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HIV & AIDS

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Medication for HIV
*goal is:
- slow replication of the virus
- suppressing, preventing or stopping opportunistic infections
- boost the immune system
*some MD's hit hard with combo therapy as soon as dx is made, some wait until CD4 levels drop below 500 d/t problems with drug resistence
What is safer sex?
*solitary masturbation
*fantasy
*mutually monogamous relationship with a noninfected partner in which both partners have been negative HIV tests 3 months apart
Other tests
Viral Load Testing - measures the presence of HIV viral genetic material (RNA) or another actual viral protein in the persons blood. Quantitative and very useful in monitoring disease progression and treatment effectiveness
Diagnostic evaluation of HIV tests
*after infection, it takes 3 weeks to 3 months to test positive for HIV antibodies
*ELISA- detects the presence of antibody
*Western Blot- done if ELISA+ detects serum antibodies to 4 specific major HIV antigens; considered + if 2 are present
What kind of isolation is a person with HIV put in?
Blood & body fluid precautions (standard precautions)
What is difference between confidential vs. anonymous test?
Confidential- name is on test
Anonymous- name is not on test (can buy these at Walgreens)
You are stuck with a needle of a patient who has not been HIV tested, what do you do?
*Wash hands (don't squeeze)
*tell manager
*go to ER, get tested, begin viral meds
*explain HIV testing to pt; get dr. order; if pt says 'no' there is nothing you can do
Retrovirus
*they only have RNA and they have reverse transcriptase (RT) an enzyme that makes them more efficient at replicating (1 virus particle can replicate 250 times)
*Retrovirus include: HIV1, HIV2, HTLV 1 (adult T cell leukemia-lymphoma) HTLV II (hairy cell leukemia) HTLV (cutaneous T cell lymphoma)
Lymphocytes
*defend the body- two types
B cells change into plasma cells and secrete antibodies (humoral immunity) T cells attack an antigen directly (cell mediated immunity)
*2 groups of T cells are important in HIV
-T4 cells (CD4 or helper T cells) are vunerable to HIV
-T8 cells (CD8 or supressor T cells) inhibit the immune response
What defines AIDS?
*HIV positive
*CD4+ T-lymphocyte (T4) count below 200/mm3 or
*CD4+ T-lymphocyte total percentage below 14
Immunodeficient people that do not have HIV or AIDS?
oncology pts, elderly, babies
Protease Inhibitors
*they inhibit the activity of HIV protease, an enzyme essential for replication. Inhibiting HIV protease leaves the viral particles non-infectious
*s/e: ^blood glucose and diabetes, fat accumulation, diarrhea, and ^cholesterol
Nucleoside analogue reverse transcriptate inhibitors (NARTI)
*slow the replication of HIV by blocking the RT enzyme. Without RT, the HIV virus does not replicate
*s/e: liver dysfunction, n/v, HA, insomnia, peripheral neuropathy, neutropenia, seizures, lethargy
What is safe sex?
*mutual masterbation
*wearing a latex glove when exploring rectum or vagina
*closed-mouth kissing
*massage
*hugging
*body to body rubbing
Best ward to place HIV/ AIDS on?
oncology...others are already immunosuppressed
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
*inhibit replication of HIV by blocking RT enzyme. By changing the RT it becomes inactive
*s/e: liver dysfunction, HA, rash, dizziness, nightmares, n/v, diarrhea, fatigue, neutropenia
HIV/AIDS, what to assess?
*Immunologic (<WBC, night sweats, fever
*integumentary (poor healing wounds, Karposi's sarcoma, Herpes) *respiratory (Mucous membrnes, candida infections, swollen lymph nodes, sores in mouth, bleeding gums) *gastrointestinal
*CNS (baseline mental status) *opportunistic infections (H. pylori-ulcers) *malignancies (cancers) *AIDS dementia complex (<LOC, confusion)
*wasting syndrome (thin, emancipated)
Opportunistic Infections
*Protozoal infections (pneumocystis carinii pneumonia, toxoplasmosis, cryptosporiosis, isoporiasis) *fungal infections (candidiasis, histoplasmosis, crytococcosis) *bacterial infections (myobacterium avium-intracellulare complex, TB) *viral infections (cytomegalovirus, herpes simplex, varicella-zoster)
Malignancies
*Karposi's sarcoma
*Non-Hodgkins lymphoma
*Hodgkin's lymphoma
*Invasive cervical carcinoma
Therapeutic interventions
*education *drug therapies *comfort
*social isolation *support
*nutrition *skin/mouth care *quality of life
*prevent infections *complementary therapy
*spiritual support *sex education

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