NCM 105 Infectious, Inflammatory, and Immunologic Problems PDF

NCM 105 INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC PROBLEMS PRIMARY IMMUNE rare inherited disorders that DEFICIENCIES DISEASES impair the immune system commonly diagnosed in infancy male-to-female ratio of 5 to 1 Pathophysio...

NCM 105 INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC PROBLEMS PRIMARY IMMUNE rare inherited disorders that DEFICIENCIES DISEASES impair the immune system commonly diagnosed in infancy male-to-female ratio of 5 to 1 Pathophysiology There are more than 200 forms of PIDDs more than 270 different genes are associated with PIDDs prevent the body from developing normal immune responses Clinical Multiple infections despite Manifestations aggressive treatment infections with unusual or opportunistic organisms failure to thrive or poor growth significant family history  Laboratory tests Assessment cellular (T-cell) defects and Diagnostic neutrophil disorders Findings complement deficiencies Prevention Do not vaccinate with live vaccines Family planning Prenatal in-utero testing Medical Management Hematopoietic stem cell transplantation (HSCT) Gene therapy Emerging new technologies allowing precise DNA targeting Pharmacologic Depends on the type and Therapy severity of infection Prophylactic drug treatment Empiric therapy Ig replacement therapy Nursing Appropriate hand hygiene and infection prevention precautions are Management essential Institutional policies and procedures related to infection prevention care must be followed scrupulously Continual monitoring of the patient’s condition Health teaching ACQUIRED IMMUNE Something that is DEFICIENCY acquired Examples are those acquired from chemotherapy and from pathogens such as HIV  Was first identified in 1981 HIV Infection The first decade, progress was associated with the recognition and treatment, including prophylactic medications, of opportunistic and infections AIDS The second decadewitnessed progress in the development of highly active antiretroviral drug therapies (HAART) as well as continuing progress in the treatment of opportunistic infections The third decade has focused on issues of preventing new infections, adherence to antiretroviral therapy (ART), development of second- generation combination medications that affect different stages of the viral life cycle, and continued need for an effective vaccine Epidemiology Global Prevalence and Incidence Global Statistics: Approximately 38 million people worldwide are living with HIV. Around 1.5 million new infections and 650,000 AIDS- related deaths were reported in 2021. High-Burden Areas: Sub-Saharan Africa remains the most affected region, accounting for about 70% of the global burden of HIV.  Modes of Transmission Epidemiology Primary Routes: HIV is transmitted through unprotected sexual contact, sharing of contaminated needles, blood transfusions, and from mother to child during childbirth or breastfeeding. Vulnerable Populations: Key populations at higher risk include men who have sex with men, sex workers, people who inject drugs, and transgender people.  Demographic and Social Determinants Gender: Women and young girls are Epidemiology disproportionately affected in certain regions, particularly in Sub-Saharan Africa, due to factors like gender-based violence, limited access to healthcare, and economic dependence. Age: Adolescents and young adults (ages 15-24) account for a significant number of new infections, emphasizing the need for youth-targeted interventions. Socioeconomic Factors: Poverty, lack of education, stigma, and discrimination contribute to the spread of HIV, limiting access to prevention, testing, and treatment services.  Trends in HIV Incidence and Mortality Decline in New Infections and Deaths: Epidemiology Since the peak of the epidemic, there has been a decrease in new infections and AIDS-related deaths, thanks to antiretroviral therapy (ART) and prevention efforts. Geographical Variation: Some regions have seen significant declines in new infections, while others, especially Eastern Europe and Central Asia, have experienced rising numbers due to limited ART coverage and increased intravenous drug use  Prevention Strategies Condom Use: Consistent use of condoms Epidemiology remains a key preventive measure. Pre-exposure Prophylaxis (PrEP): Daily use of PrEP by high-risk individuals has shown significant efficacy in preventing HIV acquisition. Education and Awareness: Public health campaigns, community engagement, and comprehensive sex education are crucial for addressing misconceptions and promoting healthy behaviors. Modes of HIV Transmission Sexual Transmission Blood and Blood Products Mother-to-Child Transmission (MTCT) Factors Viral Load Increasing Transmission Presence of Other STIs Risk Unprotected Sexual Practices Type of Sexual Contact Special Considerations Standard for Healthcare Precautions Workers Needle-stick Injury Protocol (PEP)  Family Planning Considerations for Women with HIV Related Reproductive Risks for Discordant Couples (One Education for Partner HIV-Positive) HIV Counseling for Women Considering Prevention Pregnancy Findings from the ECHO Trial on Contraception and HIV Risk Breastfeeding Recommendations for HIV-Infected Women HIV Increased HIV Risk Among Prevention LGBTQ Individuals in LGBTQ Populations Social Challenges Faced by LGBTQ Communities Cultural Competence in Healthcare  Pathophysiology of HIV The pathophysiology of HIV (Human Immunodeficiency Virus) involves the virus targeting and destroying the immune system, particularly focusing on CD4+ T cells, which play a crucial role in immune defense Pathophysiology Viral Entry and Infection of Host Cells Reverse Transcription and Integration Viral Replication and Assembly Budding and Release Destruction of CD4+ T Cells and Immune System Damage Chronic Inflammation and Immune Activation  Stage 1: Primary infection with flu- like symptoms, high viral load. Stages of Stage 2: Symptomatic stage as the immune system weakens. CD4+ HIV count is between 200-499 cells/mm3 Infection Stage 3: AIDS, characterized by severe immune suppression, opportunistic infections, and life- threatening complications. HIV Life Cycle Assessment Health History Findings Physical Examination Psychosocial Assessment  HIV Testing Diagnostic Findings CD4+ T Cell Count Viral Load Testing Other Laboratory Tests Genotypic and Phenotypic Resistance Testing  Treatment of HIV Infection ART is the cornerstone of HIV treatment, focusing on viral suppression, immune system recovery, and prevention of complications. With effective and consistent ART, individuals with HIV can lead long, healthy lives and reduce transmission risk. Advances in therapy continue to improve outcomes, convenience, and quality of life for those living with HIV. Antiretroviral Therapy (ART) Combination Therapy Goals of ART  (1) reduce HIV-associated morbidity Goals of and ART prolong the duration and quality of survival, (2) restore and preserve immunologic function, (3) maximally and durably suppress plasma HIV viral load, and (4) prevent HIV transmission  Over 30 FDA-approved antiretroviral (ARV) drugs, organized into seven classes, are available for HIV treatment. Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs) – Target stage 3. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) – Also target stage 3. Protease Inhibitors (PIs) – Target stage 7. Integrase Strand Transfer Inhibitors (INSTIs) – Target stage 4. Fusion Inhibitor – Targets stage 2. CCR5 Antagonist – Targets stage 1. CD4+ Post-Attachment Inhibitor – Targets stage 1. ART Drug (1) transmission of drug- Resistance resistant HIV at the time of initial infection and (2) selective drug resistance in patients who are receiving nonsuppressive regimens.  Immune Reconstitution Inflammatory Syndrome Immune reconstitution inflammatory syndrome (IRIS) results from rapid restoration of organism-specific immune responses to infections that cause either the deterioration of a treated infection or new presentation of a subclinical infection. Clinical Manifestations Respiratory Manifestations Pneumocystis Pneumonia Mycobacterium Avium Complex Tuberculosis Gastrointestinal Manifestations Candidiasis HIV Wasting Syndrome  Kaposi Oncologic Manifestations Sarcoma AIDS-Related Lymphomas Neurologic Subcortical Manifestations Neurodegenerative Disease Peripheral Neuropathy HIV Encephalopathy Neurologic Manifestations Cryptococcus Neoformans Progressive Multifocal Leukoencephalopathy Other Neurologic Disorders  Nutrition Therapy Nutrition therapy in HIV focuses on maintaining a balanced diet, managing symptoms and medication side effects, supporting immune function, and addressing comorbidities. A well- structured nutritional plan, often developed in collaboration with healthcare providers and dietitians, is essential for optimizing health outcomes and enhancing the quality of life for people living with HIV. 1. Goals of Nutrition Therapy in HIV 2. Key Nutritional Recommendations 3. Micronutrient Needs 4. Addressing Common Nutrition-Related Symptoms and Side Effects 5. Hydration 6. Managing Comorbidities 7. Nutritional Supplements 8. Role of Registered Dietitian 9. Lifestyle and Behavioral Support  NURSING PROCESS The nursing process for patients with HIV/AIDS involves a systematic approach to assess, diagnose, plan, implement, and evaluate care, with a focus on supporting immune function, managing symptoms, preventing infection, and promoting overall well- being Assessment Nursing assessment includes identification of potential risk factors including a history of risky sexual practices or injection drug use. The patient’s physical status and psychological status are assessed. Nutritional status is assessed by obtaining a dietary history and identifying factors that may interfere with oral intake  Diagnosis NURSING DIAGNOSES Based on the assessment data, major nursing diagnoses may include the following: Impaired nutritional intake associated with decreased oral intake Social isolation associated with stigma of HIV infection, withdrawal of support systems, isolation procedures, and fear of infecting others Grief associated with changes in lifestyle and roles Lack of knowledge associated with HIV infection, means of preventing HIV transmission, ART, and self-management strategies COLLABORATIVE PROBLEMS/POTENTIAL COMPLICATIONS Possible complications may include the following: Adverse effects of medications Development of HAND Body image changes Planning Goals for the patient may include improved nutritional and status, increased socialization, Goals expression of grief, increased knowledge regarding disease prevention and self-care, and absence of complications.  Nursing Interventions IMPROVING NUTRITIONAL STATUS DECREASING THE SENSE OF ISOLATION COPING WITH GRIEF IMPROVING KNOWLEDGE OF HIV MONITORING AND MANAGING POTENTIAL COMPLICATIONS PROMOTING HOME, COMMUNITY-BASED, AND TRANSITIONAL CARE  Expected patient outcomes may include: Maintains adequate nutritional status Experiences decreased sense of social isolation Progresses through grieving process Evaluation Reports increased understanding of HIV infection, prevention of HIV transmission, and ART, and participates in self-management strategies as possible Remains free of complications