Transcript Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 23

Medical-Surgical Nursing: An
Integrated Approach, 2E
Chapter 23
NURSING CARE OF
THE CLIENT: HIV AND
AIDS
HIV and AIDS

The human immunodeficiency virus
(HIV), first reported in the U.S. in 1981, is
a retrovirus that causes acquired
immunodeficiency syndrome (AIDS), a
progressively fatal disease that destroys
the immune system and the body’s ability
to fight infection.
HIV/AIDS Statistics
By the end of 1998, an estimated 33.4
million people in the world were living with
HIV/AIDS.
 In the U.S., 688,200 cases of AIDS
reported by the end of 1998, with as many
as 900,000 infected with HIV.

Continuum of HIV Disease
Initial Exposure
Primary HIV infection (acute infection)
Flu-like s ymptoms; develop antibodies to HIV in 1 to 6 months
Asymptomatic HIV Infection (HIV Seropositivity)
Infectious but no evidence of illness except positive HIV antibody test
Early HIV disease (Symptomatic infection)
Persistent, unexplained fever, night sweats, diarrhea, weight loss, fatigue, and lymphadenopathy;
signs and symptoms may not occur until 10 years or more after initial exposure
Advanced HIV disease (AIDS)
AIDS-Defining Conditions
Most AIDS-defining conditions are
opportunistic infections (infections in
persons with a defective immune system
that rarely cause harm in healthy
individuals).
 Pneumocytis carinii pneumonia is the
most frequent AIDS-defining condition in
the U.S. and Europe.

AIDS Testing
The enzyme-linked immunosorbent assay
(ELISA) is the basic screening test to
detect antibodies of HIV.
 A confirmatory test, the Western blot, is
always employed when the ELISA is
positive.
 The two taken together have an extremely
high accuracy rate.
 Obtaining a signed informed consent for
testing is often a nursing responsibility.

Demographics of AIDS in the
United States
Age (AIDS affects mainly people during
the most productive years of their life).
 Gender (More men from women, though
women’s rates are increasing).
 Race (The HIV/AIDS epidemic is growing
most rapidly among some minority
populations and is a leading cause of
death of African American males).

Modes of Transmission
The virus may be found in blood, semen,
vaginal secretions, and breast milk of
infected individuals.
 No evidence that HIV is spread through
sweat, tears, urine, or feces. Risk of
infection from “deep kissing” or oral sex is
unknown.

Medical-Surgical Management
MEDICAL
 Goal is to keep
disease from
progressing as
long as possible.
 Patient monitored
by viral load test.
PHARMACOLOGICAL
 Goal of anti-HIV
treatment is to
keep viral load as
low as possible for
as long as
possible.
 Use of protease
inhibitors.
Common Diagnostic Tests for
HIV and AIDS
CD4-T-cells
 ELISA
 Polymerase chain reaction (PCR)
 Western blot

Pulmonary Opportunistic
Infections
Pneumocystis Carinii Pneumonia.
 Histoplasmosis.
 Tuberculosis.

Pneumocystis Carinii
Pneumonia
The most common opportunistic infection
associated with advanced HIV disease.
 Found primarily in the lungs, but also
reported in the adrenal glands, bone
marrow, skin, thyroid, kidneys, and
spleen.
 Clinical signs include fever, shortness of
breath, nonproductive cough, and
crackles.
 Initial diagnosis made by chest x-ray.

Histoplasmosis
An infection caused by the fungus
Histoplasma capsulatum. The fungus has
been isolated in bird droppings, dirt from
chicken coops, and caves.
 Histoplasmosis should be suspected if the
person presents with fever of uncertain
origin, cough, and malaise.

Gastrointestinal Opportunistic
Infections
Mycobacterium avium complex.
 Cytomegalovirus.
 Cryptosporidiosis.
 Hepatitis.
 HIV-wasting syndrome.

Mycobacterium avium complex
In persons with AIDS, involvement of the
bowel is usually extensive. The
microorganism can fill the bone marrow
and lymph nodes.
 Most common symptoms are chronic
fever, malaise, anemia, weight loss,
diarrhea, and abdominal pain.

Cytomegalovirus (CMV)
Belongs to the herpes virus group.
 Causes disease by destroying the brain,
lung, retina, and liver.
 Signs and symptoms include weight loss,
fever, diarrhea, and malaise.

Cryptosporidosis
Caused by a protozoan that usually
infects the epithelial cells that line the
digestive tract.
 Clinical signs include profuse water
diarrhea, up to 20 liters a day. Abdominal
pain, serious weight loss, abdominal
cramping, anorexia, low-grade fever,
dehydration, electrolyte imbalance and
malaise may also be present.

Hepatitis
Hepatitis B virus, C virus, and D virus are
commonly seen with HIV infection.
 Signs and symptoms include malaise,
weakness, anorexia, nausea, vomiting,
and right upper quadrant pain.

HIV-Wasting Syndrome
Defined as unexplained weight loss of
more than 10% of body weight
accompanied by weakness, chronic
diarrhea, and fever in those affected with
HIV.
 Signs and symptoms include anorexia,
diarrhea, nausea, vomiting, changes in
taste and smell, aphthous ulcers of mouth
and esophagus, and abdominal pain.

Oral Opportunistic Infections
Oral candidiasis (thrush), a fungal
infection, is seen in more than 90% of
AIDS clients. Symptoms include
unpleasant taste, mouth dryness, and
creamy, white oral plaques.
 Oral Hairy Leukoplakia (OHL) usually
appears as a white patch on the lateral
borders of the tongue. OHL is not usually
bothersome to the client and may regress
spontaneously.

Gynecological Opportunistic
Infections
Vaginal Candidiasis is the most common
initial infection occurring in HIV-infected
women.
 Cervical Intraepithelial Neoplasia (CIN) is
of a much higher incidence in women
affected with HIV.

Central Nervous System
Opportunistic Infections
AIDS dementia complex.
 Toxoplasmosis.
 Cryptococcosis.

AIDS Dementia Complex
The most common central nervous
system complication in persons with
AIDS.
 This disorder is chronic and progressive
with cognitive, motor, and behavioral
dysfunction.

Toxoplasmosis
Caused by the protozoan Toxoplasma
gondii, found in cats and other animals.
 Clinical signs may be vague and
nonspecific, ranging from mild headache,
fever, and lethargy to poor coordination,
seizures, and coma.

Cryptococcosis
A fungal infection caused by
Cryptococcus neoformans.
 The most life-threatening fungal infection
associated with AIDS.
 Clinical symptoms include fever,
headache, nausea, vomiting, dizziness,
photophobia, mental status changes,
seizures, and stiff neck.

Opportunistic Malignancies:
Kaposi’s Sarcoma
A vascular malignancy that can occur any
place in the body, including the internal
organs.
 First lesions often appear subtly on the
face or in the oral cavity.

Opportunistic Malignancies:
Non-Hodgkin’s Lymphoma
Clinical manifestations include fever,
night sweats, and weight loss.
 Treatment of NHL in clients with
advanced HIV disease is often withheld,
because it is not tolerated well and may
even lead to earlier death.
