HIV

Question 1

HIV

Answer 1

Causes immunosuppression making person more susceptible to infection

Question 2

HIV transmission

Answer 2

through contact of certain bodily fluids: blood semen, vaginal secretions, and breast milk

Question 3

what is the most common mode of transmission of HIV

Answer 3

unprotected sex

Question 4

what is the main cause of disease, disability and death in patients with HIV

Answer 4

Opportunistic diseases

Question 5

Patho of HIV

Answer 5

· Immune problems start when CD4+ T cell counts drop to < 500 cells/μL (Normal range 800-1200 cells/μL)
· Severe problems develop when < 200 CD4+ T cells/μL

Question 6

<500 INDICATES

Answer 6

· HIV

Question 7

<200 INDICATES

Answer 7

AIDS

Question 8

what precautions is the best prevention for HIV

Answer 8

standard precaution

Question 9

HIV Infectious Process

Answer 9

· CD4+ T-cells become “HIV factory” to make new viral particles daily
· Gradually, CD4+ T-cell count falls, viral load rises
· Immune systems weakens
· Everyone with AIDS has HIV; not everyone with HIV has AIDS

Question 10

At-risk patients questions to ask

Answer 10

· Received blood transfusion or clotting factors before 1985?
· Shared needles with another person?
· Had a sexual experience with a penis, vagina, rectum, or mouth in contact with these areas of another person?
· Had a sexually transmitted infection?

Question 11

Antiretroviral therapy:

Answer 11

a combination of medication used to control and suppress HIV replication.

Question 12

· Acute HIV Infection clinical manifestations

Answer 12

· Mononucleosis-like syndrome (fever, swollen lymph nodes, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and/or a diffuse rash)
· Neurologic complications (aseptic meningitis, peripheral neuropathy, facial palsy, or Guillain-Barré syndrome)
· High viral load (the amount of HIV circulating in the blood)
· CD4+ T cell counts fall temporarily but quickly return to baseline or near-baseline levels

Question 13

what is the most infectious time during HIV

Answer 13

acute phase, 2-4 weeks after infection because of the high amount of circulating HIV

Question 14

clinical manifestations of HIV

Answer 14

· Weight loss
· Cough
· Sore throat
· Headache
· Swollen lymph nodes
· Diarrhea
· Vomiting
· Muscle pain
· Joint pain
· Skin rashes
· Fevers`

Question 15

Opportunistic Infections

Answer 15

· Oropharyngeal candidiasis (Thrush)
· Oral Hairy Leukoplakia
· Varicella - zoster virus (Shingles)
· Persistent vaginal candida infections
· Herpes (oral and/or genital)
· Pneumocystis jiroveci pneumonia
· Karposi’s sarcoma
· Hepatitis B & C

Question 16

· Oral Hairy Leukoplakia

Answer 16

o An Epstein-Barr virus infection that causes painless, white, raised lesions on the lateral aspect of the tongue, can occur at this phase of the infection and is another indicator of disease progression.

Question 17

· Pneumocystis jiroveci pneumonia

Answer 17

o A type of pneumonia that can appear as an opportunistic disease associated with HIV infection

Question 18

· Karposi’s sarcoma

Answer 18

o Malignant vascular lesions such as Kaposi sarcoma lesions can appear anywhere on skin surface or on internal organs.

Question 19

Karposi’s sarcoma Treatments

Answer 19

o Radiation therapy, cryosurgery, or a topical retinoid, may be used if a person has only a few skin lesions

Question 20

Diagnostic studies

Answer 20

· Diagnosis is made by testing HIV antibodies and/or antigens by using blood or saliva.

Question 21

Lab Studies

Answer 21

· CD4+ T-cell counts
· CD4+ T-cell count provides a marker of immune function
· Viral load
· Blood chemistries, CBC, stool testing, biopsies

Question 22

the lower the viral load, the _____

Answer 22

the less active the disease

Question 23

AIDS is diagnosed when an individual with HIV develops at least one of the following conditions:

Answer 23

· CD4+ T cell count drops below 200 cells/µL.

· One of the following opportunistic cancers:
o Invasive cervical cancer
o Kaposi sarcoma (KS)
o Burkitt’s lymphoma
o Immunoblastic lymphoma
o Primary lymphoma of the brain

Question 24

How to prevent HIV: ABCs

Answer 24

· Abstinence
· Be faithful
· Condoms

Question 25

Interprofessional Care for HIV

Answer 25

· Monitor disease progression, immune function, and manage symptoms · Initiate and monitor ART · Prevent, detect and/or treat opportunistic infections · Prevent or decrease complications of therapies · Prevent further transmission of HIV

Question 26

· Monitor disease progression, immune function, and manage symptoms · Initiate and monitor ART · Prevent, detect and/or treat opportunistic infections · Prevent or decrease complications of therapies · Prevent further transmission of HIV

Answer 26

· Patient readiness is most important concern · To avoid burnout and non-adherence, treatment is recommended when immune suppression is great · This required dedication to adhere to the treatment think about why a client may not be able to adhere, cost, inability to get the drug, transportation, lack of knowledge, teaching, anger, denial, etc. ART therapy works but only if it is taken as directed

Question 27

HIV infection is preventable so...

Answer 27

o Avoid risky behaviors o Modify risky behaviors o Candid, culturally sensitive, language- appropriate, age-specific information and behavior change counseling

Question 28

Should exposure to HIV-infected fluids occur, what is done

Answer 28

· postexposure prophylaxis (PEP) with combination ART can significantly decrease the risk of infection. The need for timely treatment and counseling makes it even more critical for nurses to report all blood exposures.

Question 29

Prevention and Early Detection of HIV

Answer 29

· Increase safter sexual practices, including condom use · Decrease equipment sharing among IV users · Increase clinician skills to assess for risk factors of HIV infection, recommended HIV testing, and provide counseling for behavior change · Make voluntary HIV testing a routine part of health care · Increase access to new HIV testing technologies, especially rapid testing · Increase access HIV testing facilities · Decrease perinatal HIV infection by offering HIV testing as a part of prenatal care · Provide counseling and appropriate HIV therapy to those who are infected

Question 30

Antiretroviral therapy (ART)

Answer 30

· Inhibits viral replication but does not kill the virus. · Monotherapy promotes drug resistance. · Doses must not be missed! · Must take 90% of doses correctly · If an HIV patient can not be compliant they should not be started on therapy.

Question 31

how to delay HIV progression

Answer 31

· Nutritional support to maintain lean body mass and proper vitamins and micronutrients · Moderating or eliminating alcohol, tobacco, and drug use · Keeping up to date with recommended vaccines · Adequate rest and exercise · Reducing stress · Avoiding exposure to new infectious agents · Accessing counseling · Support groups · Attending regular appointments

Question 32

Antiretroviral Drugs patient teaching

Answer 32

Take full dose prescribes and take it on schedule and as prescribed · Talk to HCP about dealing with side effects of drugs · Do not quit taking one drug while continuing the others · Do not take new drugs without checking with HCO for possible reactions · Goal of antiretroviral medication is to decrease the amount of virus in your blood (your viral load) to keep CD4 cell count high, get lab work done every 3-6 months

Question 33

Improving Adherence to Antiretroviral Therapy

Answer 33

· Determine whether the patient understands the importance of adherence and is ready to start therapy · Provide teaching on medication dosing · Review potential SE of drug · Assure patient that SE can be treated, if not, medication regimens can be changed · Use teaching and memory aids like pictures, pillboxes, and calendars · Engage family and friends in the teaching process. Solicit their support to help the patient take treatment · Simplify regiments, dosing, and food requirements as much as possible

Question 34

Signs and symptoms HIV-Infected Patient Need to Report

Answer 34

· Any change in LOC · HA accompanied by N/V changes in vision · Persistent SOB · N/V accompanied by abdominal pain · Vomiting blood · Dehydration · Yellowing of skin · Any bleeding from rectum not related to hemorrhoids · Pain in flank with fever · Blood in urine · New onset weakness · Seizures Rash

Question 35

· Main goals of drug therapy

Answer 35

o Decrease viral load o Maintain/increase CD4+T counts o Prevent HIV-related symptoms and opportunistic diseases o Delay disease progression o Prevent HIV transmission

Question 36

A major problem with most drugs used in ART is...

Answer 36

o resistance develops rapidly when they are used alone (monotherapy) or taken in inadequate doses. For that reason, combinations of three or more drugs should be used.

Question 37

SE of ART

Answer 37

metabolic disorder like lipodystrophy, hyperlipidemia, insulin resistance, hyperglycemia, bone disease (osteoporosis and osteopenia), lactic acidosis, renal disease, CV disease