TimbySmith Introductory MedicalSurgical Nursing 11e Chapter 35 Caring

AIDS • AIDS: infectious and fatal disorder that weakens the immune system – HIV: pathogen that causes AIDS – HIV/AIDS is pandemic— 34 million infected per World Health Organization – Occurrence: homosexual men, IV drug users, heterosexual women, healthcare workers – Mortality—declining; 1. 8 million people Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

HIV • Subtypes – HIV-1—mutates easily and frequently • More prevalent in the United States – HIV-2—less transmittable; longer interval between virus and AIDS • Western Africa is the primary site of infection. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

HIV—(cont. ) • Structural characteristics: genetically incomplete – Genetically incomplete—capsid; double layer of lipid material surrounds the virus (gp 120 and gp 41) • Capsid enzymes—reverse transcriptase, integrase, protease – T-cell lymphocyte fusion—connects HIV to T cell’s coreceptors • Entry inhibitors—development of new category of antiretroviral drugs Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

HIV—(cont. ) • Replication enzymes – Reverse transcriptase —copies viral RNA to viral DNA – Integrase— incorporates viral DNA into host cell’s DNA – Protease—freeing the replicated viral particles into the cytoplasm of the cell Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

HIV—(cont. ) • Transmission – Body fluids: blood, semen, vaginal secretions, breast milk – High risk factors • Unprotected sexual intercourse • Multiple sex partners • Sharing IV needles • Nonautologous transfusion • Infected mother to infant transmission Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

HIV—(cont. ) • Prevention strategies – Abstain from sexual intercourse. – Avoid casual sex with multiple partners. – Use a condom or spermicide; nonoxynol-9. – Abstain from using IV drugs that contribute to disinhibition and hypersexuality. – Bank autologous blood (self-donated) or directed donor blood. • Nursing practice—standard precautions; report needlestick or sharp injury Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question A client with AIDS indicates that more teaching about the condition is needed when the nurse hears which of the following statement? A) “This disease is spread by sexual contact. ” B) “I’m afraid to touch anyone; I might give them my disease. ” C) “The virus may also be spread through body fluids. ” D) “Infected mothers can pass the virus to their unborn infants. ” Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer B) “I’m afraid to touch anyone; I might give them my disease. ” Rationale: The virus is not spread by casual touching, and the clients needs to touch others. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

AIDS—(cont. ) • AIDS—end stage of HIV infection • Criteria – Markedly decrease T 4 -cell count – Development of certain cancers; opportunistic infections • Classifications of diagnosis of AIDS – Category 1, 2 or 3 and Category A, B, or C Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

AIDS—(cont. ) • Pathophysiology and Etiology: impairs the ability of infected T 4 cells to recognize foreign antigens and stimulate B-cell lymphocytes – Rate of progression: weak strain of HIV, amount of virus, atypical CCR 5 or CXCR 4 co-receptors hinder conversion of HIV to AIDS; effective drug treatment • Assessment Findings: acute retroviral syndrome – Fever, swollen and tender lymph nodes, pharyngitis, rash, muscle and joint pain, Kaposi’s sarcoma, Pneumocystis pneumonia, abnormal Pap tests, PID Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

AIDS—(cont. ) • Diagnostic tests: ELISA test, Western blot, total T-cell count – Viral load: p 24 antigen test, polymerase chain reaction • Purpose • Guides drug therapy • Progression of the disease – Other: cancer screening, PAP cervical tests Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question A client with AIDS is unable to cough because of weakness and fatigue. The client is at risk for: A) Impaired gas exchange B) Pain C) Altered thought process D) Ineffective airway clearance Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer D) Ineffective airway clearance Rationale: Inability to cough results in pooling of secretions and ineffective airway clearance. Gas exchange is not impaired but the airway is. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

AIDS—(cont. ) • Medical Management – Antiretroviral drug therapy: targets viral enzymes – Problems: drug resistance and drug cross-resistance – Treatment: CD 4 count, pregnancy, HIV -associated renal disease, hepatitis B Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

AIDS—(cont. ) • Drug regimens: highly active antiretroviral therapy (HAART) – Reverse transcriptase inhibitor—zidovudine (AZT), nevirapine (Viramune) – Protease inhibitor—indinavir (Crixivan), saquinavir (Invirase) – Entry inhibitor—enfuvirtide (Fuzeon) – Integrase inhibitor—raltegravir (Isentress) • Combinations: Atripla, Stribild, Truvada (Pr. EP) Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

AIDS—(cont. ) • Medical Management – Drug therapy goals • Keep CD 4 cell count above 350/mm 3, undetectable viral load level • Adjunct Drug Therapy – Hydroxyurea (Hydrea)—used to treat cancer – Cytokines—interferons (Roferon-A); increase blood levels of antiretroviral drugs; interleukin-2 (IL-2); stimulates the production of lymphocytes • AIDS vaccine: clinical trials Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

AIDS—(cont. ) • Opportunistic Infections – Pneumocystis pneumonia: pneumonia; mechanical ventilation, aerosol therapy, deep suctioning, Bactrim/Septra – Candidiasis—yeast infection; Candida albicans • Nystatin (Myostatin), vaginal tablets, and suppositories to treat vaginitis – Cytomegalovirus (CMV)—blindness, ulcers in esophagus, colitis, pneumonia, encephalitis • Foscarnet (Foscavir) Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

AIDS—(cont. ) • Opportunistic Infections—(cont. ) – Cryptosporidiosis: protozoan; Cryptosporidium: diarrhea leads to dehydration and electrolyte imbalance • Stool testing for ova and parasites, azithromycin (Zithromax), paromomycin (Humatin) Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

AIDS—(cont. ) • AIDS-related complications – AIDS dementia complex (ADC): degeneration of brain; affects mood, cognition, and motor functions • Treatment: memantine (Namenda), CPI-1189 – Distal sensory polyneuropathy (DSP): abnormal sensations—burning and numbness • Treatment: tricyclic antidepressants—amitriptyline (Elavil), anticonvulsants—gabapentin (Neurontin) Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

AIDS—(cont. ) • Nursing Management – Health teaching • HIV prevention strategies: sexual abstinence and safer sex practices • Diagnostic screening and counseling • Antiretroviral drug: drug teaching and side teaching • Support group and resource referrals Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

AIDS—(cont. ) • Reducing occupational risks: standard precautions – Safe handling of needles and sharp instruments – Transport specimens of body fluids in leak-proof containers. – Clean and disinfect utility gloves. – Remove barrier garments. • Client teaching—medication regimen and goals, maintain or gain weight, fluids, report weight loss, avoid exposure to people with infections, bathe daily, frequent rest periods, do not share IV needles or donate blood Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question A client with AIDS is at risk for imbalanced nutrition related to anorexia, nausea, or mouth sores. Nursing interventions that may help alleviate symptoms that interfere with intake or nutrient use include all of the following, except: A) Encourage small, frequent meals. B) Provide low-fat, high-carbohydrate meals to clients experiencing nausea and vomiting. C) Restrict fluids to promote ease of swallowing in clients with oral ulcerations. D) Avoid lactose, residue, fat or caffeine to prevent diarrhea. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer C) Restrict fluids to promote ease of swallowing in clients with oral ulcerations. Rationale: Liquids should be encouraged to replace fluid and electrolyte losses. Very hot or very cold foods can irritate the mucosa; therefore, room-temperature foods and liquids are recommended for clients with a sore mouth. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

AIDS—(cont. ) • Ethical Issues – Financial and insurance implications: fear of disclosure of HIV status will affect employment, health insurance coverage, housing – Viatical settlements: name a person as beneficiary to life insurance in exchange for immediate cash • Attorney or licensed insurance broker Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins