
1. medications
2. Diagnostic Studies
2.1. Most useful screening tests detect HIV- specific antibodies and/ or antigens
2.1.1. may take several weeks to detect antibodies
2.1.2. performed using blood or saliva
2.1.3. combinations tests can detect HIV earlier (4th generation)
2.2. HIV progression is monitored by
2.2.1. CD4 and Tcells count provides a maker of immune function
2.2.2. viral load- the lower the viral load the active the disease
2.3. abnormal blood tests are common
2.3.1. caused by HIV, opportunistic disease, or complications of therapy
2.3.1.1. decreased WBC
2.3.1.2. low platelet count
2.3.1.3. altered liver function
2.3.1.4. anemia asccociated with ART
2.4. Resistence tests can help determine if patient is resistent to ART
2.5. Assays help HCPs know which medications may be effective
2.5.1. genotype assay
2.5.2. phenotype assay
2.6. Testing is the only sure method of determining HIV infection
2.6.1. CDC recommends universal, voluntary testing as part of routine medical care
3. transmission
3.1. blood
3.2. semen
3.3. vaginal secretions
3.4. breast milk
3.5. unprotected sex with an HIV infected partner is the most common mode of transmission
3.6. sharing drug needles- puncture wounds are among the most common mean of work- related HIV transmission
4. clinical manifestations and complications
4.1. acute
4.1.1. flu-like symptoms
4.1.1.1. muscle and joint pain
4.1.1.2. fever
4.1.1.3. swollen lymphnodes
4.1.1.4. sore throat
4.1.1.5. headache
4.1.1.6. malaise
4.1.1.7. nausea
4.1.1.8. diarrhea
4.1.1.9. diffuse rash
4.1.2. occurs about 2-4 weeks after infection
4.1.3. highly infectious
4.2. assymptomatic
4.2.1. if left untreated, a Dx of AIDS is made in about 10 years after initial HIV infection
4.2.2. symptoms are generally absent or vague
4.2.3. high risk behaviors may continue
4.3. symptomatic
4.3.1. CD4 and Tcells decline closer to 200
4.3.2. symptoms become worse
4.3.3. HIV advances to more active stage
4.3.3.1. bacterial infections Ex. oral thrush
4.3.3.2. shingles
4.3.3.3. herpes
4.3.3.4. persistent vaginal candidal infections
4.3.3.5. kaposi sarcoma
4.3.3.6. oral hairy leukplakia
4.4. AIDS
4.4.1. diagnostic criteria is established by CDC
4.4.2. Immune system severely compromised
4.4.2.1. infections ex. pneumocystis jiroveci pneumonia
4.4.2.2. malignancies
4.4.2.3. wasting
4.4.2.4. HIV-related cognitive changes
4.5. metabolic disorders
4.5.1. lipodystrphy
4.5.2. hyperlipidemia
4.5.3. insulin resistence
4.5.4. hyperglycemia
4.5.5. bone disease
4.5.6. lactic acidosis
4.5.7. renal disorders
4.5.8. cardiovascular disease
4.6. increasing rates of HIV disease among older adults
4.6.1. death rate from opportunistic infections reduced
4.6.2. people 60 and older are increasingly being infected
5. the virus
5.1. called retrovirus because it can replicate in a backwards manner going from RNA to DNA
5.2. CD4 and TCell is the target cell for HIV immune problems start when CD4 and TCells drop to less than 500 -- normal range is 800-1200 cells
5.3. newly formed double stranded DNA is infected with HIV because all genetic material is replicated during cell division
5.4. viral DNA directs cell to make new HIV
5.5. insufficient immune response allows for opportunistic disease
5.6. Credentials
5.7. Knowledge
6. interprofessional care
6.1. monitor disease progression, immune function, and manage symptoms
6.2. initiate and monitor ART
6.3. prevent, detect, and/or treat opportunistic infections
6.4. prevent or decrease complications of therapies
6.5. prevent further transmission of HIV
6.6. initial patient visit
6.6.1. gather baseline data
6.6.2. establish rapport and use patient input to develop a plan of care
6.6.3. initiate teaching ablult spectrum of HIV, treatment, preventing transmission, improving health, and family planning
7. drug therapy
7.1. main goals
7.1.1. decrease viral load
7.1.2. maintain/ increase CD4 and T counts
7.1.3. prevent HIV related sypmtoms and opportunistic diseases
7.1.4. delay progression
7.1.5. prevent HIV transmission
7.2. safety alert
7.2.1. herbal therapies
7.2.1.1. ST. Johns wart
7.2.2. commonly used drugs
7.2.3. OTC drugs
7.2.3.1. antacids, proton pump inhibitors, supplements
7.3. opportunistic diseases complicate management of HIV infection
7.3.1. prevention is key
7.3.2. onset can be delayed with adequate measures
7.3.3. effective management has significantly increased life expectancy
8. prevention
8.1. PrEP (pre-exposure prophylaxis)
8.1.1. used in conjusction with proven prevention intervention
8.1.2. comprehensive strategy to reduce risk of sexually-acquired infection in adults at high risk
9. assessment
9.1. dont make assumptions
9.2. candid conversations is important for effective management of HIV
9.3. ask at-risk patients
9.3.1. received blood transfusion or clotting factors before 1985
9.3.2. shared needles with another person
9.3.3. had a sexual experience with your penis, vagina, rectum, or mouth in contact with these areas of another person
9.3.4. had sexually transmitted infection
9.4. assess throughly
9.4.1. past Hx
9.4.2. functional health patterns
9.4.3. presence of symptoms using systems review
10. planning
10.1. compliance with drug therapy
10.2. adopting a health life style
10.3. beneficail relationships
10.4. spiritaul well-being in regard to life and death
10.5. coping with disease and its Tx
11. implementation
11.1. primary prevention and health promotion are the most effective strategies for diseases of a chronic nature including disease
11.1.1. when prevention fails
11.1.1.1. disease results
11.1.1.2. early intervention is facilitated by health promotion practices
11.1.2. HIV infection is preventable
11.1.2.1. avoid high risky behaviors
11.1.2.2. modify risky behaviors
11.1.2.3. candid, culturally sensitive, language appropriate, age-specific information and behavior change counsleing
11.1.3. prevention of HIV
11.1.3.1. decreasing risks: sexual intercourse
11.1.3.1.1. abstinence
11.1.3.1.2. noncontact safe sex
11.1.3.1.3. use of barriers
11.1.3.2. decreasing risks: drug use
11.1.3.2.1. dont use
11.1.3.2.2. dont share equipment
11.1.3.2.3. dont have sexual intercourse under the influence of anything impairing substance
11.1.3.2.4. refer for help with substance use
11.1.3.3. decreasing risks: perinatal transmission
11.1.3.3.1. family plamnning
11.1.3.3.2. prevent HIV in women
11.1.3.3.3. appropriately medicate HIV- infected pregnant woman
11.1.3.4. decreasing risks: work
11.1.3.4.1. adhere to precautions and safety measures to avoid exposure
11.1.3.4.2. report all exposure for timely treatment and counseling
11.1.3.4.3. post-exposure prophylaxis with combination ART can significantly decrease the risk of infection
12. interventions
12.1. acute
12.1.1. early intervention promotes health and delays disability
12.1.2. reactions to positive HIV test
12.1.2.1. similar to any life- threatening, chronic illness
12.1.2.1.1. pain
12.1.2.1.2. anxiety
12.1.2.1.3. fear
12.1.2.1.4. guilt
12.1.2.1.5. depression
12.1.2.1.6. denial
12.1.2.1.7. anger
12.1.2.1.8. hopelessness
12.2. antiretroviral threapy
12.2.1. ART can significantly slow HIV progression, but it
12.2.1.1. is complex
12.2.1.2. as side effects
12.2.1.3. does not work for everyone
12.2.1.4. is expensive
12.2.2. when to start therapy
12.2.2.1. patient readiness is most important concern
12.2.2.2. to avoid human burnout and non-adherence, treatment is recommended when immune suppression is great
12.2.3. adherence to drug regimens is critical to prevent
12.2.3.1. disease progession
12.2.3.1.1. to delay progression support a healthy immune system
12.2.3.2. opportunist disease
12.2.3.3. viral drug resistence
12.2.4. an idividulaized approach is best
12.3. acute excerbations
12.3.1. HIV infection
12.3.1.1. has no cure
12.3.1.2. continues for life
12.3.1.3. causes physical disability
12.3.1.4. impairs social, emotional, economic,and spiritual well-being
12.3.1.5. ultimately leads to death
13. drug side-effects
13.1. common problems
13.1.1. anxiety, fear, depression
13.1.2. diarrhea
13.1.3. peripheral neuropathy
13.1.4. pain
13.1.5. nausea/ vomitting
13.1.6. fatigue
14. end of life care
14.1. focus on nursing interventions
14.1.1. patient comfort
14.1.2. promote acceptance of finite nature of life
14.1.3. helping significant other deal with
14.1.4. maintaining safe environemnt