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

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