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HIV Case 36

HIV Case 36. Andrea Sigrist. Patient. Client. Reason for Admittance. HIV positive (diagnosed 4 years ago) Exhausted all the time Sore mouth Sore throat Significant weight loss Possible pneumonia per referring physician . Terry Long Sex: Male Ethnicity: African American DOB: 5/12

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HIV Case 36

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  1. HIVCase 36 Andrea Sigrist

  2. Patient Client Reason for Admittance HIV positive (diagnosed 4 years ago) Exhausted all the time Sore mouth Sore throat Significant weight loss Possible pneumonia per referring physician • Terry Long • Sex: Male • Ethnicity: African American • DOB: 5/12 • Age: 32 • Height: 6’1” • Weight: 151 lbs

  3. Patient History Physical Exam • Stereopositive for HIV-1, confirmed by ELISA and Western Blot 4 years ago • Unknown contraction • Not currently undergoing treatment • Tonsillectomy at age 6 • Appendectomy at age 18 • Current medications; multivitamin, vitamin E, vitamin C, ginseng, milk thistle, echinacea • Quit smoking 5 years ago • Family history: father with angina, heart problems, high blood pressure (CAD, HTN) General Appearance: Thin African American in no acute distress Vitals: Temp 98.6F, BP 120/84, HR 92bpm, RR 18bpm Heart: regular rate and rhythm Nose: Mucosa pink without drainage Throat: erythematous with white, patchy exudate Extremities: good pulses, no edema Skin: warm, with flaky patches Chest/lungs: Rhonchi in lower left lung Abdomen: nondistended, nontender, hyperactive bowel sounds

  4. Lab Values

  5. Patient diagnosis and treatment DIAGNOSIS TREATMENT Antiretroviral regimen AZT (zidovudine) 200 mg every 8hr Crixivan (indinavir) 800mg every 8hr 3TC Epivir (lamivudine) 150 mg every 12hr • HIV for four years • AIDS • Clinical Cate • Oral thrush • No clinical evidence of pneumonia

  6. What is Hiv? • Infection caused by the human immunodeficiency virus which destroys the immune system and makes it hard for the body to fight off infections • Transmitted through sexual contact, blood, and mother to child • People infected may not show symptoms for up to ten years, but can still infect others • Progresses to AIDS • There is no cure, but it can be treated • People infected with HIV will develop AIDS if not treated • A small amount of people develop AIDS slowly or not at all • Is a preventable infection

  7. HIV tests Western Blot ELISA HIV antigens are added to a sample of blood and antibodies react with the HIV virus An enzyme linked to an antibody is added and reacts with the HIV antigen/antibody A catalyst is added to change the color of the enzyme-linked complex • Uses gel electrophoresis to separate specific HIV proteins being detected • After separation, the proteins are transferred to a membrane to be identified using antibodies that target a specific protein

  8. Risk factors for contracting hiv Common Risk Factors Terry’s Risk Factors Worked as a nurse in a dialysis clinic Numerous sexual partners Use of recreational drugs • Sexual contact with an infected person • Unprotected sex • Coming in contact with blood of an infected person • Sharing needles • Blood transfusions • Mother to child by blood during delivery or breast milk

  9. Prognosis • HIV is a chronic condition • It will eventually completely destroy a person’s immune system • Progression depends on each individual • There are treatment options, but no cure • Can prevent complications and delay the progression of AIDS • Almost all people infected will develop AIDS • Lack of treatment is fatal • HAART (highly reactive antiretroviral therapy) dramatically increases how long an infected person lives, but is not a cure • The weakened immune system makes individuals more susceptible to infections and cancers

  10. Treatment for hiv Treatment When to Start Symptoms become severe CD4 count is below 500 Become pregnant Have HIV-related kidney disease Being treated for Hep-C • Medications used in combination is the only way to control the virus • It is best to use three different medications from two different classes of drugs to avoid creating strains of HIV that are immune to single drugs

  11. Medications Types of Medications Terry’s Medications 200 mg of zidovudine (AZT) every 8 hours 800 mg of indinavir (Crixivan) every 8 hours 150 mg of lamivudine (3TC Epivir) every 12 hours • NNRTIs (Non-nucleoside reverse transcriptase inhibitors): disables proteins HIV needs to copy itself • NRTIs (Nucleoside reverse transcriptase inhibitors): faulty versions of building blocks HIV needs to copy itself • PIs (Protease Inhibitors): disable protease , which HIV uses to copy itself • Entry or fusion inhibitors: block HIV’s entry into CD4 cells • Integrase inhibitors: disables integrase which HIV uses to insert genetic material into CD4 cells

  12. Supplements

  13. Nutrition with hiv Terry’s Diet before Mouth Sores Suggested HIV Nutrition Consume a healthy and balanced diet like healthy individuals Calories should be 10% higher if untreated Calories should be 30% higher during recovery Take a daily multivitamin If suffering from loss of appetite: Eat several small meals Exercise to stimulate appetite Consume nutrition supplement beverage • Breakfast/Lunch: 1-2 cups of cold cereal with ½ cup of whole milk • Dinner: Meat, potatoes or rice, tea or soda • Snacks: Pizza, candy bar, or cookies with tea or soda • 1-2 beers or glasses of wine several times a week Terry’s 24-hour Diet Recall Sips of apple juice, 1 cup of yogurt, 1 cup of rice and gravy, sips of iced tea with sugar throughout the day

  14. Alcohol and hiv • Studies show regular alcohol consumption is associated with an increase in the progression of HIV • The immunosuppressive effects of alcohol may cause CD4 count to fall below 200 cells • Still being researched, not a fact

  15. Main concerns for terry Problems Suggestions Place on pureed or soft food diet Add nutritional supplement beverage Vegetable juices Soy or almond milks Educate about programs that help pay for medications • Not eating enough • Consumes a lot of sugar and soda • Alcohol consumption • Not taking medications

  16. GOALS COURSE OF ACTION Have him meet with a Medication Assistance program Create diet plan Begin with soft/liquid diet Progress to normal diet Have Terry keep a food journal Join a gym or fitness group Join a support group • Main goal is to get Terry his medications and get him taking them every day as directed • Educate about healthy diet and consequences of malnutrition and not taking medications • Get back on a normal diet • Start exercise routine

  17. Questions?

  18. References • AIDS (2012). AIDS Information, Education, Action, Awareness | CD4 (T-CELL) TESTS. AIDS Information, Education, Action, Awareness | HIV, AIDS Facts. Retrieved from http://www.aids.org/topics/aids-factsheets/aids-background-information/what-is-aids/hiv-testing/cd4-t-cell-tests/ • AIDS.org (2012). AIDS Information, Education, Action, Awareness | How is HIV Transmitted? AIDS Information, Education, Action, Awareness | HIV, AIDS Facts. Retrieved from http://www.aids.org/topics/aids-faqs/how-is-hiv-transmitted/ • Boskey, Ph. D., E. (2011, September 6). HIV Testing - How Does a Western Blot HIV Test Work? Sexually Transmitted Diseases - STDs. Retrieved from http://std.about.com/od/HIVTesting/f/How-Does-A-Western-Blot-Hiv-Test-Work.htm • Carter, M., & AIDS Map (2010, May 17). HIV & AIDS Information :: Frequent alcohol use hastens HIV disease progression. HIV & AIDS Information :: Home. Retrieved from http://www.aidsmap.com/Frequent-alcohol-use-hastens-HIV-disease-progression/page/1438821/ • Cooper, C. L., & Cameron, D. W. (2005). Effect of Alcohol Use and Highly Active Antiretroviral Therapy on Plasma Levels of Hepatitis C Virus (HCV) in Patients Coinfected with HIV and HCV. Oxford Journals | Medicine | Clinical Infectious Diseases. Retrieved from http://cid.oxfordjournals.org/content/41/Supplement_1/S105.full • FitDay. (2012). FitDay - Free Weight Loss and Diet Journal. Retrieved from http://www.fitday.com/fitness/FoodLog.html?_a_Date=1322611200.&_v_View_FoodL ogSummaryTabs-Focus=Nutri • Mayo Clinic (2011, August 11). HIV/AIDS: Treatments and drugs - MayoClinic.com. Mayo Clinic. Retrieved from http://www.mayoclinic.com/health/hiv-aids/DS00005/DSECTION=treatments-and-drugs • Medline Plus (2012, May 30). HIV infection: MedlinePlus Medical Encyclopedia. National Library of Medicine - National Institutes of Health. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000602.htm • The Body (2005, January). Herbs, Supplements and HIV - TheBody.com. The Complete HIV/AIDS Resource - TheBody.com. Retrieved from http://www.thebody.com/content/art5003.html#chart • WebMD (2007). HIV & AIDS Symptoms: Weight Loss, Lack of Energy, Fever, and More. WebMD - Better information. Better health. Retrieved from http://www.webmd.com/hiv-aids/guide/hiv-symptoms • Web MD (2012). Drug Search from WebMD. WebMD - Better information. Better health. Retrieved from http://www.webmd.com/drugs/search.aspx?stype=drug&query=lamivudine+Oral&submitDetailsTop.x=0&submitDetailsTop.y=0&source=2

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