Week 13-14-15 Immune HIV AIDS Hypersensitivity SLE Blackboard PDF

Immunity HIV/AIDS Hypersensitivity Reactions COURSE OUTCOME Describe principles of safe, patient-centered, evidence-based nursing care to adults at the basic level, guided by the Caritas philosophy. Discuss critical thinking and clinical reasoning to provide quality patient care. De...

Immunity HIV/AIDS Hypersensitivity Reactions COURSE OUTCOME Describe principles of safe, patient-centered, evidence-based nursing care to adults at the basic level, guided by the Caritas philosophy. Discuss critical thinking and clinical reasoning to provide quality patient care. Describe effective communication with patients and members of the interprofessional collaborative practice members. COMPETENCY Define patient-centered, evidenced-based care using the nursing process. Discuss factors that create a culture of safety in caring for patients with select common health alterations. Discuss health promotion, health maintenance, prevention of illness & injury and facilitation of healing. Describe principles of patient teaching that reflect developmental, ethnic, social and cultural considerations.  Competency Discuss the use of critical thinking to prioritize basic elements of patient care when implementing the nursing process. Discuss critical thinking strategies used when making clinical judgements. Discuss the roles of the interprofessional collaborative practice members. CONCEPT Immunity: The physiological response of the body to protect against foreign substances/antigens  UNIT OUTCOMES Immunity Discuss the relationship among rest and sleep, nutrition and hydration and the immune response. HIV/AIDS Explain the ways human immunodeficiency virus is transmitted. Describe the pathophysiology of HIV infection. Discuss the clinical manifestations and complications of untreated HIV infection. Identify the CDC diagnostic criteria for acquired immune deficiency syndrome.  UNIT OUTCOMES HIV/AIDS Describe patient teaching that reflects developmental, ethic, social and cultural considerations for the patient experiencing HIV. Describe the nurse’s role in facilitating diagnostic tests used to assess for an HIV infection. Discuss the nursing and collaborative management of HIV infected patients.  Unit Outcomes Discuss the nurse’s role in anticipating complications resulting in opportunistic infections associated with AIDS. Discuss evidence-based health information to provide the patient and family education to reduce transmission of HIV. UNIT OUTCOMES Hypersensitivity Reaction Compare and contrast humoral and cell-mediated effects on antigens. Differentiate among the four types of hypersensitivity reactions.  Unit Outcomes Discuss the basic collaborative and nursing management of patients experiencing; Hypersensitivity I (allergic response) Hypersensitivity II (hemolytic transfusion reaction) Hypersensitivity III (Systemic lupus erythematosus) Hypersensitivity IV (purified protein derivative (PPD). Discuss the nursing process used in caring for individuals experiencing SLE. The Concept of Immunit y  Concept of Immunity Threats Defense Function of immune Human body system constantly threatened – Protect body from by: foreign antigens – Identify, destroy – Foreign substances potentially harmful cells – Infectious agents – Remove cellular debris – Abnormal cells – Differentiate host from foreign tissue  Immunity Helps to limit tissue damage when Inflammatory process cannot Body’s natural or induced response to infection and its associated conditions Healthy Immune Systems Direct Correlation Between Sleep and Immunity  Physiology Review Leukocytes = White Blood Cells Primary cells in immune responses Derived from stem cells in bone marrow Attack and destroy anything "foreign“ Can move through tissue spaces Normal number: 4,500–10,000 cells/mm3 Leukocytosis in presence of infection: – Greater than10,000/mm3 Physiology Review Important Physiological Review  Physiology Review Leukocytes Granulocytes Short life span Key role during acute inflammation, infection Three types – Neutrophils – Eosinophils – Basophils  Physiology Review Leukocytes – Lymphocytes Memory cells Stay inactive, sometimes for years Activate immediately when exposed to same antigen Proliferate rapidly, intense immune response Responsible for acquired immunity What is acquired immunity? Diseases that cause acquired immunity?  Physiology Review Leukocytes – Lymphocytes 2 types: T cells (attack inside the cell) – Mature in thymus – Helper T, Cytotoxic T or Memory T cells B cells (attack outside the cell) – Mature in bone marrow  Substances the body recognizes as foreign that elicit an immune response Provoke specific immune response Antigens Typically, large protein molecules Subsequent encounters with an antigen trigger memory cells  Immune globulins produced by lymphocytes in response to antigens Antibodies react specifically to one Antibodies antigen Binds to antigens and inactivate them.  Physiology Review Antibodies: Immunoglobulins – Antibody-mediated immune response Types of antibodies: – IgM: first to show up immunity – IgG: most abundant, control infection – IgE: increases with allergic reactions, anaphylaxis – IgA: protects mucous membranes from invaders Organs of Immunity Normal Immune Response Central Lymphoid Organs Spleen *Filters blood Thymus Gland * Shrinks with age * T-lymphocytes mature Bone Marrow *Produces red blood cells, white blood cells, platelets Impact of Aging on the Immune System  Normal changes associated with aging Older Adult Considerati Immune function declines ons Internal factors Chronic illnesses. Decrease in immune response Lowered resistance to infection Reduced response to immunizations Auto-antibodies more common Impact of Reduced Immunity in Older Adult ↑ Incidences of tumors (malignancies) Greater susceptibility to infection ↑ Autoantibodies ↓ Cell-mediated immunity Thymus gland shrinks with age Immunoglobulin levels decrease Antibody response to immunizations decreases What education can be provided to the older adult to minimize the impact of a reduced immune system? Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS)  HIV is a ribonucleic acid virus Called a retrovirus (converts RNA to Pathophysiol DNA) ogy HIV Binds to receptors and enters the cell Infects T-Helper cells  Pathophysiology and Etiology of AIDS AIDS caused by HIV-1 and HIV-2 – Destroys body's ability to fight infection – Virus found in body fluids: blood, semen, vaginal, cervical secretions, CSF, breast milk – Transmission through body fluids – Unprotected sexual contact – Infected blood via needle sharing – Transfusions of infected blood (rare)  Pathophysiology and Etiology Initial viral infection Large viral levels in blood for 2 to 3 weeks Transmission is more likely when viral load is high. Antibodies first detectable in 3 weeks up to 3 months after infection  HIV Infection Stages Acute Asymptomatic Symptomatic AIDS  Clinical Manifestations Acute Infection Flulike symptoms Lasts for 1 to 2 weeks Fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, or a diffuse rash accompanies seroconversion serum converting from zero presence of HIV to measurable presence of HIV Occurs about 2 to 4 weeks after initial infection  Clinical Manifestations Asymptomatic Infection Median interval of 10-15 years between infection and diagnosis of AIDS Fatigue, headache, low-grade fever, night sweats CD4+T cell counts remain normal Low viral load in blood Most are not aware of infected status and thus continue usual activities which may include high-risk sexual or drug-using behaviors causing a serious public health problem.  Clinical Manifestations Symptomatic Infection CD4+ T cells drop to 200 to 500 cells/μL.: Normal range is 800 to 1200 cells/μL Viral load increases HIV advances to a more active state: Symptoms appear Opportunistic infections, cancers, neurological manifestations Indicator of disease progression  Opportunistic Infection Opportunistic Infections do not occur in the presence of a functioning immune system Opportunistic Infections Most common manifestations of AIDS – Risk predictable decrease in T cell count with an increase in plasma viral load Pneumocystis pneumonia – Most common caused by the fungus Pneumocystis jiroveci. This fungus is common in the environment and rarely causes illness in healthy people. Oral candidiasis/Thrush Oral hairy leukoplakia – Epstein-Barr virus infection that causes painless, white, raised lesions on the lateral aspect of the tongue Cytomegalovirus (CMV) Oral Candidiasis Oral Hairy Leukoplakia  Secondary Cancers Kaposi sarcoma – Most common cancer associated with AIDS – Indicator of late-stage HIV disease – Caused by associated herpes virus – Initially painless, may become painful – May obstruct organ function, cause bleeding – May impair gas exchange in lungs Kaposi Sarcoma  AIDS Center for Disease Control (CDC) When the individual develops at least one of several criteria: – CD4/T-cell below 200 – Pneumocystis pneumonia – Candidiasis infections (bronchi, trachea, lungs, beyond the oral cavity) Timeline for Untreated HIV Infection 50  Estimated 1 in 4 of those with HIV infection are Overview unaware they have of HIV it. Epidemic How do you think this effects the CDC data regarding the incidence of new cases of HIV?  HIV Testing and Counseling Testing is the only sure method of determining HIV infection. – The CDC recommends testing for all people regardless of the patient’s risk or perceived risk. At-Risk Groups Everyone  At-Risk Groups Sex Gender Children Elderly Race Economics City/Rural/Suburb Sexual partner choices Others ?  Lifespan Considerations – Older adults Adults > age 50: ~24% of cases of HIV/AIDS in the U.S. Declining immune function increases risk Newly single older adults may not practice safe sex  Prevention No immunization has been developed Educate on prevention  Pre-Exposure Prophylaxis (PrEP) Daily medication Individuals at high risk Used for prevention For people without HIV who are at very high risk for acquiring it from unsafe sex or injection drug use 90% Daily PrEP can reduce the risk of sexually acquired HIV by more than 90%. 70% Daily PrEP can reduce the risk of HIV infection among people who inject drugs by more than 70%.  Prevention for Healthcare Provider Standard precautions – Treat all patients the same – Treat all high-risk body fluids as infectious – Wear gloves during examination with exposure to body fluids – Adhere to precautions and safety measures to avoid exposure (needless system, sharps container)  Post Exposure Prophylaxis Healthcare Providers Health care as occupation – Needle stick, not intact skin contact with body fluids – Wash soap and water/REPORT STAT – Need to be assessed and determine IF need for treatment prophylaxis IMMEDIATELY (SN or RN) Report all exposures for immediate and timely treatment and counseling. Treatment should start 72 hours after exposure Post-exposure prophylaxis with combination ART can significantly decrease risk of infection Health Care Provider Post-Exposure Prophylaxis Exposure: Dirty Needle Stick; significant body fluid exposure Action: Wash with soap and water; flush area Report Immediately  Post Exposure Prophylaxis Healthcare Providers Use of 3 of the 4 Antiretroviral Drug Agents – 4 weeks  Testing For HIV: Diagnostics Screening for HIV infection, monitoring immune status Rapid diagnostic tests Widely used  immediate results Rapid HIV-antibody tests can provide results before patients leave the office but should be confirmed. Beneficial as many do not return for follow-up  Diagnostic Tests Enzyme-linked immunosorbent assay (ELISA) Tests for HIV antibodies May be negative early in infection WHY??? May take several weeks to detect antibodies (window period)  Diagnostic Tests Testing to confirm reactive test (ELISA Positive) Western blot antibody testing More reliable than ELISA More $$$ Takes Longer HIV viral load tests Measure amount of actively replicating HIV CBC WBC – opportunistic infection CD4 cell count Amount of CD4 not infected HIV Test Results o Positive: Provide or refer patient for HIV treatment and other services to maintain health and prevent further spread of HIV. o Negative: o Assess about sex and drug use behaviors. o Negative low risk: o Discuss prevention methods. o Negative high risk: o Discuss risk behaviors, PrEP, and use of other prevention methods.  Drug Classifications Nucleoside, non-nucleoside, and nucleotide reverse transcriptase inhibitors – Inhibit the ability of HIV to make a DNA copy early in replication Protease inhibitors – Interfere with activity of enzyme protease Entry inhibitors (EIs) – Prevent HIV from entering target cells  Drug Therapy Nucleoside reverse transcriptase inhibitors (NTRIs) – Inhibit action of viral reverse transcriptase – Viral reverse transcriptase necessary for viral integration into cellular DNA – Zidovudine – First antiretroviral agent approved, still in widespread use  Drug Therapy Protease inhibitors (PIs) – Protease: viral enzyme used for viral assembly and maturation – PIs inhibit function of the enzyme to produce immature viral particles – Combined with other antiretrovirals to eliminate virus – Can inhibit metabolism of other drugs – Major side effects: increase cholesterol and increase blood glucose Saquinavir  Drug Therapy. Nonnucleoside reverse transcriptase inhibitors (NNRTIs) May be used in combination with nucleoside analogues, PIs Nevirapine  Entry inhibitors (EIs) – Prevent HIV from entering Drug target cells – Improved CD4 counts, Therapy reduced viral loads – Enfuvirtide  Drug Therapy Combination therapies – Highly active antiretroviral therapy (HAART) combines three or four drugs Reduce incidence of drug resistance Increase likelihood of decreasing viral load, symptoms Drugs cause major adverse reactions Less than perfect adherence  resistance  Drug Therapy Main Goals – Decrease viral load. – CD4+ counts greater than or equal to 200 Main Outcomes – Delayed HIV progression – Delayed opportunistic diseases  Collaboration among healthcare Collabora providers essential – Large number of medications tion – Regular consultation with a Pharmaci pharmacist – Use a single pharmacy to fill st prescriptions  Standard Never assume Precautions for someone’s risk Nursing all Manageme Assess for nt Candid alcohol and/or conversation/tr recreational ust drug use  Assessment questions relate to: – Shared needles, syringes, or Nursing other injection equipment with another person? Manageme – Had a sexual experience nt: involving their penis, vagina, rectum, or mouth in contact Assessment with another person? – Had a sexually transmitted infection (STI)?  Diagnosis Ineffective Coping Compromised Family Coping Risk for Infection Anxiety Fear Deficient Knowledge Impaired Gas Exchange  Planning and Collaboration Prevention education is critical Nursing care needs will change over course of disease: Collaboration – Counseling patient with new diagnosis – Psychosocial support continues – Direct care needs – Management at home  Goals for care are aimed at: – Compliance with drug regimes Nursing – Adopting a healthy lifestyle – Beneficial relationships Manageme – Spiritual well-being in regard nt to life and death – Coping with the disease and Planning its treatment  Disease and Drug Side Effects Common physical problems – Anxiety, fear, depression – Diarrhea – Peripheral neuropathy – Pain – Nausea/vomiting – Fatigue  Nursing Management Implementation Primary prevention: health promotion When prevention fails Disease results Early intervention is facilitated by health promotion practices Begin to establish rapport and use patient input to develop a plan of care Initiate teaching about spectrum of HIV, treatment, preventing transmission, improving health, and family planning  Implementation: Promote Effective Coping Build social support network, coping methods Provide uninterrupted time with patient Interact at every opportunity Support patient's social network Promote interaction between patient, significant others  Implementation: Address Knowledge Deficits Teaching needs extensive – Guideline for safer sex practices – Nutrition, rest, exercise, stress reduction – Lifestyle changes, maintain positive outlook – Infection prevention, transmission – Importance of regular medical follow-up – Signs, symptoms of opportunistic infections – Medication adhrance and adverse effects  Implementation: Promote Adequate Nutrition to Support Immune system Provide diet high in protein and kilocalories Offer soft foods, serve small portions Provide enteral feedings or supplements (Ensure) Provide or assist with frequent oral hygiene  Evaluation Patient adheres to ART treatment Remains free from secondary infection Nutritional intake prevents malnutrition Patient demonstrates effective or improved coping  HIV and Ohio Law Each state has laws requiring HIV status disclosure Ohio Law - Based on Primary Prevention Ohio Law requires an individual that knows they are HIV positive to inform the other person of their HIV positive status prior to engaging in sexual activities. World Health Organization HIV/AIDS There is no cure for HIV infection. Effective antireroviral (ART)drugs can control the virus and reduce transmission Person taking ART have long and productive lives People with HIV and Undetectable Viral Load Effective HIV treatment (ART) reduces the amount of HIV viral load in body fluids When the amount of HIV viral load, in the blood is at an undetectable level, HIV cannot be passed during sex. Slogan: U=U – Undetectable equals untransmittable during sex – Undetectable viral load does not indicate cure – HIV cannot be cured – ART must continue to be taken Questions