HIV.pptx

HUMAN IMMUNODEFICIENCY VIRUS
Dr. Hayat AL AKOUM

HUMAN IMMUNODEFICIENCY VIRUS
H = Infects only Human beings
I = Immunodeficiency virus
weakens the immune system and
increases the risk of infection
V = Virus that attacks the body

HIV VIRUS INFECTION
The HIV Virus:
 Invades the helper T cells (CD4 cells) in the body of
the host (defense mechanism of a person).
 Is threatening a global epidemic.
 Is preventable & manageable but is NOT curable.

AIDS
Acquired Immune Deficiency Syndrome
 A = Acquired, not inherited
 I = Weakens the Immune system
 D = Creates a Deficiency of CD4+ cells in the
immune system
 S = Syndrome, or a group of illnesses taking place
at the same time

HIV AND AIDS
 When the immune system becomes weakened by HIV,
the illness progresses to AIDS
 Some blood tests, symptoms or certain infections
indicate progression of HIV to AIDS
 AIDS Predisposes our body to other opportunistic
infections.
 Opportunistic infections and malignancies that rarely
occur in the absence of severe immunodeficiency (e.g.
Pneumocystis pneumonia, central nervous system
lymphoma).
 Persons with positive HIV serology who have ever had a
CD4 lymphocyte count below 200 cells/mcL or a CD4
lymphocyte percentage below 14% are considered to
have AIDS.

OVERVIEW OF PATHOPHYSIOLOGY
 HIV destroys body’s immune system by selectively
attacking T-4 Lymphocytes, also macrophages & B
cells
 HIV indirectly affects CNS by neurotoxins produced
by the infected macrophages
 As CD4+ count declines, body becomes more
susceptible to opportunistic infections

RISK FACTORS
 Sexual Practices that promote Disease Transmission
 Under the influence of drugs
 Multiple partners
 Sores in genital area
 Exposure to blood/body fluids
 Administration of blood or blood products
 Transplantation of tissue or organs
 Implantation of infected semen
 Use of injected drugs(drug abuse)
 Occupational exposure
 Accidental needle stick
 HIV-infected mothers to infants during pregnancy,
delivery, or breastfeeding

RISK FACTORS
 Ulcerative STD’s
 Syphilis
 Herpes simplex
 Chancroid
 Non-ulcerative STD’s
 Gonorrhea
 Chlamydia
 Trichomoniasis

HIV TRANSMISSION
 Blood
 Semen
 Vaginal Secretions
 Breast milk
 Comes into contact
with:
 mucous membranes,
damaged tissue, or is
injected into the body
 Through:
 Vaginal, anal, or oral
sex
 Contaminated needles
 IV drug use

HIV TRANSMISSION
 Perinatal transmission during pregnancy, labor and
deliver, or breastfeeding
 Occupational exposure via needle stick or exposure
to eyes, nose, or open wound
 Blood transfusion or organ donation from an HIV
infected donor

HIV TRANSMISSION
 HIV is NOT transmitted by casual contact
 Working or playing with an HIV positive person
 Closed mouth kissing
 Shaking hands
 Public pools
 Hugging
 Public toilet
 HIV is not transmitted by air, food, or mosquito and
does not survive long outside the body.

PRIMARY INFECTION (ACUTE HIV)
 Most develop a flu-like illness within a month or two
after the virus enters the body.
 may last for a few weeks.
 Fever , Headache ,Muscle aches and joint pain
 Rash
 Sore throat and painful mouth sores
 Swollen lymph glands, mainly on the neck
 These symptoms can be so mild that you might not
even notice them.

CLINICAL LATENT INFECTION (CHRONIC HIV)
 Person is HIV+ but asymptomatic
 lasts for several years (subclinical)
 viral replication occurring up to 10 billion virons per day
 Chronic lymphadenopathy

EARLY SYMPTOMATIC DISEASE
 CD4 counts drop to 500-600 cells/ml
 Symptoms:
 Recurrent fever, night sweats, malaise, headache
 Physical findings:
 lymphadenopathy, spleen enlarged, rash, weight loss

SYMPTOMATIC HIV INFECTION
 Fever
 Fatigue
 Swollen lymph nodes: often one of the first signs of
HIV infection Diarrhea
 Weight loss
 Oral yeast infection (thrush)
 Shingles (herpes zoster)

PROGRESSION TO AIDS
 Average time between infection and AIDS was 10
years
 time has increased with new protease inhibitors
 CD4 count

SOME SYMPTOMS OF AIDS
 Soaking night sweats
 Recurring fever
 Chronic diarrhea
 Persistent white spots or unusual lesions on your
tongue or in your mouth
 Persistent, unexplained fatigue
 Weight loss
 Skin rashes or bumps

COMPLICATIONS
I- Infections common to HIV/AIDS
 Pneumocystic jirovecii pneumonia
 Tuberculosis Cytomegalovirus.
 Candidiasis.
 Cryptococcal meningitis.
 Toxoplasmosis.
 Cryptosporidiosis (infection that causes diarrhea. It
is caused by a parasite).

COMPLICATIONS
II. Cancers common to HIV/AIDS
 Kaposi's sarcoma: is a disease in which cancer
cells are found in the skin or mucous membranes
that line the gastrointestinal (GI) tract, from mouth
to anus, including the stomach and intestines.
 Lymphoma.

COMPLICATIONS
 Wasting syndrome: refers to unwanted weight loss
of more than 10 percent of a person's body weight,
with either diarrhea or weakness and fever that
have lasted at least 30 days.
 Neurological complications. such as confusion,
forgetfulness, depression, anxiety and difficulty
walking and dementia complex.
 Kidney disease.

MAINTAIN HEALTH
 Baseline & q 6-12 months.
 CBC
 Chemistries
 Annual Screening
 TB Skin tests/Chest x-ray
 Pregnancy
 Hep A & B to determine need for immunization; Hep
B and/or C co-infection
 Testing for pathogens known to cause
opportunistic infections
 CD4 & Viral load testing (every 3-6 months)

PREVENTION
Safer sex and safer behavior:
 Practice abstinence.
 Reduce the number of
sexual partners to one.
 Always use latex
condoms; if allergic to
latex, use female
condoms(nonlatex).
 Do not reuse condoms.
 Do not use cervical caps
or diaphragms without
using a condom as well.

PREVENTION
 Always use dental dams for oral female genital or
anal stimulation.
 Avoid anal intercourse because this practice may
injure tissues.
 Avoid manual–anal intercourse (“fisting”).
 Do not ingest urine or semen.
 Engage in nonpenetrative sex such as body
massage, social
kissing (dry), mutual masturbation, fantasy, and sex
films.
 Inform prospective sexual and drug-using partners
of your HIV-positive status.

PREVENTION
 Notify previous and present sexual partners if you learn
that you are HIV seropositive. If you are afraid for your
safety, many states have established mechanisms
through the public health department in which
professionals are available to notify exposed people.
 If you are HIV seropositive, do not have unprotected sex
with another HIV-seropositive person, because cross-
infection with another HIV strain can increase the
severity of the disease.
 Do not share needles, razors, toothbrushes, sex toys, or
other blood-contaminated articles.
 If you are HIV seropositive, do not donate blood,
plasma,body organs, or sperm.

TRANSMISSION TO HEALTH CARE PROVIDERS
1. Hand Washing/Hand Hygiene
 Wash hands/perform hand hygiene after touching blood,
body fluids, secretions, excretions, and contaminated
items, whether or not gloves are worn.
 Wash hands/perform hand hygiene immediately after
gloves are removed, between patient contacts, and
when otherwise indicated to avoid transfer of
microorganisms to other patients or environments.
 Wash hands/perform hand hygiene between tasks and
procedures on the same patient to prevent cross-
contamination of different body sites.
 Use a plain (nonantimicrobial) soap or alcohol-based
hand rub for routine hand washing.
 Use an antimicrobial agent or waterless antiseptic agent
for specific circumstances (control of outbreaks or
hyperendemic infections).

2. Gloves
 Wear clean, nonsterile gloves when touching blood,
body fluids, secretions, excretions, and contaminated
items.
 Put on clean gloves just before touching mucous
membranes and nonintact skin.
 Change gloves between tasks and procedures on the
same patient after contact with materials that may
contain a high concentration of microorganisms.
 Remove gloves promptly after use, before touching
noncontaminated items and environmental surfaces,
and before going to another patient.
 Wash hands/perform hand hygiene immediately after
removing gloves.

3. Mask, Eye Protection, Face Shield
 Wear a mask and eye protection or a face shield to
protect mucous membranes of the eyes, nose, and
mouth during procedures and patient care activities
that are likely to generate splashes or sprays of
blood, body fluids, secretions, or excretions.

4. Gown
 Wear a clean, nonsterile gown to protect skin and
prevent soiling of clothing during procedures and
patient care activities that are likely to generate
splashes or sprays of blood, body fluids, secretions,
or excretions.
 Select a gown that is appropriate for the activity and
amount of fluid likely to be encountered.
 Remove a soiled gown as promptly as possible and
wash hands/perform hand hygiene to prevent the
transfer of microorganisms to other patients or
environments.

5. Patient Care Equipment
 Handle used patient care equipment soiled with
blood, body fluids, secretions, and excretions in a
manner that prevents skin and mucous membrane
exposures, contamination of clothing, and transfer
of microorganisms to other patients and
environments.
 Ensure that reusable equipment is not used for the
care of another patient until it has been cleaned
and reprocessed appropriately.
 Ensure that single-use items are discarded
properly.

6. Environmental Control
 Ensure that the hospital has adequate procedures
for the routine care, cleaning, and disinfection of
environmental surfaces, beds, bed rails, bedside
equipment, and other frequently touched surfaces.
 Ensure that procedures are being followed.

7. Linen
 Handle, transport, and process used linen soiled
with blood, body fluids, secretions, and excretions
in a manner that prevents skin and mucous
membrane exposures and contamination of clothing
and that avoids transfer of microorganisms to other
patients and environments.

8. Occupational Health and Bloodborne Pathogens
 Take care to prevent injuries when using needles,
scalpels, and other sharp instruments or devices: When
handling sharp instruments after procedures When
cleaning used instruments When disposing of used
needles
 Never recap used needles or otherwise manipulate
them by using both hands or use any technique that
involves directing the point of the needle toward any part
of the body.
 Use either a one-handed scoop technique or a
mechanical device designed for holding the needle
sheath.

 Do not remove used needles from disposable syringes
by hand and do not bend, break, otherwise manipulate
used needles by hand.
 Place used disposable syringes and needles, scalpel
blades, and other sharp items in appropriate puncture-
resistant containers as close as practical to the area in
which the items were used.
 Place reusable syringes and needles in a puncture-
resistant container for transport to the reprocessing
area.
 Use mouthpieces, resuscitation bags, or other
ventilation devices as an alternative to mouth-to-mouth
resuscitation methods in areas where the need for
resuscitation is predictable.

9. Patient Placement
 Place a patient who contaminates the environment
or who does not or cannot be expected to assist in
maintaining appropriate hygiene or environmental
control in a private room.
 If a private room is not available, consult with
infection control professionals regarding patient
placement or other alternatives.

POST EXPOSURE PROPHYLAXIS
FOR HEALTH CARE PROVIDERS
If you sustain a needle stick injury, take the following
actions immediately:
 Wash the area with soap and water.
 Alert your supervisor and initiate the injury-reporting
system used in the setting.
 Identify the source patient, who may need to be tested
for HIV, hepatitis B, and hepatitis C. (State laws will
determine if written informed consent must be obtained
from the source patient prior to his or her testing.)
 Report to the employee health services, the emergency
department, or other designated treatment facility.
 Give consent for baseline testing for HIV, hepatitis B,
and hepatitis C.

POST EXPOSURE PROPHYLAXIS
FOR HEALTH CARE PROVIDERS
 Get postexposure prophylaxis for HIV in
accordance with CDC guidelines. Start the
prophylaxis medications within 2 hours after
exposure. Make sure that you are being monitored
for symptoms of toxicity. Practice safer sex until
follow-up testing is complete.
 Follow up with postexposure testing at 6 weeks, 3
months, and 6 months and perhaps 1 year.
 Document the exposure in detail for your own
records as well as for the employer

Nursing Care plan of the Patient With AIDS
Nursing
Diagnosis
Goal Nursing Interventions
Diarrhea related
to enteric
pathogens or HIV
infection
Resumption of
usual bowel
habit
1. Assess patient’s normal bowel habits.
2. Assess for diarrhea: frequent, loose stools;
abdominal pain or cramping, volume of liquid
stools, and exacerbating and alleviating factors.
3. Obtain stool cultures and administer
antimicrobial therapy as prescribed.
4. Initiate measures to reduce hyperactivity of
bowel:
a. Maintain food and fluid restrictions as
prescribed. Suggest BRAT diet (bananas, rice,
applesauce, tea and toast).
b. Discourage smoking.
c. Avoid bowel irritants such as fatty or fried
foods, raw vegetables, and nuts. Offer small,
frequent meals.
5. Administer anticholinergic antispasmodics and
opioids or other medications as prescribed.
6. Maintain fluid intake of at least 3 L unless
contraindicated.

Nursing
Diagnosis
Risk for infection
related to
immunodeficiency
Absence of
infection
1. Monitor for infection: fever, chills, and
diaphoresis; cough; shortness of breath;
oral pain or painful swallowing; creamy
white patches in oral cavity; urinary
frequency, urgency, or dysuria; redness,
swelling, or drainage from wounds;
vesicular lesions on face, lips, or perianal
area.
2. Teach patient or caregiver about need to
report possible infection.
3. Monitor white blood cell count and
differential.
4. Obtain cultures of wound drainage, skin
lesions, urine, stool, sputum, mouth, and
blood as prescribed. Administer
antimicrobial therapy as prescribed.

Nursing
Diagnosis
Risk for infection
related to
immunodeficiency
Absence of infection 5. Instruct patient in ways to prevent
infection:
a. Clean kitchen and bathroom
surfaces with disinfectants.
b. Clean hands thoroughly after
exposure to body fluids.
c. Avoid exposure to others’ body fluids
or sharing eating utensils.
d. Turn, cough, and deep breathe,
especially when activity is decreased.
e. Maintain cleanliness of perianal
area.
f. Avoid handling pet excreta or
cleaning litter boxes, bird cages, or
aquariums.
g. Cook meat and eggs thoroughly.
6. Maintain aseptic technique when
performing invasive procedures such
as venipunctures, bladder
catheterizations, and injections.

Nursing
Diagnosis
Ineffective airway
clearance related
to Pneumocystis
carinii pneumonia,
increased
bronchial
secretions, and
decreased ability
to cough related to
weakness and
fatigue
Improved airway
clearance
1. Assess and report signs and symptoms of
altered respiratory status, tachypnea, use
of accessory muscles, cough, color and
amount of sputum, abnormal breath sounds,
dusky or cyanotic skin color,
restlessness, confusion, or somnolence.
2. Obtain sputum sample for culture
prescribed.
Administer antimicrobial therapy as
prescribed.
3. Provide pulmonary care (cough, deep
breathing, postural drainage, and vibration)
every 2 to 4 hours.
4. Assist patient in attaining semi- or high
Fowler’s position.
5. Encourage adequate rest periods.

Nursing
Diagnosis
Ineffective airway
clearance related
to Pneumocystis
carinii pneumonia,
increased
bronchial
secretions, and
decreased ability
to cough related to
weakness and
fatigue
Improved airway
clearance
6. Initiate measures to decrease viscosity of
secretions:
a. Maintain fluid intake of at least 3 L per
day unless contraindicated.
b. Humidify inspired air as prescribed.
c. Consult with physician concerning use
of mucolytic agents delivered through
nebulizer or IPPB treatment.
7. Perform tracheal suctioning as needed.
8. Administer oxygen therapy as prescribed.
9. Assist with endotracheal intubation;
maintain ventilator settings as prescribed.

Nursing
Diagnosis
Imbalanced
nutrition, less
than body
requirements,
related to
decreased oral
intake
Improvement
of nutritional
status
1. Assess for malnutrition with height, weight, age,
BUN, serum protein, and albumin, transferrin
levels, hemoglobin, hematocrit, and cutaneous
anergy.
2. Obtain dietary history, including likes and
dislikes and food intolerances.
3. Assess factors that interfere with oral intake.
4. Consult with dietitian to determine patient’s
nutritional needs.
5. Reduce factors limiting oral intake:
a. Encourage patient to rest before meals.
b. Plan meals so that they do not occur
immediately after painful or unpleasant
procedures.
c. Encourage patient to eat meals with visitors or
others when possible.
d. Encourage patient to prepare simple meals or to
obtain assistance with meal preparation if
possible.

Nursing
Diagnosis
Imbalanced
nutrition, less
than body
requirements,
related to
decreased oral
intake
Improvement
of nutritional
status
e. Serve small, frequent meals: 6 per day.
f. Limit fluids 1 hour before meals and with meals.
6. Instruct patient in ways to supplement
nutrition: consume protein-rich foods
(meat, poultry, fish) and carbohydrates
(pasta, fruit, breads).
7. Consult with physician and dietitian
about alternative feeding (enteral or parenteral
nutrition).
8. Consult with social worker or community
liaison about financial assistance if
patient cannot afford food.

Nursing
Diagnosis
Deficient
knowledge
related to means
of preventing HIV
transmission
Increased
knowledge
concerning
means of
preventing
disease
transmission
1. Instruct patient, family, and friends about routes
of transmission of HIV.
2. Instruct patient, family, and friends about means
of preventing transmission of HIV:
a. Avoid sexual contact with multiple partners, and
use precautions if sexual partner’s HIV status is
not certain.
b. Use condoms during sexual intercourse
(vaginal, anal, oral–genital); avoid mouth contact
with the penis, vagina, or rectum; avoid sexual
practices that can cause cuts or tears in the lining
of the rectum, vagina, or penis.
c. Avoid sex with prostitutes and others at high
risk.
d. Do not use injection drugs; if addicted and
unable or unwilling to change behavior, use clean
needles and syringes.
e. Women who may have been exposed to AIDS
through sexual or drug practices should consult
with a physician before becoming pregnant;
consider use of antiretroviral agents if pregnant.

Nursing
Diagnosis
Social isolation
related to stigma
of the disease,
withdrawal of
support systems,
isolation
procedures, and
fear of infecting
others
Decreased
sense of
social isolation
1. Assess patient’s usual patterns of social
interaction.
2. Observe for behaviors indicative of social
isolation, such as decreased interaction with
others, hostility, noncompliance, sad affect, and
stated feelings of rejection or loneliness.
3. Provide instruction concerning modes of
transmission of HIV.
4. Assist patient to identify and explore resources
for support and positive mechanisms
for coping (eg, contact with family, friends, AIDS
task force).
5. Allow time to be with patient other than for
medications and procedures.
6. Encourage participation in diversional activities
such as reading, television, or hand crafts.

Nursing Diagnosis Goal Nursing Interventions
Opportunistic
infections; impaired
breathing; wasting
syndrome and fluid and
electrolyte
imbalances; adverse
reaction to medications
Absence of
complications
Opportunistic Infections
1. Monitor vital signs.
2. Obtain laboratory specimens and
monitor test results.
3. Instruct the patient and caregiver about
signs and symptoms of infection and the
need to report them early.
Impaired Breathing
1. Monitor respiratory rate and pattern.
2. Auscultate the chest for breath sounds
and abnormal lung sounds.
3. Monitor pulse rate, blood pressure, and
oxygen saturation levels.

Nursing
Diagnosis
Opportunistic
infections;
impaired
breathing;
wasting
syndrome and
fluid and
electrolyte
imbalances;
adverse reaction
to medications
Absence of
complications
Wasting Syndrome and Fluid and
Electrolyte Disturbances
1. Monitor weight and laboratory values for
nutritional status.
2. Monitor intake and output and laboratory
values for fluid and electrolyte imbalance
(potassium, sodium, calcium, phosphorus,
magnesium, and zinc).
3. Monitor for and report signs and symptoms
of dehydration.
Reactions to Medications
1. Monitor for medication interactions.
2. Monitor for and promptly report side effects
from antiretroviral agents.
3. Instruct the patient and caregiver in the
medication regimen.

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