Care of Patients with HIV/AIDS

Care of Patients with HIV/AIDS
An Inadequate Immune Response includes the following infections and malignancies: HIV/AIDS – AIDS causes and inadequate immunological respone Pulmonary Gastrointestinal Oral Gynecological CNS Opportunistic infections Opportunistic malignanices

HIV is an obligate virus
Transmission of HIV HIV is an obligate virus It cannot survive very long outside of the human body Transmitted from human to human Blood Semen Cervicovaginal secretions Breast milk Pg 739 AHN, 6th ed.

Saliva Urine Tears Feces Transmission of HIV
Other body fluids contain HIV; no evidence they are capable of transmission Saliva Urine Tears Feces Just because the virus is present does not mean that you can catch it.

Duration and frequency of exposure Amount of virus inoculated
Transmission of HIV Conditions that affect the likelihood of infection include: Duration and frequency of exposure Amount of virus inoculated The virulence of the organism The host’s defense capability Pg 739 states “HIV is generally transmitted by behaviors and not by casual contacts.” The viral load is heaviest at the beginning of the infection and at the end of the infection but at anytime the patient is capable of spreading the virus, though the higher the load the more likely hood transmission will occur. See also pg 742

Perinatal (vertical) transmission
Transmission of HIV Sexual transmission Anal or vaginal intercourse Parenteral exposure Contaminated drug injecting equipment and paraphenalia Transfusion of blood and blood products Occupational exposure Perinatal (vertical) transmission Transmission from mother to child May occur during pregnancy, delivery, or postpartum breastfeeding Pgs 739 – 740 AHN 6th Ed.

B cells reduce virus in blood T cells reduce virus in lymph nodes
Pathophysiology 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 See the table on pg 743 AHN 6th ed.

Immune dysfunction T-cells or CD4+ lymphocytes are destroyed by HIV
Pathophysiology 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 Helper T cells (CD4, or T4 cells) T-helper cells contain CD4 receptors Considered the “conductor” of the immune system because of their secretion of cytokines which control most aspects of the immune system Remember us talking about the T-cells and how there were 3 kinds? Helper Cells, Killer Cells, and Regulators? The HIV virus kills the helper cells which means there is no one to direct the immune system to kill the virus.

Immune dysfunction cont.
Pathophysiology Immune dysfunction cont. Helper T-cells cont. These are the major target of HIV Progressive Infection gradually destroys the available pool of T-helper cells overall CD4 cell count drops. Lower CD4 cell counts correspond with more immunodeficiency  onset opportunistic infections Can you name some opportunistic infections someone with HIV might get? candidiasis, The CDC developed a list of more than 20 OIs that are considered AIDS-defining conditions—if you have HIV and one or more of these OIs, you will be diagnosed with AIDS, no matter what your CD4 count happens to be: Candidiasis of bronchi, trachea, esophagus, or lungs Invasive cervical cancer Coccidioidomycosis Cryptococcosis Cryptosporidiosis, chronic intestinal (greater than 1 month's duration) Cytomegalovirus disease (particularly CMV retinitis) Encephalopathy, HIV-related Herpes simplex: chronic ulcer(s) (greater than 1 month's duration); or bronchitis, pneumonitis, or esophagitis Histoplasmosis Isosporiasis, chronic intestinal (greater than 1 month's duration) Kaposi's sarcomav Lymphoma, multiple forms Mycobacterium avium complex Tuberculosis Pneumocystis carinii pneumonia Pneumonia, recurrent Progressive multifocal leukoencephalopathy Salmonella septicemia, recurrent Toxoplasmosis of brain Wasting syndrome due to HIV Retrieved 08/12/2014 from:

Decreases resistance to life- threatening infections
Pathophysiology Decreases resistance to life- threatening infections CD = normal CD = minor immune problems CD4+ below 200 = severe immune problems

Pathophysiology HIV is a member of the lentivirus (slow virus) family of retroviruses. HIV carries its genetic material in RNA (rather than DNA) HIV replicates by converting RNA into DNA As an “obligate parasite”, it cannot replicate unless it is inside another living cell Pg 742 AHN 6th Ed.

Amts as high as 10 mil. Particles of HIV per ml
Pathophysiology Both cellular and humoral immune mechanisms limit HIV replication and slow down disease progression Initial infection with HIV  viremia during which large amounts of the virus can be isolated in the blood Amts as high as 10 mil. Particles of HIV per ml Up to 10 bil. Particles of HIV are produced and cleared daily in an infected individual What is Cellular and what is Humoral ? Humoral is the innate immune system – mucous, skin, sebaceous glands, digestive tract, antibodies – its always on guard always just floating around in the blood waiting for something to trigger the response. Cellular is the second line of defense. It is slower, delayed, requires a virus, bacteria or germ to be triggered. B-cells are Humoral and T-cells are cell mediated therefore they are cellular.

Pathophysiology The massive production of HIV is coupled with the production and destruction of nearly 2 bill. CD4 lymphocytes each day The amount of virus in the blood is directly linked to the rate of virus production, which determines the rate of CD4 cell destruction CD4 Cells - These cells have a glycoprotein called CD4 on their surface. These "helper" cells do not neutralize infection, but rather initiate the body's response to infections. They are a T-Cell – a specific kind of “Helper T-cell”

Spectrum of HIV HIV disease is a broad diagnostic term that includes the pathology and clinical illnesses caused by HIV infection. AIDS (Acquired Immunodeficiency Syndrome) is defined as an acquired condition that impairs the body’s ability to fight disease The end stage of a continuum of HIV infection CD4 count < 200 Following exposure to HIV and an incubation period of 2-4 weeks, some may develop flu-like symptoms: Fever, sweats, HA, Myalgia, Neuralgia, Sore Throat, GI ‘Distress’; Photophobia May then remain asymptomatic for 10 or more years or develop symptoms within a few months

Spectrum of HIV HIV infection may exist for many years without symptoms before it progresses to symptomatic HIV disease Asymptomatic HIV infection HIV seropositivity (seroconversion) Positive HIV antibody test 95% within 3 months; 99% within 6 months Infectious; no illness Note they are infectious without having any sign or symptom they are even ill

Acute Retroviral Syndrome
Initial exposure Virus replication occurs during the acute infection period The viral load peaks in millions of copies of virus per milliliter right before the appearance of detectable antibodies can be measured in the blood. Viral “set point” = stabilizing of the viral load; usually reached in 4-6 months after exposure Pg 745 AHN 6th ed. Symptoms if you develop them are flu like, or you feel like you have mononucleosus.- fever, headache, arthralgias, myalgias, diarrhea, nausea, and a diffuse rash over the trunk of the body. After acouple of weeks the symptoms generally disappear. As healthcare workers you should know that if you have an exposure the sooner you start on the medications the lower your set point will be for a viral load and PLEASE DON”T say it won’t happen to me. It happened to my sister when she was putting a needle away in a sharps container when someone called her name and she turned around and drove that dirty needle into her finger. It can happen to anyone who is handling sharps in a busy environment. It only takes a second and your life is no longer what you thought you knew.

Acute retroviral syndrome
Seroconversion: the development of antibodies from HIV Takes place approx. 5 days -3 months after exposure Accompanied by a flu-like or mononucleosis-like syndrome with fever, night sweats, pharyngitis, headache, malaise, arthralgias, myalgias, diarrhea, nausea, and a diffuse rash pominent on the trunk They tested my sister every month for 2 years, now they test her annually. She’s been clear so far but she Insisted that they start her immediately on the cocktail which she took everyday for a year

Early infection Early HIV disease Signs and symptoms may not appear until years after exposure Symptomatic infection Persistent, unexplained fever Night sweats Diarrhea Weight loss Fatigue

Early symptomatic disease
CD4+ cell count drops below 500 cells/mcl Persistent, unexplained fevers Drenching night sweats Chronic diarrhea Headaches Fatigue Lymphadenopathy Recurrent or localized infections Neurological manifestations During the asymptomatic period, HIV is multiplying, infecting, and killing the CD4 T-cells of the immune system

Diagnostic Studies HIV antibody testing 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 Remember me mentioning you needed to know what these tests were?

All three tests are positive (ELISA x 2 and Western blot)
Diagnostic Studies Seropositive 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 So what does it mean? Seropositive means you’ve ben exposed to the HIV virus and have developed antibodies. It does not mean you’ve developed AIDS. Of course just because you have a seronegative test does not mean you are free of infection – what it means is IF you have the infection you have not converted to having antibodies yet. If you’ve been playing fast and loose you are still in the race for HIV and AIDS. See table 16 – pg 736 in your AHN book

Diagnostic Studies CD4+ lymphocyte count Normally 600-1200 mcl
Decreases as the disease progresses Best marker for the immunodeficiency associated with HIV infection Viral load monitoring Level of virus in the blood Provides significant information toward predicting the course of the disease Pg 747 AHN 6th ed

Therapeutic Management
Therapeutic management focus Monitoring HIV disease progression and immune function Preventing the development of opportunistic diseases Initiating and monitoring antiretroviral therapy Detecting and treating opportunistic diseases Managing symptoms Preventing complications of treatment Pg 749 AHN 6th ed. HIV today is a chronic illness. People are living for decades with the disease, and the number of older Americans with the disease is growing every year. People are living longer because we are detecting it earlier, have better medications to treat the opportunistic infections and to keep the viral load down significantly improving the longevity of the patients.

Pharmacological management Antiretroviral therapy Nucleoside Reverse Transcriptase Inhibitors: inhibit activity of reverse transcriptase Abacavir (Ziagen Didanosine (Videx): Lamivudine (Epivir) Stavudine (d4T, Zerit) Zidovudine (Retrovir, AZT) Zalcitabine (ddC, Hivid) Tenofivir (Viread) Abacavir: can cause nausea; monitor for hypersensitivity reaction Didanosine: can cause n/v, d, peripheral neuropathy, pancreatitis Lamivudine: causes N, nasal congestion Stavudine: peripheral neuropathy, pancreatitis Zidovudine: N?V, anemia, leukopenia, myopathy, HA, fatigue Zalcitibine: oral ulcers, peripheral neuropathy, pancreatitis

Pharmacological management Antiretroviral therapy Non-nucleoside reverse transcriptase inhibitors Nivirapine (Viramune) Delavirdine (Rescriptor) Elfavirenz (Sustiva) Niverapine-can cause rash, Steven’s Johson syndrome, hepatitis Increased transaminase level Delaviridine-can cause rash, liver function changes, pruritis Efavirenz-can cause rash, dizziness, confusion, difficulty concentrating, dreams, encephalopathy At some point people begin to ask if the cure is worse than the disease

Alternative and complementary therapies Massage Acupuncture Acupressure Biofeedback Nutritional supplements Herbal remedies Never underestimate the power of the mind. If you believe it hard enough your body will try to make it true, that’s why we have the placebo effect, where you can give a sugar pill t0 a patient who is convinced it is a narcotic and get the same side effects as if it were a real opioid. We do know that stress decreases the effectiveness of the immune system so there is also some VERY sound medical considerations for trying non western medicine.

Pulmonary Opportunistic Infections
Most common opportunistic diseases associated with HIV Pneumocystis carinii (now called jiroveci) pneumonia (PCP) -most common bacterial infection Accounts for 70% of opportunistic infections associated w/ advanced HIV disease “Found mostly in the Lungs” – But may be in adrenal glands, bone marrow, skin, thyroid, kidneys & spleen. Bactrim/Septra-sulfa drug-allergies Pentamidine (Pentam 300) IM, IV Can cause nephrotoxicity May cause hypotension Monitor for hypoglycemia Hepatotaoxic and immunosuppressive-LFT, CBC Fiberoptic bronchoscopy is procedure of choice for definitive dx Prophylaxis against PCP is a therapeutic necessity when cd4 count is 200 or less Opportunistic diseases are found on pg in boxes 16-5 and 16-6

Pulmonary Opportunistic Infections
Pneumocystis Carinii (jirovici) Symptoms Fever; night sweats; productive cough; SOB Treatment Bactrim or Septra; pentamidine; steroids Wear gown, mask, and gloves during patient care

Pulmonary Opportunisitc Infections
Histoplasmosis – fungal infection endemic in central, southern US Spores inhaled, original infection in lung Can be disseminated to other organs Symptoms: fever, night sweats, weight loss, dyspnea Education: Avoid areas where fungus is common: disturbed soils, chicken coops, caves; do not clean bird cages Fungus comes comes from bird droppings, dirt from chicken coops and caves Suspect if patient presents w/ FUO, cough and malaise DX is confirmed by culture of biopsy of bone marrow, blood, lymph nodes, lungs or skin Treat w/ Amphotericin B initially Nizoral can be used for maintenance therapy

Histoplasmosis Infection caused by the fungus – histoplasma capsulatum – How many Urban farmers do we have in Portland? I can think of 5 – 10 houses with chickens in my neighborhood Who’s life are we putting in danger with our chickens??

Pulmonary Opportunisitc Infections
Tuberculosis –bacterial-infection More likely if CD4 counts drop below 200 cells/mm3 Treated with INH (isoniazid), rifampin, pyrazimide Mycobacterium tuberculosis, an acid-fast aerobic bacterium Spread by airborne particles and enters the body by inhalation Clinical manifestation include fever, night sweats, cough and weight loss Dx is made by a combo of tests: skin, cultures, fluids, x-rays, and/or IVP INH-Adverse effects-skin rash, HA, vertigo, nausea, jaundice, peripheral neuritis Supplemental b6 (10mg qd) given to counter act effects neuropathy Rifampin AE- hepatotaxicity, thrombocytopenia, RF -may turn body secretions red-orange color may permanently discolor soft contact lenses monitor for jaundice PO 1h a or 2-3 p meals may reduce effectiveness of oral contraceptives Pyrazimide AE-hepatotoxicity, hyperurecemia

Gastrointestinal Opportunisitc Infections
Mycobacterium avium Complex –bacterial M. avium causative agent, found everywhere May affect any organ of body Symptoms: fever, fatigue, weight loss, night sweats, diarrhea, abd. pain Depending on organism Have you noticed how many of these opportunistic infections have the same S/S as HIV? Pg 751table 16-5

Gastrointestinal Opportunistic Infections
Cytomegalovirus (CMV) – viral Found in semen, cervical secretions, saliva, urine, blood, organs Transmitted through blood, body fluids through unprotected sex Complications of CMV for patients with AIDS include retinitis, radiculopathy, encephalitis, colitis, esophagitis, pneumonia Treatment: Gancyclovir, Foscarnet ******Cytomegalovirus (CMV) – viral ++++********** Retinitis-decreased visual acuity, floaters—may lead to blindness-eye exa for diagnosis Radiculopathy-spinal cord syndrome-LE weakness, spasticity, arreflexia-diagnosis CSF cultur Encephalitis-mental changes, somnolence, HA diagnosis-brain bx Esophagitis-painful swallowing-scope Pneumonia-DOE, dry non productive cough-xray, sputum cultures Colitis-diarrhea, weight loss, fever=scope-ulcerated colon *********Gancyclovir(Cytovene)********-tx CMV retinitis PO or IV Supresses bone marrow-monitor ANC, plt count With food Foscarnet- (Foscavir)-CMV retinitis IV Nephrotoxic-monitor renal function

Gastrointestinal Opportunistic Infections
Cryptosporidosis –parasitic - infection Fairly common in environment Special threat when CD4 count falls below 200 cell/mm3 Symptoms: watery diarrhea that may be severe, persistent dehydration, electrolyte imbalance Treatment: maintain F/E balance, treat infection, good hygiene, avoid ingestion of contaminated water

Oral Opportunistic Infections
Oral/esophageal candidiasis - fungal Caused by Candida albicans, found in most soils, foods Approx 80% HIV pts. will develop Symptoms: whitish yellow patches in mouth, esophagus, GI tract, vagina, anus Treatment: Nystatin, chlortrimezole, ketoconazole, fluconazole, itraconazole, amphotericin B If oral thrush and not on antibx or chemo, pt should be tested for HIV Reappears often-monitor for reinfection ********Candidiasis - Caused by Candida albicans, found in most soils, foods ***** ******Treatment: Nystatin, chlortrimezole, ketoconazole, fluconazole, itraconazole, amphotericin B ********

Oral Candidiasis Pg 746 AHN 6th ed.

Oral Hairy Leukoplakia
Oral Hairy Leukoplakia (OHL) viral Associated with Epstein-Barr virus, more common among smokers Thick white patches on buccal mucosa, soft palate, floor of mouth, tongue Plaques cannot be scraped off (unlike candida) Often painful-ice cream, popsicles to numb area

Gynecological Opportunisitc Infections
Vaginal candidiasis - fungal Persistent infection - can be early indicator of HIV Cervical intraepithelial neoplasia - cancer

CNS Opportunistic Infections
AIDS dementia complex Triad of cognitive, motor and behavioral dysfunction, progressive Zidovidine may help This is found in the advanced stages of AIDS HIV can cause real problems for the human central nervous system because it has the ability to cross the blood-brain barrier and gain direct contact with your brain and spinal cord tissues. Researchers are still working to discover just what HIV does to injure your central nervous system, but we know that the virus itself can damage your ability to think (your “cognitive” ability) and to function in everyday life. When that happens, healthcare providers refer to the condition as “HIV-associated dementia” or AIDS dementia complex (ADC). If you are HIV-positive, ADC is considered an AIDS-defining condition. In the early days of the HIV/AIDS epidemic in the U.S., between 40–60% of people living with HIV/AIDS experienced some type of ADC. But since antiretroviral therapy became available, the incidence of ADC has dropped significantly. Most of the time, HIV-related cognitive issues are associated with advanced HIV disease and low CD4 counts (less than 200 cells/mm3). Taking HIV medications may prevent or delay the onset of ADC—and they may also improve your mental function if you already have symptoms of ADC. Retrieved 08/12/2014 from AIDS.Gov at

CNS Opportunistic Infection
Toxoplasmosis parasitic Caused by Toxoplasma gondii; cats, mammals, birds are host agents Humans infected by ingesting contaminated undercooked meat, vegetables; contact with cat feces Can affect any tissue in body, but mostly brain, lungs, eyes In HIV, encephalitis most common form *****Toxoplasmosis parasitic*****

CNS Opportunistic Infections
Toxoplasmosis Symptoms include dull constant HA, weakness, seizures, altered LOC, hemiparesis, tremor, visual field defects, photophobia Bactrim used to tx. Education: wash hands, avoid undercooked, raw meat, avoid cat litter boxes

CNS Opportunisitc Infection
Cryptococcosis fungal Causative agent Coccidiodes immitis; endemic in SW US and N Mexico Most common systemic fungal infection in AIDS patients Symptoms appear ~ 30 d after exposure fever, HA, malaise, N/V, altered LOC, stiff neck Treated with Amphotericin B+5 flucytosine, fluconazole, itraconzole IV Nephrotoxic Can cause thrombophlebitis Supresses bone marrow function-CBC Monitor infusion site Fluconazole(Diflucan)-candidiasis PO Hepatotoxic-LFT Monitor for abd pain, fever, diarrhea

Opportunistic Malignancies
*****Kaposi’s sarcoma (KS)***** Thought to be caused by sexual transmission of human herpes virus 8 Affects skin first-macular, painless, nonpruritic lesion Varies in color-pink, red, purple, brown Symptoms develop when spreads to GI tract (bleeding), lungs (hypoxia) Image URL:

Kaposi’s sarcoma Diagnosed by appearance, biopsy No cure, treatment is palliative Treatment: observation, surgical removal, cryotherapy, radiotherapy, chemotherapy Tumor growth varies from pt to pt Regardless of therapy, KS tends to reccur For pts with cutaneous KS, report blood in stools or abd pain Pg 185, 298, 734, AHN 6th ed.

Kaposi’s Sarcoma

Lymphomas Immunodeficient patients have 14x greater risk of getting lymphomas Non-Hodgkin’s lymphoma (NHL) second most common malignancy in pts with AIDS Symptoms: vague, include fever, night sweats, weight loss. A fever longer than 2 weeks suggests lymphoma *****Lymphomas***** Pg AHN 6th ed ***Non-Hodgkin’s lymphoma (NHL) second most common malignancy in pts with AIDS*****

Non-Hodgkin’s lymphoma Diagnosis based on biopsy of lymphoid tissue Survival rates: CD4 higher than 100 cells/mm months CD4 less than 100 cells/mm months CNS affected-2 months Image – non hodgkin’s lymphoma under chin: Image – non hodgkin’s lymphoma chest: Image – non hodgkin’s lymphoma inside neck:

Nursing Interventions
Patients need to be treated in a nonjudgmental and caring manner regardless of their sexual practices or history of drug use Must see the patient as a unique individual with a need to be cared for with compassion, consideration, and dignity

Knowledge of HIV transmission and competence in standard precautions and body substance isolation See Box 16-4 p. 758 of AHN text re: subjective and objective data of the Nursing Assessment for the pt. with HIV infection See Box 16-5 p. 760 for a summary of Nursing Interventions for the pt. with HIV infection or HIV Disease ****Know the interventions and assessments*****

Adherence Adhering to a prescribed regimen is of paramount importance to survival and the success of treatment Nurse can help pts. adapt and maintain vigilance with their treatment Antiretroviral tx. is life-long and complex The nurse becomes the cheering squad. Its getting really tiring of ALWAYS doing the right thing even when the wrong thing is going to kill you. See table pg 761

Palliative care The active, total care of patients whose disease is not responsive to curative treatment The goal of palliative care is to address physical, psychological, social, spiritual, and existential needs of patients with progressive, life-threatening illnesses, with the overall goal of improving quality of life. Survival times have greatly lengthened since this disease was first Dx but it still has a negative prognosis. Any nurse involved in this care group must learn to deal with the inevitable death of their patients. Before they go on hospice they will or should become part of the palliative care community. What’s the difference between Hospice and Palliative care?

Psychosocial issues Uncertainty Isolation Fear Depression Limited financial resources Pg 763 The nurse needs to assist the pt in grieving, minimize social isolation, and assist with coping – this can be done through support groups, counseling, listening and letting the ventilate while being nonjudgmental. Image URL:

Assisting with coping Educate about HIV Encourage patients to participate in their own care Encourage patients to face life a day at a time; live each day to the fullest Listen Maintain sources of psychological support

Reducing anxiety Clarification and education about HIV and AIDS Include patient and support person in planning care Encourage talking about feelings or relaxation and meditation Assess for suicidal ideation Support groups

Minimize social isolation Social stigma Based on the patients association with homosexuality, drug use, and sexual transmission Sharing diagnosis with others Need to choose carefully Support groups Patients Significant others

Assisting with grieving Listening Explore feelings, fears, and treatment options Significant others and family members May experience fear, anger, embarrassment, and shame Most people underestimate the power of being listened to. Listening can be the most beneficial thing a nurse can do for a grieving or dying patient. See pg 764 Box 16-7

Confidentiality Diagnosis should be carefully protected Need-to-know basis Not every health care worker needs to know diagnosis Universal precautions should be used with every patient If you are using universal precautions for every patient no one can point the finger at anyone or have cause to speculate what the Dx is.

Nursing and the History of HIV
Currently, a broad spectrum of individuals, from children to adults, and crossing all socioeconomic strata, are affected by this disorder.

Duty to treat Health care 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 You might be asked to volunteer to treat an Ebola patient but in the US you MUST treat all others regardless of their Dx. It is the only ethical thing to do. See pg 763 AHN 6th ed.

Acute interventions 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 Encourage your patient to embrace a healthy life style. As was said before HIV and AIDS patients are living for decades today. Encourge them to be healthy enough to enjoy the time they have. Pg 766, box 16-11, 768 box AHN 6th ed.

Later interventions 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 Pg 766 box AHN 6th ed.

Prevention of HIV Infection
Education Best means of prevention Counsel about HIV testing, behaviors that put people at risk, and how to reduce or eliminate those risks Nurse must be able to discuss behaviors Pg 755, 759 Box 16-9, and 764 box 16-7 AHN 6th ed.

Harm-reduction education is a fundamental element of HIV prevention methods Harm-reduction education focuses on minimizing the personal and social harms and costs associated with high risk behaviors and activities

HIV testing and counseling Pre- and post-test counseling must be done 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 Pg 748 box 16-3

Risk assessment and risk reduction Minimum risk assessment – Basic questions 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

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

Decreasing risks related to sexual transmission Eliminate the risk of exposure to HIV through semen and cervicovaginal secretions Abstaining from all sexual activity is most effective Limit sexual behavior in which the mouth, penis, vagina, or rectum come into contact with the same in your partner Safest: mutually monogamous relationship with a partner who is not HIV infected or at risk for 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

Decreasing risks of occupational exposure Risk is very low Hand washing 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, 6 months, and 12 months

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

Caregiver role strain, risk for
Nursing Process Nursing diagnoses Infection, risk for Caregiver role strain, risk for Altered nutrition, less than body requirements Diarrhea Pg 758

HIV/AIDS where we are today
Progressively fatal disease that destroys the immune system and body’s ability to fight infection By the end of ,000,000 people worldwide were living w/ AIDS In the US the CDC estimates that today 1,144,500 persons aged 13 years and older are living with HIV infection, including 180,900 (15.8%) who are unaware of their infection1. Over the past decade, the number of people living with HIV has increased, while the annual number of new HIV infections has remained relatively stable.

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