Adult Health HIV & AIDS PDF

HIV & AIDS  HIV--DEFINITION HUMAN IMMUNODEFICIENCY VIRUS DESTROYS THE IMMUNE SYSTEM—PRIMARILY THE T-HELPER CELLS (CD4 CELLS - THESE LYMPHOCYTES COORDINATE THE IMMUNE SYSTEM) PARISITIC (OBLIGATE VIRUS)—CANNOT REPRODUCE ON ITS OWN—USES THE HOST CELL’S DNA STAGE I: INITIAL...

HIV & AIDS  HIV--DEFINITION HUMAN IMMUNODEFICIENCY VIRUS DESTROYS THE IMMUNE SYSTEM—PRIMARILY THE T-HELPER CELLS (CD4 CELLS - THESE LYMPHOCYTES COORDINATE THE IMMUNE SYSTEM) PARISITIC (OBLIGATE VIRUS)—CANNOT REPRODUCE ON ITS OWN—USES THE HOST CELL’S DNA STAGE I: INITIAL INFECTION: MANIFESTATIONS OCCUR WITHIN 2-4 WEEKS OF INFECTION: S/S LIKE FLU, RASH, NIGHT SWEATS, SORE THROAT. RAPID RISE IN VIRAL LOAD LYMPHADENOPATHY PERSISTS THROUGHOUT DISEASE  STAGE II CHRONIC HIV INFECTION PROLONGED AND ASYMPTOMATIC UP TO 10 YEARS OR MORE LYMPHADENOPATHY OVER TIME CD4+ CELLS DESTROYED VIRAL LOAD INCREASES SLOWLY WITHOUT MEDICATIONS WITH MEDICATIONS MAY NEVER PROGRESS TO STAGE III DRAMATIC LOSS OF IMMUNITY BEGINS  STAGE III ACQUIRED IMMUNODEFICIENCY SYNDROME DAMAGE BY HUMAN IMMUNODEFICIENCY VIRUS IS GREAT ENOUGH THAT OPPORTUNISTIC DISEASES (SEE ATI MS BOOK) ARE PRESENT USUALLY OCCURS WHEN CD4 COUNT IS 200MM3 OR LOWER. VIRAL LOAD ELEVATED – VERY CONTAGIOUS FEVER, CHILLS, DIAPHORESIS, SWOLLEN LYMPH NODES, WEIGHT LOSS, WEAKNESS DEATH AVERAGE 1 1/3 YEARS FOLLOWING DIAGNOSIS  TRANSMISSION SEXUAL CONTACT (VAGINAL, ANAL, ORAL): USE OF CONDOMS, ABSTINENCE DIRECT EXPOSURE TO INFECTED BLOOD OR BLOOD PRODUCTS OCCUPATIONAL IV DRUG USE BLOOD PRODUCTS (NOT SIGNIFICANT SOURCE IN US) PRENATAL TRANSMISSION FROM INFECTED MOTHER OR DURING DELIVERY POSTNATAL TRANSMISSION FROM INFECTED MOTHER THROUGH BREASTFEEDING ***THESE ARE THE PROVEN METHODS OF TRANSMISSION  DIAGNOSTIC TESTS NUCLEIC ACID TESTS DETERMINE IF HIV IS PRESENT AND THE VIRAL LOAD (SOONER THAN OTHER TESTS BUT IS EXPENSIVE) USED FOR PROBABLE EXPOSURE NOT ROUTINE SCREENING ANTIGEN-ANTIBODY TESTING DETECTS HIV ANTIBODIES AND ANTIGENS (VENIPUNCTURE) BUT A FINGER STICK IS AVAILABLE IS RAPID TEST HIV ANTIBODY TEST (ORAL OR BLOOD) AVAILABLE AS HOME TEST ALSO ABSOLUTE CD4 CELL COUNT AND CD4%--DETERMINES THE STAGE OF THE ILLNESS AND THE PATIENT’S RISK OF COMPLICATIONS AND NEED FOR PROPHYLAXIS  HIV S/S RECURRENT DRENCHING NIGHT ABDOMINAL PAIN SWEATS COUGH DRY OR PRODUCTIVE CHILLS/RASH DISORIENTATION HEADACHE/SORE THROAT DYSPNEA UNEXPLAINED WEIGHT LOSS LYMPHADENOPATHY (2 OR MORE CHRONIC DIARRHEA LYMPH NODES FOR 3 MONTHS) PERSISTENT UNEXPLAINED MUSCLE OR JOINT PAIN FEVERS ORAL LESIONS FATIGUE POSSIBLE PARESTHESIA IN SHORTNESS OF BREATH EXTREMITIES ASSESSMENT PG 2002 BOX 56-5 SEEN WHEN CD4 COUNT IS LESS RISK ASSESSMENT PAGE 2007 BOX THAN 500/MM3 56.9  NEUROLOGICAL SIGNS/SYMPTOMS PERIPHERAL NEUROPATHY USUALLY RESULT OF ANTIVIRAL AGENTS NUMBNESS, TINGLING LOSS OF SENSE OF PROPRIOCEPTION CHANGES IN SENSITIVITY TO PAIN (INCREASED OR DECREASED) HEADACHES ASEPTIC MENINGITIS CRANIAL NERVE PALSIES MYOPATHIES AIDS DEMENTIA COMPLEX (ADC) DEMENTIA, IMPAIRED MOTOR FUNCTION BEHAVIORAL CHANGES  ORAL SIGNS/SYMPTOMS CANDIDIASIS FUNGAL TREATED WITH ANTIFUNGAL MEDS (NYSTATIN, MYCELEX TROCHES, DIFLUCAN) AMPHOTERICIN B FOR RESISTANT INFECTIONS HAIRY LEUKOPLAKIA WHITE THICKENING ON ORAL MUCOSA THAT CANNOT BE WIPED OFF; FISSURED EDGES TREATED WITH ACYCLOVIR (ZOVIRAX)  GENITAL SIGNS & SYMPTOMS RECURRENT HERPES SIMPLEX 2—THE LOWER THE CD4 COUNT, THE MORE PROLONGED AND SEVERE THE OUTBREAK (ORAL AND GENITAL) SYPHILIS THAT MAY BE DIFFICULT TO ERADICATE; GREATER RISK FOR DEVELOPING NEUROSYPHILLIS TREATED IMMEDIATELY  HEMATOLOGIC SIGNS/SYMPTOMS ANEMIA LEUKOPENIA LYMPHOPENIA NEUTROPENIA THROMBOCYTOPENIA PANCYTOPENIA  MUSCULOSKELETAL SIGNS/SYMPTOMS JOINT OR MUSCLE PAIN CAN BE RESULT OF EITHER THE DISEASE OR THE MEDICATION AZT CPK WILL RISE IF CAUSED BY MEDICATION, THE MEDICATION IS STOPPED NSAIDS AND NONNARCOTIC ANALGESICS  GI SIGNS/SYMPTOMS PAGE 2010 TABLE 56.6 DIARRHEA HEPATITIS B AND C MALABSORPTION—LACTASE MOST LIKELY ENZYME TO BE AFFECTED LIVER FUNCTION TESTS ABNORMAL  TREATMENT ANTIRETROVIRAL THERAPY DIFFERENT ART INTERRUPTS HIV AT DIFFERENT STAGES OF INFECTIOUS PROCESS HAVE COMBINATION PILLS TO INCREASE COMPLIANCE TREATED WITH 3 OR MORE ART MEDS SLOWS PROGRESSION AND DECREASES RESISTANCE PAGE 1999 TABLE 56.4 PROS AND CONS OF ART OPPORTUNISTIC DISEASES ART AND PROPHYLACTIC INTERVENTIONS CAN CONTROL EMERGENCY OR PROGRESSION PAGE 1999 BOX 56.4 LIST  AIDS DEFINING OPPORTUNISTIC CONDITIONS PNEUMOCYSTIS JIROVECI PNEUMONIA (PCP)—MOST COMMON OF THE OPPORTUNISTIC DISEASES NURSING INTERVENTIONS MONITORING RESPIRATORY STATUS ADMINISTERING MEDICATIONS OXYGEN POSITIONING TO FACILITATE BREATHING MANAGING ANXIETY PROMOTING NUTRITIONAL SUPPORT HELP CONSERVE ENERGY TO DECREASE OXYGEN DEMAND  AIDS DEFINING OPPORTUNISTIC CONDITIONS KAPOSI’S SARCOMA RARE MALIGNANCY EXTERNAL AND INTERNAL S/S PURPLE LESIONS ON SKIN TREATMENT INTERFERON ALPHA VINCRISTINE  AIDS DEFINING OPPORTUNISTIC CONDITIONS MYCOBACTERIUM TUBERCULOSIS MAJOR CAUSE OF DEATH IN HIV PATIENTS BECAUSE OF DRUG RESISTANT STRAINS S/S NIGHT SWEATS, FEVER, WEIGHT LOSS, HEMOPTYSIS, +AFB  HIV WASTING HIV WASTING LOSS OF LEAN BODY MASS AS A RESULT OF ILLNESS DISTURBANCES IN METABOLISM INTERFERING WITH EFFECTIVE USE OF NUTRIENTS CAUSING LOSS OF LEAN MUSCLE INCREASED OPPORTUNISTIC INFECTIONS, DECREASED QUALITY OF LIFE, AND REDUCED LENGTH OF SURVIVAL LOSS OF 10% OF BODY WEIGHT AND HAS HAD EITHER DIARRHEA OR WEAKNESS AND FEVER FOR 30 DAYS NUTRITIONAL CONCEPTS PG 2002, BOX 56.6 ELEVATED TRIGLYCERIDE AND LIPID LEVELS (CHOLESTEROL) PAGE 2009 NURSING CARE PLAN  AIDS DEFINING OPPORTUNISTIC CONDITIONS WASTING TREATMENT CONTROL CONTRIBUTING FACTORS CALORIE DENSE FOODS BETWEEN MEAL SHAKES ELEMENTAL FORMULAS ENTERAL FEEDINGS PARENTERAL FEEDINGS APPETITE STIMULANTS ANDROGENIC HORMONES TO PROMOTE PRODUCTION OF LEAN MUSCLE MASS  PSYCHOSOCIAL ISSUES PG 2005 BOX 56.8 COPING STRATEGIES FEAR OF ABANDONMENT TALK THERAPY ISOLATION RELAXATION FEARFUL, DEPRESSED MEDITATION PROVIDE EDUCATION STRENGTHENING REALISTIC GOAL SETTING PERSONAL AND SPIRITUAL MINIMIZE SOCIAL RELATIONSHIPS ISOLATION ASSESS FOR SUICIDAL ASSIST WITH GRIEVING TENDENCIES  HIV COUNSELING PRETEST POST-TEST PG 1997  NURSING INTERVENTIONS NONJUDGEMENTAL CONFIDENTIALITY EMPATHETIC PSYCHOSOCIAL NEEDS CARING SUPPORT SYSTEM- BELIEFS SHOULD NOT REFERRALS INTERFERE WITH CARE UNDERSTAND CONFIDENTIALITY TRANSMISSION PAGE 2002 CARE STANDARD PRECAUTIONS INTERVENTIONS  EDUCATION PRACTICE GOOD HYGIENE MENTAL HEALTH COUNSELING INCLUDING FREQUENT HAND WASH DISHES IN HOT WATER HYGIENE USING DISHWASHER AVOID CROWDED AREAS OR BATHE DAILY USING TRAVELING TO COUNTRIES WITH ANTIBACTERIAL SOAP POOR SANITATION ADHERE TO DOSING SCHEDULES KEEP HOME CLEAN; AVOID COLDS/FLU FREQUENT FOLLOW-UP AND LABS STOP SMOKING AND DRUG USE, REPORT S/S INFECTION ALCOHOL IMMEDIATELY STRESS REDUCTION AVOID EXPOSURE TO NEW INFECTIOUS AGENTS SAFER SEX  PREVENTION OF HIV INFECTION ENCOURAGE TESTING FOR EARLY RISK OF HIV TRANSMISSION DETECTION PG 2019 BOX 56.11 HOME TESTING AVAILABLE BOX 56.10 PG 2013 HIGH VIRAL LOADS 10X MORE ABSTINENCE LIKELY TO TRANSMIT HIV THROUGH SEX MALE AND FEMALE CONDOMS CONDOM APPLICATION INCREASED RISK WITH DENTAL DAMS FORCEFUL SEX OR WITH DISRUPTED MM (STI) CLEAN NEEDLES MALE CIRCUMCISION INJECTION EQUIPMENT AND UNSAFE SEXUAL PRACTICES R/T DECREASES RISK ILLICIT DRUG USE  PREVENTION OF HIV INFECTION HIV INFECTED INDIVIDUALS CAN’T DONATE ORGANS, GIVE BLOOD OR DONATE SEMEN. DON’T SHARE RAZORS, TOOTHBRUSHES, OR OTHER HOUSEHOLD ITEMS THAT MAY CONTAIN BLOOD USE BIRTH CONTROL POST EXPOSURE PROPHYLAXIS (PEP) INITIATE WITHIN 72 HOURS BUT ASAP 3 OR MORE ART MEDS 4 WEEKS IS STANDARD SE NEW ONSET DIABETES, HYPERTRIGLYCERIDEMIA, PANCREATITIS, ELEVATED CHOLESTEROL, LIVER DYSFUNCTION, KIDNEY STONES IMMUNE STATUS MAY DECREASE EFFECTIVENESS SERIAL TESTING IMMEDIATELY, 6 WEEKS, 3 MONTHS, 6 MONTHS  PREVENTION OF HIV INFECTION ABSTINENCE UNWANTED SEXUAL MONOGAMOUS SEXUAL INTERCOURSE WITHIN 72 RELATIONSHIP FOLLOWED HOURS WILL GET ART FOR 28 DAYS BY ANOTHER MONOGAMOUS SEXUAL RELATIONSHIP IN WHICH PARTNER DOESN’T KNOW HIV POSITIVE STATUS