Transcript HIV-AIDS
HIV/AIDS Keith Rischer, RN, MA, CEN What is a virus? • Most common affliction of humans • Has no metabolism of it’s own • Is incapable of replicating outside a living cell • Takes over the metabolic machinery of host cells to survive and replicate Acquired Immunodeficiency Syndrome (AIDS) • Patho – CD4 + lymphocyte or T4 cell – Directs immune system defenses – Retrovirus • Reverse transcripterase copies/replicates HIV DNA into cell to hijack • become HIV factory…10 billion particles daily • Consequences – CD4 cells removed from circulation – Early infection immune system attacks these virus particles – In time HIV overwhelms person • • • • CD4+ cell counts fail Viral load rises Opportunistic infections/cancer cause death Pathogen vs. opportunistic infections Opportunistic Infections • • • • Cervical Cancer Cryptosporidiosis Cytomegalorvirus Encephalopathy – HIV related • Herpes Simplex: Chronic ulcers > 1 month • Kaposi’s Sarcoma • Pneumocystis – PCP – common in HIV Acquired Immunodeficiency Syndrome (AIDS) • Diagnosis AIDS – HIV + – CD4+ <200mm3 • Progression – HIV to AIDS months to years • Transmission – 46% male homosexuals – 25% IV drug use • Women – Fastest growing group – 16% in North America – 50% in developing countries Health Promotion and Illness Prevention • Education is the best hope for prevention. • HIV is transmitted most often in three ways: – Sexual • Semen and blood highest concentrations of HIV • Lifetime monogamy best prevention • Women at high risk due to increased mucous membranes of vagina in comparison to men – Parenteral – Perinatal • 14-45% risk to unborn child Transmission and Health Care Workers • Needle stick or “sharps” injuries are the primary means of HIV infection for health care workers. • Workers can also be infected through exposure of nonintact skin and mucous membranes to blood and body fluids. • The best prevention for health care providers is the consistent use of standard precautions for all clients as recommended by the CDC. Collaborative Management • History • Physical assessment and clinical manifestations – Cough-fever-night sweats-fatigue-N&Vswollen lymph nodes – Infections: opportunistic, protozoal, fungal, bacterial, viral – Malignancies: Kaposi’s sarcoma, malignant lymphomas Laboratory Assessment • Lymphocyte counts – Decreased WBC <3500 • CD4 – Lower CD4 count <200 AIDS • Antibody tests – – – – Made 3 weeks to 3 months after exposure Enzyme-linked immunosorbent assay (ELISA) Western blot Viral load • Useful to monitor disease progression Nursing Priorities • Impaired gas exchange – Pneumocystis carinii pneumonia • Pain – Neuropathies from disease or drugs – Tumors • Nutrition-Imbalanced – Anorexia, N&V&D, wasting syndrome • Impaired skin integrity – Kaposi’s sarcoma…painful-restrict movement • Knowledge deficit • Psychosocial (social isolation)