Immunity, HIV/AIDS

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Questions and Answers

Which of the following is considered a hallmark opportunistic infection in AIDS patients?

Tuberculosis

Strep throat

Pneumocystis pneumonia (correct)

Hepatitis

What percentage of individuals with HIV infection are estimated to be unaware of their condition?

25% (correct)

10%

40%

50%

What is the most common cancer associated with AIDS?

Non-Hodgkin lymphoma

Skin melanoma

Lung cancer

Kaposi sarcoma (correct)

Which opportunistic infection is characterized by painless, white, raised lesions on the tongue?

Oral hairy leukoplakia Signup and view all the answers

When is an individual diagnosed with AIDS according to CDC criteria?

CD4/T-cell count below 200 Signup and view all the answers

What does the concept of immunity primarily refer to?

The body's physiological response to protect against foreign substances Signup and view all the answers

Which of the following is NOT a common manifestation of AIDS?

Skin rashes Signup and view all the answers

Which statement accurately describes the transmission of HIV?

HIV can be transmitted through sharing needles Signup and view all the answers

What typically happens to the viral load as CD4+ T cell count decreases?

Viral load increases Signup and view all the answers

What is the primary purpose of nonnucleoside reverse transcriptase inhibitors (NNRTIs)?

Inhibit reverse transcriptase Signup and view all the answers

What is a primary role of a nurse in managing patients with HIV?

To facilitate diagnostic tests and anticipate complications Signup and view all the answers

What is a significant advantage of highly active antiretroviral therapy (HAART)?

It can help delay HIV progression Signup and view all the answers

What type of hypersensitivity reaction is associated with Systemic lupus erythematosus (SLE)?

Hypersensitivity III Signup and view all the answers

Which of the following characteristics are associated with Type I hypersensitivity reactions?

Immediate allergic reactions often involving IgE Signup and view all the answers

Which drug is an example of an entry inhibitor (EI)?

Enfuvirtide Signup and view all the answers

What is the main function of leukocytes in the immune system?

Attack and destroy foreign substances Signup and view all the answers

What percentage of HIV/AIDS cases in the U.S. are accounted for by adults over age 50?

24% Signup and view all the answers

What is a recommended practice for managing medications in HIV therapy?

Consult with a pharmacist regularly Signup and view all the answers

Which type of leukocyte is primarily involved in acute inflammation?

Neutrophils Signup and view all the answers

How does nutrition impact the immune response?

Certain nutrients can enhance immune responses Signup and view all the answers

What is the goal of drug therapy for HIV patients in terms of CD4+ counts?

Increase them to levels above 200 Signup and view all the answers

What is the purpose of Pre-Exposure Prophylaxis (PrEP)?

To prevent HIV infection in high-risk individuals Signup and view all the answers

Which of the following describes the pathophysiology of untreated HIV infection?

It causes a progressive decline in immune function Signup and view all the answers

Which of the following correctly describes the composition of leukocytosis?

Greater than 10,000 cells/mm3 Signup and view all the answers

What action should a healthcare provider take immediately after a needle stick exposure to body fluids?

Wash the area with soap and water and report immediately Signup and view all the answers

What role do memory cells play in the immune response?

They remain inactive until re-exposure to the same antigen. Signup and view all the answers

Which principle is essential for patient-centered, evidence-based nursing care?

Care should be tailored to meet individual patient needs Signup and view all the answers

What major adverse effect may result from less than perfect adherence to HIV medication?

Drug resistance Signup and view all the answers

What is a key consideration in patient teaching for those experiencing HIV?

Adjusting the information based on social and cultural factors Signup and view all the answers

What is a primary characteristic of acquired immunity?

It requires exposure to pathogens to develop. Signup and view all the answers

Which method is used to confirm positive results from rapid HIV-antibody tests?

Western blot test Signup and view all the answers

What is a potential outcome of effective HIV therapy?

Delayed progression of HIV Signup and view all the answers

What physiological role do eosinophils play in the immune system?

They are involved in allergic reactions and parasitic infections. Signup and view all the answers

Which scenario increases the risk of HIV transmission?

Having a sexual experience with another person Signup and view all the answers

How long should post-exposure prophylaxis treatment be administered after an exposure incident?

4 weeks Signup and view all the answers

Which of these statements about HIV screening is true?

Rapid diagnostic tests provide immediate results but should be confirmed Signup and view all the answers

Which factor can negatively impact the health of the immune system?

Chronic stress Signup and view all the answers

What role do standard precautions serve in healthcare?

To minimize the risk of transmission of infections during patient care Signup and view all the answers

Why might an ELISA test yield a negative result early in HIV infection?

The body's immune response has not yet produced antibodies Signup and view all the answers

Which of the following is a key goal for care in managing chronic diseases?

Adopting a healthy lifestyle Signup and view all the answers

What is essential for effective nursing management when prevention fails?

Early intervention Signup and view all the answers

Which action is part of promoting effective coping for patients?

Building a social support network Signup and view all the answers

What should be included in teaching to address knowledge deficits for a patient with HIV?

Guidelines for safer sex practices Signup and view all the answers

Which side effect is commonly associated with HIV and its treatments?

Diarrhea Signup and view all the answers

What type of diet is recommended to support the immune system of an HIV patient?

High-protein and high-kilocalorie diet Signup and view all the answers

According to Ohio law, what must an individual who knows their HIV positive status do prior to engaging in sexual activities?

Inform the other person of their status Signup and view all the answers

What is a focus area for nursing care during disease management?

Fostering beneficial relationships Signup and view all the answers

What is a sign that the nutritional intake is adequate for an HIV patient?

Remains free from secondary infections Signup and view all the answers

What should be prioritized when establishing a plan of care with a patient?

Using patient input Signup and view all the answers

Study Notes

Immunity

Immunity is the body's physiological response to protect against foreign substances/antigens.

Course Outcome

Describe safe, patient-centered, evidence-based nursing care for adults at a basic level, guided by the Caritas philosophy.
Discuss critical thinking and clinical reasoning to provide quality patient care.
Describe effective communication with patients and interprofessional collaborative practice members.

Competency

Define patient-centered, evidence-based care using the nursing process.
Discuss factors creating a culture of safety in caring for patients with common health alterations.
Discuss health promotion, health maintenance, illness/injury prevention, and healing facilitation.
Describe patient teaching principles that reflect developmental, ethnic, social, and cultural considerations.

Competency (Page 4)

Discuss critical thinking strategies for prioritizing basic elements of patient care during nursing process implementation.
Discuss critical thinking strategies used when making clinical judgments.
Discuss the roles of interprofessional collaborative practice members.

Concept of Immunity

The human body is constantly threatened by foreign substances, infectious agents, and abnormal cells.
The immune system's function is to protect the body from foreign antigens, identify and destroy harmful cells, remove cellular debris, and differentiate host from foreign tissue.

Immunity (Page 13)

Immunity helps to limit tissue damage when the inflammatory process cannot.
Immunity is the body's natural or induced response to infection and its associated conditions.

Healthy Immune Systems

Sunshine, exercise, healthy food, hydration, relaxation, and sleep boost the immune system.

HIV/AIDS Unit Outcomes (Page 6)

Discuss the interplay of rest, sleep, nutrition, hydration, and the immune response.
Explain how the human immunodeficiency virus (HIV) is transmitted.
Describe the pathophysiology of HIV infection.
Discuss clinical manifestations and complications of untreated HIV infection.
Identify the CDC diagnostic criteria for acquired immunodeficiency syndrome (AIDS).

HIV/AIDS Unit Outcomes (Page 7)

Describe patient teaching to reflect developmental, ethical, social, and cultural considerations for patients with HIV.
Describe the nurse's role in facilitating diagnostic tests for HIV infection.
Discuss nursing and collaborative management of HIV-infected patients.

Unit Outcomes (Page 8)

Discuss the nurse's role in anticipating complications resulting in opportunistic infections associated with AIDS.
Discuss evidence-based health information to provide patient and family education to reduce HIV transmission.

Hypersensitivity Reaction (Page 9)

Compare and contrast humoral and cell-mediated effects on antigens.
Differentiate among the four types of hypersensitivity reactions.

Hypersensitivity (Page 10)

Discuss basic collaborative and nursing management of patients with hypersensitivity reactions, including Type I (allergic), Type II (hemolytic transfusion), Type III (systemic lupus erythematosus), and Type IV (purified protein derivative).
Discuss the nursing process used in caring for individuals experiencing systemic lupus erythematosus.

Physiology Review (Leukocytes) (Page 16)

Leukocytes, or white blood cells, are primary immune cells derived from stem cells in bone marrow.
Their role is to attack and destroy foreign substances.
They can move through tissue spaces.
Normal counts range from 4,500 to 10,000 cells/mm³. Leukocytosis—a count higher than 10,000/mm³—indicates infection.

Leukocytes (Page 17)

Leukocytes are categorized as granulocytes (eosinophils, basophils, neutrophils) or agranulocytes (lymphocytes, monocytes).

Important Physiological Review (Page 18)

Neutrophils kill bacteria, fungi, and foreign debris.
Monocytes clean up damaged cells.
Eosinophils kill parasites, cancer cells and are involved in the allergic response
Lymphocytes help fight viruses and make antibodies.
Basophils are involved in the allergic response.

Physiology Review (Lymphocytes) (Page 19)

Lymphocytes, a type of leukocyte, include memory cells that stay inactive for years.
They rapidly activate when encountering the same antigen.
Lymphocytes are responsible for acquired immunity.

Lymphocytes (Page 20)

Lymphocytes are a type of leukocyte.
Lymphocytes are further divided into T-cells and B-cells.
T-cells mature in the thymus and are involved in attacking cells from the inside.
B-cells mature in bone marrow and are involved in attacking cells from the outside.

Antigens (Page 22)

Antigens are substances that the body recognizes as foreign, eliciting an immune response.
They are typically large protein molecules provoking a specific immune response.

Antibodies (Page 23)

Antibodies are immunoglobulins produced by lymphocytes in response to antigens.
Antibodies react specifically to one antigen.
They bind to antigens and inactivate them.

Antibodies (Page 24)

Antibodies, or immunoglobulins, mediate the immune response.
IgM antibodies are the first to appear in immune response.
IgG is the most abundant antibody, controlling infection.
IgE increases with allergic reactions, including anaphylaxis.
IgA protects mucous membranes from invaders.

Organs of Immunity (Page 25)

Organs involved in immunity include tonsils and adenoids, lymph nodes, lymphatic vessels, thymus, spleen, Peyer's patches, and bone marrow.

Normal Immune Response (Page 26)

Central lymphoid organs such as the spleen filter blood, and the thymus gland matures T-lymphocytes. Bone marrow produces red blood cells, white blood cells, and platelets.

Immune System Response (Page 27)

Foreign bodies trigger the immune system response, which involves an antibody army surrounding the foreign body. The body will remember the foreign antigen and respond similarly in future attacks.

Impact of Aging on the Immune System (Page 28)

Older adults may demonstrate declining immune functions and a higher susceptibility to infections and illnesses.

Older Adult Considerations (Page 29)

Internal factors affecting older adults include chronic illnesses, decreased immune response, lowered resistance to infection, reduced response to immunizations, and increased risk of auto-antibodies.

Impact of Reduced Immunity in Older Adults (Page 30)

Older adults frequently have increased incidences of tumors, are more susceptible to infections, and demonstrate increased autoantibodies.
Immunity in older adults is affected by declining cell-mediated immunity, shrinking thymus glands, reducing immunoglobulin levels, and decreased antibody response to immunizations.

HIV/AIDS (Page 32)

HIV is a retrovirus that converts RNA to DNA.
It infects cells by binding to receptors and entering the target cell, commonly T-helper cells.
AIDS (Acquired Immunodeficiency Syndrome) is caused by HIV-1 and/or HIV-2.

HIV Pathophysiology (Page 34)

HIV is a ribonucleic acid (RNA) virus.
It infects T-helper cells.

Pathophysiology and Etiology of AIDS (Page 35)

HIV-1 and HIV-2 cause AIDS by destroying the body’s ability to fight infection.
It spreads through bodily fluids like blood, semen, vaginal fluids, cervical secretions, and breast milk. Direct contact with contaminated blood (e.g., needle sharing) or blood transfusions are also transmission routes.

Pathophysiology and Etiology (Page 37)

Initial infection: high viral loads present in the blood for 2-3 weeks, enhancing the risk of transmission.
Antibodies become detectable 3–3 months following infection.

HIV Infection Stages (Page 38)

HIV infection stages include acute, asymptomatic, symptomatic, and AIDS.

Acute Infection (Page 39)

Flu-like symptoms (lasting 1-2 weeks) accompanying seroconversion.
Fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle/joint pain, and a diffuse rash are common.
Seroconversion is when the body changes from HIV-negative to HIV-positive.

Asymptomatic Infection (Page 40)

A 10-15-year latency period potentially exists between HIV infection and AIDS diagnosis.
The patient shows few noticeable symptoms, but CD4+ T cell counts and low viral loads remain normal.

Symptomatic Infection (Page 41)

CD4+ T cells decline to 200-500 cells/µL from the normal range of 800-1200 cells/µL.
Viral load increases.
HIV advances to a more active state, and symptoms such as opportunistic infections, cancers, and neurological manifestations emerge, indicating disease progression.

Opportunistic Infections (Page 42)

Opportunistic infections appear when the immune system is weakened, as seen in AIDS. Examples include Pneumocystis pneumonia, oral candidiasis, oral hairy leukoplakia, and cytomegalovirus.

Oral Candidiasis (Page 45)

A fungal infection affecting the mouth.

Oral Hairy Leukoplakia (Page 46)

A painless, white, raised patch on the tongue, caused by Epstein-Barr virus and associated with AIDS/HIV.

Kaposi Sarcoma (Page 47)

A cancer associated with AIDS.
Caused by herpes virus. Initial symptoms are painless. But it may become painful, obstructing organ function and causing bleeding and impairing gas exchange in the lungs.

AIDS (CDC Criteria) (Page 49)

The CDC defines AIDS as an individual whose CD4/T-cell count falls below 200 and demonstrates opportunistic infections in the trachea, bronchi, lungs, or other areas beyond the oral cavity.

Timeline for Untreated HIV Infection (Page 50)

The timeline depicts the progression of untreated HIV infection from acute infection to HIV-positive status, asymptomatic infection, symptomatic infection, and ultimately, AIDS.
HIV antibody testing becomes positive within 3 weeks to 3 months following infection.

Human Immunodeficiency Virus (HIV) Infection (Page 51

Transmission through unprotected sexual intercourse, contact with blood products, and from mother to child (perinatal).
Screening involves enzyme immunoassay (EIA), rapid HIV antibody tests, and Antibody/Antigen tests.
The window period refers to 2 months between HIV infection and antibody detection.
AIDS (Acquired Immunodeficiency Syndrome) is characterized by CD4+ T-cell counts of 200 cells/µL or below or opportunistic infections.

Overview of HIV Epidemic (Page 52)

An estimated 1 in 4 individuals with HIV are unaware of their infection.

HIV Testing and Counseling (Page 53)

HIV testing is essential for determining infection.
The CDC recommends testing for all individuals regardless of risk assessment.

At-Risk Groups (Page 54):

HIV risk factors include sex, gender, children, elderly, race, economics (city/rural/suburb), sexual partner choices, and other potentially unknown factors.

At-Risk Groups (Page 55)

Sex, gender, children, elderly, race, economics (City/rural/suburb), considerations in sexual partner choices, and other factors are risk groups for HIV infection.

Lifespan Considerations (Page 56)

Approximately 24% of HIV/AIDS cases in the U.S. involve adults aged 50 and over.
Older adults experience declining immune function, increasing their susceptibility to HIV infection and related illnesses. Newly single older adults may prioritize safety measures for sexual health less than others.

Prevention (Page 57)

No immunization exists for HIV.
Education for prevention is critical.

Pre-Exposure Prophylaxis (PrEP) (Page 58)

PrEP is a daily medication for HIV prevention.
It is recommended for individuals at high risk and significantly reduces the risks of sexually acquired (90%) and injection drug-acquired (70%) HIV.

HIV Testing and Counseling (Page 59)

HIV testing is the primary method for diagnosing HIV infection.
Healthcare providers are obligated by the Centers for Disease Control (CDC) to recommend HIV testing for every patient.

Prevention for Healthcare Providers (Page 60)

Standard precautions include treating all patients as if they are infectious and using appropriate personal protective equipment (e.g. gloves).
Appropriate safety measures are essential, particularly when handling potentially infectious materials like bodily fluids.

Post-Exposure Prophylaxis for Healthcare Providers (Page 61)

Post-exposure prophylaxis (PEP) is immediate treatment for individuals who have had exposure.
The treatment must begin within 72 hours of the exposure.
Healthcare providers must report all exposures for immediate professional treatment and counseling.

Post-Exposure Prophylaxis for Healthcare Providers (Page 62)

Exposure from significant body fluid contact from a dirty needle stick or other exposure requires immediate, thorough washing with soap and water.
This must be followed by reporting the incident in order to initiate timely treatment and counseling as well as PEP.

Post-Exposure Prophylaxis Healthcare Providers (Page 63)

Post-exposure prophylaxis (PEP) involves using three of the four antiretroviral drugs for four weeks following possible exposure.

Testing for HIV: Diagnostics (Page 64)

Rapid diagnostic tests for HIV are widely used because they provide immediate results for assessing HIV infection.
Results must be confirmed; however, as many patients do not return for follow-up visits.

Diagnostic Tests (ELISA) (Page 65)

The Enzyme-Linked Immunosorbent Assay (ELISA) tests for HIV antibodies.
The ELISA may be negative early after infection—the window period—because it needs to detect antibodies.

Diagnostic Tests (Page 66)

Western blot testing confirms ELISA results; it's more reliable but more expensive and takes longer.
HIV viral load tests measure the amount of actively replicating HIV.
The Complete Blood Count (CBC) includes WBC and CD4 cell counts, which assess overall health and CD4 cells not infected.

HIV Test Results (Page 67)

A positive HIV test mandates immediate referral to HIV treatment and other related healthcare services.
A negative result requires further assessment of sexual and drug use behaviors, and prevention strategies should be discussed (low v high risk).

Drug Classifications (Page 68)

Drug classes for HIV treatment include nucleoside, non-nucleoside, and nucleotide reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs), and entry inhibitors (Els).

Drug Therapy (NRTIs) (Page 69)

Nucleoside reverse transcriptase inhibitors (NRTIs) inhibit viral reverse transcriptase activity to prevent viral DNA integration.

Drug Therapy (PIs) (Page 70)

Protease inhibitors (PIs) interfere with viral protease enzyme function for viral assembly and maturation, preventing the creation of immature viral particles.
Major side effects include increased cholesterol and blood glucose.

Drug Therapy (NNRTIs) (Page 71)

Nonnucleoside reverse transcriptase inhibitors (NNRTIs) may be used in combination with nucleoside reverse transcriptase inhibitors.

Drug Therapy (Els) (Page 72)

Entry inhibitors (Els) prevent HIV from entering target cells, improving CD4 counts and reducing viral loads.

Drug Therapy (Combination Therapies, HAART) (Page 73)

Combination therapies (e.g., Highly Active Antiretroviral Therapy—HAART) reduce drug resistance.
They also increase the likelihood of decreasing viral loads and symptoms, although adverse reactions are common.

Drug Therapy: Main Goals and Outcomes (Page 74)

Reduced viral load and increased CD4+ counts are major drug therapy goals.
Treatment outcomes include delayed HIV progression and delayed opportunistic diseases.

Collaboration Among Healthcare Providers (Page 75)

Collaboration amongst healthcare providers (like pharmacists) is critical.
This necessitates coordinated care, regular consultations, and utilizing a single pharmacy for prescription-filling.

Nursing Management (Assessment) (Page 77)

Evaluation questions relate to shared needles, syringes, other injection equipment with another person's use, sexual experiences, and if they have had a sexually transmitted infection (STI).

Diagnosis (Page 78)

Nursing diagnoses for HIV/AIDS patients may include: ineffective coping, compromised family coping, risk for infection, anxiety, fear, deficient knowledge, and impaired gas exchange.

Planning and Collaboration (Page 79)

Prevention education is crucial.
Nursing care modifications are needed during the different stages of disease progression: patient counseling with a new diagnosis, continued psychosocial support, managing direct care needs, and management at home.

Nursing Management: Planning (Page 80)

Patient care goals emphasize compliance with drug treatment, adopting a healthy lifestyle, positive relationships, spiritual well-being in regard to life and death considerations, and coping with the disease and treatment.

Disease and Drug Side Effects (Page 81)

Common side effects of HIV/AIDS medications include anxiety, fear, depression, diarrhea, peripheral neuropathy, pain, nausea/vomiting, and fatigue.

Nursing Management: Implementation (Page 82)

Primary prevention focuses on health promotion.
When primary prevention measures fail, early intervention and establishment of care plans are vital. This requires building rapport with the patient.

Implementation: Promote Effective Coping (Page 83)

Strategies for promoting effective coping include building a strong social support system, providing uninterrupted time for patient interaction, and encouraging interactions with social networks. Support should be provided for patient interactions with significant others.

Implementation: Address Knowledge Deficits (Page 84)

Extensive patient education regarding safer sex practices, nutrition, rest, exercise, stress reduction, lifestyle changes, maintaining a positive outlook, infection prevention/transmission, importance of regular follow-ups, signs/symptoms of opportunistic infections, medication adherence, and adverse effects is crucial.

Implementation: Promote Adequate Nutrition (Page 85)

Dieticians may provide patients with high protein, high-calorie diets.
Patients should be encouraged to eat small, soft portions of food and potentially provided with supplemental nutritional support (enteral feedings or supplements such as Ensure).
Patients should be helped with maintaining appropriate oral hygiene.

Evaluation (Page 86)

Evaluation of HIV/AIDS patient care focuses on treatment adherence, preventing secondary infections, nutritional health (preventing malnutrition), and evidence of successful coping strategies (or improved coping ability).

HIV and Ohio Law (Page 87)

Each state has laws requiring HIV status disclosure.
Ohio law mandates HIV-positive individuals to disclose their status to sexual partners before engaging in sexual activity.

World Health Organization HIV/AIDS (Page 88)

Effective antiretroviral therapy (ART) is the only effective method for controlling and reducing HIV transmission.
Effective HIV therapy leads to prolonged and healthy life spans for those with the virus.

People with HIV and Undetectable Viral Load (Page 89)

Effective HIV treatment (ART) significantly reduces HIV viral load to undetectable levels, preventing transmission.
"Undetectable = Untransmittable (U=U)" serves as a core public health messaging campaign.
HIV infection is incurable, ART must be continued to maintain undetectable levels.