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Transcript of Chapter035
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Timby/Smith: Introductory Medical-Surgical Nursing, 10/e
Timby/Smith: Introductory Medical-Surgical Nursing, 10/e
Chapter 35: Caring for Clients with HIV/AIDS
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Human Immunodeficiency VirusHuman Immunodeficiency Virus• Requires host for survival, duplication
• Eventually results in AIDS
– Can remain well for several years being HIV+
• Pandemic: 33.2 million people worldwide
– 63% live in sub-Saharan Africa
• 2 of 3 adults are HIV+
• 90% of children are HIV+
• No longer exclusive: Homosexual men; IV drug users
– Increasing numbers of heterosexual women infected; Transmission to newborns
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Human Immunodeficiency VirusHuman Immunodeficiency Virus• Nurses: Largest group of healthcare workers to
occupationally acquire HIV
• 2007 Deaths: 2.1 million people (decline)
• U.S. Health Problem
– African-Americans: HIV infection rate 8 times higher than whites
– 2003
• 2nd leading death cause in African-American males, ages 35-44
• 3rd leading death cause in African-American females, ages 35-44
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Human Immunodeficiency VirusHuman Immunodeficiency Virus
• Subtypes
– HIV-1: Mutates easily, frequently
• More prevalent in U.S., world
– HIV-2: Less transmittable; HIV to AIDS interval longer
• Western Africa primary infection site
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Human Immunodeficiency Virus (HIV) Human Immunodeficiency Virus (HIV)
Structure of a retrovirus
•HIV Structural Characteristics
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Human Immunodeficiency Virus (HIV) Human Immunodeficiency Virus (HIV)
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
HIV Replication; TransmissionHIV Replication; Transmission
● Transmission: Body fluids− Blood− Semen− Vaginal secretions− Breast milk
● Specific behaviors increase risk
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Human Immunodeficiency VirusHuman Immunodeficiency Virus
• Pathophysiology and Etiology
– Infected CD4 cells are unable to recognize foreign antigens
– Viral cells continue parasitic replication, resulting in decreased CD4 cell count
• >10 billion viral particles released daily
• Frequent mutations complicate drug therapy
• Render vaccine development virtually impossible
• New strains
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Human Immunodeficiency VirusHuman Immunodeficiency Virus
• Prevention Strategies
– Prevention guideline compliance
• No sex with strangers; Mutually monogamous sex – uninfected partner
• Use condoms effectively
• No IV, psychostimulant drug use
– Use standard precautions
– Immediately report needlesticks
• Get prophylactic treatment
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Acquired Immunodeficiency Syndrome Acquired Immunodeficiency Syndrome • Is End Stage HIV Infection
– Immunodeficiency develops
– Mortality from opportunistic infection; Cancers
• Progression Related to
– Viral concentration in blood
– Subtype, strain of infecting HIV
– CD4 cell status
• Few Long-term Survivors
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Acquired Immunodeficiency Syndrome Acquired Immunodeficiency Syndrome • Assessment Findings: Signs and Symptoms
– Acute retroviral syndrome (flu-like)
• Fever; Swollen, tender lymph nodes; Rash on face, trunk, pales, soles; Muscle, joint pain; HA; N/V; Diarrhea
– Liver, spleen enlargement; Weight loss; Neurologic symptoms; Kaposi’s sarcoma; Abnormal gynecologic problems in women
• Assessment Findings: Diagnostic Findings
– ELISA test (x2), Western blot test confirms
– CD4 (T-cell) count; Viral load tests
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Acquired Immunodeficiency Syndrome Acquired Immunodeficiency Syndrome
Figure 35-4 Kaposi's Sarcoma Left: Single lesion; Right: Multiple lesions
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AIDSAIDS
Supportive care
Treating anorexia, diarrhea,
weight loss
Treating side effects
of therapy
Adjunct drug therapy
Antiretroviral drugs
Medical Management
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Medical ManagementMedical Management• Antiretroviral Drug Therapy
– Initiation controversy; Very expensive
– Reverse transcriptase inhibitors
• NRTIs + NNRTIs: Cripple viral copying
• Nucleotide analogues: Activate immediately on entering CD4 cell
– Protease inhibitors: Interfere with viral copy maturation
– Entry inhibitors: Block proteins or surface coreceptors of the CD4 T-cell lymphocyte
• HAART
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Highly Active Antiretroviral Therapy (HAART)Highly Active Antiretroviral Therapy (HAART)
Combination Therapy
Reverse Transcriptase
Inhibitors
Protease Inhibitors
Fusion Inhibitors
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Medical ManagementMedical Management
• Adjunct Drug Therapy
– Hydroxyurea: Interferes with viral replication
– IL-2: Boosts immune defenses against HIV
• AIDS Vaccines: In clinical trials; Success unlikely due to frequent viral mutations
• Drug resistance development due to noncompliance
– Medication compliance difficult
• Numerous medications taken simultaneously ATC requiring near-perfect compliance
• Undesirable GI side effects
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Medical ManagementMedical Management
Figure 35-7 The effect of noncompliance on drug resistance
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Supportive Care: Opportunistic Infection Supportive Care: Opportunistic Infection
Cryptosporidiosis
Cytomegalovirus Infection
Candidiasis
Pneumocystis Pneumonia
Infectious Conditions
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
AIDS-Related Complication ManagementAIDS-Related Complication Management
• AIDS Dementia Complex (ADC)
– Antiretroviral therapy
– Drug therapy
• Distal Sensory Polyneuropathy (DSP)
– Side effect of several antiretroviral drugs
– Vitamin B12
– Thiamine supplementation
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Nursing ManagementNursing Management
• Maintain client confidentiality
• Significant health education; Counseling; Follow-up
• Diagnostics
– Test result interpretation; Appointments
• Medications
– Action and side effects of drugs
– Schedule for self-administration
• Referral to support groups and resources for information
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Nursing ManagementNursing Management
• Reducing Occupational Risks
– Observe standard precautions
– Follow guidelines: Nursing; OSHA
– Immediately report any blood exposure
• Post-exposure HIV testing at regular intervals
• Follow sexual precautions post-exposure
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End of Presentation