Module 6: Altered Immunity
Actual Notes
HIV AND AIDS majority
SLE, not majority
Types of lupus only really systemic lupus
SLE:
Autoimmune disease with unknown. causes but antibodies and antigens form antigen-antibody complexes that get trapped in the capillaries of the visceral structure
Women more than men , African Americans, Latinos, Asians, Indian
Symptoms
Butterfly rash, alopecia
SLE Triggers
Sunlight and UV light exposure
Drugs hydralazine, minocycline, procainamide
Viral infection
Silica dust
Stress vs medical stressor
SLE DX
Can take a long time
SLE the first major complication is lupus nephritis
Ealy dx is essential to prevent renal failure and ESRD
Acute kidney injury
Dehydrated can cause long-term renal damage
Medical Management
Avoiding prolonged sun exposure, daily use of sunscreen, eating a well-balanced diet, maintaining a regular sleep schedule
SLE management
Hydroxychloroquine is used to treat fatigue, skin, and the joint manifestation
You have a risk of infection due to the medication
Nursing management SLE
In some places, people won’t have these resources
High risk for PE
Petechiae: Little dots on the skin
HIV AND AIDS: As a nurse, we have to be legal warriors since it affects marginalized communities
HIV transmitted: Blood, seminal fluid, vaginal secretion, amniotic fluid, breast milk
When sharing needles we aspirate through leading to blood being left inside the needle and then sharing it leading to HIV spreading
When you have anal sex leads to tearing of the anus and semen can enter the blood
Babies can get HIV leading to the mother having a C-section. Our goal si to make the mother into an undetectable state
HIV trans
Viral Transmission
Acute viral infection
Seroconversion
Asymptomatic Chronic Infection: 3 - 10 yrs
Symptomatic Chronic Infections: 2 years
AIDS: CD 4 counts less than 200 cells
Staging Criteria
Stage 0: early HIV infection
Stage 1: Greater. than 500 cells
No AIDS-defining condition
Stage 2: 200 - 499 cells
No AIDS-defining condition
Stage 3: less than 200
Documentation of AIDS-defining condition
Stage unknown: No data
No information on AIDS-defining condition
Complications of HIV/ AIDS
A lot of words that are crazy
HIV assessment
Universal precaution including PPE
Vital signs
Assess swollen lymph nodes and oral candida
Monitor nutrition, weight measurement
S/S infection including new onset of fever, headache, blurring, changing of LOC, night sweats
Alert HCP
Diagnosis of HIV
Rapid Test: Used blood or bloody fluid to verify the presence of HIV antibodies and take 5 - 30 mins
Enzyme-Linked Immunosorbent Assay: requires a blood sample and result in 24 -48 hours
Negative test results should be repeated 3 -6 months to allow time for antibodies
HIV Western Blot: Uses blood to confirm the presence of proteins unique to HIV
Used to diagnosed HIV in individuals over 12 months; used after ELISA
Viral Load
Teaching
Medical Management
PREP pre-exposure prophylaxis for individuals at high risk of infection
Monitor CD 4 T cell count and viral load plasma HIV RNA, CBC, LFTs
PEP post-exposure prophylaxis for individuals with possible HIV exposure
Highly active antiretroviral therapy: Antiretroviral interferes with the ability of HIV to reproduce themselves
Using all 3 drugs can help suppress viral replication: protease inhibitors Ritonavir, nucleoside reverse transcriptase inhibitor Tenofovir and Retrovir; nonnucleoside analog reverse transcriptase inhibitors Nevirapine and Efavarenze
Immunization: reduce risk of infection related to compromised immune system
Nursing Management
Standard precaution
Administer HAART
Provide small frequent and nutritionally dense
Offer emotional support
Refer to social work
Patient teaching with HAART
Avoid high-risk activity
Stigma of HIV
Case Studies
Concept Map Components:
Patient Information
Name: Julie Walker
Age: 22
Diagnosis: Systemic Lupus Erythematosus (SLE)
Signs & Symptoms
Extreme fatigue
Muscle and joint aching/swelling
Butterfly rash across nose
Patchy alopecia
Low-grade fever
Loss of appetite
Diagnostic Findings
Positive ANA titer
Anemia, leukopenia, mild thrombocytopenia
Abnormal lipid profile
Proteinuria
Hypertension
Normal liver and renal function
Medications Prescribed
Ibuprofen (OTC): For joint discomfort, max 1200 mg/day
Hydroxychloroquine (Plaquenil): Taken before meals, same time daily
Prednisone (Tapering Dose): Over the next month
Lisinopril (ACE inhibitor): For hypertension
Statin: For hyperlipidemia
Priority Nursing Intervention:
Patient Education on Medication Adherence & Side Effects: Ensuring that the patient understands the importance of taking hydroxychloroquine, prednisone, and lisinopril as prescribed, monitoring for side effects, and not exceeding the ibuprofen dosage limit to prevent toxicity.
b. What is an Antinuclear Antibodies (ANA) Titer?
Definition: An ANA titer is a blood test that detects autoantibodies that attack the body's own tissues, specifically the cell nucleus.
Positive ANA Titer:
Indicates an autoimmune disorder, such as SLE.
A high ANA titer suggests an overactive immune response, leading to inflammation and tissue damage.
c. Why is the Patient Prescribed Hydroxychloroquine?
Purpose:
Used to reduce inflammation, prevent lupus flares, and improve long-term disease outcomes.
Helps with joint and skin symptoms, as well as reducing fatigue.
Teaching Points:
Take at the same time daily before meals.
Monitor for retinal toxicity: Regular eye exams (every 6–12 months) are required as long-term use can cause vision changes.
May take weeks to show benefits, so adherence is crucial.
Report any visual disturbances, muscle weakness, or unusual bruising.
d. Other Teaching Plan Topics
Medication Adherence & Side Effects:
Prednisone: Risk for weight gain, hyperglycemia, osteoporosis—do not stop abruptly.
Lisinopril: Monitor blood pressure, report dizziness or persistent cough.
Statin: Avoid grapefruit juice, monitor for muscle pain (rhabdomyolysis).
SLE Disease Management:
Avoid sun exposure (use sunscreen & protective clothing).
Recognize signs of a lupus flare (increased fatigue, joint pain, fever).
Maintain regular follow-ups with healthcare providers.
Diet & Lifestyle Changes:
Heart-healthy diet: Low-sodium, low-fat to manage hypertension & lipid levels.
Avoid smoking and limit alcohol.
Stress management and adequate rest to prevent fatigue.
Infection Prevention:
Due to leukopenia, the patient should avoid sick contacts, practice good hand hygiene, and stay up to date on vaccinations (no live vaccines while on immunosuppressants).
Patient Education for Sallie Jefferies – HIV in Pregnancy
a. Clinical Management to Reduce HIV Transmission to the Baby
Antiretroviral Therapy (ART):
The patient should start or continue ART immediately, regardless of CD4 count or viral load.
Recommended regimen includes a combination of at least three antiretroviral drugs to keep viral load undetectable and reduce the risk of transmission.
Zidovudine (AZT) During Pregnancy & Labor:
Given orally during pregnancy (from 14 weeks gestation) and intravenously during labor to lower transmission risk.
Cesarean Delivery:
Recommended if viral load >1,000 copies/mL near delivery to prevent transmission.
Neonatal Prophylaxis:
The newborn should receive zidovudine (AZT) for 4–6 weeks after birth to reduce the risk of acquiring HIV.
Avoid Invasive Procedures:
Minimize amniocentesis, scalp electrodes, and episiotomy to prevent fetal exposure to maternal blood.
b. How Zidovudine Helps Prevent HIV Transmission to the Baby
Zidovudine (AZT) reduces the amount of HIV in the mother's blood (viral load), decreasing the risk of passing the virus to the baby.
It crosses the placenta and provides protective effects to the baby by preventing viral replication in fetal cells.
The nurse should explain:
"Zidovudine helps protect your baby by preventing HIV from multiplying in both your body and your baby’s body, reducing the risk of transmission during pregnancy and delivery."
c. Explanation About Zidovudine
Purpose:
Prevents mother-to-child transmission (MTCT) of HIV.
How to Take It:
Take exactly as prescribed, usually twice daily throughout pregnancy.
Possible Side Effects:
Nausea, headache, anemia, muscle pain—encourage adherence despite mild side effects.
Important Considerations:
Do not miss doses to maintain an undetectable viral load.
The newborn will also receive zidovudine for 4–6 weeks after birth.
d. Is Breastfeeding Safe?
Breastfeeding is NOT recommended for mothers with HIV, even if on ART.
HIV can be transmitted through breast milk.
The nurse should explain:
"HIV can be passed to your baby through breast milk, so it’s safest to use formula or donor breast milk. This will help protect your baby from the virus."
e. HIV Testing Schedule for the Baby
Standard Testing Timeline:
First test: Within 48 hours of birth.
Second test: At 2 weeks of age.
Third test: At 4–6 weeks of age.
Fourth test: At 4–6 months of age.
Final antibody test: At 18 months of age to confirm HIV status.
If two tests (at separate times) are negative after 4 weeks and 4 months, the baby is likely not infected.
The nurse should say:
"Your baby will be tested at birth, and then several times during their first year to make sure they are HIV-negative. If all tests are negative after 18 months, your baby will be confirmed HIV-free."
Case Study Analysis: M.T. – HIV Progression & Complications
a. Zidovudine (AZT) – What It Is, Who Takes It, and Why She Stopped
Zidovudine (AZT) Overview:
A nucleoside reverse transcriptase inhibitor (NRTI) that prevents HIV from replicating by inhibiting reverse transcriptase.
Used in HIV treatment and prevention of mother-to-child transmission.
Who Is Prescribed AZT?
HIV-positive individuals as part of antiretroviral therapy (ART).
Pregnant women to prevent vertical transmission.
Why Did She Stop Taking It?
Adverse effects (common with AZT): Nausea, headache, anemia, fatigue.
Lack of follow-up and support—she did not return for care.
Possible substance use influence—past heroin/cocaine use may indicate poor adherence to medical treatment.
Denial or stigma—some patients discontinue ART due to psychological distress or social reasons.
b. Generalized Purplish/Brown Raised Lesions – Kaposi’s Sarcoma
Likely Diagnosis: Kaposi’s Sarcoma (KS)
An AIDS-defining illness caused by Human Herpesvirus-8 (HHV-8).
Appears as purple, brown, or red raised skin lesions, commonly on the skin, mucous membranes, and internal organs.
Affected Body Systems:
Skin & Mucosa – visible lesions.
Respiratory System – involvement in the lungs can cause cough and dyspnea.
Gastrointestinal Tract – can cause bleeding and malabsorption if present in the GI tract.
c. Cause of Her Non-Productive Cough
Likely Diagnosis: Pneumocystis jirovecii pneumonia (PJP)
Opportunistic fungal infection common in AIDS patients.
Symptoms:
Progressive dyspnea, dry cough, fever, hypoxia
Crackles on auscultation suggest lung involvement.
Diagnosis:
Chest X-ray: Diffuse bilateral infiltrates.
Sputum or bronchoalveolar lavage (BAL) for P. jirovecii detection.
Treatment:
Trimethoprim-sulfamethoxazole (TMP-SMX) (Bactrim) is the first-line treatment.
Corticosteroids if hypoxia is severe (PaO₂ < 70 mmHg).
d. Criteria for End-Stage AIDS & Expected CD4 Count
Criteria for AIDS (CDC Definition):
CD4 count < 200 cells/mm³ OR
Presence of AIDS-defining illnesses, such as:
Pneumocystis pneumonia (PJP)
Kaposi’s Sarcoma (KS)
Candidiasis (oral and vaginal thrush present in this patient)
Expected CD4 Count for M.T.:
Likely < 200 cells/mm³, possibly < 100 given her severe opportunistic infections and weight loss.
e. Nursing Care for End-Stage AIDS Patient
1. Respiratory Support
Monitor oxygen saturation, provide supplemental O₂ as needed.
Administer prescribed antibiotics/antifungals (TMP-SMX for PJP).
Encourage deep breathing & repositioning to improve oxygenation.
2. Infection Prevention & Management
Strict hand hygiene and standard precautions.
Monitor for sepsis and new infections due to immunosuppression.
Administer antifungal (fluconazole for candidiasis) and ART if tolerated.
3. Nutritional Support
High-calorie, high-protein diet to combat weight loss and cachexia.
Oral care for thrush (nystatin swish and swallow).
Consider enteral feeding if anorexia worsens.
4. Skin & Comfort Measures
Pain management for Kaposi’s sarcoma lesions.
Frequent skin assessments to prevent pressure injuries.
Moisturizing skin, covering lesions as needed for comfort.
5. Psychosocial & Emotional Support
Counseling and support groups for end-of-life care discussions.
Advance directive & palliative care planning.
Provide emotional support to the patient and family.
1. HIV Education for Older Adults at a Senior Center
Key Considerations for Older Adults:
Many do not perceive themselves at risk for HIV.
May not use protection due to postmenopausal concerns (no fear of pregnancy).
Lower health literacy regarding HIV transmission and prevention.
Possible stigma and reluctance to discuss sexual health.
Topics to Cover:
HIV Transmission
Spread through unprotected sex, sharing needles, blood transfusions (before 1985), and mother-to-child transmission.
Misconceptions: Cannot be spread through casual contact, hugging, or sharing utensils.
Risk Factors in Older Adults
Unprotected sex due to lack of pregnancy concerns.
Age-related vaginal thinning and decreased lubrication increase the risk of HIV transmission.
Multiple partners due to divorce/widowhood and dating later in life.
Comorbidities (diabetes, hypertension) that may complicate HIV progression.
Prevention Strategies
Use condoms correctly and consistently.
Regular HIV testing (especially after new partners).
Avoid sharing needles or personal items (razors, toothbrushes) that may have blood.
Discuss PrEP (pre-exposure prophylaxis) for high-risk individuals.
Encouraging Open Conversations
Encourage discussions with healthcare providers about sexual health.
Address stigma and misconceptions about HIV in older adults.
2. HIV Education for Teenagers at a High School
Key Considerations for Teenagers:
Peer pressure & risky behaviors (unprotected sex, experimenting with substances).
Low perception of risk – belief that HIV only affects certain groups.
Limited knowledge of PrEP and other preventive measures.
Social media influence – exposure to misinformation.
Topics to Cover:
HIV Transmission
Spread through blood, semen, vaginal fluids, and breast milk.
Risk factors: Unprotected sex, multiple partners, sharing needles, drug use.
Prevention Strategies
Abstinence is the only 100% effective method.
Condoms & dental dams – Demonstration on correct use.
PrEP for high-risk teens (e.g., those with HIV-positive partners).
Avoiding drug use & needle sharing.
Importance of HIV Testing & Early Detection
Routine HIV testing for sexually active individuals.
Confidential testing options available at local clinics and schools.
Myths vs. Facts
HIV is not a "death sentence" – effective treatment allows people to live long, healthy lives.
You cannot tell if someone has HIV just by looking at them.
Encouraging Safe & Informed Decisions
Open communication with partners about sexual history & testing.
Seeking guidance from parents, school nurses, or healthcare professionals.
Actual PP
Types of Adult Lupus
Systemic Lupus Erythematosus (SLE)
Subacute Cutaneous or Discoid Lupus
Drug-Induced Lupus
Systemic Lupus Erythematosus (SLE)
A chronic inflammatory disease affecting multiple organ systems.
The immune system mistakenly attacks components of the cell’s nucleus, treating them as antigens.
Antigen-antibody complexes get trapped in capillaries, leading to organ damage.
Four contributing factors: genetic, immunologic, hormonal, and environmental.
Triggers:
Stress, pregnancy, sunlight exposure, illness, major surgery.
Silica dust exposure.
Medication allergies
Systemic Lupus Erythematosus (SLE)
Definition: SLE is the most common form of lupus, an autoimmune disease where the body’s immune system attacks its own tissues, leading to inflammation and damage in various organs.
Affected Organs: SLE can impact the joints, skin, brain, lungs, kidneys, and blood vessels.
Symptoms: Widespread inflammation causes symptoms like joint pain, fatigue, skin rashes, and organ dysfunction.
Treatment: Although there is no cure, medical interventions (such as immunosuppressants and corticosteroids) and lifestyle changes (like sun protection, balanced diet, and stress management) can help manage symptoms and control disease progression.
Systemic Lupus Erythematosus (SLE) Continued
Periods of flares and remission.
4 to 12 times more common in women than men.
Higher prevalence in African Americans, Hispanics, Asians, and American Indians/Alaska Natives.
Socioeconomic status impacts disease control—lower education levels often correlate with worse prognosis.
Symptoms of SLE
Butterfly rash
Alopecia
CNS symptoms
Oral ulcers
Anemia, neutropenia, thrombocytopenia
Pleuritis, pericarditis, myocarditis
CNS Symptoms in SLE
Neuropsychiatric Presentations: SLE can cause a wide range of central nervous system (CNS) symptoms, which are often subtle.
Common Symptoms:
Psychosis
Cognitive impairment
Seizures
Peripheral and cranial neuropathies
Transverse myelitis
Strokes
SLE Triggers
Sunlight & UV exposure
Medications (e.g., hydralazine, minocycline, procainamide)
Viral infections (Flu, Epstein-Barr virus)
Silica dust exposure in industrial/agricultural settings
Medical stressors (pregnancy, surgery)
Systemic Lupus Erythematosus (SLE) Diagnosis
History & Physical Exam:
Elevated Antinuclear Antibodies (ANA)
Elevated Anti-DNA (most specific)
Elevated Anti-Sm antibody (specific to nuclear protein)
Complete Blood Count (CBC): Leukopenia, anemia, or thrombocytopenia
Urinalysis: Proteinuria, elevated creatinine
Chest X-ray and X-ray of affected joints
Diagnosis of Systemic Lupus Erythematosus (SLE)
Challenges: SLE can be difficult to diagnose early due to its symptoms being non-specific and resembling those of other diseases.
Diagnostic Methods:
Symptom Assessments: Evaluating clinical manifestations.
Physical Examination: Checking for characteristic signs like rashes or joint swelling.
X-rays: To identify potential organ damage or inflammation.
Lab Tests:
ANA (Antinuclear Antibody) Test: Detects antinuclear antibodies in the blood, which may indicate an autoimmune disorder.
Anti-dsDNA (Anti-Double Stranded DNA Antibodies): A specific marker for SLE, indicating the presence of the disease.
Complications of SLE
Lupus nephritis & renal failure
Premature heart disease
Interstitial lung disease (ILD)
Stroke & hypercoagulation
Avascular necrosis of joints
Lupus Nephritis
Immune complexes accumulate in renal structures (glomeruli, tubules, interstitium)
Activation of immune pathways by autoantibodies
Symptoms: Proteinuria, nocturia, foamy urine, edema
Diagnosis:
Urinalysis with 24hr protein collection (≥0.5g protein, +3 dipstick protein, hematuria, casts)
Elevated creatinine
Renal biopsy for classification of lupus nephritis
SLE Medical Management
Nonpharmacological:
Avoid prolonged sun exposure, use sunscreen
Maintain balanced diet and regular sleep
Regular exercise (strength and ROM)
Stress reduction
Pharmacologic:
Hydroxychloroquine: Treats fatigue, skin, and joint symptoms
NSAIDs: For headaches, myalgias, and fever
Glucocorticoids: To suppress inflammation and pain
Methotrexate: Immunosuppressant for joint inflammation
Belimumab: Reduces immune response
Organ-Specific Treatment:
Tailored based on clinical manifestations (flare vs. remission)
Nursing Management of SLE
Monitor:
Joint pain, weakness, fever, fatigue, chills
Dyspnea, chest pain, peripheral edema
Urine, skin, mucous membranes for petechiae, ulcers, or bruising
Vital signs, intake/output (I/O), weight
Lab values (CBC, BUN, creatinine, urinalysis, coagulation studies)
Promote:
Balanced diet
Emotional support
Referrals to:
Pulmonologist, nephrologist, neurologist, cardiologist, dermatologist
HIV & AIDS: Patient Teaching & Management
HIV Transmission
HIV can be transmitted through:Blood
Seminal fluid
Vaginal secretions
Amniotic fluid
Breast milk
HIV Stages:
Acute Viral Infection
Initial infection causes an inflammatory reaction at the site of infection
Rapid decrease in CD4+ lymphocytes and increase in viral load
Flu-like symptoms may appear
Seroconversion occurs when HIV antibodies are first detectable
Asymptomatic Chronic Infection (3-10 years)
CD4+ count increases to >500
Viral load stabilizes at a low set point, though viral replication continues
Gradual loss of 50-100 CD4+ cells per year
Symptomatic Chronic Infection (2 years)
CD4+ count drops, immune system fails to control HIV replication
Development of opportunistic infections (e.g., Kaposi’s sarcoma, oral hairy leukoplakia, skin infections)
Patient becomes unable to fight infections
AIDS
CD4+ count falls below 200 cells
Opportunistic infections and AIDS-defining illnesses (e.g., Pneumocystis pneumonia, Mycobacterium avium complex, Toxoplasmosis, Non-Hodgkin’s lymphoma)
Common Clinical Manifestations of HIV
Cough
Weakness
Nausea/vomiting
Diarrhea
Dysphagia (difficulty swallowing)
Forgetfulness
Shortness of breath (dyspnea on exertion)
Headache
Vision changes
Patient Teaching for HIV & AIDS:
Sun Protection: Daily use of sunscreen with UVB of 30 and wear protective clothing to avoid sun exposure.
Diet: Emphasize the importance of eating a well-balanced diet.
Energy Conservation: Prioritize activities to preserve energy and reduce stress.
Medication Adherence: Maintain regular medication therapy to minimize flare-ups and complications.
Monitor Symptoms: Contact the doctor if fever, cough, rash, chest pain, abdominal pain, or joint pain develops or persists.
Regular Appointments: Keep up with medical appointments and ensure vaccinations are current.
complications of HIV/AIDS
Opportunistic infections are common due to a weakened immune system:Herpes Zoster
Tuberculosis (TB)
Oral Candidiasis
Pneumocystis Carinii Pneumonia (PCP PNA)
Cryptococcal Meningitis
Cryptosporidiosis
Candida Esophagitis
Toxoplasmosis
Cytomegalovirus (CMV)
Mycobacterium Avium Complex (MAC)
Mycobacterium Avium Complex (MAC)
Overview: MAC is a group of bacteria closely related to tuberculosis. It primarily affects individuals with weakened immune systems, such as those with HIV/AIDS.
Oxygenation: Ensure adequate oxygenation for patients infected with MAC, as respiratory function may be compromised due to infection in the lungs.
Progressive Multifocal Leukoencephalopathy (PML)
HIV Assessment
Universal Precautions (including PPE)
Vital Signs: Regular monitoring is crucial
Physical Exam:
Assess for swollen lymph nodes
Look for oral candida infection
Monitor nutrition, weight, and appetite
Watch for skin breakdown
Be alert to new symptoms (fever, headache, blurred vision, change in LOC, night sweats)
Notify healthcare provider (HCP) of any abnormal findings
Assessment of HIV with Normal CD4+ T Count
Nursing Assessment:
Lymph Node Palpation: Regularly palpate lymph nodes to assess for swelling, which may indicate infection or inflammation.
Normal CD4+ T Count: In patients with a normal CD4+ T count, there are usually no significant signs of immunosuppression, but regular monitoring is essential for disease progression.
Progression of Disease:
The disease may progress over time, even with a normal CD4+ count, especially if viral load increases. It's important to continue monitoring CD4+ T cells and viral load to detect any early signs of HIV progression or immunosuppression.
Oral Candidiasis
Overview: Oral candidiasis (thrush) can affect anyone, but it is more common in:
Infants and toddlers
Older adults
Individuals with compromised immune systems, including those with AIDS or those taking immunosuppressive medications.
Impact: It often presents as white patches in the mouth and can be painful, affecting the ability to eat or speak.
Diagnosis of HIV
Rapid Test: Results in 5-30 minutes; detects HIV antibodies
Enzyme Linked Immunosorbent Assay (ELISA): Blood test; results in 24-48 hours
If negative, repeat test in 3-6 months
HIV Western Blot: Confirmatory test, used after ELISA for individuals over 12 months
Viral Load: Used for infants <12 months to confirm HIV presence
Teaching/Communication:
For HIV testing: Reassure the patient not to panic, and advise follow-up testing for confirmation
Western Blot Analysis and ELISA in HIV Testing
ELISA (Enzyme-Linked Immunosorbent Assay):
Purpose: Initial screening test for HIV.
Accuracy: Inexpensive and generally accurate with few false positives.
Follow-up: If the ELISA result is positive, further confirmation is needed.
Western Blot Analysis:
Purpose: Used to confirm HIV seropositivity when the ELISA test is positive.
Cost: More expensive than ELISA, so it's typically used only for confirmation of the results.
Medical Management of HIV/AIDS
Pre-exposure Prophylaxis (PrEP)
Truvada for high-risk individuals to reduce the chance of contracting HIV.
Post-exposure Prophylaxis (PEP)
Antiretroviral medications within 72 hours of possible exposure.
Highly Active Antiretroviral Therapy (HAART)
Combination therapy to suppress HIV replication:
Protease Inhibitors (PIs): e.g., Ritonavir
Nucleoside Reverse Transcriptase Inhibitors (NRTIs): e.g., Tenofovir and Retrovir
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): e.g., Nevirapine and Efavirenz
Monitoring
Regular checks of CD4+ T cell count, viral load, plasma HIV RNA, CBC, and Liver Function Tests (LFTs)
Immunizations
Vaccinations are important to reduce the risk of infections due to a compromised immune system.
HIV Diagnosis and Monitoring
Viral Load and CD4+ Count:
At diagnosis, both viral load and CD4+ count are measured.
CD4+ Count: Checked every 3 to 6 months for the first 2 years of therapy, then annually.
Viral Load: Measured every 3 months for the first 2 years (for adherent patients), then every 6 to 12 months.
Viral Load is the primary indicator of treatment success or failure but is not recommended for hospitalized patients.
Occupational Exposure
Needle Stick Risk: Healthcare workers have a 0.3% risk of becoming HIV-infected if exposed to needle sticks involving HIV-infected blood (CDC, 2018a). The risk of infection from occupational exposure is very low.
Antiretroviral Therapy (ART)
DHHS Recommendations: ART should be recommended to all HIV+ individuals.
Mechanism: Antiretrovirals interfere with the replication of HIV.
Immunizations
Vaccinations: It is crucial for HIV+ patients to maintain up-to-date immunizations due to their compromised immune systems.
Pneumovax: Administered every 5 years for HIV+ patients with a CD4+ count ≥200 cells/µL to reduce the risk of pneumococcal pneumonia.
Nursing Management of HIV
Standard Precautions: Adhere to infection control protocols (PPE, hand hygiene, etc.)
Administer HAART: Ensure timely administration of Highly Active Antiretroviral Therapy (HAART) as prescribed.
Nutrition: Offer small, frequent, and nutritionally dense meals to prevent skin breakdown.
Emotional Support: Provide counseling and encouragement.
Referrals: Refer patients to social work for support and counseling, especially pre and post-test.
Patient Teaching for HAART
Lifelong Commitment: HAART is a lifetime therapy and adherence is critical to prevent viral resistance.
Adherence: Patients must maintain 100% adherence to ART for optimal results.
Side Effects: Educate on potential side effects of HAART medications.
Consistent Schedule: Emphasize the importance of taking medications daily at the same time.
Effect on the Body: Explain the effects of HAART on the body and immune system.
Initiation Criteria: Start HAART in patients with Hepatitis B, HIV-associated neuropathy, or pregnant women, regardless of CD4+ count.
Infection Control: Teach patients how to prevent transmission through high-risk behaviors.
Medical Appointments: Encourage regular doctor’s appointments and immunization schedules.
Diet and Rest: Stress the importance of eating a balanced diet and getting adequate rest.
Stigma of HIV
Negative Attitudes: Many people hold negative beliefs about individuals with HIV, often due to fear and lack of knowledge.
Barriers to Testing: Stigma may prevent individuals from getting tested for HIV.
Psychosocial Impact: People with HIV may experience shame, isolation, and despair.
Cultural Considerations: Always be mindful of psychosocial, cultural, and economic factors when providing care.