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Summary NR324 Exam 3 Study Guide
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NR324 Exam 3 Study Guide
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NR324 Exam 3 Study GuideHIV – 7 questions
- You cannot get HIV through kissing.
- Not a disease you can get casually.
- Retroviral disease – it replicates backward – that’s why it is difficult to cure.
o Many are living longer with HIV. It is more a chronic disease today. Just like
diabetes.
- HIV is not AIDS
o AIDS is the end stage of HIV. Takes about 8-10 years from HIV to AIDS.
o Some do develop AIDS very quickly.
- HIV is a virus suppresses/destroys the immune system.
- Many will die from opportunistic diseases – pneumonia is the biggest and most deadly.
- Transmission happens with exchange of body fluids.
o Breast milk.
o Sexual contact
o Blood
o Semen
o Vaginal secretions
o Most common transmission route is sexual contact.
- Only 1 in 4 babies born to HIV+ women will contract HIV.
- Puncture wounds are the most common method of transmission to medical workers.
o Used needles! Be extremely careful.
o They check your blood for 6 months to ensure you are not infected. Some
hospitals will put you on antivirals if you are exposed.
- You cannot donate blood if you have hepatitis, are gay, get a tattoo in the last year, or are
HIV+.
- It is difficult to get HIV through a blood transfusion because of screening guidelines.
- Only 25% of babies born to untreated HIV+ mother will get HIV.
o Treatment reduces the risk down to 2%.
o Antiretrovirals
- If you are infected today, you will not know right away, but you will be serum positive for
HIV.
- Within 2 weeks you will still not know, but the viral load will rise.
o May have flu like symptoms. Lasts 3-5 days and then goes away.
o CD4 cells (T-helpers cells) fight for immunity. Normal CD4 is 800-1200. They
will combat the virus and the CD4 will drop. Then it will normalize again
because they are fighting the virus. The patient will not know they have HIV
because they have no symptoms.
- Even if someone is negative, you must come back for retesting. It can lay dormant or viral
load is very low.
- ELISA test – not a conclusive diagnosis for HIV.
- Only conclusive test for HIV is the western blot test. Takes about two weeks to get
results.
,- HIV only attacks the CD4 cells. That is how it destroys out immunity.
- It is an RNA viral disease that replicates backwards.
- It will fuse itself to the cell membrane and then it injects its genetic material into the cell.
This genetic material will be incorporated into the DNA and it will trick the cells to produce
more HIV viruses.
- It binds to specific chemokine receptors in the cell membrane.
- It can only attack in the resent of protease enzyme and reverse transcriptase enzyme.
o Without them, it will not be able to enter the host cell or replicate.
- We have protease inhibitors and reverse transcriptase inhibitors. Both block the enzymes
- Transmission is likely when the viral low is very high.
o Viremia.
- You have an initial very high viral load at first, but then a very low viral load once the CD4
cells start fighting the virus.
- Immune problems start when the CD4 level goes down to 500.
o This allows for opportunistic disease.
- Acute phase of infection (2-4 weeks – diffuse rash, fatigue), asymptomatic phase
(can last up to 11 years – fatigue – most unaware they are infected), symptomatic
phase, and then 8-10 years later they will have AIDS.
o To have AIDS their CD4 level must drop below 200, they must have one
opportunistic disease (pneumonia, thrush).
- HIV patients develop opportunistic infections because their immune system is low.
- HIV patients have specific opportunistic diseases
o Oral thrush
o Shingles
o Recurrent vaginal yeast infections
o Kaposi’s sarcoma – skin cancer that really only affects HIV patients
o Lymphoma – especially under arms
o Oral leukopenia
o Pneumocystic Jeroveci pneumonia
o Pneumocystic carnie pneumonia
o Cytomegalovirus retinitis
o Cryptococal meningitis
o TB
o Mycobacterium avian complex – MAC attack – severe diarrhea – GI distress
Loss of fluids and electrolytes
Monitor for skin breakdown around perineal area
Skin integrity is very important
- AIDS is a complication of HIV. There are great risks for opportunistic diseases.
o Malignancies
o Wasting syndrome – 15 – 20 diarrhea per day – weight loss
o AIDS Dementia Complex
- HIV people look all sorts of different.
o Many will be overweight or physically fit.
- May take several weeks for antibodies to develop.
o Virus does not show in the first two weeks of infection
,- Swab test only have 97% efficacy – cannot be used to diagnose
o Come back for an ELISA test
o Western blot test – only definitive test
- Must obtain consent before testing them for HIV
- HIV is usually screened for during prenatal care.
o Many times the doctor won’t tell the patient.
- We monitor the progression of the HIV virus by the viral load level and the CD4
levels.
- Most patients receive medication cocktails – 2-4 meds
o They can reduce the viral load until it is undetectable. They still have HIV,
but their viral load is very, very low.
- Abnormal blood tests are usually caused by the HIV or opportunistic diseases
o Extremely low white blood cells.
- Resistance test can also be done.
o Tests the effectiveness of medication
o We can do genotype and phenotype blood tests to tell which strain of HIV you
have.
- Monitor progression, treat symptoms
- Antiviral medication is used to treat HIV.
o They must take this for the rest of their life.
- Must treat opportunistic diseases too.
- Educate clients about preventing infection with HIV
o Especially those will crazy lifestyles
- Prevention is the key to HIV management
- Increase the CD4 count
- Some patients will have normal CD4 counts because of their medications.
- You want to prevent opportunistic disease and prevent progression.
- Some patients do not take medication because their CD4 levels stay high.
o They exercise, eat well, and rest to keep their immune system to stay healthy.
- The government wants all patients to receive treatment.
o Even new born with HIV will receive treatment.
- Some people are resistant to HIV infection – scientists study prostitutes who are resistant
- We want to increase the life expectancy of your patient
- Have a discrete conversation with your patients about their life style.
o Do not be rude and build trust
- Ask patients if they have received blood before 1985 – testing started after 1985
- Ask patient if they have shared needles, whether they have STDs, and what their sexual
lifestyle is like.
- Collect history (medical medication)
- Insure compliance! We do not want them to develop a resistant strain of the virus.
- Primary prevention is the key.
o Education
o When prevention fails, disease results
- Class of medication that manages HIV – most end in –vir
- Reverse transcriptase inhibitor
, o Stops HIV reproduction
- Protease inhibitors
o Stops HIV reproduction
- You cannot cure HIV, but you can minimize the reproduction of the virus
- Infusion inhibitors
o Stop the virus from fusing to cell
- Very high doses are used in HIV patients
o Nausea
o Vomiting
o Weight loss
o Diarrhea
- Educate your clients about infection and counseling
o Condom usage!
o The condom must be used appropriately.
o You cannot keep them where it is warm or experiences stress.
- Do not use needles for drug use.
o No sharing
- Do not have sexual intercourse when you are inebriated.
- Perinatal transmission
o Pregnant women should be medicated
o Baby will be treated
- Motivation of patient for treatment is crucial
o If they do not want to be treated, then they will develop a resistant strain of the
virus.
o Must be compliant with medication regimen!
o Evaluate motivation first.
- Post exposure prophylaxes
o If you get poked with a used needle, squeeze blood out of it, clean it, and go to the
ER.
- Testing is the only sure way to know your status.
- 10% of new patients are older adults
- 21% of people living with HIV have no idea they have it.
o Everyone should be getting tested.
- We do not discriminate against patients because they have HIV.
- Depression, anger, guilt are all common in an HIV patient
- There is a ton of stigma for HIV patients
- Antiviral therapy can really slow down progression
o Doesn’t work for everyone
o Very very expensive
- Start therapy when the patient is ready
- Avoid burn out and non-adherence to meds by not starting when they do not want to.
- If they already have AIDS, start treatment ASAP
- Medication will be different for different patients
- HIV patients must build a good immune system
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