Care of the Patient With HIV Adult healthh 1

Care of the Patient With HIV Adult healthh 1 Lecture notes




Care of the Patient With HIV
Adult Health I

Human Immunodeficiency Virus Infection
 HIV varied course to AIDS
 AIDS is the End Stage of this chronic, progressive immune function disorder

Pathophysiology
 Retrovirus
 HIV is an RNA virus that replicates backwards
 Replicate within a living cell
HIV infects cells with CD4+T cells
 Lymphocytes, monocytes
 Normal CD4 +T cells = 800-1200cells/ul
 Live for 100 days, with HIV die after only 2
 Virus destroys 1 billion cells a day
 HIV cells destroys the bodies abilities to replace cells
 Decrease in immune capacity and
 Develop opportunistic infections

Transmission
 Fragile virus
 Specific conditions allow transmission
 Sexual intercourse with infected partner
 Blood and blood products
 Pregnancy during delivery
 Breast feeding
 It is not spread casually


Primary Infection: Acute HIV Infection
 The development of HIV antibodies or seroconversion:
 Symptoms 1-3 weeks after infection
 HIV level is ↑and CD4+T cell decrease but returns to normal
 Lasts 1-2 weeks
 Symptoms include:
 Flu like symptoms, ,Fever, enlarged lymph nodes, pharyngitis, headache, malaise, nausea and rash
 Symptoms can be misinterpreted

HIV Asymptomatic: CDC Category A
 Often asymptomatic
 Can develop symptoms: fatigue, headache, low grade fever, night sweats and lymphadenopathy
 Symptoms are vague and non specific
 People unaware of infection
 Continue high-risk behavior
 A1: CD4 ≥ 500/µL
 A2: CD4 = 200-499/µL
 A3: CD4 <>HIV Symptomatic: CDC Category B
 Development of 1 or more opportunistic infections
 B1: CD4 ≥ 500/µL
 B2: CD4 = 200-499/µL
 B3: CD4 <>AIDS: CDC Category C
 Development of opportunistic infections, cancers, wasting syndrome, HIV encephalopathy, etc
 Classified as having AIDS
 C1: CD4 ≥ 500/µL
 C2: CD4 = 200-499/µL
 C3: CD4 <>Diagnostic and Laboratory Studies
 Based on detection of HIV specific antibodies EIA – detects serum antibodies
 Western Blot - immunfluorescence assay
 ELISA enzyme-linked immunosorbent assay (detect antibodies that bind to HIV antigens)
 Viral Load
 Quantifies HIV viral load
 Lower level associated with longer survival time and longer delay in onset to AIDS
 Other pertinent lab data:
 WBC – neutropenia, thrombocytopenia
 Anemia – disease or drug related
 Abnormal LFT – disease or drug related

Aims of Collaborative Care
 Monitoring of disease progression
 Baseline assessment
 Patient education
 Psycho-social aspects
 Prevent opportunistic infections
 Monitoring antiretroviral treatment
 Management of signs and symptoms
 Prevent complications of treatment


Drug Therapy and Interventions
Three classifications of drug therapy
1. Inhibit the activity of reverse transcriptase
Zidovudine ( AZT, Retrovir)
Lamivudine (3TC, Epiver)
Stavudine (D4T, Zerit)
Combivir (lamivudine, zidovudine combination)


Drug Therapy and Interventions
2. Protease inhibitors
Indinavir (Crixivan)
Nelfinavir (Viracept)
Ritonivir ( Norvir)
3. Fusion inhibitors
Enfuvirtide (Fuzeon)


Use of Antiviral Drugs
 Multiple medications
 Rigid dosing schedule
 Multiple side effects:
 Nausea, vomiting, diarrhea
 Rash
 Liver function changes
 Peripheral neuropathy
 Taste changes

Preventive Prophylactic Interventions
 Hepatitis B vaccine
 Influenza Vaccine
 Pneumonia
 INH
 Zovirax
 PPD

Nursing Diagnosis
 Pain, neuropathy, arthralgia
 Anxiety
 Altered thought process r/t hypoxemia
 Altered nutrition less than body requirements
 Risk for activity intolerance
 Diarrhea
 Impaired gas exchange

Nursing Interventions
 Reduce Fear
 Prevent Infection
 Improve Nutritional status
 Relieve oral Discomfort
 Minimize effects of diarrhea
 Managing altered thought process
 Reducing a fever
 Improve breathing pattern
 Improve management of therapeutic regimen

Patient Teaching
 Perinatal Risks
 Occupational exposure Risks
 Reduce Risk-reducing behaviors
 Safe sex
 Drug paraphernalia
 Patient Teaching
 Side effects of drugs
 Alternate methods of pain relief
 Energy conservation
 Infection control measures
 Information about support groups and community resources


Transmission to Health Care Workers
 Use standard precautions with ALL patients
 Use needle safe devices
 If exposed, immediately wash area
 Report exposure
 Depending on level of exposure, may need Post exposure prophylaxis (PEP)
 Give ASAP, but more than 72h post-exposure
 Give for 4 weeks
 http://www.cdc.gov/MMWR/preview/mmwrhtml/rr5409a1.htm