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Patient Centered Care 3 > Immunity: HIV/AIDS Exemplar > Flashcards

Immunity: HIV/AIDS Exemplar Flashcards

1
Q

What is AIDS caused by?

A

HIV

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2
Q

What is the primary mode of transmission for someone who has HIV/AIDS?

A

sexual contact, but it can also be transmitted through contact with infected blood

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3
Q

What type of cells does the HIV virus infect?

A

CD4 cells or Helper T cells

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4
Q

How does the HIV virus kill the CD4 or Helper T cells?

A

it grows inside the cell to the point that it bursts the membrane and explodes the cell

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5
Q

What role do helper T cells play in our immune system?

A

They recognize foreign antigens and infected cells, and they activate B cells which make antibodies. (They are like the tornado siren sounding the alarm)

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6
Q

Are men or women more likely to contract HIV?

A

Men (women account for approximately 23% )

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7
Q

What individuals are at the highest risk for acquiring HIV?

A

Transgender individuals

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8
Q

What situations, or factors, can put someone at risk for contracting HIV?

A
  1. unprotected sex
  2. sharing needles or injection drugs with others
  3. hemophilia and blood transfusions
  4. working in the healthcare environment
  5. poverty
  6. pregnancy and breastfeeding
  7. old age
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9
Q

What education should people receive to help prevent the spread of HIV?

A
  1. safe sex practices
  2. use autologous blood transfusion when possible
  3. people who are HIV + should not donate blood, organs, or sperm
  4. do not shar needles, razors, or get a tattoo if HIV +
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10
Q

What kind of precautions should healthcare workers take with HIV+ patients?

A

Standard Precautions (treat all high-risk body fluids as if they are infectious; use barrier precautions to prevent exposure to fluids)

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11
Q

What is Pre-exposure Prophylaxis, and what drug is typically used for this?

A

Treatment for someone who is HIV negative, but is at a high risk for contracting HIV. The current drug of choice is Truvada

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12
Q

What is Postexposure Prophylaxis, and when must it start for it to be effective?

A

Treatment after coming in contact with high risk fluids. Treatment needs to begin within 72 hours of an exposure and consists of 2-3 antiretroviral meds that must be taken for 28 days.

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13
Q

What are the most typical manifestations of HIV?

A
  1. Fever
  2. Sore throat
  3. Arthralgias and myalgias
  4. Headache
  5. Rash
  6. Lymphadenopathy
  7. nausea
  8. vomiting
  9. abdominal cramping
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14
Q

What are the characteristics of Stage 1 HIV?

A
  1. asymptomatic or persistent generalized lymphadenopathy
  2. Lack of an AIDS-defining condition and either a CD4+ T-lymphocyte count higher than 500 or a percentae fo total lymphocytes of more than 29%
  3. Greatest risk of transmission
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15
Q

What are the characteristics of Stage 2 HIV?

A
  1. Virus present but may not be producing symptoms
  2. CD4+ T-lymphocyte count between 200 and 499; percentage of total lymphocytes between 14-28%
  3. Moderate unexplained weight loss
  4. Recurrent respiratory infections
  5. Herpes zoster
  6. Recurrent oral ulceration
  7. Seborrheic dermatitis
  8. fungal nail infections
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16
Q

What are the characteristics of Stage 3 HIV (AIDS)?

A
  1. Presence of AIDS-defining condition (Kapsoi sarcoma, PCP, Tuberculosis) or a CD4 count of lower than 200 or a total lymphocyte percentage less than 14%
  2. Unexplained severe weight loss
  3. Unexplained chronic diarrhea for more than 1 month
  4. Unexplained persistent fever for more than 1 month
  5. Persistent oral candidiasis
  6. oral hairy leukoplakia
  7. Pulmonary tuberculosis
  8. Severe presumed bacterial infections
  9. Acute necrotizing ulcerative stomatitis, gingivitis, or periodontitis
  10. Unexplained anemia
  11. Neutropenia
  12. Chronic thrombocytopenia (less than 50,000)
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17
Q

What are the characteristics of Stage 4 HIV/AIDS?

A
  1. Wasting syndrome (weight loss greater than 10%, chronic diarrhea for 1 month, and chronic weakness with fever for 1 month)
  2. Pneumocystis jiroveci pneumonia
  3. Recurrent severe bacterial pneumonia
  4. Chronic herpes simplex
  5. Esophageal candidiasis
  6. Extrapulmonary tuberculosis
  7. Kaposi sarcoma
  8. Cytomegalovirus
  9. CNS toxoplasmosis
  10. HIV encephalopathy
  11. Chronic cryptosporidiosis
  12. Lymphoma
  13. invasive cervical carcinoma
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18
Q

What is the AIDS dementia complex?

A

The most common cause of mental status changes for patients with HIV infection. This dementia results from a direct effect of the virus on the brain and affects cognitive, motor, and behavioral functioning. Fluctuating memory loss, confusion, difficulty concentrating, lethargy, and diminished motor speed are typical manifestations

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19
Q

What is Toxoplasmosis?

A

Space-occupying lesions common in patients with AIDS that may cause headache, altered mental status, and neurologic deficits

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20
Q

What are opportunistic infections?

A

Infections that take advantage of an immunocompromised body.

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21
Q

What opportunistic infections are common with people who have HIV/AIDS?

A
  1. Pneumocystis jiroveci Pneumonia
  2. tuberculosis
  3. Candidiasis
  4. Mycobacterium avium complex
  5. parasitic infections (Toxoplasma gondii, Cryptococcus neoformans)
  6. herpes virus
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22
Q

What secondary cancers are common with people who have HIV/AIDS?

A
  1. Kaposi sarcoma
  2. Non-Hodgkin lymphoma
  3. Primary lymphoma of the brain
  4. Invasive cervical carcinoma
23
Q

What tests are used to identify HIV infection?

A
  1. Enzyme-linked Immunosorbent assay
  2. Western blot antibody testing
  3. HIV viral load tests
  4. CBC
  5. CD4 cell count
24
Q

What are the 4 primary foci for pharmacologic treatment?

A
  1. To suppress the infection itself, decreasing symptoms and prolonging life
  2. To provide prophylaxis of opportunistic infections
  3. Stimulate hematopoietic response
  4. To treat opportunistic infections and` malignancies
25
Q

What are the 4 classes of antiretroviral drugs used for treatment of HIV/AIDS?

A
  1. Nucleoside analog reverse-transcriptase inhibitors
  2. Nonnucleoside reverse-transcriptase inhibitors
  3. Protease inhibitors
  4. entry inhibitors
26
Q

What is the best method of birth for women who are pregnant with HIV?

A

Cesarean section because it decreases the risk of transmission

27
Q

Is it recommended that women who have HIV breast feed?

A

NO

28
Q

Should a woman with HIV stay on her antiretroviral medications while pregnant?

A

Yes, as long as they are not Teratogenic

29
Q

What assessments should be done for a pregnant woman who is HIV+ during her prenatal visit?

A
  1. Signs of fever or weight loss during the second or third trimester
  2. signs of a vaginal infection
  3. signs of opportunistic infections
  4. signs of enlargement in major organs
  5. CD4 counts
30
Q

What nursing interventions should be conducted for those with HIV/AIDS?

A
  1. Prevent secondary infections in those with HIV/AIDS
  2. Promote adherence to medication regimen
  3. Promote effective coping
  4. Maintain skin integrity
  5. promote adequate nutrition
  6. Address ineffective sexuality patterns
  7. Address knowledge deficits
31
Q

How would a nurse prevent secondary infections in those with HIV/AIDS?

A
  1. make sure children have their immunizations when needed
  2. Educate about opportunistic infections, sexually transmitted infections, and other infections.
  3. Encourage frequent hand hygiene, and limit exposure to sick people or crowds
  4. Avoid invasive procedures in newborns and encourage the mother to formula-feed
32
Q

How would a nurse promote effective coping with someone who has HIV/AIDS?

A
  1. Determine patient perception of the current situation. Identify cultural beliefs and previous experiences.
  2. Assess the patient’s social support network and usual methods of coping
  3. Plan for consistent, uninterrupted time with the patient
  4. Support the patient’s social network (family and friends)
  5. Promote interaction between patient, significant others, and family
  6. Encourage the patient’s involvement in making care decisions
  7. Support positive coping behaviors, decisions, actions, and achievements
33
Q

How would a nurse maintain skin integrity with someone who has HIV/AIDS?

A
  1. Monitor for lesions or breakdown
  2. look for signs of infection or impaired healing
  3. Use strategies to relieve pressure on bony prominences and improve circulation
  4. Keep skin clean and dry by using mild, nondrying soaps or oils for cleaning. Apply protective creams to reddened areas in the rectal area
  5. If you see blisters, leave them intact, and dress them with a hydrocolloid dressing
  6. Caution the patient against scratching
  7. Avoid the use of heat or occlusive dressings. Heat can further dry and damage the skin
  8. Encourage ambulation if possible; if the patient is confined to the bed, encourage active or passive ROM exercises.
34
Q

How would a nurse promote adequate nutrition with someone who has HIV/AIDS?

A
  1. Assess nutritional status (body weight, caloric intake, labs)
  2. Identify possible causes of altered nutrition
  3. Administer prescribed medications for candidiasis and other manifestations as ordered (improves comfort and facilitates food intake)
  4. Administer antidiarrhea meds after stools, and antiemetics before meals. Give antipyretics for fevers
  5. Involve patient in meal planning and encourage significant others to bring favorite foods from home
  6. Provide a diet high in protein in kilocalories. Offer soft foods which are easier to digest, and small portions.
  7. give supplementary vitamins and enteral feedings
  8. Administer appetite stimulants
35
Q

How would a nurse address ineffective sexuality patterns?

A
  1. Examine your own feelings about sexuality, your role in dealing with a patient’s sexuality, and the patient’s lifestyle and sexual preferences.
  2. Establish a trusting, therapeutic relationship through the use of time, active listening, and caring
  3. Provide factual information about HIV infection and its effects
  4. Discuss safer sex practices, including hugging, cuddling, nonsexual contact, use of latex condoms and spermicidal lubricant, and mutual masturbation.
  5. Encourage discussion of fears and concerns with the significant other, if any
  6. For the patient without a significant other, stress the need to continue meeting people and developing social relationships while practicing safer sex.
36
Q

Which assessment findings support that the patient with HIV currently has AIDS? (Select all that apply.)

  1. Persistent generalized lymphadenopathy
  2. Esophageal candidiasis
  3. Recurrent infectious pneumonia
  4. HIV-positive status
  5. Kaposi’s sarcoma
  6. wasting syndrome
A

Answer: 2, 3, 5, 6

37
Q

The nurse is assessing a client who cannot synthesize suppressor T-cells. For what other condition does the nurse assess the client?

  1. Increased Seasonal Allergies
  2. Multiple sclerosis
  3. Leukemia
  4. Graft-versus-host disease
A

Answer: 1

Suppressor T-cells function to limit the actions of general and specific responses. These cells prevent overreactions to the presence of “foreign proteins” within a person’s environment. People who are deficient in suppressor T-cell activity have more severe hypersensitivity reactions, allergies, and autoimmune responses. Low numbers of T-suppressor lymphocytes would not increase the client’s risk for multiple sclerosis (MS), Leukemia, or graft-versus-host disease.

38
Q

Which action by the nurse is most effective to prevent becoming exposed to the human immune deficiency virus (HIV)?

  1. Always use Standard Precautions with all clients in the workplace
  2. Place clients who are HIV positive in Contact precautions
  3. Wash hands before and after contact with clients who are HIV positive
  4. Convert parenteral medications to an oral form for clients who are HIV positive
A

Answer: 1

The best prevention for health care providers is the consistent use of Standard Precautions with all clients, as recommended by the Centers for Disease Control and Prevention (CDC). Contact Precautions are not indicated unless the client has an infection such as Clostridium difficile or MRSA (methicillin-resistant Staphylococcus aureus).

39
Q

A client with AIDS has been admitted with fever, night sweats, and weight loss of 6 pounds in 2 weeks. The client’s purified protein derivative (PPD) test, placed 3 days ago in the clinic, is negative. Which action by the nurse is most appropriate?

  1. Place the client in Airborne precautions
  2. Facilitate the client’s chest x-ray
  3. Initiate a 3-day calorie count
  4. Start an IV of normal saline
A

Answer: 1

The client’s symptoms are indicative of tuberculosis (TB). With AIDS, the client’s CD4+ T-cell count is so low that the client cannot mount an immune response to the PPD; thus it appears negative. The client needs to be placed in Airborne Precautions until other diagnostic tests rule out TB. The other interventions are appropriate, but they do not take priority over infection control principles.

40
Q

The nurse is caring for a newly diagnosed HIV-positive client who will be taking enfuvirtide (Fuzeon). Which precaution is important for the nurse to communicate to this client?

  1. Stop taking the medication if you develop a fever
  2. Rotate the sites where you will be giving the injections
  3. Take this medication with a snack or a small meal
  4. Do not drive or operate machinery while taking this drug
A

Answer: 2

Fuzeon is available only as a subcutaneous injection and can cause injection site reactions and nodules. The client should be taught the subcutaneous technique, including rotation of sites. The client should not stop taking this medication for fever, it can be given without regard to food, and the drug will not make the client sleepy or drowsy, so caution with driving or operating machinery is not needed.

41
Q

The nurse is teaching a client who has AIDS how to avoid infection at home. Which statement indicates that additional teaching is needed?

  1. I will wash my hands whenever I get home from work
  2. I will make sure to have my own tube of toothpaste at home
  3. I will run my toothbrush through the dishwasher every evening
  4. I will be sure to eat lots of fruits and vegetables every day
A

Answer: 4

The client should avoid eating raw fruits, vegetables, and salads because of the risk of infection.

Hands should be washed whenever returning home
immune-compromised clients should not share toothbrushes or toothpaste
Toothbrushes should be run through the dishwasher nightly.

42
Q

A client who is positive for HIV presents with confusion, fever, headache, blurred vision, nausea, and vomiting. What does the nurse do first?

  1. Assess the client’s deep tendon reflexes
  2. Ask the client to place his chin on his chest
  3. Start an IV line with normal saline
  4. Assess the client’s pupil reaction
A

Answer: 2

The client’s symptoms are associated with cryptococcal meningitis, so the nurse should first ask the client to place the chin on his or her chest. The presence of nuchal rigidity (pain when flexing the chin to chest) helps confirm the diagnosis. An IV line may be started after the neurologic assessment is completed.

43
Q

The nurse is caring for a hospitalized client who has AIDS and is severely immunocompromised. Which interventions are used to help prevent infection in this client? (Select all that apply.)

  1. Use sterile gloves and gowns whenever the nursing staff is in contact with the client
  2. Provide an incentive spirometer to encourage coughing and deep breathing by the client
  3. Keep a blood pressure cuff, thermometer, and stethoscope in the client’s room for his or her use only
  4. Use N95 respirators when in the client’s room
  5. Request that the family take home the fresh flowers that are at the client’s bedside
  6. Assist the client with meticulous oral care after meals and at bedtime
A

Answer: 2, 3, 5, 6

The nursing staff should encourage coughing and deep breathing to prevent pneumonia, and incentive spirometry will be helpful. Assessment equipment such as thermometers and blood pressure cuffs should be kept in the room only for the use of this client, rather than being used by other clients on the unit as well. Fresh flowers can harbor microorganisms and should be removed from the room. Meticulous oral care will help to prevent infection by Candida.

44
Q

The nurse is caring for an HIV-positive client. What assessment finding assists the nurse in confirming the progression of the client’s diagnosis to AIDS?

  1. Generalized lymphadenopathy
  2. HIV-positive status for 8 years
  3. Low-grade fever for the last 10 days
  4. Thick white patches on the client tongue and oral mucosa
A

Answer 4

Candidiasis, which presents with thick white patches on the tongue and oral mucosa, is associated with the development of AIDS after HIV infection. The fact that the client has been positive for 8 years or has a low-grade fever is not significant.

45
Q

The nurse has been exposed to HIV through the splashing of urine from a client who is HIV positive with a low viral load. The urine came into contact with the nurse’s face. Which drug regimen does the nurse prepare to initiate?

  1. Retrovir for 14 days
  2. Retrovir for 28 days
  3. Retrovir and Epivir for 14 days
  4. Retrovir and Epivir for 28 days
A

Answer: 4

Someone who comes in contact with risky bodily fluids should take 2-3 antiretrovirals for at least 28 days

46
Q

An HIV-positive client is taking lopinavir/ritonavir (Kaletra) and reports nausea, abdominal pain, and diarrhea. What orders does the nurse anticipate?

  1. Renal function studies
  2. Liver enzymes
  3. Blood glucose monitoring
  4. Albumin and prealbumin
A

Answer: 2

Kaletra can cause liver complications, and clients taking it should have liver function studies. The client’s symptoms could indicate a liver problem. Renal function and blood glucose are not affected by Kaletra. The client may have albumin and prealbumin drawn if he or she has lost a great deal of weight and malnutrition is suspected, but the more common diagnostic test for a client taking Kaletra would be liver function studies.

47
Q

A client who is receiving highly active antiretroviral therapy (HAART) tells the nurse, “The doctor said that my viral load is reduced. What does this mean?” What is the nurse’s best response?

  1. The HAART meds are working well right now
  2. You are not as contagious as you were anymore
  3. Your HIV infection is becoming resistant to your meds
  4. You are developing an opportunistic infection
A

Answer: 1

Viral load pertains to the amount of HIV cells infected in the body. If it is reduced, then the medication they are using is effective

48
Q

The nurse is working with a client at a public health clinic. The client says to the nurse, “The doctor said that my CD4+ count is 450. Is that good?” What is the nurse’s best response?

  1. Your count is high so you can cut back on your meds
  2. Your count is normal because your meds are working well
  3. Your count is a bit low and you are susceptible to infection
  4. Your count is very low and you actually now have AIDS
A

Answer: 3

A CD4+ T-cell count of 450 cells/mm3 of blood is low, and the client is at increased risk for developing an infection. Normal CD4+ counts range from 800 to 1000 cells/mm3. To be diagnosed with AIDS, a client must have a CD4+ T-cell count of <200 cells/mm3 (or a CD4+ T-cell percentage of <4%) and/or an opportunistic infection.

49
Q

The nurse is caring for a client with AIDS who has just been diagnosed with cryptococcal meningitis. Which is the best nursing intervention for this client?

  1. Initiate respiratory isolation for the next 72 hours
  2. Initiate seizure precautions with padded side rails
  3. Thicken the client’s liquids to honey consistency
  4. Administer IV pentamidine isethionate
A

Answer: 2

Cryptococcosis is a debilitating form of meningitis that can cause seizures, so seizure precautions should be initiated. Respiratory isolation is not indicated. Dysphagia is not seen with cryptococcal meningitis, so thickened liquids are not indicated. Pentium is given for Pneumocystis jiroveci pneumonia (PJP).

50
Q

Select the common routes by which HIV can be transmitted. Select all that apply.

  1. Contact with someone who has nausea and is HIV positive
  2. Casual contact with an HIV-positive person
  3. Perinatal transmission for previous children of a now positive HIV mother
  4. Sexual Contact with an HIV+ person
  5. Contact with blood infected with HIV
A

Answer: 4, 5

The correct answers are: Sexual Contact with an HIV-positive person and Contact with blood infected with HIV

Sexual contact with an HIV-positive person: common route of transmission of HIV. This contact exposes a person to semen, vaginal secretions, and blood.

Contact with blood infected with HIV: This can be either accidental, such as a splash with contaminated blood, sharing a contaminated needle, or unprotected sex.

HIV is not spread through casual contact such as someone who has nausea.
HIV is not spread from a now positive HIV mother to her precious children, with the understanding that she was HIV negative with the previous pregnancies.
HIV transmission when pregnant is one of the most common routes of transmission for newborns.

51
Q

To decrease the risk of developing resistance to the antiretroviral medication, the client should:

  1. Take at least two different antiretroviral medications at one time
  2. Take at least three different antiretroviral meds at one time
  3. Take at least four different antiretroviral meds at one time
  4. Take at least five different antiretroviral meds at one time
A

Answer 2

52
Q

For an HIV-positive client, toxoplasmosis is an opportunistic infection. One way to prevent this infection is to avoid which of the following.

  1. Raking leaves
  2. Cleaning cat litter
  3. Cutting the grass
  4. Emptying the vacuum bag`
A

Answer: 2

Cleaning cat litter should be avoided as the cat feces may carry the parasite Toxoplasma gondii

It is a good idea to wear gloves when raking leaves, gardening, cutting grass, or digging in the soil
Emptying the vacuum bag should not be a means to be exposed to toxoplasmosis

53
Q

An undetectable viral load means:

  1. The client can say that the virus is gone
  2. The amount of virus in the client’s blood is so low it cannot be found using the current lab test
  3. The client can no longer transmit the virus
  4. The client will no longer need to use protection when having sex
A

The correct answer is: The amount of virus in the client’s blood is so low it cannot be found using the current lab tests

With the other options, the client will still have HIV and can be transmitted and must continue to use protection.

Patient Centered Care 3 (19 decks)

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