HIV/AIDS

1. Pathophysiology
HIV virus binds with receptors on CD4 cells
Viral RNA enters the host cell
RNA transcribed into single DNA strand with the help of reverse transcriptase (enzyme made
by retrovirus)
DNA splices into genome and becomes a permanent part of cells genetic structure
Re: virus attaches to CD4, RNA enters cells, transcription to DNA, DNA copies, DNA
enters nucleus of cell, DNA becomes permanent
o 2 main things happen
Every daughter cell will have the virus
Sends chemical messages to make more viral copies
2. Assessment findings (including a focused assessment)
Acute Infection: fever, swollen lymph nodes, sore throat, muscle and joint pain, malaise,
nausea, diarrhea, and possible rash (flu-like symptoms).
o High viral load, temporary fall in CD4 count
Chronic infection:
o Early: CD4 T cell counts above 500; low viral load; Asymptomatic or fatigue,
headache, low grade fever, night sweats
o Intermediate: CD4 T cell counts 200-500 cells/microliter; viral load increasing;
symptoms include persistent fever, recurrent headaches, drenching night sweats,
chronic diarrhea, fatigue; seeing unusual infections
o Late: AIDS criteria met; CD4 T cell count less than 200; wasting syndrome; Kaposis
sarcoma malignant lesions; opportunistic infections occur; opportunistic cancers
3. Laboratory Diagnostic tests (know normal/abnormal values)
EIA: Enzyme Immunoassay
o Detects antibodies to HIV antigens
o If positive, is repeated a second time
If negative on the second try, then negative
If positive on the second try, then do the western blot
Western Blot
o More definitive
o If positive, then blood is HIV positive
o Indeterminate findings- risk assessment
Behaviors, use of drugs, sexual partners, activities
Maybe tested in 1 month, 3 months
Book: 1,2, then 6 months later
Use protection every time in sexual encounter
Rapid Testing for HIV
o Results in 20 minutes
o Follow up testing, assessment if result negative
o If positive, confirm with western blot

CD4 T cell count

o Normal is 800-1200 cells per microliter
Viral Load
o Actual number of viruses per microliter
CBC
o Decreases in WBC, neutrophils, platelets, Hgb, Hct
WBC: 5,000-10,000
Platelets: 150,000-400,000
Hgb: 13.5-18 and 12-16
Hct: 40-54 and 36-46
Liver function tests
o Abnormal due to disease/drug therapy
o Abnormal due to hepatitis B or C
o When HIV present, course of hepatitis is more serious and higher mortality

4. Nursing Interventions / treatments (including medications) with rationale

Prevent HIV transmission (condoms)
Manage symptoms (rest and medication)
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
o Combine with reverse transcriptase to block conversion of HIV RNA into HIV DNA
Nucleoside reverse transcriptase inhibitors (NRTI)
o Insert a piece of DNA into developing HIV DNA; blocks further development of the
chain, viruses cant replicate
Nucleotide reverse transcriptase inhibitors (NtRTIs)
o Inhibit action of reverse transcriptase
Protease inhibitors (PI)
o Prevent cutting of HIV proteins needed to help virus assemble and move away from
host cell membrane
Entry inhibitors
o Prevent binding of HIV to cells and replication cant occur

Result: keeping the viral load low and keeping CD4 levels within normal!!

5. Nursing Diagnoses (at least 4 priority for each disease process)

Acute Pain
Anxiety and fear
Deficient Knowledge
Fatigue
6. Patient Teaching
Work Place
o Safety devices
Especially healthcare
Safety with needles
Drug Use

o Do not do drugs
o Do not share equipment
o Do not have sex under the influence
Perinatal Transmission
o Treatment
o Prevent women from it
o Talk to the women about her options and the possibility that the child can have
HIV/AIDS
Sexual Intercourse
o Safe sex
o Abstinence
o Masturbation
o Use condoms
Male or female kind