Chapter 21 Care of Patients with HIV Disease and Other Immune Deficiencies Mrs. Kreisel MSN, RN NU130 Adult Health Summer 2011

Acquired Immune Deficiency Syndrome The most common secondary immunogenicity disease in the world Identified in 1981 Serious worldwide epidemic

Prevalence of HIV Infection by Country

HIV Infectious Process

Life Cycle of HIV

Effects of HIV Infection Everyone who has AIDS has HIV infection. However, not everyone who has HIV infection has AIDS. The distinction rests with the number of CD4+ T-cells the patient has and whether any opportunistic infections have occurred.

Virus Infection

HIV Classification Clinical categories: Clinical category A (HIV positive) Clinical category B (HIV and opportunistic infection) Clinical category Co (AIDS) SEE PAGE 365

Health Promotion and Maintenance Education is the best hope for prevention. HIV is transmitted most often in three ways: Sexual Parenteral Perinatal BLOOD, SEMEN, VAGINAL FLUID

Transmission and Health Care Workers Needle stick or “sharps” injuries are the primary means of HIV infection for health care workers. Workers can also be infected through exposure of nonintact skin and mucous membranes to blood and body fluids. The best prevention for health care providers is the consistent use of Standard Precautions for all patients as recommended by the CDC.

Collaborative Management Assessment History Physical assessment and clinical manifestations: Infections—opportunistic, protozoal, fungal, bacterial, viral Malignancies—Kaposi’s sarcoma, malignant lymphomas Endocrine complications

Other Clinical Manifestations AIDS dementia complex AIDS wasting syndrome Skin changes Dysphagia: Increase protein and calories

Laboratory Assessment Lymphocyte counts CD4+ T-cells and CD+ T-cells Antibody tests Enzyme-linked immunosorbent assay (ELISA) Western blot, viral load Quantitative RNA assays Others

Drug Therapy Nucleoside analog reverse transcriptase inhibitors Non-nucleoside reverse transcriptase inhibitors Protease inhibitors Fusion inhibitors Entry inhibitors Integrase inhibitors Immune enhancement

Nursing Diagnoses Pain Imbalanced Nutrition: Less Than Body Requirements Diarrhea Impaired Skin Integrity Disturbed Thought Processes Chronic Low Self-Esteem Social Isolation

Community-Based Care Home care management Health teaching Psychosocial preparation Health care resources

Therapy-Induced Immune Deficiencies Drug-induced immune deficiencies Radiation-induced immune deficiencies

Other Immune Deficiencies Congenital (primary) immune deficiencies Avoid breast feeding Bruton’s agammaglobulinemia Common variable immune deficiency Selective immunoglobulin A deficiency

NCLEX TIME

Question 1 What percentage of new HIV infections are reported to occur in minorities in the United States? A.More than 28% B.More than 42% C.More than 57% D.More than 72%

Question 2 Which group has the highest percentage of AIDS cases in North America? A.Men or women who use injection drugs B.Newborns of mothers who are HIV positive C.Men who have had sex with other men D.Women who have had sex with other women

Question 3 When reviewing the chart of a patient with newly diagnosed AIDS, the nurse recalls that the most common opportunistic infection in persons infected with HIV is: A.Tuberculosis (TB), caused by Mycobacterium tuberculosis B.Pneumocystis jiroveci pneumonia (PJP) C.Cytomegalovirus (CMV), causing CMV retinitis D.Toxoplasmosis encephalitis, caused by Toxoplasma gondii

Question 4 When teaching a patient with AIDS about drug therapy, the nurse emphasizes that the drugs must be taken exactly as prescribed, without missing doses. The reason for this is: A.Missed doses can promote drug resistance, lowering the effectiveness of the drugs. B.Missed doses allow for the development of opportunistic infections. C.An increased chance of allergic reaction to the drug may occur. D.Viral replication decreases when doses are missed.

Question 5 A patient is fearful that he has been infected with HIV. The nurse recognizes that the first manifestations of HIV infection is/are: A.Opportunistic infections B.Fever, night sweats, and muscle aches C.Lymphocytopenia (decreased lymphocyte count) D.Reduced numbers of CD4+ T-cells