Care of Patients with HIV Disease
and Other Immune Deficiencies
Chapter
21
Mrs. Kreisel MSN, RN
NU130 Adult Health
Summer 2011
Acquired Immune Deficiency
Syndrome
• The most common secondary
immunogenicity disease in the world
• Identified in 1981
• Serious worldwide epidemic
Prevalence of HIV Infection by Country
HIV Infectious Process
Life Cycle
of HIV
Effects of HIV Infection
• Everyone who has AIDS has HIV infection.
However, not everyone who has HIV
infection has AIDS.
• The distinction rests with the number of
CD4+ T-cells the patient has and whether
any opportunistic infections have occurred.
Virus Infection
HIV Classification
• Clinical categories:
• Clinical category A (HIV positive)
• Clinical category B (HIV and
opportunistic infection)
• Clinical category Co (AIDS)
• SEE PAGE 365
Health Promotion and
Maintenance
• Education is the best hope for prevention.
• HIV is transmitted most often in three
ways:
• Sexual
• Parenteral
• Perinatal
• BLOOD, SEMEN, VAGINAL FLUID
Transmission and Health Care
Workers
• Needle stick or “sharps” injuries are the
primary means of HIV infection for health
care workers.
• Workers can also be infected through
exposure of nonintact skin and mucous
membranes to blood and body fluids.
• The best prevention for health care
providers is the consistent use of Standard
Precautions for all patients as
recommended by the CDC.
Collaborative Management
• Assessment
• History
• Physical assessment and clinical
manifestations:
• Infections—opportunistic, protozoal,
fungal, bacterial, viral
• Malignancies—Kaposi’s sarcoma,
malignant lymphomas
• Endocrine complications
Other Clinical Manifestations
•
•
•
•
AIDS dementia complex
AIDS wasting syndrome
Skin changes
Dysphagia: Increase protein and
calories
Laboratory Assessment
•
•
•
•
Lymphocyte counts
CD4+ T-cells and CD+ T-cells
Antibody tests
Enzyme-linked immunosorbent assay
(ELISA)
• Western blot, viral load
• Quantitative RNA assays
• Others
Drug Therapy
• Nucleoside analog reverse transcriptase
inhibitors
• Non-nucleoside reverse transcriptase
inhibitors
• Protease inhibitors
• Fusion inhibitors
• Entry inhibitors
• Integrase inhibitors
• Immune enhancement
Nursing Diagnoses
• Pain
• Imbalanced Nutrition: Less Than Body
Requirements
• Diarrhea
• Impaired Skin Integrity
• Disturbed Thought Processes
• Chronic Low Self-Esteem
• Social Isolation
Community-Based Care
•
•
•
•
Home care management
Health teaching
Psychosocial preparation
Health care resources
Therapy-Induced Immune
Deficiencies
• Drug-induced immune deficiencies
• Radiation-induced immune deficiencies
Other Immune Deficiencies
• Congenital (primary) immune deficiencies
• Avoid breast feeding
• Bruton’s agammaglobulinemia
• Common variable immune deficiency
• Selective immunoglobulin A deficiency
•NCLEX TIME
Question 1
What percentage of new HIV infections are
reported to
occur in minorities in the United States?
A.
B.
C.
D.
More than 28%
More than 42%
More than 57%
More than 72%
Question 2
Which group has the highest percentage of
AIDS cases
in North America?
A. Men or women who use injection drugs
B. Newborns of mothers who are HIV
positive
C. Men who have had sex with other men
D. Women who have had sex with other
women
Question 3
When reviewing the chart of a patient with newly
diagnosed AIDS,
the nurse recalls that the most common opportunistic
infection in
persons infected with HIV is:
A. Tuberculosis (TB), caused by Mycobacterium
tuberculosis
B. Pneumocystis jiroveci pneumonia (PJP)
C. Cytomegalovirus (CMV), causing CMV retinitis
D. Toxoplasmosis encephalitis, caused by
Toxoplasma gondii
Question 4
When teaching a patient with AIDS about drug
therapy, the nurse
emphasizes that the drugs must be taken exactly as
prescribed,
without missing doses. The reason for this is:
A.
B.
C.
D.
Missed doses can promote drug resistance,
lowering the effectiveness of the drugs.
Missed doses allow for the development of
opportunistic infections.
An increased chance of allergic reaction to the
drug may occur.
Viral replication decreases when doses are
missed.
Question 5
A patient is fearful that he has been infected
with HIV.
The nurse recognizes that the first
manifestations of
HIV infection is/are:
A. Opportunistic infections
B. Fever, night sweats, and muscle aches
C. Lymphocytopenia (decreased
lymphocyte count)
D. Reduced numbers of CD4+ T-cells