AIDS Care & Oncology Essentials – Comprehensive Nursing Notes

AIDS: Health Issues & Signs

• Long-term Diarrhea & Wasting Away
  
  • Why it happens: Sores in the mouth/gut (like thrush or canker sores), body chemistry problems, not wanting to eat, and poor nutrient absorption.
  
  • What nurses do:
  
  – Check weight daily, count calories for 3 days, refer to a special diet expert.
  
  – Give nutritious drinks (Boost, Ensure, Sustacal) and protein shakes.
  
  – Track all fluids taken in and out; check blood tests (like CMP) for minerals such as K^+, Na^+, PO_4^{3-}, protein, and albumin.
  
  – Diet: Eat foods that are low in fiber to reduce how often you have bowel movements ("BRAT" diet: bananas, rice, applesauce, toast; avoid raw fruits/vegetables, celery, carrots).
  
  – Watch for need of feeding through a vein (PPN/TPN).

• AIDS Brain Disorder (ADC)
  
  • When the virus affects the brain, leading to memory loss, changes in personality, seeing things that aren't there, problems with balance, slow reactions, and wobbly knees.
  
  • Safety: Keep the bed where nurses can see it, check on the patient often, take steps to prevent falls, and help them stay aware of reality.
  
  • Use very few calming medications; only give low doses for anxiety if absolutely needed.

• Common Infections AIDS Patients Get (Opportunistic Infections or OIs)
  
  • Yeast infection (Candida albicans) in the mouth, throat, or vagina – give nystatin liquid to swish and swallow 4 \text{ times/day } (5{-}10\,\text{mL}).
  
  • Cytomegalovirus (CMV) – can cause eye swelling, stomach pain/diarrhea, fever, enlarged liver, abnormal liver tests, fast weight loss, and night sweats.
  
  • Pneumocystis jiroveci pneumonia (PJP/PCP) – causes foggy patches in both lungs on X-ray, cough, fever, and low oxygen; treated with Bactrim/Septra.
  
  • Tuberculosis (TB) and other infections from bacteria, viruses, parasites, and STIs (like syphilis, gonorrhea, herpes).
  
  • Cancer link: Kaposi sarcoma (purple, open sores on skin or inside the body; requires a tissue sample for diagnosis), and cancers of the anus/cervix.

HIV Tests & Lab Monitoring

• How HIV is Diagnosed 1. First test: HIV Antigen/Antibody Combination Test (a newer, 4th-generation blood test).

  2. If positive, do it again using a different, more specific test.

  3. Confirm with a Western Blot OR a test that looks directly for the virus's genetic material (NAT, DNA/RNA PCR).

  4. Quick finger-prick tests are available but still need regular lab confirmation.

• Important Numbers
  
  • AIDS is diagnosed when: CD4 cells (a type of immune cell) are less than 200\,\text{cells}/\mu L (normal count is around 600-1{,}500).
  
  • Viral load: Measures the amount of HIV in the blood; used to track how the disease is progressing and how well treatment is working; the goal is to have an "undetectable" level.
  
  • Regular checks: Blood count (CBC w/ diff), full body chemistry (CMP), genetic test to see if the virus is resistant to drugs, tests for STDs and hepatitis, and urine test (to check for kidney problems if protein is found).

HIV Treatment (Antiretroviral Therapy - ART)

• Start as soon as possible; it's a lifelong treatment.

• It's a combination of drugs ("cocktail") – typically 3 or more drugs from at least 2 different categories (like NRTIs, NNRTIs, PIs, Integrase inhibitors, CCR5 antagonists, Fusion inhibitors).

• Monitoring: Check viral load at the start, after 1 month, then every 4 months for 2 years; also check CD4 counts and genetic tests for drug resistance.

• Common drugs/examples: AZT (zidovudine) – watch for low red blood cells and headaches; Truvada (FTC/TDF); Protease and Integrase inhibitors.

What Patients & Families Need to Know

• Preventing infection: Wash hands very carefully, stay in a private room if white blood cell count is low, avoid sharing personal grooming items, report any fever over 100.4^{\circ}\text{F}.

• Eating well: Eat small, frequent meals; choose bland, cold foods if mouth sores are present; take anti-nausea medicine as needed; brush teeth daily with a soft brush and use numbing mouthwash.

• Using condoms: Check expiration date, store them in a cool, dry place, check for tears, put it on before any skin-to-skin contact, leave space at the tip, and use only once.

• Taking medicine: Never miss doses, understand side effects, and keep all lab appointments.

• Emotional support: Connect with support groups, spiritual care, mental health professionals, and get help for caregivers.

Cancer Basics

Cell Behavior & How Cancer Starts

• Normal cells: Divide in a controlled way, stop growing when they touch other cells, and die when they're supposed to.

• Cancer cells: Have damaged DNA, which means they lose control over dividing, keep multiplying nonstop, don't stop when they touch other cells, and live forever.

• Steps: Initiation (a harmful substance damages DNA) → Promotion (cells grow more easily) → Progression (cancer spreads and invades other areas).

Main Causes of Cancer & Risk Factors

• Chemicals: Tobacco, alcohol, asbestos, certain food chemicals (nitrosamines, processed meats), artificial sweeteners (some debate exists).

• Physical things: UV light from the sun, radiation (like X-rays or from radon gas).

• Germs/Viruses: HIV (connected to Kaposi sarcoma), HPV-16/18 (cervical and anal cancer), HBV/HCV (liver cancer), EBV (Burkitt lymphoma).

• Hormones: Estrogen (breast/uterus), Testosterone (prostate/testis).

• Other risks: Weakened immune system, ongoing inflammation, genetics (like BRCA, APC, p53 genes), and age.

Cancer Naming

• Carcinoma (starts in protective linings, like lung, colon, breast).

• Sarcoma (starts in support tissues, like bone, muscle).

• Leukemia (cancer of white blood cells).

• Lymphoma (cancer of the lymph system, like Hodgkin/Non-Hodgkin).

• Melanoma (skin cancer from pigment cells).

• Benign tumors often end in “-oma” (like lipoma for a fatty lump, fibroma for a fibrous lump) versus harmful cancers which are called “carcinoma/sarcoma”.

Cancer Spread & Common Locations

• How it spreads: Through the lymph system and bloodstream.

• Often goes to: Lungs, liver, brain, bone.

• Words to know: Original tumor versus Secondary tumors ("mets" for metastases).

Quick Look at Cancer Rates (USA)

• Most common: Prostate, breast, lung/bronchus, colorectal.

• Most deadly: Lung, colorectal, breast, prostate.

Early Warning Signs “CAUTION”

• C – Change in bowel or bladder habits

• A – A sore that doesn't heal

• U – Unusual bleeding or discharge

• T – Thickening or lump

• I – Indigestion or trouble swallowing

• O – Obvious change in a wart or mole

• N – Nagging cough or hoarseness.

Diagnosis & Staging

• Best way to diagnose: Taking a piece of tissue (biopsy – can be removing the whole thing, part of it, using a needle, or guided by imaging).

• Imaging: X-ray, CT scan, MRI, Ultrasound, PET scan, Nuclear bone scan.

• Lab blood tests for tumor markers:
  
  • CEA (colon, gut cancers)
  
  • CA-125 (ovarian cancer)
  
  • CA19-9 (pancreas, bile duct cancers)
  
  • AFP (liver, certain reproductive cancers)
  
  • PSA (prostate cancer)

• TNM System (how cancer is staged)
  
  • T (size of the main tumor: 0-4; Tis means it's localized and hasn't spread)
  
  • N (number of nearby lymph nodes with cancer: 0-3)
  
  • M (whether it has spread to distant parts of the body: 0-1).
  
  • Higher numbers mean a more advanced stage; Stage IV means it has spread widely.

Main Ways to Treat Cancer

• Surgery (to cure, reduce the tumor size, or relieve symptoms).

• Radiation
  
  • External beam (from outside the body), brachytherapy (radioactive seeds inside), stereotactic (very precise beams).
  
  • Rules for safety: Time (limit exposure), Distance (stay at least 6 feet away), Shielding (use lead aprons, wear a dosimeter to measure exposure).
  
  • Main side effects: Tiredness, skin burns, mouth sores.

• Chemotherapy
  
  • Drugs that kill cancer cells at specific times in their growth or anytime; often given into a vein through a port placed under the skin.
  
  • Often used with immunotherapy/targeted therapy.
  
  • "Pre-meds": Give drugs like dexamethasone and diphenhydramine beforehand to reduce allergic reactions.

• Targeted / Immunotherapies (special antibodies, drugs that block cell signals, CAR-T cell therapy).

Common Side Effects of Chemo & Radiation + Nursing Care

• Tiredness → group nursing tasks together, allow rest periods.

• Nausea/Vomiting → give ondansetron (8\,\text{mg}), aprepitant, serve small bland meals, ginger, encourage fluids.

• Diarrhea → low-fiber diet, loperamide, replace lost fluids/minerals, clean anal area carefully.

• Mouth sores (Stomatitis/Mucositis) → rinse with salt water/baking soda, nystatin, numbing mouthwash, eat cold foods, avoid spicy foods.

• Dry mouth (Xerostomia) → use moisturizers, sugar-free candy, good oral hygiene.

• Hair loss (Alopecia) → wear head coverings, wigs, use cold caps on the scalp.

• Nerve damage (peripheral neuropathy) → gabapentin, pregabalin, B-vitamins, alpha-lipoic acid, check for safety (e.g., prevent falls).

• Reproductive issues: Reduced sperm/egg production, shrinking of testicles/ovaries, advise on freezing eggs/sperm if wished.

• Skin reactions → gentle cleaning, steroid creams, avoid perfumes/sun.

Bone Marrow Suppression (When Blood Counts Are Lowest)

• Nadir = the point when blood cell counts are lowest (specific to the drug, usually around day 7-14).

• Low white blood cells (Leukopenia/Neutropenia) if WBC is less than 5\times10^3 or ANC is less than 500 → take precautions to prevent infection (private room, no flowers/raw food, wear a mask, only healthy visitors).

• Low platelets (Thrombocytopenia) if PLT is less than 100\times10^3 → take precautions to prevent bleeding (use electric razor, soft toothbrush, no shots into muscle).

• Low red blood cells (Anemia) if Hgb is less than 10\,\text{g/dL} → manage tiredness, possibly need blood transfusion.

Drugs to Boost Blood Cell Production (Colony-Stimulating Factors - CSF)

• Erythropoietin (Procrit/Epogen) 20{,}000{-}40{,}000\,U given under the skin weekly → increases red blood cells; watch blood pressure, risk of blood clots.

• Filgrastim (Neupogen) 5\,\mu g/kg/day given under the skin → increases white blood cells when ANC is low.

• Interleukin-11 (Oprelvekin) → increases platelets (less common).

• Teach how to inject at home, monitor blood tests and side effects (bone pain, high blood pressure).

Cancer Emergencies

• Superior Vena Cava Syndrome – swelling of the face/neck, shortness of breath, chest pain → give high-dose steroids, radiation, possibly a stent.

• Spinal Cord Compression – back pain, risk of paralysis → get an MRI, give steroids, possibly surgery to relieve pressure.

• High Calcium (Hypercalcemia) (tumor breaks down bone) when blood calcium is over 12\,\text{mg/dL} → give lots of IV fluids, bisphosphonates, calcitonin.

• Tumor Lysis Syndrome – high K^+, PO4^{3-}, low Ca^{2+}, sudden rise in uric acid → give aggressive IV fluids, allopurinol/rasburicase, IV\,NaHCO3, monitor heart rhythm (ECG).

Emotional Support, Hospice & Nursing Issues

• Common nursing concerns: Trouble coping, risk of infection, poor nutrition, tiredness, body image issues, caregiver stress, lack of knowledge.

• Hospice care: For patients expected to live less than 6 months (can be extended), focuses on comfort, provided by a team.

• Important discussions: Advance directives (end-of-life wishes), pain control (opioid and other pain medicines), spiritual support, creating projects to leave a legacy.