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med 2 exam 4 > [Exam 1] Chapter 36: Management of Patients with HIV Infection and AIDS (Page 1025-1053) > Flashcards

[Exam 1] Chapter 36: Management of Patients with HIV Infection and AIDS (Page 1025-1053) Flashcards

1
Q

HIV-1 is transmitted by

A

body fluids containing HIV or infected CD4 lymphocytes

fluids include blood, seminal fluid, vaginal secretions, and breast milk

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2
Q

HIV: Most prenatal infections occur during

A

Delivery

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3
Q

HIV: And Casual Contact

A

Does not cause transmission

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4
Q

HIV: Breaks in skin or mucosa increases

A

risk

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5
Q

HIV and Gerontologic Considerations: signs of HIV/AIDS can be mistaken for

A

the aches and pains of normal aging

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6
Q

HIV and Gerontologic Considerations: Older adults living with HIV/AIDS also experience development of other comorbidities such as

A

cardiovascular disease, and diabetes

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7
Q

HIV and Prevention: In order to prevent the spread of HIV during intercourse, what can be done?

A

Pre-Exposure Prophylaxis (PrEP) involves taking one pill containg two HIV medications daily in order to avoid risk of sexual HIV acquisiton.

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8
Q

HIV and Prevention: Women who are pregnant can take this to reduce perinatal HIV transmission

A

ART. Should also not breast-feed their infants

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9
Q

Preventiion for Health Care Workers

A

Hand Hygiene
PPE

Soiled Patient Care Equipment Handling

environmental Control

Textiles and Laundry

Needles and Other Sharps

Patient REsuscitation

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10
Q

HIV and Health Care PRovider Treatment: If exposed, what must be done?

A

Post-Exposure Prophylaxis (PEP) includes taking antiretroviral medicine as soon as possible but no more than 3 days after exposure. 2-3 drugs prescribed must be taken for 28 days

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11
Q

STages of HIV Disease

A

Primary Infection

HIV Asymptomatic

HIV Symptomatic

AIDS

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12
Q

HIV Patho: HIV is a retrovirus because

A

it carries its genetic material in the form of RNA

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13
Q

HIV Patho: Illness is closer when caused by

A

HIV-2, which is more common in WEstern Africa

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14
Q

HIV Patho: What cna be done to screen for HIV-1?

A

Blood tests

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15
Q

HIV Patho: HIV cosnsits of a viral core contianing viral RNA surrounded by an envelope cosisiting of protruding

A

glycoproteins

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16
Q

HIV Patho: Virusees target cells with

A

CD4 receptors, which are expressed on surface of T Lymphocytes, Monocytes, Dendritic Cells, and Brain Microglia

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17
Q

HIV Patho: Stage 0, known as acute/recent infection, attacks T Cells how?

A

USe chemokine cell receptor molecule CCR5 to entry to T cells in addition to CD4 REceptors

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18
Q

HIV Patho Life Cycle: (1) Attachment / Binding Stage

A

First step, GP 120 and GP 41 glycoproteins of HIV bind with CCR5 which results in fusion of HIV with CD4

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19
Q

HIV Patho Life Cycle: (2) Uncoating / Fusion

A

Two strands of RNA nd three vital enzymes (reverse transcriptase, integrase and protease) emptied in here

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20
Q

HIV Patho Life Cycle:(3) DNA Syntehsis:

A

HIV changes its genetic material from RNA to DNA

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21
Q

HIV Patho Life Cycle: (4) Integration

A

New Viral DNA enters nucleus of CD4 and bleds with DNA of CD4

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22
Q

HIV Patho Life Cycle: (5) Transcription

A

When Cf4 T is acivated, DNA forms isngle stranded RNA which builds new viruses

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23
Q

HIV Patho Life Cycle: (6) TRanslation

A

MRNA creates chains of new proteins and enzymes

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24
Q

HIV Patho Life Cycle:(7) Cleavage

A

HIV protease enzyme cuts the polyprotein chain into the indivudual protein

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25
Q

HIV Patho Life Cycle:(8) Budding

A

New proteins and viral RNA migrate to the memrbane o fthe infacted CD4 and exit the cell

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26
Q

Hiv Patho: REsting CF4 T Cells can be stimuled to produce new particles if

A

something activates them, such as another infection

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27
Q

Hiv Patho: Whenevr the CD4 is activated, HIV replication and budding occur which..

A

can destroy the host cell. Newly formed HIV released into blood can infect over CD4 cells

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28
Q

Hiv Patho: Calculasins may have a mutation of CCR5, which may leave them

A

protected against HIV infection even if exposed

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29
Q

Hiv Patho: What determiens T Cells influence on HIV Acquisition?

A

CCR5

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30
Q

How many stages are there of HIV infection?

A

Five

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31
Q

Stages of HIV Infection: Period from infection with HIV to development of HIV specific antibodies is known as

A

primary infection or acute HIV infection and is part of stage 0

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32
Q

Stages of HIV Infection:Acute HIV infection is the inerval between

A

appearance of detectable HIV RNA and first detection of antibodies

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33
Q

Stages of HIV Infection:Primary or acute infection is characterized by

A

high levels of viral replication, widespread dissemination of HIV throughout the body, and destruction of CD4 T Cells.

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34
Q

Stages of HIV Infection:What is Viral Set Point?

A

The amount of virus in the body after the initial immune response subsides

Results in equilivrium betwee HIV levels and the immune response.

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35
Q

Stages of HIV Infection: The higher the set point, the poorer the

A

prognosis

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36
Q

Stages of HIV Infection:Stage 2 occurs when

A

CD4 T Lymphocytes are between 200 and 499 stages.

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37
Q

Stages of HIV Infection:Stage 3 occurs when

A

count drops bellow 200 cells . At this point, patient is considered to have AIDS for survillence purposes.

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38
Q

Primary Infection: PArt of CDc Categorry

A

A

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39
Q

Primary Infection: Symptoms are

A

none to flulike syndrome

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40
Q

Primary Infection: WIndow PEriod is

A

lack of HIV antibodies

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41
Q

Primary Infection: THis is a period of

A

rapid viral replication and dissemination through the body

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42
Q

HIV Asymptomatic: CDC category is

A

A

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43
Q

HIV Asymptomatic: How many T Lymphocytes / MM^3 do youhave?

A

> 500

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44
Q

HIV Asymptomatic: Upon reaching the virsl set point, what happens?

A

Chronic asymptomatic state begins

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45
Q

HIV Asymptomatic: Body has sufficent immune response to defend against

A

pathogens

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46
Q

HIV Symptomatic: CDC category

A

B

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47
Q

HIV Symptomatic: T Cell Count is between

A

200-499

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48
Q

HIV Symptomatic: CD4 T Cells grdually

A

fall

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49
Q

HIV Symptomatic: Patient develops symptoms or conditions releated to the HIV infection, which are not classified as

A

Category C infections

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50
Q

HIV Symptomatic: Patients who are once treated for Category B condiiton are considered

A

Category B

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51
Q

AIDS: CDC category

A

C

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52
Q

AIDS: How many T Lymphocytes?

A

< 200

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53
Q

AIDS: What happens as levels drop below 100?

A

Immune system is significantly impaired

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54
Q

Gerontology Considerations: what percentage of populcation over 50 hasHIV?

A

25%

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55
Q

Gerontology Considerations: Reasons for high number of cases in this population?

A

Unprotected Intercourse

Dont consider themselves a risk

Social bias toward homosexuality

MAy use IV drugs

May have received HIV infected blood before 1985

REduction in immune system function

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56
Q

HIV Tests: What is used to determine if HIV infection is recent or ongoing?

A

Serologic Testing Algorithm (STARHS)

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57
Q

HIV Tests: What are the three types of HIV diagnostic tests?

A

Anti-body tests, antigen/antibody tests, and nucleic acid (rna) tests

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58
Q

HIV Tests: Antibody test detect

A

antibodies, not HIV itself

59
Q

HIV Tests: Antigen and RNA Tests directly test

A

HIV

60
Q

HIV Tests: Antigen/Antibody tests detect infection in blood before

A

Antibody tests

61
Q

HIV Tests: Follow up testing is performed if

A

the intial test result is positive to ensure a correct diagnosis

62
Q

HIV Tests: HIV Follow Up Tests Include

A

Antidifferentiation Tests

HIV-1 Nucleic Acid Tests

63
Q

HIV Tests: What is the EIA test?

A

Antibodies are detected, resulting positive results and marking the end of the window period

64
Q

HIV Tests: What is the Western Blot?

A

Also detects antibodies to HIV, used to confirm EIA

65
Q

HIV Tests: What is VIral Load?/

A

Measures HIV RNA in the plasma

66
Q

HIV Tests: What is CD4/Cd8 Test

A

Markers found on Lymphocytes. HIV Kills CD4 cells which results in significantly impaired immune system

67
Q

HIV Tests: What is OraQuick Test?

A

In-home HIV Test

68
Q

HIV Tests: Viral Load Tests use

A

targeet amplification methods to quantify HIV RNA or DNA levels in teh plasma .

This measures plasma HIV RNA levels

69
Q

HIV Tests: RT-PCR is also used to detect

A

HIV in high-risk seronegative poeple before antibodies are measurable to confirm a positive EIA

70
Q

HIV Tests: Virial Load is better predictor of the risk of HIV disease progression than CD4 count because

A

lower the viral load, the longer the time to aids diagnosis and the longer the survivial time.

71
Q

Treatment of HIV Infection: Overreaching goal of ART is to

A

suppress HIV replication to a level below which drug-resistance mutations do not emerge

72
Q

Treatment of HIV Infection: Optimal Viral Suppression is defined as

A

viral load persistently below the level of detection.

73
Q

Treatment of HIV Infection: Achieving viral suppression requires use of ART with at least two or three more drugs and should occur within

A

12-25 weeks.

74
Q

Treatment of HIV Infection: Different drug classes of ART target

A

some of the stpes in the HIV/host cycle

75
Q

Treatment of HIV Infection: Six Classes of drugs include

A

Nucleoside/Nucleotide Reverse TRanscriptase Inhibitors

Non-Nucleoside Reverse TRanscriptase Inhibitors

Protease Inhibitors

Fusion Inhibitors
CCR5 Antagonist

Integrase Strand TRasnfer Inhibitors

76
Q

Treatment of HIV Infection: Adverse Effects associated with all HIV treatment regimens include

A

Hepatotoxicity

Nephrotoxicity

Osteopenia

along with increased risk of cardiovascular disease

77
Q

Treatment of HIV Infection: Many of the antiretroviral agents may cause

A

fat reditrubition syndrome and metabolic alterations such as dyslipidemia and insulin resistance

78
Q

Drug REsistance: Two major components of ART resistance and they are

A
  1. Transmission of drug-resistant HIV at the time of intial infection and
  2. Selective drug resistance in patietns who are receiving non-suppressive regimens
79
Q

Drug REsistance: Genotypic assays detect

A

drug-resistant mutations present in relevant viral genes while

80
Q

Drug REsistance: Phenotypic measures

A

ability of a virus to grow in different concentrations of ART drugs

81
Q

Drug REsistance: Genotypic is preferred because of

A

lower cost, more rapid turnaround time, the assays ability to detect mixtures of wild tpe and resistant virus and relative ease of interpreting test results

82
Q

Immune Reconstitution Inflammatory Syndrome (IRIS) : REsults from

A

rapid restortion of organism specific immune response to infections that cause either the deterioration of a treated infection or new presentation

83
Q

Immune Reconstitution Inflammatory Syndrome (IRIS) : Typically occurs when

A

Initial months after beginning ART and is associated with a wide spectrum of organisms , most commonly myobacteriaa.

84
Q

Immune Reconstitution Inflammatory Syndrome (IRIS) : Characterized by

A

fever , respiratory, and abdominal symptoms and worsening of clinical manifestions

85
Q

Immune Reconstitution Inflammatory Syndrome (IRIS) : Treated with

A

anti-inflammatory medications usch as cortisone

86
Q

Immune Reconstitution Inflammatory Syndrome (IRIS) : Patients with HIV-TV co infection with low CD4 counts who start ART are at high risk for devlelpoing

A

TB_IRIS

87
Q

HIV and Clinical Manifestations - Respiratory: What is associated with various opportunistic infections

A

Shortness of breath, dyspnea, cough, chest pain and fever

88
Q

HIV and Clinical Manifestations - Respiratory and Pneumocystis Pneumonia: Caused by

A

P. Jorovecii and the incidience has declined substantially with widespread use of PCP Prophylaxis, which i sused to prevent PCP and ART

89
Q

HIV and Clinical Manifestations - Respiratory and Pneumocystis Pneumonia: Most common manifestations of PCP are

A

subacute onset of progressive dyspnea, fever, nonproductive cough and chest discomfort that worsens within days to weeks

90
Q

HIV and Clinical Manifestations - Respiratory and Pneumocystis Pneumonia: Is the most common

A

life-threatening infection

91
Q

HIV and Clinical Manifestations - Respiratory and Pneumocystis Pneumonia: Initial symptoms may be

A

nonspecific and may include nonnproductive cough, fever, chills, dyspnea and chest pain

92
Q

HIV and Clinical Manifestations - Respiratory and Pneumocystis Pneumonia: If untreated, progreses to

A

pulmonary impairment and respiratory failure

93
Q

HIV and Clinical Manifestations - Respiratory and Pneumocystis Pneumonia: Treamtnet includes

A

TMP -SMZ or PEntamidine , Prophylactic TMP-SMZ

94
Q

HIV and Clinical Manifestations - Respiratory and Mycobacterium Avium Complex: What is this?

A

Disease that is a common opportunistic infection that typically occurs in patients with CD4 T Lympho count less than 50

95
Q

HIV and Clinical Manifestations - Respiratory and Mycobacterium Avium Complex: MAC caused by

A

infection with diffferent types of mycobacterium

96
Q

HIV and Clinical Manifestations - Respiratory and Mycobacterium Avium Complex: Early symptoms may be

A

minimal and can precede detectable mycobacterium by severalweeks and include fever, night sweats, weight loss, fatigue, diarrhea

97
Q

HIV and Clinical Manifestations - Respiratory and Mycobacterium Avium Complex: Confirmed diagnosis based on

A

compatible clinical signs and symptoms coupled with isoloation of MAC from cultures of blood, lymph node, bone marrow, and other normally sterile tissues

98
Q

HIV and Clinical Manifestations - GI: GI Manifestations include

A

loss of appeite, nausea, vomiting, oral and esophagal candidiasis adn chronic diarrhea

99
Q

HIV and Clinical Manifestations - GI: Symptoms may be realted to

A

direct inflammatory effect of HIV Cells on lining of the intestines

100
Q

HIV and Clinical Manifestations - GI: For patients with AIDS, effects of diarrhea cna be devasting in terms of

A

profound weight loss (Octreotide acetate) , fluid and electrolyte imbalance perianal skin excoveration, weakness, and inability to perform the usual activites

101
Q

HIV and Clinical Manifestations - GI and Candidiasis: Oranpharyngeal Candidiasis is characterized by

A

painless, creamy white, plque like lesions that can occur on the buccal surface

102
Q

HIV and Clinical Manifestations - GI and Candidiasis: Lesions can be easily scraped of with

A

a tongue depressor or other instrument

103
Q

HIV and Clinical Manifestations - GI and Candidiasis: Treatment with

A

Mycelex Troches or Nystatin, Ketoconazole

104
Q

HIV and Clinical Manifestations - GI and HIV Wasting Syndrome: Defined as

A

involuntary loss of more than 10% of ones body weight while having experienced diarhea or weakness and fever for more than 30 days

105
Q

HIV and Clinical Manifestations - GI and HIV Wasting Syndrome: Wasting refers to

A

loss of muscle mass although part of weight loss may also be due to part of fight

106
Q

HIV and Clinical Manifestations - GI and HIV Wasting Syndrome: hat may contribute to this?

A

Anorexia, diarrhea, GI malabsorption and lack of nutriton

107
Q

HIV and Clinical Manifestations - Oncologic Manifestations: Those with HIV / AIDS are greater risk for developing certain cancers like

A

Kaposi Sarcoma , Lymphoma, And Invasive Cervical CAncer

108
Q

HIV and Clinical Manifestations - Oncologic Manifestations and Kaposi Sarcoma: Caused by

A

human herpevirus and affects eight times more men than women. Spreads through sexual contact

109
Q

HIV and Clinical Manifestations - Oncologic Manifestations and Kaposi Sarcoma: Involves the

A

epithelial layer of blood and lymphatic vessels

110
Q

HIV and Clinical Manifestations - Oncologic Manifestations and Kaposi Sarcoma: Exhibits a variable and aggressive course, and it may start as

A

cutaneous lesions but may involve multiple organ systems

111
Q

HIV and Clinical Manifestations - Oncologic Manifestations and Kaposi Sarcoma: Lesions cause

A

discomfort, disfigurement, ulceration and potential for infection

112
Q

HIV and Clinical Manifestations - Oncologic Manifestations and Kaposi Sarcoma: What cna be the first manifestation?

A

They can appear anywehre on the body and are usually brownish pink to deep purple.

113
Q

HIV and Clinical Manifestations - Oncologic Manifestations and Kaposi Sarcoma: Diagnosis confirmed by

A

biopsy of suspected lesions. Prognosis depends on the extent of the tumor

114
Q

HIV and Clinical Manifestations - Oncologic Manifestations and AIDS Related Lymphomas: Unclude both

A

Hodgkin lymphoma and non-hodgkin lymphoma. Non more common

115
Q

HIV and Clinical Manifestations - Oncologic Manifestations and AIDS Related Lymphomas: Three times of AIDS related LYmphomas?

A

Diffuse Large B Cells

B Cell Immunoblastic

Small Noncleaved Cell Lymphoma

116
Q

HIV and Clinical Manifestations - Oncologic Manifestations and AIDS Related Lymphomas: Symptoms include

A

weight loss, night sweats, and fever

117
Q

HIV and Clinical Manifestations - Neurologic Manifesations: HIV Related brain changes have profound effects on the body including

A

motor function, exectuvie function, attention, visual memory, and visusoatial function

118
Q

HIV and Clinical Manifestations - Neurologic Manifesations: Neurologic dysfunction results from

A

direct effects of HIV on nervous sytem tissue, opportunistic infections, primary or metastatic neoplasm.,

119
Q

HIV and Clinical Manifestations - Neurologic Manifesations and Peripheral Neuropathy: This is the most common

A

Neurologic symtpom at any stage of HIV infection

120
Q

HIV and Clinical Manifestations - Neurologic Manifesations and Peripheral Neuropathy: May be side effect of some

A

ART drugs and may occur in a variety of patterns.

121
Q

HIV and Clinical Manifestations - Neurologic Manifesations and Peripheral Neuropathy: Can lead to

A

significant pain of feet and hands and functional impairment

122
Q

HIV and Clinical Manifestations - Neurologic Manifesations and HIV Encephalopathy: Formerly referred to as

A

AIDS Dementia Complex

123
Q

HIV and Clinical Manifestations - Neurologic Manifesations and HIV Encephalopathy: Clinical syndrome that is characterized by

A

progressive decline in cognitive, behavioral, and motor functions as a direct result of HIV.

124
Q

HIV and Clinical Manifestations - Neurologic Manifesations and HIV Encephalopathy: HIV infection is thought to trigger relase of

A

toxins or lymphokines that result in cellular dysfunction, inflammation, or intereference with neurotransmitter function

125
Q

HIV and Clinical Manifestations - Neurologic Manifesations and HIV Encephalopathy: Signs and Symptoms may be subtle but include

A

memory deficits, headache, difficulty concentrating, progressive confusion, psychomotor slowing , apathy and ataxia

126
Q

HIV and Clinical Manifestations - Neurologic Manifesations and HIV Encephalopathy: LAter stages of signs and symptoms include

A

Cognitive impairment, delay in verbal responses, a vacant stare and hyperflexia

127
Q

HIV and Clinical Manifestations - Neurologic Manifesations and HIV Encephalopathy: Diagnosing includes

A

Extensive CT Scan. MRI and analysis of CSF as well.

128
Q

HIV and Clinical Manifestations - Neurologic Manifesations and HIV Encephalopathy: Probably related to

A

HIV infection

129
Q

HIV and Clinical Manifestations - Neurologic Manifesations and Cytococcus NEoformans: What is this?

A

Fungal infection characterized by fever, headache, malaise, stiff neck, nause and mental status changes

130
Q

HIV and Clinical Manifestations - Neurologic Manifesations and Progressive Multifocal Leukoencephalopathy: What is this?

A

Demyelinating CNS disorder tha taffects the oligodendroglia.

131
Q

HIV and Clinical Manifestations - Neurologic Manifesations and Progressive Multifocal Leukoencephalopathy: Clinical manifcations include

A

mental confusion and rapidly progress to include

blidness, aphasia, muscle weakness, paresis and death

132
Q

HIV and Clinical Manifestations - Neurologic Manifesations and Depressive Manifestations: What substanceshave been associated with this?

A

Cocaine and Alcohol use and depression has been associated with less adherence with ART

133
Q

HIV and Clinical Manifestations - Neurologic Manifesations and Integumentary Manifestations: Cutanous manifestions are associated with

A

HIV infection and the accompanying opportunistic iinfections and malignancies

134
Q

HIV and Clinical Manifestations - Neurologic Manifesations and Treatment of Pneumocystis Pneumonia: Persons in stage 3 HIV should reieve

A

Chemoprophylaxis to prevent PCP with trimetroprim.

135
Q

HIV and Clinical Manifestations - Neurologic Manifesations and Treatment of Pneumocystis Pneumonia: When person diagosed with PCP, What is the treatment of choice?

A

TMP-SMX lowering the dose if there was any abnromal renal function

136
Q

HIV and Clinical Manifestations - Neurologic Manifesations and Treatment of Pneumocystis Pneumonia: Treatment duration lasts

A

21 days

137
Q

HIV and Clinical Manifestations - Neurologic Manifesations and Treatment of Pneumocystis Pneumonia: Should be started when?

A

As soon as possible, preferentially within 72 hours.

138
Q

HIV and Clinical Manifestations - Neurologic Manifesations and Treatment of Mobacterium Avium Complex: Initial treatment should consist of

A

2 or moer antimycobacteial drugs to prevent the delay the emergence of resistance

139
Q

HIV and Clinical Manifestations - Neurologic Manifesations and Treatment of Mobacterium Avium Complex: Preferred first agent?

A

Clarithromycin but Azithromycin can be subbed

140
Q

HIV and Clinical Manifestations - Neurologic Manifesations and Treatment of Cypotoccal Meningitis: Most commonly occurs as

A

subacute meningitis or meningoencephalitis with fever, malaise, and headache..

141
Q

HIV and Clinical Manifestations - Neurologic Manifesations and Treatment of Crypotococcal Meningitis: Treatment includes

A

Three phasees, induction, consolidation, and maintenace.

142
Q

Nursing Process: Care of PAtient with HIV/AIDS - Assessment: This incudes

A

Assess patients support system
Identidy potential risk factors, IV drug abuse

Immune system function

Nutritonal Status

Skin integrit

Respiratory status

fluid and electrolyte balance

143
Q

Nursing Process: Care of PAtient with HIV/AIDS - Assessment: Nutritonal status obtained by

A

obtaining a dietary history and idetnifying factors that may interfere with oral intake

med 2 exam 4 (10 decks)

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