HIV Transmission and Prevention

HIV Transmission

• HIV transmits through direct human-to-human contact via infected blood, semen, vaginal secretions, and breast milk
• HIV cannot transmit through kissing, hugging, insect bites, or casual contact
• Sexual intercourse whether vaginal, anal, or oral can transmit HIV
• Exposure to contaminated blood products like shared needles can transmit HIV
• High correlation exists between drug use and unsafe sexual practices
• Tattooing where equipment is not sterilized, or cultural rituals, like tatau and moko can transmit HIV
• Sterilize all equipment, use gloves, and appropriate PPE to prevent transmission during such procedures
• Accidental needle sticks require immediate notification and follow-up
• Post-exposure prophylaxis (PEP) treat percutaneous, mucous membrane, or non-intact skin exposure

HIV Prevention

• Community education on modes of transmission
• Education about safe sex including proper condom use
• Education about Pre-exposure prophylaxis (PrEP) for high-risk populations
• PrEP is available if patients choose to participate in condomless sex with a partner whose HIV status is unknown
• PrEP is available if the sex partner has a detectable viral load, recent bacterial STI, injects drugs with shared needles, participates in survival or transactional sex, and/or desires to conceive with a partner who is HIV positive

HIV Nursing Management: Assessment

• Look for signs of infection
• Look for drastic changes in weight
• Monitor CD4 count to indicate immune status
• Monitor viral load indicate risk for transmission/progression to AIDS
• Assess patient's adherence to ART
• Assess TB status
• Assess immunization status
• Monitor for depression

HIV Nursing Management: Actions/Education

• Use universal precautions
• Educate patients about importance of adherence to ART and knowing their viral load
• Educate patients about nutritionally dense foods and small, frequent meals
• Provide emotional support and Social Services Referral
• Educate about high-risk behaviors and infection control precautions at home
• Educate about signs and symptoms to report to their provider

Rheumatoid and Osteoarthritis

• Obesity single most modifiable risk factor for Osteoarthritis
• Morning stiffness lasts less than 30 minutes for Osteoarthritis
• Osteoarthritis typically has no symmetrical joint involvement
• Osteoarthritis typically involves large weight-bearing joints
• Osteoarthritis involves no systemic organ involvement
• Osteoarthritis can cause Heberden's and Bouchard's nodes
• Rheumatoid Arthritis is an autoimmune inflammatory disease
• With Rheumatoid Arthritis morning stiffness lasts more than 30 minutes
• Rheumatoid Arthritis typically has symmetrical joint involvement
• All joints may be involved in Rheumatoid Arthritis
• Rheumatoid Arthritis could have systemic organ involvement (lungs, heart, spleen, anemias)
• Rheumatoid Arthritis can result in Swan-neck and Boutonniere deformity in hands

Rheumatoid and Osteoarthritis: Nursing Management

• Pain is greater with activity but physical activity prescribed to increase Joint mobility and reduce skin breakdown for Osteoarthritis
• Monitor intake of analgesics and anti-inflammatory meds while checking renal impairment and bleeding precautions w/excessive use of NSAIDs for Osteoarthritis
• Use ice and/or heat to treat muscles for Osteoarthritis
• Monitor joint pain and mobility to ensure med regimen effectiveness for Rheumatoid Arthritis
• Promote adherence to treatment plan to delay disease progression (immunosuppression therapy in these patients) for Rheumatoid Arthritis
• Monitor for signs/symptoms of infection for Rheumatoid Arthritis
• Promote maintaining current vaccines for Rheumatoid Arthritis

Stroke

• Review class slides from Wednesday for Stroke
• Identify primary Risk Factors and previous TIAs for stroke
• Differentiate clinical manifestations of Left-and Right-sided Stroke (Brain Injury/Brain Attack)
• Review terminology

Neuro Conditions

• All presented disorders affect the nervous system, but each one hits a different target
• Parkinson's is characterized by dopamine deficiency and movement issues: tremors, rigidity, and slow steps
• Multiple Sclerosis is an autoimmune response, where body attacks the myelin in brain and spine: vision problems, balance issues, and flare-ups appear
• ALS is all motor-progressive muscle weakness, but the mind stays sharp
• GBS moves fast: feet tingling progressing to to respiratory failure and follows closely behind infection
• Myasthenia Gravis includes fluctuating weakness, face ptosis, weak chewing, and risk of crisis

Symptoms to know for Neuro Conditions

• Parkinson's = tremor + slow movement
• MS = visual issues + ataxia + fatigue
• ALS = muscle weakness + speech/swallowing problems
• GBS = ascending paralysis + potential for respiratory distress
• MG = weakness worsens with activity, especially face and eyes

Nursing Priorities for Neuro Conditions

• For ALS and GBS watch the airway
• For MS and Parkinson's promote falls prevention & increase function
• For MG aim for aspiration risk & timing of meds (meds must be taken at regular intervals)

Parkinson's Disease

• A progressive neurodegenerative disorder affecting movement due to dopamine depletion in the brain
• Resting tremors (pill-rolling), muscle rigidity, bradykinesia, shuffling gait, postural instability, late-stage dementia are key signs and symptoms
• Loss of dopamine-producing neurons in the substantia nigra leads to impaired motor control
• Treatments & Medications involved Levodopa/carbidopa (increases dopamine): physical and occupational therapy promoting fall prevention strategies
• Monitor for fall risk, swallowing difficulty, medication effectiveness, and mobility needs
• Encourage mobility, medication adherence, safety at home, and high-fiber diet for constipation

Multiple Sclerosis

• A chronic autoimmune disorder that damages the myelin sheath around nerves in the CNS
• Blurry vision, diplopia, muscle spasticity, ataxia, fatigue, bowel/bladder dysfunction, and emotional lability are Key Signs & Symptoms
• Immune system attacks myelin slowing nerve transmission resulting in intermittent flare-ups and remissions
• Treatments & Medications: Corticosteroids for exacerbations; immunomodulators (e.g., interferon beta) treat symptoms
• Promote rest, avoid triggers (heat, stress), assist with ADLs during flare-ups, bladder training
• Balance activity, remain rested and cool, adhere to treatment, and plan for flares

Amyotrophic Lateral Sclerosis (ALS)

• A progressive neurodegenerative disease affecting motor neurons causes muscle weakness and atrophy
• Muscle weakness, dysarthria, dysphagia, spasticity and respiratory failure in later stages are Key Signs & Symptoms:
• Motor neurons degenerate causing muscle atrophy and paralysis, while sensory and cognition remain intact
• Riluzole slows progression: supportive respiratory care and a PEG tube used for nutrition as needed
• Monitor for aspiration, respiratory effort, need for ventilation, and communication needs
• Advance directives, safety with feeding, conserve energy, and increased use of communication aids

Guillain-Barre Syndrome

• An acute autoimmune condition causing demyelination of peripheral nerves, often following infection
• Paresthesia, ascending paralysis, areflexia, facial weakness, respiratory muscle paralysis, and autonomic instability are Key Signs & Symptoms
• Immune attack on peripheral myelin following infection leads to nerve conduction block and paralysis
• IVIG or plasmapheresis; supportive care; respiratory monitoring; pain control are Medicines & treatments
• Frequent respiratory assessment, monitor autonomic function (BP, HR), prevent complications of immobility
• Monitor breathing closely and prepare for possible intubation, reassure all patients to recover fully

Myasthenia Gravis

• A chronic autoimmune that causes fluctuating weakness of voluntary muscles, especially facial and respiratory
• Ptosis, diplopia, weak voice, difficulty chewing/swallowing, worse at end of day are Key Signs & Symptoms, especially risk for myasthenic crisis
• Antibodies attack acetylcholine receptors at neuromuscular junction reducing muscle contraction
• Assess for respiratory muscle weakness, aspiration risk, and schedule meds before meals
• Teach signs of crisis, take meds on time, eat when energy is highest, and avoid illness/stress

General Testing Guidance

• Focus on the data provided, and do not read into or bring into!
• Base responses on the provided information, and NOT a diagnosis!
• Look for strategic words to guide your answer
• Determine if the question is a positive or negative inquiry
• Use the elimination method
• Reread the question for the correct answer