hiv and aids

A 16-year-old has come to the clinic and asks to talk to a nurse. The teen states that she has become sexually active and is concerned about getting HIV. The teen asks the nurse what she can do to keep from getting HIV. What would be the nurse's best response?

"Other than abstinence, only the consistent and correct use of condoms is effective in preventing HIV."

Primary infection (acute HIV infection)

CDC Category A - no symptoms or may feel like flu - no HIV antibodies - Cells are replicating and spreading rapidly - viral set point is established - viral load is high and then body makes specialized cytotoxic T cells to bring load down to set point

HIV asymptomatic

CDC category A - more than 500 CD4 T lymphocytes - Body has sufficient immune response so no opportunistic infections

HIV symptomatic

CDC category B - 200-499 CD4 T lymphocytes - start to see opportunistic infections - once a pt has category B infection, they are considered HIV symptomatic regardless of CD4 cells

AIDS

CDC category C - less than 200 CD4 T lymphocytes - development of specific diseases - AIDS dementia, neoplasms

A client with acquired immune deficiency syndrome (AIDS) comes to the clinic reporting difficulty swallowing. The client says, "It hurts so much when I swallow." Inspection reveals creamy white patches in the client's mouth. What will the nurse suspect?

Candidiasis (a fungal infection caused by a yeast)

Other than abstinence, what is the only proven method of decreasing the risk of sexual transmission of HIV infection?

Consistent and correct use of condoms

A client is considering beginning sexual relations and wants to know the best way to be protected from a sexually transmitted infection and HIV. What is the best response by the nurse?

"Using a latex condom and spermicidal jelly is one of the most effective ways to decrease the risk of transmission of an STI and HIV."

The nurse is discussing sexual activity with a client recently diagnosed with human immunodeficiency virus (HIV). The client states, "As long as I have sex with another person who is already infected, I will be okay." What is the best response by the nurse?

"You should avoid having unprotected sex with a person who is HIV positive because you can increase the severity of the infection in both you and your partner."

A client who has been exposed to the human immunodeficiency virus (HIV) tests negative. Which explanation by the nurse would be most appropriate?

"Your body may not have developed antibodies yet, so we need to follow up."

Assessment for HIV pt

- Assess support system and knowledge base - Assess for potential risk factors - Immune system function - Nutritional status & GI o White patches in mouth, sore o Diarrhea o Wasting syndrome-10% wt loss, diarrhea, fever, weakness o Protein levels low o Anorexia - Skin integrity o Kaposi's sarcoma (Painful Cutaneous lesions that ulcerate and can effect organs) - Respiratory status o Pneumocystic Carinii pneumonia (PCP) o Non-productive cough o Fever with chills o Dyspnea o Chest pain - Neurological status - Fluid and electrolyte balance - Medication regimen

Labs and Diagnostics

- CD4 T-cells: want high o ↑500-HIV asymptomatic o 200-499 HIV symptomatic o ↓200 AIDS - EIA & Western blot (HIV antibodies) o None in primary infection - Viral load: want low (below 40, results will read "undectable")

Risk Factors for HIV

- Homosexual/bisexual male - IV drug use - Neonates of infected mothers - Blood product/organ transfusions (1978-1985) - Heterosexual with multiple partners - Older population

Nursing Diagnosis for HIV

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

Complications for HIV

- Opportunistic infections - Arthritis - Adverse medication reaction GI disorders - Diarrhea - Oral candidiasis (yeast infection) - Wasting syndrome - Fluid and electrolyte imbalance - GI malabsorption - Anorexia Oncology disorders o Kaposi's sarcoma & non-Hodgkin's lymphoma Respiratory disorders o Pneumocystic Carinii pneumonia (most common life threatening infection) o TB o Mycobacterium Avium Complex (MAC) Neurological disorders o AIDS dementia complex o HIV encephalopathy o Peripheral Neuropathy o Depression o Cryptococcus neoformans

Interventions for HIV

- Reposition every 2 hours-semi-fowlers or high fowler's positions - Gentle nondrying soaps - Avoid adhesive tape - Perianal skin care frequently-moisture barrier creams - Avoid raw fruits and vegetables, carbonated beverages, spicy food and extreme temperature foods-these increase diarrhea - Small frequent meals - Dietary supplements and/or parenteral or enteral feedings - Monitor wt and dietary intake - I&O - Oral care every 2 hours and before eating - Maintain balance between activity and rest - Orient to surrounds - Maintain safe environment - Maintain a supportive atmosphere - Allow pt to express feelings - CPT with postural drainage - Cough and deep breathing - Assess for hypoxia

Prevention for HIV

- Standard precautions - Safer sex practices - No sharing of needles - Blood product screenings - Working development of vaccine - Specific healthcare provider practices - Health Care Providers o Hand hygiene o PPE o Needles and sharps o Pt resuscitation o Equipment, Laundry

Which client is more at risk of becoming infected with human immunodeficiency virus (HIV)?

A person having casual intercourse with multiple partners

How is HIV transmitted?

HIV enters the body through sexual contact, transfusion of blood products, contaminated needles, or transplacental/postpartum

What is the most common AIDS-related cancer?

Kaposi's sarcoma

While caring for a patient with pneumocystis pneumonia, the nurse assesses flat, purplish lesions on the back and trunk. What does the nurse suspect these lesions indicate?

Kaposi's sarcoma

A client with acquired immunodeficiency syndrome is admitted with Pneumocystis cariniipneumonia. During a bath, the client begins to cry and says that most friends and relatives have stopped visiting and calling. What should the nurse do?

Listen and show interest as the client expresses feelings.

When developing the plan of care for a client with a primary immunodeficiency, which nursing diagnosis would be the priority?

Risk for infection related to altered immune cell function

A client has received the results of a HIV antibody test, which is positive. What is the best explanation for the nurse to give to the client?

The client has been infected and has produced antibodies.