chapter035

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Chapter 35: Caring for Clients with HIV/AIDS


Human Immunodeficiency VirusHuman Immunodeficiency Virus• Requires host for survival, duplication

• Eventually results in AIDS

– Can remain well for several years being HIV+

• Pandemic: 33.2 million people worldwide

– 63% live in sub-Saharan Africa

• 2 of 3 adults are HIV+

• 90% of children are HIV+

• No longer exclusive: Homosexual men; IV drug users

– Increasing numbers of heterosexual women infected; Transmission to newborns


Human Immunodeficiency VirusHuman Immunodeficiency Virus• Nurses: Largest group of healthcare workers to

occupationally acquire HIV

• 2007 Deaths: 2.1 million people (decline)

• U.S. Health Problem

– African-Americans: HIV infection rate 8 times higher than whites

– 2003

• 2nd leading death cause in African-American males, ages 35-44

• 3rd leading death cause in African-American females, ages 35-44


Human Immunodeficiency VirusHuman Immunodeficiency Virus

• Subtypes

– HIV-1: Mutates easily, frequently

• More prevalent in U.S., world

– HIV-2: Less transmittable; HIV to AIDS interval longer

• Western Africa primary infection site


Human Immunodeficiency Virus (HIV) Human Immunodeficiency Virus (HIV)

Structure of a retrovirus

•HIV Structural Characteristics


Human Immunodeficiency Virus (HIV) Human Immunodeficiency Virus (HIV)


HIV Replication; TransmissionHIV Replication; Transmission

● Transmission: Body fluids− Blood− Semen− Vaginal secretions− Breast milk

● Specific behaviors increase risk



• Pathophysiology and Etiology

– Infected CD4 cells are unable to recognize foreign antigens

– Viral cells continue parasitic replication, resulting in decreased CD4 cell count

• >10 billion viral particles released daily

• Frequent mutations complicate drug therapy

• Render vaccine development virtually impossible

• New strains



• Prevention Strategies

– Prevention guideline compliance

• No sex with strangers; Mutually monogamous sex – uninfected partner

• Use condoms effectively

• No IV, psychostimulant drug use

– Use standard precautions

– Immediately report needlesticks

• Get prophylactic treatment


Acquired Immunodeficiency Syndrome Acquired Immunodeficiency Syndrome • Is End Stage HIV Infection

– Immunodeficiency develops

– Mortality from opportunistic infection; Cancers

• Progression Related to

– Viral concentration in blood

– Subtype, strain of infecting HIV

– CD4 cell status

• Few Long-term Survivors


Acquired Immunodeficiency Syndrome Acquired Immunodeficiency Syndrome • Assessment Findings: Signs and Symptoms

– Acute retroviral syndrome (flu-like)

• Fever; Swollen, tender lymph nodes; Rash on face, trunk, pales, soles; Muscle, joint pain; HA; N/V; Diarrhea

– Liver, spleen enlargement; Weight loss; Neurologic symptoms; Kaposi’s sarcoma; Abnormal gynecologic problems in women

• Assessment Findings: Diagnostic Findings

– ELISA test (x2), Western blot test confirms

– CD4 (T-cell) count; Viral load tests


Acquired Immunodeficiency Syndrome Acquired Immunodeficiency Syndrome

Figure 35-4 Kaposi's Sarcoma Left: Single lesion; Right: Multiple lesions


AIDSAIDS

Supportive care

Treating anorexia, diarrhea,

weight loss

Treating side effects

of therapy

Adjunct drug therapy

Antiretroviral drugs

Medical Management


Medical ManagementMedical Management• Antiretroviral Drug Therapy

– Initiation controversy; Very expensive

– Reverse transcriptase inhibitors

• NRTIs + NNRTIs: Cripple viral copying

• Nucleotide analogues: Activate immediately on entering CD4 cell

– Protease inhibitors: Interfere with viral copy maturation

– Entry inhibitors: Block proteins or surface coreceptors of the CD4 T-cell lymphocyte

• HAART


Highly Active Antiretroviral Therapy (HAART)Highly Active Antiretroviral Therapy (HAART)

Combination Therapy

Reverse Transcriptase

Inhibitors

Protease Inhibitors

Fusion Inhibitors


Medical ManagementMedical Management

• Adjunct Drug Therapy

– Hydroxyurea: Interferes with viral replication

– IL-2: Boosts immune defenses against HIV

• AIDS Vaccines: In clinical trials; Success unlikely due to frequent viral mutations

• Drug resistance development due to noncompliance

– Medication compliance difficult

• Numerous medications taken simultaneously ATC requiring near-perfect compliance

• Undesirable GI side effects


Medical ManagementMedical Management

Figure 35-7 The effect of noncompliance on drug resistance


Supportive Care: Opportunistic Infection Supportive Care: Opportunistic Infection

Cryptosporidiosis

Cytomegalovirus Infection

Candidiasis

Pneumocystis Pneumonia

Infectious Conditions


AIDS-Related Complication ManagementAIDS-Related Complication Management

• AIDS Dementia Complex (ADC)

– Antiretroviral therapy

– Drug therapy

• Distal Sensory Polyneuropathy (DSP)

– Side effect of several antiretroviral drugs

– Vitamin B12

– Thiamine supplementation


Nursing ManagementNursing Management

• Maintain client confidentiality

• Significant health education; Counseling; Follow-up

• Diagnostics

– Test result interpretation; Appointments

• Medications

– Action and side effects of drugs

– Schedule for self-administration

• Referral to support groups and resources for information


Nursing ManagementNursing Management

• Reducing Occupational Risks

– Observe standard precautions

– Follow guidelines: Nursing; OSHA

– Immediately report any blood exposure

• Post-exposure HIV testing at regular intervals

• Follow sexual precautions post-exposure


End of Presentation

chapter035

Documents

transmittable hiv

world hiv

drug resistance copyright

hiv infection rate

effects copyright

newborns copyright

retrovirus copyright

hivaids copyright