Understanding HIV/AIDS: Transmission and Impact

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HIV/AIDS

• HIV attacks the body's immune system, and there is no effective cure.
• AIDS is the last stage of conditions caused by HIV infection.
• HIV is a primarily sexually transmitted disease (STD), transmitted through anal, vaginal, and oral sex.
• AIDS is a chronic, potentially life-threatening condition caused by HIV, damaging the immune system and interfering with the body's ability to fight infection.
• HIV is a sexually transmitted infection (STI) that can also be spread by contact with infected blood, illicit injection drug use or sharing needles, and from mother to child during pregnancy, childbirth, or breastfeeding.
• Medications can control HIV/AIDS, preventing disease progression, and antiviral treatments reduce AIDS deaths worldwide; international organizations work to increase access to preventive measures and treatment in resource-poor countries.

5 Prime Modes of Transmission

• Unprotected penetrative sex between men - anal sex
• Unprotected heterosexual intercourse
• Injection drug use
• Unsafe blood and blood by-products
• Mother to child spread during pregnancy, delivery, and breast feeding

Other Causes

• HIV is transmitted through certain bodily fluids via sexual contact, blood contact, or from mother to child during pregnancy, childbirth, or breast-feeding, and sharing needles.
• Risk factors: unprotected sex with an infected person, multiple partners, other STIs, and sharing IV drug needles.

Stages of HIV Infection

• Stage 1 (Acute HIV infection): Occurs 1-2 weeks after infection, presenting with nonspecific symptoms like low-grade fever, headache, malaise, rash, and lymphadenopathy.
• Stage 2 (Asymptomatic infection): Shows no symptoms; infection remains controlled until the immune system becomes compromised, leading to Stage 3.
• Stage 3 (Symptomatic infection): Years of viral activity cause damage to the immune system.
• Stage 4 (AIDS): Major opportunistic infections and cancers develop due to severe damage to the immune system.

Symptoms of HIV/AIDS Include

• Fatigue
• Fever
• Malaise
• Weight loss
• Chronic diarrhea
• Swollen lymph glands, mainly on the neck
• Muscle aches and joint pain
• Sore throat
• Skin rashes and bumps
• Headache
• Soaking night sweats
• White spots or unusual lesions on the tongue or in mouth

Prevention

• Use condoms during sex.
• Always use sterile needles.
• Avoid sharing razors.
• Watch out for blood stain needles or metal objects.
• Abstinence is a method
• Be loyal
• Condom use
• Do not do drugs.
• Education

Complications of HIV/AIDS

• Infections: tuberculosis (TB), cytomegalovirus, candidiasis, cryptococcal meningitis, toxoplasmosis, cryptosporidiosis.
• Cancers: Kaposi's sarcoma, lymphomas.
• Other syndromes: wasting syndrome, neurological complications, kidney disease.

Pathophysiology

• HIV is commonly transmitted via unprotected sexual activity, blood transfusions, hypodermic needles, and from mother to child.
• The virus replicates inside and kills T helper cells, required for adaptive immune responses, leading to an initial flu-like illness and a latent phase.
• Progression to AIDS occurs when the CD4 lymphocyte count falls below 200 cells/ml of blood, resulting in cell-mediated immunity deficiency and increased susceptibility to opportunistic infections and certain cancers.

Common Tests and Procedures

• Blood test: Low CD4 count indicates HIV infection.
• Viral load: Measures the amount of HIV in the blood.
• Drug resistance test: Checks if the virus is resistant to certain drugs.
• Laboratory examination: Checks for tuberculosis, hepatitis, toxoplasmosis, STIs, liver or kidney damage, and urinary tract infection.
• Nucleic acid amplification test: Detects the genetic material of the causative virus.

ELISA Test

• The enzyme-linked immunosorbent assay (ELISA), detects HIV antibodies and antigens in the blood.
• The ELISA test is typically the first test ordered by a healthcare provider, followed by an HIV differentiation assay to confirm HIV infection; a provider may also order an HIV genetic material detection test.

Substance Abuse

• Commonly abused substances during pregnancy include cocaine, amphetamines, opioids, marijuana, ethanol, tobacco, caffeine, alcohol and toluene-based solvents.

• Substance abuse, or drug abuse, is using a drug in amounts or methods harmful to the individual or others, and is a form of substance-related disorder.

• It is defined as a pattern of harmful use of any substance for mood altering purposes.

• It can be harmful if repeated.

• From the mother to her fetus - through the placenta.

• Alcohol consumption or any kind of substance abuse is the leading cause of preventable birth defects in the fetus.

• Risk for: miscarriage, stillbirth, mental retardation, and fetal abnormalities

• A newborn will have low birth weight and may have SUDDEN INFANT DEATH SYNDROME (SIDS)

Causes/Etiology

• Causes of substance abuse include genetic or personality traits, peer pressure, seeking fun and confidence, family discordance/economic stress, domestic violence, poor interpersonal relationships, social anxiety, depression, PSTD, or alleviating effects of substance withdrawal.
• Prescription drug abuse, illegal drug abuse, alcohol abuse, solvent abuse, legal high abuse - psychotic drug.

Signs and Symptoms

• Behavioral changes: Sudden mood swings, poor work performance, isolation, having sore jaw, stealing and lying, lack of self-care, lack of confidence and self-esteem.

Physical Changes

• Red, glassy eyes, talkative and hyperactive, shaky and sweating, cold hand, pale skin, poor hygiene, disturbance of sleep

• There will be a weight loss, lack of focus

• Drug addiction, also called substance use disorder, is a disease.

• It affects a person's brain and behavior and leads to an irritability to control the use of a legal or illegal drug or medicine.

• Substances such as alcohol, marijuana, and nicotine also are considered drugs.

• When you're addicted, you may continue using the drug despite the harm it causes.

• Drug addiction can start with experimental use of a recreational drug in social situations, and, for some people, the drug use becomes more frequent.

• Other people, particularly with opioids, drug addiction begins when someone when they take prescribed medicines or receive them from others who have prescriptions.

• The risk of addiction and how fast you become addicted varies by drug. Some drugs, such as opioid painkillers, have a higher risk and cause addiction more quickly than others.

• As time passes, you may need large doses of drugs to get high.

• Soon you may need the drug just to feel good.

• As your drug use increases, you may find that it's increasingly difficult to go without the drug.

• Attempts to stop drug use may cause intense cravings and make you feel physically ill or withdrawal symptoms.

• Help from health care providers, family, friends, support groups or an organized treatment program can help you overcome your drug addiction and stay drug-free.

• One particular danger of club drugs is the liquid, pill, or powder forms of these drugs available on the street often contain unknown substances that can be harmful, including other illegally manufactured or pharmaceutical drugs.

• Due to the toxic nature of inhalants, users may develop brain damage of different levels of severity and sudden death can occur even if after a single exposure.

• People who are addicted to a drug are more likely to get an infectious disease, such as HIV, either through unsafe sex or by sharing needles with others.

• Drug addiction can lead to a range of both short-long term mental and physical health problems, depending on the drug taken and accidents.

• Drug users are more likely to drive or do other dangerous activities while under the influence, or commit suicide and experience family problems.

• Behavioral changes may cause relationship or family conflict and custody issues.

• Drug use can cause declining performance at work, absenteeism and eventual loss of employment.

Pregnancy and Substance Abuse

• Pregnant and soon to be pregnant females are therefore at increased risk of substance use.
• Prenatal substance use correlates with several harmful consequences for mother and fetus. Tobacco is the most common substance used during pregnancy, followed by alcohol, cannabis, and other illicit substances.
• Excessive alcohol use during pregnancy can result in major body organs birth defect, developmental problems, and damage of multiple brain structures, resulting in lifelong disabilities, and multiple health and social problems for both mother and child.
• Drug use can negatively affect academic performance and motivation to excel in school leading to legal or financial issues

The 5 P's Labor and Delivery Problems and Issues

The 5 P's are:

• Passenger: Fetus malposition and malpresentation
• Passage: Maternal bony pelvis
• Psyche: Mental state/mindset of the mother about labor and delivery process
• Power: Primary uterine contractions
• Placenta: Placental age

Problems Associated with Passenger (Fetus)

• Fetal size
• Fetal presentation or position
• Fetal anomalies
• Multiple pregnancies
• Arrest descent- CPD
• Prolonged active phases

Rotation Abnormalities

• Engagement: Head enters and becomes fixed in the true pelvis
• Descent: First requisite of NSVD
• Flexion: Head meets resistance at the birth canal, rotates at 45 degrees
• Internal rotation: Occiput moves to the symphysis pubis
• Extension: Delivery of the fetal head, "couple of force theory"
• External rotation/restitution: Rotation of head back to its original position Expulsion: Full delivery of the fetus.

Malpresentation

• Breech
• Shoulder presentation- transverse
• Footling

Passage

• Maternal bony pelvis. Woman may experience poor contraction, slow dilation, slow descent, and long labor.

Abnormally Shaped Pelvis

• Gynecoid- ideal, round, shallow, and open
• Android- male pelvis, narrow, shaped like a heart
• Anthropoid- narrow and deep or egg or oval
• Platypelloid- flat pelvis
• Less than 11-12 cm. Normal: 12.5 to 13.5 cm.
• CPD and shoulder dystocia.

Psyche

• Mental state/mindset of the mother about labor and delivery process
• Fear and anxiety
• Labor: A stressful event for most women; perceived threat caused by pain, fear, non-support or personal situation can result in excessive maternal stress and interfere with normal progress.
• Cultural influences: Integrating maternal attitudes; how a particular society views childbirth.
• Expectations and goals: for the labor process; whether realistic, achievable or otherwise
• A pregnant mother's psychologic response to uterine contractions; fear and anxiety affect labor process.

Power

• Primary uterine contractions.
• Involuntary, rhythmical, regular activity of uterine musculature.
• Voluntary: ability of the mother to bear down.
• The purpose is to propel the presenting part downward/forward.
• Effacement of the cervix- thinning out, pulling up, shortening of the cervical canal.
• Dilatation of the cervix- opening, widening, enlarging, increasing in diameter of the cervical OS from 0 to 10cm.

Cesarean Section

• Delivery via an abdominal incision
• Removal of the fetus from the uterus through an incision made into the abdominal wall and uterus

Types of Cesarean Sections

• Primary: refers to the patient's initial experience
• Repeat: refers to any subsequent abdominal deliveries
• Elective: Planned and performed before the onset of labor
• CPD: Cephalopelvic Disproportion- Leading cause of primary cesarean section

Most common

• Previous CS: leading cause of secondary cesarean section
• Contracted pelvis

Indications/Predisposing Factors

• Fetal distress- CPD
• Dystocia- prolonged, painful labor
• Gestational Diabetes Mellitus
• Placenta previa/ abruptio placenta
• PIH
• Postmaturity
• Abnormal fetal presentation and position: breech/transverse lie
• Cord prolapse
• Fetal abnormalities such as Hydrocephalus.
• Pelvic tumor/pelvic fracture that may be an obstruction.
• Large body fetus or MACROSOSMIA- infant that weighs more than 4000 g or 8.8 Ibs or more in birth
• Multiparity- uterine may not be able to hold any more fetus
• Vaginal infection: HIV and Herpes or any STI are untreated.

Types of Incision

• Vertical incision
• A low vertical incision is made in the lower part of the uterus behind the bladder. These incision types are used when the baby is large, transverse (sideways), or for placenta previa and if the scar extends far enough up into the uterus.
• Horizontal/Transverse "Bikini cut" Pfannenstiel Incision: across the abdomen. 1 to 2 inches above the pubic hair-less pain+faster healing, cosmetic appearance

Complications

• Placenta attachment disorders
• Anesthesia complications: CNS Depressant
• Damage to the bladder
• Longer healing would lead to infection.
• Respiratory risks for newborn
• Uterus stretching due to scars will lead to uterine rupture.

Nursing Implementation

• Pre-operative

• Follow regular preparation for abdominal/pelvic surgery

• Secure consent and inform the patient of the purpose of the procedure

• Make sure that all pre-operative orders have been carried.

• History taking- medications/illnesses/family history/history of OB GYNE cases.

• Post-operative -- Ensure a patent airway and prevent respiratory obstruction -- Vital signs monitoring every 15 minutes -- Assist deep breathing and coughing exercises -- Monitor uterine fundus gently to ensure firmness. -- Check the dressing and signs of infection: REEDA. -- Maintain fluid and electrolyte balance. -- Clear liquids after passage of FLATUS- peristaltic activity has returned to normal. -- Monitor passage of urine and stool within 24 hrs POSTOP. -- Provide emotional support and promote bonding.

• Implement strict postoperative care.

• Maintain adequate circulation.

• Prevent infection and thromboembolism.

Neonatal Sepsis

• Immediate treatment with antibiotics is imperative with bacteria going inside the blood stream

Sources of Neonatal Sepsis

• Mother to fetus
• Fetal anomalies
• External forces/environmental- Nosocomial infection (hospital acquired infection)

Neonatal Sepsis, Pathophysiology, and Treatment

• Sepsis is a serious medical condition caused by the body's response to an infection.
• It includes inflammation throughout the body, leading to organ failure, and MAY REACH THE BRAIN.
• The immature immune system of the NEWBORN is the major contributing factor for increased neonatal susceptibility to sepsis. - It can come from bacteria or viruses from an hospital.

Testing and Treating Sepsis in Newborns

• Tests for sepsis in newborns can include blood tests like blood cell counts or blood cultures to identify the bacteria or viruses in the blood.
• Intravenous fluids or antibiotics are given- Oxygen administration may also be necessary

Newborns at Risk for Sepsis

• Prematurity
• Prolonged period between rupture of membranes and delivery (PROM and incompetent cervix)
• Dystocia
• Maternal infection
• Small for gestational age
• Meconium aspiration (when a newborn has swallowed meconium)
• Iatrogenic infected personnel: equipment lead to nosocomial infection

Other causes? risk:

• If the is a mother to have an infection of the amniotic fluid ( a condition known as chorioamnioitis)
• High in the rate with newborns
• The mother may or may not of had a low birth weight ( a risk factor for sepsis)
• If Mothers do not break down enough water, they need PROM (more than 14 hours before the NEWBORN is DELIVERED).
• The mother may not have bacteria? sexually transmitted? It was never treated

Nursing Responsibility for Sepsis

• Monitor and Maintain newborns with dehydration, poor skin turgor, and or oliguria, fever.
• Provide emotional support to mothers
• Provide a good nutrition and provide hydration

Signs/Symptoms of Sepsis

• Increased the temperature of the baby- fever to abnormal
• Hypothermia, skin is irritable
• They have a poor tone and a weak suck
• The baby is know to be more of a weak, and or irritability child

Nursing Responsibilities

• Isolate newborn
• Practice strict handwahsing
• Provide oxygen therapy and respiratory support
• Administer antibiotics
• Keep the newborn warm
• Maintain nutrition and hydration: IVF, daily monitor
• Meet the newborn's emotional needs

Meconium Stained/Aspiration

• Refers to the stool that a newborn passes out. It is made up of ingested materials that are being taken in from the entire moment that the FETUS stays and growing in the uterus until delivery and these are the intestinal epithelial cells, amniotic fluid, lanugo, bile, water, and mucus.
• The unique characteristic of the meconium unlike the later type of feces they can have, is that it appears sticky like tar, it is viscous, and is taking a very dark olive green in color, and the smell is almost odorless.
• Meconium is usually found in a newborns bowels even at the time after birth, although it can also have the chance to be expelled and mixed with the amniotic fluid just before the time of birth, or during the process of labor and delivery, and it is called the amniotic liquor.
• Meconium aspiration occurs when meconium is swallowed by the fetus intrauterine that would cause problems like respiratory distress syndrome.
• Occurs most frequent in post term infants who have decreased amniotic fluid.

Pathophysiology

• Meconium mixes with amniotic fluid, the intrauterine life.
• If something get swallowed by the fetus-it will irritates the airway, which causes more airway problems, and then leads to more problems.

Nursing Management for Meconium Staining

• Observe the signs. And they can make all the different and proper procedures and practices
• There will then have to be Lavage- so that you can keep the baby’s secretions clear and good
• Monitor patients from 48 - 72 hours
• Have the airwaves suctioned and clear

Respiratory Distress Syndrome/Hyaline Membrane Disease (Lungs Compromised)

• Respiratory distress syndrome (RDS) occurs in premature NEWBORN whose lungs are not fully developed.
• The earlier the infant is born, the more likely it is for the newborn to have RDS and to need extra oxygen and help breathing.
• RDS is caused by insufficient surfactant in the lungs.
• Etilogy. By 24 to 36 gestational weeks, surfactant in not mature enough to enalbe to breathe normally outside the fetus. Which causes less protduction of surfactant and lead to breathing difficulty.

Pathophysiology of Respiratory Issues

• An immature lung gives Less production of surfactnat, which causes the baby to not get perfused well or the lungs do not function because their terminal broncioles are collasped or are full

Types of Jaundice

• Acidosis is a condition which is to much acis in th body fluid while alkanos is the complete opposite

Nursing Alert for Respiratory Issues

• You will have to know your stuff

Complications Associated with RDS

• Hypoxia: is the lack or low oxygen
• They will may had blindess due to retrollentilal fibropalasia
• Lung disease which makes it hard to breath even damaged may be caused
• Or it could be acalled an alteclitas lung failure, which can cause the lungs to not get oxygen with leads to other probems such as a collapse lung

Signs and Symptoms of RDS

• High breath very shortly after birth, high fast breath rate and hard to hear

• Apgar of 3 to the 5

• And or the change in color

• A fast diagnosis can only start after the New born is examined, seeing the results of the chest x rays

• Or a blood results test

Hydrocephalus

• Hydrocephalus-roughly means"water in the brain"-the buildup of fluid in the cavities (ventricles) deep within the brain
• The fluid does not flow or get absorbed the way it should from the blood to the fluids that flow in and around the tissues

Purpose of Cerebrospinal Fluid

• Allows the relatively heavy brain to float within the skull.
• Removes waste products of the brain's metabolism
• Flows back and forth between the brain activity and spinal column to regulate pressure on the brain.

Symptoms of Problems

• Seizures? Danger side. In order to not hurt the brain
• Poor muscle turn? Poorly strength
• Be less respsonies? To touches
• A larger head and the spots in the head would be very sofy

Different Types of Hydrocephalus

• Comgetrical, compsenatical, and aquirtical
• These are caused by swelling in the small, open areas of the bring without change in pressure

Hydrocephalus Diagnosis

• Nurological exames
• Sound? To create a wave
• Magentical waves, in orders of your brain CT and series of take by images

Hydrocephalus Complications

• Have or may be a headaches?

Failure to thrive

• Failure to thrive in a child is defined as “lack of expected normal physcial growth.
• May caused and will need to get proper and prootate in the malnutritioned
• A failure to thrive means in illness , to care and provide proper needs

Causese

• Can be used as a severe illness
• Problems in relations or issues that does not seem to be there
• Skin to problems? Ex mapililis

Intussusepetion

• Describes that what the intetsels come in and cause an issue, more comens in illiness, and causes more abdodmemnt

Pathology

• Causes pain relating to the abstructions
• Hard too breath
• A susicpitle? To recive

Diagnosose

• Palpitiatons, and abdomments walls

Bilirubiem

• Jundices? Yes

Risk factors

• Immaturate lever, sepsis
• Women may have all sorts of issues

Treatments

• Early morning sunlight and stop all the brasseated issues