HIV/AIDS

Complications: herpes simplex

"cold sores"; clear vesicles with red base that evolve into pustules, usually at lip-skin junction

AIDS patho

-Retrovirus- inserts DNA copy of its genome into host cell in order to replicate. -Hx of HIV/AIDS- 1981- AIDS. Cases of pneumocystis carinii pneumonia, Kaposi's sarcoma in young, healthy, gay men. 1983 first antibody identified, 1984 HIV isolated. AIDS caused by HIV1: destroys body's ability to fight infection, virus found in body fluids, virus infects cells that have CD4 binding site. Viral DNA integrated into host DNA, may remain latent, inactive for years, antibodies detectable in 6 weeks to 6 months. Vertical transmission (mother to baby), can be reduced. -Reason it spread so rapidly among gay men population bc anal sex- anal tissue very fragile and that's how virus permeated into their systems. Then IV drug users. Then women. AIDS epidemic how standard precautions came to be. Do need to know it's transmitted by body fluids! Women are routinely tested because we can transmit this to baby

HIV nursing interventions

-Standard precautions- IMPORTANT! Remember- putting another pair of gloves over dirty gloves is not standard precautions. If your gloves are dirty you take them off and get a clean pair- sounds like an exam question - If you are taking care of an HIV/AIDS pt and they were to start developing a cough, would want to report that! IMPORTANT. Bc TB would be what you were worried about. However, where we live and where we practice there hasn't been a case of TB in Frederick County for a long time- so much so that hospital employees aren't required to get TB tests anymore. But TB is not eradicated, so if person were to acquire a cough while in your care, report. If think may have TB, negative pressure room. While that's important, it's not as important to us as reporting. TEST QUESTION for sure. -Want to know T cell count/WBC bc want to know how protective you have to be of them, not you. Wash hands well, universal precautions etc...they probably know more about taking care of themselves than you do. They know not to be around people who are sick, will get flu shots etc.

Complications: infections

All opportunistic infections can show up in AIDS pts. If have as some point in life taken in herpes virus, can suddenly erupt when immune system fails. Varicella also in this class- if person had chx pox as kid, that virus is sitting in them just waiting to have something better to do- shingles! Anything opportunistic can be fair game for this immunosuppressed people- they catch everything.

Complications: oral yeast infections

Candidiasis or thrush, a fungal infection, occurs in almost all patients with AIDS and AIDS-related conditions

AIDS dx

ELISA (enzyme-linked immunosorbent assay) = quick test- detects and measures antibodies in your blood Western blot antibody testing- used to confirm a positive ELISA. Separates the blood proteins and detects the specific proteins (HIV antibodies) that indicate an HIV infection. HIV viral load tests-measures amount of HIV genetic material (RNA) is in the blood and reports how many copies of the virus are present. Evidence shows that keeping the viral load at undetectable levels decreases an infected person's risk of progressing to AIDS and greatly improves long-term health. -CBC, CD4 count, blood culture for HIV, immune-complex-dissociated p24 assay (rapid serologic test), detect secondary cancers, infections. -HIV not always detectable right off bat = can have latency. May not have acute infection- may be latent for years before it rears its head. Now can remain HIV positive without having full-blow AIDS. May take care of pt who is HIV positive- remember there's still a stigma about that, so protect that health information- don't go around and tell other people. - All pregnant women are tested for AIDS

Stage 2- Clinical latency

HIV asymptomatic: More than 500 CD4 lymphocytes. Upon reaching the viral set point, chronic asymptomatic state begins. Body has sufficient immune response to defend against pathogens. Can spread the virus regardless of sx. By about 6 months, the rate of viral replication reaches a lower but relatively steady state that is reflected in the maintenance of viral levels at a set point. This set point varies greatly from patient to patient and dictates the subsequent rate of disease progression; on average, 8 to 10 years pass before a major HIV-related complication develops. In this prolonged, chronic stage, patients feel well and have few if any symptoms. Apparent good health continues because CD4+ T-cell levels remain high enough to preserve defensive responses to other pathogens. When body still has everything under control. Even though you're "latent" you can still spread disease. HIV symptomatic: 200-499 T lymphocytes. CD4 T cells gradually fall. Pt develops sx of conditions related to HIV.

Stage 1- Acute/primary infection

Intense viral replication and dissemination of HIV throughout body. Window period- period during which person with HIV infection tests negative on the HIV antibody blood test. About 3 weeks into this acute phase, the person may display symptoms similar to mononucleosis or flu, such as fever, enlarged lymph nodes, rash, muscle aches, and headaches. These symptoms resolve within another 1 to 3 weeks as the immune system begins to recuperate. The body produces antibody molecules in an effort to contain the virus; they bind to free HIV particles (outside cells) and assist in their removal. This balance between the amount of HIV in the body and the immune response is referred to as the viral set point; it results in a steady state of infection that can last for years. This set point often begins your latency period of no symptoms. May be sero-positive at this time, might not be.

Complications: TB

Mycobacterium tuberculosis tends to occur in IV/injection drug users and other groups with a pre-existing high prevalence of tuberculosis (TB) infection.

Complications: HIV encephalopathy/neuro effects

Neuro effects include dementia, delirium, seizures. HIV encephalopathy- impacts motor, cognitive, behavioral functioning. Opportunistic infections: toxoplasmosis, non-Hodgkin's lymphoma. CNS manifestations common. Neuro deficits, nervous system gets attacked. Encephalopathy- what you need to know is word encephalopathy whether in regards to HIV/hepatic/whatever- fix is different, but sx are the same. Person gets a little crazy.

Pt education

Prevention- standard precautions, safer sex practices (abstain from sharing sexual fluids, reduce number of sexual partners to one, always use latex condoms, if allergic, use non-latex), blood screening and tx of blood products, do not share drug injection equipment

HIV medical tx

continually evolving. Focus on the tx of specific manifestations and conditions related to the disease. -Not everyone gets implanted venous access device- that's just if you're ill and getting some sort of drugs intravenously. People nowadays can maintain T cells so they don't get immunosuppressed and don't catch every bug down the pike and can live normal lives. Also when drugs first came out were fabulously expensive and a lot of people couldn't afford them. Now it's easily affordable- 99% of health insurances pay for it, so everyone who needs treatment can be treated. Pharmacologic therapies: -Highly active antiretroviral therapy (HAART)- minimum of 3 antiretroviral agents- reduces incidence of drug resistance. Scheduled for specific times during day. Less than perfect adherence results in resistance. -In pregnancy delay until after first trimester if possible and current regimen is effective; no drugs with known teratogenic effects (teratogenic = harmful to fetus); intrapartum and postpartum recommendations. Term infant- prophylaxis or multidrug antiretroviral regimen -also may see chemo, antidepressants, nutrition therapy, complementary and alternative medicine

Complications: CMV retinitis

cytomegalovirus retinitis- inflammation of retina that can lead to blindness. Retinitis is the most common clinical manifestation of CMV. Peripheral retinitis might be asymptomatic or present with floaters, scotomata (a loss of vision within the visual field), or reduced visual acuity. Patients with CD4+ counts of less than 50 should be examined by an ophthalmologist on a yearly basis

Complications: pneumocystis pneumonia

huge complication and often what kills pt with AIDS. Any kind of opportunistic infection in an immunocompromised person is serious business.

Nursing dx

impaired skin integrity, diarrhea, risk for infection, activity intolerance, disturbed thought process, ineffective airway clearance, pain, imbalanced nutrition, social isolation, anticipatory grieving, deficient knowledge -Assess resp function- At least daily; evaluate fluid volume status, mental and neuro function -Assess vitals frequently, weigh daily, elevate HOB, refer to nutritionist -Maintain good skin care, improve activity tolerance/balance between activity and rest -Assess bowel pattern and factors that exacerbate diarrhea -Prevent infection- monitor s/s infection

Stage 3- AIDS

less than 200 CD4 lymphocytes. As levels drop below 100, the immune system is significantly impaired. Development of following conditions (see notes below) stage we don't get to so much anymore. Full-blown AIDS. Rarely will you see in developed countries w good drug therapy a person who has AIDS.

Nursing assessment

psychosocial status, identify potential risk factors, immune system function, nutritional status, skin integrity, resp status, neuro status, fluid and lyte balance, knowledge level

Complications: wasting syndrome

severe involuntary weight loss. In some AIDS- associated illnesses, pts experience a hypermetabolic state in which excessive calories are burned and lean body mass is lost. The distinction between wasting (cachexia) and malnutrition is important because the metabolic derangement seen in wasting syndrome may not be modified by nutritional support alone

Complications: Kaposi's sarcoma

the most common HIV-related malignancy, is a disease that involves the endothelial layer of blood and lymphatic vessels. Cutaneous lesions can appear anywhere on the body and are brownish pink to deep purple. Ulcerative lesions disrupt skin integrity and increase discomfort and susceptibility to infection. Kaposi's starts on skin and moves to organs- sort of like melanoma. Once it makes its way to lymph nodes it travels to whole body. Then it's curtains for person with AIDS.

HIV transmission

through body fluids containing HIV or infected CD4 lymphocytes. Blood, seminal fluid, vaginal secretions, amniotic fluid, breast milk. Most prenatal infections occur during delivery. Casual contact does not cause transmission. Breaks in skin or mucosa increase risk.

Complications: cryptococcal meningitis

type of meningitis caused by fungus called cryptococcus; mainly affects people with weakened immune systems. Sx develop gradually- HA, N/V, fatigue, confusion or hallucinations, personality changes, sensitivity to light, fever, stiff neck, blurred vision. Untreated can lead to fluid on brain, coma, hearing loss, death.

HIV risk factors

· Hemophilia and blood transfusions- no risk for donating thanks to blood screening methods. · Health care as an occupation- needle stick, non-intact skin contact, 0.3% risk. · High-risk behaviors- sharing infected injection equipment, having sexual relations with infected individuals. Poverty- less access to preventative healthcare. · Pregnancy and breast feeding. · Older age- decline in immune system function, failure to use condoms. In the United States, new infection rates by race/ethnicity show that nearly half of the cases (49%) are African American.