Nursing considerations: take same time ea day with meals, no grapefruit juice. Lifelong therapy with f/u appointments needed. Instruct on SE and dental hygiene. Teach s/s of infection and rejection. May need reverse isolation
What is HIV? When does it change to a diagnosis to AIDs?
Human Immune Deficiency Virus
Caused by virus that invades cells, injects genetic material into host's DNA in the CD4 + T-cell.
Stage of HIV and AIDs depends on amount of CD4 + T-cells as well as opportunistic infections
AIDs confirmed when <200cells/mm3 or less with opportunistic infection
What are the stages of HIV and AIDs?
Stage 1: confirmed HIV CD4 + T lymphocytes >500 cells/mm3
Stage 2: confirmed HIV 200-499 cells/mm3
Stage 3: confirmed HIV <200 cells/mm3 or less with opportunistic infection (AIDs criteria)
Stage 4: Confirmed HIV, no other info
How is HIV transmitted? What routes are most common?
Sexual contact: mucus membranes and infectious disease. More common when rectum is involved. Female more likely to contract due to amount of muc mem.
Parenteral: trans by needles, equip, blood. Decreased by autologous transfusions, needle exchange programs
Perinatal: from placenta, maternal breast milk. If pregnant lady is HIV pos, continue treatment
How is HIV diagnosed? What is seroconversion?
ELISA (Enzyme Linked Immunosrobent Assay): tests serum for HIV antibodies
Western Blot: tests for 4 HIV Antigens
Quantitative viral load testing: amount of HIV RNA in serum
Lymphocyte counts: 5-10 thousand cells/mm3 is normal, AIDs <3,500 cells/mm3
CD4 + T-cell: 500-1500 cells/mm3, AIDs <100
Seroconversion: time lag between the infection and antibody production
What is PCP? What are the s/s?
Most common opportunistic infections for HIV
Low Grade Fever
Crackles in Lungs
What is toxoplasmosis? What are the s/s?
One-celled parasite that reproduces only in cats, transmitted by eating undercooked meat or handling cat feces
Decreased mental status
What is cryptosporidium? What is the hallmark s/s?
Microscopic parasite that causes diarrhea
Severe wasting (assess for wt loss 5lb or more)
Describe Candida and why it's important for those who are immunocompromised
Overgrowth of normal fungal flora
Oral (stomatitis) or esophogitis
Vaginal candida infection in women
If its on the outside, its on the inside
What are the hallmark s/s of TB? What kind of precautions should be used?
Cough, dyspnea, night sweats, weight loss, fever chills, anorexia
May or may not have positive PPD (so immunocompromised it doesnt have a welt), so use Quantiferon gold test
Airborne precautions until labs are negative
What is Karposi's Sarcoma? Why is it relevant for AIDS?
Unique to AIDs towards the end of life
Purple lesions (if on outside, on inside)
Mouth, with or without candida, diagnosed with fine needle aspiration or biopsy
GI tract- N/V/D, intestinal obstruction. Diagnosed by endoscopy
Resp tract- fever, cough, hemoptysis, diagnosed by bronchoscopy
Describe AIDs Dementia
Aids demetia complex (ADC)
Late stage HIV
Similar to other dementias, ranging from mild to severe
Results from infected cells in the central nervous system
What kinds of medications are used for HIV/AIDs? Describe Zidovudine (Retrovir)
Use: HIV infection with other antiretrovirals. Reduction of transmission from mother to fetus
Action: Prevents viral replication by inhibiting the enzyme DNA polymerase
Contraindications: hypersensitivity, no breast feeding
Side/Adverse effects: Seizures, hepatomegaly, pancreatitis, lactic acidosis, n/v/d, HA, weakness, abd pain, anemia, granulocytopenia
Dose: IV- 1mg/kg over 1 hr, q 4hr until PO
PO- 100 mg q4hr while awake or 200mg 3x daily or 300 mg 2x daily
Nursing considerations: Teach on around the clock and consistent therapy. Encourage follow up visits. teach about SE and s/s of infection, hepatitis and pancreatitis. May use fall precautions because of dizziness. Monitor Labs and CBC for infection and anemia. Monitor for cushingoid symptoms. Keeps meds away from sun. Do not BF
What is anaphylaxis? What are the s/s?
Systemic response that occurs rapidly and is life threatening
Nursing Considerations: fall risk (Esp older adults), admin 20 min before sleep or 30 min before travel, admin with meals or milk. Teach pt about safety and drowsiness, dry mouth and sleep hygiene techniques
Uses: management of reversible airway disease such as asthma or COPD. Management of severe allergic reactions.
Actions: Effects both beta 1 and beta 2. Results in an accumulation of cAMP to inhibit release of mediators of immediate hypersensitivity reactions from mast cells
Contraindications: Hypersensitivity, caution for cardiacs
SE/AE: Nervousness, restlessness, HA, angina, HTN, tachycardia, N/V, hyperglycemia.
Overdose: if toxicity occurs, beta blockers an supportive therapy used. BB may cause bronchospasm, use with caution
Route: Subcut, IV, IM, Inhalan, Intracardiac, Intratracheal, Intraosseos
Dose: many different doses. Subcut/IM- 0.1-0.5 mg for anaphylaxis
Nursing considerations: Assess HR, BP, lung sounds prior to admin. Assess for hypersensitivity and monitor for paroxysmal bronchospasm. Monitor for increase in cardiac, assess E/F for hyperkalemia, hyperglycemia and lactic acid. Assess for toxicity