hiv

Smeltzer Textbook of Medical Surgical NursingChapter 37
HIV and AIDS Advancements
Treatment has improved steadily since the advent of combination medication therapy.
Survival rates have increased dramatically in the past 20 years
1.2 million people in the United States are living with HIV; one in five are unaware they are infected, according to the CDC.
50,000 new infections per year
Number of new HIV infections, globally, declined 19% over the past decade
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transmission of HIV
Transmitted by body fluids containing HIV or infected CD4 lymphocytes
Blood, seminal fluid, vaginal secretions, amniotic fluid, and breast milk
Most prenatal infections occur during delivery
Casual contact does not cause transmission
Breaks in skin or mucosa increase risk
Risks Associated With HIV Infections
Question
Is the following statement true or false?
The major means of HIV transmission are unprotected sex and the sharing of injection drug use equipment.
Answer
True
The major means of HIV transmission are unprotected sex and the sharing of injection drug use equipment.
Prevention
Abstain from sharing sexual fluids
Reduce the number of sexual partners to one
Always use latex condoms; if allergic to latex, use nonlatex condoms
Do not share drug injection equipment
Blood screening and treatment of blood products
Prevention for Health Care Providers
Hand hygiene
Environmental control
Health Care Provider Treatment
HIV Life Cycle
Structure of HIV-1
Life Cycle of HIV-1
Stages of HIV Disease
Primary Infection
Part of CDC category A
Symptoms: none to flulike syndrome
Window period: lack of HIV antibodies
Period of rapid viral replication and dissemination through the body
Viral set point: balance between amount of HIV and the immune response
HIV Asymptomatic
Upon reaching the viral set point, chronic asymptomatic state begins
Body has sufficient immune response to defend against pathogens
HIV Symptomatic
CD4 T cells gradually fall
The patient develops symptoms or conditions related to the HIV infection, which are not classified as category C conditions.
Patients who are once treated for a category B condition are considered category B.
AIDS
Less than 200 CD4+ lymphocytes/mm3
As levels drop below 100 cell/mm3 the immune system is significantly impaired.
Development of listed conditions
Gerontology Considerations
One quarter of people living with HIV are older than age 50 years.
Reasons
Social bias toward homosexuality
May use IV drugs
Reduction in immune system function
Lab Tests for Diagnosing and Tracking
Treatment
Antiretroviral agents
Protease inhibitors (PIs)
Management also focuses upon the treatment of specific manifestations and conditions related to the disease.
Concept Mastery Alert
Drug-resistant HIV at time of initial infection
Selective drug resistance
Rapid restoration of pathogen-specific immune responses
Causes deterioration of treated infection or new presentation of a subclinical infection
Question
Is the following statement true or false?
A fungal infection present in almost all patients with HIV/AIDS is Kaposi’s sarcoma.
Answer
False
A fungal infection present in almost all patients with HIV/AIDS is candidiasis, not Kaposi’s sarcoma.
Clinical Manifestations of HIV/AIDS: Respiratory
Pneumocystic carinii pneumonia (PCP):
Most common life-threatening infection
Initial symptoms may be nonspecific and may include nonproductive cough, fever chills, dyspnea, and chest pain
If untreated, progresses to pulmonary impairment and respiratory failure
Treatment: TMP-SMZ or pentamidine, prophylactic TMP-SMZ
Mycobacterium avium complex (MAC)
Clinical Manifestations of HIV/AIDS: GI
Oral candidiasis
Treatment with Mycelex troches or nystatin, ketoconazole
Diarrhea related to HIV infection or enteric pathogens
Octreotide acetate for severe chronic diarrhea
Wasting syndrome
10% weight loss and chronic diarrhea or chronic weakness and fever with absence of other cause
Protein energy malnutrition
Anorexia, diarrhea, GI malabsorption, and lack of nutrition may contribute
Clinical Manifestations of HIV/AIDS: Oncologic
Kaposi's sarcoma
Lesions cause discomfort, disfigurement, ulceration, and potential for infection
B-cell lymphomas
Lesions of Kaposi’s Sarcoma
Manifestations of HIV/AIDS: Neurologic
Probably directly related to the HIV infection
Cryptococcus neoformans
Nursing Process: The Care of the Patient With HIV/AIDS—Assessment
Assess physical and psychosocial status
Identify potential risk factors: IV drug abuse, risky sexual practices
Immune system function
Fluid and electrolyte balance
Nursing Process: The Care of the Patient With HIV/AIDS—Diagnosis
Impaired skin integrity
Collaborative Problems and Potential Complications
Opportunistic infections
Wasting syndrome
Nursing Process: The Care of the Patient With HIV/AIDS—Planning
Goals may include
Resumption of usual bowel patterns
Absence of infection
Improved activity tolerance
Improved thought processes
Improved airway clearance
Increased socialization
Absence of complications
Nursing Process: The Care of the Patient With HIV/AIDS—Interventions: Skin
Frequent routine assessment of skin and mucosa
Encourage patient to maintain balance between rest and activity
Reposition at least every 2 hours and as needed
Pressure reduction devices
Use gentle, nondrying soaps or cleansers
Avoid adhesive tape
Perianal skin care
Nursing Process: The Care of the Patient With HIV/AIDS—Interventions: Bowels
Assess bowel pattern and factors that may exacerbate diarrhea
Avoid foods that act as bowel irritants, such as raw fruits and vegetables, carbonated beverages, spicy foods, and foods of extreme temperatures
Small, frequent meals
Assess and promote self-care strategies to control diarrhea
Nursing Process: The Care of the Patient With HIV/AIDS—Interventions: Activity
Maintain balance between activity and rest
Instruction regarding energy conservation techniques
Relaxation measures
Nursing Process: The Care of the Patient With HIV/AIDS—Interventions: Thoughts
Assess mental and neurologic status
Use clear, simple language if mental status is altered
Establish and maintain a daily routine
Orientation techniques
Instruct and involve family in communication and care
Nursing Process: The Care of the Patient With HIV/AIDS—Interventions: Nutrition
Monitor weight, I&O, dietary intake, and factors that interfere with nutrition
Dietary consult
Oral hygiene
Nursing Process: The Care of the Patient With HIV/AIDS—Interventions: Isolation
Promote an atmosphere of acceptance and understanding
Assess social interactions and monitor behaviors
Allow patient to express feelings
Address psychosocial issues
Educate ancillary personnel, family, and partners
Nursing Process: The Care of the Patient With HIV/AIDS—Interventions: Other
Improving airway clearance
Pulmonary therapy; coughing and deep breathing, postural drainage, percussion, and vibration
Ensure adequate rest
Managing Potential Complications and Collaborative Care
Opportunistic infections
Respiratory failure
Question
What antiretroviral medication when taken with a high-fat, high-caloric meal increases peak plasma concentrations of capsules?
Delavirdine (Rescriptor)
Efavirenz (Sustiva)
Nevirapine (Viramune)
Answer
Efavirenz (Sustiva)

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