mediated, cell mediated, or combined) -Examples: Selective immunoglobulin A (IgA) deficiency; Bruton's Agammaglobulinemia; common variable immune deficiency Secondary deficiencies: acquired -Occurs when the immune system is compromised by an external factor -Examples: chemotherapy, DM, severe burns, malnutrition

HIV transmission

Sexual: genital, anal, or oral sexual contact with exposure of mucous membranes to infected semen or vaginal secretion -More easily transmitted from infected male to uninfected female than vice versa -Highest risk is anal intercourse Parenteral: sharing of needles or equipment contaminated with infected blood or receiving contaminated blood products Perinatal: from the placenta, from contact with maternal blood and body fluids during birth, or from breast milk from an infected mother to child

What precautions should be used as a member of the health care team to prevent HIV transmission to you, other patients, and other members of the health care team

Standard precuations

Special considerations for women

Stigma of raising kids and being positive Need special prenatal care

Psychosocial issues related to HIV infection

Stigma, substance abuse, care of children, loss of social support, worries about mortality

High-risk behaviors for HIV

Unprotected sex Multiple sex partners Occupational exposure Perinatal exposure Blood transfusions (not significant in the US) IV drug use (especially with unclean needles)

HIV envelope

outer surface of HIV

HIV enzymes

proteins that carry out steps in the HIV life cycle

HIV glyycoproteins

protien "spikes" embedded in the HIV envelope

Techniques for infection risk reduction in an immunosuppresed patient

• At home o Avoid crowds o Don't share personal hygiene items o Bathe daily with antimicrobial soap o Clean toothbrush weekly o Wash hands thoroughly with antimicrobial sop before eating/drinking o Avoid eating raw fruits/vegetables; undercooked meat, fish, and eggs; and pepper and paprika o Wash dishes between use - do not reuse before washing o Do not drink water, milk, juice, or other cold liquids that have been standing longer than 1 hour o Do not change pet litter boxes o Avoid turtles and reptiles as pets o Do not feed pets raw or undercooked meats o Take temperature at least once a day and additionally when you do not feel well o Report any signs or symptoms of infection immediately o Take all prescribed drugs o Do not dig in the garden or work with houseplants o Ensure a condom is used during sex o Avoid travel to areas of the world with poor sanitation or less-than-adequate health care facilities o Maintain up-to-date immunizations, including yearly flu shot and pneumococcal vaccine o Maintain adequate fluid and nutrition intake • At the hospital o Make sure patient is in a private room o Use good hand hygiene before touching the patient or their belongings o Clean patients room and bathroom at least once a day o Do not use supplies from common areas o Keep a dedicated box of gloves in the patients room o Use individually wrapped medical items o Use single-use food products o Limit number of health care personnel entering the patient's room o Monitor vitals every 4 hours o Inspect patient's mouth at least every 8 hours o Inspect patient's skin and mucous membranes at least every 8 hours o Inspect open areas and IV sites every 4 hours o Change gauze-containing wound dressings daily o Obtain specimens of all suspicious areas for culture o Assist the patient in performing coughing and deep-breathing exercise o Encourage activity at a level appropriate for current health status o Keep frequently used equipment in the room for use with this patient only (blood pressure cuff, stethoscope, thermometer) o Limit visitors to healthy adults o Use strict aseptic techniques for all invasive procedures o Avoid the use of Foley catheters o Keep fresh flowers and potted plants out of patient's room o Teach the patient to eat a low-bacteria diet (avoid raw fruits and vegetables; undercooked meat, fish, and poultry; pepper and paprika) o Providers should use standard precautions when caring for the patient o Maintain adequate fluid and nutrition intake