Chapter 21

Care of Patients with HIV Disease and Other Immune Deficiencies

Mrs. Kreisel MSN, RNNU130 Adult HealthSummer 2011

Acquired Immune Deficiency Syndrome

• The most common secondary immunogenicity disease in the world

• Identified in 1981• Serious worldwide epidemic

Prevalence of HIV Infection by Country

HIV Infectious Process

Life Cycle of HIV

Effects of HIV Infection

• Everyone who has AIDS has HIV infection. However, not everyone who has HIV infection has AIDS.

• The distinction rests with the number of CD4+ T-cells the patient has and whether any opportunistic infections have occurred.

Virus Infection

HIV Classification

• Clinical categories:• Clinical category A (HIV positive)• Clinical category B (HIV and

opportunistic infection)• Clinical category Co (AIDS)

• SEE PAGE 365

Health Promotion and Maintenance

• Education is the best hope for prevention.• HIV is transmitted most often in three

ways:• Sexual• Parenteral• Perinatal• BLOOD, SEMEN, VAGINAL FLUID

Transmission and Health Care Workers

• Needle stick or “sharps” injuries are the primary means of HIV infection for health care workers.

• Workers can also be infected through exposure of nonintact skin and mucous membranes to blood and body fluids.

• The best prevention for health care providers is the consistent use of Standard Precautions for all patients as recommended by the CDC.

Collaborative Management

• Assessment• History • Physical assessment and clinical

manifestations:• Infections—opportunistic, protozoal,

fungal, bacterial, viral • Malignancies—Kaposi’s sarcoma,

malignant lymphomas• Endocrine complications

Other Clinical Manifestations

• AIDS dementia complex• AIDS wasting syndrome• Skin changes• Dysphagia: Increase protein and

calories

Laboratory Assessment

• Lymphocyte counts• CD4+ T-cells and CD+ T-cells• Antibody tests• Enzyme-linked immunosorbent assay

(ELISA)• Western blot, viral load• Quantitative RNA assays• Others

Drug Therapy

• Nucleoside analog reverse transcriptase inhibitors

• Non-nucleoside reverse transcriptase inhibitors

• Protease inhibitors• Fusion inhibitors• Entry inhibitors• Integrase inhibitors• Immune enhancement

Nursing Diagnoses

• Pain• Imbalanced Nutrition: Less Than Body

Requirements• Diarrhea• Impaired Skin Integrity• Disturbed Thought Processes• Chronic Low Self-Esteem• Social Isolation

Community-Based Care

• Home care management• Health teaching• Psychosocial preparation• Health care resources

Therapy-Induced Immune Deficiencies

• Drug-induced immune deficiencies• Radiation-induced immune deficiencies

Other Immune Deficiencies

• Congenital (primary) immune deficiencies• Avoid breast feeding

• Bruton’s agammaglobulinemia• Common variable immune deficiency• Selective immunoglobulin A deficiency

•NCLEX TIME

Question 1

What percentage of new HIV infections are reported to

occur in minorities in the United States?

A. More than 28%B. More than 42% C. More than 57% D. More than 72%

Question 2

Which group has the highest percentage of AIDS cases

in North America?

A. Men or women who use injection drugsB. Newborns of mothers who are HIV

positive C. Men who have had sex with other menD. Women who have had sex with other

women

Question 3

When reviewing the chart of a patient with newly diagnosed AIDS,

the nurse recalls that the most common opportunistic infection in

persons infected with HIV is:

A. Tuberculosis (TB), caused by Mycobacterium tuberculosis

B. Pneumocystis jiroveci pneumonia (PJP)C. Cytomegalovirus (CMV), causing CMV retinitisD. Toxoplasmosis encephalitis, caused by

Toxoplasma gondii

Question 4

When teaching a patient with AIDS about drug therapy, the nurse

emphasizes that the drugs must be taken exactly as prescribed,

without missing doses. The reason for this is:

A. Missed doses can promote drug resistance, lowering the effectiveness of the drugs.

B. Missed doses allow for the development of opportunistic infections.

C. An increased chance of allergic reaction to the drug may occur.

D. Viral replication decreases when doses are missed.

Question 5

A patient is fearful that he has been infected with HIV.

The nurse recognizes that the first manifestations of

HIV infection is/are:

A. Opportunistic infectionsB. Fever, night sweats, and muscle aches C. Lymphocytopenia (decreased

lymphocyte count) D. Reduced numbers of CD4+ T-cells