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Nursing of Adults with Medical & Surgical Conditions

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Presentation on theme: "Nursing of Adults with Medical & Surgical Conditions"— Presentation transcript:

1 Nursing of Adults with Medical & Surgical Conditions

2 HIV Human Immunodeficiency Virus Type 1 Type 2
Found throughout the world Responsible for the majority of HIV infection cases Usually progresses to AIDS within 10 years Type 2 Found primarily to West Africa and associated countries Less virulent; does not tend to progress to AIDS as quickly as type 1

3 Transmission of HIV HIV cannot survive very long outside of the human body Transmitted from human to human Blood Semen Cervicovaginal secretions Breast milk

4 Transmission of HIV Other body fluids contain HIV
No evidence they are capable of transmission Saliva Urine Tears Feces

5 Transmission of HIV Most common modes of transmission
Sexual Transmission Anal or vaginal intercourse Parenteral Exposure Contaminated injecting drug equipment and paraphernalia Transfusion of blood and blood products 1% of adult and adolescent AIDS cases 5% of pediatric AIDS cases Occupational Exposure Perinatal (vertical) Transmission Transmission from mother to child may occur during pregnancy, delivery, or postpartum breastfeeding

6 Pathophysiology of HIV & AIDS
Normal immune response Foreign antigens interact with B cells B cells initiate antibody development B cells and T cells initiate cellular immune response B cells reduce virus in blood T cells reduce virus in lymph nodes

7 Pathophysiology of HIV & AIDS
Immune Dysfunction T- cells or CD4+lymphocytes are destroyed by HIV HIV is then able to reproduce in the lymphatic system and eventually “spills over” into the blood Decreases resistance to life-threatening infections CD normal CD minor immune problems CD4 below 200 severe immune problems

8 Spectrum of HIV Initial Exposure Primary HIV Infection
Flulike symptoms Develop antibodies to HIV in 2 weeks to 6 months Asymptomatic HIV Infection HIV seropositivity (seroconversion) positive HIV antibody test 95% within 3 months; 99% within 6 months Infectious; no illness

9 Spectrum of HIV Early HIV Disease Advanced HIV Disease
S/S may not appear until years after exposure Symptomatic infection persistent, unexplained fever night sweats diarrhea weight loss fatigue lymphadenopathy Advanced HIV Disease AIDS

10 AIDS Diagnosis HIV positive AND CD4 (T4) count below 200 OR
One or more AIDS-Indicator Conditions Page 672 (category C)

11 Opportunistic Infections
Table 16-6; Pages Most Common Opportunistic Infections Pneumocystis Carinii Pneumonia (PCP) (Most common infection) Symptoms Fever Night sweats Productive cough SOB Treatment Bactrim or Septra Pentamidine Steroids Wear gown, mask, and gloves during patient care

12 Opportunistic Infections
Kaposi’s Sarcoma Symptoms Reddish-purple spots on the skin overgrowth of blood vessel cells Treatment Radiation Chemotherapy Most common neoplasm found in HIV infected patients

13 Opportunistic Infections
Cytomegalovirus (CMV) Symptoms Retinitis blurring of vision spots in visual field Colitis diarrhea abdomial pain bloating Treatment Gancyclovir Foscarnet

14 Opportunistic Infections
Cryptococcal Meningitis Symptoms Fever Headache Treatment Amphotericin B Fluconazole

15 Opportunistic Infections
Toxoplasma Encephalitis Symptoms Fever Headache seizures mental changes lethargy coma Treatment Pyrimethamine & folic acid Sulfadiazine Clindamyhcin

16 Opportunistic Infections
Mycobacterium (Avium Complex & Tuberculosis) Symptoms Fever Chills Sweats Abdominal pain Bone pain Fatigue Diarrhea Nausea Weight loss Treatment Rifampin INH Ciprofloxacin

17 Diagnostic Studies HIV Antibody Testing CD4 Lymphocyte Count
ELISA Detects the presence of HIV ANTIBODIES If positive, ELISA is done a second time Western Blot Done if second ELISA is positive More sensitive than ELISA CD4 Lymphocyte Count Normally Decreases as the disease progresses Viral Load Monitoring Level of virus in the blood

18 Diagnostic Studies Seropositive Seronegative
All three tests are positive ELISA x 2 and Western blot Does NOT mean the person has AIDS Seronegative Not an assurance that an individual is free from HIV infection Seroconversion may not have occurred yet Assurance of seronegativity All three tests are negative AND no risky behavior for previous 6 months

19 Therapeutic Management
Objectives of Treatment Monitor HIV disease progression and immune function Prevent development of opportunistic diseases Initiate and monitor antiretroviral therapy Detect and treat opportunistic diseases Manage symptoms Prevent complications of treatment

20 Pharmacological Management
Opportunistic Illness Prophylaxis Table 16-7; Page Medications for HIV Disease Antiretrovirals Pages ; List of medications Combination therapy prevents development of resistance Must be given around the clock ie, not three times a day while awake Usually initiated CD4 count below 500, or Viral load greater than 10,000

21 Nursing Interventions
Psychosocial Issues Uncertainty Isolation Fear Depression Limited financial resources

22 Nursing Interventions
Assisting with Coping Educate about HIV Encourage to participate in their own care Face life a day at a time; live each day to the fullest Listen Maintain sources of psychological support

23 Nursing Interventions
Reducing Anxiety Clarification & education about HIV & AIDS disease process complications treatment Include patient and support person in planning care Encourage talking about feelings or relaxation and meditation Assess for suicidal ideation Support groups

24 Nursing Interventions
Minimize Social Isolation Social Stigma associate with homosexuality, drug use, and sexual transmission Sharing diagnosis with others need to choose carefully Support groups patients significant others

25 Nursing Interventions
Assisting with Grieving Listening Explore feelings, fears and treatment options Significant others and family members may experience fear, anger embarrassment, and shame

26 Nursing Interventions
Confidentiality Diagnosis should be carefully protected Need to know basis not every health care worker needs to know diagnosis Universal precautions should be used on every patient

27 Nursing Interventions
Duty to Treat Healthcare professionals may not pick and choose their patients Rehabilitation Act of 1973 prohibits discrimination against the handicapped and the disabled HIV and AIDS are included

28 Nursing Interventions
Early Good nutritional habits Elimination of smoking and drug use Elimination or moderation of alcohol intake Regular exercise Stress reduction Avoidance of exposure to new infectious agents Mental health counseling Involvement in support groups Safer sexual practices

29 Nursing Interventions
Later Treat opportunistic diseases Diarrhea is often a long term problem Low fat, low fiber, high potassium diet adequate fluid intake good skin care Nutritional Encourage nutritional supplements Increase protein Enteral supplements (NG tube) TPN

30 Prevention of HIV Infection
Education Best means of prevention Counsel about HIV testing, behaviors that put them at risk, and how to reduce or eliminate those risks Nurse must be able to discuss behaviors forthright, relaxed, and non-judgemental

31 Prevention of HIV Infection
HIV Testing and Counseling Pre- and Post-test counseling must be done Table 16-5; page 683 Patient should not be pressured to be tested Informed consent must be obtained before drawing blood consent laws are established by state laws Confidential or anonymous testing

32 Prevention of HIV Infection
Risk assessment and Risk Reduction Minimum risk assessment (Box 16-6; Page 698) Have you ever had a transfusion or used clotting factors? Was it before 1985? Have you ever shared needles, syringes, or other injecting equipment with anyone? Have you ever had a sexual experience in which your penis, vagina, rectum, or mouth came into contact with another person’s penis, vagina, rectum, or mouth? Positive response to any one of these questions will require further assessment and/or referral

33 Prevention of HIV Infection
Barriers to Prevention Denial “it won’t happen to me” Ignoring risks Fear, misunderstanding, and potential for social isolation Cultural and community attitudes, values and norms opposed to HIV and AIDS education in schools

34 Prevention of HIV Infection
Decreasing Risks Related to Sexual Transmission Eliminate the risk of exposure to HIV through semen and cervicovaginal secretions NURSES RESPONSIBILITY IS TO COUNSEL ON SAFE PRACTICES – NOT TO JUDGE THE CHOICE OF PRACTICES! Abstaining from all sexual activity Limit sexual behavior in which the mouth, penis, vagina, or rectum come into contact with blood, semen, or cervicovaginal secretions Massage Masturbation; mutual masturbation Telephone sex Use of barriers condoms are not 100% effective, but reduce risk Chart 16-7; Page 704 and Chart 16-8; page 706

35 Prevention of HIV Infection
Decreasing Risks Related to Drug Use Stop the use of injectable drugs Provide drug treatment opportunities If drugs are going to be injected use sterile needles and equipment Instructions on cleaning needles and equipment Deactivation of HIV requires a 30 second exposure to 100% bleach fill the syringe with bleach two times; empty two times fill the syringe with clean water two times; empty two times

36 Prevention of HIV Infection
Decreasing Risks of Occupational Exposure Risk is very rare; only 5% of AIDS cases Handwashing is the single most effective means of preventing the spread of infection Universal precautions and body substance isolation High-risk exposure treatment Begin antiretroviral medications within 1-4 hours for at least 4 weeks HIV testing Baseline, six months and twelve months

37 Prevention of HIV Infection
Other Methods to Reduce Risk HIV-Infected person should be given the following instructions Do not give blood, donate organs or donate semen Do not share razors, toothbrushes, or other household items that may contain blood or other body fluids shower instead of tub bath Avoid infecting sexual and needle-sharing partners Do not breastfeed

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