What happens during the inflammatory response with HIV?
The body attacks the "foreign" or "non-self" protein
The body's inflammatory response keeps us from getting sick despite exposure (most of the time)
Our body doesn't recognize "self" so it attacks our own proteins and no just foreign proteins
What is HIV (The human immune deficiency virus)?
It takes over a cell and forces it into making more copies of the virus
Then those cells look for more cells to overtake and change until there are no more new cells to infect
Typically hijacks the CD4 T-Cell
(CD4 T-cell directs the immune systema nd regulates the activity of all immune system cells)
HIV is a retrovirus, what is on it's surface and what does that do?
Retrovirus with proteins on its surface which allows it to incorporate its genetic material into the host cell
This feature gives HIV a huge advantage for infecting humans by reproducing suficient viruses to pass the infection along
How is HIV transmitted?
(Accidental needle sticks)
CAN BE TRANSMITTED TO OTHERS AT ALL STAGES OF THE DISEASE
Most Common infected male to uninfected female
ABC - Abstinence, Be faithful, Condom
Who should be tested for HIV?
People with STI's
IV drug users
Anyone who thinks they are at risk/sexually active
Protitutes or their customers
People who received blood transfusions between 1978-1985
Those getting married or admitted tothe hospital
Manifestations of the disease process
What are some immunity disorders related to HIV?
(Dec # of lymphocytes, especially CD4+ T-Cell levels)
- A specific type of WBC that builds our antibodies - May give antibiotics to prevent infection (Neutropenia Isolation)
Increased production of incomplete and nonfunctional antibodies
Abnormally functioning macrophages
What are some facts about the HIV progression to AIDS?
Everyone who has AIDS has HIV but not everyone with HIV has AIDS
Progression varies and takes months to years
Progression depends on how HIV was acquired; personal factors such as frequency of re-exposure, the presence of other STI's, nutritional statuse and stress and the interventions used
What stage is confirmed HIV, CD4 T-Cell count of >500 cells/mm3 and no AIDS defining the illness?
What stage is confirmed HIV, CD4 T-Cell count of <200 cells/mm3 or a higher count and an AIDS defining the illness?
Stage 3 (AIDS)
What stage is confirmed HIV, CD4 T-Cell count of 200-499 cells/mm3 and no AIDS defining the illness?
What stage is confimed HIV and no other available information?
What is required to have a diagnosis of AIDS?
Positive HIV test
One of the following:
- A CD4+ T-Cell count of less than 200 cells/mm3
- An opportunistic infection
What are opportunistic infections?
Infections caused by organisms that are present as part of the body's normal environment and are kept in check by the body's normal immune function
They occur because of the profound immunosuppression in a person with HIV/AIDs
These infections may result from a newly acquired infection or reactivation of an old infection
Pneumocystis Jiroveci Pneumonia (PCP) is the most common opportunistic infection assoiciated with HIV, it can be protozoan or fungal. What are some S&S?
Persistent dry cough
Fatigue and Weight loss
Crackles heard upon auscultation
Kaposi's (KS) is a malignancies opportunistic infection assoiciated with HIV, and is the most common neoplasm in HIV clients. What are some S&S?
Dark blue/purple/red papue on skin
Mucous membranes in the following:
Malignant Lymphomas is a malignancies opportunistic infection assoiciated with HIV. Also known as Hodgkin's Lymphoma, Non-Hodgkin's B-Cell Lymphoma What are some S&S?
swollen Lymph nodes
Small Freq meals
Good Oral Care
What are some CMV & Herpes Viruses that are opportunistic infections with HIV?
- Form of Herpes
-May infect eye, respiratory and GI tracts and CNS
Herpes Simplex Virus
- Can infect the brain, liver, lungs, cause blindness, seizures, deafness and death
Some present with subtle cognitive changes: Sweizure, eyesight change, gait)
(They usually feel tingling 24 hours before blisters appear)
What are some other common infections seen in HIV patients?
Fungal Infections (Candida Albicans) - Cottage cheese like plaque
(MAC-most common bacterial infection)
AIDS Dementia Complex
What are some pharmacology for AIDs (they do not cure)?
Nucleoside/Nucleotide reverse transriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
Ribonucleotide reductase inhibitors
HAART is highly active antiretroviral therapy, what is it and what are a couple teachings?
To prevent Drug-resistant mutations
Clients need to be able to be compliant with the medication regimen
Missed doses lead to resistance
If they become resistant to a drug it can NEVER be used again
What are some diagnostic tests for HIV?
Lymphocyte counts >1500
Western blot: Confirms dx when lymphocyte is positive
Blood Chemistry: CBC with diff and platelets, liver fx tests
Sputum Culture (Test for TB)
What are some risk factors for HIV?
Born in certain country
Engage in high risk behaviors with the exchange of body fluids
High Risk Behaviors
Not known to be transmitted by:
Mosquitoes, saliva, tears, cough, sneeze, toilet seat, swimming pools or linens
What are some community and home care options?
Education and more education to teach how to stop the spread
Use universal precautions
View each client as potentially infected
Porper clean up of a spill with 1:10 bleach to water
What assessments would you do for HIV?
AIDs dementia, disturbed thought process, seizures, confusion
Acute chest pain, dyspnea, anemia, Inc HR(fever, dehydration), Dysrhythmias (hypokalemia)
Persistant dry cough, Pneumonia, dyspnea, SOB
Weight loss, nausea/vomiting, diarrhea
Dry skin, poor wound healing, skin lesions, night sweats
What are some interventions for HIV?
Nutritional support such as small freq meals, increased total calories or protein, NO RAW FOODS, eliminate hot or spiced foods if there are oral lesions
Soft tooth brush
Shower rather than bath
Mild soaps/lotions without ETOH
Eliminate ETOH/street drugs and smoking
What is viral load?
Amount of virus found in the blood and tissues
Higher the viral load the easier to transmit
TB is a secondary infection that can occur in HIV/AIDS, what are some things you need to know about it in them and to diagnose?
Occurs in 2-10%
Cannot diagnose with PPD
BEST WAY: sputum culture and Acid-fast bacillus test to diagnose
AIDs Dementia Complex is a secondary infection that can occur in HIV/AIDS, what are some things you need to know about it in them and to diagnose?
Results from HIV infection itself
Virus may indirectly inflame brain cells
Vary from person to person
Affects 4 diff areas of brain: thinking, behavior, coordination and movement and your mood