HIV- retrovirus that causes immunosuppression making persons more susceptible to infections; stig...

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HIV- retrovirus that causes immunosuppression making persons more susceptible to infections; stigma can lead to discrimination and results in social isolation, dependence, frustration, low self-image, loss of control and economic pressure this in turn could lead to further involvement in risky behaviors by Mind Map: HIV- retrovirus that causes immunosuppression making persons more susceptible to infections; stigma can lead to discrimination and results in social isolation, dependence, frustration, low self-image, loss of control and economic pressure this in turn could lead to further involvement in risky behaviors

1. Diagnostic Studies

1.1. Most useful screening tests detect HIV- specific antibodies and/ or antigens

1.1.1. may take several weeks to detect antibodies

1.1.2. performed using blood or saliva

1.1.3. combinations tests can detect HIV earlier (4th generation)

1.2. HIV progression is monitored by

1.2.1. CD4 and Tcells count provides a maker of immune function

1.2.2. viral load- the lower the viral load the active the disease

1.3. abnormal blood tests are common

1.3.1. caused by HIV, opportunistic disease, or complications of therapy decreased WBC low platelet count altered liver function anemia asccociated with ART

1.4. Resistence tests can help determine if patient is resistent to ART

1.5. Assays help HCPs know which medications may be effective

1.5.1. genotype assay

1.5.2. phenotype assay

1.6. Testing is the only sure method of determining HIV infection

1.6.1. CDC recommends universal, voluntary testing as part of routine medical care

2. transmission

2.1. blood

2.2. semen

2.3. vaginal secretions

2.4. breast milk

2.5. unprotected sex with an HIV infected partner is the most common mode of transmission

2.6. sharing drug needles- puncture wounds are among the most common mean of work- related HIV transmission

3. interprofessional care

3.1. monitor disease progression, immune function, and manage symptoms

3.2. initiate and monitor ART

3.3. prevent, detect, and/or treat opportunistic infections

3.4. prevent or decrease complications of therapies

3.5. prevent further transmission of HIV

3.6. initial patient visit

3.6.1. gather baseline data

3.6.2. establish rapport and use patient input to develop a plan of care

3.6.3. initiate teaching ablult spectrum of HIV, treatment, preventing transmission, improving health, and family planning

4. prevention

4.1. PrEP (pre-exposure prophylaxis)

4.1.1. used in conjusction with proven prevention intervention

4.1.2. comprehensive strategy to reduce risk of sexually-acquired infection in adults at high risk

5. planning

5.1. compliance with drug therapy

5.2. adopting a health life style

5.3. beneficail relationships

5.4. spiritaul well-being in regard to life and death

5.5. coping with disease and its Tx

6. interventions

6.1. acute

6.1.1. early intervention promotes health and delays disability

6.1.2. reactions to positive HIV test similar to any life- threatening, chronic illness pain anxiety fear guilt depression denial anger hopelessness

6.2. antiretroviral threapy

6.2.1. ART can significantly slow HIV progression, but it is complex as side effects does not work for everyone is expensive

6.2.2. when to start therapy patient readiness is most important concern to avoid human burnout and non-adherence, treatment is recommended when immune suppression is great

6.2.3. adherence to drug regimens is critical to prevent disease progession to delay progression support a healthy immune system opportunist disease viral drug resistence

6.2.4. an idividulaized approach is best

6.3. acute excerbations

6.3.1. HIV infection has no cure continues for life causes physical disability impairs social, emotional, economic,and spiritual well-being ultimately leads to death

7. drug side-effects

7.1. common problems

7.1.1. anxiety, fear, depression

7.1.2. diarrhea

7.1.3. peripheral neuropathy

7.1.4. pain

7.1.5. nausea/ vomitting

7.1.6. fatigue

8. medications

9. the virus

9.1. called retrovirus because it can replicate in a backwards manner going from RNA to DNA

9.2. 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

9.3. newly formed double stranded DNA is infected with HIV because all genetic material is replicated during cell division

9.4. viral DNA directs cell to make new HIV

9.5. insufficient immune response allows for opportunistic disease

9.6. Credentials

9.7. Knowledge

10. clinical manifestations and complications

10.1. acute

10.1.1. flu-like symptoms muscle and joint pain fever swollen lymphnodes sore throat headache malaise nausea diarrhea diffuse rash

10.1.2. occurs about 2-4 weeks after infection

10.1.3. highly infectious

10.2. assymptomatic

10.2.1. if left untreated, a Dx of AIDS is made in about 10 years after initial HIV infection

10.2.2. symptoms are generally absent or vague

10.2.3. high risk behaviors may continue

10.3. symptomatic

10.3.1. CD4 and Tcells decline closer to 200

10.3.2. symptoms become worse

10.3.3. HIV advances to more active stage bacterial infections Ex. oral thrush shingles herpes persistent vaginal candidal infections kaposi sarcoma oral hairy leukplakia

10.4. AIDS

10.4.1. diagnostic criteria is established by CDC

10.4.2. Immune system severely compromised infections ex. pneumocystis jiroveci pneumonia malignancies wasting HIV-related cognitive changes

10.5. metabolic disorders

10.5.1. lipodystrphy

10.5.2. hyperlipidemia

10.5.3. insulin resistence

10.5.4. hyperglycemia

10.5.5. bone disease

10.5.6. lactic acidosis

10.5.7. renal disorders

10.5.8. cardiovascular disease

10.6. increasing rates of HIV disease among older adults

10.6.1. death rate from opportunistic infections reduced

10.6.2. people 60 and older are increasingly being infected

11. drug therapy

11.1. main goals

11.1.1. decrease viral load

11.1.2. maintain/ increase CD4 and T counts

11.1.3. prevent HIV related sypmtoms and opportunistic diseases

11.1.4. delay progression

11.1.5. prevent HIV transmission

11.2. safety alert

11.2.1. herbal therapies ST. Johns wart

11.2.2. commonly used drugs

11.2.3. OTC drugs antacids, proton pump inhibitors, supplements

11.3. opportunistic diseases complicate management of HIV infection

11.3.1. prevention is key

11.3.2. onset can be delayed with adequate measures

11.3.3. effective management has significantly increased life expectancy

12. assessment

12.1. dont make assumptions

12.2. candid conversations is important for effective management of HIV

12.3. ask at-risk patients

12.3.1. received blood transfusion or clotting factors before 1985

12.3.2. shared needles with another person

12.3.3. had a sexual experience with your penis, vagina, rectum, or mouth in contact with these areas of another person

12.3.4. had sexually transmitted infection

12.4. assess throughly

12.4.1. past Hx

12.4.2. functional health patterns

12.4.3. presence of symptoms using systems review

13. implementation

13.1. primary prevention and health promotion are the most effective strategies for diseases of a chronic nature including disease

13.1.1. when prevention fails disease results early intervention is facilitated by health promotion practices

13.1.2. HIV infection is preventable avoid high risky behaviors modify risky behaviors candid, culturally sensitive, language appropriate, age-specific information and behavior change counsleing

13.1.3. prevention of HIV decreasing risks: sexual intercourse abstinence noncontact safe sex use of barriers decreasing risks: drug use dont use dont share equipment dont have sexual intercourse under the influence of anything impairing substance refer for help with substance use decreasing risks: perinatal transmission family plamnning prevent HIV in women appropriately medicate HIV- infected pregnant woman decreasing risks: work adhere to precautions and safety measures to avoid exposure report all exposure for timely treatment and counseling post-exposure prophylaxis with combination ART can significantly decrease the risk of infection

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