Chapter 21

1. Chapter 21 Care of Patients with HIV Disease and Other Immune Deficiencies

2. Acquired Immune Deficiency Syndrome • The most common secondary immunogenicity disease in the world • Identified in 1981 • Serious worldwide epidemic

3. Prevalence of HIV Infection by Country

4. HIV Infectious Process

5. Life Cycle of HIV

6. Effects of HIV Infection • Everyone who has AIDS has HIV infection. However, not everyone who has HIV infection has AIDS. • The distinction rests with the number of CD4+ T-cells the patient has and whether any opportunistic infections have occurred.

7. Virus Infection

8. HIV Classification • Clinical categories: • Clinical category A • Clinical category B • Clinical category Co

9. Health Promotion and Maintenance • Education is the best hope for prevention. • HIV is transmitted most often in three ways: • Sexual • Parenteral • Perinatal

10. Transmission and Health Care Workers • Needle stick or “sharps” injuries are the primary means of HIV infection for health care workers. • Workers can also be infected through exposure of nonintact skin and mucous membranes to blood and body fluids. • The best prevention for health care providers is the consistent use of Standard Precautions for all patients as recommended by the CDC.

11. Collaborative Management • Assessment • History • Physical assessment and clinical manifestations: • Infections—opportunistic, protozoal, fungal, bacterial, viral • Malignancies—Kaposi’s sarcoma, malignant lymphomas • Endocrine complications

12. Other Clinical Manifestations • AIDS dementia complex • AIDS wasting syndrome • Skin changes

13. Laboratory Assessment • Lymphocyte counts • CD4+ T-cells and CD+ T-cells • Antibody tests • Enzyme-linked immunosorbent assay (ELISA) • Western blot, viral load • Quantitative RNA assays • Others

14. Drug Therapy • Nucleoside analog reverse transcriptase inhibitors • Non-nucleoside reverse transcriptase inhibitors • Protease inhibitors • Fusion inhibitors • Entry inhibitors • Integrase inhibitors • Immune enhancement

15. Nursing Diagnoses • Pain • Imbalanced Nutrition: Less Than Body Requirements • Diarrhea • Impaired Skin Integrity • Disturbed Thought Processes • Chronic Low Self-Esteem • Social Isolation

16. Community-Based Care • Home care management • Health teaching • Psychosocial preparation • Health care resources

17. Therapy-Induced Immune Deficiencies • Drug-induced immune deficiencies • Radiation-induced immune deficiencies

18. Other Immune Deficiencies • Congenital (primary) immune deficiencies • Bruton’s agammaglobulinemia • Common variable immune deficiency • Selective immunoglobulin A deficiency