Aleksandra Djordjevic

Disease Process:HIV

Definition:

HIV infection is a condition caused by the human immunodeficiency virus (HIV). The condition gradually destroys the immune system, which
makes it harder for the body to fight infections.
The human immunodeficiency virus (HIV) can be spread by the following:
• Through sexual contact -- including oral, vaginal, and anal sex
• Through blood -- via blood transfusions (now very rare in the U.S.) or needle sharing
• From mother to child -- a pregnant woman can transmit the virus to her fetus through their shared blood circulation, or a nursing
mother can pass it to her baby in her breast milk
People who become infected with HIV may have no symptoms for up to 10 years, but they can still pass the infection to others. After being exposed
to the virus, it usually takes about 3 months for the HIV ELISA blood test to change from HIV negative to HIV positiv

Pathophysiology:

• HIV primarily infects CD4+ T- lymphocytes.

• Continuous viral replication occurs throughout the course of HIV disease.
• Up to 10 billion virions are produced and cleared daily.
• The half-life of an HIV-infected CD4 cell is about 1.3 days.
• Most CD4 cells turn over rapidly, but some belong to a latent pool with a long half-life.
• Virus-specific CD4 cells, which are critical in maintaining an effective host immune response in chronic viral infections, are present early in
HIV infection but are generally lost over time.
• The patient's immune system keeps pace with this activity during the clinical latency period.
• However, in the absence of effective antiretroviral treatment, the immune system ultimately reaches a "point of exhaustion" at which viral
replication exceeds its ability to produce CD4 cells; this leads to a decline in immunologic function and the development of clinical disease
manifestations, including opportunistic infections and neoplasms.
• The rate of viral replication is thought to stabilize after primary infection at a particular level or "set point"; this level may be maintained
within a ten-fold range over months and possibly years; the viral load is highly correlated with the rate of disease progression and mortality.
Clinical Manifestations:
• Diarrhea
• Fatigue
• Fever
• Frequent vaginal yeast infections
• Headache
• Mouth sores, including yeast infection (thrush)
• Muscle stiffness or aching
• Rash of different types, including seborrheic dermatitis
• Sore throat
• Swollen lymph glands

Nursing Assessments:
• History: when symotoms started, severity, past treatments
• ADLs
• Physical changes
• Previous sexual partners
• Opportunistic infections
• Psychosocial assessment
• Laboratory assessment

NURSING INTERVENTIONS:

Physician-Initiated/Collaborative (Dependent):
 • Nucleoside analog reverse transcriptase inhibitors
• Protease inhibitors

• Fusion inhibitors

• Support groups

Nurse-Initiated (Independent):
• Preventing infections
• Encourage fluid intake
• teaching about the spread of HIV
• Assess skin for color, moisture, texture, and turgor (elasticity). Keep accurate, ongoing documentation of changes
• Use alternatives to indwelling catheters whenever possible (external catheters, incontinence pads, bladder control techniques). Sterile
technique must be used when inserting urinary catheters

Common Nursing Diagnoses: (List 7)

• Risk for infection r/t immune deficiency
• Impaired gas exchange r/t anemia
• Acute/chronic pain r/t neuropathy,cancer, infection
• Impaired skin integrity r/t KS
• Disturbed thought process r/t AIDs dementia complex
• Chronic low self esteem r/t changes in body image
• Activity intolerance r/t fatigue
Reference/s: medical surgical nursing Ignatavicius workman Volume 1 6th edtion