Care of the Patient with HIV/AIDS

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Terms in this set (...)

AIDS
advanced stage of HIV infection that weakens the body's immune system
HIV
AIDS causing virus which attacks cells that help fight off infections
CD4/ymphocyte/T cell
the host cell for HIV/AIDS
CDC
centers for disease control; were initially responsible for responding to the AIDS crisis
retrovirus
viruses in which transcription of genetic material is revered and it changes from RNA to DNA instead of vice versa
seroconversion
development of detectable specific antibodies to microorganisms in the blood serum as a result of infection or immunization
viral load
how much of a virus is found in the blood
virulent
extremely severe or harmful in its effects
exposure to bodily fluids: blood, semen, breast milk, vaginal secretions, rectal secretions

Although HIV has also been isolated in urine, saliva and tears, it is highly unlikely that it will be present in sufficient concentrations for transmission to occur
describe the methods of viral transmission
no
determine if each of the following methods is likely to transmit HIV: sharing food/drinks
no
determine if each of the following methods is likely to transmit HIV: using the same toilet seat
yes
determine if each of the following methods is likely to transmit HIV: using the same needle/sharps
yes
determine if each of the following methods is likely to transmit HIV: sexual intercourse- vaginal/oral/anal
no
determine if each of the following methods is likely to transmit HIV: hugging
yes
determine if each of the following methods is likely to transmit HIV: sharing razors
no
determine if each of the following methods is likely to transmit HIV: blood transfusion
yes
determine if each of the following methods is likely to transmit HIV: mother to baby
yes
determine if each of the following methods is likely to transmit HIV: mother to fetus
no
determine if each of the following methods is likely to transmit HIV: kissing
yes
determine if each of the following methods is likely to transmit HIV: body fluid splash (if it comes in contact with open areas on your skin? I'm not sure about this one but......)
-the virus attaches to CD4 lymphocytes/T-Helper cells/T4 cells and instructs the cell to make more virus by injecting viral DNA into the cell
-the virus is released, destroying the T cells and infecting other T cells
-cells are destroyed faster than they are replaced
-this gives opportunistic infections an opportunity to attack because the WBC count is low
what happens once the virus has entered the body?
fever, fatigue, muscle aches, skin rash, nausea, vomiting
discuss early s/s of HIV infection
once t cell count drops below 200 cells/mm^2
at what point does a patient transition from HIV to AIDS status?
ELISA
detects and measures antibodies in blood
Western blot
used to identify specific amino-acid sequences in proteins
opportunistic infection
an infection that could normally be resisted but occurs due to having a suppressed immune system
they are elevated
what happens to WBC counts with infections?
1- male-to-male sexual contact
2- heterosexual contact
3- injection drug use
4- mother-to-child (perinatal)
5- other (blood transfusions and unknown causes)
describe the methods of viral transmission from most to least common
virus
can only reproduce itself by taking over a cell in the body of its host
the late 1970s, however some cases are suspected to occur as early as 1959
when was HIV initially seen?
GRID
gay-related immune deficiency; the first name for AIDS when it was thought to only occur in gay men
1982
when was the disease first referred to as HIV/AIDS?
1984
when was the actual retrovirus discovered?
American scientist Gallow battled with France for the "claim to fame" on who discovered the virus first
who discovered the retrovirus?
1985; the test was later used to diagnose the infection in people by detecting antibodies
when was the ELISA test developed and used to safe guard the blood supply?
1987; AZT is often the first line of defense against HIV/AIDS
when was AZT approved by the FDA?
1996
when was HAART (Highly Active Anti-retroviral Therapy), a combination of various anti-retroviral therapies, introduced?
1997
when was it required to report people who had HIV/AIDS to the government/CDC?
2000-present
new meds, new testing methods, and clinical trials; there are thought to be over 200 variances of HIV, which means that not all meds will work with all the types. it is also therefore possible to get "double-HIV" and increase your viral load
33.3 million people worldwide
1.5 million in North America
African Americans have the highest burden
MSM (men who have sex with men) are the most severely affected group
Discuss the statistics of those infected with HIV/AIDS
cellular immunity- cells directly attack microorganism

humoral immunity- production of antibodies
discuss the types of immunity
-an entry site
-HIV must be present and virulent
-HIV must be in sufficient quantities
-the person must be susceptible to the pathogen
HIV transmission- list the 4 factors that must all be present at the same time for transmission to occur
common: blood, semen/pre-ejaculatory fluid, vaginal/cervical/rectal secretions, breast milk - "white-ish fluids" b/c fluids are white b/c they contain WBCs and these are the host cells for HIV

less common: cerebrospinal (brain/spine), pericardial (heart), synovial (joints), pleural (chest), and amniotic (fetus forms in this fluid) fluids
list the infectious body fluids
barrier methods: male condom (latex, polyurethane- no animal skin like lamb skin), female condom, dental dam- for oral sex on females
discuss prevention options for sexual contact
the inner layer of the foreskin is more susceptible to HIV penetration and survival and has greater susceptibility to tears during intercourse

therefore it is healthier for a man to be circumcised and reduces the risk of HIV transmission
discuss male circumcision and risk for HIV transmission
-AZT during pregnancy and a bloodless C-section birth
-baby gets AZT for 1st few months of life
-decreases baby's risk of having HIV/AIDS by 95%
-no breastfeeding
discuss prevention options for a woman who is pregnant and also has HIV
confidential and anonymous
HIV testing is...?
positive, negative, indeterminate
what are the 3 possible HIV test results
3-6 months
what is the period of time between exposure to HIV and the development of antibodies?
2-8 weeks
how long of a wait is needed from the time of exposure to testing in order to get an accurate test result?
blood, oral fluid, or urine

results can take up to 2 weeks
ELISA and enzyme immunoassay (EIA) tests use what to detect HIV antibodies? how long do results take?
ELISA
what is usually always the first test done if HIV is suspected?
a western blot test is done to confirm because false positives can occur
what happens if there is a positive ELISA test?
blood, oral fluid, or urine

results can take 10-20 minutes

these tests are good because they can be done at home and therefore provide privacy and fast results but bad because the patient is left alone and vulnerable with the results and may do something bad
what do rapid HIV antibody tests use to detect HIV antibodies? how long do results take? what makes these tests good and what makes them bad?
a western blot test is done to confirm because false positives can occur
what happens if there is a positive rapid HIV antibody test?
PCR Test
polymerase chain reaction; tests for the actual virus; the window period for this test is approximately 10 days; it is very expensive and is usually not one of the first few tests done
viral load testing
measures the amount of HIV RNA in blood of HIV infected individuals; the lower the viral load the better (preferably less than or equal to 10,000 per mL); however there are undetectable levels of virus in places other than the blood so this test may not be completely accurate
-conspiracy beliefs and mistrust of the health care system
-socioeconomic reasons- poverty, unemployment, lack of health insurance, homelessness
-psychosocial health issues (depression, violence, low self-esteem)
-culture
what are some reasons that people don't get tested for HIV/AIDS?
counseling and testing is voluntary and informed consent is required (except for people who are in jail, prostitutes, and those who use them, who are able to be tested without any consent)

in the public sector pre and post test counseling is done (public health departments are required to do pre-test counseling whereas the private sector is not)
discuss legal issues with HIV/AIDS testing in Florida
1988
employers may not discriminate based on HIV status
3rd degree felony
what kind of a crime is it to knowingly infect another person with HIV or donate infected blood/tissue?
AIDS definition- CDC, 1993
a positive HIV test AND
a T-cell count of less than 200 OR an opportunistic infection
10-12 years
how long is the latent period following initial HIV infection?
flu-like symptoms, malaise, swollen lymph nodes OR no signs/symptoms and feel completely healthy
what symptoms might someone experience following exposure?
when the immune system continues to decline and T-cell count reaches below 400

thrus or other candida albicans infections, TB (a ppd may be negative because the body won't produce antibodies), Herpes
when do opportunistic infections begin to occur? which ones occur?
fever, night sweats, diarrhea (which leads to excoriation of the rectum and anorexia), weight loss of more than 10%, fatigue, enlarged lymph glands
what are some signs/symptoms that occur when the T-cell count is below 200 and the patient officially has AIDS?
pneumocystic carinni pneumonia (PCP)- lung scarring, Kaposi's sarcoma, cytomegalovirus (CMV)- causes blindness, toxoplasmosis- cat feces, inhaled, cervical cancer, cryptosporidium- bug in water- advice bottled water- causes diarrhea

these will eventually lead to death
what are some opportunistic infections that occur at this time?
TB and PCP (pneumocystic carinni pneumonia)
what are the two most common causes of death in AIDS patients?
depression, memory loss, psychosis/dementia, encephalitis
what are some neurological impairments that occur?
keep healthy and support the immune system! - most important
early intervention helps a lot
encourage to prevent infection: avoid raw meat, eggs, shellfish, ill people, crowds, & cat liter
reverse isolation prn (if T-cell count is super low), vaccinations, activity and rest periods, comfort measures, emotional support, prompt medical attention of illness

want to keep them from getting sick because being sick = increased WBC count = more cells for the virus to infect

encourage good nutrition, less stress, safer sex/abstinence, educate the patient and the family on how to stay healthy and prevent the spread of the infection
discuss treatment for patients with HIV/AIDS
they stop the replication of the virus

anti-retrovirals
how do HIV meds work? what are they called?
fusion inhibitors (stop binding of HIV and T-cell), attachment inhibitors (prevents entrance of HIV inside the T-cell), NRTI & NNRTI (stop the transformation of RNA to DNA), integrase & protease inhibitors
list different types of HIV meds
drug cocktail
This is a combination of drugs, used to treat AIDS. Each drug targets a specific cycle, so it slows the progression of the disease. some patients take way more than others like one may take 3 and the other may take 11
headaches, rash, dizziness, abdominal discomfort, diarrhea, nausea, hypersensitivity (allergic reaction), change in taste, increased cholesterol, fat redistribution "buffalo lump" - protease pounch
discuss the side effects of anti-retrovirals
liver and kidney function
what is important to monitor when patients are on anti-retrovirals?