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What is HIV RNA virus replicates backwards to DNA taking over CD4 T-cells
What is Aids Immune incompetence and develop one of the following: CD4 T cell <200 OI OC Wasting syndrome AIDS Dementia
Common OI's in Aids are Viral, Fungal, Bacterial Protozoa Candida Albicans thrush Mycobacterium pneumonia CMV, VSV, HSV Coccidiodides/ Pneiumonia PCP Flu Kaposi Sarcoma
What is wasting syndrome loss of 10% or more of body mass
How is HIV diagnosed? First an EIA is done- if pt has risky behavior re-resting is recommended at 3wks/6wks/3mo. If positive, another EIA is done. If repeated EIA is positive then a Western blot test is performed.
Normal T-cell range is 800-1200
What level do immune problems begin with t-cell levels? when they drop below 500
What are the early signs of HIV infection? Mono-flu like symptoms, malaise, headache, fatigue, and seroconversion
Seroconversion is (when HIV-specific antibodies develop) accompanied by a mono-like syndrome of fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and/or a diffuse rash
Transferrable methods of HIV are what sexual intercourse with an infected partner, exposure to HIV-infected blood or blood products, and perinatal transmission during pregnancy, delivery, or breastfeeding
Most common form of transmission is sexual anal or vaginal
Highest incidence rate of HIV is in what kind of men? Gay and African American
Metabolic s/e of ART are body changes like fat accumulation, peripheral wasting, lipid abnormalities ↑Trig ↓HDL, ↑ insulin resistance, and hyperlipidemia
Opportunistic Cancers KAPOSI SARCOMA, lymphoma, cervical cancer
What happens in the acute phase? Seroconversion shows up 2-4wks after infection and lasts 2 weeks. High viral load and low t-cell occurs but return to baseline at the end of this stage.
What would you see in an acute exacerbation of HIV in a patient who has had the disease for years? Sharp decrease in CD4 count
Early chronic infection is Asymptomatic, T-cells remain above 500, BUT fatigue, headache, low-grade fever, night sweats, persistent generalized lymphadenopathy (PGL) can occur
Intermediate chronic infection is... Symptomatic, CD4 200-500, viral load ↑, fever, night sweats, chronic diarrhea, recurrent headaches, fatigue, localized infections, lymphadenopathy, and nervous system issues can occur.
Most common infection in intermediate chronic is Thrush/Candida. Zoles.
Other infections that can happen in the intermediate phase are Kaposi sarcoma, caused by human herpesvirus 8 (Fig. 15-6). Oral hairy leukoplakia, an Epstein-Barr.
Late chronic phase or AIDS occurs... 10 years plus after initial infection
Diagnostic tests for HIV are EIA, western blot (only done after 2 positive EIA's), oral fluid test not saliva home test, urine test. rapid tests blood or oral 20 min test.
What is ART Antiretroviral therapy drugs and it reduces viral load have interactions and don't work for everyone. Increases life span by 20yrs.
When do we start ART? To avoid burnout and nonadherence, treatment is recommended when immune suppression is great and the pt is ready.
What are some antiretroviral agents? Reverse Transcriptase InhibitorsNucleoside – NRTI (AZT) Non-Nucleoside – NNRTI (Sustiva) Protease Inhibitors / PI (Norvir) Fusion Inhibitors / Entry Inhibitors (Fuzeon) HAART – Highly Active Antiretroviral therapy
Entry Inhibitors Prevent binding of HIV to cells, thus preventing entry of HIV into cells where replication would occur
Protease Inhibitor Prevent the protease enzyme from cutting HIV proteins into the proper lengths needed to allow viable virions to assemble and bud out from the cell membrane
NuceloSIDE reverse inhibitor Prevent the protease enzyme from cutting HIV proteins into the proper lengths needed to allow viable virions to assemble and bud out from the cell membrane
NuceloTIDE reverse inhibitor Inhibit the action of reverse transcriptase
Non-nucleoSIDE reverse inhibitor Combine with reverse transcriptase enzyme to block the process needed to convert HIV RNA into HIV DNA
Integrase inhibitor Binds with the integrase enzyme and prevents HIV from incorporating its genetic material into the host cell
Treatment for candida Treatment: fluconazole (Diflucan), clotrimazole (Lotrimin), nystatin (Mycostatin); if fluconazole refractory, amphotericin B (Fungizone) 2° Prophylaxi: fluconazole (Diflucan), itraconazole (Sporanox)
Side effects of Drug therapy are Rash, GI symptoms, N & V, Diarrhea, Headache, Malaise, Lactic Acidosis, Hepatotoxicity, Hyperglycemia, Fat maldistribution, lipodystrophy
Overall nursing care plans are encourage health promotion, manage health problems/ infections caused by HIV/, maximize quality of life (rx's financial family), discuss end of life issues
How to promote immune system planning Adhere to drugs Promote healthy life Prevent OIs/STI’s Prevent transmission- condoms, PrEP, ART moral support relationships Maintain activity living with disease, death, and spirituality
What is PrEP prophylaxis drugs for not transmitting the disease- 2 pills are taken- high risk individuals tenofovir and emtricitabine
What is the nursing collaborated care? Gather baseline data Education about spectrum of HIV, treatment, preventing transmission, improving health, and family planning Decrease viral load Maintain/raise CD4+ counts Delay HIV-related symptoms and opportunistic infections
Created by: matthew0116