NURS 444 week 8

Question 1

HIV
acute infection

Answer 1

mononucleosis like symptoms:
fever, swollen lymph nodes, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and or diffuse rash

occurs 2 to 4 weeks after infection

highly infectious

Question 2

HIV
asymptomatic infection

Answer 2

left untreated, a diagnosis of AIDS is made about 10 years after HIV infection

high risk behaviors may continue

Question 3

HIV stages

Answer 3

Stage 1:
acute phase

Stage 2:
Kaposi sarcoma-cancer (specific to HIV)

Stage 3:
AIDS- waisting syndrome

Question 4

HIV: symptomatic infection

Answer 4

immune problems happen when CD4 T cells drop < 500 cells
- severe problems when < 200 CD4 T cells
- normal range is 800-1200

symptomatic infection
- CD4 T cells decline closer to 200 cells
- HIV advances to more active stage
- symptoms become worse

insufficient immune response allows for opportunistic infections

Question 5

HIV progression monitored by;

Answer 5

CD4 cell count-

Viral load- if lower, then the disease is less active (Nucleic Acid Test)

Resistance tests (determine if HIV strain is resistant to ART drug)

Question 6

AIDS

Answer 6

CD4 T call count < 200

immune system severely compromised

great risk for opportunistic infections

possible malignancies, wasting syndrome, HIV related cognitive changes

Question 7

Drug Therapy Goals for HIV

Answer 7

> decrease viral load
maintain/ increase CD4 counts
prevent HIV related symptoms and opportunistic diseases
delay disease progression
prevent HIV transmission
drug therapy has significantly increased life expectancy

Question 8

ART drugs

Answer 8

Attachment inhibitors, entry inhibitors

integrase inhibitors
# nucleoside, non-nucleoside, and nucleotide reverse transcriptase inhibitors
# protease inhibitors
# fusion inhibitors
# combination antiretroviral therapy

Question 9

PrEP: preexposure prophylaxis

Answer 9

preventing transmission of HIV

involves taking part of an HIV antiretroviral regimen daily

used in conjunction with other proven interventions

Question 10

Integrase inhibitors

Answer 10

prevents HIV from incorporating genetic material into host cell

Question 11

nucleoside, non-nucleoside and nucleotide reverse transcriptase inhibitors

Answer 11

inhibit the ability of HIV to make a DNA copy early in replication

Question 12

protease inhibitors

Answer 12

interfere with activity of enzyme protease

Question 13

fusion inhibitors

Answer 13

interfere with HIV CD4 receptor site binding and entry into cells

Question 14

combination antiretroviral therapy

Answer 14

three or more drugs from different groups are prescribed at full strengths

Question 15

ART drug interactions

Answer 15

herbal: St. John’s wort

OTC: antacids, PPI, supplements

Question 16

Disease and ART side effects

Answer 16

• anxiety, fear, depression
• nausea, vomiting, diarrhea
• insomnia, nightmares
• neuropathy, headache, seizures
• pain
• fatigue
• rashes
• oral ulcers
• fetal defects (first 12 weeks especially)

Question 17

Disease and ART potential disorders

Answer 17

^ renal disease
^ CVD
^ hyperlipidemia
^ insulin resistance
^ hyperglycemia
^ bone disease
^ liver disease
^ lactic acidosis
^ lipodystrophy

Question 18

Stages 1 Liver Disease

Answer 18

Stage 1: any damage to the liver; toxins, immune system, NAFLD (non-alcoholic fatty liver disease), alcohol, hepatitis, biliary duct disease

Question 19

Stage 2 Liver Disease

Answer 19

Stage 2: chronic and hepatocyte start to change into fibrous tissue

Question 20

Stage 3 Liver Disease

Answer 20

continuation of change plus nodules

Question 21

Stage 4 Liver Disease

Answer 21

Cirrhosis
sufficient amount of liver has been damaged

Type 1= compensated
Type 2= decompensated

Question 22

Types of Cirrhosis

Answer 22

Alcoholic (previously Laennec’s)

Post-necrotic- a complication of viral, toxic, or idiopathic hepatitis

Biliary- associated w/ chronic biliary obstruction and infection

Cardiac- resulting from long-standing, severe right-sided HF

Question 23

Cirrhosis risk factors

Answer 23

• alcohol
• malnutrition
• hepatitis
• biliary obstruction
• Right-sided HF

Question 24

Early liver disease manifestations

Answer 24

fatigue
enlarged liver

dyspepsia
flatulence
N&V
change in bowel habits
abd pain (RUQ or epigastric)

Question 25

Later manifestations of liver failure

Answer 25

Result from liver failure and portal hypertension

• jaundice
• skin lesions (spider angiomas, palmer erythema)
• hematological problems
• endocrine problems
• peripheral neuropathy

Question 26

Decompensated Cirrhosis

Answer 26

! portal htn
! varices
! peripheral edema
! abdominal ascites
! hepatic encephalopathy
! hepatorenal syndrome

Question 27

Hepatic Encephalopathy

Answer 27

!!! terminal comp. in liver disease
!!! liver unable to convert ammonia into urea
!!! toxic changes in neurologic function and mental responsiveness (sleep disturbance, lethargy, coma)
!!! Asterixis- characteristic symptom. Flapping tremors
!!! Fetor hepaticus- musty sweet odor in breath, digestive byproducts

Question 28

Hepatorenal syndrome

Answer 28

• serious complication of cirrhosis
• functional renal failure with; azotemia, oliguria, intractable ascites
• no structural abnormality of kidney
• splanchnic and systemic vasodilation and decrease arterial blood vol.; renal vasoconstriction occurs with renal failure

Question 29

Liver: Diagnostic studies

Answer 29

** liver biopsy (other tests can be done first)
* liver US
* differential analysis of ascitic fluid
* labs

Question 30

Goals for liver disease

Answer 30

slow progression of disease
- rest
- B-complex vitamins
- avoidance of alcohol, aspirin, acetaminophen, NSAIDs
- prevention of variceal bleeding
- management of encephalopathy

Question 31

Managing Hepatic encephalopathy

Answer 31

GOAL: decrease ammonia formation
- sterilization of GI tract w/ antibiotics
- lactulose
- cathartics/ enemas

Tx of precipitating cause
- control GI bleed
- treat electrolyte imbalances (hypokalemia), acid-base imbalances, infections

Question 32

Contraindications for Liver Transplant

Answer 32

• advanced hepatocellular carcinoma
• severe extrahepatic disease: cancers, advanced heart/ lung/ renal disease
• ongoing drug/ alcohol abuse
• inability to understand or follow post-transplant treatment regimen