Ch 47: Peds AIDS Flashcards Preview

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Flashcards in Ch 47: Peds AIDS Deck (22):
1

HIV process

Infects CD4+ T cells
gradual decrease in these cells occurs
causes progressive immunodeficiency

2

HIV transmission

blood, semen, vaginal secretions, and breast milk
incubation period is months - years

3

Most common opportunistic infections in HIV children

Pneumocystic jiroveci pneumonia
most frequently occurs between the ages of 3-6 mo.

4

Common assessment findings in HIV children

chronic cough
chronic / recurrent diarrhea
dev. delay or regression of milestones
failure to thrive
hepatosplenomegaly
lymphadenopathy
malaise and fatigue
night sweats
oral candidiasis
parotitis
weight loss

5

Common AIDS defining conditions in children

candidal esophagitis
cryptosporidiosis
cytomegalovirus disease
herpes simplex disease
HIV encephalopathy
lymphoid interstitial pneumonitis
Mycobacterium avium intracellulare infection
Pneumocystic jiroveci pneumonia
pulmonary candidiasis
recurrent bacterial infections
wasting syndrome

6

Antiretroviral meds

bgoal is to suppress viral replication to slow the decline in number of CD4 cells, preserve immune fxn, reduce the incidence and severity of opportunistic infections, and delay disease progression.
meds affect different stages of the HIV life cycle to prevent reproduction of new virus particles

7

Immunizations

immunizations against childhood diseases is recommended for all children exposed to / infected w HIV

8

Immunization guidelines

symptomatic child, severe immunosupp:
only the inactivated influenza vaccine (given IM) should be used (yearly)
measles vaccine should NOT be given, (immunoglobulin may be prescribed after measles exposure)
only the inactivated polio vaccine (given IM) should be used
rotavirus vaccine should NOT be given
varicella zoster virus vaccine should NOT be given, immunoglobulin may be prescribed after chicken pox exposure
tetanus immunoglbulin may be rx for tetatnus prone wounds.

9

HIV children do NOT give vaccines

measles
rotavirus
varicella-zoster

10

HIV dx tests

ELISA > 18 mo
Western blot > 18 mo
PCR < 18 mo
p24 antigen < 18 mo
CD4+ lymph count/ T lymph count b-13 yr

11

ELISA

> 18mo
determines: response of antibodies to HIV
if found to be + in infacts < 18 mo, indicated only that mother is infected --> maternal antibodies are transmitted transplacentally; use another test

12

Western blot

>18 mo
determines: presence of HIV antibodies
if + at only indicates mother is infected

13

PCR

<18 mo
determines: presence of proviral DNA
very accurate for dx infants 1-4 mo

14

p24 antigen

<18 mo
determines: HIV antigen specific
very accurate for dx infants 1-4 mo

15

CD4+ lymphocyte count, T-lymphocyte count

infant - 13 yr
determines: immune system status r/t suppression specifically
age adjustment is essential bc normal counts are relatively high in infants and steadily decline until 6 yrs of age
severe supp in all age groups is < 15% total lymphocytes
<200 cells/L in child 6-12 yr

16

Antiretroviral meds

Reverse Transcriptase Inhibitors:
(Nucleoside/Nucleotide Reverse Transcriptase Inhibitors
Non-nucleoside/Nucleotide Reverse Transcriptase Inhibitors)

Integrase Inhibitor
Protease Inhibitors
Fusion Inhibitor
Chemokin Receptor 5 (CCR5) Antagonist

17

Reverse Transcriptase Inhibitors

action: inhibit enzymes req for HIV replication
Nucleoside/tide Rev Trans Inhi:
abacavir (Ziagen)
didanosine (Videx)
emtricitabine (Emtriva)
lamivudine (Epivir)
stavudine (Zerit)
tenofovir (Viread)
zidovudine (Retrovir)

non Nucleoside/tide Rev Trans Inhi:
delavirdine (Rescriptor)
efavirenz (Sustiva)
etravirine (Intelence)
nevirapine (Viramune)

18

Integrase Inhibitor

action: inhibit enzymes required for HIV replication
raltegravir (Isentress)

19

Protease Inhibitors

action: inhibit enzymes required for HIV replication
amprenavir (Agenerase)
atazanavir (Reyataz)
darunavir (Prezista)
fosamprenavir (Lexiva)
indinavir (Crixivan)
lopinavir/ritonavir (Kaletra)
nelfinavir (Viracept)
ritonavir (Norvir)
saquinavir (Invirase)
tipranavir (Aptivus)

20

Fusion Inhibitor

action: block viral entry into cells
enfuvirtide (Fuzeon)

21

Chemokine Receptor 5 (CCR5) Antagonist

action: block viral entry into cells
maraviroc (Selzentry)

22

AIDS tx

provide high calorie and high protein diet to child
administer appetite stims to child as prescribed and PRN
do not share eating utensils w child
do not allow child to eat fresh fruits or veggies or raw meat / fish (neutropenic diet if immunosuppressed)
clean up any of the child's body fluid spills w a bleach solution (10:1 water: bleach)