HIV- retrovirus that causes immunosuppression making persons more susceptible to infections; stig...
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
1.3.1.1. decreased WBC
1.3.1.2. low platelet count
1.3.1.3. altered liver function
1.3.1.4. 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
6.1.2.1. similar to any life- threatening, chronic illness
6.1.2.1.1. pain
6.1.2.1.2. anxiety
6.1.2.1.3. fear
6.1.2.1.4. guilt
6.1.2.1.5. depression
6.1.2.1.6. denial
6.1.2.1.7. anger
6.1.2.1.8. hopelessness
6.2. antiretroviral threapy
6.2.1. ART can significantly slow HIV progression, but it
6.2.1.1. is complex
6.2.1.2. as side effects
6.2.1.3. does not work for everyone
6.2.1.4. is expensive
6.2.2. when to start therapy
6.2.2.1. patient readiness is most important concern
6.2.2.2. 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
6.2.3.1. disease progession
6.2.3.1.1. to delay progression support a healthy immune system
6.2.3.2. opportunist disease
6.2.3.3. viral drug resistence
6.2.4. an idividulaized approach is best
6.3. acute excerbations
6.3.1. HIV infection
6.3.1.1. has no cure
6.3.1.2. continues for life
6.3.1.3. causes physical disability
6.3.1.4. impairs social, emotional, economic,and spiritual well-being
6.3.1.5. 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
10.1.1.1. muscle and joint pain
10.1.1.2. fever
10.1.1.3. swollen lymphnodes
10.1.1.4. sore throat
10.1.1.5. headache
10.1.1.6. malaise
10.1.1.7. nausea
10.1.1.8. diarrhea
10.1.1.9. 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
10.3.3.1. bacterial infections Ex. oral thrush
10.3.3.2. shingles
10.3.3.3. herpes
10.3.3.4. persistent vaginal candidal infections
10.3.3.5. kaposi sarcoma
10.3.3.6. oral hairy leukplakia
10.4. AIDS
10.4.1. diagnostic criteria is established by CDC
10.4.2. Immune system severely compromised
10.4.2.1. infections ex. pneumocystis jiroveci pneumonia
10.4.2.2. malignancies
10.4.2.3. wasting
10.4.2.4. 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
11.2.1.1. ST. Johns wart
11.2.2. commonly used drugs
11.2.3. OTC drugs
11.2.3.1. 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
13.1.1.1. disease results
13.1.1.2. early intervention is facilitated by health promotion practices
13.1.2. HIV infection is preventable
13.1.2.1. avoid high risky behaviors
13.1.2.2. modify risky behaviors
13.1.2.3. candid, culturally sensitive, language appropriate, age-specific information and behavior change counsleing
13.1.3. prevention of HIV
13.1.3.1. decreasing risks: sexual intercourse
13.1.3.1.1. abstinence
13.1.3.1.2. noncontact safe sex
13.1.3.1.3. use of barriers
13.1.3.2. decreasing risks: drug use
13.1.3.2.1. dont use
13.1.3.2.2. dont share equipment
13.1.3.2.3. dont have sexual intercourse under the influence of anything impairing substance
13.1.3.2.4. refer for help with substance use
13.1.3.3. decreasing risks: perinatal transmission
13.1.3.3.1. family plamnning
13.1.3.3.2. prevent HIV in women
13.1.3.3.3. appropriately medicate HIV- infected pregnant woman
13.1.3.4. decreasing risks: work
13.1.3.4.1. adhere to precautions and safety measures to avoid exposure
13.1.3.4.2. report all exposure for timely treatment and counseling
13.1.3.4.3. 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