question

The best way to prevent parenteral transmission of HIV

answer

-Is to avoid or stop injecting drugs -enroll in a substance abuse treatment program.

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Injection Drug Use:

answer

Avoid Do Not Share Drug Injection Equipment Clean Equipment if Won't Stop Sharing (If injection equipment is reused, it should be boiled or cleansed with bleach) PrEP Reduces Transmission Risk Autologous Blood Transfusions (Ones own blood) -Reduces Risk Additionally, sexual activity should be discouragedwhen judgment is impaired from drug use because protective measures, which should be taught, may not be used.

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Perinatal Transmission Prevention:

answer

Routine Testing During Prenatal Care Repeat - Third Trimester for High Risk If HIV Positive, Antiretroviral Therapy Pregnancy, Labor, Delivery (NO BREAST FEEDING/C-SECTION ONLY) Infant Given Zidovudine (AZT) for 6 Weeks (ARV THERAPY)

question

Prevention for Health-Care Workers: (RARE)

answer

-Hand Hygiene -Personal Protective Equipment Standard Precautions -If it's wet & not yours, DON'T TOUCH it! -Cover your own open lesions/cuts Needlesticks: -No Recapping of Needles -Needleless Systems -Needle Safety Devices

question

Postexposure Prophylaxis Guidelines:

answer

Urgent Medical Condition Wash Exposure Site with Soap/Water (Test Source) Mucous Membrane Exposure, Flush with Water (Report to the closest emergency room immediately for further assessment and possible treatment) Consider Risk Test Source Treatment for 4 Weeks Begin Within Hours of Exposure

question

Postexposure *Initial* S/S of HIV?

answer

Initially after HIV infection, the patient can have no symptoms or can develop acute *retroviral syndrome* Can start 6-12 weeks post exposure and can be mild. -Extreme Fatigue -HEADACHE -Fever -Lymphadenopathy (enlarged lymph nodes in two sites other than inguinal nodes) -Diarrhea -Sore Throat These symptoms are usually mild and not attributedto the HIV infection.

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What are *late* S/S of HIV?

answer

After an extended asymptomatic phase, untreated HIV infection usually progresses to a symptomatic stage when the virus has greatly impaired the immune system. SOB Wt. Loss Night sweats Persistent Diarrhea Oral/Vaginal Candidiasis Dry Skin Peripheral Neuropathy Shingles Sz Dementia

question

What is the Final Stage of HIV?

answer

AIDS Diagnosis (Aids confirmation) CD4+T Lymphocyte Count Below 200 or Opportunistic Infections and Diseases (ONE) CDC Defined

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What is HAART?

answer

Highly Active Antiretroviral Therapy

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Complications Include:

answer

AIDS Dementia Complex (ADC) -Memory Impairment -Personality Changes -Hallucinations -Loss of Balance -Slow Responses *Safety Important*

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What is AIDS Wasting Syndrome?

answer

Involuntary loss of more than 10% of baseline weight + chronic weakness or fever or diarrhea for more than 30 days

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What are some of the contributing factors related to Wasting Syndrome?

answer

-Decreased appetite -Oral lesions -Altered metabolism -Malabsorption -Gastrointestinal (GI) infections -Diarrhea -Medication side effects -Cognitive impairment.

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What is HIV-Associated Neurocognitive Disorder?

answer

CNS infection by HIV

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What are S/S of HIV-Associated Neurocognitive Disorder?

answer

Memory Impairment Personality Changes Hallucinations Leg Weakness Loss of Balance Slower Responses

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Opportunistic Infection/ Cancer:

answer

Candida Albicans Cytomegalovirus Pneumocystis Jiroveci Pneumonia Tuberculosis Viral Infections Kaposi's Sarcoma

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What is the opportunistic infection Candida Albicans?

answer

Fungus found in GI tract. S/S: Oral or Esophageal Pain Dysphagia *Yellow-white Plaque cottage cheese in the mouth and throat* Itching/Discharge (Women w/aids)

question

What is the opportunistic infection Cytomegalovirus?

answer

CMV Causes retinitis -->Blindness *HIV/AIDS, especially when CD4+ T-lymphocyte counts fall below 100/mm3* S/S: Fever Fatigue Diarrhea GI Upset Hepatitis

question

What is the opportunistic infection Mycobacterium Avium Complex?

answer

MAC *Serious Bacterial infection can occur in those with AIDS when CD4+ T-lymphocyte counts drop below 50*. Found in Water, Food, Soil S/S: Fever Night Sweats Weight loss Abdominal Pain Tiredness Diarrhea Treatment includes a combination of clarithromycin and ethambutol, and possibly rifabutin

question

What is the opportunistic infection Pneumocystis Pneumonia?

answer

PCP S/S: SOB Fever Dry Cough Prophylactic oral trimethoprim-sulfamethoxazole (TMP-SMX [Bactrim, Septra, Cotrim]) is recommended

question

What is the opportunistic infection tuberculosis?

answer

Tuberculosis is a bacterial infection caused by the mycobacterium tuberculosis s/s dyspnea, cough, chest-pain, fever, night sweats, and weight loss. Mantoux tuberculin skin test (TST) with tuberculin purified protein deriva-tive should be performed at least yearly in patients with HIVinfection. Induration of 5 mm or more is defined as a positiveresult in patients with HIV infection (Only the palpable, raised, hardened area orswelling) is measured across the forearm and recorded in millimeters

question

What is the opportunistic infection Kaposi's Sarcoma (skin)?

answer

Raised lesion or flat, size of a quarter, brown/purple

question

What are some Diagnosis?

answer

HIV Antibody Tests CBC Lymphocyte Count CD4+/CD8+ T-lymphocyte Count Viral Load Testing Genotyping

question

HIV Antibody Testing Pattern?

answer

Enzyme-linked Immunosorbent Assay (ELISA) -Done to detect antibodies to HIV antigen in the patient's blood using test plates -*If Positive, Repeat Test* -If Again Positive, *Western Blot Test*(Done to detect the presence of antibodies to four major HIV antigens) If All Positive, HIV-antibody Positive

question

Viral Load Testing? (How much virus in blood)

answer

*Measures Amount of HIV RNA in Plasma* -Shows Response to Antiretroviral Therapy (Working/decreased) -1-Month After New Treatment -Then 3-Month Intervals Goal: Ultra-sensitive Undetectable Viral Load

question

Genotyping?

answer

Measures Resistance to Current Antiviral Treatments Guides Treatment Regimens that will most likely be effective against that person's virus.

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General Testing for?

answer

Syphilis Hepatitis A, B, C Liver Chemistry Panels -Coinfections can influence the course of either the patient's HIV or the coinfection. -It can also affect the HIV treatment options.

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Therapeutic Interventions

answer

No Cure Begin HAART Highly Active Antiretroviral Tx (Make sure they comply with regiment) Goal of Therapy -Prevent/Delay Opportunistic Diseases

question

Prophylactic Intervention

answer

Hepatitis A, B Flu Vaccine Pneumonia Vaccine Herpes Simplex Microbacterium Avium Complex -Found in H2O, food & soil Pneumocystis jiroveci Pneumonia -Prophylactic Sulfa med tx (Bactrim, Septra)

question

Therapeutic Intervention Antiretroviral Therapy (ART) (Stops the virus from replicating)

answer

*Saquinavir (Invirase)* -*Interfere with virus replication by doing/surpresses HIV infectionto prevent complication* Early, Aggressive Treatment Multiple-drug Therapy -Three Drugs in at Least Two Classes of Treatment Categories Reduces Viral Load to Undetectable Level -This, viral load testing is routinely performed to monitor the effectiveness of ART Prolongs Survival

question

Nursing Interventions Ineffective Protection:

answer

Hand Hygiene/Bathing Avoid Sharing Grooming Items Wash Toothbrush Clean Dishes Report Infection Symptoms

question

Nursing Interventions Pain:

answer

Identify Cause Medications Complementary Therapy Heat/Cold Massage Positioning

question

Nursing Interventions Fatigue:

answer

Alternate Activity and Rest Prioritize Activity Timing

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Nursing Interventions Imbalanced Nutrition: Less Than Body Requirements:

answer

Identify Interfering Factors Weigh Monitor Caloric Intake Dietary Consult Small, Frequent Meals Antiemetics

question

Nourishing the Patient With HIV or AIDS:

answer

•Offer small, frequent feedings. •Serve food cold or at room temperature. •Alter seasonings. •Add powdered milk to mashed potatoes or puddingsto increase calories and protein. •Modify texture to accommodate chewing difficulty or oral lesions. •Provide nutritional supplements (e.g., Boost or Ensure)

question

Teach the family of a patient with AIDS which signs and symptoms to report to the physician or nurse immediately

answer

Fever; increased dyspnea; pain; change in sputum production; upper respiratory tract infection; pneumonia; respiratory distress syndrome; diarrhea five times a day or more for 5 days; uncontrolled weight loss greater than 10 pounds in the past month; persistent headaches; falling; seizures; mental status changes, including memory loss and personality changes; rashes and skin changes; difficulty swallowing; and problems with urination.

question

The nurse would evaluate the patient as understanding modes of HIV transmission if the patient stated that the modes of HIV transmission include which of the following? 1.Saliva, tears, fecal-oral contamination 2.Close physical contact involving skin surfaces,mosquito bites 3.Sharing towels, sharing eating utensils, skin contact 4.Unprotected sex with HIV-infected partner, contact with infected blood products

answer

4. HIV is transmitted from human to human only through infected blood, through sexual secretions, and from an infected mother to her unborn baby or to her infant via breast milk.

question

The nurse is teaching a patient about HIV testing. Placetraditional HIV-1 diagnostic tests in the sequential orderin which they are performed. 1.Western blot test 2.Enzyme-linked immuno sorbent assay (ELISA) test 3.Repeated ELISA test

answer

2, 3, 1. ELISA detects antibodies to the HIV antigen. If positive,the test is repeated. If positive again, the Western blot test detects antibodies to four major HIV antigens and is positive if two antibodies are present.

question

A patient who is newly diagnosed with HIV infection asks what to expect for future health status. The best re-sponse for the nurse to give is based on the understanding that HIV disease and AIDS are characterized as which of the following? 1.An acute disease 2.A life-ending disease 3.A chronically managed disease 4.A disease with remissions and exacerbations

answer

3. HIV is a chronically managed disease with treatment.

question

The nurse is planning to teach a patient about HIV prevention. What should the nurse include in a teaching plan to prevent HIV infection? Select all that apply. 1.Recapping of used needles by caregiver permitted. 2.Abstain from sexual intercourse. 3.Avoid injection drug use. 4.Avoid use of male or female condoms. 5.Plan for autologous blood transfusion. 6.Test for HIV at time of labor.

answer

2, 3, 5, 6. Ways to prevent HIV infection include abstinence,avoiding injection drug use, autologous (self) blood transfusion,and testing for HIV at the time of labor to begin treatment.

question

The nurse is contributing to the teaching plan for a patient with HIV on reducing infection risks. Which of the following should the patient with HIV be taught to do to decrease risk of infections? Select all that apply. 1.Wash hands before eating. 2.Wash toothbrush. 3.Reuse dishes. 4.Buy prepared deli foods. 5.Report signs of infection. 6.Share razor if no visible blood.

answer

1, 2, 5. Preventing infection risk is done with good hygiene(hand washing, toothbrush washing, not reusing dishes, not sharing grooming items), avoiding deli foods that may harbor bacteria, and promptly reporting infection signs.

question

The nurse would recognize that the patient needs further reinforcement of knowledge if the patient stated that one of the goals of antiretroviral therapy is which of the following? 1.Reduce the viral load. 2.Improve survival rates. 3.Decrease CD4+ T lymphocytes. 4.Delay the progression of HIV disease.

answer

3. HIV causes decreased CD4+ T lymphocytes, so the goal of antiretroviral therapy is to control the virus so CD4+ T lymphocytes will increase.

question

The nurse would recognize that the patient is having a reaction to abacavir sulfate (Ziagen) if which of the following occurred? 1.Flu-like symptoms 2.Edema 3.Abdominal pain 4.Blurred vision

answer

1. Flulike symptoms indicate a reaction to abacavir sulfate (Ziagen) can be occurring.

Chapter 20 Nursing Care of Patients With HIV Disease and AIDS – Flashcards

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