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

1. transmission

1.1. blood

1.2. semen

1.3. vaginal secretions

1.4. breast milk

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

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

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. 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. the virus

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

8.2. 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

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

8.4. viral DNA directs cell to make new HIV

8.5. insufficient immune response allows for opportunistic disease

8.6. Credentials

8.7. Knowledge

9. clinical manifestations and complications

9.1. acute

9.1.1. flu-like symptoms

9.1.1.1. muscle and joint pain

9.1.1.2. fever

9.1.1.3. swollen lymphnodes

9.1.1.4. sore throat

9.1.1.5. headache

9.1.1.6. malaise

9.1.1.7. nausea

9.1.1.8. diarrhea

9.1.1.9. diffuse rash

9.1.2. occurs about 2-4 weeks after infection

9.1.3. highly infectious

9.2. assymptomatic

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

9.2.2. symptoms are generally absent or vague

9.2.3. high risk behaviors may continue

9.3. symptomatic

9.3.1. CD4 and Tcells decline closer to 200

9.3.2. symptoms become worse

9.3.3. HIV advances to more active stage

9.3.3.1. bacterial infections Ex. oral thrush

9.3.3.2. shingles

9.3.3.3. herpes

9.3.3.4. persistent vaginal candidal infections

9.3.3.5. kaposi sarcoma

9.3.3.6. oral hairy leukplakia

9.4. AIDS

9.4.1. diagnostic criteria is established by CDC

9.4.2. Immune system severely compromised

9.4.2.1. infections ex. pneumocystis jiroveci pneumonia

9.4.2.2. malignancies

9.4.2.3. wasting

9.4.2.4. HIV-related cognitive changes

9.5. metabolic disorders

9.5.1. lipodystrphy

9.5.2. hyperlipidemia

9.5.3. insulin resistence

9.5.4. hyperglycemia

9.5.5. bone disease

9.5.6. lactic acidosis

9.5.7. renal disorders

9.5.8. cardiovascular disease

9.6. increasing rates of HIV disease among older adults

9.6.1. death rate from opportunistic infections reduced

9.6.2. people 60 and older are increasingly being infected

10. drug therapy

10.1. main goals

10.1.1. decrease viral load

10.1.2. maintain/ increase CD4 and T counts

10.1.3. prevent HIV related sypmtoms and opportunistic diseases

10.1.4. delay progression

10.1.5. prevent HIV transmission

10.2. safety alert

10.2.1. herbal therapies

10.2.1.1. ST. Johns wart

10.2.2. commonly used drugs

10.2.3. OTC drugs

10.2.3.1. antacids, proton pump inhibitors, supplements

10.3. opportunistic diseases complicate management of HIV infection

10.3.1. prevention is key

10.3.2. onset can be delayed with adequate measures

10.3.3. effective management has significantly increased life expectancy

11. assessment

11.1. dont make assumptions

11.2. candid conversations is important for effective management of HIV

11.3. ask at-risk patients

11.3.1. received blood transfusion or clotting factors before 1985

11.3.2. shared needles with another person

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

11.3.4. had sexually transmitted infection

11.4. assess throughly

11.4.1. past Hx

11.4.2. functional health patterns

11.4.3. presence of symptoms using systems review

12. medications

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