Chapter 85: HIV and AIDS
The main treatment concepts of HIV therapy are to use medications specifically designed to combat a part of the retroviral replication cycle of HIV. The drugs are collectively referred to as antiretrovirals (ARVs) or highly active antiretroviral therapy (HAART or ART), or just as?
"The Cocktail."
Functions of the immune system
- Protects the body from adverse effects of invasion by microorganisms and other foreign substances - Regulates the removal of damaged cells and disposes of abnormal cells that arise within the body
HIV is transmitted through infected body fluids by the following routes
- Unprotected sexual contact (vaginal, oral, and anal sex) - Sharing of infected needles - Accidental exposure to infected blood - From an infected pregnant woman to her fetus - From an infected mother to her child through breastfeeding
More than half of all new cases of HIV involve individuals between?
25 and 44 years of age
PEP treatment should begin no later than?
72 hours or 3 days after a single high-risk event.
Occurs during the later stages of HIV infection.
AIDS
An undetectable viral count indicates
An excellent response to therapy
Heterosexual transmission of HIV has increased across ethnic groups as well as in assorted age groups.
Males who have unprotected sex with males comprise the largest growth group, followed by high-risk hetero-sexual contact and use of contaminated needles
Opportunistic Infections and Conditions Related to HIV/AIDS Viral Infections:
• Cytomegalovirus (CMV) • Hepatitis C • Herpes simplex virus (oral and genital herpes) • Herpes zoster virus (shingles) • Human papillomavirus (HPV, genital warts, anal/cervical dysplasia/cancer) • Molluscum contagiosum • Oral hairy leukoplakia (OHL) • Progressive multifocal leukoencephalopathy (PML)
These HIV medications classifications prevent HIV from entering CD4 cells:
• Entry inhibitors (including fusion inhibitors) • Integrase inhibitors
Outcomes of care evaluated by the entire healthcare team, client, and family:
•Evaluate client needs - Community services - Home care services - Need financial assistance - Psychiatric care •Planning for further nursing and healthcare considers the client's prognosis and responses to care.
Nursing Process: Nursing Diagnosis for HIV/AIDS
•Imbalanced Nutrition: Less Than Body Requirements •Ineffective Breathing Pattern •Risk for Infection •Risk for Disuse Syndrome •Hopelessness •Impaired Tissue Integrity •Impaired Social Interactions •Ineffective Coping •Disturbed Thought Processes
Nursing Implications for Clients With AIDS
•Individuals in later stages of the disease are more likely to require special nursing care(provide comfort care). •Family members need education regarding care. •Focus is on providing the client with emotional comfort. •Family, client and care providers evaluate the outcome of the care
Testing for HIV is associated with many legal implications. Although the laws vary from state to state, they generally hold that:
- An informed consent must be obtained from the client before testing. - Pre- and post-test counseling (usually by a state-approved HIV counselor) is required regardless of the test results. - Results cannot be given over the telephone. Most laws identify specific standards for when and how the results can be given and to whom. - Ensuring client confidentiality is essential. Most laboratories use a coding system rather than the client's name. - The laboratory must be approved by the state for HIV testing.
Opportunistic infections and conditions related to HIV/AIDS fungal infections:
- Aspergillosis - Candidiasis (thrush, yeast infection) - Coccidioidomycosis - Cryptococcal meningitis - Histoplasmosis
Care of the Patient with HIV Encephalopathy with disturbed thought processes:
- Assess mental status and neurologic functioning. - Monitor for medication interactions, infections, electrolyte imbalance and depression. - Frequently orient the patient to time, place, person, reality, and the environment. - Use simple explanations. - Teach the patient to perform tasks in incremental steps. - Provide memory aids (clocks and calendars). - Provide memory aids for medication administration. - Post activity schedule. - Give positive feedback for appropriate behavior. - Teach caretakers how to orient patient to time, place, person, reality, and the environment. - Encourage the patient to designate a responsible person to assume power of attorney.
Definition of AIDS
- Continually revised by CDC and medical community - HIV-positive individuals with T-cell count below 200/mm3 considered to have AIDS - When an HIV-positive person's T-cell count falls between 200 and 400/mm3, the first opportunistic infections may appear - Persons with HIV and certain opportunistic infections or cancers also considered to have AIDS
Function of T cells and B cells
- Fight infection - Produce antibodies for specific immune responses
Symptoms suggesting primary HIV or AIDS:
- General malaise (profound or unexplained fatigue) - Anorexia - Dry cough - Oral thrush - White spots on tongue, in mouth or throat - Herpes zoster infection or shingles - Pneumonia - Red, brown, pink, or purple spots on or under the skin, inside the mouth, nose, or eyelids - Memory loss - Lipotrophy (loss of fat in face, arms, legs, and buttocks) - Lipodystrophy (excessive fat buildup on back of neck and shoulders, breasts, or abdominal areas)
Medications to Treat or Prevent Common Opportunistic Infections To Treat or Prevent Pneumocystis jiroveci (carinii) Pneumonia:
-trimethoprim/sulfamethoxazole (Septra, Bactrim) -dapsone -aerosolized pentamidine (NebuPent)
Clients with HIV that is not controlled with medications may have readings as high as?
1,000,000 copies or more of viral cells read as viral load.
The nurse is caring for a client undergoing testing for HIV. Which of the following nursing considerations is related to this process? A) An informed consent must be obtained from the client before testing. B) Posttest counseling is required only if the test is positive. C) Results can be given over the phone or sent to the person in writing. D) Most laboratories use the last name of the client and a code to ensure confidentiality.
A) An informed consent must be obtained from the client before testing.
A nurse is caring for a client with AIDS. When caring for this client, which of the following should the nurse document as a characteristic sign of the disease? A) Anorexia B) Weight gain C) Productive cough D) Build up of fat in arms and legs
A) Anorexia
A client with AIDS is in the terminal stage of the disease. What would be the focus of care for this client? A) Comfort B) Medications C) Rehabilitation D) Social interaction
A) Comfort
The nurse is explaining to a client how HIV is transmitted. Which of the following is a method of contracting the disease? Select all that apply. A) Having vaginal sex with an infected person B) Shaking hands with an HIV positive person C) Sharing infected needles D) Breathing air when an infected person sneezes E) Being in contact with the feces of an infected person F) Cleaning up the vomit of an infected person
A) Having vaginal sex with an infected person C) Sharing infected needles E) Being in contact with the feces of an infected person F) Cleaning up the vomit of an infected person
A nurse is required to care for a client who is HIV-positive. Which of the following nursing care measures should be employed when caring for the client? A) Take suitable precautions to protect the client from nosocomial infections. B) Discuss the client's health condition with the client's relatives. C) Put the client's infectious wastes in a closed bag and dispose of in a sanitary landfill. D) Break the needles off the syringes manually before disposing of them.
A) Take suitable precautions to protect the client from nosocomial infections.
The nurse is teaching the student nurse what occurs when human HIV invades a normal human cell. Which of the following events occurs? A) The virus uses its own RNA to change the healthy cell's existing DNA. B) The virus's DNA duplicates and spreads HIV within the body. C) The original purpose and function of the normal cell is recreated in the HIV cells. D) A reverse transcriptase protein converts the virus's RNA into DNA.
A) The virus uses its own RNA to change the healthy cell's existing DNA.
These medications are specifically designed to combat the retrovirus. They have exerted a profound effect on the progression of HIV disease to AIDS.
Antiretroviral therapy
A client is diagnosed with HIV and is undergoing a CD4 (T cell) count to measure his immune function. Which of the following represents a normal value range for CD4 cell counts? A) 250 cells/mm3 B) 1,000 cells/mm3 C) 1,750 cells/mm3 D) 2,000 cells/mm3
B) 1,000 cells/mm3
The nurse documents pneumonia in a client who is HIV-positive. Which of the following T-cell counts represents the level at which the first opportunistic infections may appear? A) 150/mm3 B) 250/mm3 C) 500/mm3 D) 750/mm3
B) 250/mm3
A nurse is caring for a female client with HIV. Which of the following manifestations of HIV is frequently seen in female clients? A) Endometrial cancer B) Cervical cancer C) Ovarian cancer D) Breast cancer
B) Cervical cancer
The nurse caring for clients with HIV knows that opportunistic infections and cancers account for a large proportion of deaths related to HIV. Which of the following is a viral infection that commonly occurs with HIV? A) Candidiasis B) Hepatitis C C) Tuberculosis (TB) D) Syphilis
B) Hepatitis C
A client recently diagnosed with HIV infection is being cared for at home. What should the nurse include in the education provided to the family caregivers of the client? A) Encourage them to keep the client on complete bed rest. B) Inform them on how to take care of infectious waste. C) Recommend that they provide a diet reduced in salt. D) Ask them to assist the client with all daily activities.
B) Inform them on how to take care of infectious waste.
The nurse is researching the incidence of HIV transmission in the United States. Which of the following is the fastest growing group of persons living with HIV? A) Infants born to infected mothers B) Males having unprotected sex with males C) People engaging in high-risk heterosexual contact D) Users of contaminated needles
B) Males having unprotected sex with males
The nurse caring for a client in a hospital setting receives a needlestick injury on the job. What is the initial intervention for this possible exposure to HIV? A) Screening the clients for HIV B) Thoroughly washing the exposed area C) Starting postexposure treatment within 1 week D) Attending counseling sessions
B) Thoroughly washing the exposed area
The school nurse is educating students regarding the practice of safe sex to avoid contracting HIV. Which of the following would the nurse recommend to provide safer sex? A) Practicing oral sex B) Using condoms C) Taking contraceptives D) Using the "day after" pill
B) Using condoms
Performed regularly on infected persons to ascertain the need for antiretroviral therapy and the adequacy of response to these medications.
Both the CD4 count and the viral load
The nurse is assisting in performing a viral load (HIV-RNA) test to measure how virulent the HIV is in a client diagnosed with AIDS. Which of the following information regarding this testing is accurate? A) A person who is not infected with HIV has a minimum viral load. B) Clients with controlled HIV may have readings as high as 1,000,000 copies. C) An undetectable reading is considered an excellent response to therapy. D) The inability to detect the virus in the blood indicates a person is no longer infected.
C) An undetectable reading is considered an excellent response to therapy.
A nurse is caring for client infected with HIV. Which of the following opportunistic infections in the client can be documented as a fungal infection? A) Tuberculosis B) Toxoplasmosis C) Cryptococcosis D) Herpes zoster
C) Cryptococcosis
The nurse is teaching a class on HIV/AIDS in a local community setting. Which of the following are accurate descriptions of these conditions that could be included as teaching points? A) The terms HIV and AIDS are synonymous. B) AIDS is the virus responsible for causing HIV. C) HIV is a retrovirus overtaking living cells to duplicate itself. D) The only known cure for AIDS is HAART.
C) HIV is a retrovirus overtaking living cells to duplicate itself.
When providing client education regarding AIDS, which of the following viruses should the nurse identify as the causative organism for AIDS? A) Human papilloma virus B) Epstein-Barr virus C) Human immunodeficiency virus D) Varicella zoster virus
C) Human immunodeficiency virus
The nurse caring for clients with HIV knows that, if untreated, HIV can lead to the development of both minor and major opportunistic infections and cancers, eventually leading to death. The depletion of what system leads to this chain of events? A) Respiratory system B) Cardiovascular system C) Immune system D) Integumentary system
C) Immune system
A nurse working with clients with AIDS in a local clinic experiences a needlestick injury. Which of the following drugs would be prescribed to prevent HIV from entering CD4 cells? A) Nucleoside reverse transcriptase inhibitors (NRTIs) B) Nonnucleoside reverse transcriptase inhibitors (NNRTIs) C) Integrase inhibitors D) Protease inhibitors (PIs)
C) Integrase inhibitors
The nurse explains to the client with HIV infection that HIV infection compromises the body's immune mechanism, thus predisposing the client to a number of opportunistic infections. Which of the following cells does HIV specifically invade? A) Erythrocytes B) Granulocytes C) Lymphocytes D) Platelets
C) Lymphocytes
The nurse is caring for a client with AIDS. Who is responsible for evaluating the outcomes of care for this client? A) The physician and nurse B) The nurse and the client C) The healthcare team, client, and family D) The client and family
C) The healthcare team, client, and family
A client diagnosed with HIV/AIDS develops Pneumocystis carinii (pneumonia). Which of the following drugs are used to treat this infection? Select all answers that apply. A) Azithromycin (Zithromax) B) Loperamide (Imodium) C) Trimethoprim/sulfamethoxazole (Septra, Bactrim) D) Dapsone (Avlosulfan) E) Aerosolized pentamidine (Nebupent) F) Acyclovir (Zovirax)
C) Trimethoprim/sulfamethoxazole (Septra, Bactrim) D) Dapsone (Avlosulfan) E) Aerosolized pentamidine (Nebupent)
The main cells affected by HIV are the helper T4 lymphocytes, better known as?
CD4 cells. HIV destroys CD4 cells.
A client is to undergo the enzyme immunoassay (EIA) test. Which of the following information should the nurse provide regarding the test? A) HIV antibodies effectively fight against the HIV virus. B) Blood is the only body fluid used for EIA testing. C) EIA test is more expensive than the western blot test. D) A positive EIA test does not necessarily indicate HIV infection.
D) A positive EIA test does not necessarily indicate HIV infection.
The nurse is educating a client who contracted HIV regarding the nature of the human cells that are invaded by the virus. Which type of cell is the main cell affected by HIV? A) B cells B) C cells C) Lymphocytes in bone marrow D) CD4 cells
D) CD4 cells
A client is diagnosed with encephalopathy as a result of opportunistic infections following HIV infection. What nursing diagnosis should the nurse document? A) Ineffective breathing pattern B) Impaired tissue integrity C) Risk of disuse syndrome D) Disturbed thought process
D) Distrubed thought process
Nurses and caregivers need to be aware of the more common opportunistic infections associated with AIDS. Which of the following infections causes small, painful blisters on the skin of the lips, nose, or genitalia? A) Cryptococcus B) Cytomegalovirus C) Toxoplasmosis D) Histoplasmosis
D) Histoplasmosis
A nurse is caring for a client with HIV infection. Exposure to which of the following has a low occupational risk of transmission of HIV infection to the nurse? A) Cerebrospinal fluid B) Peritoneal fluid C) Vaginal secretions D) Lacrimal secretions
D) Lacrimal secretions
Nurses working in healthcare settings may be exposed to HIV. Which of the following is the greatest source of exposure for healthcare workers? A) Exposure to vomit B) Exposure to feces C) Airborne pathogens D) Needlestick injuries
D) Needlestick injuries
The nurse is describing to a client diagnosed with AIDS the use of "the cocktail" to attack development cycles of the virus. Which of the following class of drugs that may be found in this cocktail disables a protein that the HIV needs for replication? A) Entry inhibitors B) Nonnucleoside reverse transcriptase inhibitors (NNRTIs) C) Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) D) Protease inhibitors (PIs)
D) Protease inhibitors (PIs)
Recommendations for standard precautions on environmental control:
Develop procedures for routine care, cleaning and disinfection of environmental surfaces especially frequently touched surfaces in patient care areas.
Diagnostic test that detects antibodies to HIV proteins. Saliva and blood are used for testing. Less specific than Western blot test. Possible false-positive reactions (A positive test does not necessarily indicate HIV infection)
Enzyme immunoassay (EIA) formerly known as enzyme-linked immunosorbent assay (ELISA)
Determines the strength of the virus.
HIV-RNA or viral load
Recommendations for standard precautions on textiles and laundry:
Handle in a manner that prevents transfer of microorganisms to others and to the environment.
Recommendations for standard precautions on soiled patient care equipment:
Handle in a manner that prevents transfer of microorganisms to others and to the environment; wear gloves if visibly contaminated; and perform hand hygiene.
One disorder that affects the functions of the immune system is the?
Human immunodeficiency virus or HIV.
Individuals who maintain a healthy immune system despite HIV infection, without the use of medication
Long-term non-progressors
Less than 1% of HIV infections in healthcare workers result from work-related exposure. Most of these exposures are needlestick injuries. Therefore:
Never recap needles
Account for a large proportion of deaths related to HIV.
Opportunistic Infections and cancers
Are among the fastest-growing groups of persons living with HIV.
Persons older than 50 years
Should begin immediately with thorough washing of the exposed area.
Postexposure prophylaxis (PEP)
This retrovirus commonly invades two types of white blood cells:
T cells (lymphocytes that mature in the thymus) and B cells (lymphocytes that originate in the bone marrow).
HIV is an infectious human retrovirus that invades a healthy, normal white blood cell. The virus uses its own ribonucleic acid (RNA) to change the healthy cell's existing deoxyribonucleic acid (DNA) into cells that replicate, that is?
The virus overtakes the biosynthesis of existing cells to duplicate and spread HIV within the body.
There are two basic types of information available regarding protection against HIV infection: before exposure or PrEP and after exposure or PEP. According to the CDC, the word "prophylaxis" means
To prevent or control the spread of an infection or disease.
Women should be aware that HIV infection may be overlooked and attributed to other disorders, such as genital ulcer disease, STDs, human papillomavirus (HPV) infections, and pelvic inflammatory disease (PID). Although women may experience the characteristic signs and symptoms, more commonly women experience?
gynecologic problems as the initial clinical manifestations
Condoms do not guarantee safe sex. They provide?
safer sex
Key Teaching Topics for Understanding HIV and AIDS
• Disease process, signs and symptoms • Ways for transmitting and not transmitting HIV • Infection control measures • Proper disposal for sharps and contaminated objects • Maintenance of hygiene in kitchen • Possible side effects of medication • Nutritional plans, including the use of dietary supplements • Psychological support • Available community resources and services to provide home management • Sources for hospice care
These HIV Medications classifications are effective after entering a CD4 cell:
• Nucleoside reverse transcriptase inhibitors (NRTIs) • Nonnucleoside reverse transcriptase inhibitors (NNRTIs) • Protease inhibitors (PIs)
In women, other common HIV-related signs and symptoms include:
• Recurrent vaginal candidiasis • Menstrual abnormalities, including amenorrhea (absence of periods) or bleeding between periods • Abnormal Pap tests • Cervical cancer
If an individual is known to be infected with HIV, the following tests are performed regularly to assess the need for antiretroviral therapy.
•CD4 (T cell) counts - Used to measure a person's immune function - Normal values range between 500 and 1,500 cells per cubic millimeter (mm3).
Opportunistic Infections
•Candidiasis •Cryptococcus •Cytomegalovirus •Herpes simplex •Histoplasmosis •Mycobacterium avium-intracellulare •Pneumocystis carinii pneumonia •Toxoplasmosis
