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HIV/AIDS Nursing Notes (NUR 4636)

HIV/AIDS Nursing Notes

HIV overview

  • HIV stands for Human Immunodeficiency Virus. It attacks the immune system by invading and destroying CD4 cells, key players in immune defense.
  • When CD4 cells are reduced, the body becomes less able to fight infections, increasing risk of opportunistic infections and progression to AIDS.

Transmission and pathophysiology

  • Transmission occurs through body fluids, such as blood or semen; the virus enters the bloodstream and targets CD4 cells, leading to immunosuppression.

HIV testing and ART (antiretroviral therapy)

  • HIV testing sequence:
    • Initial positive result commonly via an Enzyme-linked immunoassay (ELISA) test.
    • A second, confirmatory test is required: options include Western blot or immunofluorescence assay.
  • Start antiretroviral therapy (ART) after confirmation to suppress viral replication and preserve immune function.

Stages of HIV infection (CDC outline)

  • Acute infection
    • Occurs after exposure; flu-like symptoms appear after about 2-4\ \text{weeks}.
    • Signs and symptoms: weight loss, low-grade fever, fatigue, sore throat, night sweats, myalgia.
    • Ability to spread HIV is highest during this stage because large amounts of HIV are produced and the CD4 count drops.
  • Asymptomatic infection or clinical latency
    • Viral replication continues within lymphatics but slows down.
  • Persistent generalized lymphadenopathy
    • Usually free of symptoms; lymphadenopathy is present.
  • End-stage disease (AIDS)
    • Severe immune deficiency; very vulnerable to infections.
    • Opportunistic infections occur; signs and symptoms include fever, wasting, fatigue, neoplasms, and cognitive changes.
  • Note: CDC references indicate progression timelines and descriptions; progression to AIDS is common without treatment, with varying durations.

HIV and pregnancy: transmission risks

  • During pregnancy, HIV can cross the placenta and infect the fetus.
  • During labor and delivery, exposure to maternal blood and fluids increases transmission risk, especially when the amniotic sac ruptures (water breaks).
  • Most babies who acquire HIV are infected around the time of delivery.
  • Breastfeeding can also transmit HIV to the newborn.

Goals to reduce transmission

  • Two primary goals:
    • Protect the pregnant individual's health.
    • Prevent transmission of HIV to the fetus/newborn.

Reducing transmission during pregnancy

  • Take a combination anti-HIV drug regimen during pregnancy as prescribed (ART).
  • If lab tests show a high HIV level, delivery by cesarean birth may be recommended; vaginal delivery is possible if viral load is not high.
  • Continue anti-HIV drugs during labor and delivery as needed.
  • Administer anti-HIV drugs to the baby after birth.
  • Do not breastfeed.
  • Following these guidelines, 99\% of HIV-infected women will not pass HIV to their babies.
  • Nurses should adhere to standard precautions throughout care.

Women Who Are HIV-Positive: Impact and nursing management

  • Impact of pregnancy and HIV: threats to the self, fetus, and newborn.
  • Therapeutic management:
    • Oral antiretroviral drugs twice daily from 14\text{ weeks} until birth.
    • IV administration during labor.
    • Oral syrup for the newborn in the first 6\text{ weeks} of life.
    • Decisions regarding birthing method based on clinical status and preferences.
  • Nursing assessment:
    • Comprehensive history and physical examination.
    • HIV antibody testing.
    • Testing for other sexually transmitted infections (STIs).

Nursing management: Pretest and posttest counseling

  • Education topics:
    • Preparation for labor, birth, and postpartum period.
    • Consideration of elective cesarean birth when indicated.
    • Compliance with antiretroviral therapy.
    • Family planning methods.
  • Support mechanisms for the patient and family.