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NURSING 3 > Week 11 HIV-AIDS > Flashcards

Week 11 HIV-AIDS Flashcards

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1
Q

What is a primary immunodeficiency

A

Genetic in origin
Predominately X-linked
Manifest in infancy and childhood

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2
Q

What are the characteristics of a secondary immunodeficiency

A

Affects the normal immune function

Extrinsic and intrinsic factors impair the immune response

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3
Q

18% of newly diagnosed HIV infections consist of what group of people?

A

people greater than 50 years old

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4
Q

HIV - gero considerations

A

a. older adults recently widowed or divorced are dating again and may not be aware of HIV
b. Many older adults are sexually active but do not use condoms, viewing them only as a means of unneeded birth control.
c. Older adults may be IV/injection drug users.
d. Older adults may have received HIV-infected blood through transfusions before 1985.
e. Normal age-related changes include a reduction in immune system function, which puts the older adult at greater risk for infections, cancers, and autoimmune disorders. Many older adults also experience the loss of loved ones, resulting in depression and bereavement, factors that are associated with depressed immune function

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5
Q

HIV is what?

A

A virus whose genetic data is organized into dingle strands called RNA

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6
Q

HIV - survival requires what

A

HIV virus can not survived without a host - it needs a host/living cell to survive and replicate

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7
Q

HIV - what happens with the T cells

A

A T cell called CD4+ Helper cell helps destroy abnormal cells by signaling to its homeboys that there’s an intruder on the block

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8
Q

HIV seeks out what kind of cells?

A

CD4+ cells, infects them and takes over the way they function

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9
Q

What can HIV do once it seeks out CD4+ cells

A

HIV can now turn its RNA into DNA strands using enzyme reverse transcriptase (they fancy…)

HIV DNA is now infused into CD4+ cells’ nuclei…”new phone, who dis”?

CD4+ cells are now like robots – instead of them being the “look out boys” their purpose now is to rapidly produce more HIV inside their cells

CD4+ cells are stripped of all their street cred (dishonorable discharge) – these cells eventually have a shorter lifespan and are destroyed…dying without any honorable mentions

HIV virions are like little gremlins, once that CD4+ cell is dead, they push themselves out of that cell and look for more CD4+ to attack and the cycle repeats itself

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10
Q

What group has the biggest population that is most affected by HIV?

A

Gay and bisexual men

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11
Q

What kind of virus is HIV

A

blood borne, sexually transmission virus

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12
Q

What can transmit HIV to recipients?

A

Blood and blood products

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13
Q

How can HIV be transmitted?

A

Blood, blood products, vaginal secretions, seminal fluid, amniotic fluid, breast milk

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14
Q

What did the emergence of HIV prompt?

A

The implementation of standard precautions and the need for post-exposure prophylaxis

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15
Q

HIV risk factors:

A
  1. Sharing infected IV drug use equipment (needles)
  2. Sexual contact with HIV infected persons
  3. Infants born to HIV+ mothers who are breastfed by HIV+ mothers
  4. People who received organ transplants or HIV infected blood primarily between 1978-85
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16
Q

HIV prevention and education: safe sex practices

A

Abstinence usually not realistic

Education on safe sex practices - condoms, limiting partners, etc.

Early access to testing - most people will change behaviors to protect partners if they know they are infected

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17
Q

HIV prevention and education

A

Safe sex
Needle exchange programs
HIV women and pregnancy
PrEP: Pre-exposure prophylaxis

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18
Q

HIV prevention and education: Women and pregnancy

A

Education on risks of HIV exposure and transmission to baby

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19
Q

HIV prevention and education: PrEP (Pre-exposure prophylaxis)

A

One pill that contains two different HIV medications
Taken daily in order to reduce the risk of sexual HIV acquisition
Patient should be tested for HIV ever 3 months

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20
Q

HIV: Prevention measures for HCP

A

Implementation of standard precautions

Healthcare workers who are exposed to a needle stick involving HIV-infected blood have a 0.23% risk of becoming HIV infected

PEP: Post-exposure prophylaxis

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21
Q

HIV prevention for HCP: PEP (Post-exposure prophylaxis)

A

Includes taking antiretroviral medicines as soon as possible, but not more than 72 hours (3 days) after possible HIV exposure

2 to 3 drugs are usually prescribed which must be taken for 28 days

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22
Q

Post-exposure prophylaxis for HCP - if you sustain a puncture, take the following actions immediately:

A
  1. Wash area thoroughly with soap and water
  2. Alert supervisor/nursing facility and initiate the injury-reporting system used in that setting
  3. Identify the source patient who may need to be tested for HIV, hepatitis B, and hepatitis C. State laws will determine whether written informed consent must be obtained from the source patient before his or her testing. Rapid testing should be used, if possible, if the HIV status of the source patient is unknown because results can be available within 20 minutes
  4. Report as quickly as possible to employee health services, the emergency department, or other designated treatment facility. This visit should be documented in the health care worker’s confidential medical record.
  5. Give consent for baseline testing for HIV, hepatitis B, and hepatitis C. Confidential HIV testing can be performed up to 72 hours after the exposure but should be performed as soon as the health care worker can give informed consent for baseline testing.
  6. Get postexposure prophylaxis for HIV in accordance with CDC guidelines. Start the prophylaxis medications within 2 hours after exposure. Postexposure prophylaxis must be initiated within 72 hours of exposure to be effective. Make sure that you are being monitored for symptoms of toxicity. Practice safer sex until follow-up testing is complete. Continue the HIV medications for 4 weeks.
  7. Follow up with postexposure testing at 1 month, 3 months, and 6 months.
  8. Document the exposure in detail for your own records, as well as for the employer.
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23
Q

What are examples of diagnostic tests for HIV?

A

HIV antibody test
Antigen and RNA testing specifically detect HIV
STARHS
Viral blood test

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24
Q

HIV diagnostics: HIV antibody test

A

Screens for bodies development of antibodies to HIV, not virus itself

Enzyme immunoassay (EIA) test

Nucleic Acid Testing (NAC)

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25
HIV diagnostics: STARHS
Serologic Testing Algorithm for Recent HIV Seroconversion | -- analyzes HIV+ blood to determine if infection is recent or has been ongoing
26
HIV diagnostics: Viral blood load
Better predictor of disease progression than CD4+ counts Lower viral load usually correlates to longer time until AIDS diagnosis and longer survival time
27
What are the stages of HIV?
Acute infection HIV asymptomatic HIV symptomatic/AIDS
28
Stages of HIV: Acute infection
1st stage Period of infection to development of HIV antibodies (Time of infection to 2-4 weeks) High levels of viral replication, widespread dissemination of HIV throughout body, and destruction of CD4+ cells Patient may have vague, flu-like symptoms Person may be unaware of infection, high risk of transmission
29
Stages of HIV: HIV asymptomatic
2nd stage - "clinical latency stage" - virus slowly developing but does not cause s/s Patient appears in good health - still have enough CD4+ cells to preserve immune defense CD4+ counts: 500-1500 Without treatment, can last up to 10 years; with treatment, several decade
30
Stages of HIV: HIV symptomatic/AIDS
3rd stage - CD4+ count less than 200 or presence of opportunistic infection(s) High viral load, high risk of transmission Survival without treatment averages 3 years
31
HIV Asymptomatic - body develops "viral set point", which is what?
a balance between HIV levels and the immune response that is elicited -- higher set point = poorer prognosis
32
HIV manifestations: Respiratory
``` SOB Dyspnea (labored breathing) Cough Chest pain Fever ``` All associated with various opportunistic infections
33
HIV manifestations: GI
Decrease appetite, n/v, oral and esophageal candidiasis, chronic diarrhea Symptoms may be related to the direct inflammatory effect of HIV on the cells lining the intestines or infection with various bacteria- Cryptosporidium, Salmonella, Giardia, CMV, C Diff Effects of diarrhea can be devastating in terms of profound weight loss (more than 10% of body weight), fluid and electrolyte imbalances, perianal skin excoriation, weakness, and inability to perform the usual activities of daily living
34
HIV manifestations: neuro
``` Immune response to HIV infection in the CNS includes: inflammation atrophy demyelination degeneration opportunistic infections primary or metastatic neoplasms metabolic encephalopathies ```
35
What neuro condition do we give IgG
Guillan barre (this is immunology but putting it in this set so i dont forget)
36
What are complications of HIV
``` HIV encephalopathy Depression Opportunistic infection Wasting syndrome B-cell lymphoma ```
37
What are common opportunistic infections someone with HIV is prone to?
``` Pneumocystic pneumonia (PCP) Tuberculosis Kaposi Sarcoma Cytomegalovirus (CMV) Candidiasis Cryptococcus Neoformans Mycobacterium Avium Complex (MAC) ```
38
What is Wasting syndrome?
Involuntary loss of >10% of one’s body weight while having experienced diarrhea, weakness or fever for more than 30 days Loss of muscle mass in addition to fat
39
Complication of HIV: B-cell lymphomas
Higher incidence of Hodgkin’s and Non-Hodgkin’s Lymphoma
40
Complication of HIV: HIV encephalopathy
Progressive decline in cognitive, behavioral, and motor functions as a direct result of HIV infection HIV infection is thought to trigger the release of toxins or lymphokines that result in cellular dysfunction, inflammation, or interference with neurotransmitter function
41
What are early manifestations of HIV encephalopathy
memory deficits, headache, difficulty concentrating, progressive confusion, psychomotor slowing, apathy, and ataxia.
42
What are later manifestations of HIV encephalopathy
global cognitive impairments, delay in verbal responses, a vacant stare, spastic paraparesis, hyperreflexia, psychosis, hallucinations, tremor, incontinence, seizures, mutism, and death.
43
Complication of HIV: Depression
30-40% of patients, generalized apathy is common | Correlates with decreased compliance with ART
44
What is HIV treatment?
Antiretroviral therapy (ART)
45
What is the goal of ART?
To suppress HIV replication to a level below which drug-resistance mutations do not emerge
46
What are related ART goals?
Reduce HIV-associated morbidity and prolong the duration and quality of survival Restore and preserve immunologic function Maximally and durably suppress plasma HIV viral load Prevent HIV transmission
47
How many approved antiretroviral meds are there?
more than 20 approved antiretroviral medications
48
how many meds will an HIV patient on ART be taking
patients will be on at least 3 different medications from 2 different classes
49
ART - what is essential?
Adherence - many meds have horrible sfx
50
What are barriers to adherence to ART?
Psychosocial barriers such as depression and other mental illnesses Neurocognitive impairment Low health literacy Low levels of social support Stressful life events High levels of alcohol consumption and active substance use Homelessness/poverty Denial/poor coping mechanisms Fear from associated stigma Inconsistent access to medications affect adherence to ART Drug side effects
51
How can the nurse promote adherence to ART?
1. Simplifying treatment regiments 2. Decreasing number of medications needing to be taken 3. Linking medication taking to daily activities or using a medication reminder system or a pill organizer 4. Positive relationship between the patient and health care provider 5. Individualized plans of care that consider housing and social support issues
52
Nursing assessment and interventions: HIV / AIDS nutritional status
Obtaining a dietary history and identifying factors that may interfere with oral intake, such as anorexia, nausea, vomiting, oral pain, or difficulty swallowing. Socioeconomic factors: patient’s ability to purchase, prepare, and store food safely Weight history (changes over time)
53
What are labs that are monitored with someone how has HIV/AIDS in regard to nutrition
blood urea nitrogen (BUN), serum protein, albumin, and transferrin levels provide objective measurements of nutritional status.
54
HIV/AIDS: nutrition interventions
a. Daily weight / dietary intake log b. encourage high calorie, high protein foods that do not stimulate intestinal motility c. antiemetics prior to meals d. treat oral thrush e. dietician consult, nutritional supplements/shakes f. enteral or parenteral nutrition
55
HIV Skin integrity assessment
Inspect daily for breakdown, ulceration or infection Assess oral cavity for redness, ulcerations, and presence of creamy-white patches (yeast) Peri area: assess for excoriation and infection in patients with profuse diarrhea Wounds are cultured to ID infectious agents
56
HIV skin interventions
Skin and oral mucosa are monitored routinely for changes in appearance, location, and size of lesions and evidence of infection and breakdown Q2turn, low air loss mattress Adhesive tape - avoided Skin surfaces are protected from friction and rubbing by keeping free of wrinkles and avoiding tight or restrictive clothing
57
HIV respiratory assessment
Assess for cough, sputum production (amount and color), SOB, orthopnea, tachypnea, chest pain Presence and quality of breath sounds CXRay results, ABG, pulse oximetry, pulmonary function test results
58
HIV respiratory interventions
Pulmonary therapy (cough, deep breathing, postural drainage, percussion, vibration) Q2 hours to prevent stasis of secretions and to promote airway clearance Adequate hydration to facilitation mucous clearance Humidified o2 Suctioning
59
HIV neuro assessment
LOC, orientation (person, place, time, and memory lapses) Assess mental status ASAP to establish baseline Sensory deficits (visual changes, headache, numbness, tingling) and/or motor involvement (altered gait, paresis, or paralysis) and seizure activity
60
HIV neuro interventions
Speak in simple, clear language and give the patient sufficient time to respond to questions Reorientation to surroundings and location as needed Post schedule to prominent area (ex. fridge) Provide night lights for bedroom and bathroom Maintain routine Incorporate patient preferred activities to maintain sense of normalcy
61
HIV - imbalanced fluid and electrolyte status
Examining the skin and mucous membranes for turgor and dryness Increased thirst, decrease UOP, postural hypotension, weak/rapid pulse, urine specific gravity of 1.025 or more
62
What are common electrolyte imbalances for someone with HIV/AIDS
decreased Na, K, Ca, Mg, Chl., - typically result from the profuse diarrhea
63
What are the s/s of electrolyte deficits with someone with HIV/AIDS
``` decreased mental status muscle twitching muscle cramps irregular pulse nausea and vomiting shallow respirations ```

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