NUR102 - Chp. 35 - Caring for Patients with HIV/AIDS

An 18-year-old pregnant client has tested positive for HIV and asks the nurse if the baby is going to be born with HIV. What is the nurse's best response?

"It's possible that your baby could contract HIV, either before, during, or after delivery." * Parent-to-child transmission of HIV-1 is possible and may occur in utero, at the time of delivery, or through breast-feeding.

What HIV tests test directly for the virus?

- HIV-1 p24 antigen test - HIV-1 nucleic acid amplification test * There are five screening blood tests for HIV. The tests that are used to directly check for the virus include the HIV-1 p24 antigen test and the HIV-1 nucleic acid amplification test.

How long does it take the body to produce HIV antibodies if the patient has been infected?

3 weeks - 6 months or longer.

Western Blot Test

A blood test to confirm the diagnosis of HIV

Combination Antiretroviral Therapy (cART)

"Drug cocktail"; multiple antiretroviral drugs used together.

A client with HIV infection has begun experiencing severe diarrhea. What is the most appropriate nursing intervention to help alleviate the diarrhea?

Administer antidiarrheal medications on a scheduled basis, as prescribed. * Administering antidiarrheal agents on a regular schedule may be more beneficial than administering them on an as-needed basis, provided the client's diarrhea is not caused by an infectious microorganism.

Reverse Transcriptase Inhibitors

Antiretroviral drug that blocks reverse transcriptase/interferes with the ability of HIV to make a genetic blueprint, thus, preventing replication.

Protease Inhibitor (PI)

Antiretroviral drug that inhibits the ability of HIV particles to leave the host cell.

Integrase Inhibitors

Antiretroviral drugs that block integrase, thus, preventing the incorporation of HIV DNA into the T-cell's DNA.

A hospital client is immunocompromised because of stage 3 HIV infection and the physician has ordered a chest radiograph. How should the nurse most safely facilitate the test?

Arrange for a portable x-ray machine to be used. * A client who is immunocompromised is at an increased risk of contracting nosocomial (hospital related) infections due to suppressed immunity. The safest way the test can be facilitated is to have a portable x-ray machine in the client's room. This confers more protection than disinfecting the radiology department or using masks.

The nurse is preparing to start an IV for a client who is combative. What precautionary measure should the nurse take in order to avoid a needlestick?

Ask for assistance. * If a client is uncooperative, ask for assistance when starting IV therapy. Restraints can cause the client to become more agitated and less cooperative. Sedation can be considered chemical restraint and can have side effects that are undesirable.

A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client?

Bank autologous blood. * Banking autologous blood that is self-donated is the safest option for the client.

Drug Cross-Resistance

Diminished drug response among similar drugs.

Reverse Transcriptase * RNA to DNA *

Enzyme that copies RNA into DNA.

Candidiasis

Fungal; Yeast infection caused by the Candida albicans microorganism that may develop in the oral, pharyngeal, esophageal, or vaginal cavities or within the folds of the skin.

The nurse is reviewing the medical record of a client who is positive for human immunodeficiency virus (HIV). The nurse notes that the client is classified as HIV asymptomatic based on which CD4+ T lymphocyte count?

Greater than 500/mm3. * A person is considered HIV symptomatic when the CD4+ count is 200 to 499/mm3. A person is considered to have acquired immunodeficiency syndrome (AIDS) when the CD4+ count is less than 200/mm3. * The lower the number, the more severe. CD4+ >500/mm3 - Asymptomatic CD4+ 200 - 499/mm3 - Symptomatic CD4+ <200/mm3 - AIDS

When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by which characteristic?

HIV-1 is more prevalent than HIV-2 subtypes. * HIV-1 mutates easily & frequently, producing multiple sub-strains that are identified by letters from A through O. HIV-2 is less transmittable & the interval between initial infection with HIV-2 & development of AIDS is longer. * HIV-1 is more prevalent in the United States and in the rest of the world.

A client with HIV will be receiving care in the home setting. What aspect of self-care should the nurse emphasize during discharge education?

Importance of personal hygiene. * Infection control is of high importance in clients living with HIV, thus personal hygiene is paramount.

Drug Resistance

Ineffective response to a prescribed drug because of the survival & duplication of exceptionally virulent mutations.

Enzyme-Linked Immunosorbent Assay (ELISA)

Initial HIV screening test that is positive when there are sufficient HIV antibodies (disease-fighting proteins that the body produces in response to HIV infection; produced when exposed to viruses like HIV).

Since the emergence of the human immunodeficiency virus (HIV), there have been significant changes in epidemiologic trends. At present, members of which group are most affected by new cases of HIV?

Male-to-male sexual contact.

A nurse is assessing the skin integrity of a client who has AIDS. When performing this inspection, the nurse should prioritize assessment of what skin surfaces?

Perianal region and oral mucosa. * Oral mucosa and perianal region are particularly vulnerable to skin breakdown and fungal infection and thus should be prioritized.

A hospital nurse has experienced percutaneous exposure to an HIV-positive client's blood because of a needlestick injury. The nurse has informed the supervisor and identified the client. What action should the nurse take next?

Report to the emergency department or employee health department. * Need immediate blood testing done.

AIDS Drug Assistance Program (ADAP)

State-based programs partially funded by Title II of the Ryan White CARE Act that help low- and middle-income clients obtain expensive AIDS medications.

A client's current antiretroviral regimen includes emtricitabine. What dietary counseling will the nurse provide based on the client's medication regimen?

Take this medication without regard to meals. * Emtricitabine has no limits regarding meals.

The lower the client's viral load,

The longer the survival time. * The lower the client's viral load, the longer the time to AIDS diagnosis and the longer the survival time. The key goal of antiretroviral therapy is to achieve and maintain durable viral suppression.

Acquired Immunodeficiency Syndrome (AIDS)

The most advanced, and fatal, stage of an HIV infection; profoundly weakens the immune system.

What is used to test viral load and evaluate response to treatment?

The p24 antigen test and nucleic acid sequence-based amplification test are used to test viral load & evaluate response to treatment. * Used to directly check for the virus include the HIV-1 p24 antigen test and the HIV-1 nucleic acid amplification test.

OraSure Test

Uses saliva to perform an EIA test/detect HIV.

Protease

Viral enzyme that breaks down proteins; cuts long chains of replicated viral particles & releases them into the cytoplasm of a cell.

Integrase

Viral enzyme that incorporates a viral code into a host cell's DNA; incorporation of HIV DNA into the T-cell's DNA. *Think "integrate".

A client has been diagnosed with HIV and has been placed on antiretroviral therapy. What does the nurse inform the client will be required for determining the progression of the disease as well as guiding drug therapy?

Viral load and T4-cell counts will be performed every 2 to 3 months. * Viral load testing is used to guide drug therapy and follow the progression of the disease.

A nurse is implementing appropriate infection control precautions for a client who is positive for human immunodeficiency virus (HIV). The nurse knows which body fluid is not a means of transmission?

Urine. * HIV is transmitted in body fluids that contain free virions and infected CD4+ T cells. These fluids include blood, seminal fluid, vaginal secretions, amniotic fluid, and breast milk. Urine is not a body fluid responsible for HIV transmission.

Salvage Therapy

Treatment for a disease when standard therapy fails; treatment option for individuals with significant HIV drug resistance with limited possibilities for effective drug management.

The nurse assesses a client who is diagnosed with human immunodeficiency virus (HIV) for adverse reactions associated with the prescribed medication, abacavir. Drag words from the choices below to fill in each blank in the following sentence. The nurse provides emergency intervention when the client exhibits the following symptoms:

Dyspnea, Sore Throat, Cough. * A client who is prescribed abacavir is at risk for anaphylaxis; thus, respiratory symptoms, including a sore throat, a cough, and/or dyspnea, require emergency action by the nurse.

A public health nurse is preparing an educational campaign to address a recent local increase in the incidence of HIV infection. The nurse should prioritize what intervention?

Educational programs that focus on control and prevention. * Until an effective vaccine is developed, preventing HIV by eliminating and reducing risk behaviors is essential. Educational interventions are the primary means by which behaviors can be influenced.

A nurse on a medical unit is providing care for a patient who has been admitted because of the simultaneous development of several complications of AIDS. For the past several days, the patient has been experiencing six to eight watery bowel movements each day. The nurse should consequently assess the patient's:

Electrolyte levels. * Electrolyte imbalances, such as decreased serum sodium, potassium, calcium, magnesium, and chloride, typically result from profuse diarrhea.

A client who is prescribed antiretroviral therapy admits to skipping medication doses, sometimes for days at a time. Which response by the nurse is appropriate?

"You are at risk for developing medication resistance and failure if you continue skip doses." * When drug levels are not adequately maintained, viral replication and mutations increase.

A client experiencing flu-like symptoms over the last several weeks is concerned about being symptomatic for the HIV virus. After determining risk factors for contraction of the HIV virus, the nurse knows which tests may be ordered for this client? Select all that apply.

- HIV-1 p24 antigen test - HIV-1 nucleic acid amplification test * There are five screening blood tests for HIV. The tests that are used to directly check for the virus include the HIV-1 p24 antigen test and the HIV-1 nucleic acid amplification test.

Autologous Blood

A person's own blood. May be donated in advance of surgery & transfused if needed.

Pre-exposure Prophylaxis (PrEP)

A pill containing a combo of antiretroviral drugs taken before someone is exposed to the virus to prevent HIV acquisition.

A client with AIDS has become forgetful with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms?

AIDS dementia complex (ADC). * ADC, a neurologic condition, causes the degeneration of the brain, especially in areas that affect mood, cognition, and motor functions. Such clients exhibit forgetfulness, limited attention span, decreased ability to concentrate, and delusional thinking.

HIV Encephalopathy

An infection that spreads throughout the brain - the greater the spread of infection in the brain, the worse the dementia symptoms become. * It is one cause of dementia in people infected with HIV. * Characterized by a progressive decline in cognitive, behavioral, and motor functions - same as those in AIDS Dementia Complex.

Directed Donor Blood "Direct Family/Friends"

Blood obtained from specified blood donors among a patient's relatives & friends.

When is a person with HIV considered symptomatic?

CD4+ count 200 - 499/mm3 * The lower the number, the more severe. CD4+ >500/mm3 - Asymptomatic CD4+ 200 - 499/mm3 - Symptomatic CD4+ <200/mm3 - AIDS

When is a person considered to have AIDS (Acquired Immunodeficiency Syndrome)?

CD4+ count <200/mm3. * The lower the number, the more severe. CD4+ >500/mm3 - Asymptomatic CD4+ 200 - 499/mm3 - Symptomatic CD4+ <200/mm3 - AIDS

Which is usually the most important consideration in the decision to initiate antiretroviral therapy?

CD4+ counts. CD4+ >500/mm3 - Asymptomatic CD4+ 200 - 499/mm3 - Symptomatic CD4+ <200/mm3 - AIDS

A client with acquired immune deficiency syndrome (AIDS) informs the nurse of difficulty eating and swallowing, and shows the nurse white patches in the mouth. What problem related to AIDS does the nurse understand the client has developed?

Candidiasis. * Candidiasis, a fungal infection, occurs in almost all clients with AIDS and immune depression. Oral candidiasis is characterized by creamy-white patches in the oral cavity & if left untreated, can progress to involve the esophagus and stomach. Associated signs and symptoms include difficult and painful swallowing and retrosternal pain.

A client who is HIV positive is successfully treated for a stage 3 opportunistic illness. In which way will the client's care change when the CD4+T-lymphocyte count is 1500 cells/L?

Care remains at stage 3 of the disease. * HIV disease progression is classified from less to more severe; once a case is classified into a surveillance severity stage, it cannot be reclassified into a less severe stage even if the CD4+ T-lymphocytes increase. Therefore, the client may have a CD4+ T-lymphocyte count of stage 1 disease, staging will remain at level 3.

Opportunistic Infections aka Super Infections

Conditions in which nonpathogenic or remotely pathogenic microorganisms overwhelm the host.

Kaposi Sarcoma

Connective tissue cancer associated with HIV infections; develops from cells that line lymph or blood vessels.

A nurse is caring for a client who is HIV positive and is taking zidovudine. Which side effects should the nurse expect in this client?

Diarrhea and abdominal pain. * Common side effects associated with the administration of zidovudine and other NRTIs include headache, nausea, rash, vomiting, peripheral neuropathy, abdominal pain, and diarrhea. The nurse should also monitor for pancreatitis and liver dysfunction (not renal dysfunction).

HIV-1 Differentiation Assay

Differentiates HIV-1 from HIV-2.

Distal Sensory Polyneuropathy (DSP)

Disorder characterized by abnormal sensations, such as burning & numbness, in the feet & later in the hands.

Capsid

Double layer of lipid material that surrounds the genetically incomplete HIV.

AIDS Dementia Complex *Mood, Cognition, & Motor*

Neurologic condition that causes degeneration of the brain, especially in the areas that affect mood, cognition, & motor functions.

Acute Retroviral Syndrome aka Viremia "Flu-like Symptoms"

Occurs in some cases of primary HIV infection that is often mistaken for "flu" or some other common illness; aka Viremia.

During the admission assessment of an HIV-positive patient whose CD4+ count has recently fallen, the nurse carefully assesses for signs and symptoms related to opportunistic infections. What is the most common life-threatening infection?

Pneumocystis pneumonia. * Other opportunistic infections may involve Salmonella, Mycobacterium tuberculosis, and Clostridium difficile, but they are not the most common life-threatening infection.

Reverse Transcription * The Process of Reverse Transcriptase *

Process in which the enzyme reverse transcriptase copies RNA into DNA.

A client who is HIV/AIDS positive has orders for laboratory tests to be performed. What precautions should the nurse observe whenever there is a risk of exposure to the blood and body fluids of an infected client?

Transport the specimens of body fluids in leak-proof containers.

The nurse receives a phone call at the clinic from the family of a client with AIDS. They state that the client started "acting funny" and reported headache, tiredness, and a stiff neck. Checking the temperature resulted in a fever of 103.2°F. What should the nurse inform the family member?

"The client may have cryptococcal meningitis and will need to be evaluated by the health care provider." * A fungal infection, Cryptococcus neoformans is another common opportunistic infection among clients with AIDS, and it causes neurologic disease. Cryptococcal meningitis is characterized by symptoms such as fever, headache, malaise, stiff neck, nausea, vomiting, mental status changes, and seizures.

Phenotype Testing

A measured amount of antiviral drug is mixed with the virus until there is a quantity that prevents the virus from reproducing; blood test to detect drug resistance.

Viatical Settlement

An arrangement that allows someone living with a terminal illness to sell their existing life insurance policy and use the proceeds when and where they are most needed, before death; individual names a person as beneficiary to their life insurance in exchange for immediate cash.

When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following?

Antibodies to HIV are not present in his blood. * Antibodies identify & neutralize antigens. * A negative test result indicates that antibodies to HIV are not present in the blood at the time the blood sample for the test is drawn. A negative test result should be interpreted as demonstrating that if infected, the body has not produced antibodies (which take from 3 weeks to 6 months or longer). Therefore, subsequent testing of an at-risk patient must be encouraged.

Genotype Testing "Genetic Changes Measured - Drug Resistance Test"

Blood test used to detect drug resistance in which genetic changes in circulating HIV particles are measured.

What does the HIV-1/HIV-2 immunoassay tests test for?

Both HIV-1 & HIV-2 antibodies.

What does the HIV-1/HIV-2 antigen/antibody combination immunoassay tests test for?

Both virus (antigen) & antibodies for both HIV-1 & HIV-2.

In an adult client, which stage of HIV infection is indicated when the results are more than 500 CD4+ lymphocytes/mm?

CDC stage 1: Acute HIV infection. * Stage 0: If there is a negative HIV test within 6 months of the diagnosis of HIV. * Stage 1: Acute HIV Infection; CD4+ >500/mm3 - Asymptomatic. * Stage 2: Clinical Latency (HIV Inactivity or Dormancy); CD4+ 200 - 499/mm3 - Symptomatic. * Stage 3: AIDS; CD4+ <200/mm3.

Chemokines

Chemicals responsible for immune surveillance & immune cell recruitment. ** Attracts WBCs.

A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of?

Chronic diarrhea. * It can cause profound weight loss and severe fluid and electrolyte imbalances.

Cryptococcal Meningitis aka Cryptococcal Neoformans

Common opportunistic infection among patients with AIDS & it causes neurologic disease. *S/S: Fever, headache, malaise, stiff neck, nausea, vomiting, mental status changes, seizures.

Entry Inhibitor aka Fusion Inhibitors

Drugs that interfere with the HIV's ability to fuse with & enter the CD4 cell.

A clinic nurse is caring for a client admitted with AIDS. The nurse has assessed that the client is experiencing a progressive decline in cognitive, behavioral, and motor functions. The nurse recognizes that these symptoms are most likely related to the onset of what complication?

Human immunodeficiency virus (HIV) encephalopathy.

Polymerase Chain Reaction (PCR) Test

Measures the number of viral particles in the blood & is used to guide drug therapy & follow the progression of HIV infection.

Human Immunodeficiency Virus (HIV)

Pathogen that causes AIDS (Acquired Immunodeficiency Syndrome).

Pneumocystis Pneumonia

Pneumonia caused by the Pneumocystis carinii organism, a common opportunistic infection in those who are positive for the human immunodeficiency virus (HIV); rare in those with intact immune systems.

Codons

Points on HIV genes where mutation occurs.

A client has undergone diagnostic testing for human immunodeficiency virus (HIV) using the enzyme immunoassay (EIA) test. The results are positive and the nurse prepares the client for additional testing to confirm seropositivity. The nurse would prepare the client for which test?

Western blot assay. * A positive EIA test indicates seropositivity. To confirm this, a Western blot assay would be done. * The RT-PCR (Reverse Transcriptase-Polymerase Chain Reaction) tests may be used to confirm a positive EIA result.