_________________ Chapter 35Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 35.1
Slide 27
Viral Infections (cont.)
• Progressive multifocal leukoencephalopathy (PML)
• Caused by the Jamestown Canyon virus
• Develops in 2% to 4% of AIDS patients
• Progressive degeneration of white matter of the brain
TALKING POINTS:
• What medication may be used for treatment of PML?
• Maintaining low viral loads through antiretroviral therapy seems to be the best strategy for
preventing PML.
Slide 28
Bacterial Infections
• Bacillary angiomatosis (BA)
• Causes skin lesions; may affect any organ
• Transmitted by cats and their fleas
Slide 29
Bacterial Infections (cont.)
• Mycobacterium avium complex (MAC)
• Found everywhere, including most food, animal, and soil sources
• May affect any organ of the body
• Causes fever, fatigue, weight loss, night sweats, abdominal pain, and diarrhea
• Not contagious
Slide 30
Bacterial Infections (cont.)
• Mycobacterium tuberculosis (TB)
• HIV patients much more likely than a healthy person to become infected with TB if
exposed, especially when CD4 counts drop below 200 cells/mm³
Slide 31
Kaposi Sarcoma (KS)
• Common neoplasm that develops with AIDS
• Affects the skin first, appearing as a macular painless, nonpruritic lesion
• Color varies: pink, red, purple, and brown
TALKING POINTS:
• What is thought to cause KS?
• When KS is confined to the skin, there are no symptoms.
• When KS affects the GI system, bleeding may result causing anemia.
• When KS affects the respiratory system, hypoxia may occur.
14 Chapter 35Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome __________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 35.1
Lymphomas
• A type of cancer that originates in lymphoid tissue: bone marrow, spleen, thymus gland
• Two types: Hodgkin’s and non–Hodgkin’s
TALKING POINTS:
• Immunodeficient patients have 14 times greater risk than the general population of getting
lymphomas.
• What is used to treat lymphoma?
5
Slide 33
Medical Diagnosis of HIV
• HIV diagnosis
• Positive HIV antibody test
• ELISA
TALKING POINTS:
• Why do some individuals never test positive for HIV even though they are infected?
Medical Diagnosis of HIV (cont.)
• AIDS diagnosis
• CD4 count of <200 cells/mm³; asymptomatic
TALKING POINTS:
• What symptoms are included in category B? Category C?
Slide 35
Home Testing
• Home Access HIV 1 Test System: submitted by mail
• Home testing kit: OraQuick ADVANCE uses cheek swab, with results in 20 minutes
• Controversial because of false-positive and false negative results, lack of professional
counseling
TALKING POINTS:
• Why would a person in the early stage of infection possibly produce negative test results?
6
Medical Treatment
TALKING POINTS:
• How will healthy habits prevent complications of HIV infection?
Slide 37
Women and HIV
• Women with HIV during pregnancy and delivery should be treated with antiviral drugs
• Newborns should be treated during first 6 weeks of life
_________________ Chapter 35Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 35.1
Slide 38
Older Adults and HIV
• Incidence increasing
TALKING POINTS:
• What are some reasons the incidence of HIV in older adults is increasing?
Slide 39
Medical Treatment: Highly Active Antiretroviral Therapy (HAART)
• Recommended for HIV viral load
• Usual drug combination: 1 protease inhibitor and 2 nucleoside reverse transcriptase
inhibitors
TALKING POINTS:
• Zidovudine (AZT) is a common nucleoside reverse transcriptase inhibitor (NRTI) used to
treat HIV infection.
• What is a protease inhibitor?
• What are common side effects of HAART?
7
Nursing Care of the Patient with HIV
• Patient usually treated as outpatient
Slide 41
Assessment
• Signs and symptoms of infection
• Most common sites are lungs, mouth, GI tract, skin, blood, and central nervous
system
TALKING POINTS:
• Infection is the leading cause of death in patients with HIV infection.
Slide 42
Health History
• Sexually transmitted infection history
• Surgical history
• Medication history and allergies
16 Chapter 35Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome __________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 35.1
Slide 43
Health History (cont.)
• Tobacco/alcohol use history
• Illegal drug use history
• Pet history
• Occupational history
• Nutritional history
• Gynecologic history
Slide 44
Physical Examination
• Height, weight, vital signs
• Skin
• Head, ears, eyes, nose, and throat
• Lymphatic system
• Respiratory system
TALKING POINTS:
• What tests would be included in the laboratory profile?
Slide 45
Interventions
• Ineffective therapeutic regimen management
• Patient should receive accurate, consistent information from all members of the health
care team
Slide 46
Interventions (cont.)
• Anxiety
• Dealing with emotions of facing a life-threatening illness
• Encourage patients to ask questions and talk about their feelings
• Information about disease and treatment may help patient and family deal with their
anxiety
• May need referral to a social worker, chaplain, or mental health counselor
_________________ Chapter 35Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome 17
LESSON 35.1
Slide 47
Interventions (cont.)
• Infection
• Early detection and prompt treatment are vital
• May be on antiinfective drugs prophylactically
• Important to take drugs as prescribed
TALKING POINTS:
• Stopping antibiotic therapy early can result in incomplete treatment and the development
of resistant organisms.
Slide 48
Interventions (cont.)
• Impaired oral mucous membranes
• Encourage regular teeth and mouth cleaning with dental floss and a soft toothbrush
• Encourage fluids to maintain hydration to keep mucous membranes moist
• Topical anesthetics applied before eating
• Regular dental evaluations can help prevent and manage oral disease and infections
TALKING POINTS:
• Why is the patient with HIV at risk for altered oral mucous membrane integrity?
Slide 49
Interventions (cont.)
• Imbalanced nutrition: Less than body requirements
• Refer to dietitian for nutrition counseling as soon as the patient is diagnosed
• Oral supplements with Carnation Instant Breakfast, Ensure, Sustacal, or Resource
• Administer medications
Slide 50
Interventions (cont.)
• Confusion
• Patients with HIV encephalopathy may experience cognitive and motor impairment
• May withdraw from social activities because of embarrassment
• May become angry and hostile
• Safety constantly reevaluated based on mental and physical capabilities
Slide 51
Interventions (cont.)
• Pain
• From opportunistic infections, viral invasion into the nerves and muscles, malignant
tumors, and diagnostic procedures
• Closely monitor pain level and medication use
TALKING POINTS:
• Pain has been an underrecognized problem for patients with HIV infection.
• What are possible pharmacologic and nonpharmacologic measures for pain
management?
18 Chapter 35Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome __________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 35.1
Slide 52
Ineffective Coping
• Diagnosis can overwhelm the ability to cope
• May experience fear, anxiety, anger, shame, depression and self-esteem loss
• May be reluctant to share diagnosis with others
TALKING POINTS:
• How can a nurse deal with own feelings, fears, especially to possible body fluid exposure?
Slide 53
Question 1
• In 2005, which race had the highest amount of acquired immunodeficiency syndrome
AIDS?
A. Asians
B. Black Americans
C. Hispanics
D. White Americans
Slide 54
Question 2
• Approximately _____ weeks after infection, the body produces enough antibodies to be
detected by standard HIV testing.
A. 4
B. 8
C. 12
D. 16
TALKING POINTS:
_________________ Chapter 35Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 35.1
Activities
Classroom Choose from below to make 30 minutes
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the time period in which HIV-related
infections were initially noticed by health
care providers.
• Discuss when HIV was officially recognized
by the Centers for Disease Control and
Prevention.
PRACTICE
2
DISCUSS
• Discuss the incidence of HIV infections in
relation to age groups.
• Discuss the racial differences in relation to
3
DISCUSS
• Discuss populations that are at a higher risk
for HIV infection.
PRACTICE
• Contact the local health department. Obtain
pamphlets relating to the prevention of HIV
20 Chapter 35Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome __________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 35.1
4
DISCUSS
• Discuss the signs and symptoms of an
opportunistic infection in the patient with HIV
infection.
• Discuss the appropriate use of universal
precautions and the use of reverse isolation.
PRACTICE
• Divide the class into small groups of three to
5
DISCUSS
• Discuss use of informed consent when
preparing to complete HIV testing.
• Discuss local options available for HIV
testing.
6
DISCUSS
• Discuss the mode of action for commonly
used drugs for the treatment/management of
HIV.
PRACTICE
• Contact a local pharmacy. Obtain drug
inserts from commonly prescribed
_________________ Chapter 35Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 35.1
7
DISCUSS
• Discuss nursing diagnoses appropriate for
the patient with HIV infection.
• Discuss the primary emotional and
physiological needs of the HIV-positive
patient.
PRACTICE
• Solicit three to four volunteers from the
class. Assign each of the students a role to
play. The roles include the patient recently
diagnosed with HIV, the nurse assigned to
students to critique the students’ portrayal.
Critical Thinking Question
A patient who was recently diagnosed with HIV infection has been discussing with the nurse
the need to have protected sexual intercourse. The patient does not feel it is necessary as
both he and his partner are positive for the disease. What information should be provided to
the patient to reinforce the need for engaging only in protected sexual activities?
Discussion Guidelines: While the patient and his partner are both positive for HIV infection, the
Instructor Notes/Student Feedback
22 Chapter 35Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome __________________
Introduction to Medical-Surgical Nursing, 6th ed.
35
Assessments for
Human Immunodeficiency Virus and Acquired
Immunodeficiency Syndrome
CHAPTER OBJECTIVES
Lesson 35.1:
2. Explain the pathophysiology and cause of HIV infection.
4. Identify complications associated with HIV infection.
6. Name the major HIV drugs, indications, side effects, and nursing considerations.
7. Describe appropriate nursing care of the HIV/AIDS patient.
Assessments by Lesson & Objective
1
Study Guide
• Part IA: 2-4 (p. 211)
Evolve Student Resources
• NCLEX Review: 5
2
Study Guide
Evolve Instructor Resources
• Test Bank: 2, 6, 7, 8, 21, 25, 29
• Open Book Quiz: 1, 2
Evolve Student Resources
• NCLEX Review: 6
3
Evolve Student Resources
• NCLEX Review: 9
Study Guide
• Part IIE: 3, 19 (pp. 212-213)
Evolve Instructor Resources
• Test Bank: 1, 3, 4, 27
_________________ Chapter 35Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome 23
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
4
Study Guide
• Part IA: 1 (p. 211)
• Part IB: 1-5 (p. 211)
• Part IIE: 1, 16, 21, 27, 28 (pp. 212-214)
• Part IIF: 1-13 (p. 214)
• Part IIIG: 1, 6 (p. 215)
Evolve Instructor Resources
Evolve Student Resources
• NCLEX Review: 1, 2, 3
• Prioritization: 2, 3
5
Study Guide
• Part ID: 1-6 (p. 212)
Evolve Instructor Resources
• Test Bank: 5, 11, 22
• Open Book Quiz: 7
Evolve Student Resources
6
Study Guide
• Part IIE: 4, 7-10, 13, 17, 18 (pp. 212-213)
Evolve Instructor Resources
• Test Bank: 10, 24, 30
7
Study Guide
• Part IIE: 22 (p. 213)
Evolve Instructor Resources
• Test Bank: 9, 12, 13, 15, 16, 26
Evolve Student Resources
Instructor’s Notes/Student Feedback