What type of cell is HIV attracted to?
- CD4 T-cells
- immune system cells
What is the attraction of the HIV virus to the CD4 cells?
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
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
How is the HIV virus transmitted?
via body fluids (Semen, blood, vaginal secretion, breast milk)
The HIV virus transmits through broken skin of the?
Parenteral acts that lead to transmission?
- sharing needles
- blood transfusion
- occupational exposure
Perinatel acts that lead to transmission?
- mother to baby via:
- pregnancy (via placenta)
- breast feeding
When the HIV viral load increases the CD4 T-Cells ?
- making pt susceptible to opportunistic infections
CD4 antibodies continue to develop but they are ...?
- incomplete and non-functional
- abnormally functioning macrophages
Stage 1 HIV definition
- CD4 T-cell count >500 or >=29%
- No aids defining illness
Stage 2 HIV definition
- CD4 T-cell count 200-499 or 14-28%
- No aids defining illenss
Stage 3 HIV definition
- CD4 T-cell count <200 or <14%
- Has aids defining illness
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
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
Why is anal sex the riskiest for any gender?
Skin tears easily
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
What is the first test done to look for HIV antibodies?
Name the 2nd test done if positive ELISA
Western Blot or IFA (immunofluorescence assay)
What is the 3rd test done if positive for HIV
- Viral load (how much of the HIV virus is there)
- CD4 T-cell counts
What do HAART or cAART drugs do?
interferes with the replication of RNA – does NOT kill the virus
Why do we not give monotherapy?
INCREASES DRUG RESISTANCE
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.
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)
Name Viral (defining conditions) opportunistic infections:
- Herpes 1 & 2
- Varicella (Shingles)
- Hepatitis B & C
- Cytomegalovirus: major cause of blindness in patients – don’t need to know
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)
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
Name malignancies (defining conditions) opportunistic infections:
Karposi sarcoma – cancer of connective tissue – interferon seems to help with decreasing lesions
Name another (defining conditions):
Wasting syndrome – wasting from HIV+ - significant diarrhea, oral-esophageal lesions
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
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
What can we do for patients with decreased gas exchange?
- pace activities
- HOB up
- cluster care
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
What do we do for thrush?
- frequent oral care
- soft tooth brush
- soft foods
- avoid alcohol mouthwashes
- get an order for medication
What do we do for diarrhea?
- safety (falls)
- skin integrity
- find out if it is infectious of nature (WILL NEVER GIVE LAMOTIL – IF INFECTIOUS)
- decreased fat
- decreased spices, sweets, alcohol…
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.
What are the priorities for patients with Confusion/dementia?
Early manifestations of RA
- joint inflammation
- low-grade fever
Late manifestations of RA
- joint deformities
- moderate to severe pain and morning stiffness
- severe fatigue
- weight loss
- SQ nodules
- peripheral neuropathy
- fibrotic lung disease
- sjogren's syndrome
- kidney disease
- felty's syndrome
What are the symptoms of Sjogren's?
- dry eyes
- dry mouth (Xerostomia)
- dry vagina
Why are we concerned when an RA patient has neck pain?
C3-C4 Subluxation – can paralyze patient or impair breathing
What is Felty's syndrome?
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
What part of the healthcare team assists RA patients?
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
What are the adverse effects of meds for SLE?
What is the leading cause of death for SLE?
What are the classic signs of SLE?
What are common effects of SLE?
Raynaud’s phenomenon – secondary to arterial vasospasm
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
Education for SLE patients regarding the sun
- avoid prolonged exposure
- wear long sleeves and large hats
- sun block SPF30 or higher