1 / 43

Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome

Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome. By: Rhian Smith and Whitney Mosher. History. 1970s: HIV epidemic became more apparent in the United States and Canada 1981: Public health officials recognized the presence of new disease now known AIDS

hazina
Download Presentation

Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome By: Rhian Smith and Whitney Mosher

  2. History • 1970s: HIV epidemic became more apparent in the United States and Canada • 1981: Public health officials recognized the presence of new disease now known AIDS • 1985: Routes of transmission were determined and antibody tests were developed • 1987: Drug therapy became available • 1994 to current: New tests to assess viral load have been developed, along with combination drug therapy, and treatment to decrease transmission from mother to baby

  3. Statistics • Over 1 million people in North America were infected with HIV in 2004 • Increased rates have been noted in: women, people of color, those who live in poverty, and adolescents • Since the beginning of pandemic, more than 20 million people have died • The most common mode of transmission is unprotected sex with an HIV-infected partner

  4. Transmission-General • Transmission can occur through multiple routes: • Sexual intercourse with an infected person • Exposure to infected blood or blood products • Perinatal transmission (at time of delivery or through breast feeding) • Transmission of the disease to others can occur only a few days after becoming infected • Ability to transmit disease is lifelong • Factors affecting transmission: • Duration of contact • Volume of fluid transmitted • Concentration of organism • Immune status of host

  5. Transmission-General Continued • Large viral load is found during the first six months, and during the late stages of the disease • Casual transmission is not possible. • HIV cannot be transmitted through: • Tears • Saliva • Urine • Emesis • Sputum • Feces • Sweat • Health care workers are at low risk for developing HIV, even after needle stick injury

  6. Sexual Transmission • Most common mode is unprotected sexual contact with an infected partner • Unprotected anal intercourse is the highest risk sexual activity • Risk for infection is greatest for the partner who receives the semen • They receive a high volume of fluid

  7. Blood and Blood Product Transmission • Exposure comes from use of drug equipment, which exposes a person to blood • Infection transmission through blood transfusions is low due to current testing standards • Work related transmission is most common through puncture wounds

  8. Perinatal Transmission • Most common infection route for children • ¼ infants born to untreated HIV mothers will have HIV transmitted to them

  9. Pathophysiology • HIV virus is a ribonucleic acid • The virus must enter a living cell to be allowed to replicate • Once replication process occurs in cell, the virus becomes a permanent part of the genetic structure • Replication occurs at a fast pace, and a continual rate • Rapid replication can cause errors which leads to mutations of the virus • HIV attacks cells with CD4 receptors • CD4 cells are key player in ability of the immune system to function properly

  10. Pathophysiology Continued • Normal life span for a CD4 cell averages 100 days • Normal life span for an HIV infected CD4 cell averages 2 days • HIV ability to destroy cells eventually exceeds bone marrow and thymus ability to replace cells • Immune problems develop when CD4 count drops below 500 • Severe immune problems develop when CD4 counts drop below 200

  11. Case Study • Deneisha Richards, a 20 year old African American, heterosexual female, presents at the local, free health clinic with flu like symptoms. Further evaluation of symptoms reveal: fever, swollen lymph glands, sore throat, and muscle pain. Deneisha stated, “I feel like I have the flu” • Further assessments were completed

  12. Health History • Full health history was taken, and was further noted when sexual history was discussed • Deneisha reported sexual activity beginning at age 18, which included protected and unprotected vaginal and anal intercourse with three different partners • Deneisha reports unprotected anal intercourse 3 months prior with a new partner in which his sexual history is unknown • Many health care provides mistake early HIV symptoms for the flu, but due to the sexually history, HIV testing was ordered

  13. Pertinent Health History Questions Related to HIV • The nurse asks Deneisha 4 basic questions to assess for HIV infection • Have you ever had a blood transfusion or used clotting factors? If so, was it before 1985? • Have you shared drug user equipment with another person? • Have you ever had a sexual experience in which your penis, vagina, rectum, or mouth came into contact with another person’ s penis, vagina, rectum, or mouth? • Have you ever had a sexually transmitted disease? • A positive response to any of these questions requires further evaluation

  14. Diagnostic Tests • The health care provider orders an ELISA test • After a period of time, the health care provider tells Deneisha her positive results from the ELISA test • A follow up order is provided for the Western Blot to confirm HIV diagnosis • If she had come in earlier, rapid testing would have been performed.

  15. Video-Rapid Testing http://www.youtube.com/watch?v=IKdw7tsDQic

  16. Physical Exam Findings • After completing a physical exam on Deneisha, the following was discovered: • Flu-like symptoms included: • *Fever • *Swollen lymph glands • *Sore throat • Headache • Malaise • Nausea • *Muscle and joint pain • Diarrhea • Diffuse rash • Anorexia • Weight loss • Night sweats • The starred items were Deneisha’s symptoms

  17. Additional Diagnostic Tests Completed • Monitoring of CD4 lymphocyte count • Complete blood count (CBC) • Viral load • The lower the viral load, the less active the disease • Skin test anergy • Common antigen is injected under the skin, with the purpose being to see if a patient’s immune system is reacting properly to antigens in general

  18. Normal Lab Values • CD4 count: 800-1200 ul • CBC • White Blood Cells: 4000-11,000 cells/mm3 • Neutrophils: 1800-7800 cells/mm3 • Platelets: 150,000-400,000 cells/mm3 • Viral Load: Undectable • Skin Test Anergy: Nonreactive

  19. Pertinent Lab Values • CD4 count: 600 cells/ul • Viral load: undetectable at this time • Does not indicate the virus is not present, just undetectable by a test at this time • Skin test Anergy: nonreactive • This proves the immune system is functioning adequately • CBC: • White blood cells: 3,500 cell/mm3 • Neutrophil count: 1,500 cells/mm3 • Platelets: 130,000 cells/mm3

  20. A follow up appointment was made to discuss management of disease process with Deneisha • Upon arrival to the appointment, Deneisha was crying hysterically • She stated, “I’m so afraid of dying”

  21. Nursing Diagnosis #1 • Acute pain related to acute infection of HIV as evidence by previous client statement of muscle and joint pain, along with a headache • Goal: Client will state proper management of pain • Interventions: • Assess pain in client by using self-report through numerical scale (0= no pain, 10= extreme pain) • Administer pain medication PRN or around the clock per physician order • Teach and implement non-pharmacological interventions, like deep breathing ad imagery, to help decrease pain • Ask client to describe appetite, bowel elimination, and patterns of sleep related to medication administration

  22. Nursing Diagnosis #2 • Fear related to impending premature death as evidence by client stating, “I’m so afraid of dying” • Goal: Client will identify, verbalize, and demonstrate coping behaviors that reduce fear • Interventions: • Stay with client when they express fear • Provide verbal and non-verbal re-assurance to client • Explore coping skills previously used by client to deal with fear, and reinforce these skills and explore other outlets • Teach of appropriate community resources involving fear and HIV infection

  23. Home Care Instructions • Drug Regimes: • Antiretroviral medications are not started at this time, because great immune suppression has not occurred as noted in previous lab values • Continual monitoring of lab values will determine when antiretroviral therapy will initiate

  24. Home Care Instructions Continued • Promotion of a healthy lifestyle: • Nutritional support to help maintain an appropriate vitamin and mineral balance • Elimination of tobacco and alcohol use • Keep immunizations up to date • Adequate rest, exercise, and stress reduction • Avoid exposure to new infectious agents • Teach patients to recognize symptoms of disease progression

  25. Home Care Instructions Continued • Sex Education: • Tell client to have protected sex using a male condom • “Male condoms are more effective against sexually transmitted infections such as gonorrhea, Chlamydia, Trichomoniasis, and HIV” (Healthy Sexuality, 2006) • Notify partners of HIV infection prior to any sexual encounter • This protects future partners from HIV infection! • Patient should have as much information as needed to guide care at home!!

  26. Routine Visit • Deneisha returns for routine visits, in which physical assessments are completed, lab values are monitored, and education is reinforced • During this visits, Deneisha is started on 2 antiretroviral medications, because her labs reveal a drop in CD4 levels, and an increase in viral load

  27. Antiretroviral Therapy • The goal of antiretroviral medications include: decrease opportunistic infections, delay the development of HIV-related symptoms, decrease viral load, and maintain and raise CD4 counts • Multiple medications are started, because HIV can quickly become resistant to one medication, thus defeating the purpose • Combination therapy can be very expensive, so many patients are unable to maintain the financial expense

  28. Antiretroviral Therapy Continued • Nonnucleoside Reverse Transcription Inhibitors: Works by blocking the process for HIV RNA to convert into HIV DNA • Nucleoside Reverse Transcriptase Inhibitors: Works by inserting DNA into developing strand thus causing the incomplete formation of HIV DNA • Nucleotide Reverse Transcriptase Inhibitors: Works by inhibiting reverse transcription • Protease Inhibitors: Works by preventing HIV proteins formation thus preventing formation of HIV DNA • Entry Inhibitors: Works by preventing binding of HIV onto cells

  29. AIDS Diagnosis • Deneisha continues her routine visits for the next 8 years, and one routine visit presents progression of the disease • Labs are drawn, and reveal that Deneisha’s CD4 count has dropped to 150 (normal 800-1200 ul), and the viral load has increased dramatically • For AIDS diagnosis regarding CD4 Count: needs to be below 200 ul

  30. AIDS Diagnosis Continued • Physical assessment findings reveal: • A persistent high fever • Chronic diarrhea • Extreme weight loss • Chronic fatigue that is interrupting normal ADLs • Further assessment reveals the following: • Candidiasis (Thrush) • Kaposi Sarcoma • Pneumocystis Carinii Pneumonia

  31. Video-Opportunistic Infections http://www.youtube.com/watch?v=68I7JlVhuhY

  32. Candidiasis • Whiteish lesions in the mouth and on the tongue • Not common among adults unless HIV positive • Treatment: Nystatin mouth wash

  33. Kaposi Sarcoma • Purplish red lesions of the internal organs and skin • Can vary in size and appear in a variety of shades • Treatment: Cryotherapy for skin lesions

  34. Pneumocystis Carinii Pneumonia • Nonproductive cough, shortness of breath, fever, fatigue • Treatment: Bactrim, increase in fluids, encourage movement

  35. Nursing Diagnosis #1 • Impaired oral mucous membrane related to immunosupression as evidence by whiteish lesions on the mouth and tongue • Goal: Client will demonstrate ways to maintain an intact, moist, mucous membrane • Interventions: • Teach client to inspect oral cavity and monitor for signs of infection • Teach client how to use Nystatin mouthwash • Instruct client in ways to soothe oral cavity (use popsicles, cold beverages)

  36. Nursing Diagnosis #2 • Impaired skin integrity related to immunosupression as evidence by purplish red lesions on skin surface • Goal: Client will describe measures to protect and care for lesions • Interventions: • Educate client on importance of adequate nutrition • Teach client signs and symptoms of infection • Monitor client’s continent status and minimize moisture exposure

  37. Nursing Diagnosis #3 • Fatigue related to progression of immunocompromised status as evidence by client statement of decreased ability to accomplish ADLs • Goal: Client will utilize strategies to promote and relieve fatigue • Interventions: • Teach client the importance of prioritizing activities • Teach client strategies for energy conservation, like sitting instead of standing • Teach the importance of following a healthy lifestyle with adequate nutrition

  38. End of Life Care/Evaluation • Deneisha is sent home with Hospice care to provide adequate comfort and care during the end stages of her life • Focus is placed on physical and emotional care to provide holistic care for Deneisha • Deneisha died quietly at her home

  39. Video on AIDS Awareness http://www.youtube.com/watch?v=COfdnY27LP4

  40. Famous People who had HIV/AIDS • Freddie Mercury (Lead Singer of Queen) • Magic Johnson (Basketball Player) • Liberace (Pianist) • Pedro Zamora (MTV’s Real World Cast Member)

  41. More Famous People with HIV/AIDS • Tom McBride (Marlboro Man) • Anthony Perkins (Norman Bates in Psycho) • Rock Hudson (Actor) • Robert Reed (Mike Brady on The Brady Bunch)

  42. References • Ackley, B., & Ladwig, G. (2008). Nursing diagnosis handbook: An evidence-based guide to planning care (8th ed.). St. Louis, MO: Mosby. • Avert (n.d.) Introduction to hiv and aids drug treatment. Retrieved from http://www.avert.org/treatment • Blonna, R., & Levitan, J. (2006). Healthy Sexuality. Belmont, CA: Wadsworth. • HIV InfoSource (2009) Understanding your hiv test results. Retrieved from http://www.hivinfosource.org • Lewis, S., Heitkemper, M., & Dirksen, S. (2007). Medical surgical nursing: Assessment and management of clinical problems (7th ed. Volume II). St. Louis, MO: Mosby. • Mayo Clinic (2010) HIV/AIDS. Retrieved from http://www.mayoclinic.com/health/hiv-aids • Medline Plus (2010) Early symptomatic hiv infection. Retrieved from http://www.nlm.nih.gov • Silvestri, L.A. (2008). Saunders comprehensive review for the nclex-rn examination (4thed.). St. Louis, MO: Saunders. • The New York Times (2010) Skin test anergy. Retrieved from http://www.health.nytimes.com/health • World Health Organization (2010) HIV/AIDS. Retrieved from http://www.who.int • Images Retrieved from Google Images • Videos Retrieved from Youtube

More Related