Nursing Management of Clients with HIV and AIDS

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Nursing Management of Clients with HIV and AIDS

• Tracy Heberlig, MSN, RN
• NURS 228 Spring 2007

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Stress the Immune Response

• ? / function of NK cells
• ? lymphocyte production
• ? production of cytokines (interferon,
  interleukins)
• ? phagocytosis

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HIV AIDS

• "These are the faces of children and families
  living in a world of AIDS. Their spirit, their
  determination, and their resilience inspire all
  of us to join the fight. We are one world, and
  these children are our children. Their destiny is
  our destiny. Each of us can make a difference.
  Each of us can help save lives. "
• Archbishop Desmond Tutu

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HIV AIDS

• Global Estimates
• 38.6 million adults and children living with HIV
  or AIDS
• Highest in sub-sahara Africa
• Global Epidemic
• More than 39 million people have died of AIDS
  since 1982
• Africa More than 12 million orphans
• AIDS kills 8,000 people each day
• 1 person every 10 seconds

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HIV AIDS

• Global Epidemic
• By the end of 2005, women (15 24 years of age)
  accounted for half of all new HIV infections
  worldwide around 6,000 become infected with HIV
  every day
• In developing and transitional countries, 6.8
  million people are in need of life saving HIV
  meds. Only 1.65 million receive the meds.

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HIV AIDS

• US Data
• African Americans accounted for 50 of all
  HIV/AIDS cases diagnosed in 2003
• Males 72 of these cases
• Approximately 40,000 newly diagnosed HIV
  infections yearly
• Half of these in men women under age 25

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HIV AIDS

• North Carolina
• Continued ? in minority deaths related to HIV /
  AIDS (African Americans males up 29 from 1999
  -2000)
• 5th leading cause of death in NC (2000) for all
  persons ages 15 44

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Risk Factors

• Sexual Transmission
• Blood Borne Transmission
• Perinatal Transmission
• High Risk Behaviors
• SAFE SEX NO SEX
• Safer Sex

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HIV Transmission

• HIV-1 CD4 T lymphocytes
• How is it transmitted?
• How is it not transmitted?
• Window Period

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HIV

• Diagnostic Findings
• HIV Antibody Tests
• EIA
• Western Blot
• OraSure
• OraQuick Rapid HIV-1 Antibody
• Viral Load Tests
• Diagnostic Implications for Patients
• Positive test
• Negative test

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HIV

• Stages
• Primary Infection
• HIV Asymptomatic
• HIV Symptomatic
• AIDS

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Clinical Manifestations

• Fatigue
• Respiratory
• PCP (most common infection in PWAs)
• MAC
• TB

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Clinical Manifestations

• GI
• Diarrhea (50-90) of all AIDS patients
• Oral Candidiasis (occurs in almost all PWAs and
  those w/ ARCs)
• Wasting Syndrome Category C
• Oral Hairy Leukoplakia (EB virus)

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Clinical Manifestations

• Oncologic
• Kaposis Sarcoma (KS)
• Most common HIV-related malignancy
• Cutaneous signs may be 1st manifestation of HIV
• Appears 90 of HIV patients as immune system
  deteriorates
• B-cell Lymphomas

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Kaposis sarcoma in HIV
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Clinical Manifestations

• Neurologic
• Occurs in an estimated 80 of PWAs during the
  course of HIV infection
• HIV Encephalopathy
• Formerly called AIDS dementia complex
• Cryptococcal meningitis
• PML
• Depression

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Clinical Manifestations

• Gynecologic
• Persistent, recurrent vaginal candidiasis
• May be the 1st sign of HIV infection in women
• Ulcerative STDs
• HPV

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HAART

• CDC Protocols, Individualized
• Antiretrovirals
• Bone marrow suppression
• Lipodystrophy syndrome
• Hypercholesterolemia, Heart Disease, DM
• NRTIs
• NNRTIs
• PIs
• Hepatotoxicity

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HAART Nsg Interventions

• Education
• Compliance
• VL testing
• Lifetime regimen
• Combination therapy
• Resistance

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Medical Management

• TMP-SMZ (Bactrim, Septra)
• Intermediate-acting sulfonamide
• IV and Oral (bid)
• Treatment of choice for PCP or chemoprophylaxis
• Drug-related rash (pruritic, pinkish-red macules
  papules) 60 will develop
• Increased fluid intake recommended
• More susceptible to toxicity

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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

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Medical Management

• Biaxin (clarithromycin) and Zithromax
  (azithromycin)
• Chemoprophylaxis against MAC
• amphotericin B (Fungizone)
• Antifungal for cryptococcal meningitis
• IV
• Highly toxic
• Nephrotoxicity, Hypokalemia, Hypomagnesemia

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Medical Management

• acyclovir (Zovirax), famciclovir (Famvir),
  valacyclovir (Valtrex)
• Purine Nucleosides
• Zovirax, Famvir HSV, HZ, Candidiasis
  (oral/esophageal)
• Valtrex - HSV, HZ
• Monitor renal and hepatic functions

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Medical Management

• ganciclovir (Cytovene) and valganciclovir
  (Valcyte)
• Purine Nucleoside for treatment of CMV retinitis
• IV
• Adverse effects
• Neutopenia common adverse reaction
• Limits use of AZT
• Thrombocytopenia, Granulocytopenia

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Nutritional Therapy

• Nutritional consult
• Appetite stimulants
• Oral supplements

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Nursing Process

• Assessment
• Identification of risk factors
• Nutritional status
• Physical assessment

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Nursing Process

• What are the common nursing diagnoses for
  HIV/AIDS?
• What are the overall goals for the patients?

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Nursing Interventions

• How can we promote skin integrity?
• What are the major risks PWAs have?
• What will we teach them?
• What are the PCs that can develop?
• What is the nurses role?

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HIV and AIDS

• What psychosocial issues develop?
• What ethical issues develop?
• Emotional and Ethical Concerns

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Healthcare Provider Exposure

• Wash area immediately
• Alert supervisor
• Identify source patient testing
• Employee Health or ED
• Baseline testing
• Prophylaxis
• Follow up testing
• Counseling

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How will the faces of AIDS affect you?
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• RYAN WHITE 1971-1990

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Jonathan Larson (February 4, 1960 January 25,
1996)