Chapter 56 Care of the patients with HIV/AIDS
Early S/S of HIV
occur when the CD4 cell count drops below 500/mm; fever, fatigue, headaches, swollen lymph nodes, skin rash, NVD, sore throat, night sweats
HIV- Stage 1
occurs within 2-4 weeks of infection flu like symptoms very infectious with elevated numbers of virus in fluids
Phase 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
HIV- Stage 3
patient develops AIDS most severe stage develops opportunistic infections viral loads elevated and very contagious CD4 count <200cell/mm fever, chills, swollen lymph nodes, weight loss, weakness
HIV is found in
pericardial, synovial, cerebrospinal, peritoneal, amniotic fluids
late signs and symptoms of HIV
persistent high fever, severe chills, white spots in mouth, severe fatigue, brown red purple or pink rashes, significant weight loss
Multidisciplinary Care for HIV patients
physician who specializes in HIV disease social worker case manager dietitian nurse mental health professional
Seroconversion
point at which you can detect antibodies to HIV usually 1-3 weeks after infection
Physician
prescribes medications antiretroviral therapy monitor viral load monitor lab values
Nursing interventions for HIV pts
prevention of infection, modify alternations in body temperature, promote good nutrition, promote self care, and provide counseling
HIV treatment
prevents immune system damage limiting viral loads to undetectable levels
Karposi sarcoma
rare cancer of the skin and mucous membrane characterized by blue, red, purple raised lesions; occurs in Mediterranean men
CD4 (Tcell) count
reflects number of CD4+ cells per cubic millimeter(microliter) of blood used to measure a persons immune function normal values range between 500 and 1500 cells per cubic millimeter
HIV modes of transmission
sexual intercourse (most common) anal/vaginal IV drug use Infected blood, semen, rectal secretions, cervi-covaginal secretions, breast milk
Proper PPE for HIV
standard precautions unless at risk for blood or body fluids. If so the nurse would don mask with face shield or goggles, gloves, gown
1985
start of blood screening for HIV 1
1992
start of screening for HIV 2
CD4 count
test that measures how many CD4 cells you have in your body. These are a type of wbc called T Cells that moves throughout your body to find and destroy bacteria, viruses, other invading germs
What levels go down in me with aids
testosterone
Viral Load
the amount of measurable HIV present in an infected person's blood
AIDS stage
the host can no longer protect itself and body is injured CD4+ count decreases to fewer than or equal to 200 cells/mm number of viruses detectable in blood increases rapidly without treatment, the median time for AIDS diagnosis to death 1 1/3 years
Drug Resistant ART
-HIV mutates easy, makes treatment/containment hard -Mutation is why there is no vaccine -During acute stage important to test for resistance to make sure appropriate ART is administered -Patient specific combination -patient commitment to taking ART at correct time, dosage is a must to prevent resistance
HIV antibody tests
-antibodies to HIV develop in an infected individual within as little as 3 weeks to as much as 14 months after exposure to virus -person can falsely test negative for the virus during this time
Opportunistic Diseases
-candidiasis of bronchi,trachea,esophagus,;lungs -invasive cervical cancer -coccidioidomycosis-valley fever(fungus infection) -cryptococcosis(yeast like fungus) -cryptosporidiosis(parasite), chronic intestinal(greater that 1 month duration) -Cytomegalovirus(virus in the herpes family)(particularly CMV retinitis) -Encelphalopathy, HIV related -Herpes Simplex
Testing for HIV Legal Implications
-informed consent must be obtained prior to testing -pre and post test counseling(usually by state approved HIV counselor) is required regardless of the results -results can not be given over phone. -ensuring client confidentiality is essential; labs use coding instead of patient name -lab musty be approved by state for HIV testing
route of expsoure
-initial exposure -Primary HIV infection(acute illness)- flulike symptoms, develop antibodies to HIV in 1-2 weeks -Asymptomatic(HIV seropositivity) infectious but no eveidence of illness except positive result -Early HIV disease- persistent unexplained fever, night sweats, diarrhea, weight loss, fatigue, lymphadenopathy; signs and symptoms may not occur until 10-14 years after initial exposure without treatment -Advanced HIV disease- AIDS
ART side effects
-severe gastrointestinal upset with nausea, vomiting, diarrhea -Bone marrow suppression - Peripheral Neuropathy - Diabetes - Increased cholesterol - Increased triglyceride levels
CD4 count of AIDS
200 OR LESS
Cocktail
3 or more compounds that are effective in treating HIV/AIDS
Time line of hiv antibodies
3 weeks to 14 months; can test false
Normal CD4 count
500-1500
Infant is HIV tested
6 weeks after birth
Nutrition
Diarrhea-lactose free, low fat,low fiber, high potassium Constipation- high fiber food Nausea/vomiting- low fat foods Candidiasis- soft/ pureed food fever- high calorie, high protein food altered taste-diet as tolerated anemia- high iron food fatigue- high calorie
Lab results identifying progression of HIV
CD4 count, antibody testing, viral load testing
OraQuick Rapid HIV-1 Antibody test
Detects antibodies to HIV-1 in home rapid screening test to determine HIV exposure 99% accuracy uses only one drop of blood results available in 20 minutes
what is screened in blood products
HIV 1&2, HEP B&C, WEST NILE, TRYPANOSOMA CRUZI,
Phase 1: Binding(Attachment)
HIV binds to receptors on surface of CD4 cell *CCR5 antagonist *Post-attachment inhibotors
Phase 2: Fusion
HIV envelope and CD4 cell membrane fuse, which allows HIV to enter the CD4 cell *fusion inhibitors
Opportunistic Diseases
Histoplasmosis(fungal infection) Isosporiasis(parasite) chronic intestinal <1month Kaposi sarcoma- rare skin cancer Lymphoma, multiple forms Mycobacterium avium complex(causes TB and Leprosy Pneumocystitis jiroveci pneumonia(fungal infection in lungs pneumonia, recurrent Salmonella(bacteria) septicema,recurrent contaminated food and water Toxoplasmosis(parasite/protozoa class) of brain- cat feces wasting syndrome due to HIV
HIV in pregnancy
In US 30% of infected mothers will transmit to infants 50% to 70% of transmissions occur late in utero or intrapartum
Phase 6: Assembly
New HIV proteins and HIV RNA move to the surface of the cell and assemble into immature noninfectious HIV
Six Classes of ART used
Nucleoside reverse transcriptase inhibitors(NRTIs) Non-nucleoside reverse transcriptase inhibitors(NNRTIs) Protease inhibitors(PI) Integrase strand transfer inhibitors Fusion inhibitors CCR5 antagonists(also referred to as entry inhibitors)
What is given after exposure to HIV
PEP
How can a mother prevent spreading HIV to baby during pregancy
Take ART(antiretroviral therapy)
Postexposure prophylaxis (PEP)
Treatment administered to an individual after exposure to an infectious disease to prevent the disease
Antiretroviral Therapy (ART)
a combination of several medications prescribed for people who are HIV-positive to delay the onset of AIDS
Opportunistic Infections/cancers
account for a ;large portion of deaths related to HIV
AIDS( Acquired Immunodeficiency Syndrome)
acronym used to describe the end stage of the spectrum of HIV infection
More likely to be diagnosed with HIV
african americans
HIV is NOT spread by
air, water, insects, saliva, tears, sweat, casual contact, sharing dishes, closed-mouth kissing
Nurse role in coping
assess coping styles encourage healthy patterns of coping encourage patient to focus on positives aid pt in controlling anxiety use therapeutic communication
what effects does aids have on immune system
attacks cd4 helper cells or t cells, when left untreated minor infections could become severe
HIV takes over host
binding-attaches to cell receptor fusion-hiv fuses to cd4 cell reverse transcription- hiv releases enzyme to convert to DNA replication-uses cd4 to replicate hiv protein assembly-new hiv moves to the surface budding-newly formed hiv leaves cd4 cell
Immunosuppression
having weakened immune system and unable to fight infections
Mental Health Professional
helps HIV/AIDS patients with denial helps care for mental health
Possible Treatments for HIV
can be controlled with use of antiretroviral meds some opportunistic infections can be prevented with prophylaxis HIV is not curable; only treatable
nurse must stress pts who take hiv meds
continue prescription until finished, do not ration, infection will resist if not taken properly
pneumocytic diroveccia
cough(non productive), rapid breathing, fever, weight loss
other infections that are important to test for in HIV pt
hep c/ syphilis
To gain weight
high calorie diet
High prevalence rates since 2000
hispanics
enzyme-linked immunosorbent assay (ELISA)
detects antibodies to HIV proteins saliva and blood are used for testing less specific than western blot test possible false-positive reactions
HIV-RNA or viral load
determines the strength of the virus measurement of the amount of viral RNA in the blood stream
Risk Factors
homosexual men (highest number of HIV/AIDS patients Hispanics and african americans disproportionately infected African American adults/ adolescents 10 times more likely to be diagnosed than Caucasian
Nutrition related to hiv
increase in protein intake, high calorie, high potassium, low residue, foods that are easy to swallow when dysphagia is present and avoid spicy or acidic food
1996
increase in use of HAART (highly active antiretroviral therapy)
HIV
infectious human retrovirus; commonly invades T cells and B cells
ELISA
enzyme-linked immunosorbent assay; detects antibodies in the blood
Nurses
establishes rapport treat in nonjudgemental manner prevent infection provide education encourage adherence to medication regimen
Function of T cells and B cells
fight infection produce antibodies for specific immune responses
Social Worker
focus on pointing patient to needed resources case manager works for social worker in planning/meeting patient needs
Western Blot Assay
follow up to Elisa Seropositive testing More specific protein and expensive than Elisa
Pre-exposure prophylaxis (PrEP)
for people who do not have HIV but are high risk prevention of HIV infection pill taken every day must test negative before you start Brands: truvada-contains 2 meds tenofovir/emtricitabine
Phase 3: Reverse Transcription
inside CD4 cell. HIV releases and uses transcriptase(HIV enzyme) to convert its genetic material HIV RNA INTO HIV DNA. This conversion allows HIV to enter the CD4 cell nucleus and combine with the cells genetic material *Non-nucleoside reverse transcriptase inhibitors(NNRTIs) *Nucleoside reverse transcriptase(NRTIs)
Phase 4: Integration
inside the CD4 cell nucleus, HIV releases integrase(HIV enzyme). HIV uses integrase to insert its viral DNA into the DNA of the CD4 *Integrase Inhibitors
Commonly overlooked problem in females related to hiv infections
invasive cervical cancer
HIV- Stage 2
known as clinical latency often asymptomatic (no symptoms) low levels of virus present in blood
CD4 count for HIV
less than 500
What does HIV treatment limit
limits viral load/ immune system damage
HIV wasting
loss of body mass caused by disturbance in metabolism, interferes with nutrients increase opportunistic infection 10% body weight loss, diarrhea, weakness over 30 days intestine absorption decrease decrease testosterone in men
Its important for nurses to teach caregivers of HIV pts
modes of transmission for HIV
Oral Candidiasis
most common infections seen in individuals with early symptomatic disease
S/S of HIV
muscle/joint pain, weight loss, sore throat, night sweats, thrush, lesions, diarrhea, unexplainable fever and fatigue
Less common HIV transmission
needle sticks, receiving blood transfusion, eating prechewed food from hiv person, being bitten by a person, contact between broken skin
Main Symptoms of AIDS
neurological -encephalitis -Meningitis Eyes -Retinitis Lungs -Pneumocystis -Tuberculosis -Tumors Gastrointestinal -Esophagitis -Chronic Diarrhea -Tumors
Phase 7: Budding
newly formed immature noninfectious HIV pushes itself out of the host CD4 cell. New HIV releases protease. Protease acts to break up the long protein chains that form the immature virus. The smaller HIV proteins combine to form mature infectious HIV *Protease inhibitors (PIs)
Palliative Care
not with hospice enables patient to achieve the highest level of comfort focus on spiritual, psychological, social, physical needs
HIV wasting management
nutritional supplements increase protein enternal supplement_NG/PEG TPN
Vertical Transmission
transmission from mother to fetus during pregnancy, delivery, or breastfeeding
Pneumocytitis jiroveci (formerly carinii)
unusual pulmonary disease caused by fungus that infects people with suppressed immune system.
Western Blot Testing
used to identify specific amino-acids sequences in protein
Treatment as Prevention(TasP)
uses of antiretroviral(ARV) meds to prevent HIV transmission taken directly as prescribed regular follow up care regular viral load tests to ensure viral load is staying undetectable