Chapter 20 Nursing Care of Patients with Hiv Disease and Aids

Answers CHAPTER 20 NURSING CARE OF PATIENTS WITH HIV DISEASE AND AIDS AUDIO CASE STUDY Mrs. Harris and HIV 1. Incidents of HIV are increasing for adults 50 and older and for African Americans. 2. Unprotected sex (e.g., no condom or no dental dam for oral sex), multiple partners. 3. No, HIV is transmitted only through infected blood, semen, vaginal secretions, or breast milk. AIDS can occur as the end stage of an HIV infection. VOCABULARY 1. AIDS 2. CD4 T lymphocyte 3. Genotyping 4. Opportunistic infections 5. AIDS wasting syndrome 6. Viral load DIAGNOSTIC TESTS 1. HIV antigen/antibody combination immunoassay detects both HIV-1 and HIV-2 antibodies and HIV-1 p24 antigen. If the test is positive, an antibody immunoassay test to differentiate between HIV-1 and HIV-2 antibodies should be done. If the combination immunoassay is positive but the antibody differentiation immunoassay is nonreactive or inconclusive, an HIV-1 nucleic acid test should be done for confirmation. 2. Viral load measures the amount of HIV RNA in plasma and is extremely important for determining prognosis and risk of opportunistic infections and for monitoring the response to antiretroviral therapy. Viral load should be performed before starting antiretroviral therapy (ART) and then within 1 month afterward and then at 3 to 4 months for 2 years. After 2 years, monitoring for consistently suppressed viral load is done every 6 months or for detectable viral load every 3 months. 3. CD4 T lymphocyte count is essential for initial evaluation of the status of the immune system and the need for ART. In healthy adults, levels average approximately 332 to 1,642 cells/microL. It is recommended that CD4 T lymphocyte counts be performed at 3- to 6-month intervals when ART is deferred. Those who begin ART should be tested at 3 months. For those who have consistent CD4 levels above 300 cells/microL, suppressed viral load testing is recommended every 3 to 6 months or when clinically needed for 2 years, and then annually. 4. Genotyping measures resistance to currently available antiviral treatments. This information guides health care providers in choosing treatment regimens that will most likely be effective against that person’s virus. HIV 1. blood, semen, vaginal secretions, breast milk 2. many 3. early 4. window HIV AND AIDS 1. True 2. False. The end stage of HIV infection is AIDS. 3. False. Anyone may contract HIV if exposure occurs. 4. True 5. False. An incubation period occurs following exposure, so testing 1 to 2 days later would be inconclusive; antigens are detectable 2 weeks after infection with the virus. Antibodies form usually within 3 weeks to 3 months. Early detection HIV tests detect HIV infection as soon as 1 week after potential exposure. 6. False. Standard precautions are used with all patients, so isolation is not routinely necessary for patients with AIDS unless ordered for special reasons. CRITICAL THINKING 1. The patient is told that he is HIV positive but does not have AIDS at this time. With therapy, HIV disease is a chronic, sometimes progressive immune disorder. If AIDS develops, there is currently no cure, but it may be treatable in most cases. 2. AIDS occurs when the CD4 T lymphocyte cell count is less than 200 cells/microL and/or when there is the presence of an opportunistic infection or cancer. 3. To prevent pneumocystis pneumonia and toxoplasmosis opportunistic infections from developing. 4. (a) Candidiasis, medications, and peripheral and central nervous system disease tend to decrease the senses of taste and smell. This, along with discomfort, anorexia, 1 2 Chapter 20 Answers and fatigue, predisposes the patient with AIDS to nutritional deficiencies. (b) Medicated swish and swallows, topical anesthetic sprays, and flavor enhancers may promote increased food intake. 5. Dementia occurs from encephalopathy caused by direct infection of brain tissue by HIV. 6. Possible ways include bodily secretions or blood of an infected person coming into contact with a nurse’s blood through a break in the nurse’s skin or needle stick, or through contact with mucous membranes. 7. The recommended disinfectant is household bleach in a 1:10 dilution mixture prepared daily. Use it to disinfect body fluid spill areas, to clean toilet seats and bathroom fixtures, and to clean inside the refrigerator to avoid growth of mold. Rinse clothing and then wash separately from other clothes with 1 cup of bleach if soiled with blood, urine, feces, or semen. Dishes and silverware are washed in hot, soapy water and rinsed thoroughly or placed in dishwasher. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (2) is correct. AIDS is the final phase of a chronic progressive immune disorder caused by HIV. It is characterized by a CD4 T lymphocyte count below 200 cells/microL, or a CD4 T lymphocyte percentage under 14% of total lymphocytes, or the presence of one or more specified clinical conditions, some of which are candidiasis, pneumocystis pneumonia, cytomegalovirus disease, and mycobacterium tuberculosis. (1, 3, 4) are incorrect. 2. (1, 3, 5, 6) are correct. CD4 T lymphocyte testing is done before antiretroviral therapy is started and at 3 months after beginning antiretroviral therapy. Then, those who have consistent CD4 levels above 300 cells/microL and suppressed viral load are tested every 3 to 6 months for 2 years or as clinically needed, and then annually. (2, 4) are incorrect. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 3. (3, 4, 5) are correct. The only fluids from a person infected with HIV that can transmit HIV include blood, semen, preseminal fluid, vaginal secretions, rectal fluids, and breast milk. (1, 2) are incorrect. These fluids do not transmit HIV. 4. (1, 2, 3, 4) are correct. These tests are used to identify an HIV infection. (5) is incorrect. A urinalysis does not identify the presence of HIV. 5. (2) is correct. High fiber foods such as grains, fruits, and vegetables increase bowel function. (1, 3, 4) are incorrect. 6. (1) is correct. (2, 3, 4) are incorrect. With antiretroviral therapy, severe opportunistic infections occur less commonly. 7. (4) is correct. Guidelines for HIV screening of pregnant women recommend that HIV counseling and then voluntary testing be offered during routine prenatal care for all pregnant women and again in the third trimester for women at high risk. (1, 2, 3) are incorrect. 8. (2, 6) are correct. Safe food items can include steaminghot foods and self-peeled fruits. So, cooked vegetables are safer. (1, 3, 4, 5) are incorrect because they are a soft cheese, are raw foods, or contain uncooked eggs, which are riskier for infection. 9. (2) is correct. Standard precautions are used for all patients. (1, 3, 4) are incorrect. HIV is not an airbornetransmitted virus. 10. (1, 3, 5, 6) are correct. Viral load testing is done before antiretroviral therapy is started and within 1 month after beginning antiretroviral therapy. Then, it is done for those who have consistently suppressed viral loads every 3 to 4 months or as clinically needed for 2 years, and then every 6 months thereafter. (2, 4) are incorrect. 11. (1, 3, 4) are correct. HIV risk reduction includes using condoms and dental dams (latex sheets) as a barrier for the mouth and genitals or anus every time. Latex is used because other materials have large pores that allow HIV to pass through. Condoms should be new for each sex act. Studies show that high-risk sexual behavior associated with contracting sexually transmitted infections puts people at increased risk for HIV exposure. (2, 5, 6) are incorrect. An estimated one in eight people are not aware of being infected, so precautions should be used every time. Petroleum- or oil-based lubricants such as petroleum jelly, cooking oil, shortening, or lotions can damage latex condoms. Adults over 50 tend to think of condoms only as a birth control measure, which is only one of their purposes.