Nursing Care of the Individual with HIV/AIDS

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Nursing Care of the Individual with HIV/AIDS
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What is HIV?
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Transmission

1. What is the most common mode of HIV transmission?
   
2. How else is HIV transmitted?
3. What is the most common mode of work related
   transmission?

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How is HIV transmitted? Select all that
apply.

• Vaginal secretions
• Kissing
• Semen
• Urine and feces
• Breast milk
• Coughing, sneezing
• Using the same comb as person with HIV

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HIV / AIDS

• What is the main receptor to which the HIV virus
  must bind in order to gain entry into the hosts
  body?

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Pathophysiology

• Viruses cannot reproduce /replicate without a
  host, what is the host, target cell for HIV?
• What is the function of T-cells?
• The normal CD4 cell count in an adult is ______?

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HIV / AIDS

• What is the difference between HIV and AIDS?
• How long does it take for HIV to become AIDS?

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When is a person said To have AIDS?
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Timeline for Untreated Illness
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Signs and Symptoms

• Flu-like symptoms
• Fatigue
• Sore throat
• Enlarged lymph nodes
• Headache
• Muscle and joint pain
• Goes through stages

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Oral Hairy Leukoplakia
Which stage does this occur?
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Signs and Symptoms

• Swollen lymph glands
• Thrush
• Muscle and joint pain
• Low-grade fever
• Oral hairy leukoplakia
• Sore Throat
• CD4 T cells drop to 200 to 500 cells/µl
• Localized infections

1. Acute Stage
2. Early Chronic
3. Intermediate Chronic
4. Late Chronic/ AIDS

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Diagnosis
What is major problem rt diagnosis?
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Acquired Immunodeficiency Syndrome (AIDS)

• Diagnostic CDC criteria
• CD4 T cell count below 200 cells/µl
• Specific opportunistic infection or cancer
• Wasting syndrome
• AIDS dementia complex (ADC)
• Must meet CDC criteria outlined in Table 15-10 in
  textbook

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What tests are used in diagnosis

• Enzyme immunoassay (EIA) to detect serum
  antibodies
• If test is negative what do they do?
• If test is positive what do they do?
• If re-test is positive what do they do?
• A confirming test (Western blot)
• If this test is positive reported as

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Testing used to Monitor Treatment Effectiveness

• Progression monitored by
• CD4 T cell counts
• viral load
• Abnormal blood tests common
• Neutropenia, thrombocytopenia, and anemia

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HIV Viral Load

• Measures amount of HIV specific RNA,
• Viral load correlates strongly with stage of
  disease

• HIV RNA levels during course of infection
• or at the time of seroconversion 5 million
  copies
• 5 yrs 25, 000 copies
• 8 yrs 300,000 copies

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What is the Major Goal of Care?
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Treatment and Nursing Care
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HAART - Highly Active Antiretroviral Therapy

• When should Therapy be Started?

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Antiretroviral Therapy

• Adherence to drug regimens is critical to prevent
• Disease progression
• Opportunistic disease
• Viral drug resistance

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Antiretroviral Therapy

• Non-nucleoside reverse transcriptase inhibitor
  (NNRTIs) ex efavirenz (sustiva)
• Nucleoside/nucleotide reverse transcriptase
  inhibitor (NRTIs/NtRT)
• ex zidovudine (retrovir, AZT,
• SDV), tenovir DF (viread, TDF)
• Work by inhibiting viral replication

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Antiretroviral Therapy

• Protease inhibitors disable protease, a protein
  that HIV needs to make more copies of itself ex
  darunavir (prezista)
• Entry/Fusion inhibitors blocks HIV entry into
  cells ex enfuvirtide (FuzeonT-20)

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Antiretroviral Therapy

• Integrase inhibitors disable integrase, a
  protein that HIV uses to insert its viral genetic
  material into that of the infected cell ex
  raltegravir (isentress)
• Fixed dose combination contain 2 or more meds
  from 1 or more drug classes
• ex.- efavirenz, tenofovir (atripla)

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Side Effects Toxicities

• Common physical problems
• Depression
• Diarrhea
• Peripheral neuropathy
• Pain
• Nausea/vomiting
• Fatigue

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Side Effects Toxicities

• Common metabolic disorders
• Lipodystrophy
• Hyperlipidemia
• Insulin resistance
• Bone disease
• Lactic acidosis
• Cardiovascular disease

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• If the side effects occur what would the nurse
  expect to happen next?

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Medication Therapy

• What is the major problem encountered in treating
  with ART primarily when one drug alone is being
  used?
• What to do about it?

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What strategies are Used to improve adherence To
ART?
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• How would the nurse know that ART is effective?

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Summary of Opportunistic Infections

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Health Promotion / Prevention

• Major goal Prevention
• Four CDC strategies
• Use testing as routine health care
• Use rapid testing
• Work to modify risky behaviors
• Offer tests universally to pregnant women

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Health Promotion/ Prevention

• What is important to teach to decrease the risk
  of spread via
• Sexual intercourse?
• Drug use?
• Perinatal transmission?

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Nursing Care

• Ways to promote a healthy immune system (slow
  disease progression)
• Nutritional support
• Moderation or elimination of alcohol, tobacco,
  and drug use
• Mental health counseling
• Vaccines
• Rest, exercise, and stress reduction
• Avoid exposure to infectious agents

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HIV Transmission to Healthcare Workers

• Source of
  Exposure HIV

• Needlesticks (open bore needle) or cuts
• Skin contact (intact)
• Splashes in mucous membrane
• (eye, nose or mouth)

• 0.3-0.4
• lt0.1
• 0.1

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And the research continues

• The End