Ch. 37 Management of Patients with HIV infection and AIDS

What is primary infection of HIV disease?

AKA acute HIV infection or acute HIV syndrome Part of CDC category A Symptoms: none to flulike syndrome Window period: lack of HIV antibodies Period of rapid viral replication and dissemination through the body Viral set point: balance between amount of HIV and the immune response

What are some nursing interventions for bowels for HIV?

Assess bowel pattern and factors that may exacerbate diarrhea Avoid foods that act as bowel irritants, such as raw fruits and vegetables, carbonated beverages, spicy foods, and foods of extreme temperatures Small, frequent meals Administer medications as prescribed Assess and promote self-care strategies to control diarrhea

What are some nursing interventions for thoughts for HIV?

Assess mental and neurologic status Use clear, simple language if mental status is altered Establish and maintain a daily routine Orientation techniques Ensure patient safety and protect from injury Strategies to maintain and improve functional ability Instruct and involve family in communication and care

What is the nursing process assessment for a patient with HIV?

Assess physical and psychosocial status Identify potential risk factors: IV drug abuse, risky sexual practices Immune system function Nutritional status: n/v, anorexia, oral pain, diff swallowing Skin integrity: inspection vital Respiratory status: cough, sputum, sob, orthopnea, tachypnea, chest pain Neurologic status: level of consciousness, orientation, memory, sensory deficits, motor involvement and any seizures Fluid and electrolyte balance Knowledge level

What is the HIV infection stages?

Attachment of the HIV virus to an uninfected CD4+ receptor Uncoating: contents of HIV's viral core emptied into CD4+ T cell DNA synthesis: reverse transcription produces a mirror image of the viral RNA and double-stranded DNA molecule Integration of viral DNA into host DNA Transcription of the inserted viral DNA to produce viral messenger RNA Translation of viral messenger RNA to create viral polyprotein Cleavage of the viral polyprotein into individual viral proteins that make up the new virus Assembly and release of the new virus from the host cell

What is HIV asymptomatic?

CDC category A More than 500 CD4+ T lymphocytes/mm3 Upon reaching the viral set point, chronic asymptomatic state begins Body has sufficient immune response to defend against pathogens

What is HIV symptomatic?

CDC category B 200-499 CD4+ lymphocytes/mm3 CD4 T cells gradually fall The patient develops symptoms or conditions related to the HIV infection, which are not classified as category C conditions. Patients who are once treated for a category B condition are considered category B.

What is AIDS?

CDC category C Less than 200 CD4+ lymphocytes/mm3 As levels drop below 100 cell/mm3 the immune system is significantly impaired. Development of listed conditions Candidiasis of bronchi, trachea, lungs and esophagus Cervical cancer, invasive See table in text

What is some health care provider treatment?

Consent for baseline HIV, hepatitis B and C Get postexposure prophylaxis for HIV according the CDC guidelines Start within 2 hours after exposure Monitor for symptoms of toxicity Practice safe sex Continue HIV medications for the full 4 weeks after exposure Follow up with postexposure testing at 1 month, e months, 6 months and 1 year Documentation

What are some lab tests to diagnose and track HIV?

EIA- antibodies are detected, resulting in positive results and marking the end of the window period Western period- also detects antibodies to HIV, used to confirm EIA Viral Load- measures HIV RNA in the plasma CD4/CD8- these are the markers found on lymphocytes. HIV kills CD4+ cells, which results in a significantly impaired immune system OraQuick- in home HIV test

What are some nursing interventions for skin for hIV?

Frequent routine assessment of skin and mucosa Encourage patient to maintain balance between rest and activity Reposition at least every 2 hours and as needed Pressure reduction devices Instruct patient to avoid scratching Use gentle, nondrying soaps or cleansers Avoid adhesive tape Perianal skin care

What are some planning (goals) for a patient with HIV?

Goals may include Achievement and maintenance of skin integrity Resumption of usual bowel patterns Absence of infection Improved activity tolerance Improved thought processes Improved airway clearance Increased comfort, improved nutritional status Increased socialization Expression of grief Increased knowledge regarding disease prevention and self-care Absence of complications

Stages of HIV disease?

HIV asymptomatic (more than 500 CD4+ T Lymphocytes): Patients feel well and have few symptoms because CD4+ T-cell levels remain high enough to preserve immune defensive responses HIV symptomatic (200-499 CD4+ T Lymphocytes), AIDS: CD4+ T-cell level drops below 200 When the levels drop below 100, the immune system is significantly impaired Important for entitlements: housing, disability benefits and food stamps)

What are emotional and ethical considerations for someone with HIV?

Health care professional concerns: fear of infection, responsibility for giving care, values clarification, confidentiality, poor prognostic outcomes Stigmatized behaviors: nurses may not want to take care Patient's right to privacy Sexual partners should know about the potential for infection Unlike cancer, AIDS is associated with controversies challenging our legal and political systems as well as religious and personal beliefs

What are some nursing interventions for improving airway clearance and pain?

Improving airway clearance Position in semi-Fowler's or high Fowler's position Pulmonary therapy; coughing and deep breathing, postural drainage, percussion, and vibration Ensure adequate rest Pain Medications as prescribed Skin and perianal care

What is nursing process for the diagnosis for HIV?

Ineffective airway clearance Pain Imbalanced nutrition Social isolation Anticipatory grieving Deficient knowledge Impaired skin integrity Diarrhea Risk for infection Activity intolerance Disturbed thought processes

What are the clinical manifestations integumentary and gynecologic?

Integumentary: herpes zoster & herpes simplex Gynecologic: candidiasis, genital ulcers put females at risk for contracting HIV, HPV, cervical neoplasms, PID, menstrual abnormalities

What are clinical maifestations of HIV/AIDS: oncology?

Kaposi's sarcoma: common in men who have sex with men Endothelial layer of blood and lymphatic vessels Cutaneous lesions (brownish pink to deep purple) but may involve multiple organ systems Lesions cause discomfort, disfigurement, ulceration, and potential for infection Visceral involvement: lymph nodes, GI tract and lungs B-cell lymphomas: develop outside the lymph nodes, brain, bone marrow and GI tract

What are some nursing interventions for nutrition for HIV?

Monitor weight, I&O, dietary intake, and factors that interfere with nutrition Dietary consult Control of nausea with antiemetics Oral hygiene Treatment of oral discomfort Dietary supplements May require enteral feedings or parenteral nutrition

What are some gerentology considerations for people with HIV?

One quarter of people living with HIV are older than age 50 years. Reasons Unprotected intercourse Do not consider themselves at risk Social bias toward homosexuality May use IV drugs May have received HIV-infected blood before 1985 Reduction in immune system function

What are some collaborative problems and potential complications for HIV?

Opportunistic infections Impaired breathing or respiratory failure Wasting syndrome Fluid and electrolyte imbalance Adverse reaction to medication

How do you manage potential complications and collaborative care for HIV?

Opportunistic infections Respiratory failure Cachexia and wasting Medication side effects Educate about self-care Community support systems Emotional and ethical concerns

What are clinical manifestations of HIV/AIDS: GI?

Oral candidiasis: creamy white patches in the oral cavity May progress to esophagus and stomach, difficult and painful swallowing and retrosternal pain Treatment with Mycelex troches or nystatin, ketoconazole Diarrhea related to HIV infection or enteric pathogens Octreotide acetate for severe chronic diarrhea Wasting syndrome 10% weight loss and chronic diarrhea or chronic weakness and fever with absence of other cause Protein energy malnutrition Anorexia, diarrhea, GI malabsorption, and lack of nutrition may contribute

What are the clinical manifestations of HIV/AIDS: neurologic?

Peripheral neuropathy: pain and functional impairment HIV encephalopathy (aids dementia complex) Progressive cognitive, behavioral, and motor decline Probably directly related to the HIV infection Cryptococcus neoformans: fungal infection, cryptococcal meningitis: fever, headache, malaise, stiff neck, nausea, vomiting, mental status changes and seizures Progressive multifocal leukoencephalopathy: mental confusion, aphasia, muscle weakness, paralysis, & death Other neurologic disorders Depression: higher rates of depression History of preexisting mental illness, neuropsychiatric disturbances, psychosocial factors

What are Clinical Manifestations of HIV/AIDS: Respiratory?

Pneumocystic carinii pneumonia (PCP): Most common life-threatening infection Initial symptoms may be nonspecific and may include nonproductive cough, fever chills, dyspnea, and chest pain If untreated, progresses to pulmonary impairment and respiratory failure Mycobacterium avium complex (MAC): opportunistic infection in people with AIDS with severe immune depression Tuberculosis: can develop in the lungs as well as CNS, bone, pericardium, stomach, peritoneum and scrotum

What are some Prevention for Health Care Providers/Standard Precautions for HIV?

Prevents the transmission of bloodborne pathogens and pathogens from moist body substances Hand hygiene Personal protective equipment (PPE): gloves, gown, mask (goggles, face shield) Soiled patient care equipment handling: wear gloves and perform hand hygiene Environmental control: Infection Control/Policies Textiles and laundry: handle to prevent transfer of microorganisms Needles and other sharps Patient resuscitation: no contact with oral secretions

What are the stages of the HIV disease?

Primary infection: acute/recent HIV infection, Acute HIV Syndrome Primary: period from infection with HIV to the development of HIV-specific antibodies Window period: HIV-positive person tests negative on the HIV antibody blood test, although they are infected and highly infectious Characterized by high levels of viral replication, dissemination of HIV throughout the body and destruction of CD4+ T cells Viral set point: remaining amount of virus in the body after initial immune response; steady state of infection that lasts for years

What are some nursing interventions for isolation for HIV?

Promote an atmosphere of acceptance and understanding Assess social interactions and monitor behaviors Allow patient to express feelings Address psychosocial issues Provide information related to the spread of infection Educate ancillary personnel, family, and partners

What are some preventative of HIV infection?

Standard precautions Safer sex practices and safer behaviors Abstain from sharing sexual fluids Reduce the number of sexual partners to one Always use latex condoms; if allergic to latex, use nonlatex condoms. Latex condoms provide the best protection against HIV (http://www.aids.gov) Do not share drug injection equipment Blood screening and treatment of blood products

What is the medication treatment for HIV?

The CD4 count serves as indicator for immune function when deciding to start ART treatment (see able 37-3) ART NRTIs NNRTIs

What is transmission of HIV?

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

What are some treatments for HIV?

Treatment and protocols are continually evolving Antiretroviral agents Nucleoside reverse transcriptase inhibitors (NRTIs) Non-nucleoside reverse transcriptase inhibitors (NNRTIs) Protease inhibitors (PIs) Integrate inhibitors Use of combination therapy Management also focuses upon the treatment of specific manifestations and conditions related to the disease.

What are the HIV and AIDS advancements?

Treatment has improved steadily since the advent of combination medication therapy. Survival rates have increased dramatically in the past 20 years 1.2 million people in the United States are living with HIV; one in five are unaware they are infected, according to the CDC. 50,000 new infections per year Number of new HIV infections, globally, declined 19% over the past decade

What are some risks associated with HIV infection and AIDS?

sharing infected injection drug use equipment having sexual relations with infected individuals (both male and female) infants born to mothers with HIV infection and/or who are breast fed by HIV infected mothers people who receive organ transplants, HIV infected blood , or blood products