Nursing Management: HIV and AIDS

Acquired Immunodeficiency Syndrome is defined as the most severe form of a continuum of illnesses associated with the retroviral human immunodeficiency virus (HIV) infection Primary infection is associated with... High levels of HIV in the blood are accompanied by dramatic drops in CD4 + T-cell counts, normally between 500 and 1,500 cells/ mm3. Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0:03 / 0:15 Full screen Brainpower Read More HIV asymptomatic 500 CD4 + T lymphocytes/ mm3 HIV symptomatic 200 to 499 CD4 + T lymphocytes/ mm3 AIDS 200 CD4 + T lymphocytes/ mm3 What are the risk factors for acquiring HIV? - High-risk behaviors such as sexual intercourse with an HIV-infected partner or injection drug use • Blood transfusion or blood products contaminated with HIV • Children born to mothers with HIV infection, breastfed infants of HIV-infected mothers • Health care workers exposed to needle-stick injury or transmucosal contamination from an infected patient • Potentially infected body fluids, including blood, seminal fluid, vaginal secretions, amniotic fluid, and breast milk • Estrogen and progesterone may increase a woman's risk for HIV infection through changes in the cervical mucosa. What are the respiratory manifestations of HIV? Dyspnea, cough, chest pain, and fever What are the GI manifestations of HIV? - Anorexia, nausea, and vomiting • Oral and esophageal candidiasis or thrush - Chronic diarrhea - causing profound weight loss, fluid and electrolyte imbalances, perianal skin excoriation, weakness, and inability to perform activities of daily living What are the S/S of wasting syndrome (cachexia)? - Multifactorial protein- energy malnutrition; - Profound involuntary weight loss - Either chronic diarrhea for more than 30 days or chronic weakness and documented intermittent or constant fever with no concurrent illness • Anorexia, diarrhea, gastrointestinal (GI) malabsorption, lack of nutrition What are the oncologic manifestations of patients with AIDS? - Kaposi's sarcoma -- is the most common - B-cell lymphomas - second most common What are the neurologic manifestations of AIDS? - HIV encephalopathy - HIV-associated dementia - HIV-related peripheral neuropathy What are the symptoms of HIV encephalopathy? memory deficits headache difficulty concentrating progressive confusion psychomotor slowing apathy ataxia global cognitive impairments delayed verbal responses a vacant stare spastic paraparesis hyperreflexia psychosis hallucinations tremor incontinence seizures mutism death S/S of HIV-related peripheral neuropathy pain and numbness in the extremities weakness diminished DTR orthostatic hypotension impotence. What are the integumentary manifestations of HIV? - KS, herpes simplex, herpes zoster viruses, and various forms of dermatitis • Folliculitis, atopic dermatitis including eczema or psoriasis What are the gynecologic manifestations of HIV? - Persistent recurrent vaginal candidiasis may be the first sign of HIV infection. • Ulcerative sexually transmitted diseases, such as chancroid, syphilis, and herpes, are more severe in women with HIV. - HPV - cervical intraepithelial neoplasia - pelvic inflammatory disease - menstrual abnormalities What are the immunological manifestation of HIV? Immune reconstitution inflammatory syndromes (IRIS) is characterized by fever and worsening of clinical manifestations of opportunistic infections, or the appearance of new manifestations. Dx of HIV Enzyme immunoassay Western blot assay confirms seropositivity. Viral load tests Pharmacologic therapy of HIV nucleoside/ nucleotide reverse transcriptase inhibitors (NRTI) non-nucleoside reverse transcriptase inhibitors (NNRTI) protease inhibitors fusion inhibitors integrase inhibitors entry inhibitors. Effective medication regimen contains at least ... three antiretroviral medications from at least two classes. What are the prolong side effects of pharmacologic therapy? - lipodystrophy syndrome - risk for early-onset hypercholesterolemia, heart disease, and diabetes. - Fat redistribution syndrome, Assessment for patients with AIDS - Identify potential risk factors, including sexual practices and IV/ injection drug use history. • Assess physical and psychological status and explore factors affecting immune system functioning. Assessment for nutritional status for patients with AIDS • Obtain dietary history, identifying factors that may interfere with oral intake, such as anorexia, nausea, vomiting, oral pain, or difficulty swallowing. • Assess patient's ability to purchase and prepare food. • Measure nutritional status by weight, anthropometric measurements (triceps skinfold measurement), and blood urea nitrogen (BUN), serum protein, albumin, and transferrin levels. Assessment of skin and mucous membranes • Inspect daily for redness, breakdown, ulceration, and infection. • Monitor oral cavity for and creamy-white patches (candidiasis). • Assess perianal area for excoriation and infection. • Obtain wound cultures to identify infectious organisms. Assessment of respiratory status • Monitor for cough, sputum production, shortness of breath, orthopnea, tachypnea, and chest pain; assess breath sounds. • Assess other parameters of pulmonary function including chest X-rays, arterial blood gases (ABGs), pulse oximetry, pulmonary function tests. Assessment of neurologic status • Perform baseline assessment of mental status as early as possible. - Note level of consciousness and orientation to person, place, and time, and memory lapses. • Observe for sensory deficits, such as visual changes, headache, and numbness and tingling in the extremities. • Observe for motor impairments, such as altered gait, paresis, or paralysis. • Observe for seizure activity.