HIV

Question 1

Spread through

Answer 1

-blood, semen, breast milk, vaginal secretions

Question 2

Sexual contact

Answer 2

-Genital, anal, oral

Question 3

Parental

Answer 3

• IV drug use, blood transfusion

Question 4

Perinatal

Answer 4

-placenta, maternal blood, delivery, breastmilk

Question 5

Risky behavior….. who is likely to be more infected

Answer 5

• females from infected males
  Anal intercourse is highest risk
• Higher viral load > higher chance

Question 6

Prevention via sexual transmission

Answer 6

• ABCD
• Abstinence, being faithful, condom use, Drugs
• PEP

Question 7

Prevention through parental transmission

Answer 7

• use of cleaning needles with diluted bleach
• needle excahnge programs
• PrEP
• Blood donation screening

Question 8

Perinatal prevention

Answer 8

• Drup therapy drops risk of transmission
• babies born to mothers with HIV should betreated with meds 4-6 weeks after delivery
• Cesarean delivery
• no breastfeeding

Question 9

For HCW

Answer 9

• Common route is dirty needle stick
• may come from infected wounds and body fluids
• use standard precautions
• Sharps injury prevention
• PEP

Question 10

4th generation testing

Answer 10

• Blood 4th gen HIV assay
  -Detects HIV antibodies (HIV IgM and IgG) within 21 days
  -Detects p24 antigen (HIV capsid protein) within 14 days
  If positive-> test for HIV-1 vs HIV-2
  NAT (nucleic acid test) looking for HIV RNA (acute infection

Question 11

Home testing kits

Answer 11

Transmucosal exudate- results in 20 minutes
Drop of blood
If test is +, results should be verified with further testing

Question 12

Viral Load

Answer 12

• Measures amount of HIV virla RNA particles in blood
• The higher the viral load, the greater the risk of transmitting
• Can detect as little as 40 particles/ mL - 80,000 particles
• For HIV infectivity and therapy effectiveness

Question 13

Other diagnostic testing

Answer 13

-Lymphocyte count, Cd4 count, Viral load testing/ Quant RNA assays, CBC, CMP, Toxoplasmosis antibody titer, LFT, HEp A,B,C, Lipid profile, Syphilis

Question 14

If they have syphillis

Answer 14

needs to be tested once a year

Question 15

1) Acute HIV infection

Answer 15

flu- like symptoms

VEry contagious/ high viral load

Question 16

2) Chronic HIV infection (asymptomatic)

Answer 16

• HIV active and reproducing slowly
• Lasts ten years, untreated
• Can transmit HIV to others
• With medication some people remain in this pahse indefinitely

Question 17

3) AIDS

Answer 17

• Immune system is severely damaged
• CD4+ count is below 200 cells/ mm
• or they develop opportunistic infections
• Without treatment, death occurs in about 3 years

Question 18

HIV stages (1-4)

Answer 18

Stage 1- CD4 T-cell count> 500 cells/ mm3 (no AIDs defining illness)
Stage 2 CD4 T-cell count btw 200-499 with no AIDS defining illness
Stage 3 CD4 T-cell count less than 200 cells or a person with over 200 but has an AIDS defining illness
Stage 4: Confirm HIV with no further info regarding CD4 status/ illnesses

Question 19

HIV becomes AIDs when

Answer 19

CD4 T-cell count <200 cells or HIV positive with presence of OI’s

Question 20

Who should be screened

Answer 20

• All adults btwn ages 13 and 65
• annual screening for those at higher risk for HIV
• Prenatal screening
• Frequent testing for people with repeated high- risk exposure

Question 21

Assessment

Answer 21

• History
• Infections
• Malignancies
• Endocrin problems
• Neuro problesm
• Protein wasting
• Skin problems
• kidney problems
• support
• current level of fxn

Question 22

Important Assessment priority!!!!

Answer 22

INfection!!
- should be monitored on a routine basis for immune fxn
and presence of infections/ disease progression
At risk for OIs and pathogenic infections

Question 23

Opportunistic infections Your Role!

Answer 23

Assess for signs and symptoms for OI and how patinet is responding to treatments of OI’s
-report immediately

Question 24

Most common OI

Answer 24

PCP
- Fungal infection
Symptoms: persistant cough, low-grade fever, tachypnea, dyspnea, crackles in lungs, wheezing, fatigue

Question 25

PCP Diagnosis

Answer 25

-Presentation, sputum culture, bronchial lavage, transbronchial or open lung bioposy

Question 26

PCP Txt

Answer 26

- TMP/SMX Bactrim | - support (O2, positive pressure)

Question 27

Toxoplasmosis Enephalitis

Answer 27

Protozoa | - Stay away from cat litter and cook meat

Question 28

Toxo encephilitis manifestations

Answer 28

- Neuro changes - fever - lethargy - headaches

Question 29

Txt for TE

Answer 29

Treated with pyrimethamine and sulfadiazine

Question 30

Disseminated MAC

Answer 30

- CD4 < 50 | - occurs in patinet who are not on antiretroviral therapy

Question 31

Manifestation of Dissminated MAC

Answer 31

- Dissminated multi-organ infection | - anemia, fever, night sweats, fatigue, diarhhea, abd pain, wt loss

Question 32

Dissiminated MAC txt

Answer 32

support | - Clarithromycin, ethambutol and rifabutan

Question 33

TB manifestations

Answer 33

Cough, dyspnea, chest pain, night sweats, weight loss, anorexia, fever, chills - CD4+ T-cell count is below 200 cells/mm 3 TB skin test may be positive - Diagnosed by NAAT, CXR, sputum smear or culture - Tx is complicated

Question 34

Malignancies

Answer 34

- Karposi's Sarcoma - Kymphomas - Cervical cancer - Lung cancer - Anal cancer - GI cancer

Question 35

Anal cancer

Answer 35

Caused by HPV - Also cause cervical cancer - Cervical PAP test every 6 months - Can also perform anal PAP test

Question 36

other findings

Answer 36

- Gonadal dysfunction - Body shape changes - Lipid abnormalaties - Lipodystrophy - Lioatrophy - Type 1 DM - AIDs dementia complex - AIDs wasting syndrome

Question 37

Interventions

Answer 37

- Education - Montiro VS and tmep - No fresh plants or flowers - No visitors who are sick - Hand washing - Inspect patinet mouth, skin and genitals (watch for skin lesions) - avoid catheters

Question 38

Education

Answer 38

Avoid contact with sick people, bathe daily with antibacterial soap, avoid sharing personal items, dietary changes, avoid pet litter, signs of infection/ report

Question 39

Drug therapy

Answer 39

ART - Inhibits viral replications - HAART - Drugs should taken 90% correctly

Question 40

Intervention oxygen

Answer 40

Apply oxygen as needed - positioning - rest/ limiting activities

Question 41

Intervention nutrition

Answer 41

- cause by nausea, anorexia, diarhhea, n/v, mucosial lesions/ thrush - determin cause make adjustments - monitor weights I's and O's - High calorie/ high protien/ low fat - small frequent meals - Mouth care (sodium bicarb, soft brush) - Avoid foods that cause infections

Question 42

Intervention Diarhhea

Answer 42

Symtom mangment, drug therpapy, food choices, avoid alcoholand caffeine, avoid dairy, small, frequent meals, fluid intake, skin assessment

Question 43

Intevention for skin integrity

Answer 43

``` KArposi responds to ART - Analgesics -prevent infections Herpes simplex -clean with NS - Assess, assess ```

Question 44

Care Continumm

Answer 44

Identify level of assistance needed - social support - pt and family support - dealing with social stigma - peer to peer education