Exam #1, Ch. 15 HIV

Chapter 15 – Infection and HIV Infection (Lecture and Ch. 15)

1. Explain the pathophysiology of HIV/AIDS. (Lewis Study Guide)
*virus binds to CD4 and chemokine receptors and enters cell
*virus splices itself into DNA of cell and reverse transcriptase assists to make viral DNA
*all replicated cells from that point on are infected
**greatly reduces the immunity

2. Use the NP to explain the nursing care of a patient with HIV/AIDS.
**assessment:
-subjective: lifestyle (high risk behavior), past medical history (STDs, family history, blood transfusions, clotting factors), flu-like symptoms (fatigue, nightsweats, fever), weight loss
-objective: thrush, oral hairy leukoplakia, localized infections, wasting syndrome, dementia, opportunistic diseases (AIDS diagnoses if one or more of the following criteria are met for a person with HIV: CD4 count under 200 cell per microliter, development of one opportunistic infection or cancer, wasting syndrome, or AIDS dementia)
-dx: EIA, WB, IFA, rapid tests, CD4 tests

**diagnoses:
-prevention stage: prevent or detect early HIV infection
-ongoing infection stage: promote health and disability and manage problems caused by infection
-dying stage: maximize quality of life and resolve end-of-life issues

**planning:
-keep viral load low
-maintain immune function: prevent opportunistic disease and new infections
-improve quality of life
-reduce disability: coping
**interventions:
-adhere to drug regimen
-promote healthy lifestyle: prevent transmission, have supportive relationships, maintain productive activity, explore spirituality
-cope with disease, symptoms, and treatments

**implementation:
-holistic and individualized approach
-health prevention promotion: safe lifestyle practices, appropriate medication for pregnant women
-therapeutic communication: coping with stress and social stigma
-antiviral therapy: are they ready?
>schedule fitting of lifestyle?
>lifestyle changes to promote healthy immunity
>side effects: depression, N/V/D, fatigue, pain, peripheral neuropathy

**evaluation:
-how is the patient adhering to the medication?
-does the patient understand the importance of lifestyle changes?
-is the patient abstain from high risk behaviors?
-is the patient coping?

3. Identify complications of HIV/AIDS and resulting nursing care.
*treat each patient in an individual and holistic approach
*opportunistic diseases: prevent infections and treat each disease and its side effects respectively
*coping: counseling and therapeutic communication
*transmission: patient education on high risk behavior and correlation with transmission to others

4. Explain diagnostic studies, criteria and collaborative care for patients with HIV/AIDS.
*Rapid tests: tests for antibodies yielding quick results, but need to be confirmed by WB and IFA if positive test
*EIA, WB, IFA: test for antigens
-risk assessment before the test and patient education after the test should be initiated
*collaborative care:
-get baseline and monitor CD4 and viral load of patient over a period of time
-prevent and detect opportunistic infections and complications of drug therapy
-maintain ongoing health assessement
-patient education regarding disease process and prevention

5. Explain the different opportunistic diseases associated with AIDS and general nursing management.
*pneumocystis jiroveci infection: pneumonia with dry, nonproductive cough
*herpes simplex 1 infection: cold sores of mouth and lips
-patient teaching: avoid kissing and oral sex
*kaposi sarcoma: hyperpigmented lesions of skin, lungs, and GI tract
*cytomegalovirus infection: retinitis, esophagitis, gastritis, colitis, stomatitis
-hydration for diarrhea, assess airway, daily weights
*varicella-zoster virus infection: shingles with maculopapular, pruritic rash
-medication for itching and redness
*candida albicans: yeast infection of mouth, esophogus, GI tract

6. Explain the indications for the initiation of antiretroviral therapy of the HIV patient.
*should be started when immune suppression is greatest to avoid burnout and nonadherence
*must be ready to initiate therapy to ensure better adherence to the regimen
*patient should understand the importance of taking medication on schedule and the side effects of the medication like pain, fatigue, N/V/D, depression and peripheral neuropathy

7. Explain the different drug categories of antiretroviral agents used in HIV infection. (Table 15-14)
*NNRTIs and NRTIs: inhibition of HIV to make a DNA copy in early replication
*NtRTIs: inhibit action of reverse transcriptase
*PIs: stops budding activity to occur on cell membrane
*Fusion or entry inhibitors: stops HIV from binding to cell receptors