M/S - Exam 2 HIV and Rheum

  1. What type of cell is HIV attracted to?
    • CD4 T-cells
    • immune system cells
  2. What is the attraction of the HIV virus to the CD4 cells?
    the membrane
  3. 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
  4. 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
  5. How is the HIV virus transmitted?
    via body fluids (Semen, blood, vaginal secretion, breast milk)
  6. The HIV virus transmits through broken skin of the?
    • genitals
    • anus
    • mouth
    • eyes
  7. Parenteral acts that lead to transmission?
    • sharing needles
    • blood transfusion
    • occupational exposure
  8. Perinatel acts that lead to transmission?
    • mother to baby via:
    • delivery
    • pregnancy (via placenta)
    • breast feeding
  9. When the HIV viral load increases the CD4 T-Cells ?
    • decrease
    • making pt susceptible to opportunistic infections
  10. CD4 antibodies continue to develop but they are ...?
    • incomplete and non-functional
    • abnormally functioning macrophages
  11. Stage 1 HIV definition
    • CD4 T-cell count >500 or >=29%
    • No aids defining illness
  12. Stage 2 HIV definition
    • CD4 T-cell count 200-499 or 14-28%
    • No aids defining illenss
  13. Stage 3 HIV definition
    • CD4 T-cell count <200 or <14%
    • Has aids defining illness
  14. 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
  15. 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
  16. Why is anal sex the riskiest for any gender?
    Skin tears easily
  17. 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
  18. What is the first test done to look for HIV antibodies?
  19. Name the 2nd test done if positive ELISA
    Western Blot or IFA (immunofluorescence assay)
  20. What is the 3rd test done if positive for HIV
    • Viral load (how much of the HIV virus is there)
    • CD4 T-cell counts
  21. What do HAART or cAART drugs do?
    interferes with the replication of RNA – does NOT kill the virus
  22. Why do we not give monotherapy?
  23. 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
  24. 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)
  25. 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
  26. 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)
  27. 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
  28. Name malignancies (defining conditions) opportunistic infections:
    Karposi sarcoma – cancer of connective tissue – interferon seems to help with decreasing lesions
  29. Name another (defining conditions):
    Wasting syndrome – wasting from HIV+ - significant diarrhea, oral-esophageal lesions
  30. 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
  31. 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
  32. What can we do for patients with decreased gas exchange?
    • pace activities
    • rest
    • O2
    • HOB up
    • bronchodilator
    • cluster care
  33. 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
  34. What do we do for thrush?
    • frequent oral care
    • soft tooth brush
    • soft foods
    • avoid alcohol mouthwashes
    • get an order for medication
  35. 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…
  36. 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.
  37. What are the priorities for patients with Confusion/dementia?
    • safety
    • reorient
  38. Early manifestations of RA
    • joint inflammation
    • low-grade fever
    • fatigue
    • weakness
    • anorexia
    • paresthesias
  39. 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
  40. What are the symptoms of Sjogren's?
    • dry eyes
    • dry mouth (Xerostomia)
    • dry vagina
  41. Why are we concerned when an RA patient has neck pain?
    C3-C4 Subluxation – can paralyze patient or impair breathing
  42. What is Felty's syndrome?
    • hepatosplenomegaly
    • leukopenia
  43. 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
  44. What part of the healthcare team assists RA patients?
    Occupational therapy
  45. 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
  46. What are the adverse effects of meds for SLE?
    • osteonecrosis
    • osteoporosis
  47. What is the leading cause of death for SLE?
    Lupus nephritis
  48. What are the classic signs of SLE?
    • fever
    • fatigue
  49. What are common effects of SLE?
    Pleural effusions


    Raynaud’s phenomenon – secondary to arterial vasospasm
  50. 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
  51. Education for SLE patients regarding the sun
    • avoid prolonged exposure
    • wear long sleeves and large hats
    • sun block SPF30 or higher
Card Set
M/S - Exam 2 HIV and Rheum
M/S - Exam 2 HIV and Rheum