HIV transmission

-Transmitted in fluids:

blood

seminal

vaginal

amniotic

breast milk

Mother-to-child can occur in:

utero

at time of delivery

through breast feeding

Infection rate from receiving blood or blood products is now almost zero

HIV among older adults

often don't use condoms

older gay men have relationships w/younger men

older adults sometimes use IV/inj drugs

infected blood products before 1985

HIV prevention

-consistent & correct use of condoms

-nonlatex condoms do not protect vs. HIV

-needle exchange porgrams for addicts

Preventing transmission

to

Health careProviders

-standard precautions: ALL THE TIME

-Hand hygiene: ALL THE TIME

-PPE: gloves, gown, mask, googles when needed

-Pt resuscitation: use mouthpiece or bag

Patho

of

HIV

HIV is a retrovirus:

carries genetic material in RNA rather than DNA

consists of a viral core containing:

RNA surrounded by envelope of protruding glycoproteins, which bind to CD4 receptors or T lymphocytes

Once attached, it can replicate

HIV

life cycle

1) attachment

2) uncoating

3) DNA synthesis to RNA= reverse transcriptase

4) Integration

5) transcription

6) translation

7) cleavage

8) budding

Stages

of

HIV disease

Primary Infection:

period of infection to development of HIV=specific antibodies

"window period":

pt will test neg. for antibodies, but is highly infectious b/c viral load is very high.

virus is replicating & disseminating throughout the body @ a rapid rate.

CD4 & Tcells are being destroyed.

Normal CD4 to T count is 500-1500 cells

Stages

of

HIV disease

continued:

body produces antibodies to contain HIV

viral set point:

amount of virus remaining after initial immune response.

the higher the set point, the poorer the prognosis

pt may have s/sx of acute retroviral syndrome:

"flulike" fever, lymphadenopathy, pharyngitis, skin rash, myalgias/arthralgias. 

Categories

of

HIV

staging

CDC cat. A:

>500 CD4 &  T cells

last on avg. 8-10yrs

pt feels well, w/few s/sx

CDC cat. B:

200-499 CD4 & T cells

CDC cat. C:

<200 CD4 & T cells

when person is said to have AIDS

HIV

antibody test

EIA-enzyme immunoassay:

formerly known as ELISA= identifies HIV antibodies

Western blot assay confirms seropositivity

Orasure uses saliva to test EIA antibodies

Oraquick Test:

quick & accurate test for antibodies (use in ER)

RT-PCR & viral load test:

used to track response to tx

lower viral load indicates longer time to AIDS dx & longer survival time.

HIV

treatment

when to start Tx usu. bassed on CD4 & T cells count

pts must take >1 antiviral drug

adherence to meds regimen is critical once started

positive relatonship b/t pt & provider can enhance adherence

HIV

effects

on

Respiratory

Pneumocystis Pnx: most common

opportunistic infection> resp. failure

Mycobacterium avium complex (MAC):

usu. causes resp. infection, also GI tract, lymph nodes, & bone marrow. *strikes pts w/T cell counts <100, often fatal.

Tuberculosis:

can affect lungs, also CNS, bone, pericardium, stomach, peritoneum, & scotum.

HIV

effects

on

GI

diarrhea in 50-90% AIDS pts

oral candidiasis:

fungal infection in mouth & throat; creamy-white patches, can spread to esophagus & stomach.

Wasting syndrome:

profound involuntary wt loss & loss of lean muslce tissue.

HIV

effects

on

Onocologic

Kaposi's Sacroma:

most common in HIV related malignancy. Brownish pink to purple lesions, flat or raised, sometimes surrounded by ecchymosis & edema; can invade organs.

B-cell Lymphoma:

aggressive, resistant to Tx, often multiple sites of organs involved.

HIV

effects

on

Neuro

Peripheral Neuropathy:

painful, occurs in variety of patterns

HIV encephalopathy:

brain & CSF infected w/HIV

*Early s/sx:

memory deficits, HA, confusion, slow movements; can be hard to distinguish from depression or adverse effects of Tx.

Prevention

of

Opportunistic

Infections

Bactrim: often used

People w/T cell count <200 should receive Bactrim preventively until T cell goes up

Antidiarrheal therapy:

Sandostatin has been shown to be effective

Nutriton Therapy

w/HIV

pts

pts w/diarrhea:

diet low in fat, lactose, insoluble fiber, caff., & high in soluble fiber might help.

appetite stimulants: Megace (can be helpful).

Marionl (synthetic THC):

can relive N/V

CAM Therapies

for

pt w/HIV

CAM may improve pt's well-being

pt may not report so we need to assess carefully

Nsg process:

ASSESSMENT

of pt

w/HIV

-nutrition:

help w/oral intake, LABS; BUN, serum protein, albumin, & transferrin.

-skin integrity:

inspect skin & mucous membranes daily

-resp status:

cough, sputum, SOB, increased RR, chest pain?

-neuro status:

LOC, orientation, memory laspes

-fluid & lytes:

s/sx of dehydration, pts @risk for F&E imbalances

-knowledge level:

teach about transmission, identify pt's support systems

Collaborative

Problems

w/HIV

Oppornistic Infections

Impaired breathing or resp. failure

Wasting syndrome & F&E imbalances

Adverse reaction to meds.

Nsg Interventions

w/HIV

Promote skin integrity:

assess for breakdown & lesions, avoid pt w/scratching, use mild soap.

Promote BM patterns:

assess for diarrhea

Prevent infection:

monitor for s/sx; fever, chills, night sweats, cough, oral pain, wt loss, painful urination, drainage from skin wounds.

Improving activity intolerance:

encourage as much activity as pt can tol.

Maintaining thought process:

assess for altered mental status & safety

Improving airway clearance:

assess rate, rhythm, use of acessory muscles, & breath sounds daily.

Relieving pain & discomfort:

assess pain & its effect on elimination, nutrition, sleep, affect, & communication.

Improving nutritional status:

monitor wt, dietary intake, LABS; albumin, BUN, protein & transferrin levels.

Decreasing the sense of isolaton:

stigma surrounding HIV

Coping w/grief:

help pt verbalize feelings

Monitoring & managing

PC of HIV

Opportunistic Infections:

assess for s/sx

Resp. failure:

intruct pt to report SOB or diff. performing ADLs

Cachexia or Wasting:

evaluate nutritional & electrolytes status by monitoring wt gain/loss, skin turgor, ferritin, hgb & hct, electrolyte levels.

Side effects of meds:

HIV meds can be very toxic

Teach pts w/HIV

self-care:

-discuss transmission

-be clear about avoiding infection; personal & enviromental hygiene

-avoid pet waste; bird cage or cat litter

-avoid others who are sick

-instruct not to donate blodd

-drug using pts; instruct to not share needles w/others if they refuse to stop using

-learn about local resources

-assess adherence to regimen w/home visits

-reinforce teaching

-wound care may be complex

-provide references to Hospice as pt enters terminal stages

-discuss end of life decisions

Emotional & ethical

concerns

when taking care

of an

HIV pt

-RN sometimes fears infection

-hard to care for pt w/poor prognosis

-examine your feelings about behaviors that lead to Dx

-protect pt privacy