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What type of cell is HIV attracted to?
- CD4 T-cells
- immune system cells
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What is the attraction of the HIV virus to the CD4 cells?
the membrane
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Name the 7 steps of HIV Pathophysiology
- 1.) exposure into blood stream
- 2.) attracted to CD4 T-cells – this is a helper cell that plays a huge roll in the functioning of the immune system (particularly the membrane)
- 3.) Virus fuses to membrane and breaks it down
- 4.) This allows it to ENTER THE CELL
- 5.) Retrovirus – takes RNA (own genetic material) and inserts it into the DNA of the cell via enzyme reverse transcriptase –
- 6.) roll changed to HIV factory instead of immune cell (increases viral load)
- 7.) CD4 T-cells start to become destroyed over time
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How does the retrovirus act on the cell?
takes RNA (own genetic material) and inserts it into the DNA of the cell via enzyme reverse transcriptase
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How is the HIV virus transmitted?
via body fluids (Semen, blood, vaginal secretion, breast milk)
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The HIV virus transmits through broken skin of the?
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Parenteral acts that lead to transmission?
- sharing needles
- blood transfusion
- occupational exposure
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Perinatel acts that lead to transmission?
- mother to baby via:
- delivery
- pregnancy (via placenta)
- breast feeding
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When the HIV viral load increases the CD4 T-Cells ?
- decrease
- making pt susceptible to opportunistic infections
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CD4 antibodies continue to develop but they are ...?
- incomplete and non-functional
- abnormally functioning macrophages
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Stage 1 HIV definition
- CD4 T-cell count >500 or >=29%
- No aids defining illness
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Stage 2 HIV definition
- CD4 T-cell count 200-499 or 14-28%
- No aids defining illenss
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Stage 3 HIV definition
- CD4 T-cell count <200 or <14%
- Has aids defining illness
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What to teach all people about HIV
all are susceptible to HIV regardless of age, gender, ethnicity, or sexual orientation
anyone that is sexually active should be tested
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Why are females at higher risk for getting HIV?
- larger surface area of mucous membrane
- Low estrogen (older women) = breaks in the integrity of vagina because of dryness
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Why is anal sex the riskiest for any gender?
Skin tears easily
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What do we need to teach to patients taking Truvada for Pre-Exposure prophylaxis?
- Safe sex practices (condoms)
- adhere to every-3-month HIV testing
- monitor for side effects
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What is the first test done to look for HIV antibodies?
ELISA
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Name the 2nd test done if positive ELISA
Western Blot or IFA (immunofluorescence assay)
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What is the 3rd test done if positive for HIV
- Viral load (how much of the HIV virus is there)
- CD4 T-cell counts
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What do HAART or cAART drugs do?
interferes with the replication of RNA – does NOT kill the virus
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Why do we not give monotherapy?
INCREASES DRUG RESISTANCE
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Name bacterial (defining conditions) opportunistic infections:
- Mycobacterium avium: most common non-TB in the US
- Mycobacterium tuberculosis: ppd will show negative because they are too compromised to produce antibodies to react.
- Salmonellosis
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What to do if you have a patient with cough, night sweats
put a mask on the patient and get away from other patients, mask, isolate, airborne precautions (negative pressure room)
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Name Viral (defining conditions) opportunistic infections:
- Herpes 1 & 2
- Varicella (Shingles)
- Hepatitis B & C
- HPV
- Cytomegalovirus: major cause of blindness in patients – don’t need to know
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Name Fungal (defining conditions) opportunistic infections:
- Histoplasmosis – bird and bat feces
- Cryptoccoccosis – bird feces – moves from lungs to brain (neuro checks, HA, alert for seizure)
- Coccidiodomycosis – Valley Fever
- Candidiasis – yeast (thrush)
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Name Protozoal (defining conditions) opportunistic infections:
- Toxoplasmosis encephalitis – monitor neuro
- Cryptosporidosis – exceptionally water diarrhea (dehydration)
- Pneumocystitis jiroveci pneumonia (PCP) – this happens often when patients don’t know they are HIV+ alveoli damage. Septra is the drug of choice
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Name malignancies (defining conditions) opportunistic infections:
Karposi sarcoma – cancer of connective tissue – interferon seems to help with decreasing lesions
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Name another (defining conditions):
Wasting syndrome – wasting from HIV+ - significant diarrhea, oral-esophageal lesions
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When taking care of a patient with HIV/Aids what do we need to do regarding their friends and family?
find out who is aware in the patient's circle
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Education for HAART or cAART drugs focus on ...?
- do not miss, delay or lower doses
- even a few missed doses per month can promote drug resistance
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What can we do for patients with decreased gas exchange?
- pace activities
- rest
- O2
- HOB up
- bronchodilator
- cluster care
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What do we do to promote weight gain?
- learn food preferences
- learn foods for their culture
- high, dense calories
- high protein
- low fat
- monitor albumin, prealbumin, proteins
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What do we do for thrush?
- frequent oral care
- soft tooth brush
- soft foods
- avoid alcohol mouthwashes
- get an order for medication
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What do we do for diarrhea?
- malabsorption
- hydration
- safety (falls)
- skin integrity
- find out if it is infectious of nature (WILL NEVER GIVE LAMOTIL – IF INFECTIOUS)
- decreased fat
- decreased spices, sweets, alcohol…
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What do we need to do to preserve skin integrity?
- check Q6-8H
- keep the perianal area clean and dry
- tell UAP to report any changes that they see.
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What are the priorities for patients with Confusion/dementia?
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Early manifestations of RA
- joint inflammation
- low-grade fever
- fatigue
- weakness
- anorexia
- paresthesias
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Late manifestations of RA
- joint deformities
- moderate to severe pain and morning stiffness
- osteoporosis
- severe fatigue
- anemia
- weight loss
- SQ nodules
- peripheral neuropathy
- vasculitis
- pericarditis
- fibrotic lung disease
- sjogren's syndrome
- kidney disease
- felty's syndrome
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What are the symptoms of Sjogren's?
- dry eyes
- dry mouth (Xerostomia)
- dry vagina
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Why are we concerned when an RA patient has neck pain?
C3-C4 Subluxation – can paralyze patient or impair breathing
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What is Felty's syndrome?
- hepatosplenomegaly
- leukopenia
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What do we teach patients taking MTX?
- risk of infection
- avoid ETOH - liver tox
- monitor for oral ulcers, dyspnea (pneumonitis)
- monitor for lymph node tumors (rare)
- Folic Acid to decrease side effects
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What part of the healthcare team assists RA patients?
Occupational therapy
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Education on energy conservation for patient with RA
- balance activity with rest - naps
- pace yourself
- set priorities
- delegate responsibilities
- plan ahead to prevent rushing and stress
- learn activity tolerance and don't exceed it
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What are the adverse effects of meds for SLE?
- osteonecrosis
- osteoporosis
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What is the leading cause of death for SLE?
Lupus nephritis
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What are the classic signs of SLE?
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What are common effects of SLE?
Pleural effusions
Pancytopenia
Raynaud’s phenomenon – secondary to arterial vasospasm
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Education for patients taking steroids and DMARD's
- avoid large crowds and ill
- report early signs of infection
- report adverse effects
- take meds in am before breakfast when corticosteroid level is the lowest
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Education for SLE patients regarding the sun
- avoid prolonged exposure
- wear long sleeves and large hats
- sun block SPF30 or higher
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