HIV Concept Map

HIV Concept Map

Clinical Manifestations

General Pathophysiology of HIV

What is HIV?

Treatment

HIV has no cure, continues for life, causes physical disability, and contributes to impaired health.

• Drug therapy
• Entry Inhibitors- prevent binding of HIV to cells
• Reverse Transcriptase Inhibitors
• Integrase Inhibitors
• PIs Protease Inhibitors
• Fixed Dose combination products
• (ART) Antiretroviral therapy
• decreases viral replication
• combination therapy
• more difficult for virus to recover
• decreased likelihood of drug resistance

• Human immunodeficiency virus infection
• Retrovirus that causes immunosupression
• The person becomes susceptible to infections that would normally be controlled by the immune response
• Transmitted by contact with infected blood, semen, vaginal secretions, or breast milk.
• Once you have HIV, you will be able to transmit it to others for the rest of your life.

• The initial infection with HIV results in viremia.
• In the first stage of the infection, B cells are making antibodies to reduce viral loads in the blood and T cells are initiating a cellular immune response in the lymph nodes.
• For a few weeks, HIV levels remain low and symptoms are limited.
• HIV is replicating rapidly and continuously.
• Mutations can occur due to rapid replication, which can contribute to ART resistance.

• HIV infects CD4+ T cells, which are cells that recognize and defend against pathogens.
• Normally healthy adults have 800-1,200 CD4+ T cells.
• The immune system is healthy with more than 500 CD4+ T cells
• Immune dysfunction occurs when it is less than 500 CD4+ T cells
• Severe immune dysfunction occurs less than 200 CD4+ T cells

• The body usually replaces the destroyed CD4+ T cells, but the destruction exceeds the body's ability to replace the cells.
• Opportunistic diseases can occur when there is a low count of CD4+ T cells.

Acute Infection:

• "Mononucleosis like" symptoms including: fever, sore throat headache, swollen lymph glands, malaise, diarhhea, muscle and joint pain.

Some people also develop neurologic complications such as aseptic meningitis

Symptoms:

• Occur within 2 to 4 weeks after the initial infection
• Last for 1 to 3 weeks, although some symptoms may persist for several months
• A high viral load (the amount of HIV circulating in the blood) is noted
• CD4+ T cell counts fall temporarily but quickly return to baseline or near-baseline levels

Managing HIV is complicated by many opportunistic diseases that develop as the immune system deteriorates.

• adequate ART
• vaccines (including Hep B, Influenza, and pneumococcal)
• prophylactic medications

Patient Background Cont.

Nursing Interventions for HIV

Expected Outcomes

Diagnostic Tests

Patient Background

Symptomatic Infection:

Expected Outcomes of HIV treatment

• Decrease viral load
• Maintain or increase CD4+ T cell counts
• Prevent HIV-related symptoms and opportunistic diseases
• Prevent HIV transmission

SUBJECTIVE DATA CONT.

• States he is taking his ART medications as prescribed
• Has had multiple sexual partners; is currently in a monogamous relationship
• Denies tobacco use
• Has history of IV drug abuse but has not used any drugs since receiving HIV diagnosis
• Denies recent travel out of the country

Objective Data

Physical Examination

• Vital signs: blood pressure 115/70, pulse 112, temperature 102° F, respiration 20
• Cachexia
• Crackles at bases of lungs, left side greater than right
• Heart rate and rhythm regular, no murmurs
• Nonproductive cough
• Pulse oximetry is 90% on room air
• One anterior cervical lymph node on left side is palpable

Diagnostic Tests

• CD4+ lymphocyte count 76 cells/µL
• Chest x-ray shows probable pneumonia in left lower lobe

Common Complications of this phase:

• oral thrush
• shingles
• persistent vaginal candidal infections
• outbreaks of oral or genital herpes
• bacterial infections
• Kaposi sarcoma
• Oral hairy leukoplakia

• Rapid HIV antibody testing
• Negative: risk assessment to determine the need to repeat the test
• Positive: confirm with Western blot
• Home kits use an oral fluid sample to test for HIV
• ELISA/EIA test
• Negative: it's negative unless they report risky behaviors
• encourage them to retest at 3 week, 6 week, and 3 month.
• Positive: repeat test
• If it comes out positive again, confirm with Western blot
• Western blot to confirm positive results

• Maintain lean body mass
• Vitamins, micronutrients
• Refrain from using alcohol, tobacco, and drug
• vaccines
• Adequate rest and exercise
• Reduce stress
• Avoid exposure to new infectious agents
• Mental health counseling, support groups, community activities
• Consistent relationship with health care providers
• Teach to recognize symptoms that may indicate disease progression

Symptoms Include:

• fever
• frequent drenching night sweats
• chronic diarrhea
• recurrent headaches
• fatigue severe enough to interrupt normal routines
• Other problems may include localized infections, lymphadenopathy, and nervous system manifestations.

• Patient Name: A.D.
• Age: 37 Years Old
• History: A.D. has been HIV positive for 6 Years. He went to the outpatient clinic with a cough that will not go away, and SOB. He is being admitted to the unit today.
• Medications:
• EFAVIRENZ (Sustiva) 600 mg PO daily at bedtime
• Tenofovir DF and Emtricitabine (Truvada) 1 Tab PO at bedtime

Subjective Data

• Has had increasing fatigue and shortness of breath over the past week

• States “I can’t even walk to the bathroom without stopping to catch my breath”

• Has had a nonproductive cough for two weeks and pain with coughing

• Has lost 13 pounds over the past two months

FIN

Extra Information

Asymptomatic Infection:

Concept Map

Q & A Cont

Q & A

3. What are your priorities in A.D.’s plan of care?

1. What is the likely medical diagnosis for A.D.? What assessment data leads you to this conclusion?

• Monitor HIV/AIDS progression and immune function
• Monitor drug regimen
• Prevent the development of another opportunistic disease
• Treat pneumonia or other opportunistic diseases
• Protect others from HIV/AIDS

• A.D. Likely has progressed from HIV to AIDS with a secondary pneumonia infection.
• CD4+ lymphocyte count 76 cells/ microliter (Below 200)
• Opportunistic infections (Pneumonia) are common in diminished immune systems, and lung crackles were heard
• Significant weight loss (13 lbs)

4. Is A.D. now considered to have AIDS? Explain your rationale.

Presentation By:

Erika Aban

Sally Cho

& Mia Lauterio

2. Discuss the medications that the patient is taking and the rationale for multiple medications.

• The interval between untreated HIV infection and a diagnosis of AIDS is about 10 years.
• CD4+ T cell counts remain above 500 cells/µL
• The viral load in the blood is low.
• Some mild symptoms include:
• infection
• although fatigue
• headache
• low-grade fever
• night sweats
• persistent generalized lymphadenopathy (PGL)
• other symptoms may be present.

• Yes because he has a CD4 count of 76 cells/µL, has pneumonia, and has lost 13 pounds in the past two months.

• Efavirenz: is a nonnucleoside reverse transcriptase inhibitor (NNRTI). It works by blocking the growth of HIV.
• Truvada: (emtricitabine and tenofovir) is an antiviral medicine that prevents human immunodeficiency virus (HIV) or hepatitis B from multiplying in your body.
• It is important to take multiple medications to decrease the chance of antiviral resistance in HIV patients

Q & A Cont.

7. Using the Roy Model, identify two priority nursing diagnoses. Select one. What would be your goal and nursing interventions for that diagnosis? How would you evaluate if your interventions were successful?

5. A.D. has been HIV positive for six years, yet he has not developed AIDS. What factors might have delayed A.D.'s transitioning to AIDS?

• takes his ART medications as prescribed
• doesn't use any drugs or smokes
• doesn't travel out of the country
• decreases chance of getting an opportunistic disease

6. What areas should you address in A.D.’s discharge teaching?

• signs and symptoms of opportunistic infections
• monitor ART
• management of symptoms
• preventing further transmission of HIV
• ongoing assessment
• clinician-patient interactions

1) Diagnosis of Imbalanced Nutrition related to nutritional needs (fever/infection) as evidenced by weight loss, decreased subcutaneous fat/muscle mass, and cachexia.

2) Infection related to immunosuppression or recurrent pneumonia as evidenced by fever of 102 F, nonproductive cough, and difficulty breathing.

Goal:

• Prevent development of opportunistic diseases, restore and preserve immunologic function, reduce HIV-associated morbidity, prolong duration and quality of survival, prevent HIV transmission.

Nursing Interventions:

• Ensure that pt is adhering to effective ART regimen. If appropriate, take prophylactic meds for opportunistic infections. Symptom management, ensure adequate oxygenation, and teaching, be up to date with vaccines.

Evaluate:

• Patient won't catch new infections, maintained or increased CD4+ counts, takes all medications, knows the signs and symptoms of disease progression.

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Lewis, Sharon, Shannon Dirksen, Margaret Heitkemper, Linda Bucher. Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 9th Edition. Mosby, 122013. VitalBook file.