Care patients with HIV disease and other immune deficiencies

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Care patients with HIV disease and other immune deficiencies
2013-08-13 22:03:42
RN patient care

flashcards for care of patients with HIV disease and other immune deficiencies
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  1. immunity system failure - can be a result of of primary congenital ammune deficiency in which one or more part to the system ate not functioning properly from birth.
    these problems are usually genetic mutations that are discovered in the infant or child who is repeatedly sick.
  2. immune system failure can also be  secondary acquired after birth.
    as the result of viral infection, contact with a toxin, or medical therapy.
  3. the cause of HIV infection is a virus
    HIV is a parasite looking for a way into a cell, to take over the cell, and to force the cell into making more copies of the virus. this cycle repeat as long as there are new host cells to infect.
  4. the virus has two protein coding and the genetic material along with the enzymes called....
    reverse transcriptase and integrase.
  5. one of the cells that it hijacks is the cd4 T cell, also known as the cd4 cell, helper / inducer T cell, or t4 cell.
    this cell directs immune system defenses and regulates the activity of all immune system cells.
  6. viral binding to the CD4 receptor into either of the co-receptors is needed to enter the cell
    the new drug class known as  entry inhibitors works here to block the receptor and prevent the interaction needed for entry of the HIV into the CD4+ T cell.
  7. HIV belongs to a family of viruses called retroviruses
    the drug class is known as nucleoside analog reverse transcriptase inhibitors and non nucleoside reverse transcriptase inhibitors work here to inhibit HIV reverse transcriptase.
  8. HIV also brings an enzyme called integrase. this enzyme allows to viral ds-dna to be inserted into the host ds-dna, which completes the infection of the cd4+ T cell.
    the drug class known as integrase inhibitors works here to prevent viral DNA from integrating into the cells normal human DNA.
  9. HIV particles are made within the infected cd4+ t cell, using all the metabolic machinery of the host. The new virus particle is made in a form of a long protein strand. The Strand is clipped, using chemical enzyme scissors called HIV protease, into several small functional pieces. These pieces are formed into a new finished viral particles.
    the drug class known as protease inhibitors work here to inhibit HIV protease.
  10. the immune system is made weaker by removing some of the CD 4 + tcells from circulation, and the most important cell in the immune system becomes an HIV factory. Up to ten billion virus particles are made daily. Early in the HIV infection, the immune system can still attack and destroy most of the newly-created virus particles.
    with time, the number of HIV particles overwhelms the immune system. Gradually the cd4 plus T cell count fall, viral numbers rise, and without treatment, the patient eventually dies of opportunistic infections or cancer.
  11. everyone who has AIDS has HIV infection, however, not everyone who has HIV infection has AIDS.
    the distinction rest with the number of cd4+ T cells the patient has and weather in the opportunistic infections have occurred.
  12. poor Cd4+ T cell functionas a result of HIV infection leads to these immune system abnormalities:
    • lymphocytopenia
    • increase production of incomplete or non functional antibodies
    • abnormally functioning macrophages
  13. as the CD4+ T cell level drops, the patient is at risk for bacterial, fungal, and viral infections, as well as opportunistic cancers.
    opportunistic infections are those caused by organisms that are present as the part of the body's normal environment and are kept in check by normal immune function.
  14. a diagnosis of AIDS requires that the person be HIV positive and have either a CD4+ t cell count of less than 200 cells or an opportunistic infection.
    once aids has been diagnosed, even if the patient cell count goes higher than 200 cells or the infection is successfully treated, the AIDS diagnosis remains and the patient never reverts to being just HIV positive.
  15. the person with HIV infection can transmit the virus to others at all stages of disease, but the recently infected person with the high viral load and those at the end stage without drug therapy can be particularly infectious.
    there are four stages
  16. stage 1 CDC case definition describe any patient with confirmed HIV infection and a cd4 + t-cell count of greater than 500 cells or a cd4 + t-cell percentage of 29 percent or greater.
    a person at this stage has no age defining illnesses.
  17. stage to CDC case definition describe any patient with a confirmed HIV infection and a cd4 + T cell count between 200 and 499 cells or a CD4 + tcell percentage between 14 percent and 28 percent.
    a person at this stage has no aids to defining illnesses
  18. stage 3 CDC case definition described any patient with a confirmed HIV infection and a CD4+ t cell count of less than 200 cells or a CD4+ T cell percentage of less than 14 percent.
    a person who has a higher cd4 + T cell count or percentages but who also has a documented AIDS defining illness meets the requirements of stage 3 CDC case definition.
  19. stage 4 CDC case definition is used to describe any patient with a confirmed HIV infection, but no information regarding cd4 plus T cell count, cd4+ T cell percentages, & a defining illnesses is available.
    see table 21-1 on page 360 for the Centers for Disease Control and Prevention of classification of a defining condition in adults- there 26 of them
  20. the changing demographics of the infection indicate that the perception that HIV AIDS is only a problem for homosexual white man is false.
    aids hits hardest among people between 21 and 44 years of age. the loss of productivity and wage earning power among this group devastates the patient and strains the insurance and health care industry.
  21. HIV has been found in most influence of infected patients, including blood, semen, vaginal secretions, breast milk, amniotic fluid, urine, feces, saliva, tears, cerebral spinal fluid, lymph nodes, cervical cells, corneal tissue, & brain tissue.
    the fluid with the highest concentrations of HIV are the semen and the blood.
  22. HIV is transmitted most often in these three ways:
    • sexual: genital, anal, or oral sexual contact with exposure of mucus membranes to infected semen or vaginal secretions.
    • Parenteral: sharing of needles or equipment contaminated with infected blood or receiving contaminated blood products.
    • Perinatal: from the placenta, from contact with maternal blood and body fluids during birth, or from breast milk from an infected mother to child.
  23. teach everyone about the transmission roots and ways to reduce their exposure. also stressed that HIV is not transmitted by casual contact in the home, school, or workplace.
    sharing household utensils, towels and linens, and toilet facilities does not transmit HIV. In addition, HIV is not spread by mosquitoes are other insects.
  24. Nursing Action Alert:
    teach all people, regardless of age, gender, ethnicity, or sexual orientation, that they are susceptible to HIV infection.
  25. the CDC describes the ABC safer sex method as A: abstinence, B: be faithful, & C: condoms.
    abstinence and mutually monogamous sex with a non infected partner are the only absolutely safe method of preventing HIV infection from sexual contact.
  26. gender affects HIV transmission.
    the vagina has much more mucous membrane then does the penis. Thus HIV, like other sexually transmitted diseases, is more easily transmitted from an infected male to uninfected female then vice versa.
  27. sexual acts of practice is that from its infected seminal fluid to come in contact with mucous membranes or non intact skin are the most risky for sexual transmission of HIV.
    anal intercourse in which the semen depositor is infected is very risky sexual practice regardless whether the semen receiver is male or female.
  28. viral load affects transmission. the higher the blood level of hiv called viremia, the greater risk for sexual transmission. current highly active antiretroviral therapy (HAART) to drop below detectable levels.
    although there is the less virus in seminal or vaginal fluids of people receiving HAART, the risk for transmission still exists.
  29. needles stick sharp injuries are the main means of occupation related h_i_v infection for healthcare workers.
    the best prevention for healthcare providers is the consistent use of standard precautions for all patient as recommended by the c_d_c and required by the joint commission
  30. all sexually active people should know their HIV status
    pretest and post-test counselling should be performed by personal trained in HIV issues
  31. pathogenic infections are caused by a virulent organisms and occurs even among people who immune systems are functioning normally.
    opportunistic infections are those caused by organisms that are present as part of the body normal environment and are kept in check by normal immune function.
  32. priority nursing action and caring for a patient who is HIV positive are continually assessing for presence of an opportunistic infection and monitoring the patience response to therapy.
    these infections can result in death if appropriate treatment is not started quickly
  33. opportunistic infections do not pose a threat to the immunocompetent health care worker caring for a patient with HIV infection or AIDS. When the patient with HIV infection or AIDS has a pathogenic infection, health care personnel must use precautions appropriate to the specific disease to prevent disease spread.
    for example, when the person with HIV / AIDS is also has tuberculosis at a transmitable stage, airborne precautions are needed in addition to standard precautions.
  34. protozoal infections assess for dyspnea on exertion, tachypnea, a persistent dry cough, and fever. patient may also report fatigue in weight loss. listen to breath sounds for crackles that may be present on lung 
    Pneumocystis jiroveci pneumonia
  35. toxoplasmosis encephalitis assess the patience for subtle changes in mental status, neurological deficits, headaches, and fever. other symptoms to assess include difficulties with speech, gait, and vision; seizures; lethargy; and confusion.
    perform a comprehensive baseline mental status examination and mom to the patient to detect subtle changes.
  36. cryptosporidiosis is an intestinal infection caused by Cryptosporidium
    illness ranges from mild diarrhea too severe wasting with electrolyte imbalance. Diarrhea may result in fluid boss up to 15 to 20 liters per day. Ask patient about the presence of diarrhea or an unplanned weight loss of 5 pounds or more.
  37. fungal infections- candidiasis occurs because the weekend immunity system can no longer control fungal growth.
    on examination of the mouth and on the back of the throat you may see a cottage cheese like, yellowish white plaques and inflammation. patients may report food tasting funny, mouth pain, difficulty in swallowing, and retrosternal pain.
  38. Cryptococcosis is a debilitating meningitis and is sometimes a widely spread infection and AIDS
    ask about fever, headache, blurred vision, nausea and vomiting, nuchal rigidity, mild confusion, and other mental status changes.
  39. histoplasmosis begins as a respiratory infection and progresses to widespread infection
    assess whether dyspnea, fever, cough, and weight loss are present. check for in largement of lymph nodes, the spleen, or liver
  40. bacterial infections are acquired from other people or sources and as overgrowth of skin flora.
    positive cultures may be obtained from lymph nodes, bone marrow, and blood. Assess for fever, debility, weight loss, malaise, and sometimes swollen lymph glands or organ tissue.
  41. tuberculosis ask about the presence of cough, dyspnea, chest pain, fever, chills, night sweats, weight loss, and anorexia.
    a person with TB and a CD4+ T cell count below 200 may not have a positive TB skin test because of an inability to mount an immune response to the antigen, a condition known as anergy.
  42. Nursing safety priority action alert:
    until parameters other than a skin test come back negative for TB in a patient with AIDS who also has TB symptoms, maintain airborne precautions along with standard precautions.