HIV/AIDS & TB: Comprehensive Notes

HIV/AIDS & TB

Learning Outcomes

• Apply standard precautions to client scenarios.
• Discuss the pathophysiology of HIV and progression to immunosuppression.
• Describe the epidemiology of HIV infection, methods of transmission, and strategies for prevention.
• Discuss the nurse's role in addressing psychosocial, legal, and ethical issues and the impact on national health care policy.
• Discuss the pathophysiology of tuberculosis and its impact on safety.
• Describe the epidemiology of TB and methods of transmission.
• Relate the epidemiology of TB and HIV to the client with altered immunity and impaired physiological safety.
• Analyze abnormal assessment and diagnostic findings in clients with alterations in safety needs.
• Identify and prioritize selected nursing diagnoses for the client with safety alterations in response to HIV, AIDS, and TB.
• Make clinical judgments regarding nursing interventions to promote optimum adaptation of the client with altered safety needs.
• Use problem-solving and collaboration to promote holistic lifestyle changes related to diet, risk-prone behaviors, and standard precautions in the client with chronically altered safety needs.
• Discuss the nurse's role in pharmacological management of the client with safety alterations.
• Provide clients and families with accurate health promotion, maintenance, and restoration information regarding safety needs.
• Communicate assessment data, plan of care, interventions, and outcome evaluations of the client with specific safety needs accurately, descriptively, and concisely.
• Identify realistic client-centered outcomes for care when chronic alterations of physiological safety exist due to immunosuppression.
• Review personal views and beliefs regarding clients with chronic alterations of physiological safety related to HIV, AIDS, and TB.
• Identify community resources and web resources available to assist those with chronically impaired safety needs.
• Provide information regarding pharmacological interventions: anti-virals.

Significance of the Problem Globally

• 1.2 million people living with HIV in the US.
• 2.7 million new infections each year.
• In the United States, there are 36,400 new infections each year.

Transmission of HIV

• Body fluids are modes of transmission.
  • Unprotected coitus with an infected partner.
  • Exposure to infected blood or blood products.
  • Using dirty needles.
  • Pregnancy, delivery, or breastfeeding.
• Unprotected sexual contact with a person who has a high HIV viral load is the most common mode of transmission.
• It is not possible to transmit HIV sexually if the person with HIV has an undetectable viral load. Known as “U=U”; undetectable = untransmittable.

Body Fluids Containing CD4 Cells or HIV

• Most people remain asymptomatic for 10 to 12 years.
• An infected person carries the virus in certain body fluids.

CD4 Cell Count & Viral Load

• CD4 cell count determines the degree of immune suppression.
  • Normal range: 800 to 1,200 CD4+ T cells/µl of blood.
  • <500 indicates increased risk of infections.
• Viral Load: relates to transmission risk.

Timeline for Untreated HIV Infection

• Acute Infection:
  • Mononucleosis-like symptoms.
• Chronic Infection:
  • Asymptomatic.
  • Symptomatic.
• Late Chronic or AIDS:
  • Severely compromised immune system.
  • Opportunistic Infections (OI).
  • Varied Cancers.
  • Wasting.
  • HIV-related cognitive changes.

Opportunistic Infections (OI’s)

• Common OI’s include:
  • Pneumocystis jiroveci pneumonia.
  • Cryptococcal meningitis.
  • Cytomegalovirus retinitis.
  • Mycobacterium avium complex.
  • Kaposi sarcoma.
  • Influenza virus.

Diagnostic Studies

• Most useful screening tests detect HIV-specific antibodies and/or antigens.
  • May take several weeks to detect antibodies (window period).
• Progression monitored by CD4+ T-cell counts and viral load.
• Other findings:
  • Neutropenia, thrombocytopenia, and anemia.
  • Altered liver function tests.
• HIV antibodies do not mean AIDS.

Interprofessional Care

• HIV cannot be cured.
• Focus of care:
  • Monitor disease progression and immune function.
  • Initiate and monitor ART (Antiretroviral Therapy).
  • Prevent opportunistic diseases.
  • Detect and treat opportunistic diseases.
  • Manage symptoms.
  • Prevent or decrease treatment complications.
  • Prevent further HIV transmission.

Drug Therapy: Anti-Retroviral Therapy (ART)

• Major principle:
  • Use combination therapy with drugs from different classes.
    • Work at various points in the HIV replication cycle.
    • Inhibit viral replication in different ways.
  • It makes it more difficult for the virus to recover.
  • Decreases chances of drug resistance.
  • Single tablet combination therapy is available.
• Side effects and expense are ART disadvantages.
• Main goals:
  • Decrease viral load.
  • Maintain/raise CD4+ counts.
  • Prevent HIV-related symptoms and opportunistic infections.
  • Delay disease progression.
  • Prevent HIV transmission.

Nursing Management: Assessment

• Do not make assumptions about who may be at risk.
• Candid conversation is important for effective management of HIV.
• Establishing rapport and gathering baseline data begins with the first visit.
• Ask people without infection.
• Follow up affirmative answers.
• Assess diagnosed patients thoroughly.

Clinical Problems & Planning

• Clinical Problems:
  • Risk for infection.
  • Deficient knowledge.
  • Difficulty coping.
  • Nutritionally compromised.
• Planning goals for nursing care are aimed at:
  • Adherence to ART.
  • Adopting a healthy lifestyle.
  • Protecting others from HIV.
  • Having supportive relationships.
  • Maintaining activities and productivity.
  • Exploring spiritual issues.
  • Coming to terms with issues related to disease, disability, death.
  • Coping with disease symptoms and its treatment.

Nursing Interventions: Implementation

• Promote skin integrity.
• Promote usual bowel patterns.
• Prevent infection.
• Improve activity intolerance.
• Maintain thought processes.
• Improve airway clearance.
• Relieve pain and discomfort.
• Improve nutritional status.
• Adhere to drug regimens.
• Promote healthy lifestyle.
• Prevent transmission to others.
• Come to terms with living with disease, disability, and death.
• Cope with symptoms and treatments.
• HIV is a highly variable chronic disease.
  • Holistic and individualized approach is best.
  • Health Promotion.

Health Promotion: Preventing HIV Infection

• HIV infection is preventable.
• Goal – develop safer, healthier, less risky behaviors.
• Consistent and correct use of prevention methods is a critical component of effective prevention.
• Nursing interventions are based on each individual person’s risk behaviors.
• Provide culturally sensitive, language-appropriate, and age-specific teaching, and behavior change counseling.
• Become comfortable talking about sensitive topics such as sexuality and drug use.

What Should a Nurse Do When Exposure Happens

• Proper hand washing with soap and water.
• Notify clinical nurse manager.
• Follow facility protocol.
• Blood tests monitoring.

Counseling

• Testing is the only sure method to determine infection.
• Negative results: opportunity for prevention education.
• Positive results: treatment and education to protect sexual and drug-using partners.
• All testing should be accompanied by pretest and posttest education.
• Early intervention.
• Reactions to positive HIV test.

Tuberculosis Associated with HIV

• Mycobacterium tuberculosis tends to occur in IV/injection drug users and other groups with pre-existing high prevalence of TB (Tuberculosis) infection.
• TB that occurs late in HIV infection is characterized by the absence of an immune response to the tuberculin skin test.
• This is referred to as Anergy, and it occurs because the compromised immune system can no longer respond to the TB antigen.
• For this reason, TB testing is essential upon the initial diagnosis of HIV.

Latent TB Infection and TB Disease

• Spread via airborne droplets.
• Not everyone infected with TB bacteria becomes sick.
• As a result, two TB-related conditions exist: Latent TB Infection & TB Disease.
• Negative pressure isolation room is required, and an N95 mask must be worn.

Risk Factors

• Once a person is infected with TB bacteria, the chance of developing TB disease is higher if the person:
  • Has HIV infection.
  • Recently infected with TB.
  • Other health problems.
  • Abuses alcohol or uses illegal drugs.
  • Not treated correctly.

Manifestations

• A bad cough that lasts 3 weeks or longer.
• Pain in the chest.
• Coughing up blood or sputum.
• Weakness or fatigue.
• Weight loss.
• No appetite.
• Chills.
• Fever.
• Sweating at night.

Diagnostics

• History.
• Physical Exam.
• PPD (Purified Protein Derivative) skin test.
• Chest X-Ray.
• CT Scan.
• Sputum testing.
• Bronchoscopy.

Interprofessional Care

• Most patients are treated as outpatients.
• Many people can continue work and maintain lifestyle.
• Infectious for first 2 weeks after starting treatment if sputum +.
• Restrict visitors and avoid public exposure.
• Hand hygiene and oral hygiene.
• Aggressive drug therapy is used to treat active disease and prevent MDR-TB; monitor adherence.

Treatment

• Most common TB drugs:
  • Isoniazid.
  • Rifampin (Rifadin, Rimactane).
  • Ethambutol (Myambutol).
  • Pyrazinamide.
• Medication side effects:
  • Nausea or vomiting.
  • Loss of appetite.
  • A yellow color to your skin (jaundice).
  • Dark urine.
  • Easy bruising or bleeding.
  • Blurred vision.

Nursing Management

• Assessment:
  • History
  • Physical Symptoms
• Clinical Problems:
  • Impaired Respiratory Function
  • Infection
  • Deficient Knowledge
  • Lack of Knowledge
• Planning Goals:
  • Have normal lung function
  • Adhere to the treatment plan
  • Take measures to prevent the spread of TB
  • Have no recurrence

Health Promotion/Health Education

• Encourage the patient to remain at home if actively infected.
• Medication Regimen.
• Nutrition.
• Sleep.
• Patient education.