HIV/AIDS

Major focus is prevention Women are the fastest growing group with poorer outcomes and a lower survival rate More easily transmitted from infected male to uninfected female ABCs ( Abstinence, Be faithful, Condoms) Attacks CD 4+ T-cells that help the body fight infection, turns them into an HIV factory and immune system is weakened Modes of transmission: Parenteral: Shared needles or equipment, receiving contaminated blood products Perinatal: From mother to baby from placenta, contact with body fluids during birth or from breast milk. (meds help decrease transmission rate) Health Care Workers: Needle sticks or sharps, exposure of non-intact skin to body fluids ( use standard precautions)

HIV is not transmitted by: casual contact sharing utensils, towels or toilets, mosquitoes or insects Viral Load: Amount of virus present in blood and other body fluids, the higher the level of HIV the greater the risk for transmission Acute Infection: Fever/chills, night sweats headache, rash, muscle aches, sore throat (pt will initially feel better and can be asymptomatic for 6 mths to 10 years) Chronic Infection: CD 4+T-cell count drops, lymphocytopenia HIV Classifications: A: asymptomatic B: Symptomatic C: AIDS Nursing goal is to prevent pt from moving to the next stage HIV Progression: How acquired, freq of exposure, presence of other STDs, nutritional status, stress, interventions Opportunistic Infections: occur due to prolonged immune suppression, can be protozoan, fungal, bacterial, or viral

Opportunistic Infections
Protozoa: 1. Pneumocystis jiroveci pneumonia (PCP): listen for crackles, given antibiotics 2. Cryptosporidium Parasite: Diarrhea, fluid loss, *HYDRATION* ask about wt loss, NO CURE, will have fatty stool and gas

3. Toxoplasmosis Encephalitis: From feces or undercooked meat, check baseline mental status, seizures, ask family members about LOC changes * May need to take med for rest of life* ( Pyrimethamine + sulfadiazine) FUNGAL: 1. Candida: Food tastes funny, cottage-cheese like yellow plaques, itchy vag. Treat with Fluconazole 2. Cryptococcosis: Debilitating meningitis, fever blurred vision N/V, sepsis, LOC changes, Treat with Fluconzole. 3. Histoplasmosis: Respiratory infection, widespread, dyspnea, fever, wt loss, lymphadenopathy. Treat with Itraconazole( side effects: skin falls off, nausea, hepatotoxicity)

BACTERIA: 1. Mycobacterium Avium complex (MAC): Infects respiratory and Gi tract, systemic infection. Treat with Z-pack, pt will be at risk for skin breakdown due to incontinent diarrhea 2. Tuberculosis: Cough *Night sweats* wt loss, pt may NOT have a + TB test* (Anergy) 3. Pneumonia: 2 or more cases within 12 mths ia AIDS case definition VIRAL 1. Cytomegalovirus: Impaired vision, abd bloating, from kitty litter, TX: Valgerciclovir 2. Herpes Simplex Virus (HSV): numbness tingling blisters open lesions, tingling before outburst 3. Varicella-zoster virus: Fluid-filled blisters, HA, low fever, Clean abscess once a shift with NaCl and allow to air dry, modified burrows solution soaks promote healing, pain relief

MALIGNANCIES: 1. Kaposis sarcoma: Most common, small purplish raised lesions, not painful or itchy, treat with local radiation, cryotherapy, analgesics, keep open, weeping lesions clean and dressed to reduce risk for infection 2. Hodgkins Lymphoma 3. Non-Hodgkins Lymphoma 4. Invasive Cervical cancer ENDOCRINE CHANGES:

Sexual dysfunction: Men low testosterone, women irreg menstrual cycle, decress body muscle mass Body shape changes: Fat redistribution, Buffalo hump, wasted appearance to face, arms, legs Adrenal Insufficiency: Infected glands, wt loss, N/V, electrolyte imbalances

Other Problems: Dementia Neuro, gait changes, ataxia, muscle pain AIDS wasting syndrome Skin changes, dry itchy, eczema, bleeding gums

Diagnostic Testing: ELISA: blood test, initial test done, if 2 are positive then move on to the WESTERN BLOT (more $ more but more specific) Home Test Kits: absorbent pads collect saliva, take 20 min for results Pre/Post Counseling If negative test, reinforce pretest counseling and prevention, remind pt that test needs to be repeated in intervals up to 6 mths after most recent exposure risk

Drug Therapy: HAART ( Highly Active Anti-Retroviral Therapy) 1. NARTIs: These drugs interfere with HIVs reverse transcription enzyme 2. NNRTIs 3. Protease Inhibitors: Prevent viral replication and release of viral particles 4. Entry Inhibitors: Prevents infection of new cells, blocks the CD4+ T-cell, MED: FUZEON, high risk for infection at injection site, teach patient sterile injection techniques MED: SELZENTRY Side effects: lower BP, liver toxicity 5. Integrase: Inhibit the enzyme integrase, prevent viral replication( MED: ISENTRESS Side effect: diarrhea) Also FIXED DOSE COMBINATIONS: easier for dosing and compliance

OTHER THERAPIPES:

Bone marrow transplant Vitamins Botanical products Lymphocyte transfusion

Inactivated vaccines are ok, live are bad NURSING MANAGEMENT: Wash food, hands Wear gloves Stay away from crowds, kitty litter Elevate HOB Pain meds Teach pt to increased protein and increase high calorie food avoid bad odors Provide mouth care and ice chips Keep open lesions clean Show concern and watch for social isolation PREVENTION: Use condoms Fill and flush needles with clean water, fill with bleach and shake for 20-30 sec, advise user to carry a small container with this solution with them Educate about needle exchange program Encourage HIV + women to keep taking their meds, and not to breastfeed their babies Health Care workers use Post-Exposure Prophylaxis (PEP) initial testing, then again at 6 weeks, 12 weeks and 6 months, follow up with counseling HEALTH PROMOTION: Elimination or moderation of alcohol, tobacco and drug use Keep vaccines up to date Adequate rest, exercise and stress reduction Avoid exposure to new agents HEALTH TEACHING: How to identify the presence of an infection Self-care, good hygiene Good nutrition Avoid rare fish, fowl or meat, wash all fruits and veggies, proper food refrigeration TERMINAL PATIENT CARE: Keep Patient comfortable

Facilitate emotional and spiritual acceptance of life Maintain a safe environment ONGOING CARE: HIV testing, counseling, clinic services, buddy system, respite care, education, referral services, housing, home care, behavioral health, meals on wheels, internet