HIV

1
HIV

• NURS 1228
• Spring 2003
• By Nina Green, BSN, RN

2
Background

• 1981 New disease AIDSdiscovered
• 1985 Causative agent.HIV.isolated
• 1987 Drug therapy started
• 1994 great medical advances made

3
Significance of disease

• June of 1998 665,000 cases of AIDS and over
  401,000 AIDS related deaths in USA
  
• An estimated 650,000 to 900,000 people in the USA
  are infected with HIV
  
• Globally, over 29,000,000 people are infected
  with HIV.
  
• World wide, more than 8500 people are infected
  with HIV every day

4
Significance of disease

• The fastest growing group of people infected are
  women and young girls
  
• 10 of people with AIDS in the USA are over 50
  years old
  
• It is affecting people in every part of society
  and race.
  
• It is found in rural areas now where there is
  less medical help available

5
Transmission

• Sexual intercourse
• Contact with contaminated blood or blood
  products
  
• Perinatal transmission

6
Pathophysiology

• HIV is an RNA virus
• Discovered in 1983
• Called retroviruses, because they replicate in
  a backward manner
  
• Can only replicate if inside of a living cell
• Initial infection.called viremia
• Replication occurs rapidly and at a constant rate
  in blood and lymph

7
Pathophysiology

• Normal immune response is
• B cells marking and destroying antigens
• T cells initiating the cellular immune response
  in body
  
• HIV infects cells that have CD4 receptors
• Immune dysfunction is caused by destruction of
  CD4 cells

8
Pathophysiology

• HIV viral activity destroys about 1 billion CD4
  T cells every day
  
• The bone marrow and the thymus gland can replace
  this for a number of years
  
• Eventually the HIVs ability to destroy exceeds
  the bodys ability to produce good T-cells,
  compromising immune capability

9
Pathophysiology

• HIV can infect monocytes
• Infected monocytes move into body tissues
• Differentiate into macrophages and become HIV
  factories. Some burst
  
• Skin, lymph nodes, lungs, CNS, and other tissues
  have been infected directly in this manner

10
Clinical timeline

• Phases of infection
• Acute viremia (1-3 weeks)
• HIV antibody test is positive (2 months)
• Early HIV infection (1-8 years)
• Early HIV symptomatic infection (about 2 years)
• AIDS (approximately 2 years)
• DEATH

11
Clinical Manifestations

• Acute viremia stage (1-3 weeks)
• Flu-like or mononucleosis-like symptoms
• Fever, lymphadenopathy, pharyngitis, headache,
  malaise, nausea, muscle and joint pain
  
• Diarrhea, photophobia and/or a diffuse rash
• Symptoms last for 1-2 weeks or longer

12
Clinical manifestations

• Early infection stage (1-8 years)
• Asymptomatic
• Vague symptoms, fatigue, headache, low grade
  fever, and night sweats may occur
  
• Because they dont know they are infected, many
  times they continue on with their lives and may
  be spreading the disease to others

13
Clinical manifestations

• Early symptomatic disease (Approx. 2 years)
• Usually persistent fever, recurrent drenching
  night sweats, chronic diarrhea, headaches, and
  fatigue.
  
• Usually severe enough to bring to physician
  because it is interrupting normal routines
  
• Candida and leukoplakia lesions in the mouth are
  early indicators of HIV infection

14
Clinical manifestations

• Early symptomatic stage
• Other infections are shingles, persistent
  vaginal Candida infections, and outbreaks of oral
  and genital herpes
  
• Neurologic problems are headache, aseptic
  meningitis, cranial nerve palsy, myopathy, and
  painful peripheral neuropathies

15
Clinical manifestations

• AIDS
• Diagnosed only when the immune system is
  severely compromised
  
• Opportunistic diseases occur these can be
  recurring infections, malignancies, wasting, and
  dementia

16
Diagnostic Studies

• ELISA
• Done to detect serum antibodies that bind to HIV
  antigens
  
• Western Blot or immunofluorescence assay
• Used when ELISA is recurrently positive
• Detects antibodies in serum (WB)
• Identifies HIV in infected blood (IFA)

17
Diagnostic Studies

• HIV antibody testing can now be done on saliva
  and with home testing kits.
  
• Diagnosis is more difficult in newborns.
• Polymerase chain reaction (PCR) or viral culture
  can be used to diagnose HIV at 4 weeks.

18
Collaborative Care

• Focuses on
• Monitoring HIV disease progression
• Monitoring immune function
• Monitoring antiretroviral therapy
• Preventing opportunistic diseases
• Managing symptoms
• Preventing complications of treatment

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Collaborative Care

• Initial visit
• Gather baseline data
• Establish rapport
• Complete history and physical exam
• History of immunizations, psychosocial, and
  nutrition
  
• Findings from history, lab and assessment help
  identify patients needs

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Collaborative Care

• Start patient education
• Related to the spectrum of HIV disease
• Related to the treatments
• Prevention of transmission to others,
• Improving health
• Family planning
• Also remember that a newly diagnosed patient may
  be in shock or denial and unable to retain or
  synthesize information

21
Drug therapy

• Goals
• To decrease HIV RNA levels
• To maintain or raise CD4 T cell counts
• To delay the development of HIV-related symptoms
• To prevent the development of viral resistance
  to the available drugs (in chronically infected
  patients)
  

22
Drug therapy

• Three types
• Nucleoside Reverse Transcriptase Inhibitors
• Non-nucleoside Reverse Transcriptase Inhibitors
• Protease inhibitors

23
Drug therapy for opportunistic diseases

• Antibiotic therapy
• Antifungal therapy
• Analgesics
• Plus others depending on problem presented
• vaccines

24
Nursing Functional Health Patterns

• Health perception-health management
• Perception of illness?
• Alcohol or drug use?
• Malaise?

25
Nursing Functional Health Patterns

• Nutritional-metabolic
• Weight loss, anorexia, N/V, lesions, bleeding, or
  ulcerations of lips, mouth, gums, tongue, or
  throat?
  
• Sensitivity to acidic, salty, or spicy foods
  difficulty swallowing, abdominal cramping skin
  rashes, lesions, color changes, or non-healing
  wounds?

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Nursing Functional Health Patterns

• Elimination
• Persistent diarrhea?
• Change in character of stools?
• Painful urination?

27
Nursing Functional Health Patterns

• Activity-exercise
• Chronic fatigue?
• Muscle weakness?
• Difficulty walking?
• Cough?
• Shortness of breath?

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Nursing Functional Health Patterns

• Sleep-rest
• Insomnia?
• Night sweats?

29
Nursing Functional Health Patterns

• Cognitive-perceptual
• Headaches, stiff neck, chest pain, rectal pain,
  retrosternal pain?
  
• Blurred vision, photophobia, diplopia, loss of
  vision?
  
• Hearing impairment, confusion, forgetfulness,
  attention deficit, changes in mental status,
  memory loss, personality changes, paresthesias,
  hypersensitivity in feet, and pruritis?

30
Nursing Functional Health Patterns

• Role relationship
• Support system?
• Financial resources?

31
Nursing Functional Health Patterns

• Sexuality-reproductive
• Lesions on genitalia? (internal or external)
• Pruritis or burning in vagina?
• Painful sexual intercourse?
• Changes in menstruation?
• Vaginal or penile discharge?

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Nursing Functional Health Patterns

• Coping-stress tolerance
• Stress levels?
• Previous losses?
• Coping patterns?
• Self concept?

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Nursing Functional Health Patterns

• Values and beliefs
• Church or community support groups

34
Nursing interventions

• Teach health promotion and limit disability
• How to prevent HIV infection
• Decreasing risks related to sexual intercourse
• Decreasing risks related to drug use
• Decreasing risks of perinatal transmission
• Decreasing risks at work
• HIV testing and counseling

35
Nursing intervention

• In early intervention stage
• Education about new treatments, therapeutic
  regimens, medications, drug interactions, and
  side effects to report to PCG
  
• Promote good nutrition, stopping smoking and
  street drugs, reducing or stopping alcohol
  intake, getting regular exercise, getting
  adequate rest, avoiding infection, mental health
  counseling, and involvement in support groups and
  community activities.

36
Nursing Interventions in acute exacerbations

• Greater risk of chronic diseases
• Pneumocystis carinii pneumoniacaused by a fungus
  (respiratory impairment)
  
• Cryptococcal meningitiscaused by a fungus
  (neurological impairment)
  
• Cytomegalovirus retinitiscaused by virus (vision
  loss)
  
• Mycobacterium avium complex(bacterium) (GI
  problems and general sepsis)
  

37
Ambulatory and Home Care

• Nursing management
• Encourage good nutrition
• Encourage good fluid and electrolyte replacement
• Encourage good skin care, especially if patient
  is excoriated due to diarrhea and etc
  
• Encourage patient to wear peri pads of necessary

38
Ambulatory and Home Care

• Nursing Management
• Assess for factors that may trigger the diarrhea
  (like anxiety, medications, caffeine, or lactose
  intolerance)
  
• Encourage relaxation techniques
• Educate patient to assess fatigue patterns, to
  prevent infections, and in medications
  
• Encourage patients to avoid caffeine, nicotine,
  alcohol, and other drugs.

39
Terminal Care

• Nursing care
• Focus on keeping the patient comfortable
• Facilitate emotional and spiritual acceptance of
  the finiteness of life and help the patient and
  family and friends as they deal with the grief
  and loss.
• Wasting and dementia are two common problems

40
Terminal Care

• Nursing care
• Encourage self care, and help caregivers support
  those activities.
  
• Maintain a meaningful environment for the
  patient
  
• Reorient patient as needed
• Assist and instruct in stress reduction measures
• Provide support to family and significant others
  who may have difficulty dealing with the
  patients loss of mental and physical health