COMPLEX PROBLEMS OF IMMUNITY & INFECTION (Part 1)
Exemplars: HIV/AIDS, Hepatitis
Course: NURS 231
Course Outcomes: 2, 3, 4
Evaluation: Exam 3 &
Final
1. Define and describe the concept of immunity.
a. Define: biological process that allows the body to resist/defend against harmful
substances such as pathogens, toxins, and other foreign substances.
b. Describe: A complex system that involves various cells, tissues, and molecules
working together to protect the body from diseases.
-Innate immunity, also known as natural or non-specific immunity, is our
body's first line of defense. It is present from birth and provides immediate
protection against a wide range of pathogens. Innate immunity includes physical
barriers (such as the skin and mucous membranes), chemical barriers (such as
stomach acid), and various immune cells (such as neutrophils and macrophages)
that can recognize and eliminate pathogens.
-Adaptive immunity, also known as acquired or specific immunity, develops
over time as a response to exposure to specific pathogens. It is more specialized
and targeted than innate immunity. Adaptive immunity involves the activation and
coordination of specific immune cells (such as B cells and T cells) that can
recognize and remember specific pathogens or harmful substances. This type of
immunity provides long-term protection and is responsible for the creation of
immune memory, allowing the body to respond more quickly and efficiently upon
future encounters with the same pathogen.
2. Notice risk factors for impaired immune function.
a. Age
b. Chronic Diseases
c. Poor Nutrition
d. Lack of sleep
e. Stress
f. Smoking/Alcohol
g. Sedentary lifestyle.
3. Recognize when an individual has altered immunity.
a. Frequent infections
b. Delayed healing
c. Allergies
d. Chronic fatigue
e. Autoimmune disorders
f. Poor growth/development
g. Blood disorders
4. Provide appropriate nurse and collaborative interventions to support optimal
immunity.
a.
b.
c.
d.
e.
f.
Health Education
Immunizations
Infection Prevention
Chronic Disease Management
Stress Management
Collaboration with Interdisciplinary Team
5. Define and describe the concept of infection.
a. Define: invasion/multiplication of harmful microorganisms in the body that can
cause illness and disrupt the normal functions of tissues and organs
b. Describe: classified as localized (specific area), systemic (throughout the whole
body), and healthcare-associated (acquired during hospitalization)
6. Notice the risk factors for infection.
a. Weakened immune system.
b. Age
c. Chronic medical conditions
d. Surgical procedures
e. Invasive medical devices
f. Environmental exposure
7. Recognize when an individual has an infection.
a. Fever greater than 100.4 F
b. Pain/Inflammation
c. Fatigue/Malaise
d. Change in vital signs
e. Respiratory symptoms
f. Skin changes
g. Urinary issues
h. GI issues
8. Provide appropriate nursing and collaborative interventions to eliminate
infection.
a. Hand hygiene: Practicing proper hand hygiene is crucial in preventing the
spread of infections. Healthcare workers should wash their hands with soap and
water or use alcohol-based hand sanitizers before and after patient contact.
b. Personal Protective Equipment (PPE): Healthcare workers should wear
appropriate PPE, such as gloves, masks, gowns, and eye protection, when
providing care to patients with known or suspected infections.
c. Environmental cleaning: Regularly cleaning and disinfecting surfaces and
equipment in healthcare settings is essential to prevent the spread of infections.
Follow the recommended cleaning protocols and use appropriate disinfectants.
d. Isolation precautions: Implementing isolation precautions, such as contact,
droplet, or airborne precautions, depending on the type of infection, can help
minimize the transmission of infectious agents.
e. Vaccinations: Ensuring healthcare workers and patients are up to date with
vaccinations, such as influenza and hepatitis B vaccines, can reduce the risk of
infections.
f. Antibiotic stewardship: Promoting appropriate use of antibiotics can help
prevent the development of antibiotic resistance. Healthcare providers should
follow guidelines for antibiotic prescribing and educate patients on the proper use
of antibiotics.
1. Explain the pathophysiology of HIV and AIDS.
a. Patho: A virus that attacks the immune system, specifically targeting CD4+ T
cells, which are a type of white blood cell. Once inside the body, HIV replicates
itself and gradually destroys these CD4+ T cells, weakening the immune
system's ability to fight off infections and diseases. The pathophysiology of HIV
involves various stages:
b. Transmission: HIV is transmitted through contact with infected bodily fluids,
such as blood, semen, vaginal fluids, or breast milk. The most common modes of
transmission are through unprotected sexual contact, sharing needles or
syringes, or from an HIV-positive mother to her child during childbirth,
breastfeeding, or pregnancy.
c. Acute Infection: After exposure to HIV, an individual may experience flu-like
symptoms within 2 to 4 weeks. This stage is called acute HIV infection. During
this phase, the virus rapidly replicates, and the immune system responds by
producing antibodies. However, the virus can still continue to spread and
damage immune cells.
d. Clinical Latency Stage: Following the acute infection stage, individuals often
enter a period of clinical latency, also known as chronic HIV infection or
asymptomatic HIV infection. During this phase, the virus remains active but at a
much lower level, and the individual may not experience any symptoms.
However, HIV is still replicating and slowly damaging the immune system.
e. AIDS: Without treatment, HIV eventually progresses to Acquired
Immunodeficiency Syndrome (AIDS). This occurs when the immune system
becomes severely compromised, and the CD4+ T cell count falls below a specific
threshold. At this stage, the individual is highly susceptible to opportunistic
infections, such as pneumonia, tuberculosis, or certain cancers. These conditions
can be life-threatening.
2. Identify the risk for/causes of HIV/AIDS, including the HIV infectious process
and its progression.
Risks/Causes
a. Unprotected sex
b. Sharing needles
c. Mother-to-child transmission
d. Blood transfusions
Process/Progression
a. Acute HIV infection: initial stage of infection, occurs w/in a few weeks after
exposure. Symptoms may appear flu-like in nature (fever, fatigue swollen lymph
nodes, sore throat, and rash)
b. Clinical Latency: virus multiplies at lower level (may be asymptomatic) and
slowly damages the immune system.
c. AIDs: advanced stage of HIV. The immune system is severely damaged, leaving
the infected individual open to life-threating opportunistic infections/cancers.
3. Understand and identify the classification of HIV.
a. HIV-1: This is the most common and widespread type of HIV. It is responsible for
the majority of HIV infections worldwide. HIV-1 is further classified into various
groups, subtypes, and circulating recombinant forms (CRFs). These
classifications are based on the genetic variations of the virus.
- Group M: This is the most prevalent group of HIV-1 and is responsible for the
global pandemic. It is further divided into subtypes (A, B, C, D, etc.) and CRFs
(CRF01_AE, CRF02_AG, etc.). Subtype B is mostly found in Western countries,
while subtypes A, C, and D are more common in sub-Saharan Africa.
- Group O: This is a less common group of HIV-1 and is mainly found in West
and Central Africa. Group O infections have a different genetic composition than
Group M.
- Group N: This is an extremely rare group of HIV-1 that has been identified in a
few individuals in Cameroon.
b. HIV-2: This type of HIV is less common and mainly found in West Africa,
although cases have been reported in other parts of the world. HIV-2 is typically
less virulent and progresses more slowly than HIV-1. However, it can still lead to
AIDS and cause similar complications.
- HIV-2 is further classified into different subtypes (A, B, etc.) and has CRFs,
although they are less common than in HIV-1.
4. Discuss health promotion and maintenance of HIV/AIDS, including HIV status
and sexual transmission.
a. HIV Status Awareness: Promoting HIV testing and awareness is crucial for
early detection and managing the spread of the virus. Encouraging routine HIV
testing, particularly for high-risk individuals, helps identify those who are HIVpositive and link them to care and treatment services.
b. Prevention of Sexual Transmission: Sexual transmission is the most common
mode of HIV transmission. Health promotion efforts aim to reduce the risk of
sexual transmission through various approaches:
- Safe Sex Practices: Promoting the consistent and correct use of condoms
during sexual activity reduces the risk of transmission. Providing education on
condom use and availability is essential.
- Pre-Exposure Prophylaxis (PrEP): PrEP involves taking antiretroviral
medication before engaging in sexual activity to prevent HIV transmission.
Promoting PrEP as an additional prevention method can be effective, especially
for individuals at high risk.
- Partner Reduction and Monogamy: Encouraging individuals to limit their
number of sexual partners and practice monogamy can reduce the risk of HIV
transmission.
c. Health Maintenance for People Living with HIV/AIDS: Health promotion efforts
also focus on supporting the overall well-being and quality of life for individuals
living with HIV/AIDS. This includes:
- Antiretroviral Therapy (ART): Promoting adherence to ART is crucial for
managing HIV infection. Educating individuals about the importance of taking
medications as prescribed and providing support services to overcome barriers
to adherence can help maintain viral suppression and improve health outcomes.
- Regular Medical Care: Encouraging people living with HIV/AIDS to engage in
regular medical care and follow-up appointments with healthcare providers helps
monitor their health, manage potential complications, and address any emerging
concerns.
- Supportive Services: Providing access to mental health services, substance
abuse treatment, support groups, and social services can contribute to overall
health maintenance and well-being.
- Prevention of Opportunistic Infections: Promoting vaccinations and
strategies to prevent opportunistic infections is essential for individuals with
compromised immune systems due to HIV.
5. Compare and contrast pre-exposure prophylaxis and postexposure
prophylaxis.
a. Definition and Purpose
- PrEP: PrEP involves taking antiretroviral medication (typically a combination pill
of tenofovir disoproxil fumarate and emtricitabine) on a daily basis to prevent HIV
infection in individuals who are at high risk but are HIV-negative.
- PEP: PEP is a time-limited course of antiretroviral medication taken after a
potential exposure to HIV to prevent infection. PEP is typically prescribed for
individuals who have recently experienced a high-risk exposure, such as
unprotected sex or needle sharing with someone known or suspected to have
HIV.
b. Timing of Use
- PrEP: PrEP is taken on an ongoing basis, ideally before potential exposure to
HIV. It provides protection against HIV infection when taken consistently every
day.
- PEP: PEP must be started within a specific timeframe after a potential
exposure, ideally within 72 hours but can still be prescribed up to 72 hours after
the exposure. The treatment generally lasts for 28 days.
c. Effectiveness
- PrEP: When taken consistently and correctly, PrEP has been shown to be
highly effective in preventing HIV infection. Studies have demonstrated its
effectiveness in reducing the risk of acquiring HIV by more than 90%.
- PEP: PEP is also effective in preventing HIV infection; however, its
effectiveness decreases the longer the delay in starting treatment. Prompt
initiation of PEP after a potential exposure is crucial to maximize its
effectiveness.
d. Usage Population
- PrEP: PrEP is recommended for individuals who are at high risk of acquiring
HIV, such as individuals with HIV-positive partners, individuals engaging in
unprotected sex, individuals who inject drugs, and those who have recently
completed PEP.
- PEP: PEP is recommended for individuals who have recently experienced a
high-risk exposure to HIV, such as unprotected sex, needle-sharing, or
occupational exposure (e.g., healthcare workers).
5. Duration of Use
- PrEP: PrEP is intended for long-term use as a preventive measure against HIV
infection. It should be continued as long as the individual remains at high risk of
exposure.
- PEP: PEP is a short-term treatment course typically lasting for 28 days. It is not
intended for ongoing or continuous use.
6. Discuss parenteral transmission, perinatal transmission, and health care
worker transmission.
a. Parenteral Transmission
Parenteral transmission refers to the transmission of infectious agents through
the penetration of the skin and mucous membranes via routes other than the
digestive or respiratory systems. Some key modes of parenteral transmission
include:
- Needlestick Injuries: Healthcare workers can be at risk for parenteral
transmission when they are accidentally stuck with contaminated needles or
sharp instruments, potentially exposing themselves to bloodborne pathogens
such as HIV, hepatitis B, and hepatitis C.
- Intravenous Drug Use: The sharing of contaminated needles among
intravenous drug users can also lead to parenteral transmission of bloodborne
infections.
- Medical Procedures: Inadequately sterilized or contaminated medical
equipment, such as needles, syringes, or surgical instruments, can transmit
infections through parenteral routes if proper infection control practices are not
followed.
b. Perinatal Transmission
Perinatal transmission, also known as vertical or mother-to-child transmission,
occurs when a pregnant woman with an infectious disease passes the infection
to her baby during pregnancy, childbirth, or breastfeeding. Key examples include:
- Human Immunodeficiency Virus (HIV): Without appropriate interventions, an
HIV-positive mother can transmit the virus to her child during pregnancy, labor
and delivery, or breastfeeding.
- Hepatitis B Virus (HBV): HBV can be transmitted from an infected mother to
her newborn during childbirth if the baby encounters the mother's blood or body
fluids.
c. Healthcare Worker Transmission
Healthcare worker transmission refers to the transmission of infectious agents
from healthcare personnel to patients or other healthcare workers. Inadequate
adherence to infection control practices can increase the risk of healthcare
worker transmission. Examples include:
- Hand Hygiene: Poor hand hygiene practices can contribute to the transmission
of various healthcare-associated infections, including multidrug-resistant
organisms.
- Improper Use of Personal Protective Equipment (PPE): Failure to use
appropriate PPE, such as gloves, masks, or gowns, when needed can increase
the risk of transmission.
- Asymptomatic Carriers: Healthcare workers who are asymptomatic carriers of
infectious agents but unaware of their status can unintentionally transmit
infections to patients or other healthcare workers
7. Identify the clinical manifestations of HIV/AIDS.
a. Acute Retroviral Syndrome
- Within a few weeks of contracting HIV, some individuals may experience flu-like
symptoms, including fever, headache, fatigue, muscle aches, and swollen lymph
nodes. These symptoms typically last for a few weeks.
b. Asymptomatic Stage
- After the initial acute infection, the virus may enter a phase of clinical latency
where there are no apparent symptoms. This stage can last for several years,
during which the virus continues to replicate and progressively damages the
immune system.
c. Symptomatic HIV Infection
- As the immune system becomes compromised, individuals may start
experiencing symptoms such as persistent fatigue, recurrent fevers, night
sweats, unexplained weight loss, and frequent infections (e.g., respiratory,
skin, or urinary tract infections).
- Oral manifestations: Individuals with HIV/AIDS may develop oral lesions
such as candidiasis (thrush), oral hairy leukoplakia, or painful ulcers.
- Neurological symptoms: HIV can affect the central nervous system, leading
to symptoms like confusion, memory loss, difficulty concentrating, and even
peripheral neuropathy.
- Gastrointestinal issues: Individuals may experience diarrhea, nausea,
vomiting, abdominal pain, and malabsorption.
d. AIDS
- Without treatment, HIV infection can progress to Acquired Immunodeficiency
Syndrome (AIDS). At this stage, the immune system is severely damaged, and
individuals become susceptible to opportunistic infections and certain cancers.
Common AIDS-defining illnesses include Pneumocystis pneumonia, Kaposi's
sarcoma, and Tuberculosis.
8. Prioritize assessment needs for patients with HIV/AIDS.
a. Medical History
- Obtain a comprehensive medical history, including the duration of HIV infection,
previous opportunistic infections, or complications, and previous or current
antiretroviral therapy (ART).
- Ask about any current symptoms and their duration, such as fever, fatigue,
weight loss, respiratory or gastrointestinal symptoms, or neurological changes.
b. Immune Function Assessment
- Assess the CD4+ T-cell count and viral load through laboratory tests to
determine the level of immune suppression and the efficacy of antiretroviral
therapy.
- Review previous CD4+ T-cell counts and trends to evaluate disease
progression.
c. Opportunistic Infections and Complications
- Assess for any signs or symptoms of opportunistic infections, such as
respiratory (e.g., cough, shortness of breath), gastrointestinal (e.g., diarrhea,
abdominal pain), dermatological (e.g., skin lesions), or neurological (e.g.,
cognitive changes, neuropathy) symptoms.
- Evaluate the presence of AIDS-defining illnesses, such as Pneumocystis
pneumonia, Kaposi's sarcoma, Tuberculosis, or other infections like
cytomegalovirus or cryptococcal meningitis.
d. Psychosocial Assessment
- Evaluate the patient's social support system, mental health status, and any
ongoing stressors or psychosocial issues.
- Assess for depression, anxiety, substance abuse, or other mental health
concerns that may impact their overall well-being and ability to adhere to
treatment.
e. Sexual and Reproductive Health
- Assess the patient's sexual history, including the presence of any sexually
transmitted infections (STIs) and the use of barrier methods for safer sex
practices.
- Discuss family planning and reproductive health, including the prevention of
mother-to-child transmission of HIV.
f. Medication Adherence and Side Effects:
- Inquire about the patient's adherence to antiretroviral therapy (ART) and any
challenges they may face in taking medications consistently.
- Discuss any reported side effects and their impact on the patient's daily
activities and quality of life.
g. Education and Support Needs
- Assess the patient's knowledge and understanding of HIV/AIDS, including
transmission, prevention, and the importance of adherence to medications.
- Identify any educational or support needs, such as connecting the patient to
HIV/AIDS support groups, counseling services, or resources for financial
assistance.
9. Explain the identifying factors of HIV/AIDS related opportunistic infections.
a. CD4+ T-cell Count: The CD4+ T-cell count is a crucial indicator of immune
function in individuals with HIV/AIDS. Opportunistic infections are more likely to
occur when the CD4+ T-cell count drops below a certain threshold (usually <200
cells/mm). Monitoring the CD4+ T-cell count helps identify individuals at a higher
risk of opportunistic infections.
b. Viral Load: The viral load refers to the amount of HIV present in a person's
blood. Higher viral loads indicate more active HIV replication, which can lead to
increased immune system damage and a higher risk of opportunistic infections.
c. Presence of AIDS-Defining Illnesses: Certain infections and diseases are
considered AIDS-defining illnesses. These include Pneumocystis pneumonia,
Kaposi's sarcoma, Cryptococcal meningitis, Tuberculosis, and several others. If a
person with HIV/AIDS presents with any of these illnesses, it is a clear indication
of advanced immunosuppression and a need for appropriate management and
treatment.
d. Symptomatology: Specific symptoms may point to the likelihood of an
opportunistic infection in individuals with HIV/AIDS. These symptoms can vary
depending on the type of infection but may include prolonged fever, weight loss,
persistent cough, shortness of breath, chronic diarrhea, skin rashes/lesions, oral
thrush, or neurological symptoms.
e. Prophylaxis and Vaccination History: Individuals with HIV/AIDS may receive
prophylactic treatment to prevent certain opportunistic infections. Inquiring about
the patient's history of prophylaxis, such as cotrimoxazole for Pneumocystis
pneumonia, antiretroviral therapy (ART), or vaccinations for conditions like
influenza or hepatitis B, can provide insight into their level of protection against
opportunistic infections.
10. Identify and explain endocrine complications, cardiovascular complications,
and other complications for patients with HIV/AIDS.
a. Endocrine Complications
- Diabetes: HIV/AIDS patients have an increased risk of developing diabetes,
which can be a result of the virus's direct effect on insulin-producing cells or
due to the side effects of antiretroviral therapy (ART).
- Adrenal insufficiency: This condition occurs when the adrenal glands do
not produce enough hormones. HIV/AIDS can affect the adrenal glands,
leading to adrenal insufficiency.
- Thyroid abnormalities: HIV/AIDS can cause thyroid dysfunction, resulting
in either an overactive or underactive thyroid gland.
b. Cardiovascular Complications
- Coronary artery disease: HIV/AIDS patients are at a higher risk of
developing heart disease, including coronary artery disease. This can be due
to chronic inflammation, lifestyle factors, or side effects of medications.
- Myocardial infarction (heart attack): People with HIV/AIDS have an
increased risk of heart attacks, which can be attributed to inflammation, HIVrelated medication, or other associated risk factors.
- Heart failure: HIV/AIDS can lead to heart failure, where the heart's ability to
pump blood efficiently is compromised. This can occur due to direct damage
to the heart muscle or as a result of other complications like infections, drug
toxicity, or high blood pressure.
c. Other Complications
- Neurological complications: HIV/AIDS can affect the central nervous
system, leading to conditions like HIV-associated neurocognitive disorders
(HAND), peripheral neuropathy, or meningitis.
- Kidney disease: HIV/AIDS can cause kidney damage, leading to conditions
such as HIV-associated nephropathy or chronic kidney disease.
- Opportunistic infections: Patients with HIV/AIDS have weakened immune
systems, making them susceptible to opportunistic infections like pneumonia,
tuberculosis, or certain fungal infections.
- Cancer: HIV/AIDS patients have a higher risk of developing certain types of
cancer, such as Kaposi's sarcoma, non-Hodgkin lymphoma, or cervical
cancer.
11. Analyze significance of laboratory results in patients with HIV/AIDS.
a. CD4+ T-cell count: CD4+ T-cells are a type of white blood cells that help the
immune system fight off infections. Monitoring CD4+ T-cell count is essential as it
indicates the health of the immune system and helps determine the stage of HIV
infection. A lower CD4+ count suggests a weakened immune system and a
higher risk for opportunistic infections.
b. Viral load: The viral load test measures the amount of HIV present in the blood.
It provides valuable information about the effectiveness of antiretroviral therapy
(ART) and helps gauge the progression of the infection. A low or undetectable
viral load indicates successful suppression of the virus and reduces the risk of
transmission.
c. Resistance testing: Resistance testing is performed to identify any mutations or
changes in the HIV virus that may render it resistant to certain antiretroviral
drugs. This helps guide the selection of appropriate ART regimens for individual
patients, ensuring optimal treatment outcomes.
d. Complete blood count (CBC): CBC measures the levels of various blood
components, such as red blood cells, white blood cells, and platelets. It helps
identify anemia, infections, and potential side effects of medications.
e. Liver function tests: HIV/AIDS and certain antiretroviral drugs can affect liver
function. Monitoring liver enzyme levels, such as ALT and AST, can help detect
any liver inflammation or damage.
f. Kidney function tests: Renal function tests, including creatinine and estimated
glomerular filtration rate (eGFR), assess kidney function. HIV/AIDS and some
medications can cause kidney damage, so regular monitoring is important.
g. STD screening: HIV/AIDS patients are at a higher risk of acquiring sexually
transmitted infections (STIs). Regular screening for STIs like syphilis, gonorrhea,
and chlamydia helps ensure early detection and appropriate treatment.
h. Tuberculosis (TB) screening: HIV/AIDS patients are also more susceptible to
tuberculosis. TB screening, such as a tuberculin skin test or interferon-gamma
release assay, helps detect latent or active TB infection.
12. Develop a patient-centered plan of care for patients with HIV/AIDS, including
preventing infection, enhancing gas exchange, managing pain, enhancing
nutrition, managing diarrhea, and restoring skin integrity.
a. Preventing infection
- Educate the patient about the modes of HIV transmission and provide guidance
on safe sexual practices, such as condom use.
- Encourage regular testing for sexually transmitted infections (STIs) and provide
appropriate treatment.
- Promote adherence to antiretroviral therapy (ART) to suppress viral replication
and reduce infectivity.
b. Enhancing gas exchange
- Monitor respiratory status regularly, including oxygen saturation levels.
- Encourage the patient to quit smoking and avoid exposure to secondhand
smoke.
- Promote adherence to ART to improve immune function and reduce the risk of
respiratory infections.
c. Managing pain
- Assess the patient's pain levels regularly using appropriate pain scales.
- Administer analgesic medications as prescribed.
- Explore non-pharmacological pain management strategies, such as relaxation
techniques and heat therapy.
d. Enhancing nutrition
- Assess the patient's nutritional status and dietary intake.
- Collaborate with a registered dietitian to develop an individualized meal plan.
- Encourage a well-balanced diet rich in fruits, vegetables, whole grains, and lean
proteins.
- Provide nutritional supplementation if needed.
e. Managing diarrhea
- Assess the frequency and characteristics of diarrhea.
- Promote adequate fluid intake to prevent dehydration.
- Encourage the consumption of easily digestible and low-fiber foods.
- Consider antidiarrheal medications or probiotics as appropriate.
f. Restoring skin integrity
- Perform regular skin assessments to identify any signs of breakdown or
infection.
- Keep the skin clean and dry, using gentle cleansing techniques.
- Apply appropriate medical dressings or topical agents to promote wound
healing.
- Encourage the patient to maintain good personal hygiene practices.
13. Develop a teaching plan for preventing infection in an HIV-infected patient.
a. Introduction and Assessment
- Begin by introducing yourself and establishing a rapport with the patient.
- Assess the patient's current knowledge and understanding of HIV and its
implications on their immune system.
b. HIV Transmission
- Explain the modes of HIV transmission, including sexual contact, sharing
needles, and mother-to-child transmission.
- Emphasize the importance of practicing safe sex by using barrier methods,
such as condoms, to prevent the spread of HIV.
- Provide information on harm reduction strategies for individuals who use
intravenous drugs, including the use of clean needles and syringes.
c. Hand Hygiene
- Demonstrate proper handwashing technique using soap and water for at least
20 seconds.
- Encourage the patient to wash their hands regularly, especially after using the
bathroom, before preparing or consuming food, and after coming into contact
with potentially contaminated surfaces.
d. Respiratory Hygiene and Cough Etiquette
- Educate the patient about the importance of covering their mouth and nose with
a tissue or their elbow when coughing or sneezing.
- Emphasize the need to dispose of used tissues properly and perform hand
hygiene afterward.
e. Immunizations
- Discuss the recommended immunizations for individuals living with HIV, such
as the annual influenza vaccine and the pneumococcal vaccine.
- Encourage the patient to follow the immunization schedule recommended by
their healthcare provider.
f. Environmental Precautions
- Explain the importance of maintaining a clean and hygienic living environment.
- Advise the patient to regularly clean and disinfect frequently-touched surfaces
and objects, such as doorknobs and countertops.
- Inform the patient about the potential risks associated with exposure to certain
environmental hazards, such as mold or poorly-maintained ventilation systems.
g. Personal Protective Equipment (PPE)
- Teach the patient about the appropriate use of PPE, such as gloves and masks,
when providing care to others or coming into contact with potentially infectious
materials.
- Demonstrate how to properly put on, take off, and dispose of PPE.
h. Oral Hygiene
- Emphasize the importance of good oral hygiene in preventing oral infections.
- Encourage the patient to brush their teeth at least twice a day, floss regularly,
and schedule regular dental check-ups.
i.
Diet and Nutrition
- Discuss the importance of maintaining a balanced and nutritious diet to support
a healthy immune system.
- Encourage the patient to consume a variety of fruits, vegetables, lean proteins,
and whole grains.
- Address any specific dietary considerations related to HIV medication side
effects or complications.
j.
Support and Resources
- Provide information about support groups, counseling services, and community
resources available to individuals living with HIV.
- Encourage the patient to engage with healthcare providers and take an active
role in managing their health.
14. Identify and promote safe and effective drug therapy for patients with HIV/AIDS.
a. Antiretroviral Therapy (ART)
- Promote adherence to ART as the cornerstone of HIV/AIDS treatment.
- Educate patients about the importance of taking medications on schedule and
as prescribed.
- Monitor CD4 cell count and viral load regularly to assess the effectiveness of
the therapy.
- Collaborate closely with healthcare providers to ensure appropriate drug
selection and combination.
b. Pre-exposure Prophylaxis (PrEP)
- Educate individuals at high risk of HIV infection about the use of PrEP
medications, such as Truvada (emtricitabine/tenofovir disoproxil fumarate).
- Provide counseling and resources to support adherence to PrEP.
- Regularly monitor patients on PrEP for potential side effects and HIV status.
c. Post-exposure Prophylaxis (PEP):
- Evaluate individuals at risk of HIV exposure and provide timely PEP within 72
hours of exposure.
- Prescribe a combination of antiretroviral medications for a 28-day course.
- Monitor for adverse effects and follow up for HIV testing.
d. Co-infection management
- Identify and manage co-infections that commonly occur in patients with
HIV/AIDS, such as hepatitis B and C, tuberculosis (TB), and sexually transmitted
infections.
- Follow specific treatment guidelines for each co-infection and maintain regular
monitoring.
- Consider potential drug interactions when prescribing treatments for coinfections.
e. Adverse effect management
- Monitor patients for potential adverse effects of antiretroviral medications, such
as gastrointestinal issues, skin rashes, liver toxicity, and metabolic complications.
- Educate patients about possible side effects and the importance of reporting
them promptly.
- Adjust medications or initiate supportive therapies to manage side effects as
necessary.
15. Choose nursing actions that promote safe and effective drug therapy for
patients with HIV/AIDS.
a. Patient Education
- Provide comprehensive education to patients about their antiretroviral therapy
(ART) and other medications.
- Explain the importance of adhering to the prescribed drug regimen and the
consequences of non-adherence.
- Teach patients about potential side effects and symptoms to watch for, as well
as when to report them to the healthcare provider.
- Instruct patients on proper administration techniques, timing of doses, and any
dietary restrictions or drug interactions.
b. Medication Administration
- Follow proper medication administration techniques, ensuring accurate dosing
and patient safety.
- Double-check the medication orders with the prescription and verify the
patient's identity before administering any medication.
- Administer antiretroviral medications as scheduled, paying attention to specific
instructions regarding food intake or restrictions.
- Document the administration of medications promptly and accurately.
c. Adverse Effect Management:
- Monitor patients for potential adverse effects of HIV/AIDS medications, such as
gastrointestinal issues, skin rashes, and liver toxicity.
- Assess for signs of medication toxicity or drug interactions and report them
promptly to the healthcare provider.
- Educate patients on self-monitoring for adverse effects or any changes in their
physical or mental health.
- Collaborate with the healthcare team to manage side effects effectively, which
may involve dose adjustments or the addition of supportive therapies.
d. Medication Reconciliation:
- Conduct a comprehensive medication reconciliation during each patient
encounter to ensure accurate and up-to-date medication lists.
- Identify any potential drug interactions, duplications, or omissions in the
patient's medication regimen.
- Communicate medication changes or additions to other healthcare providers
involved in the patient's care.
e. Patient Monitoring and Follow-up:
- Regularly monitor patients' adherence and response to drug therapy through
laboratory testing, such as CD4 cell count and viral load measurements.
- Schedule and coordinate follow-up appointments to assess treatment
effectiveness and adjust the drug therapy if needed.
- Collaborate with the healthcare team to address any concerns or barriers to
medication adherence that patients may be experiencing.
- Provide ongoing support and counseling to help patients cope with the
challenges of living with HIV/AIDS and maintain treatment adherence.
1. Explain the pathophysiology of hepatitis.
a. Inflammation of the liver, with several types of hepatitis (HAV, HBV, HCV, HDV,
HEV) that are caused by different types of viruses.
-Hepatitis A: This type of hepatitis is caused by the hepatitis A virus (HAV),
which is typically transmitted through ingestion of contaminated food or water.
Once the virus enters the body, it primarily affects the liver cells. The virus
replicates within the liver cells, leading to their destruction and subsequent
inflammation. The immune system recognizes the viral antigen and mounts an
immune response, resulting in further inflammation. Hepatitis A is usually acute
and self-limiting, meaning it resolves on its own without causing chronic liver
disease.
-Hepatitis B: Hepatitis B is caused by the hepatitis B virus (HBV) and is primarily
transmitted through blood-to-blood contact, sexual contact, or perinatal
transmission from an infected mother to her newborn. The virus targets liver cells
and enters them, where it replicates. The immune response to HBV infection
plays a significant role in the pathophysiology of hepatitis B. The interaction
between the virus and the immune system triggers an inflammatory response,
which can lead to liver cell damage and inflammation. In some cases, the
immune response becomes chronic, leading to ongoing inflammation and the
potential development of liver cirrhosis or liver cancer.
-Hepatitis C: Hepatitis C is caused by the hepatitis C virus (HCV) and is
primarily transmitted through blood-to-blood contact. Similar to hepatitis B, HCV
targets liver cells and enters them. HCV has a high rate of replication and a
tendency to mutate, making it difficult for the immune system to mount an
effective response. As a result, chronic hepatitis C infection can develop, leading
to ongoing liver inflammation and potential liver damage in the form of cirrhosis
or liver cancer.
-Hepatitis D: Hepatitis D, also known as delta hepatitis, is caused by the
hepatitis D virus (HDV). HDV only infects individuals who are already infected
with hepatitis B, as it requires the presence of the HBV surface antigen to form
complete viral particles. The interaction between HDV and HBV can lead to more
severe liver disease compared to HBV infection alone.
-Hepatitis E: Hepatitis E is caused by the hepatitis E virus (HEV) and is primarily
transmitted through ingestion of contaminated food or water. The
pathophysiology of hepatitis E is like hepatitis A, with the virus primarily affecting
liver cells and causing inflammation. However, in certain cases, especially in
pregnant women or individuals with compromised immune systems, hepatitis E
can lead to more severe liver disease.
2. Compare and contrast the etiology, mode of transmission, onset, and
incubation periods for Hepatitis A virus (HAV), Hepatitis B virus (HBV),
Hepatitis C virus (HCV), Hepatitis D virus (HDV), and Hepatitis E virus (HEV).
a. Hepatitis A virus (HAV)
- Etiology: HAV is a single-stranded RNA virus belonging to the Picornaviridae
family.
- Mode of Transmission: HAV is primarily transmitted through ingestion of
contaminated food or water, often via the fecal-oral route. It can also be
transmitted through close personal contact with an infected individual.
- Onset: Symptoms typically appear 2 to 6 weeks after exposure to the virus.
- Incubation Period: The incubation period for HAV ranges from 15 to 50 days.
b. Hepatitis B virus (HBV)
- Etiology: HBV is a partially double-stranded DNA virus belonging to the
Hepadnaviridae family.
- Mode of Transmission: HBV is primarily transmitted through blood-to-blood
contact, sexual contact, or perinatal transmission from an infected mother to her
newborn. It can also be transmitted through sharing of contaminated needles or
other sharp instruments.
- Onset: Symptoms can appear within 6 weeks to 6 months after exposure to the
virus, but it can also be asymptomatic.
- Incubation Period: The incubation period for HBV ranges from 30 to 180 days.
c. Hepatitis C virus (HCV):
- Etiology: HCV is a single-stranded RNA virus belonging to the Flaviviridae
family.
- Mode of Transmission: HCV is primarily transmitted through blood-to-blood
contact. It can occur through sharing contaminated needles, receiving infected
blood transfusions or organ transplants, or through sexual contact.
- Onset: Symptoms can appear within 2 weeks to 6 months after exposure to the
virus, but it can also be asymptomatic.
- Incubation Period: The incubation period for HCV ranges from 14 to 180 days.
d. Hepatitis D virus (HDV)
- Etiology: HDV is a defective RNA virus that requires the presence of HBV for
replication.
- Mode of Transmission: HDV can only infect individuals who are already
infected with HBV. It is transmitted through similar routes as HBV, primarily
through blood-to-blood contact or perinatal transmission.
- Onset: Symptoms can appear within 4 to 8 weeks after exposure to HDV.
- Incubation Period: The incubation period for HDV is approximately 30 to 150
days.
e. Hepatitis E virus (HEV):
- Etiology: HEV is a single-stranded RNA virus belonging to the Hepeviridae
family.
- Mode of Transmission: HEV is primarily transmitted through ingestion of
contaminated food or water, similar to HAV. It is most common in areas with poor
sanitation and hygiene practices.
- Onset: Symptoms can appear within 2 to 9 weeks after exposure to the virus.
- Incubation Period: The incubation period for HEV ranges from 15 to 64 days.
3. Discuss the complications of hepatitis.
a. Chronic Hepatitis: Infections caused by Hepatitis B (HBV) and Hepatitis C
(HCV) viruses can progress to a chronic state, where the infection persists for
more than six months. Chronic hepatitis can lead to long-term liver damage,
including inflammation and fibrosis (scarring of the liver tissue). Over time, this
can progress to cirrhosis, which is severe scarring of the liver.
b. Liver Cirrhosis: Chronic hepatitis, particularly caused by HBV and HCV, can
eventually lead to liver cirrhosis. Cirrhosis is characterized by extensive scarring
of the liver tissue, resulting in impaired liver function. It can lead to complications
like portal hypertension (high blood pressure within the liver), ascites
(accumulation of fluid in the abdomen), hepatic encephalopathy (brain
dysfunction due to liver failure), and an increased risk of liver cancer
(hepatocellular carcinoma).
c. Fulminant Hepatitis: Although rare, some individuals may develop fulminant
hepatitis, which is a severe and rapidly progressing form of liver failure. It can
lead to hepatic encephalopathy, coagulopathy (blood clotting abnormalities), and
multi-organ failure. Immediate medical attention is necessary in such cases, and
a liver transplant may be required for survival.
d. Hepatocellular Carcinoma (HCC): Chronic hepatitis, especially Hepatitis B and
C, significantly increases the risk of developing hepatocellular carcinoma, which
is the most common type of liver cancer. HCC typically occurs after years of liver
inflammation and cirrhosis.
e. Extrahepatic Manifestations: Hepatitis can sometimes lead to complications
beyond the liver. Certain types of viral hepatitis, such as Hepatitis B and C, have
been associated with extrahepatic manifestations, including kidney disease,
autoimmune disorders, pancreatic inflammation, and cardiovascular conditions.
4. Identify the clinical manifestations of viral hepatitis.
a. Fatigue: Fatigue and a lack of energy are common symptoms experienced by
individuals with viral hepatitis.
b. Jaundice: Jaundice is characterized by the yellowing of the skin and eyes. It
occurs due to the buildup of bilirubin, a yellow pigment, in the blood. Jaundice is
a common sign of liver dysfunction and is often seen in individuals with viral
hepatitis.
c. Dark Urine/Pale Stools: The presence of dark-colored urine and pale or claycolored stools is a characteristic symptom of viral hepatitis. Dark urine is a result
of increased levels of bilirubin in the urine, while pale stools occur due to a
decreased production of bile.
d. Abdominal Pain: Some individuals with viral hepatitis may experience
abdominal pain or discomfort, which can range from mild to severe. This may be
due to inflammation and enlargement of the liver.
e. Loss of Appetite/Weight Loss: Viral hepatitis can lead to a loss of appetite and
subsequent weight loss. This is often accompanied by a general feeling of
malaise.
f. Nausea/Vomiting: Nausea and vomiting are common symptoms associated with
viral hepatitis. These symptoms may be more pronounced in the acute phase of
the infection.
g. Muscle/Joint pain: Many people with viral hepatitis may experience muscle and
joint pain, which can range from mild to severe discomfort.
h. Fever: Fever is a common symptom in the early stages of viral hepatitis. It is
often accompanied by general flu-like symptoms, such as headache and body
aches.
5. Prioritize assessment needs for patients with viral hepatitis, including physical
assessment and psychosocial assessment.
Physical Assessment
a. Jaundice: Assess the degree of jaundice by examining the skin, sclera, and
mucous membranes for yellow discoloration.
b. Abdominal Examination: Palpate the abdomen to assess for tenderness,
hepatomegaly (enlargement of the liver), or splenomegaly (enlargement of the
spleen).
c. Ascites: Assess for the presence of ascites (fluid accumulation in the abdominal
cavity), which may be indicated by abdominal distension and fluid wave.
d. Edema: Check for peripheral edema, especially in the ankles and lower legs,
which may indicate liver dysfunction.
e. Neurological Assessment: Evaluate for any signs of hepatic encephalopathy,
such as confusion, disorientation, or asterixis (liver flap) in the hands.
Psychosocial Assessment
f. Risk Factors: Assess for known risk factors for viral hepatitis, such as exposure
to contaminated blood, injection drug use, or unprotected sexual activity.
g. Social History: Inquire about the patient's living situation, employment, and
support systems, as these factors can impact their ability to adhere to treatment
regimens and manage their condition effectively.
h. Mental Health: Screen for any signs of depression, anxiety, or substance abuse
that may impact the patient's overall well-being and ability to cope with the
diagnosis.
i.
Sexual History: Discuss the patient's sexual history to determine potential risks
for transmitting or acquiring viral hepatitis.
j.
Knowledge and Education: Assess the patient's understanding of their
condition, including knowledge about viral hepatitis, its transmission, and
strategies for prevention.
6. Analyze the significance of laboratory results in patients with viral hepatitis.
a. Liver Function Tests (LFTs):
- Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST):
Elevated levels of ALT and AST indicate liver cell damage or inflammation, which
can occur in acute or chronic viral hepatitis.
- Bilirubin: Increased bilirubin levels can indicate impaired liver function, typically
seen in hepatitis-related jaundice.
- Alkaline Phosphatase (ALP) and Gamma-Glutamyl Transferase (GGT):
Elevated levels of ALP and GGT can indicate cholestasis or obstruction of the
bile ducts.
b. Viral Serology:
- Hepatitis B surface antigen (HBsAg) and Hepatitis B core antibody (antiHBc): HBsAg is the marker of acute or chronic hepatitis B infection, while antiHBc indicates previous or ongoing infection.
- Hepatitis C antibody (anti-HCV): The presence of anti-HCV indicates
exposure to Hepatitis C virus (HCV), but further testing is required to confirm
active infection.
- Hepatitis A antibody (anti-HAV): Positive anti-HAV antibodies indicate
previous exposure to Hepatitis A virus (HAV) or previous vaccination.
c. Viral Load/Genotyping:
- Hepatitis B viral load: Quantifies the amount of HBV genetic material in the
blood and helps monitor the response to antiviral therapy.
- Hepatitis C viral load: Measures the amount of HCV RNA in the blood and is
used to monitor viral replication and treatment response.
- Hepatitis C genotyping: Identifies the specific genotype of HCV, which can
influence the choice and duration of antiviral treatment.
d. Prothrombin Time (PT) and International Normalized Ratio (INR):
- PT and INR reflect liver synthetic function as they measure the clotting ability of
the blood. Impaired liver function seen in viral hepatitis can lead to prolonged PT
and increased INR values.
e. Complete Blood Count (CBC):
- CBC helps assess for any signs of anemia, leukopenia, or thrombocytopenia,
which can occur in viral hepatitis or as side effects of antiviral treatment.
7. Develop a patient-centered plan of care for patients with hepatitis, including
promoting nutrition and managing fatigue.
a. Assess nutritional status: Conduct a thorough assessment of the patient's
nutritional status, including dietary habits, weight changes, and any symptoms
related to malnutrition. Evaluate the patient's calorie and protein intake
requirements based on their age, gender, weight, and activity level.
b. Provide dietary education: Offer dietary education tailored to the patient's
needs. Emphasize the importance of a well-balanced diet rich in fruits,
vegetables, whole grains, and lean proteins. Encourage small, frequent meals to
ensure adequate nutrient intake. Discuss the significance of consuming foods
that support liver health, such as those high in antioxidants and omega-3 fatty
acids.
c. Manage symptoms and side effects: Hepatitis can cause symptoms such as
nausea, vomiting, and loss of appetite, which may impact nutritional intake.
Provide supportive measures such as antiemetics and appetite stimulants as
needed. Consider a consult with a registered dietitian to assist with specialized
dietary recommendations and meal planning.
d. Encourage hydration: Dehydration can worsen fatigue and other symptoms.
Encourage the patient to drink an adequate amount of fluids throughout the day,
preferably water or other non-caffeinated beverages, to maintain hydration.
e. Monitor liver function: Regularly monitor the patient's liver function tests,
including liver enzymes and bilirubin levels. Assess nutritional status and adjust
the dietary plan accordingly based on results and individual patient needs.
f. Manage fatigue: Fatigue is a common symptom in hepatitis patients. Advise the
patient to balance rest and physical activity, incorporating regular breaks and
naps as needed. Collaborate with the healthcare team to schedule appointments
and treatments at times when the patient has the most energy. Encourage the
patient to engage in light exercise, such as walking, to improve overall energy
levels.
g. Supportive therapies: Consider complementary therapies such as acupuncture,
yoga, or meditation, as they may help manage fatigue and improve overall wellbeing. Discuss these options with the patient and ensure they are carried out by
trained professionals.
h. Coordinate with a multidisciplinary team: Collaboration with other healthcare
providers, such as hepatologists, registered dietitians, and mental health
professionals, is essential to provide comprehensive care. Seek their expertise to
optimize the patient's plan of care and ensure a patient-centered approach.
i.
Provide emotional support: Being diagnosed with hepatitis can be emotionally
challenging. Offer emotional support to the patient and their family, and refer
them to support groups or counseling services that can help them cope with their
diagnosis and treatment.
8. Identify and promote safe and effective drug therapy for patients with viral
hepatitis.
a. Diagnosis/Assessment: Proper diagnosis and assessment of the type and
stage of hepatitis are crucial before initiating drug therapy. Different tests, such
as blood tests and imaging studies, can be used to determine the status of the
virus and the extent of liver damage.
b. Antiviral Medications: For chronic viral hepatitis B and C, antiviral medications
are available and can be prescribed based on specific guidelines. These
medications can help control viral replication, reduce liver inflammation, and
prevent further liver damage.
c. Adherence to Treatment: Adherence to prescribed medications is important for
successful treatment outcomes. Healthcare providers should educate patients
about the importance of taking medications as directed and the potential side
effects they may experience.
d. Monitoring/Follow-up: Regular monitoring of viral load, liver function tests, and
other parameters is important to assess treatment response and adjust therapy if
needed. Healthcare providers should schedule regular follow-up appointments to
monitor the patient's progress.
e. Supportive Care: In addition to antiviral medications, patients with viral hepatitis
may benefit from supportive care measures aimed at improving liver health, such
as lifestyle modifications (e.g., a healthy diet, regular exercise, and avoiding
alcohol and illicit substances), vaccinations (e.g., for hepatitis A and B), and
regular screening for liver cancer.
9. Choose nursing actions that promote safe and effective drug therapy for
patients with viral hepatitis.
a. Education and Counseling: Nurses play a crucial role in educating patients
about their condition, the importance of medication adherence, and any potential
side effects they may experience. It is important to provide clear instructions on
how to take medications correctly and address any concerns or questions that
patients may have.
b. Medication Administration/Monitoring: Nurses should ensure accurate
medication administration, following the prescribed dosage and schedule. They
should also closely monitor the patient's response to the medication, as well as
any potential adverse effects. Regularly communicating with the healthcare team
regarding medication efficacy and side effects is essential for timely intervention
if needed.
c. Infection Control Measures: Nurses should emphasize the importance of
infection control practices to prevent the spread of viral hepatitis, especially for
patients with acute hepatitis A or E. This may involve educating patients on hand
hygiene, safe disposal of sharps, and proper hygiene practices in personal and
environmental settings.
d. Collaboration with the Healthcare Team: Nurses need to work collaboratively
with other healthcare professionals involved in the patient's care, such as
physicians, pharmacists, and dietitians. This collaboration ensures that the
patient receives appropriate medication therapy, monitoring, and supportive care
measures.
e. Patient Advocacy: Advocating for patient rights and safety is a crucial nursing
responsibility. Nurses should actively participate in interdisciplinary discussions
and care planning, ensuring that the patient's individual needs and preferences
are considered when determining the most suitable drug therapy.
f. Emotional Support: Living with viral hepatitis can be challenging for patients.
Nurses can provide emotional support by actively listening to their concerns,
providing information and resources, and connecting them with support groups or
counseling services when needed.