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Jan Nio A. Estrella Mary Breathe B. Mabaquiao BSN 4B, RLE Group 2

Acquired Immunodeficiency Syndrome (HIV Infection)

AIDS is defined as the most severe form of a continuum of illness associated with HIV infection. HIV belongs to a group of viruses known as retro viruses. These viruses carry their genetic material in the form of ribonucleic acid (RNA) rather than deoxyribonucleic acid (DNA). Infection with HIV occurs when it enters the host CD4 (T) cell and causes this cell to replicate viral RNA and viral proteins, which in turn invade other CD4 cells. The stage of HIV disease is based on clinical history, physical examination, laboratory evidence of immune dysfunction, signs and symptoms, and infections and malignancies. The stage of primary infection is acute and spans the time from infection to antibody development. Four categories of infected states have been denoted: Primary infection (part of CDC Category A: dramatic drop in CD4 T-cell counts from normal level between 500 and 1500 cells/mm3) HIV asymptomatic (CDC Category A: more than 500 CD4+ T lymphocytes/mm3) HIV symptomatic (CDC Category B: 200-499 CD4+ T-lymphocytes/mm3) AIDS (CDC Category C: fewer than 200 CD4+ T-lymphocytes/mm3)

Blood transfusions or blood products contaminated with HIV Children born to mothers with HIV infection Breastfed infants of HIV-infected mothers Health care workers exposed to needle-stick injury associated with an infected patient

Clinical Manifestations
AIDS begins with HIV infection. People who are infected with HIV may have no symptoms for 10 years or longer, but they can still transmit the infection to others during this symptom-free period. If the infection is not detected and treated, the immune system gradually weakens and AIDS develops. Acute HIV infection progresses over time (usually a few weeks to months) to asymptomatic HIV infection (no symptoms) and then to early symptomatic HIV infection. Later, it progresses to AIDS (advanced HIV infection with CD4 T-cell count below 200 cells/mm3 ). Almost all people infected with HIV, if they are not treated, will develop AIDS. There is a small group of patients who develop AIDS very slowly, or never at all. These patients are called nonprogressors, and many seem to have a genetic difference that prevents the virus from significantly damaging their immune system. The symptoms of AIDS are mainly the result of infections that do not normally develop in people with a healthy immune system. These are called opportunistic infections.

Risk Factors
Heterosexual intercourse with an HIVinfected partner Injection drug use Male homosexual relations

Respiratory - Shortness of breath - Dyspnea - Cough - Chestpain - Fever - HIV associated tuberculosis

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Gastrointestinal - Loss of appetite - Nausea and vomiting - Oral and esophageal candidiasis - Chronic diarrhea - Cachexia Neurologic - HIV encephalopathy - HIV-related peripheral neuropathy - Vascular myelopathy Integumentary - Kaposis sarcoma, herpes simplex, and herpes zoster viruses and various froms of dermatitis assosciated with painful vesicles. - Dry flaking skin Reproductive - Persistent recurrent vaginal candidiasis maybe the first sign of HIV - Venereal warts - Cervical cancer - Higher ncidence of pelvic inflammatory disease and menstrual abnormalities. Hematologic/ lymphatic - B-cell lymphomas -develop outside the lymph nodes, grow aggressively, affect multiple organs and exhibit resistance to treatment. Other -

Assessment and Diagnostic methods

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Enzyme immunoassay
-(EIA) is a test used to detect and quantify specific antigen-eliciting molecules involved in biological processes, specifically processes related to cancer and autoimmune disorders. EIA can be used on most types of biological samples, such as plasma, serum, urine, and cell extracts. In the assay, a plate is coated with a primary antibody, which recognizes the antigen of the target molecule and bonds with it. The antigen-antibody complex is recognized by a secondary antibody that is joined to an enzyme that catalyzes the reaction mixture, yielding a specific color. By measuring the optical density of this color, the presence and number of a specific molecule can be determined; the density of color is proportional to the advancement of the reaction or disease being tested.

HIV-1 western blot assay

-This test measures the amount of antibodies to the HIV virus in blood. This test is used to confirm the diagnosis of a suspected HIV infection.

Higher than usual incidence of cancer Depressive symptoms Irrational guilt Shame Loss of self esteem Helplessness Worthlessness Suicidal ideations

Viral load test

-A viral load test measures the amount of HIV in your blood. It does this by measuring the number of copies of a specific part of the virus called RNA or ribonucleic acid.

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Why do I need a viral load test if I have already had an HIV test?
An HIV antibody test indicates whether you are infected with HIV, the virus that causes AIDS. A viral load test shows how much of the HIV virus is in your blood. While you will have an HIV antibody test only at diagnosis, you will have viral load tests on a regular basis.

Combination therapy is defined as a regimen containing at least two antiretroviral agents; highly active antiretroviral therapy (HAART) includes at least one nucleoside reverse transcriptase inhibitor plus various other drug combinations.

Pharmacologic Therapy
Antiretroviral Therapy (ART) (For combination regimens with at least three medications) Nucleoside/nucleotide reverse transcriptase inhibitors (NRTI) Non-nucleoside reverse transcriptase inhibitors (NNRTI) Protease inhibitors (PI) Fusion inhibitors (FI) Medications for HIV-Related Infections PCP: trimethroprim-sulfamethoxazole (TMPSMZ) and antibacterial agents, such as dapsone; alternatively, pentamidine, an antiprotozoal agent. MAC: treatment for MAC infections involves use of either clarithromycin (Biaxin) or azithromycin (Zithromax). The combination of azithromycin with rifabutin (Mycobutin) is more effective but costly, with more adverse effects and interactions. Cryptococcal meningitis: intravenous amphotericin B with or without antifungal agents, such as fluconazole (Diflucan) or flucytosine (Ancobon) CMV retinitis: ganciclovir, foscarnet, or cidofovir Encephalitis: pyrimethamine (Daraprim) and sulfadiazine or clindamycin (Cleocin) Candidiasis: clotrimazole (Mycelex), ketoconazole, or fluconazole

Collaborative problem/ potential Complications

Opportunistic infections Impaired breathing or respiratory failure Wasting syndrome and fluid and electrolyte imbalance Adverse reaction to medications

Medical Management
Currently there is no cure for HIV or AIDS, although researchers continue to work on developing a vaccine. Treatment decisions for an individual patient are based on three factors: HIV RNA (viral load) CD4 T-cell counts Clinical condition of the patient (severity of symptoms and patients commitment to participate in lifelong therapy) Goals of reatment: Maximal and durable suppression of viral load Restoration and/or preservation of immunologic function Improvement of quality of life Reduction of HIV-related morbidity and mortality

Page 4 of 5 Anticancer Agents KS: alpha-interferon, surgical excision of lesions, liquid nitrogen to lesions , vinblastine injected into intraoral lesions, interferon; chemotherapy with doxorubicin (Adriamycin), bleomycin, and vincristine (ABV); radiation Lymphomas: limited successful treatment; chemotherapy and radiation therapy may be used Immunomodulators Alpha-interferon Other substances under evaluation (interleukin-2, interleukin-12, and other cytokines and lymphokines) Antidepressants Psychotherapy is integrated with pharmacology (imipramine (Tofranil), desipramine (Norpramine), fluoxetine (Prozac), methylphenidate (Ritalin); electroconvulsive therapy if depression is severe) Antidiarrheal Agents and Appetite Stimulants Octreatide acetate (Sandostatin) is given to treat diarrhea and megestrol acetate (Megace) or dronabinol (Marinol) to stimulate appetite Parenteral nutrition, vegetarian and macrobiotic diets Vitamin C or beta-carotene supplements, turmeric (curcumin), and Chinese herbs

Administration of intravenous fluid and electrolyte replacement may treat imbalances Drug and Biologic Oxygen, ozone, and urine therapy Physical Forces and devices Acupuncture, acupressure, massage therapy, yoga, therapeutic touch, reflexology, crystals

Nursing Management
1. Improving airway clearance
Note and document presence of cough and quantity and characteristics of sputum. Encourage adequate rest to minimize energy expenditure and prevent fatigue. Provide pulmonary therapy,s uch as coughing, deep breating, percussion and vibration, every 2 hours to prevent stasis of secretions and promote airway clearance. Assist patient into a position that facilitates breathing and airway clearance. Encourage increase in fluid intake.

Supportive Care and Alternative Therapies

Spiritual Laughter, hypnosis, faith healing, guided imagery, positive affirmations Nutritional Goal is to attain and maintain ideal weight and decrease risk of infections Appetite stimulants, oral supplements

2. Promoting skin integrity

Inspect daily for skin breakdown, ulceration, and infection. Encourage patient to balance rest and activity; assist immobile patients to change position every 2 hours. Keep bed linen free of bed wrinkles, and avoid tight or restrictive clothing to redue friction to skin.

Page 5 of 5 Maintain perianal integrity. Instruct the patient to keep the area as clean as possible, to cleanse after bowel movement, and to dry them are thoroughly after cleaning.

6. Improving nutritional status

Monitor oral cavity for redness, ulcerations and creamy white patches. These can interfere with eating. Control nausea and vomiting Encourage patient to eat easy to swallow foods. Provide oral care before and after eating. Encourage rest before meals.

3. Promoting usual bowel habits

Assess bowel patterns for diarrhea (frequency and consistency of stool, pain or cramping with bowel movements) Counsel patient on ways to decrease diarrhea (rest bowel, avoid foods that acts as bowel irritants, including raw fruits and vegetables)

7. Decreasing sense of social isolation

Provide an atmosphere of acceptance and understanding of AIDS patients, families, and partners. Encourage patient to express feelings of isolation and loneliness; assure patient that these feeling are no unique or abnormal. Assure families and friends that AIDS is not spread by casual contact.

4. Preventing infection
Monitor laboratory values that indicate the presence of infection. Limit visitors, let the patients folks/visitor wear masks if they are coughing or is having flu. Teach patient and folks about proper hand washing. Strongly urge patients and partners to avoid exposure to body fluids and to use condoms for any sexual activities. Strongly discourage IV injection drug use because of risk to patient of other infections and transmission of HIV infection. Maintain strict aseptic technique for invasive procedures.

5. Relieving pain and discomfort

Assess patient for quality of pain associate with impaired perianal skin integrity. Teach patient about relaxation techniques.