Nr203 Test 2 Hiv/aids Four Final Questions?

Front 1

Generally, what groups of people are contracting AIDS?

Back 1

IV drug users
women
heterosexuals

(homosexual men are still a big group)

Front 2

How does HIV/AIDS relate to people over 50?

Back 2

Current estimates are that 20-30% of people over 50 are acquiring the HIV disease
Women over 50 years of age acquire HIV infection primarily through heterosexual contact.

Front 3

What cells are infected more readily by the HIV virus?

Back 3

T helper cells

Front 4

How are the T helper cells depleted?

Back 4

1. once inside the host, HIV attaches to the target cell membrane by way of its receptor molecule, CD4
2. The virus is uncoated, and the RNA enters the cell.
3. The enzyme known as reverse transcriptase is released, and viral RNA transcribed into DNA
4. This newly created DNA moves into the nucleus and the DNA of the cell
5. A provirus is created when the viral DNA integrates itself into the cellular DNA or genome of the cell.
6. Once the provirus is in place, its genetic material is no longer pure cell but is part virus
7. The cell may function abnormally
8. The host cell dies, and viral budding occurs.

Front 5

The main target for HIV is the ________ cell; however the "glue" to which HIV is attracted is the ____ molecule, which acts......

Back 5

The main target for HIV is the T4 helper cell; however the "glue" to which HIV is attracted is the CD4 molecule, which acts as the receptor for HIV on the T4 helper cell

Front 6

What is the average lab range for the CD4, T-cell count?

Back 6

500-1600 mm cubed

Front 7

What is a considerably low CD4 count, and what happens when the count is low?

Back 7

In the adult, CD4 cell counts below 200 are considered dangerously low and infection is likely to develop.

Front 8

What are lab changes that indicate immune function besides CD4 count?

Back 8

An overall decline in the total numbers of white blood cells.
Decreases in both the total number and percentage of lymphocytes
Significant changes in the CD4/CD8 ratio
Decreased CD4 T-cell test findings
Absent or Decreased skin test reactivity
Increased immunoglobin levels.

Front 9

How fast does the HIV virus replicate

Back 9

HIV replicates at a rapid rate. It may produce 10 million new virions daily

Front 10

How do Antiretroviral drugs help an HIV patient

Back 10

Antiretroviral drugs play a key role in interrupting the HIV disease process by inhibiting the ability of the virus to replicate, thus reducing the amount of circulating virus in the body and halting its destructive activity. Once this happens, the immune system begins to heal and restore itself, as noted by rising CD4 cell counts.
Sustaining the beneficial effects from antiretroviral therapy entails many challenges. The greatest problem is HIV's ability to mutate and become resistant to antiretroviral drugs. When this drug failure occurs, plasma viral load rises and the CD4 cell count decreases.

Front 11

what cofactors accelerate immunodeficiency?

Back 11

malnutrition
continued substance abuse
allergic conditions
genetics
age
pregnancy
gender
presence of infections

Front 12

What factors link to mortality and morbidity of HIV infected people

Back 12

lower socioeconomic status
lack of access to adequate care
receiving care in a hospital with limited AIDS experience
being treated by a physician with little experience in AIDS care.

Front 13

what does HAART stand for

Back 13

Highly active antiretroviral therapy
Uses varying combinations of drugs from three different classes of antiretroviral medications.
Combined with prophylactic treatment for commonly occurring oportunistic infections, HAART has led to HIV disease changing form a rapidly fatal disease to a chronic, more manageable condition.

Front 14

Long term progression of the illness-Signs of perfectly healthy HIV infected people

Back 14

Documented evidence of HIV infection for more than 10 years
Lack of manifestations
Normal, stable immune profiles
Never required any treatment for HIV disease
Long term non progressors appear to produce vigorous amounts of serum antibodies that keep HIV activity at extremely low levels, thus preventing damage to the immune system.

Front 15

What systems of the body does the HIV virus damage, what does this cause?

Back 15

Immune system
Cranial and peripheral neuropathies
uveitis
cardiomyopothy
pneumonitis
malabsorption in the small intestine
nephritis
cervicitis
arthritis
psoriasis
gonad dysfunction
adrenalitis
damage to the hemotologic system which is due in part to impaired blood cell production, commonly results in anemia, granulocytopenia, and thrombocytopenia throughout the course of disease

Front 16

what are pre-existing comorbid conditions seen in HIV infected clients

Back 16

alcoholism
drug dependence
liver disease
kidney disease
psychiatric illness
history of STDs

Front 17

What are the two monitoring parameters used to follow a client to classify the HIV disease

Back 17

1. Laboratory data (CD4 cell counts)
2. Clinical presentation (the person's clinical manifestations of diseases).

Front 18

A community health nurse has been asked to educate a group of high-risk adolescents on the prevention of the transmission of HIV. When planning this workshop, the nurse recognizes that the primary mode of transmission for HIV is which of the following?
1. Sharing needles during drug injections
2. Sexual contact
3. Blood transfusions
4. From mother to fetus

Back 18

2.Sexual contact

The primary mode of transmission for HIV is sexual contact. Contact with infected blood on needles shared during drug injection, and lateral infection from mother to fetus are also modes of transmission. A small number of cases contract the virus through blood transfusions.
Planning; Health Promotion and Maintenance; Analysis

Front 19

A client with HIV is receiving 4 antiretroviral drugs under the highly active anti-retroviral therapy (HAART) protocol. The client asks why she must take 4 different medications when she doesn't feel sick. The nurse's best response will be based on the knowledge of which of the following?
1. The combination therapy helps to reduce the incidence of drug resistance in the HIV client.
2. The combination therapy is necessary since there is no way to identify which drug will be effective.
3. The combination therapy helps to prevent opportunistic infections.
4. The combination therapy is used to treat opportunistic infections.

Back 19

1. The combination therapy helps to reduce the incidence of drug resistance in the HIV client.

Highly active anti-retroviral therapy (HAART) is the new treatment protocol that combines three to four of the antiretroviral drugs to reduce the incidence of drug resistance. These drugs do not treat or prevent opportunistic infections.
Implementation; Physiological Integrity; Application

Front 20

A client with HIV has a CD4 cell count of 190. The nurse anticipates the client will be treated prophylactically for which of the following potential infections in the HIV client?
1. Mycobacterium avium complex
2. Pneumocystis carinii pneumonia (PCP)
3. Tuberculosis
4. Kaposi's sarcoma

Back 20

3. Pneumocystis carinii pneumonia (PCP)
Prophylactic treatment for pneumocystis carinii (PCP) is begun when the CD4 cell count falls to less than 200. Prophylactic treatment for mycobacterium avium complex is begun with CD4 cell counts of less than 100. Kaposi's sarcoma is a cancer and there is no prophylaxis for this disease. The client is treated prophylactically for tuberculosis in the event the client is exposed to the disease.
Planning; Physiological Integrity; Analysis

Front 21

A client with HIV is being seen in the health clinic for follow up lab analysis. Which of the following assessments by the nurse would indicate the client has likely progressed to AIDS?
1. Weight loss of 4 pounds in the past 3 months
2. Lymphadenopathy of the cervical chain
3. Violet lesions over the client's nose and pinnae of the ears
4. Complaints of decreased appetite

Back 21

3. Violet lesions over the client's nose and pinnae of the ears


The presenting symptom of AIDS is often Kaposi's sarcoma (KS), a tumor of the endothelial cells lining small blood vessels. The tumor presents as vascular macules, papules, or violet lesions that affect the skin and viscera. The 4 pound weight loss and decreased appetite may be attributed to the stress of having a fatal disease and does not necessarily indicate AIDS. Lymphadenopathy of the cervical chain may be seen in some clients with HIV.
Assessment; Physiological Integrity; Analysis

Front 22

A client with HIV is asymptomatic. She informs the nurse that her live-in boyfriend is aware of her infection, and they practice "safe sex". The nurse knows that the client requires further teaching when she makes which of the following statements?
1. "We use latex condoms for vaginal and anal sex."
2. "We use latex condoms for oral sex."
3. "We use Vaseline for lubrication."
4. "We use nonoxynol-9 spermicide."

Back 22

3. "We use Vaseline for lubrication."
Latex condoms and nonoxynol-9 spermicide for lubrication are recommended for reducing the risk of transmitting HIV. Vaseline is not recommended for lubrication.
Evaluation; Health Promotion and Maintenance; Analysis

Front 23

2. A 25-year old man is admitted to the hospital with a diagnosis of acquired immune deficiency syndrome (AIDS). He is being treated for pneumocystis carinii pneumonia. The nurse evaluates the care provided to this patient by other members of the health care team. The nurse should intervene in which of the following situations?





A. A housekeeper cleans up spilled blood with a bleach solution

B. A nursing student takes the patient’s blood pressure wearing a mask and gloves

C. A technician wears gloves to perform a venipuncture

D. A nurse attendant allows visitors to enter his room without masks

Back 23

B. A nursing student takes the patient’s blood pressure wearing a mask and gloves – CORRECT: inappropriate practice; mask and gloves necessary only when possibility of contact with blood and body fluids; when taking a BP very low risk for contact with blood and body fluids, behavior insensitive to patient’s feelings, does not promote trust

Front 24

Which of the following are unique characteristics associated with human immunodeficiency virus (HIV) infection in the older person?
1. HIV infection in the older person most likely is underdiagnosed and underreported.
2. Healthcare workers often do not take sexual histories of older patients or recommend HIV testing.
3. Symptoms of memory loss and weight loss related to HIV often are treated as common age-related health problems.
4. Older persons are contacting HIV infection through heterosexual and homosexual activities.

Back 24

1. HIV infection in the older person most likely is underdiagnosed and underreported.

Healthcare workers often do not take sexual histories of older patients or recommend HIV testing.

Symptoms of memory loss and weight loss related to HIV often are treated as common age-related health problems.

Older persons are contacting HIV infection through heterosexual and homosexual activities.

Front 25

A nurse has been instructed to place an IV line in a patient that has active TB and HIV. The nurse should where which of the following safety equipment?
A: Sterile gloves, mask, and goggles
B: Surgical cap, gloves, mask, and proper shoewear
C: Double gloves, gown, and mask
D: Goggles, mask, gloves, and gown

Back 25

(D) All protective measures must be worn, it is not required to double glove.

Front 26

What are the etiologies and risk factors for HIV

Back 26

Etiology
First identified in 1983
HIV-1 (worldwide) mostly U.S. and Europe
HIV-2 (mostly in West African nations)
Risk Factors
Modes of Transmission
-Certain sexual practices
-Exposure to blood
-Perinatal (Vertical) transmission

Front 27

In the past 20 years, what has changed in the transmission Patterns of HIV/AIDS?

Back 27

1980s vs. 1990s
-Significant>IV drug users, women, and heterosexuals
-Most Americans with HIV are MSM (men who have sex with men), but overall number has decreased considerably
-Decrease is in white men only, other races and ethnicity groups continue to increase

Front 28

Gender Bias Transmission-explain

Back 28

Transmission is:
-More efficient from man to woman than woman to man
-Related to number of infectious particles in body fluid
-Related to volume of fluids exchanged
-Related to surface area coming in contact with infected body fluid

Front 29

How are women and HIV connected

Back 29

3rd leading cause of death for all women between the ages of 25-44
The leading cause of death for African American women in this age group
92,242 cumulative AIDS cases had occurred in adult and adolescent women in the US by the middle of 1997
Women comprise approximately 15% of the total number of adult and adolescent AIDS cases.

Front 30

How are youth, sex, and drugs connected to HIV?

Back 30

Half of the 40,000 people diagnosed with HIV in the United States each year are adolescents
3 million contract a sexually transmitted disease
Nearly 10% of students had tried cocaine or crack in the previous month
80% of the students had tried alcohol
1/3 of these having had 5 or more drinks in the past month
Nearly ½ had used marijuana in the previous month
African American students were significantly more likely to use condoms than Hispanics and whites
48% of more than 16,000 students aged 10-24 surveyed have had sex
-7% of the sexually active students were under the age of 13
-16% reported having had at least 4 sex partners
58% reported that either they or their partner had used a condom during their last sexual encounter

Front 31

What is the Pathophysiology of HIV

Back 31

HIV is a retrovirus
HIV infects T helper cells (T4 lymphocytes), macrophages and B cels
T helper cells are infected the most readily
Glue to which HIV is attracted is the CD4 molecule (acts as receptor on T helper cell)
Clinicians refer to T4 helper cells as CD4 cells

Front 32

Clinical Manifestations of HIV
What are the 2 monitoring parameters used to follow a client

Back 32

2 monitoring parameters used to follow a client
1. Laboratory data (CD4 cell counts), viral load testing
2. Clinical presentation (the person’s clinical manifestations of diseases)

Front 33

Asymptomatic HIV infection
Signs and Symptoms

Back 33

Fatigue, Night sweats
Low grade fevers, diarrhea, H/A
CD4 Cell counts
Anergy Panel

Front 34

Symptomatic HIV Infection

Back 34

Lymph nodes
Skin assessment
Thrush
Diarrhea
Oral candida
Oral hairy leukoplakia
Herpes Simplex
Varicella Zoster

Front 35

Why does CD4 cell count jump around

Back 35

The CD4 count often jumps around because the determination can often be inaccurate
Lab. Variations can occur within the same sample.
It can change
-based on the time of day
-if patient smokes before venapuncture
-If patient has a current illness such as cold or flu

Front 36

Diagnosis of HIV
Diagnostic tests of AIDS

Back 36

ELISA indirect measurement of antibodies, incredible false + rate
-Western Blot More reliable test for HIV, used to confirm + ELISA, More time consuming
-p24 antigen produces a lot of false, only + when virus is dividing. Helpful in monitoring disease progress and effectiveness of therapy.
-Viral cultures very expensive and difficult to grow on culture.

Front 37

Medical Management of HIV:
What are the desired outcomes when HIV is managed?

Back 37

Desired Outcomes:
Maintain the person’s health
Initiate and maintain an effective antiretroviral regimen
Prevent infectious complications

Front 38

Current Directions in HIV Disease Management

Back 38

Perform viral load testing and CD4 count to assess disease progression and treatment efficacy
Initiate therapy upon diagnosis of HIV infection as appropriate?? More conservative approach recommended by most experts
Combination therapy should be utilized

Front 39

What do people with HIV need to do to maintain their health

Back 39

Detailed laboratory and clinical assessment
-CBC, chemistry panels, urinalysis
-Annual TB test, Chest X-Ray
-Pregnancy tests, PAP smear
-STD screening annually
-Hepatitis antibody testing
-Serologic tests to detect exposure to pathogens that can cause opportunistic infections
-CD4 counts, viral load testing

Front 40

What is Viral Load Testing

Back 40

Quantitative HIV RNA by PCR or by DNA (Viral load) is a direct measurement of circulating HIV virions in plasma.
It is the best predictor or long term clinical course.
The higher the viral load value (in copies of HIV RNA/ml) the higher the risk of progression to AIDS

Recent studies also indicate it is an important factor associated with perinatal HIV transmission.

Front 41

Guidelines for using viral load assays in practice

Back 41

Measure HIV RNA when first seeing pt to estimate baseline
Estimate prognosis and make TX decisions, baseline in conjunction with, physical exam, and CD4 cell count.
Strongly consider antiretroviral TX if level of HIV RNA is > 30,000 copies /ml regardless of CD4 count
Measure HIV RNA 2-4 wk after starting or changing tx; dc regimens that fail to reduce HIV RNA at least 3-10 fold or undetectable level
Monitor pts q 3-4 mo. For evidence of drug failure, which is indicated by a rise in HIV RNA

Front 42

Guidelines for Using Viral Load Assays in Practice

Back 42

Do not overreact to changes in HIV RNA that are less than 3-fold because that degree of variation could be due to assay variation alone.
Use the same kind of collection tube, the same assay, and the same laboratory to minimize variation in results

Front 43

Numbers of Infected Cells in Clinically Silent Phase of HIV disease

Back 43

1 billion actively replicating infected cells
1 billion covertly infected cells
1 trillion lymphocytes

Viral load increases continuously and eventually overwhelms the immune system

Front 44

If HIV infection is a war between the virus and the immune system

Back 44

“CD4” estimates the number of casualties
HIV RNA estimates the strength of the enemy

Front 45

Antiretroviral Therapy

Back 45

Current guidelines from the US department of HHS
-Symptomatic clients: treat
-Asymptomatic with CD4 count < 200: Treat
-Asymptomatic with CD4 counts 200-350: Therapy should be offered
-Asymptomatic with CD4 counts >350: Defer or consider therapy if viral load is high.

Front 46

Drug Therapy of HIV
Antiretrovirals

Back 46

Antiretrovirals
-Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTI’s)
-Nonnucleoside Reverse
Transcriptase Inhibitors (NNRTI’s)
Protease Inhibitors (PI’s)
Entry Inhibitors

Front 47

Antiretrovirals: NRTI’s and NNRTI’s
Explain what these drugs do

Back 47

Agents that interfere with the virus’s ability to replicate
Only work after the virus has infected the cell
Goal is to raise the T cell count so the body can deal with the infection

Front 48

Zidovudine (AZT, ZDV, Retrovir)
Antiretroviral, Nucleoside Analogue

Dose, route, implications, adverse effects

Back 48

Administration:
200 mg. po tid
300 mg po bid
With or without food

Major adverse effects
Nausea and headache at initiation
Decreases over weeks
Anemia
Neutropenia
Lactic acidosis/hepatoegaly with steatosis
Myopathy

Front 49

Didanosine (ddi, Videx)
Antiretroiral Nucleoside Analogue

Dose, route, implications, adverse effects, Directions for taking

Back 49

Administration:
>60 kg:200 m po bid (tablets); 250 mg po bid (powder)
<60kg: 125 mg po bid (tablets); 167 mg po bid (powder)
Formulated with an antacid buffer
Major adverse effects
-pancreatitis
-peripheral neuropathy

Directions:
May be taken on an empty stomach
Adults should take 2 tablets/dose
Palatability can be improved by simple measures (taking drug with cold water)
Liver failure
Retinal depigmentation

Front 50

Antiretrovirals: Protease inhibitors
explain how these drugs help treat HIV

Back 50

Since 1995, combination therapy has greatly improved prognosis
Primary goal of ART is to drive viral load below the level of detection

Front 51

Indinavir (Crixivan)
Antiretroviral Protease Inhibitor
Dose, route, implications, adverse effects

Back 51

Administration:
800 mg po tid
-Give one hour before or 2 hours after a full meal; or give with a light meal
Drug interactions
-rifabutin
-terfenadine
-astemizole
-Medazolam
-Triazolam

Major adverse effects
-Nephrolithiasis
-Hyperbilirubinemia (not clinically significant)
-Headache
-Rash
-Diarrhea
-Nausea

Front 52

Saquinavir (Invirase)
Antiretroviral: Protease Inhibitor

Back 52

Administration:
-600 mg PO tid (adjust for CrCl <50 ml/min)
-Should be given within 2 hours after a full meal
Drug interactions
Terfenadine
Astemizole
Rifampin
Rifabutin
Phenobarbital
Phenytoin
Dexamethasone
Carbamazepine

Major Adverse Effects
-Diarrhea
-Abdominal discomfort
-Nausea

Front 53

Antiretrovirals: Entry Inhibitor

Back 53

The only antiretroviral to work Before the HIV enters the cell
Blocks HIV from entering the cell.
Fuzeion, T-20
Must be given BID in SQ injection
Adverse Reactions
-Bacterial pneumonia or allergic reactions
Injection site infections
Diarrhea, nausea, fatigue.

Front 54

Combivir
Antiretroviral: 2 Nucleoside Analogues combined

Back 54

Combination of existing drugs
-Retrovir (AZT) 300 mg
-Epivir (3CT) 150 mg
Dosage
One tablet twice a day

Front 55

Trizivir Combination drug

Back 55

Combination of 3 drugs:
-AZT 300 mg
-3TC 150 mg
-Abacavir 300 mg
Take 1 BID
Cost: 987.88/month

Front 56

Required AIDS Medications

Back 56

Antibiotic: Trimethoprim sulfamethoxazole (Bactrim DS)
Antifungal: Fluconazole (Diflucan)
Antiviral:
Acyclovir (Zovirax)
Antiretrovirals:
Nonnucleosides
Zidovudine (ADV, AZT, Retrovir)
Antiretrovirals: protease Inhibitors
-Sequinavir (Invirase)

Front 57

What drugs are used Prevent Infections

Back 57

Often give prophylactic medications to patients with CD4 cell counts <200
Antibiotics
Antifungals
Antivirals

Front 58

Perinatal and HIV
Explain the implications of a pregnant HIV woman, what can be done to protect the baby?

Back 58

All babies born to HIV+ mother will be + a birth (could be a false +)
ELISA needs to be checked at 15 months, again in 18 months if inconclusive
Studies have shown it is imperative to offer antiretrovirals (AZT) to mother to decrease transmission to baby

Front 59

Doctors urged to counsel ALL pregnant women

Back 59

Although 43% of physicians routinely advise universal HIV screening for prenatal patients, 90% agree with the practice
Only 10% of prenatal patients were actually screened for HIV
Female physicians were more likely to test for HIV

Front 60

Zidovudine Monotherapy Common Among HIV infected women

Back 60

By the 3rd trimester:
61% of HIV1 + pregnant women were being treated with AZT monotherapy
39% received combination therapy
Antiretroviral treatment naïve patients: 42% received the recommendation of AZT monotherapy
25% combination antiretroviral therapy
33% individually tailored tx recommendations

Front 61

Maternal Viral Load “Powerful” Predictor of HIV vertical transmission

Back 61

Estimated Rates of transmission
2% at 1,000 HIV RNA copies/ml
11% at 10,000 copies
40% at 100,000 copies
These findings extend the information from natural history studies which demonstrate that viral load is more effective in predicting progression of HIV disease than CD4 cell count.

Front 62

Pediatric HIV/AIDS

Back 62

HIV in Infants: the disease often produces severe bacterial and lung infections not seen in adults
An estimated 93% of children with HIV have developmental disabilities that result in some degree of physical or mental impairment
The mean total lifetime charges for care of children with HIV infection were $491,936

Front 63

When does HIV become AIDS

Back 63

Opportunistic Disease
Cancers
HIV wasting
HIV dementia
CD4 or T4 cell counts <200 if asymptomatic or <500 and AIDS indicator condition

Front 64

Medical and Nursing Management of AIDS

Back 64

Prevent and treat opportunistic infections
Treat Neoplasms
Treat other conditions specific to AIDS

Front 65

Opportunistic Infections

Back 65

Protozoal
-PCP (pneumocystitis carinii pneumonia)
Cryptosporidiosis
Bacterial
TB
Mycobacterium Avium Complex (MAX)
Salmonella
Recurrent Bacterial Pneumonia

Front 66

Pneumocystis Carninii Pneumonia (PCP)
Parasite
Etiology

Back 66

-Usually AIDS clients get if T4 count drops below 200.
-Ubiquitous, exist in lungs of animals and most humans
-Most children have acquired PCP infection by 4 years of age
Up to 80% AIDS clients may develop PCP

Front 67

Pathophysiology for
Pneumocystis Carninii Pneumonia (PCP) parasite

Back 67

-Reactive of latent infection
-Reported in adrenals, bone marrow, skin, ears, eyes, thyroid, liver, kidney, and spleen

Front 68

Pneumocystis Carninii Pneumonia (PCP)
Manifestations

Back 68

-fever, fatigue, weight loss, cough, dyspnea, 6% asymptomatic initially.
-Sputum may look clear with PCP.
-May get a false- on chest X-ray

Front 69

Pneumocystis Carninii Pneumonia (PCP)
Diagnosis

Back 69

-Sputum washing, bronchial alveolar lavage, lung biopsy, ET suction

Front 70

Pneumocystis Carninii Pneumonia (PCP)
Pharmacology
Prophylaxis
Nursing Interventions

Back 70

-Bactrim is the drug of choice
-50% get skin rash with bactrim
-May choose to treat with benadryl
-2nd choice is Pentamidine then Dapsone

Prophylaxis
If T4 drops to less than 200, prophylaxis is recommended
-Bactrim, Pentamidine, Dapsone

Nursing Interventions
-Treat Cough, SOA, fever, Fatigue

Front 71

Cryptosporidiosis (Protozoon)
Etiology
Pathophysiology

Back 71

-Self limiting in normal person, but in HIV usually causes death.
-Animal to human handling infected animals)
-Waterborne or contaminated food
-Anal-oral sex

Pathophysiology (GI Tract infection)

Front 72

Cryptosporidiosis (Protozoon)
Manifestations
Diagnosis

Back 72

-Voluminous diarrhea (10-25 l/d)
-Cramping, flatulence, steatorrhea, malabsorption, fatigue, dehydration, electrolyte imbalance, myalgia, n/v, weight loss, anorexia, fever, malnutrition, dehydration
Diagnosis
-Microscopy

Front 73

Cryptosporidiosis (Protozoon)
Pharmacology

Back 73

Spiramycin, Eflornithine, diclazuril, trimetrexate, somatostatin, bovine grensfer factor, hyperimmune bovine colostrum, cow’s milk, flobulin
-not really an adequate drug TX though ay be tried.

Front 74

Nursing Intervention
Cryptosporidiosis (Protozoon)

Back 74

Prevention: chlorine does not kill this and swimming pools can be a problem. Need ammonia to kill.
Treat diarrhea, pain, weight loss, fatigue, fever, stomatitis, skin breakdown, enteric precautions, household cleaning and body image
Nurses can get this from not using universal precautions (hand washing/gloving)

Front 75

Salmonelosis (bacteria)
Etiology

Back 75

Contaminated food, water, medication, or fecal-oral

Front 76

Salmonelosis (bacteria)
Pathophysiology

Back 76

GI tract to blood and spreads to lungs and throughout body

Front 77

Salmonelosis (bacteria)
Manifestations

Back 77

Fever, chills, night sweats, weight loss, anorexia, diarrhea, fatigue, abd. Pain

Front 78

Salmonelosis (bacteria)
Diagnostic tests used to diagnose

Back 78

Bacterial culture, stool culture

Front 79

Salmonelosis (bacteria)
Pharmacology

Back 79

Antibiotics
Ampicillin
Chloramphenicol
Amoxicillin
Cipro
Bactrim

Front 80

Salmonelosis (bacteria)
Nursing Interventions

Back 80

Prevention-enteric precautions
Treat fever, diarrhea, skin breakdown, dehydration

Front 81

Tuberculosis (TB)-explain disease and how it relates to HIV/AIDS

Back 81

Pulmonary or extracellular (other than pulmonary) TB was added as diagnostic of AIDS in 1993 with positive HIV
Multidrug resistant TB (MDR-TB) is most evident in AIDS, closed environments, and large urban areas.
Infectious disease specialist should be consulted MDR-TB
Prevention and TX of MDR-TB requires concurrent admin. Of more drugs for a longer period of time (2 years or longer)
HIV/AIDS client may require TB therapy for the rest of their lives with the impaired immune system.

Front 82

Mycobacterium Avium Complex (MAC)
Etiology

Back 82

Etiology
-Found in H20, food, and soil throughout the U.S.
-Transmitted by inhalation of droplets of contaminated water.

Front 83

Mycobacterium Avium Complex (MAC)
Manifestations

Back 83

Fever
Night sweats
Fatigue
Anorexia
Weight loss
Abdominal pain

Front 84

Mycobacterium Avium Complex (MAC)
Pathophysiology

Back 84

Rarely causes significant disease in immuno-competent persons but causes an opportunistic pulmonary infection in about 50% of those with advance HIV.
Major cause of wasting syndrome with AIDS

Front 85

Mycobacterium Avium Complex (MAC)
Diagnosis

Back 85

As disease becomes disseminated through the body, chronic lung disease develops and the organism is found in blood, bone marrow, liver, lymph nodes, and other body tissues.

Front 86

Mycobacterium Avium Complex (MAC)
Treatment

Back 86

Combination of antitubercular drugs that were not effective due to high rate of drug resistance and relapse

Newer drugs used are:
Azithromycin, Clarithromycin, and Rifabutin

Life long prophylactic drug therapy of
Azithromycin or Clarithromycin

Front 87

Opportunistic Infections
Cryptococcus (Fungi)
Etiology

Back 87

Ubiquitous (pigeon droppings), nesting places, soil, fruit and fruit juice
Organism is aerosolized and inhaled

Front 88

Opportunistic Infections
Cryptococcus (Fungi)
Pathophysiology

Back 88

Can cause central nervous system, pulmonary and disseminated infection
Meningoencephalitis in HIV disease, reactivation of infection.

Front 89

Opportunistic Infections
Cryptococcus (Fungi)
Manifestations

Back 89

-CNS
-Fever, malaise, Headache, stiff neck, N/V, diarrhea, photophobia, altered mentation, focal deficits, seizures
Pulmonary
Cough, dyspnea, pleuritic chest pain

Front 90

Opportunistic Infections
Cryptococcus (Fungi)
Diagnostic tests used to diagnose

Back 90

Microscopy and/or culture

Front 91

Opportunistic Infections
Cryptococcus (Fungi)
Pharmacology

Back 91

Systemic antifungal like Amphotericin-B, Flucystosine, Fluconazole.

Front 92

Opportunistic Infections
Cryptococcus (Fungi)
Nursing Interventions

Back 92

Side effects of medications,
Impaired cognition, fever, cough, dyspnea H/A, mouth lesions

Front 93

Opportunistic Infections
Viral Infections-Name

Back 93

Cytomegalovirus
Herpes Simplex
Hepatitis

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Cytomegalovirus (CMV) Virus
Etiology

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Widely distributed throughout the world
Most primary infections occur perinatally, during preschool year, or with sexual activity.
Blood products, transplants, or organs.

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Cytomegalovirus (CMV) Virus
Pathophysiology

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Directly destroys tissue in the brain, lungs, liver, retina; causes hemolytic anemia, thrombocytopenia
Facilitates neoplastic transformation

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Cytomegalovirus (CMV) Virus
Manifestations

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Choriorentinitis
-Pneumonitis, Encephalitis, Adrenalitis, Colitis, Esophagitis, Hepatitis

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Cytomegalovirus (CMV) Virus
Diagnostic test used to diagnose

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Microscopy and/or culture
-Retina exam

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Cytomegalovirus (CMV) Virus
Pharmacology

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Ganciclovir
Foscarnet,

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Cytomegalovirus (CMV) Virus
Nursing interventions

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Teach the need to practice safer sex to prevent viral loading
Occupational concerns with vision loss
Diarrhea, fatigue, fever, weight loss

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Hepatitis-Explain disease and how it relates to HIV

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The leading cause of death among AIDS clients is now hepatic failure secondary to hepatitis B.
A dramatic increase in rates of co-infection with HIV and Hepatitis C.
Treatable with combination drug therapy/adds to complexity of therapy for those already on HAART.

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Name 3 types of Neoplasms/Opportunistic cancers

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Kaposi’s Sarcoma
Non-Hodgkin’s Lymphoma
Invasive Cervical Cancer

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Opportunistic Cancers
Kaposi’s Sarcoma
Explain Kaposi’s Sarcoma and how it relates to HIV/AIDS

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Kaposi’s Sarcoma (KS)
-A cancer of the lining of the blood vessels
Most common cancer associated with HIV/AIDS

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Opportunistic Cancers
Lymphomas

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Usually are aggressive tumors, growing and spreading rapidly.
-Primary lymphoma of the brain
-H/A and changes in mental status are common early symptoms
Non Hodgkin’s lymphomas-example

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Opportunistic Cancers
Invasive Cervical Cancer

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Of women with HIV, 40% have cervical dysplasia.
Cervical cancer develops frequently and tends to be aggressive. HIV + women with cervical cancer usually die from the cancer, not the HIV.
Recommended that women with HIV have PAP smear every 6 months and aggressive treatment of cervical dysplasia with colposcopic exam and cone biopsy

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AIDS Specific Conditions-name 2

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AIDS Dementia
(HIV encephalopathy)
HIV wasting syndrome

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AIDS Dementia
Etiology

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Spread of HIV to the brain occurs early and is widespread. Not correlated with disease progression

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AIDS Dementia
Pathophysiology

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HIV penetrates the blood brain barrier
HIV can be found in 75-90% of neurologically asymptomatic
Neural losses even in the absence of encephalitis

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AIDS Dementia
Manifestations

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-Cognitive dysfunction-difficulty with concentration and memory, impaired judgment, slow thinking
-Motor deficits—
Leg weakness,
ataxia,
clumsiness
Dropping things
Hand activities become slower and less precise.
Behavioral Changes-Apathy, reduced spontaneity, social withdrawal, irritability, anxiety, delirium.

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AIDS Dementia
Stages/Diagnosis

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5 stages
1-minimal S/S
5-nearly vegetative
Diagnosis: HIV + CSF
Grossly under diagnosed, may be misdiagnosed as depression
Antidepressants can exaggerate delirium

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AIDS Dementia
Pharmacology

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Antiretrovirals (Combination therapy preferred)
Psychotropics (caution)

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AIDS Dementia
Expected Outcomes

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-Client Safety prime concern. Protect from falls, medication misadministration
Independence for as long as possible.

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HIV wasting syndrome
Etiology
Related to

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Etiology-Occurs in >90% of AIDS clients
Related to:
-Reduced food intake
-Malabsorption of nutrients
-Altered metabolism of nutrients
-Low testosterone levels.

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HIV wasting syndrome
Diagnosis

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Profound involuntary weight loss > 10% total baseline weight with either chronic diarrhea or chronic weakness and fever

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HIV wasting syndrome
Assessment

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-Diet history, adequacy of protein/calorie intake. Substituting vitamins for intake.

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HIV wasting syndrome
Pharmacology

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-Nutritional supplements: Dronabinal, (the major psychoactive component of Marijuana
Increases appetite
Prevents vomiting
Megace, synthetic version of hormone Progesterone
Increases fat synthesis
Testosterone
Anabolic steroids
TPN as last resort
Human Growth Hormone (more successful than others)

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HIV wasting syndrome
Goals

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Prevent further weight loss
Stimulate appetite
Produce weight gain
Increase lean muscle mass

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Nursing Diagnoses in HIV/AIDS

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Impaired skin integrity
-Assess for lesions and breakdown
-Monitor for signs of infection/impaired healing
-Prevent skin shearing
-Monitor nutritional intake as well as albumin levels.

Altered Nutrition: Less than body requirements
Nutritional assessment for baseline
Assess for cause of altered nutrition
Administer medication for candidiasis and other manifestations.
Oral hygiene

Altered Sexuality patterns
Examine your feeling about sexuality
Provide factual information about HIV infection

Self care deficit related to systemic infection

Risk for injury: Recurrent infection, falls, medication compliance, family responsibilities, adequate nutrition

Ineffective individual coping

Altered thought processes.

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Client and Family Teaching
about HIV/AIDS

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Disease progression, treatment options, and how HIV is spread.
Guidelines for safer sex practices, even if HIV+
Inform all medical personnel of HIV status
Abstain from donating organs, tissue, or blood
Maintain optimum health: diet, exercise, rest, stress reduction, lifestyle changes, regular checkups, and hand-washing.
Proper medication administration, side effects, viral load, and CD4 counts
S/S of opportunistic disease and when to seek medical assistance.

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How much does the medicine cost to treat HIV/AIDS

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A lot!!!!
Nucleoside Analogues
Combivir $478.90 (3TC/AZT) 1X150 mg/300 mg tab TID
Epivir $220.90 (lamivudine/3TC) 1X150 mg tab BID
Videx $181.55 (didanosine/ddl) 2X100mg tab BID
Retrovir $258.10 (zidovudine/ZDV/AZT)
2X100 mg cap TID, 1X300 mg tab BID
Protease Inhibitors
Crixivan ($405.05) indavir $405.05
You get the picture

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treatment of HIV/AIDS has had three stages: what are these stages?

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(1) sequential monotherapy, (2) HAART (highly active antiretroviral therapy), and (3) the newest phase of boosting antiretroviral therapy with protease inhibitors (PIs) with ritonavir. Boosting with ritonavir prevents the liver from breaking down the drug as quickly, leaving a higher sustained blood level of the PI. This translates into easier dosing, because drugs that needed to be taken three to five times daily can now be taken twice daily with food. This will enhance adherence to therapy and reduce the development of resistant strains of HIV. Some boosted PIs are showing efficacy against strains resistant to PIs.

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1. What are the two major subtypes of HIV-1?
A. HIV-1 major and HIV-1 minor
B. HIV-1 major and HIV-2 major
C. HIV-1 major and HIV-1 outlier
D. HIV-1 major and HIV-2 outlier

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C: HIV-1 major and HIV-1 outlier

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2. Sexual practices that are completely safe include which of the following?
A. Autosexual activities
B. Mutual, monogamous relationships
C. Abstinence
D. All of the above are correct.

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D. All of the above are correct.

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3. The average laboratory range for CD4+ T-cell count is:
A. 500 to 1600 mm3.
B. 500 to 1000 mm3.
C. 1600 to 2000 mm3.
D. 2000 to 2500 mm3.

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A. 500 to 1600 mm3.

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The most recent classification system for HIV disease in adults and adolescents is based on what two monitoring parameters?
A. CD4+ counts and clinical presentation
B. Enzyme immunoassay and CD4+ count
C. Clinical presentation and enzyme immunoassay
D. Western blot and CD4+ count

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A. CD4+ counts and clinical presentation

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In general, HIV test results are reported as:
A. positive and negative.
B. positive, negative, and determinate.
C. positive, negative, and indeterminate.
D. positive, negative, and controlled.

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C. positive, negative, and indeterminate.

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What are the three types of drug resistance concern in treating HIV?
A. Genotype resistance, phenotype resistance, and RNA resistance
B. Genotype resistance, phenotype resistance, and cross-resistance
C. Genotype resistance, phenotype resistance, and DNA resistance
D. Genotype resistance, phenotype resistance, and therapeutic resistance

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B. Genotype resistance, phenotype resistance, and cross-resistance

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Which of the following is not a main type of opportunistic infection?
A. Bacterial
B. Fungal
C. Viral
D. Congenital

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D. Congenital

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The drug that is used to treat HIV/AIDS that works by preventing the successful assembly and release of a new virus particle is:
A. reverse transcriptase inhibitors.
B. protease inhibitors.
C. entry inhibitor.
D. NNRTIs.

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B. protease inhibitors.

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__________ __________ is the capability of HIV to change its appearance or mutate very rapidly.

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Genetic promiscuity

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The principal mode of transmission of HIV throughout the world has been through __________ __________.

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sexual exposure

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HIV infection in the central nervous system is indirectly caused by __________ produced by infected macrophages.

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neurotoxins

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The main target for HIV is the __________ __________ __________.

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T4 helper cell

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The __________ __________ __________ __________ are the regulating cells in the immune system.

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CD4+ T helper cells

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Survival among clients with AIDS has been dramatic since the advent of __________ __________ __________ __________ __________, which uses varying combinations of drugs from three different classes of antiretroviral medications.

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highly active antiretroviral therapy (HAART)

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The period in which a person becomes infected with the HIV virus is referred to as __________ __________.

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primary infection

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If the enzyme immunoassay result is positive, a second test, the __________ __________, is performed to confirm a positive HIV status.

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Western blot

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In 1996 __________ __________ __________ became available to directly measure viral activity in a person with HIV.

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viral load testing

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The therapeutic intervention of trying combinations of four to six drugs in an effort to suppress HIV activity is commonly called __________ __________.

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salvage therapy

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__________ __________ __________, the precursor to cervical cancer, occurs at a high rate in women infected with HIV.

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Cervical intraepithelial neoplasia

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HIV-encephalopathy, also referred to as __________ __________ __________, appears to affect the very young and older HIV-infected clients.

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AIDS dementia complex

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CD4+ cell counts

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Prognostic indicator to identify whether a client infected with HIV is at risk for developing opportunistic infections

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HIV classification system for adolescents and adults

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The CDC's classification system that is divided into laboratory and clinical categories

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HIV illness trajectory

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The course of the disease progression from caring for the person with HIV disease to AIDS

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NNRTIs (non-nucleoside reverse transcriptase inhibitors): nevirapine (Viramune)

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Works similar to nucleoside analogs; blocks RNA and DNA, disrupting the enzyme's site

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5. NRTIs (nucleoside reverse transcriptase inhibitors): retrovir, AZT

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Blocks HIV replication by protecting noninfected cells

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PGL

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Persistent, generalized lymphadenopathy

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PIs (protease inhibitors): indinavir (Crixivan)

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Renders HIV particles noninfectious

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Viral load

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Measures viral activity in a person infected with HIV