Introduction to Medical-Surgical Nursing, 6th ed.
35
Lesson Plans for
Human Immunodeficiency Virus and Acquired
Immunodeficiency Syndrome
CHAPTER LESSON PLANS & 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.
CHAPTER TEACHING FOCUS
• In this chapter, the student will be introduced to topics relating to HIV infection.
• The history of this disorder will be reviewed.
• The underlying pathophysiology and etiology will be presented.
• The progression of the disease and management therapies will be relayed.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
THEME: Protection and Movement
• Concept: Immunity
• Exemplar: Demographics, p. 664
• Table 35-1: HIV and AIDS Statistics by Geographical Region, 2001 and 2010, pp. 665–666
• Table 35-2: Acquired Immunodeficiency Syndrome Cases by Age, United States, p. 666
• Table 35-3: Acquired Immunodeficiency Syndrome Cases by Race and Ethnicity, United States, p.
666
2 Chapter 35Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome __________________
Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) At least 50% of new HIV infections occur in which of the following populations?
a) Teenage females
b) Young adults between the ages of 15 and 24 years
c) Homosexual males
d) Heterosexual males
2) Which of the populations listed below has the lowest rate of HIV infection?
a) Ages 15 to 19 years
b) Ages 65 or older
c) Ages 40 to 44 years
d) Ages 20 to 24 years
3) Which of the following modes is recognized by the Centers for Disease Control and Prevention as a
primary means of transmission for HIV?
a) Homosexual female to female contact
b) Tears
c) Saliva
d) Blood transfusion
4) The occurrence of cancers in patients with HIV infection involves approximately what percentage of
patients?
a) 50%
b) 40%
c) 25%
d) 75%
5) The leading cause of death for patients with AIDS is __________.
a) histoplasmosis
b) pneumonia
c) fungal infections
d) cancer
6) A patient with HIV infection has been diagnosed as being in the initial phase of the disease. Based
upon your knowledge, when was the patient likely exposed to the virus?
a) Less than one month ago
b) 4 to 8 weeks ago
c) 3 to 6 months ago
d) 12 to 18 months ago
7) A patient is considered to have AIDS when which of the following occurs?
a) CD4 cell levels are less than 200 cells/mm3
b) CD6 cell levels are greater than 500 cells/mm3
c) CD8 cell levels are greater than CD4 levels
d) CD4 levels are less than 400 cells/mm3
8) A patient with HIV infection presents with lower extremity weakness, spasticity, areflexia, and urinary
retention. Which of the following diagnoses can be anticipated?
a) CMV retinitis
b) CMV radiculopathy
c) CMV subacute encephalitis
d) CMV pneumonia
9) A pregnant woman has been diagnosed with HIV infection. She asks about therapies available to her
baby after delivery to reduce the rate of transmission of HIV. Which of the following statements best
describes the standard pharmacologic therapy after delivery?
a) There are no medications prescribed after delivery because they are seen as ineffective.
b) The infant will be treated with antiviral therapies for the first year of life.
c) Medications will be prescribed for the first 6 weeks after birth.
d) Medication therapies will be initiated only after the newborn has been tested for HIV infection.
Introduction to Medical-Surgical Nursing, 6th ed.
10) The patient was started on HAART. Which of the following statements about HAART is most correct?
a) The This category of medication has improved the 10 year survival rate to 65%.
b) The medication is best when initiated during the initial phase of infection.
c) Noncompliance may result in an increase in CD4 counts.
d) HAART therapy enables HIV to successfully bind with the human cell.
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Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
1) b
6) b
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: A patient who has a history of HIV infection has presented to the acute care facility with
complaints of weakness, constant headaches, seizures, and alterations in level of consciousness. The
physician has diagnosed the patient with toxoplasmosis. How did the patient become exposed to this
disorder? What patient teaching can assist reduce the incidence of reoccurrence?
Question: A patient presents to an ambulatory care setting with concerns about contracting HIV from her
roommate. During the interaction, the patient asks what behaviors can likely cause infection. What
information should the nurse share with the patient?
Answer: The nurse should determine the type of relationship between the patient and the individual with
_________________ Chapter 35Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome 5
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 35.1
Instructor Preparation
Textbook Objectives Covered
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.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speaker: Department of Health representative
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying human immunodeficiency virus and acquired immunodeficiency syndrome.
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
• drug inserts
Key Terms
• AIDS (p. 663)
• HAART (p. 668)
• protease inhibitor (p. 674)
Assignments 2 hours
1
READ – Textbook (pp. 663-664)
ANSWER – Study Guide
• Part IA: 2-4 (p. 211)
2
READ – Textbook (pp. 664-668)
REVIEW
• Table 35-8: Normal Lymphocyte Counts (p. 668)
ANSWER – Text
ANSWER – Study Guide
• Part IC: 1 (p. 212)
• Part IIE: 2, 11, 12, 14, 15, 20, 23, 24 (pp. 212-213)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 35.1
3
READ – Textbook (pp. 665-667)
REVIEW
• Table 35-1: HIV and AIDS Statistics by Geographical Region (pp. 665-666)
• Table 35-2: US Acquired Immunodeficiency Syndrome Cases by Age (p. 666)
• Table 35-3: US Acquired Immunodeficiency Syndrome Cases by Race and Ethnicity (p. 666)
• Table 35-4: US Acquired Immunodeficiency Syndrome Cases by Exposure Category (p. 667)
ANSWER – Text
• Review Questions for the NCLEX Examination: 7 (p. 680)
ANSWER – Study Guide
• Part IIE: 3, 19 (pp. 212-213)
4
READ – Textbook (pp. 666–673)
REVIEW
• Figure 35-2: Tissues affected by HIV (p. 670)
• Table 35-9: Cytomegalovirus Infections (p. 672)
ANSWER – Text
• Review Questions for the NCLEX Examination: 4, 10 (p. 680)
ANSWER – 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)
5
READ – Textbook (p. 673)
REVIEW
• Figure 35-1: Clinical symptoms of acquired immunodeficiency syndrome (AIDS) (p. 672)
ANSWER – Text
• Review Questions for the NCLEX Examination: 5, 6 (p. 680)
ANSWER – Study Guide
• Part ID: 1-6 (p. 212)
• Part IIE: 2, 5, 25, 26 (pp. 212-214)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 35.1
6
READ – Textbook (pp. 673-674)
REVIEW
• Table 35-10: Medications for Treating Patients with HIV infection (p. 675)
ANSWER – Text
• Review Questions for the NCLEX Examination: 8, 9 (p. 680)
7
READ – Textbook (pp. 674-679)
REVIEW
• Nursing Care Plan 35-1 (p. 676)
ANSWER – Text
• Review Questions for the NCLEX Examination: 11 (p. 680)
ANSWER – Study Guide
• Part IIE: 22 (p. 213)
• Part IIIG: 3, 4, 8 (p. 215)
• Part IIIH: 1-4 (pp. 215-216)
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 35
Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome
1
Slide 2
Origin of HIV and AIDS
• Might have been as early as the 1940s
• Not recognized as a new pathogen until the early 1980s
TALKING POINTS:
• What specific immune-deficiency conditions were associated with HIV infection?
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LESSON 35.1
Slide 3
Origin of HIV and AIDS (cont.)
• Men who have sex with men were just the first to be affected
• Infection soon seen in other populations
• Hemophiliacs
• Patients who received a transfusion with HIV-infected blood or blood products
• Newborns and breastfed infants of HIV-infected mothers
• Injection drug users
• Partners having unprotected sex with those infected
TALKING POINTS:
• How is HIV transmitted?
3
Slide 4
Demographics
• Age
• Highest rate persons is for 20-24 (36.4%) and 25-29 (35.2%)
• Since 1981, AIDS has affected 15,074 adults older than 65 years of age
TALKING POINTS:
• What are the five primary transmission categories for HIV and AIDS established by the
Centers for Disease Control and Prevention (CDC)?
2
Slide 5
Pathophysiology
• Infection with HIV virus causes destruction of immune cells
• Retrovirus
• Transcription of genetic material is reversed
• RNA made into deoxyribonucleic acid (DNA) rather than the normal pattern of
DNA to RNA
• Reverse transcriptase
• An enzyme that is responsible for transcribing RNA into DNA
Slide 6
Pathophysiology (cont.)
• The life cycle of HIV
• Penetrates body via blood and body fluids
• Spherical
• Two protein markers protrude from the virus
• Attach to protein markers found on macrophages and T4 helper cells or CD4 and
infuse genetic material into the host cell
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LESSON 35.1
Slide 7
Pathophysiology (cont.)
• HIV DNA incorporated into host cell’s DNA
• Billions of copies of HIV are made
• 21 billion new HIV virions are produced daily
TALKING POINTS:
• How quickly can an entire supply of T4 cells be depleted in a person who is HIV positive?
Slide 8
Pathophysiology (cont.)
• The body’s response to HIV infection
• Mounts a defense against the HIV virus through antibodies and T cells
• About 12 weeks after infection, the body produces enough antibodies to be
detected by standard HIV test
• HIV viral load begins to drop, indicating partial effectiveness of the body to rid
itself of HIV
• CD8 cells drop drastically in the late stages, and CD4 cells slowly decline
throughout the whole infection
TALKING POINTS:
• What are normal lymphocyte counts?
Slide 9
Stages of HIV Infection
• Initial stage
• Lasts 4 to 8 weeks
• High levels of virus in the blood
• Generalized flulike symptoms
• Latent stage
TALKING POINTS:
• What symptoms occur in the latent stage?
Slide 10
Stages of HIV Infection (cont.)
• Third stage
• Lasts 2 to 3 years
• Patient experiences opportunistic infections
• TH CD4 cells are usually <500 cells/mm³
• Viral levels in the blood increase
• Acquired immunodeficiency syndrome (AIDS)
• CD4 cell levels drop <200 cells/mm³
• HIV/AIDS considered chronically managed disease
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LESSON 35.1
4
Slide 11
Signs and Symptoms of HIV Infection
• Initial stage
• Generalized flulike symptoms
• Latent stage
• May have no symptoms initially
• Eventually, frequent and persistent infections
TALKING POINTS:
• What warrants consideration of a diagnosis of HIV infection?
Slide 12
Complications
• Opportunistic infections
• Wasting syndrome
• Secondary cancers
• Central nervous system involvement, encephalopathy, dementia
Slide 13
Opportunistic Infections
• When CD4 cells, CD8 cells, and/or HIV antibodies fall below normal, infections and
cancers take advantage and cause infection or cancer in the body
• Causes: parasites, fungi, bacteria, viruses
• Leading cause of death with AIDS non–AIDS–related cancers
TALKING POINTS:
• What tissues may be affected by HIV?
Slide 14
Parasitic Infections
• Cryptosporidiosis and isosporiasis
• Fairly common in the environment, especially in developing countries
• Watery diarrhea; may be severe/persistent
• Nursing care: preventing dehydration and maintaining fluid and electrolyte balance
• Antidiarrheal drugs
TALKING POINTS:
• When do parasitic infections pose a special threat to the HIV patient?
• Diagnosis is based on laboratory examination of a stool specimen.
Slide 15
Parasitic Infections: Toxoplasmosis
• Cats, mammals, and birds serve as hosts
• Humans become infected by ingesting contaminated, undercooked meats or vegetables
or by contact with cat feces
• Affects any tissue; mainly brain, lungs, eyes
• Toxoplasmosis encephalitis the most common in immunosuppressed patients
• Dull, constant headache, weakness, seizures
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LESSON 35.1
Slide 16
Parasitic Infections: Toxoplasmosis (cont.)
• Pulmonary infection
• Feverish illness that mimics Pneumocystis jiroveci pneumonia with shortness of
breath and nonproductive cough
• Eye infection
Slide 17
Fungal Infections
• Microsporidiosis
• Source of human infection is unknown
• Watery diarrhea with weight loss, malabsorption, abdominal cramps, and flatulence
• No curative therapy; treat the symptoms
• Low-fat, low-residue, high-protein, high-calorie diet
• 3 L of fluid per day; avoid milk products
• Teach good handwashing and good hygiene; avoid ingestion of food or water
contaminated with fecal matter
Fungal Infections (cont.)
• Pneumocystis jiroveci pneumonia
Slide 19
Fungal Infections (cont.)
• Aspergillosis
• Lives in soil, water, and air
• Pulmonary infection can develop when spores are inhaled
• Causes fever, cough, dyspnea, chest pain, and hemoptysis
• Usually fatal within 8 weeks
• Avoid wet, cool places; decreases risk of infection
TALKING POINTS:
• What are common sources of aspergillosis?
Slide 20
Fungal Infections (cont.)
• Candidiasis
• Found in most foods, soil, and inanimate objects
TALKING POINTS:
• What should the patient with an oral or vaginal candidiasis infection who is not on
antibiotic therapy be tested for?
• Inform the patient that candidiasis often reappears and to monitor for reinfection.
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LESSON 35.1
Slide 21
Fungal Infections (cont.)
• Coccidioidomycosis
• Endemic in the southwestern United States and northern Mexico
Slide 22
Fungal Infections (cont.)
• Cryptococcosis
• Most common systemic fungal infection in AIDS patients
• Symptoms appear approximately 30 days after exposure
• Fever, headache, malaise, nausea, vomiting, altered mental status, and a stiff neck
Slide 23
Fungal Infections (cont.)
• Histoplasmosis
• Endemic in the central and southern United States
• Found in soil and bird droppings
Slide 24
Viral Infections
• Cytomegalovirus (CMV)
• Found in semen, cervical secretions, saliva, urine, blood, and organs
• Mainly transmitted by blood and body fluids through unprotected sex
• Complications include chorioretinitis, radiculopathy, subacute encephalitis, colitis,
esophagitis, and pneumonia
Slide 25
Viral Infections (cont.)
• Herpes simplex virus (HSV) and herpes zoster virus (HZV)
• Reactivated HSV in HIV patients can cause serious disease and tissue destruction
• HSV infection follows a predictable pattern
Slide 26
Viral Infections (cont.)
• Oral hairy leukoplakia (OHL)
• Thick white patches on the buccal mucosa, soft palate, floor of mouth, and tongue
• Associated with Epstein-Barr virus
• More common among smokers
• The mouth is often painful