HIV and AIDs

AH2 exam 4

acquired immunity

immunity that develops during your life time

active immunity

develops in response to an infection or vaccination

natural active immunity

antibodies develop in response to an infection

artificial active immunity

antibodies develop in response to a vaccination

passive immunity

develops after you receive antibodies from someone or somewhere else

natural passive immunity

antibodies received from mother (i.e. breast milk)

artificial passive immunity

antibodies received from medicine

immune system locations

lymph nodes, tonsils, thymus, spleen (activate filter system and circulation), peyer’s patch, lymph vessels (activate filter system and circulation), bone marrow

WBCs

cells of immune system

made inside the bone marrow

travel through the body inside lymph vessels, which are in close contact w the blood stream

neutrophils

engulf and destroy

most plentiful and first to respond

monocytes (macrophages)

engulf, digest and destroy

the clean up crew

eosinophils

fight parasitic infections and allergic reactions

basophils

release histamine

inflammation and allergic response

lymphocytes

attack specific pathogens

viral and bacterial

B and T cells

plasma cells

produce antibodies

immune system affected by

CNS integrity

physical and emotional status

meds

diet

stress of illness, surgery or trauma

nursing assessment - background

assess: nutrition, recent infection, hx of autoimmune, cancer, chronic illness, surgery, meds and blood transfusions

weak immune system is unable to fight pathogens —> lacks sufficient WBC or antibodies

nursing assessment - symptoms

frequent infections w severe symptoms..

• high fevers

• chills

• weakness

joint swelling

skin rashes

hypotension, anemia, hepatomegaly, NV, hematuria, resp distress, dysuria, polyuria, hematuria, inflammation, wound discharge, decreased cognition, headache

causes

autoimmune

• lupus

• RA

• DM 1

infections

• HIV —> AIDs

• pneumonia

lymphoma

leukemia

sickle cell

immune cell deficiency

meds

• immune suppressants

  • chemo

HIV

targets T cells

alters genetics

reshapes immune system

HIV causes

unprotected sex

sharing needles

needle stick

blood, semen, or vaginal fluids into open cuts or sores

blood transfusions w infected blood

passed from mother to baby during pregnancy, birth or breastfeeding

HIV stage 0

primary or acute HIV infection —> first detectable antibodies

1-2 weeks of initial infection

1-6 weeks of influenza like symptoms

temporary —> return to baseline

early symptoms of stage 0

fever and chills

sore throat, swollen lymph nodes, mouth ulcers

muscle fatigue and aches

NV, loss of appetite

joint pain

headaches and mood swings

pneumonia, cough w phlegm, SOB and chest pain

high HR and low BP

clamminess, rashes and blueness of the skin

women: changes in menstruation, lower belly pain and vaginal yeast infection

HIV stage 1

HIV asymptomatic (viral set point)

1-8 years

remain > 500 CD4

HIV stage 2

HIV symptomatic

CD4 200-499

chronic stage

• coughing

• breathing problems

• weight loss

• diarrhea

• fatigue

• rash

• increased infections

• cognitive changes

HIV stage 3

AIDS

lot of infections at one time

CD4 < 200

recurrent pneumonia

herpes

wasting syndrome

TB

AIDs main symptoms

central

• encephalitis

• meningitis

eyes

• retinitis

lungs

• pneuomocytitis pneumonia

• TB (multiple organs)

• tumors

skin

• tumors

GI

• esophagitis

• chronic diarrhea

• tumors

criteria for AIDS diagnosis

must have at least one

CDR < 200 and/or presence of an AIDS defining condition

• cytomegalovirus retinitis (w loss of vision)

• pneumocystis jiroveci pneumonia (PJP)

• chronic intestinal cryptosporidosis

• HIV related encephalopaty

• mycobacterium TB

• invasive cervical cancer

AIDS RF

unprotected sex

multiple sex partners

occupational exposures

perinatal exposure

blood transfusions

IVDU

older adults

• fluid and electrolyte imbalance

• decreased skin integrity

  • women: dry vagina, thin walls

dx

HIV-1/HIV-2 EIA —> repeatedly active —> HIV western blot

—> positive = report as HIV +

—> negative or indeterminate

• HIV -2 EIA —> repeatedly reactive —> HIV-2 supplemental test

  • positive

  • negative

  • indeterminate

blood tests

CBC: neutropenia, thrombocytopenia, anemia

LFTs: altered liver function

infection w Hep B or C

lipid panels: hyperlipidemia common SE of meds

resistance tests: determine if HIV is becoming resistant to drugs

AIDS CM

immunologic

• low WBC

• opportunistic infection

• lymphadenopathy

• fatigue

integumentary

• poor wound healing

• skin lesions

• night sweats

respiratory

• cough

• SOB

GI

• diarrhea

• weight loss

• NV

CNS

• confusion

• dementia

• headache

• visual changes

• personality changes

• pain

  • seizures

opportunistic infections

protozoal infections

• pneumocystis carini pneumonia

• toxoplasmosis (encephalitis)

• cryptosporidosis (GI)

fungal infections

• candidasis - stomatitis, esophagitis, vaginal

bacterial infections

• mycobacterium complex

• TB

viral infections

• cytomegalovirus

• herpes

  • varicella-zoster virus

malignancies

Kaposi's sarcoma

Non-hodgkin's lymphoma

Hodgkin’s lymphoma

Invasive cervical carcinoma

AIDS dementia complex

cognitive, motor, and behavioral impairments in 70% AIDS clients

complications of AIDS

opportunistic infections

wasting syndrome

fluid and electrolyte imbalance

seizures from HIV encephalopathy

social isolation

pharm therapt

highly active antiretroviral therapy (HAART) —> use combination therapy

• nucleoside reverse transcriptase (NRTIs) “nukes”

• non-nucleoside reverse transcriptase (NNRTis) “non-nukes”

• protease inhibitors (PIs)

• integrase strand transfer inhibitors

• fusion inhibitors

• CCR5 antagonist

• CD4 attachement inhibitor

issues w pharm therapy

does not kill the virus, only stops replication

drug resistance

drug resistance at time of HIV infection

selective drug resistance

med SE

hepatoroxicity

nephrotoxicity

osteopenia

increased risk of MI and cardiovascular disease

fat redistribution syndrome

metabolic alterations —> dyslipidemia, insulin resistance, facial wasting

prevention

HIV testing

treat all

end mother to child transmission

end discrimination

pre-exposure prophylaxis

post-exposure prophylaxis

test and treat STI

use condoms

increase funding

prevention for nurses

maintain standard precaution

• hand hygiene, gloves, mask, eye shield, gown

do not recap needles and syringes

clean up spills of blood and bodily fluids using germicidal solution

consider all body fluids to be contaminated

avoid contaminating the outside of specimen containers

cleanse work surface areas w appropriate germicide

PREP

must be taken every day in order to be effective

people who use PREP include HIV negative people in monogamous relationship w HIV positive people, non-monogamous people in a high risk population and IVDU

when taken daily reduces chance of contracting HIV by 92%

SE: upset stomach, loss of appetite, headache

PEP

taken w/in 72 hours post exposure

contains 3 anti-HIV medications that must be taken daily for 28 days after exposure

SE: quite sick —> common cause for non-adherence

not 100% effective

nursing priorities

• Transmission risk

• Impaired skin integrity

• fluid/electrolyte imbalance

• Diarrhea

• Risk for infection

• Activity intolerance

• Distributed thought process

• Ineffective airway clearance

• Pain

• Imbalanced nutrition

• Social isolation

• Anticipatory grieving

• Knowledge deficit 

nursing goals

• Keep viral load low

• Maintain immune function (increased CD4 count)

• adequate/good quality sleep

• Access to medication

• improve/maintain quality of life

• Prevent opportunistic disease and new infections

• reduce/prevent disability

• Maintain medication and monitoring regimen

patient education

• Good hand hygiene

• Avoid crowds

• Avoid raw and undercooked foods

• Avoid cleaning cat litter

• Keep home environment clean

• Wash dishes in hot water

• Transmission and infection control measures

• Safe sex practices

• PREP and PEP

• Med admin and SE

• Adherence to meds

• Support systems

nursing interventions

• Assess RF

• Monitor I&O

• Daily weights

• Nutritional intake

• Electrolytes

• Assess skin

• Pain management

• Monitor vitals

• Assess resp status

• Assess neuro status

• Prevent transmission