AIDS

OUTLINES
Introduction
Definition
Statistic
Pathophysiology
Risk factor
Stage of HIV
Modes of HIV/AIDS Transmission
Manifestatation
Complication
management

OBJECTIVES
Relate principles of anatomy physiology to the
nursing care of individuals with immunologic
health problems.
Determine and apply a nursing plan of care to
address the needs of the adult patient with
alterations in the immunologic system
Evaluate the various roles and contributions of
the health care team in providing care for adult
patient with immunology system diagnoses.
Develop nursing interventions to assist the adult
patient with alterations in immunological
function.

OBJECTIVES
Discuss major care concerns for patients and
families undergoing immunological treatments.
Evaluate the effectiveness of nursing
interventions appropriate to achieving optimal
outcomes of planned care for the adult patient
with immunologic system disorders

WHAT IS AIDS?
A Aquired
I Immune
D- Deficiency
S- Syndrome

WHAT IS AIDS?
HIV is the virus that causes AIDS
Disease limits the bodys ability to fight infection
due to markedly reduced helper T cells.
Patients have a very weak immune system
(defense mechanism)
Patients predisposed to multiple opportunistic
infections leading to death.

WHAT IS HIV?
H Human
I Immunodeficiency
V Virus

WHAT IS HIV?
Human Immunodeficiency Virus
A unique type of virus (a retrovirus)
Invades the helper T cells (CD4 cells) in the body
of the host (defense mechanism of a person)
Threatening a global epidemic.
Preventable, managable but not curable.

AIDS (DEFINITION)
This

condition gradually destroys the immune

system, which makes it hard for the body to fight
infections.

Epidemiology

GLOBAL EPIDEMIOLOGY

39.5 million people living with HIV/AIDS in 2006

4.3

million newly infected with HIV (more than half

are younger than 25)
2.9 million people died from AIDS

More than 25 million people have died from AIDS

since 1981
Africa has over 12 million AIDS orphans

PATH PHYSIOLOGY
1.Human beings produce antibodies against specific
infections.
2.When HIV infection takes place, anti-HIV antibodies
are produced but they do not appear immediately.
This is called the window effect.
HIV become detectable 4 to 3.In some cases antibodies,
6 weeks after infection.
4.When HIV is in circulation, it invades several types
of cells -the lymphocytes, macrophages, the
Langerhans cells, and neurons within the CNS
5.HIV attacks the bodys immune system.

*Sexual contact with infected person

*Injection of infected blood or blood
products
*Prenatal or vertical transmission

FOUR STAGES OF HIV

STAGE 1 - PRIMARY
Short, flu-like illness occurs one to six
weeks after infection
no symptoms at all
Infected person can
infect other people

STAGE 2 - ASYMPTOMATIC
Lasts for an average of ten years
This stage is free from symptoms
There may be swollen glands
The level of HIV in the blood drops to very low
levels
HIV antibodies are detectable in the blood

STAGE 3 - SYMPTOMATIC
The symptoms are mild
The immune system deteriorates
emergence of opportunistic infections and cancers

STAGE 4 - HIV AIDS

The immune system

weakens
The illnesses become
more severe leading to
an AIDS diagnosis

MODES OF HIV/AIDS TRANSMISSION

THROUGH BODILY FLUIDS

Blood products

Semen

Vaginal fluids

Breast Milk

THROUGH IV DRUG USE

Sharing

Needles

Without

Increases

sterilization

the chances of contracting HIV

THROUGH SEX
Intercourse (penile penetration into the vagina)
Oral
Anal
Digital Sex

MOTHER-TO-BABY
Before Birth
During Birth
Postpartum

After

the birth

Clinical Manifestations

CLINICAL MANIFESTATIONS
Fatigue
Respiratory
- PCP (most common)
- TB (increased incident of resistant strains)

GI
-Diarrhea (50-90)
-Oral Lesions
-Candidiasis oral thrush, esophagitis
-Hairy leukoplakia
-Gingival inflammation
-Ulcerations
-Wasting Syndrome Category C

Oncologic
-Kaposis Sarcoma (KS)
Most common HIV-related malignancy
May be 1st manifestation of HIV present that
causes patient to see health care provider
Indicates deterioration of immune system
-Lymphomas

Neurologic
-Dementia, Delirium, Seizures
-HIV Encephalopathy
-Formerly called AIDS dementia complex
Depression
Other
-HSV
-CMV

Gynecologic
-Persistent, recurrent vaginal candidiasis
May be the 1st sign of HIV infection present
inwomen
-Cervical Cancer
Cervical dysplasia
-HPV

COMPLICATIONS
HIV infection weakens your immune system,
making you highly susceptible to numerous
infections and certain types of cancers.
Infections common to HIV/AIDS
Tuberculosis (TB)
Salmonellosis
Cytomegalovirus
Candidacies
Cryptococcus meningitis

Toxoplasmosis
Cryptosporidiosis
Cancers common to HIV/AIDS
Kaposi's sarcoma
Lymphomas
Other complications
Wasting syndrome
Neurological complications
Kidney disease

RISK FACTOR
1.Non-modifiable Risk Factors:
A-more in Male transmitting to Female than
Female transmitting to Male
B-African- American descent
2.Modifiable Factors:
A-Sexual contact
B-Giving birth
E-Drug abuse using syringes
D-BT/Transplant

Prevention

HOW TO PROTECT YOUR BABY

FROM GETTING HIV :
Mother-to-child

transmission of HIV

can be prevented by using antiretroviral drugs,

which reduce the chances of a child becoming
infected with HIV from 20% to less than 5%.

HOW TO PREVENT WOMEN FROM

GETTING HIV

Don't have sex.

Don't use drugs or alcohol with sex.

Use a condom.

DIAGNOS
IS

DIAGNOSIS

home tests the only home test approved by the

food and drug administration is called the home
access express test which is sold in pharmacies

saliva tests a cotton pad is used to obtain saliva

from the inside of your cheek the pad is placed in
a vial and submitted to a laboratory for testing

DIAGNOSIS
ELISA Test stand for enzyme linked use to Detect
HIV infection
_Elisa is quite sensitive in chronic HIV infection

DIAGNOSIS
*viral load test this test measures the amount of
HIV in your blood
*western blot this is a very sensitive blood test
used to confirm a positive ELISA test result

MEDICAL MANAGEMENT AIDS

MEDICAL MANAGEMENT AIDS

Treatment of infection Non-curative
ART, HAART
Antidiarrheals
Chemotherapy
Antidepressants
Nutrition
-Megace, Marinol, Advera
-Parenteral nutrition

MEDICAL MANAGEMENT

Nucleoside Reverse Transcriptase Inhibitors

(NRTIs) ziduvodine (Retrovir) AZT
Stops replication/growth in HIV (CD4
-Penetrates blood brain barrier
Periodic monitoring of blood work essential
Cautious use of Tylenol
Monitor for
-Bone marrow suppression
-Neurotoxicity
-Pancreatitis

MEDICAL MANAGEMENT
o

Protease Inhibitors
Not curative
Used to decrease viral load in AIDS/ARC
Side Effects
-Increased cholesterol, triglycerides
Treat w/ pravastatin (Pravachol) or
atorvastatin(Lipitor).
-Lipodystrophy
-Insulin resistance

MEDICAL MANAGEMENT
o

Protease Inhibitors
Adverse Effects
-Bone marrow suppression (neutropenia,
anemia,thrombocytopenia)
-Hepatotoxicity
-Nephrotoxicity
Encourage fluid intake 1,500 mL/day

MEDICAL MANAGEMENT
o

TMP-SMZ (Bactrim, Septra)

Sulfonamide
Treatment of choice for PCP
IV and Oral (bid)
Common side effect
-Rash (pruritic, pinkish-red macules papules)
60 will develop
-Photosensitivity

MEDICAL MANAGEMENT
Pentamidine (Pentam, NebuPent)
Antiprotozoal
Alternative treatment for PCP
IV
-Severe hypotension if given too rapidly
Risks
-Pancreatic damage (impaired glucose
metabolism,development of DM)
-Renal damage, Hepatic dysfunction, Neutropenia
o

MEDICAL MANAGEMENT

amphotericin B (Fungizone)
Antifungal (cryptococcal meningitis)
Given IV
Premedicate acetaminophen
Protect medication from light
Monitor VS during administration
Adverse Reactions
-Nephrotoxicity
-Hypokalemia, Hypomagnesemia

NURSING MANAGEMENT-HIV
PREVENTION
o

Primary Tools
-Education
-Counseling
-Behavior Modification
ABCs
-Abstinence
-Be faithful
-use Condoms

NURSING MANAGEMENT-HIV
PREVENTION
Water-based lubricants
Limit of partners
Dont share needles
Talk to your partner children
Avoid douching
If pregnant, get tested Dont breastfeed

INTERDISCIPLINARY CARE
Early identification
Promote of health maintenance
Prevent of OIs
Treat of disease complications
Provide emotional psychosocial support

NURSING MANAGEMENT HIV TREATMENT

Compliance long-term regimen adherence to

drug
therapy
Follow-up w/ physical examination diagnostic
tests response to therapy
Communication to provider areas of concern

NURSING MANAGEMENT HIV

TREATMENT
Confidentiality
Nutritional Support to Maintain IBW
Immunization/Vaccination Recommendations

NURSING DIAGNOSES/
COLLABORATIVE PROBLEMS -AIDS
Risk for Infection
Activity Intolerance
Ineffective Airway Clearance
Imbalanced nutrition
Caregiver Role Strain
Knowledge Deficit
Social Isolation