AIDS

kaposi sarcoma-Disseminated disease involves

Involving multiple organ systems Lymph nodes, GI tract, Lungs Organ failure, hemorrhage, infection, death

what are the s/s for TB

Loss of appetite Nausea and vomiting Chronic diarrhea- stool cultures *To check for MRSA* -Candidiasis (Oral and Esophageal) Painless, creamy plaque like lesions oropharyngeal mucosa and tongue

vaginal candidia

Persistent or recurrent Often the first sign of infection women

subacute cutaneous lupus erythematosus

Sun exposed areas

A person with HIV is considered to have progressed to AIDS when:

The number of CD4 cells falls below 200 They develop one or more opportunistic infection regardless of their CD4 count

Viral set point

(amt of virus in blood after initial infection) -higher the set point prognosis poorer Amount of virus in the body after initial immune response subsides

Progressive Multifocal Leukoencephalopathy

-Demyelinating CNS disorder -Usually caused by damage to myelin sheath

systemic lupus erythematosus education

-Sun exposure is associated with SLE exacerbation -Patients should use sunscreen with an SPF of at least 15 and stay out of the sun between 11:00 AM and 3:00 PM. -Low-grade fever may occur with an exacerbation but should not be expected all the time. -A positive attitude may decrease the incidence of SLE exacerbations - Teach patient to self-monitor for symptoms that might indicate changes in the disease process. -Symptoms may worsen during pregnancy and especially during the postpartum period.

When a nurse infuses gamma globulin intravenously, the rate should not exceed

3 ml/min

When a person is infected with HIV, the immune system responds by producing antibodies against the virus, usually within

3 to 12 weeks after infection.

Primary immune deficiency diseases (PIDDs)

A rare, genetic disorder that impairs the immune system.' Without a functional immune response, people with PIDDs may be subject to chronic illnesses, which can increase the risk of developing cancer.' Some PIDDs can be fatal.

AIDS

AIDS is the late stage of HIV infection Occurs when the body's immune system is badly damaged because of the virus.

ART for HIV/aids

ART (antiretroviral therapy) Highly effective in keeping CD4 count high, reduce mortality Keeps viral load down, restores/preserves immune function Suppresses replication of virus Medications are lifelong Adapt medication regimen to facilitate adherence Use of combination drugs

St. John's Wort decreases

ART effectiveness -Ask patient to report use of CAM

physical forces for HIV management

Acupuncture, acutherapy, reflexology, therapeutic touch, yoga

relieving pain and discomfort for HIV

Affects all aspects of patient care Promote comfort Cleaning Topical anesthetics Assistive devices Antispasmodics Antidiarrheals Systemic analgesics NSAIDS with ART Hepatic/ hematologic status

Serological testing algorithm for recent HIV sero-conversation (STARHS)

Analyzes HIV-positive blood samples to determine whether an HIV infection is recent or has been ongoing.

cbc for Systemic lupus erythematosus

Anemia (low rbc) Thrombocytopenia Leukocytosis Leukopenia Could see increase in BUN and creatinine if kidney is involved

3 types of test for HIV

Antibody test - detects antibody NOT HIV Antigen/antibody test - detects HIV - detected only in blood NOT oral fluids Nucleic acid (RNA)test - detects HIV - detected only in blood NOT oral fluids

kaposi sarcoma localized cutaneous lesions can be

Anywhere on body( mouth, nose, throat) Pink, brownish, deep purple Disrupt skin integrity Body image - from disfigurement

improve airway clearance for HIV

Assess respiratory status, mental changes, skin color, cough Pulmonary therapy - Prevent secretion stasis Positioning assistance Adequate rest Maintain adequate ventilation Humidified O2 Suctioning Intubation Mechanical ventilation

Mycobacterium avium complex (MAC) dx

Blood cultures lymph node test bone marrow test

HIV modes of transmission

Body fluids: Blood, seminal fluid, vaginal secretions, amniotic fluid, breast milk. Mother to child: in utero, in delivery, breast feeding. Sharing infected needles Having sexual relations with infected persons. Receiving blood products or organ transplants from infected persons.

stage 3 HIV

Cd4 T lymphocyte count below 200 Severe immune deficiency The person develops AIDS opportunistic infections

stage 2 HIV

Cd4 t lymphocyte count (200-499) No opportunistic infections present b/c the person is not below 200

Cryptococcus Neoformans/Meningitis s/s

Fungal Infection Fever Headache Malaise Stiff neck Nausea Vomiting Mental changes seizures Sensitive to light *Can end up with permanent brain damage and hearing loss* They will start to develop fluid (hydrocephalus)

systemic lupus erythematosus is Believed to be brought about by

Genetics Immunologic Hormonal Estrogen Environmental Cigarette smoke UV fluorescent light medication viral infections stress

Below 10,000 is a low viral load however that does not mean that one does not have

HIV

Alterations in LIPID METABOLISM are associated with

HIV infection and the use of antiretroviral therapy (ART). Malnutrition increases risk for infection Feed, oral, enteral Maintain ideal weight...increase prn

Cutaneous manifestations are associated with:

HIV infections. Opportunistic infections - Herpes zoster & herpes simplex-painful vesicles Malignancies.

Pneumocystis pneumonia have elevated

Elevated Lactate dehydrogenase levels (LDL) -seen as PCP Marker Confirmed through bronchoalveolar lavage

coping with HIV

Explore resources Encourage contact with friends/family Prevent isolation promote acceptance Promote acceptance, understanding Support groups Mental health consults Explore feelings Body image changes

Autoimmunity

Failure of the body immune system to recognize its own cells and tissues as self Instead immune response are launched against these cells and tissue as if they were foriegn or invading bodies

Spiritual or psychological management for HIV

Faith healing, hypnosis, guided imagery, humor, positive affirmations

Symptoms of Systemic lupus erythematosus

Fever Malaise Weight loss Anorexia Mucocutaneous Musculoskeletal Arthralgias Arthritis Cardiac Butterfly Erythematous rash across bridge of nose and cheeks

Seborrheic Dermatitis

Integumentary Opportunistic Infection diffuse scaly rash *Can be seen on the hairline and different area*

Most people with HIV do not develop AIDS because taking

HIV medicine every day as prescribed stops the progression of the disease. -People who start Anti ritual virals medications soon after they get HIV experience more benefits—that's why HIV testing is so important.

Monoclonal antibodies for lupus

Halts production of antibodies Live vaccines contraindicated

side effect of ART

Hepatotoxicity-liver Nephrotoxicity-kidneys Osteopenia-attacks the bone Cardiovascular disease Myocardial infarction-can cause strokes Fat redistribution (Lipodystrophy, Lipohypertrophy).

Antimalarial agents for SLE

Hydroxychloroquine (plaquenil) - classified as an antimalarial drug.

renal lups nephritis s/s

Hypertension Swelling of lower extremities Weight gain Dark urine - urge to urinate at night Blood work to determine/monitor renal involvement No cure Renal failure and death

immunosuppressive drugs for SLE

Methotrexate, mycophenolic acid, cyclophosphamide, and azathioprine Reserved for more serious forms When not responding to conservative therapies Contraindicated in pregnancy Used most frequently in SLE nephritis

nursing management of SLE

Monitoring for complications (esp renal failure) Avoid UV/sun exposure Prevent infection (avoid sick ppl) Take frequent rest periods for the fatigue Osteoporosis screening - Calcium and Vitamin D supplementation Weight bearing activities Patient Education Routine screening Dietary consults Avoid sun exposure Report S/S of infection

Management of lupus

Monoclonal antibodies Corticosteroids Antimalarial agents NSAIDS immunosupressive agents Topical steroid cream for butterfly rash or other skin issues

Drug-induced lupus

More Temporary Rarely affects brain or kidneys

drug and biological therpies for HIV management

Not approved by FDA, oxygen therapy, ozone therapy, and urine therapy

Mycobacterium avium complex (MAC)

Opportunistic Infection Fever, night sweats, fatigue Weight loss, diarrhea, abdominal pain

Tuberculosis

Opportunistic Infection Gastrointestinal symptoms wasting syndrome *People with HIV and have this it can be very fatal*

Corticosteroids for lupus

Osteoporosis -> fractures Infection

Pneumocystis pneumonia s/s

Progressive dyspnea and on exertion Nonproductive cough fever chest discomfort Oral thrush Often causes airway closure and alteration in oxygen perfusion Hypoxemia *Symptoms worsen over days to weeks*

stress reduction for HIV

Relaxation Guided imagery Decrease anxiety

Routine HIV testing in hospitals

Routine testing for all persons 15-65 years old Routine test for HIGH RISK persons younger than 15 yrs. and older than 65 yrs

Diagnostics for HIV

Screening test are used to dx HIV infection Routine HIV testing in hospitals Serological testing algorithm for recent HIV sero-conversation (STARHS)

cardaic s/s in Systemic lupus erythematosus

Substernal chest pain Myocarditis Hypertension Cardiac dysrhythmias Valvular incompetence Early atherosclerosis stroke and MI

the immune system is Made up of tissues and organs that helps create or store cells that work around the clock to keep the whole body healthy for example

Tonsils Digestive system Bone marrow Skin Lymph nodes Spleen Thin skin on the inside the nose, throat and genitals

medication for integumentary Opportunistic Infection

Trimethoprim-sulfamethoxazole (bactrim) - Drug related causes pinkish-red macules - Drug related causes pinkish-red macules in which the med will have to be discontinued

Gynecologic opportunistic infections

Vaginal Candida Genital ulcers HPV- precursor for cervical ca Cervical Carcinoma Pelvic inflammatory disease Menstrual abnormalities

Nutritional therapies management for HIV

Vegetarian and macrobiotic diets, vitamins, curcumin, bitter melon

patho of HIV

Viruses are intracellular parasites They are organisms which can only feed and live within the cell of a different animal HIV is the sub-family of lentiviruses HIV is a RETROVIRUS- it carries a genetic material in the form of ribonucleic acid (RNA)....not deoxyribonucleic acid (DNA).

wasting syndrome

Weight loss 10% Diarrhea- devastating, perianal skin excoriation Fluid and electrolyte imbalances Inability to perform ADL's

Opportunistic infections

are infections that occur more often or are more severe in people with weakened immune systems than in people with healthy immune systems.

the higher your CD4 count, the

better.

kaposi sarcoma is confirmed through

biopsy

Cryptococcus Neoformans/Meningitis is confirmed with

csf analysis which is dine through spinal tap procedure

HIV encephalopathy or AIDS dementia late s/s

delayed responses vacant stare hallucinations spastic paraparesis tremors seizure mutism death

the lesions for kaposi sarcoma can be

flat, others raised- with edema and disseminated

how does death result for kaposi sarcoma

from tumor progression or other complications of HIV

The cd4 cells are t cells (aka t lymphocytes/helper cells) that play a key role in the

immune system. -They are natural defense systems against infection against your body.

PIDDs may be diagnosed in

infancy, childhood, or adulthood, depending on disease severity.

Arthralgias

joint swelling causing pain and stiffness

Opportunistic infections can be caused by

pathogens (bacteria, viruses, fungi, or protozoa) that take advantage of an opportunity not normally available, such as a host with a weakened immune system, or breached integumentary barriers.

Lentivirus

represents a genus of slow viruses with long incubation period (months, even years)

Discoid lupus erythematosus affects

skin on face

Kaposi sarcoma is transmitted

through sexual contact

ART are HIV and aids med that lower the

viral load and fight infections and improve the pt quality of life and gives them more time. ART are not cures for this they just control the growth of the virus and improve the immune system

if you have HIV should you avoid others with active infections?

yes

Pneumocystis pneumonia

opportunistic infection of the lungs caused by the Pneumocystis jirovecii fungus

Immune system

-the most complex system in the body Protects the body from infectious germs Is always at work, protecting the body from infections It does so by identifying and destroying harmful microorganism Helps to build immunity so that when the body encounters certain invading germs again it can fight them faster the next time around, often without even getting sick at all

Arthritis

......inflammation causing pain and morning stiffness

someone with a healthy immune system, CD4 counts are between

500 and 1,600 cells/mm3.

AIDS related lymphoma

Opportunistic Infection Hodgkin and Non-Hodgkin Aggressive Weight loss Night sweats Fever *Confirmed through biopsy*

Primary infection/acute (stage 1 of HIV infection)

Infection with HIV to the development of HIV Antibodies -2-3 weeks after infection develop symptoms (viral illness) Fever, fatigue, rash High level of replication Widespread dissemination throughout body Destruction of CD4- dramatic drop in CD4 count (500-1500) Viral set point

Lupus nephritis

Inflammation of kidney which can lead to blood in the urine and high levels of protein in the urine diet to inflammation -Caused by buildup of antibodies and proteins that damage the nephrons

Cryptococcus Neoformans/Meningitis

Inflammation of the meninges that covers the brian and spinal cord Can be causes by bacterial, virus and fungal Cryptococcus Neoformans are more common in ot with compromised immune system

systemic lupus erythematosus

Inflammatory autoimmune disorder - Affects nearly every organ 6 to 10 times more women than men 3 times more in African Americans than Caucasians Immune system inaccurately recognizes cells as foreign/ antigen Body develops antibodies B cells overproduce antibodies Antibodies destroy hosts cells

Molluscum contagiosum

Integumentary Opportunistic Infection -Deforming plaque formation

Herpes Zoster & Herpes Simplex

Integumentary Opportunistic Infection -Painful vesicles disrupt skin integrity *Seen in perineal area and flank area*

Appetite stimulants. In patients with AIDS related anorexia include

Megestrol (Megace) Dronabinol (Marinol)

Progressive Multifocal Leukoencephalopathy s/s

Mental confusion Rapidly progressing to blindness Aphasia Muscle weakness Paresis Death *ART medication can greatly reduce mortality threat*

HIV encephalopathy or AIDS dementia

Opportunistic infection Progressive cognitive decline, behavior, motor functions HIV can be detected in the brain and spinal cord fluid (CSF) of patients with encephalopathy.

Kaposi sarcoma

Opportunistic infection Aids related have Localized cutaneous lesions Disseminated disease

POTENTIAL FOR INFECTION for HIV

Opportunistic infections Failure of ART response Monitor S/S of infection Cough, fever, night sweats Pain, urgency, frequency on urination Lesions Headaches, visual changes, mental status changes

skin protection for HIV

Oral mucosa-Need special mouthwashes Assess for changes Skin moisturizers Cotton socks/ undergarments Pressure alleviating devices Avoid tape

nutritional support for HIV

Oral supplements - lactose free High calorie Easily digested protein Low fat, and easily digested Parental nutrition- Final option- cost - infection -Fruits should be washed thoroughly and peeled before eating Foods such as yogurt contains live bacteria and can lead to opportunistic infections Meat should be cooked thoroughly

Pelvic inflammatory disease presents with

Pain-abdomen, lower back, vagina Chills, fever, fatigue Increases risk HIV transmission

Subacute cutaneous lupus erythematosus

Papulosquamous/annular polycyclic rash Annular (ring-shaped) / polycyclic (two or more connected rings) / arciform (arc-like) Discoid rash- red flaky, itchy skin rashes that are usually oval or round and occur frequently on the face, neck, scalp and trunks. Exacerbations provoked by sunlight or artificial UV Oral lesions

IN THE EARLY STAGES OF THE HIV INFECTION the person may be

Person may be ASYMPTOMATIC May have s/s of fatigue, skin rash

reproductive counseling for HIV

Prevention of transmission Breastfeeding Bearing children

HIV encephalopathy or AIDS dementia early s/s

initially are subtle, resembling depression, fatigue -memory loss headache difficult in concentration slowing difficulty walking confusion.

The viral load in a pt with HIV gives an idea of how

much HIV virus is on the body and helps to tell what's going on with the infection and can tell how the tx is working, it predicts how far the disease has progressed.

HIV encephalopathy or AIDS dementia dx

spinal tap, when it's done HIV can be detected in the brain