HIV/AIDS

HUMAN IMMUNODEFICIENCY VIRUS (HIV)

 It is a virus that attacks the body’s immune system
 It is a virus that attacks cells that help the body fight infection
 It is a retrovirus that causes AIDS
 It is transmitted primarily through sexual intercourse, during which
blood, semen, and vaginal secretions are shared
 It is also transmitted through contaminated blood that enters the
body by way of parenteral or percutaneous routes or by way of
mucous membranes or open wounds; such transmission can result
from sharing or accidental injection with a contaminated needle,
transfusion of contaminated blood, or perinatal transfer in the womb,
during birth, or through breast milk

ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)

 It is the late stage of HIV infection that occurs when the body’s
immune system is badly damaged because of the virus.
 It is characterized by a progressive compromise of the immune
system.

STAGES OF HIV
1. STAGE 1 (ACUTE HIV INFECTION)
 People have a large amount of HIV in their blood. They are very
contagious.
 Some people have flu-like symptoms. This is the body’s natural
response to infection.
 But some people may not feel sick right away or at all.
 If you have flu-like symptoms and think you may have been exposed
to HIV, seek medical care and ask for a test to diagnose acute
infection.

2. Stage 2: Chronic HIV Infection

 This stage is also called asymptomatic HIV infection or clinical
latency.
 HIV is still active but reproduces at very low levels.
 People may not have any symptoms or get sick during this phase.
 Without taking HIV medicine, this period may last a decade or longer,
but some may progress faster.
 People can transmit HIV in this phase.
 At the end of this phase, the amount of HIV in the blood (called viral
load) goes up and the CD4 cell count goes down. The person may
have symptoms as the virus levels increase in the body, and the
person moves into Stage 3.
 People who take HIV medicine as prescribed may never move into
Stage 3.
 3. Stage 3: Acquired Immunodeficiency Syndrome (AIDS)
 The most severe phase of HIV infection.
 People with AIDS have such badly damaged immune systems that
they get an increasing number of severe illnesses,
called opportunistic infections.
 People receive an AIDS diagnosis when their CD4 cell count drops
below 200 cells/mm, or if they develop certain opportunistic
infections.
 People with AIDS can have a high viral load and be very infectious.
 Without treatment, people with AIDS typically survive about three
years.

SIGNS AND SYMPTOMS

1. Flu-like symptoms within 2 to 4 weeks after HIV infection
 Fever
 Chills
 Rash
 Night sweats
 Muscle aches
 Sore throat
 Fatigue
 Swollen lymph nodes
 Mouth ulcers
2. Persistent generalized lymphadenopathy at two or more extra-
inguinal sites may persist for more than 3 months in the absence of
concurrent illness.
3. Infected patient also may display signs of opportunistic infections and
other diseases
4. Cognitive changes
5. Motor disturbances
6. Behavioral changes
7. Atypical aseptic meningitis
8. Spinal cord degeneration
9. HIV wasting syndrome

DIAGNOSTICS
1. ENZYME-LINKED IMMUNOSORBENT ASSAY (ELISA)
 detects the presence of HIV-1 antibodies; if a patient’s blood
has a positive reaction on two ELISA tests, the Western blot
test is used to confirm the results
2. WESTERN BLOT TEST (Immunofluorescence Assay)
 Confirmatory test for ELISA
 3. RAPID TESTING
 It is a current method of screening being used in clinics,
emergency departments, and physician offices in which results
can be available within 10 to 30 minutes.
4. BLOOD TESTS
5. Patient may also be tested for Syphilis, Hepatitis B,
Tuberculosis, and Toxoplasmosis

MANAGEMENT
1. PHARMACOLOGICAL
 ANTIRETROVIRALS
 Protease inhibitors, such as ritonavir (Kaletra), indinavir
(Crixivan), nelfi navir (Viracept), fosam prenavir (Lexiva), and
saquinavir (Invirase)
 Nucleoside and nucleotide reverse transcriptase inhibitors, such
as zidovudine (Retrovir), didanosine (Videx), lamivudine
(Epivir), abacavir (Ziagen), and tenofovir (Viread)
 Nonnucleoside reverse transcriptase inhibitors, such as
nevirapine (Viramune), efavirenz (Sustiva), and etravirine
(Intelence)
 Integrase inhibitors such as raltegravir (Isentress)
 CCR5 co-receptor antagonist such as maraviroc (Selzentry)
 Fusion inhibitors, such as enfuviritide, which interfere with the
virus’ ability to fuse with the cellular membrane, thereby
blocking entry into the host cell
 These antiretrovirals are used in various combinations to inhibit HIV
viral replication; this is called highly active antiretroviral therapy
(HAART)
 Treatment protocols combine two or more drugs in an effort to gain
the maximum benefit with the fewest adverse reactions
 Combination therapy helps to inhibit the production of resistant,
mutant strains
 Combination agents that combine two or three drugs in one dose are
available and help improve compliance

2. NURSING MANAGEMENT/INTERVENTIONS
 Provide respiratory care
 Encourage activity, as tolerated
 Administer medications, as prescribed
 Monitor vital signs and laboratory values (arterial blood gas
levels, oxygen saturation by pulse oximetry, sputum cultures,
CD4+ count, and complete blood count [CBC])
 Provide pulmonary hygiene (including coughing and deep
breathing every 2 hours), splinting while coughing, and
suctioning
 Provide throat lozenges and warm saline gargles
  Administer antitussives and expectorants, as prescribed
 If appropriate, help the patient to decrease or stop smoking
 Perform GI care
 Monitor fluid intake and output, weight, urine specific gravity,
serum electrolyte levels, and skin turgor
 Obtain stool cultures
 Encourage the patient to drink at least 3 qt (3 L) of fluid daily;
administer I.V. therapy, as prescribed
 Administer antibiotics and antivirals
 Promote good nutrition
 Offer small, frequent meals
 Engage the patient in menu planning, and invite the patient’s
family and friends to meals
 Allowing the patient to include personal food preferences
gives him some control over the diet
 Eating with others may improve appetite
 Encourage the patient to eat meals sitting and out of bed
 Provide a low-residue, high-protein, high-potassium, high-
calorie, lactose-free diet
 Use oral dietary supplements
 Initiate and monitor tube feedings or total parenteral nutrition
as prescribed
 Avoid serving rare meats and raw vegetables
 Monitor daily weight and laboratory values—including serum
protein, albumin, blood urea nitrogen, hemoglobin, and serum
electrolyte levels and hematocrit
 Provide mouth care, using viscous oral lidocaine (Xylocaine) before
meals and use saline rinses after meals
 Perform skin care
 Use pressure-relieving devices (convoluted foam mattress,
pressure mattress, or pressure pads), and turn the patient
every 2 hours
 Apply ointment or other skin barrier to the perianal area
 Maintain wound and skin precautions
 Prevent and control infection
 Restrict the patient’s contact with visitors, staff members, and
other patients who have infections, such as colds or flu
 Make sure that staff members and visitors adhere to hand
hygiene procedures before approaching the patient
 Use reverse isolation if the patient is immunocompromised
 Consider moving the patient to a private room and leaving
equipment such as a thermometer, blood pressure cuff, and
stethoscope in the room to minimize pathogen exposure
 Follow standard precautions to reduce pathogen transfer
  Inspect the skin, I.V. sites, vascular access devices, and
invasive cardiovascular monitoring lines because loss of skin
integrity is a potential source of infection
 Monitor antimicrobial therapies because antibiotics can increase
the likelihood of superinfection and the development of
resistant organisms
 Encourage and maintain adequate nutritional intake, which
promotes healing and prevents infection
 Provide neuropsychiatric care
 Encourage the patient to discuss emotional issues because
mood swings may be related to an inability to cope with the
illness
 Identify resources for patient and family support
 Use reminder devices, such as pictures and appointment books
to help orient the patient
 Arrange for continuity of caregivers and avoid frequent room
changes to prevent patient confusion
 Consult occupational and physical therapists
 Promote health maintenance
 Teach the patient, family, significant others, and caregivers
about the diagnosis, treatments, modes of transmission, and
symptoms to report
 Explain medications to the patient, including dose, frequency,
and adverse effects; reinforce the importance of compliance to
help suppress the virus and to prevent the development of drug
resistant strains
 Discuss the importance of avoiding high-risk behaviors and
reducing the risk of transmission to others
 Make appropriate referrals—for example, for home care, pain
management, legal services, support groups, financial support,
and hospice care

SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

 It is a chronic, systemic autoimmune disease that causes skin, heart,
lung, and kidney inflammation
 It varies in severity from mild to rapidly progressing with multiple
organ involvement
 It is a result of disturbed immune regulation that causes an
exaggerated production of autoantibodies
 Occurs most commonly in women during their childbearing years
SIGNS AND SYMPTOMS
 arthritis with synovitis,
 a characteristic butterfly rash over the nose and cheeks (develops in
50% of patients)
 photosensitivity
 fever
 malaise
 weight loss
 extreme fatigue
 diffuse and patchy hair loss
 seizures
 psychosis
 pleuritis
 endocarditis
 myocarditis
 Raynaud’s phenomenon
 anemia, abdominal pain
 menstrual irregularities
 lymph node enlargement throughout the body
 Pericarditis
 Hypertension

DIAGNOSIS AND TREATMENT

 Diagnosis may be based on patient history; physical examination;
serologic studies, such as CBC, ESR, antinuclear antibody tests, and
lupus erythematosus cell test; electrocardiography; chest X-ray; and
kidney function studies
 Treatment typically calls for NSAIDs and corticosteroids to decrease
inflammation
 Other drugs—such as immunosuppressants, cardiotonics, and
antimalarials—are prescribed based on the severity of the disease

NURSING INTERVENTIONS
 Monitor vital signs to evaluate the extent of inflammation
 Monitor the patient for reports of arthritis, joint or chest pain,
respiratory difficulties, and other symptoms; SLE symptoms vary
among patients
 Monitor the patient for seizures, headaches, and vision disturbances;
neurologic problems may accompany the disease
 Monitor the patient for numbness and tingling of the hands and feet;
peripheral neuropathy may occur
 Monitor the degree of fatigue, color of skin and conjunctivae, and
color of stools; anemia is common in patients with SLE
 Test urine and stool for occult bleeding, a possible adverse effect of
prescribed medications
 Provide for rest periods to avoid fatigue; promote independence in
activities of daily living to improve self-esteem
 Encourage the patient to express feelings about changes in body
image and the chronic nature of the disease
 Teach the patient about family planning, genetic counseling,
medications, the treatment plan, avoidance of sun exposure, and
wearing protective clothing and sunscreen when outdoors