1 / 42

Chapter 52 Management of Patients With HIV Infection and AIDS

Chapter 52 Management of Patients With HIV Infection and AIDS. Epidemiology. United States Approx 1.1 million infected at end of 2006 (CDC) 21% undiagnosed African Americans accounted for 44% of all cases through 2007, but make up only 12% of the population

delora
Download Presentation

Chapter 52 Management of Patients With HIV Infection and AIDS

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. Chapter 52Management of Patients With HIV Infection and AIDS

  2. Epidemiology • United States • Approx 1.1 million infected at end of 2006 (CDC) • 21% undiagnosed • African Americans accounted for 44% of all cases through 2007, but make up only 12% of the population • Minority groups disproportionately affected • Males accounted for 72% of all cases in 2003 • Most common routes: • MSM, heterosexual contact, IVDA • Fastest growing infection rate among women, minorities and adolescents

  3. Epidemiology • Wordwide • AIDS kills 8,000 people/day • 33.4 million people infected worldwide • 22.4 million of these in Subsaharan Africa • In underdeveloped countries, heterosexual transmission is primary route

  4. Transmission of HIV • Transmitted by body fluids containing HIV or infected CD4 lymphocytes • Blood, seminal fliud, vaginal secretions, amniotic fluid, and breast milk • Most prenatal infections occur during delivery • Risk via blood transfusion in developed countries is very low • Casual contact does not cause transmission • Breaks in skin and mucosa increase risk

  5. High-Risk Behaviors (USA) • Sharing infected injection equipment • Having sexual relations with infected individuals • Gerontologic considerations

  6. Prevention • Standard precautions for healthcare providers • Practice safe activities and risk-reducing activites • Abstain from sharing sexual fluids • Reduce the number of sexual partners to one • Always use latex condoms; if allergic to latex, use nonlatex condoms (male or female) • Avoid sexual practices that may cause tears in mucous membranes

  7. Prevention • Practice safe activities and risk-reducing activities • Do not use drugs • If drugs are used, do not share equipment • Do not have sex under the influence of any drug • Needle exchange programs • Clean equipment properly (bleach) • See table 15-21

  8. Prevention • Perinatal transmission • Treatment during pregnancy reduces transmission to less than 2%

  9. Transmission to healthcare providers • Standard precautions • Risk of seroconversion after needlestick about 0.3% • Postexposure prophylaxis • Baseline testing within 72 hours and testing at 1, 3, 6 months • If needed: start prophylaxis meds within 24 hours of exposure • Documentation

  10. Structure of HIV-1 (retrovirus)

  11. Life Cycle of HIV-1

  12. Pathophysiology • HIV is a retrovirus; it makes DNA from RNA • Replicates via reverse transcription and viral DNA is integrated into the host DNA • Target cells • T cells (CD4 or CD8) • B cells • Natural killer cells

  13. Categories • The three CD4+ T-lymphocyte categories are defined as follows: • Category 1: greater than or equal to 500 cells/mL • Category 2: 200-499 cells/uL • Category 3: less than 200 cells/uL • Clinical categories

  14. Stages of HIV Disease • Acute infection • Early chronic infection • Intermediate chronic infection • AIDS

  15. Primary Infection • Acute HIV infection/acute HIV syndrome • Part of CDC category A • Symptoms: none to severe flu-like syndrome • Occurs about 3 weeks after exposure, lasts 1-3 weeks • Window period: lack of HIV antibodies • Period of rapid viral replication and dissemination through the body • Viral set point: balance between amount of HIV and the immune response

  16. Early Chronic Infection • CD4 remains above 500 • Viral load is low • Asymptomatic disease • May have persisten generalized lymphadenopathy, fatigue, mild symptoms

  17. Intermediate Chronic Infection • CD4 drops to 200-500 • Viral load increases • Symptoms may include persistent fever, night sweats, chronic diarrhea, headaches, fatigue, infection • Most common infection oropharyngeal candidiasis; also shingles, vaginal candidiasis, increase in herpes, oral hairy leukoplakia

  18. AIDS - Late Chronic Infection • CDC criteria for AIDS (table 15-10) • CD4 <200 • Certain opportunistic infection • Certain opportunistic cancers • Wasting syndrome • AIDS dementia complex

  19. Diagnosis • Includes detailed history and physical exam • HIV antibody tests • Informed consent - state specific laws • Antibodies detected within 3-12 wks of infection • ELISA performed; confirmation by Western Blot • Rapid HIV • Viral load tests • “undetectable”

  20. Treatment • Treatment and protocols are continually evolving • Most current recommendations include early, aggressive treatment • Antiretroviral agents: see 15-14) • Nucleoside reverse transcriptase inhibitors (NRTIs) • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) • Protease inhibitors (PIs) • Use of combination therapy

  21. Treatment • Management focuses upon: • Preservation of the immune system-maintain or raise CD4 counts • Suppression of viral load • Improved quality of life • Reduction of HIV-associated morbidity and mortality • Treatment of specific manifestations and conditions related to the disease • Viral load is monitored (may become undetectable), as well as T cell count

  22. Treatment • Adverse effects vary by medication, but may include: • Lipodystophy syndrome • Fat redistribution syndromes • Facial wasting • Liver dysfunction • GI intolerance • Drug resistance • Immune reconstitution syndromes

  23. Manifestations of AIDS—Respiratory • Pneumocystis carinii pneumonia (PCP) • Most common infection resulting in AIDS diagnosis • Initial symptoms may be nonspecific and may include nonproductive cough, fever chills, dyspnea, and chest pain • If untreated, progresses to pulmonary impairment and respiratory failure • Treatment: TMP-SMZ or pentamidine; prophylactic TMP-SMZ • Mycobacterium avium complex (MAC) • May cause respiratory or GI infection • Tuberculosis

  24. Manifestations of AIDS—GI • Oral candidiasis • May progress to esophagus and stomach • Treatment with Mycelex troches or nystatin and ketoconazole • Diarrhea related to HIV infection or enteric pathogens (50-90%) • Octreotide acetate for severe chronic diarrhea • Wasting syndrome • 10% weight loss and chronic diarrhea or chronic weakness and fever with absence of other cause • Protein energy malnutrition • Anorexia, diarrhea, GI malabsorption, and lack of nutrition may contribute

  25. Manifestations of AIDS—Oncologic • Kaposi's sarcoma • Cutaneous lesions but may involve multiple organ systems • Lesions cause discomfort, disfigurement, ulceration, and potential for infection • Death may result from tumor progression • B cell lymphomas • Second most common HIV associated malignancy

  26. Lesions of Kaposi’s Sarcoma

  27. Manifestations of AIDS—Neurologic • HIV encephalopathy • Progressive cognitive, behavioral, and motor decline • Probably directly related to the HIV infection • Signs/symptoms may be difficult to distinguish from depression, fatigue/ • Includes headaches, memory deficit, apathy, confusion, psychomotor deficits • HIV - related peripheral neuropathy • Cryptococcus neoformans (fungal infection) • Other neurologic disorders (often infectious) • Depression

  28. Manifestations of AIDS- gynecologic • Invasive cervical cancer

  29. Nursing Process—Assessment of the Patient With AIDS • Assess physical and psychosocial status • Identify potential risk factors: IV drug abuse and risky sexual practices • Assess immune system function • Assess nutritional status • Assess skin integrity • Assess respiratory status and neurologic status • Assess fluid and electrolyte balance • Assess knowledge level

  30. Nursing Process—Diagnosis of the Patient With AIDS • Impaired skin integrity • Diarrhea • Risk for infection • Activity intolerance • Disturbed thought processes • Ineffective airway clearance • Pain • Imbalanced nutrition • Social isolation • Anticipatory grieving • Deficient knowledge

  31. Collaborative Problems/Potential Complications • Opportunistic infections • Impaired breathing or respiratory failure • Wasting syndrome • Fluid and electrolyte imbalance • Adverse reaction to medication

  32. Nursing Process—Planning the Care of the Patient With AIDS • Goals may include: • Achievement and maintenance of skin integrity • Resumption of usual bowel patterns • Absence of infection • Improved activity tolerance • Improved thought processes • Improved airway clearance • Effective coping

  33. Nursing Process—Planning the Care of the Patient With AIDS (cont.) • Goals may include (cont.) • Increased comfort • Improved nutritional status • Increased socialization • Expression of grief • Increased knowledge regarding disease prevention and self-care • Absence of complications

  34. Skin Integrity • Conduct frequent routine assessment of skin and mucosa • Encourage patient to maintain balance between rest and activity • Reposition at least every two hours and as needed • Use pressure reduction devices • Instruct patient to avoid scratching • Use gentle, nondrying soaps or cleansers • Avoid adhesive tape • Provide perianal skin care

  35. Promoting Usual Bowel Pattern • Assess bowel pattern and factors that may exacerbate diarrhea • Avoid foods that act as bowel irritants, such as raw fruits and vegetables, carbonated beverages, spicy foods, and foods of extreme temperatures • Small, frequent meals • Administer medications as prescribed • Assess and promote self-care strategies to control diarrhea

  36. Activity Intolerance • Maintain balance between activity and rest • Instruction regarding energy conservation techniques • Relaxation measures • Collaboration with other members of the health care team

  37. Maintaining Thought Processes • Assess mental and neurologic status • Use clear, simple language if mental status is altered • Establish and maintain a daily routine • Use orientation techniques • Ensure patient safety and protect from injury • Implement strategies to maintain and improve functional ability • Instruct and involve family in communicationand care

  38. Nutrition • Monitor weight, I&O, dietary intake, and factors that interfere with nutrition • Provide dietary consultation • Control nausea with antiemetics • Provide oral hygiene • Treat oral discomfort • Administer dietary supplements • May require enteral feedings or parenteral nutrition

  39. Decreasing Isolation • Promote an atmosphere of acceptance and understanding • Assess social interactions and monitor behaviors • Allow patient to express feelings • Address psychosocial issues • Provide information related to the spread of infection • Educate ancillary personnel, family, and partners

  40. Other Interventions • Improve airway clearance • Use semi-Fowler's or high-Fowler’s position • Pulmonary therapy; coughing and deep breathing; postural drainage; percussion; and vibration • Ensure adequate rest • Pain • Administer medications as prescribed • Provide skin and perianal care

  41. The Nursing Process - Evaluation • Maintains skin integrity • Resumes usual bowel habits • Experiences no infections • Maintains adequate level of activity tolerance • Maintains usual level of thought processes • Experiences increased sense of comfort • Maintains adequate nutritional status • Reports understanding of AIDS and participates in self-care activities

More Related