hivAidsNotes

hivAidsNotes - Slide 1 HIV& AIDS HIV Presented by Manuel...

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Unformatted text preview: ___________________________________ Slide 1 ___________________________________ HIV & AIDS HIV Presented by Manuel Ramos RN, MSN ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 2 HIV & AIDS HIV ___________________________________ ___________________________________ • HIV-1 and HIV-2 attack the immune HIVHIVsystem • T or B cell functions impaired • increased susceptibility to infections and cancers ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 3 Pathophysiology Pathophysiology • HIV is a retrovirus – RNA, has a protein coat, has reverse transcriptase • HIV invades cells with CD4 antigens • Takes over cell’s DNA, duplicates cell’ • May remain dormant or active • Active: forms virions which destroy host cell ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 4 Transmission Transmission ___________________________________ ___________________________________ • • • infected blood and body fluids contaminated needles infants born to HIV + mothers ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 5 Risk Factors in transmission of HIV Risk • Men who have sex with men (MSM) • Injecting drug users ( IDUs) IDUs) • Heterosexual intercourse with infected persons • Blood transfusion • Neonates of infected women • Occupational risk to health care workers ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 6 Prevention Prevention • Safe sexual practices • No sharing of needles or drug paraphernalia • Educational campaigns • Standard precautions by health care workers • Prenatal counseling, testing ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 7 Diagnostic tests Diagnostic • Enzyme-linked immunoassay (ELISA) Enzymetests • Western blot antibody • HIV viral load • CD4 cell count ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 8 Other tests Other • • • • • • • CBC: anemia, leukopenia, thrombocytopenia leukopenia, Chest X-ray XHepatitis serology and liver chemistry panel Tuberculin skin testing MRI Specific cultures and serology for infections Pap smears q 6 months ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 9 7 Stages of the Clinical Course of Stages HIV Infection 1. Viral transmission 2. Primary HIV infection 3. Seroconversion 4. Asymptomatic chronic infection with or without persistent generalized lymphadenopathy (PGL) 5. Symptomatic HIV infection 6. AIDS (presence of AIDS indicator conditions or CD4 cell count < 200/mm3) 7. Advanced HIV infection (CD4 cell count < 50/mm3) ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 10 Disease Progression Disease ___________________________________ ___________________________________ • CD4 count < 200/mm3, 3.5 years survival without HAART • AIDS- secondary infections and cancers, AIDSHIV dementia complex, 1.5 years survival • General malaise, fever, fatigue, night sweats, involuntary weight loss, chronic diarrhea, rash, oral lesions, candidiasis ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 11 ___________________________________ HAART HAART • • • • • • • Highly active antiretroviral therapies CD4 < 500/mm3 or viral load > 10k/ml Combination medications Decreased viral load Preserve or restore immune function Improve quality of life Reduce morbidity and mortality • http://www.hopkins-aids.edu/hiv_lifecycle/hivcycle_flsh.html http://www.hopkins- ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 12 Drug Category Mechanism of Action Examples Fusion Inhibitors Blocks HIV entry into cells Enfuvirtide (Fuzeon, Fuzeon, T-20) Nucleoside analog reverse transcriptase inhibitors (NARTI) or nucleoside analogs Inhibits HIV reverse transcriptase, inhibits HIV DNA synthesis abacavir (Ziagen, ABC) abacavir Ziagen, zidovudine (Retrovir, ZDV, AZT) Retrovir, didanosine (Videx, ddl) Videx, ddl) stavudine (Zerit, d4T) Zerit, lamivudine (Epivir, 3TC) Epivir, zalcitabine (HIVID, ddc) ddc) tenofovir ( Viread, PMPA) Viread, Protease inhibitors (PI) Prevents cleavage and maturation of the HIV polypeptides amprenavir ( Agenerase, AMP) Agenerase, indinavir (Crixivan, IDV) Crixivan, nelfinavir (Viracept, NFV) Viracept, ritonavir (Norvir, RTV) Norvir, saquinavir (Invirase, Fortovase) Invirase, Fortovase) lopinavir/ritonavir (Kaletra) Kaletra) Nonnucleoside reverse transcriptase inhibitors (NNRTIs) (NNRTIs) Binds directly with HIV reverse transcriptase efavirenz (Sustiva, EFV) Sustiva, delavirdine (Rescriptor, DLV) Rescriptor, nevirapine (Viramune, NVP) Viramune, ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 13 Other medications Other • Combivir (zidovudine/AZT,lamivudine) zidovudine/AZT,lamivudine) • Trizivir (Ziagen/Retrovir/Epivir) Ziagen/Retrovir/Epivir) • Pharmacologic Treatment of Common Opportunistic Infections and Malignancies in HIV Disease (Refer to Table 9-4, page 9261 Lemone & Burke© 2004) Burke© ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 14 Secondary Infectious Diseases Secondary Microbiological Agent Organism Condition Protozoa Cryptospiridium Toxoplasmosis gondii Microsporidia Cryptosporidiosis Toxoplasmosis Microsporidiosis Fungi Pneumocyctis jiroveci Candida albicans Cryptococcus neoformans Histoplasma capsulatum PCP Candidiasis Cryptococcosis Viruses Herpes Herpes simplex 1 and 2 Cytomegalovirus (CMV) Cytomegalovirus retinitis,GI,lungs Bacteria Mycobacteria tuberculosis Mycobacteria avium Histoplasmosis Tuberculosis Mycobacteria avium complex ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 15 Pneumocystis jerovici pneumonia Pneumocystis • Most common opportunistic infection • mild cases: pulmonary exam normal at rest • Hypoxemia • Fever with exertion: • Tachypnea • Tachycardia • dry ("cellophane") rales • progressive exertional dyspnea • nonproductive cough & chest discomfort worsens over a period of days to weeks ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 16 Pneumocystis pneumonia Pneumocystis • Trimethoprim-sulfamethoxazole (TMP-SMX) is Trimethoprim(TMPthe treatment of choice • corticosteroid therapy • Supportive care for common adverse effects: • Rashes: antihistamines • nausea: antiemetics • fever: antipyretics • ICU admission or mechanical ventilation with severe PCP ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 17 Candidiasis Candidiasis • often the indication of progression to AIDS • manifests as oral thrush, esophagitis, esophagitis, vaginitis, stomatitis vaginitis, • oral fluconazole superior to topical therapy (clotrimazole troches or nystatin suspension or pastilles) • Itraconazole oral solution less tolerated ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 18 Cryptococcosis Cryptococcosis • • • • • • • • Debilitating meningitis Fever Malaise headache neck stiffness Photophobia blurred vision N/V encencephalopathic symptoms: • Lethargy • altered mentation • personality changes • memory loss ___________________________________ ___________________________________ ___________________________________ ___________________________________ pulmonary infection: • cough • dyspnea • abnormal chest radiographs • Skin lesions ___________________________________ ___________________________________ ___________________________________ Slide 19 Treatment Treatment • Untreated cryptococcal meningitis is fatal • amphotericin B with flucytosine followed by fluconazole • amphotericin B: monitor for nephrotoxicity and electrolyte disturbances • fever, chills, renal tubular acidosis, hypokalemia, hypokalemia, orthostatic hypotension, tachycardia, nausea, headache, vomiting, anemia, anorexia, and phlebitis • Premed: acetaminophen, diphenhydramine, diphenhydramine, corticosteroids ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 20 cryptococcal meningitis cryptococcal • Possible increased ICP 2o to cerebral edema despite a microbiologic response • repeated daily lumbar punctures • CSF shunting ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 21 Histoplasmosis Histoplasmosis • Begins as a respiratory infection then spreads as a systemic infection • Dyspnea, fever, cough, weight loss, Dyspnea, enlarged spleen, lymphadenopathy ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 22 Tuberculosis Tuberculosis • diffuse pulmonary infiltrates, productive cough w/ purulent sputum, fever, fatigue, weight loss, lymphadenopathy • Multidrug resistant strains • Disseminated disease affects body organs • 6-month regimen: INH, RIF or rifabutin, PZA, and EMB rifabutin, • monitor hepatotoxicity, renal function (serum creatinine), hepatotoxicity, creatinine), and platelet count • EMB: possible blurred vision or scotomata • Monthly testing of visual acuity and color discrimination ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 23 Mycobacterium Avium Complex Mycobacterium (MAC) • • • Major cause of “wasting syndrome” syndrome” person-to-person transmission is unlikely. person- tochills, fever, weakness, night sweats, abdominal pain, diarrhea, weight loss • lymphadenitis, pneumonitis, pericarditis, osteomyelitis, pneumonitis, pericarditis, osteomyelitis, skin or soft tissue abscesses, genital ulcers, or CNS infection. • Clarithromycin, preferred, azithromycin can be Clarithromycin, substituted • Ethambutol is the recommended second drug ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 24 Cytomegalovirus Cytomegalovirus • CMV retinitis, colitis,adrenalitis, colitis,adrenalitis, pneumonitis, esophagitis pneumonitis, • necrotizing retinitis: progressive retinal necrosis and atrophy, retinal detachment • Colitis: fever, anorexia,malaise, abdominal anorexia,malaise, pain, N/V, watery then bloody diarrhea, weight loss, dehydration ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 25 Herpes simplex Herpes Herpes simplex virus: oral, perirectal, genital perirectal, Chronic painful lesions, malaise, myalgia, myalgia, lymphadenopathy Varicella-zoster virus: VaricellaFever, headache, fluid filled vesicles, pain along dermatome nerve tracks ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 26 Cryptosporidiosis Cryptosporidiosis • gastrointestinal tract and respiratory tract may be • involved profuse, nonbloody watery diarrhea (17 L/d), nausea, vomiting, and lower abdominal cramping, fever • Malabsorption is often present • Cholangitis and pancreatitis • ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 27 Cryptosporidiosis Cryptosporidiosis • contamination of water supplies and recreational water from human/animal feces with viable oocysts despite standard chlorination • oral-anal sex oral• Diaper change of children with cryptosporidial diarrhea • handwashing, use of barriers during anal sex, handwashing, might help prevent person-to-person person-totransmission ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 28 Cryptosporidiosis Treatment Cryptosporidiosis • No consistently effective pharmacologic or immunologic therapy for C. parvum exists C. • Oral or IV rehydration and repletion of electrolyte losses • antimotility agents: Loperamide or tincture of opium • monitor for volume depletion, electrolyte and weight loss, and malnutrition • Total parenteral nutrition ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 29 Toxoplasmic encephalitis Toxoplasmic • leading cause of focal CNS disease in AIDS • Primary infection occurs after eating undercooked meat, ingestion of oocysts from cat feces • headache, confusion and drowsiness, seizures, focal weakness, aphasia, ataxia, cranial nerve palsies, and language disturbance • Personality and mental status changes, stupor then coma ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 30 Toxoplasmic encephalitis Toxoplasmic Treatment • combination of pyrimethamine plus sulfadiazine plus leucovorin • parenteral TMP-SMX or parenteral TMPclindamycin • Anticonvulsants with hx. of seizures hx. • pyrimethamine toxicities: rash, nausea, and bone-marrow suppression bone- ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 31 Microsporidiosis Microsporidiosis • gastrointestinal tract infection with diarrhea • Disseminated infection: encephalitis, ocular infection, sinusitis, myositisART with immune restoration Treatment: • Albendazole and fumagilli • Fluid support for diarrhea • nutritional support for malnutrition and wasting ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 32 Secondary Cancers: Secondary Kaposi’s Sarcoma (KS) Kaposi’ • Most common cancer associated with AIDS • Tumor of the endothelial cells lining small blood vessels • Manifests as vascular macules, papules, or purple skin lesions commonly on the face, nose, ears, GI tract, lungs • Indicator of late stage HIV disease ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 33 Lymphomas Lymphomas • Malignancies of the lymphoid tissue • Aggressive tumors, rapid spread • Non-Hodgkin’s lymphoma- malignant Non- Hodgkin’ lymphomatumors of the B or T lymphocytes • Primary brain lymphoma ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 34 Cervical cancer Cervical • cervical dysplasia frequently develops to cervical cancer • Women with HIV usually die of cervical cancer, not AIDS ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 35 Other post-infection related issues: Other post• • • AIDS dementia complex-cognitive, complexmotor, behavioral impairment HIV encephalopathy Peripheral sensory neuropathy ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 36 Nursing Care Nursing • Prevention • Nursing Diagnoses: Impaired skin integrity Imbalanced Nutrition: less than body requirements Risk for infection Activity intolerance Social Isolation Ineffective sexuality patterns Situational low self-esteem selfChronic confusion Caregiver role strain Ineffective coping Disabled family coping ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 37 Community Resources Community http:/www.orangecountyfl.net/dept/hfs/HIV/default.htm http:/www.orangecountyfl.net/dept/hfs/HIV/default.htm Health and Family Services HIV and AIDS Resources • Aids Resource Alliance • Brevard County Health department • Centaur • Centerpeace • Comprehensive Health Care • Food with Care • Haven of Hope Ministries • The Hope and Help Center of Central Florida • Hug-Me Program Hug• Kinsman Transportation • • • • • • • • Orange County Medical Clinic Project Response AIDS Center Reach Out Program Seminole County Health Department Serenity House Pediatric AIDS Foundation Thayers Pharmacy The Open Center Turning Point of Central Florida ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 38 Web sites Web • • • • • http://www.hab.hrsa.gov/ HIV/AIDS Bureau http://www.aidshealth.org AIDS Healthcare Foundation http://www.aegis.com AIDS Educational Global Information System httpp://www.cdc.gov/hiv HIV information, statistics and surveillance httpp://www.cdc.gov/hiv http://www.doh.state.fl.us/disease_ctrl/aids/index.html HIV trends and statistics for Florida, legal and legislative information, patient patient services • http://www.hivatis.org AIDS Treatment Information Service. Federally approved treatment guidelines for HIV and AIDS • http://www.anacnet.org/ Association of Nurses in AIDS Care. National organization of nurses who care for HIV/AIDS patients ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ...
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This note was uploaded on 10/18/2011 for the course NUR 2211 taught by Professor Judithclark during the Fall '11 term at Valencia.

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