written Presentation about HIV AND AIDS
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HIVANDAIDS.pptxHIV AND AIDS TITLE
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Teacher :
OUTLINE:
Introduction
Pathogenesis
Risk factors
Clinical Manifestation
Diagnosis
History taking
Physical examination
Laboratory studies
VI. Infection control Policies
VII. Nursing Diagnosis And Intervention
VIII. Summary
OBJECTIVES:
At the end of this lecture, students will be able to:
1. Know and understand what is HIV AND AIDS.
2. Understand the process how disease develop.
3. Practice how to deal and take care a patient according to infection control sets of guidelines.
4. Identify Nursing diagnosis and make interventions that help promote patient care and comfort.
INTRODUCTION
The human immunodeficiency virus (HIV) targets the immune system and weakens people's defense against many infections and some types of cancer that people with healthy immune systems can fight off. As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient. Immune function is typically measured by CD4 cell count.
The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS), which can take many years to develop if not treated, depending on the individual. AIDS is defined by the development of certain cancers, infections or other severe long-term clinical manifestations.
Since HIV was first identified almost 30 years ago, remarkable progress has been made in improving the quality and duration of life for people living with HIV disease.
HIV or human immunodeficiency virus and acquired immunodeficiency syndrome is a chronic condition that requires daily medication.
HIV- 1 is a retrovirus isolated and recognized as the etiologic agent of AIDS.
HIV-2 is a retrovirus identified in 1986 in AIDS patients in West
HIV
AIDS
is defined by the Centers for Disease Control and Prevention (CDC) as any person with HIV infection and a CD4 lymphocyte count below 200 cells/mcL (or a CD4 count below 14%) or having an AIDS-indicator condition
The primary route of transmission of the HIV virus is by entering the mucosal surface (predominantly sexual contact).
Following mucosal entry, the virus binds to peripheral circulating T cells and macrophages (e.g., dendritic cells) that express the CD4 and CCR5 receptors.
As the disease progresses to later stages after years of infection, the virus uses the CD4 and CXCR4 receptor to primarily enter T cells.
Hosts with a congenitally deleted CCR5 receptor generally fail to establish a productive infection.
Once the virus enters the intended target cell, it replicates by converting RNA to DNA by RNA-dependent DNA polymerase (reverse transcriptase).
Pathogenesis.
This DNA is integrated in the host genome and leads to the production of new viruses that result in a burst of HIV viremia and widespread dissemination.
HIV establishes a chronic infection and elicits a robust humoral and cell-mediated immune response.
The infection results in the reduction of CD4 T cells as the result of HIV-induced cytolysis and T-cell-induced cytolysis.
The course of HIV infection to AIDS parallels the reduction of CD4 T cells and the amount of circulating
virus in the blood.
RISK FACTORS
Behaviours and conditions that put individuals at greater risk of contracting HIV include:
having unprotected anal or vaginal sex;
having another sexually transmitted infection (STI) such as syphilis, herpes, chlamydia, gonorrhoea and bacterial vaginosis;
sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs;
receiving unsafe injections, blood transfusions and tissue transplantation, and medical procedures that involve unsterile cutting or piercing; and
experiencing accidental needle stick injuries, including among health workers
APPROACH TO THE PATIENT
date of diagnosis, nadir(the lowest) CD4 count, and past HIV-related conditions
The duration of HIV
source of the infection
Chronic medical conditions Social history and family history
HEALTH HISTORY
Whether caring for a newly HIV-infected patient or an ART treatment–experienced infected patient, a thorough comprehensive history should
be taken at the initial assessment
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Physical Examination
This can help to diagnose conditions that may indicate advanced HIV disease or AIDS. Areas to focus include:
| Head, eyes, ears, nose, and throat (HEENT) | Funduscopic examination may suggest findings of CMV retinitis. Oral cavity lesions may suggest thrush, oral hairy leukoplakia, HSV (more commonly located on the vermilion border of the lip), or Kaposi’s sarcoma. |
| Dermatologic examination | Kaposi’ssarcoma lesions, cutaneous candidiasis, scabies, seborrheic dermatitis, molluscum contagiosum, and paronychia |
| Gastrointestinal | Hepatomegaly, splenomegaly, and hepatosplenomegaly can give clues to systemic comorbid infections. |
| Genitourinary | can help uncover other sexually transmitted diseases such as human papillomavirus (HPV) and HSV infections |
| Lymph node | Lymphadenopathy, localized or generalized, can help strengthen suspicions of OIs. |
| Neurologic | Level cognitive function and peripheral neurologic status should be determined |
A comprehensive physical examination should be performed on initial evaluation including a careful eye, skin, and rectal examination. This can help to diagnose conditions that may indicate advanced HIV
disease or AIDS. Areas to focus include:
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Laboratory Studies
is most commonly used and has a reported sensitivity and specificity of over 99%.
Positive or indeterminate EIA results must be confirmed with a more specific assay such as the Western blot (WB).
False-positive results can occur with recent immunization (hepatitis B virus [HBV], infl uenza), autoimmune diseases
False-negative results can occur during acute HIV infection prior to antibody development (this can range from 12 to 22 days); this period is otherwise known as the window phase.
The most recent EIA tests combine detection of antibodies with HIV p24 antigen to allow earlier diagnosis.
Point of care rapid screening tests are available to screen in appropriate clinical situations
A positive EIA test still needs confirmation with a WB
Enzyme immunoassay (EIA)
The CDC recommends a policy of performing HIV testing routinely for everyone between ages 13 and 64 in healthcare settings.
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This is essentially an EIA test to detect specific HIV proteins after they are subject to electrophoresis with separation on a membrane. The false-positive rate without EIA is estimated at 2%.
Western blot (WB)
Detects HIV-1 p24 protein in an EIA-based format. Only 30% to 90% sensitive
p24 antigen capture assay.
Three molecular techniques are available and
include: reverse transcriptase polymerase chain reaction (PCR), branched
DNA (bDNA), and nucleic acid sequence based amplification (NASBA).
Can be used in making a diagnosis of primary HIV infection especially in the window period.
These tests are more useful in monitoring the effects of therapy
Direct detection of HIV
Immunologic monitoring
CD4 T lymphocyte counts are commonly determined by flow cytometry and are useful to stage disease, assess risk for OIs, diagnose AIDS, and monitor immunologic response to therapy.
It’s commonly measured at the time of diagnosis and every 3 to 6 months thereafter.
a. Standard assays use molecular methods and can detect as few as 20 to 40
copies of HIV RNA per milliliter of plasma.
Virologic monitoring
b. Measure approximately 2 to 8 weeks after initiation of ART and then every 3 to 6 months to evaluate continued effectiveness. In most instances HIV RNA will drop to less than 50 copies per milliliter within 6 months after the initiation of antiretroviral treatment.
Resistance testing
a. Usually performed at baseline HIV evaluation (due to the frequency of
transmission of resistant viruses) and in cases of virologic failure (persistent viral detection on a seemingly adequate regimen).
b. Generally must have a viral load greater than 1,000 copies/mL to
obtain an accurate result
PREVENTION
MANAGEMENT OF HIV/AIDS
Treatment of HIV Infection. The treatment for HIV infection consists of using a combination of antiretroviral agents (usually a combination of three agents) with the goals of suppressing viral replication to undetectable levels, reducing HIV associated morbidity, and prolonging the duration and the quality of the patient’s life.
Adherence counseling is a major prerequisite of starting HIV treatment. Usually, a physician trained in HIV care is consulted when ART is being started or changed.
The treatment for HIV is called antiretroviral therapy (ART). ART involves taking a combination of HIV medicines (called an HIV treatment regimen) every day.
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INFECTION CONTROL POLICIES
When Standard Precautions alone cannot prevent transmission, they are supplemented with Transmission-Based Precautions. This second tier of infection prevention is used when patients have diseases that can spread through contact, droplet or airborne routes (e.g., skin contact, sneezing, coughing) and are always used in addition to Standard Precautions. Transmission-based precautions are based upon the mode of transmission of the infectious agent.
For STDs patients we mainly observe contact precaution.
Contact Precautions are intended to prevent transmission of infectious agents, including epidemiologically important microorganisms, which are spread by direct or indirect contact with the patient or the patient’s environment. Contact Precautions are indicated to reduce the risk of transmission of epidemiologically important microorganisms thru direct and indirect contact with the patient or the patient's environment..
INFECTION CONTROL POLICIES
Following the infection control guidelines in your workplace.
Treating all blood and body fluids as though they are infectious.
Handling and disposing of needles and sharp instruments correctly.
Getting immunized for necessary vaccines
Using protective gear, such as gloves, goggles, and/or masks.
For known STD patient, wearing PPE, double gloves when doing procedures that expose you to blood.
No recapping of needles and following the proper disposal.
In Accidental needle prick, report immediately and follow protocol.
NURSING DIAGNOSIS AND INTERVENTION
The list of potential nursing diagnoses is extensive because of the complex nature of the disease.
Impaired skin integrity related to cutaneous manifestations of HIV infection, excoriation, and diarrhea.
Diarrhea related to enteric pathogens of HIV infection.
Risk for infection related to immunodeficiency.
Activity intolerance related weakness, fatigue, malnutrition, impaired F&E balance, and hypoxia associated with pulmonary infections.
Disturbed thought processes related to shortened attention span, impaired memory, confusion, and disorientation associated with HIV encephalopathy.
Ineffective airway clearance related to PCP, increased bronchial secretions, and decreased ability to cough related to weakness and fatigue.
Pain related to impaired perianal skin integrity secondary to diarrhea, KS, and peripheral neuropathy.
Imbalanced nutrition, less than body requirements related to decreased oral intake.
NURSING DIAGNOSIS AND INTERVENTION
The plan of care for a patient with AIDS is individualized to meet the needs of the patient.
Promote skin integrity. Patients are encouraged to avoid scratching; to use nonabrasive, nondrying soaps and apply nonperfumed moisturizers; to perform regular oral care; and to clean the perianal area after each bowel movement with nonabrasive soap and water.
Promote usual bowel patterns. The nurse should monitor for frequency and consistency of stools and the patient’s reports of abdominal pain or cramping.
Prevent infection. The patient and the caregivers should monitor for signs of infection and laboratory test results that indicate infection.
Improve activity intolerance. Assist the patient in planning daily routines that maintain a balance between activity and rest.
Maintain thought processes. Family and support network members are instructed to speak to the patient in simple, clear language and give the patient sufficient time to respond to questions.
Improve airway clearance. Coughing, deep breathing, postural drainage, percussion and vibration is provided for as often as every 2 hours to prevent stasis of secretions and to promote airway clearance.
Relieve pain and discomfort. Use of soft cushions and foam pads may increase comfort as well as administration of NSAIDS and opioids.
Improve nutritional status. The patient is encouraged to eat foods that are easy to swallow and to avoid rough, spicy, and sticky food items.
SUMMARY
When HIV is introduced into the body, this virus is too strong for the helper T cells and killer T cells. The virus then invades these cells and starts to reproduce itself, thereby not only killing the CD4 T cells, but also spreading to infect otherwise healthy cells.
Some people apparently remain well after infection of the AIDS virus. They may have no physically apparent symptoms of illness. However, if proper precautions are not used with sexual contacts and/or intravenous drug use, these infected individuals can spread the virus to others.
Until an effective vaccine is developed, nurses need to prevent HIV infection by teaching patients how to eliminate or reduce risky behaviors.
Confirming Diagnosis: Signs and symptoms may occur at any time after infection, but AIDS isn’t officially diagnosed until the patient’s CD4+ T-cell count falls below 200 cells/mcl or associated clinical conditions or disease.
Medical management focuses on the elimination of opportunistic infections.Treatment of opportunistic infections. For Pneumocystis pneumonia, TMP-SMZ is the treatment of choice; for mycobacterium avian complex, azithromycin or clarithromycin are preferred prophylactic agents; for cryptococcal meningitis, the current primary treatment is IV amphotericin B.
THANK YOU……!!!!
REFERENCES:
Essentials of Clinical Infectious Diseases Second Edition William F. Wright.
https://www.who.int/news-room/fact-sheets/detail/hiv-aids
https://www.healthcentral.com/condition/aids-and-hiv-infection
