NURS 443 Lecture Notes - Lecture 2: Opportunistic Infection, Intravenous Sugar Solution, Hypotension
Immunity
Book notes
A. HIV
a. Definition: RNA virus that causes immunosuppression by bonding w/ CD4 +T cell,
destroying the cell, and replicating itself
i. Normal lifespan of CD4 is 100 days, with HIV (+) it is 2 days.
b. Facts about HIV:
i. Window period (acute retroviral syndrome/ seroconversion)- will last 2-4 weeks
or up to 6 mo, here our od has the irus ut ou phsiall do’t ko ad
it o’t sho up i the ELISA test either
1. Will typically get diagnosed with flu or viral meningitis during this time
ii. Degree of infection depends on duration and frequency of contact w/ organism,
olue/irulee/oetratio of orgais, ad host’s iue status
iii. If pregnant prophylactic testing will be performed in first and third trimester
iv. There are three stages of HIV
1. Acute or primary infection last 1-3 wks (No sptos to “flu-like sympt)
2. Clinical latency (asymptomatic period may last >10 yrs if symptomatic
may be 8-10 yrs)
3. AIDS lasts 10-13yrs (opportunistic infections and secondary cancers)
v. Can be transmitted through all phases of the disease
c. Transmission
i. Contact w/ infected blood, semen/vaginal secretions (most common mode of
transmission), or breast milk
d. Sign and symptoms
i. Acute infection: Fever, lymphadenopathy (swollen lymph nodes), sore throat,
headache, malaise, nausea, sweats, muscle aches, diarrhea, rash w/
seroconversion
1. Typically have pneumonia, candida esophagitis, facial palsy, peripheral
neuropathy, Guillain-Barre syndrome, meningitis, and wasting
syndrome
ii. Chronic asympt: usually about 10 yrs. Typically have fatigue, headache, low-
grade fever, night sweats, persistent generalized lymphadenopathy or none at
all
iii. Chronic symptomatic: Weight loss, dry cough, white spots in mouth or throat/
thrush, recurring fever, drenching night sweats, chronic diarrhea, oral hairy
leukoplakia (painless/ white/ raised lesions on lateral aspect of tongue)
iv. Aids: malaise/ fatigue, low-grade fever, night sweats, involuntary weight loss,
skin dryness/ rashes, diarrhea, oral lesions, confused, delirium, seizures,
neuropathy
e. Testing
i. Elisa (enzyme linked immunity assay)-
1. Detects serum antibodies that bind to HIV antigens on test plates
2. False positive if have high antibodies: mothers, IV drug use, Hx of
malaria, hepatitis,
3. If positie…. Will take agai… if still positie the ill get a western blot
or IFA test
ii. Rapid HIV-Antibody test
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1. Highly accurate and can be done at home. Results take 20 mins
2. Is an oral fluid sample and screens for antibodies not antigens
3. If (+) then follow up with Western blot or IFA test will need to be done
iii. Western blot
1. Detects specific serum HIV antibodies. If you have 2-4 antibodies it will
be a positive test
2. They will then say you have HIV and then test you to see how far along
you are
iv. CD4+T cell counts
1. Provides a marker of immune function
2. Normal range is 800-1200
3. Diagnosed with AIDS if under 200
v. Viral load test
1. Occurs during acute HIV infection phase which is w/I 2-4 wks and will
last for 1-3 wks.
2. The lower the viral load the less active the disease is
3. Test typically taken while getting treatment for HIV
4. Sees how much HIV is circulating through body
5. Will help determine if viral load is going up or down.
6. If taking ART and test is undetectable does not mean you are cured
from the virus and it is gone
vi. Genotype assay and phenotype assay
1. Determine if HIV is resistant to ART (antiretroviral therapy)
2. Geno: detects drug-resistant viral mutation Pheno: growth of HIV in
various concentrations of antiretroviral drugs
f. Diagnosed with AIDS
i. Must be HIV positive
ii. CD4 level must be under 200 or have an opportunistic infection
1. Viral load increasing, and absolute number and percentage of T cell
decrease
iii. One of the following opportunistic infections
1. candidiasis of bronchi/trachea/lungs/esophagus, pneumonia,
cytomegalovirus, toxoplasmosis, mycobacterium tuberculosis
iv. one of the following opportunistic cancers
1. erial aer, Kaposi saroa, Burkitt’s lphoa, iuolasti
lymphoma, primary lymphoma of brain
v. wasting syndrome & AIDS dementia complex
g. Management
i. No cure is available but the main goal is preventing any severe secondary
medical conditions from occurring
ii. Drug therapy (Table 15-12 pg. 237)
1. Main goal: prevent replication of virus
2. They either inhibit RNA replication or prevent virus from entering
3. ART does not cure but it can delay disease progression
4. Patient can become drug resistance: occurs when missing a dose or
taking less than prescribed dosage
5. Encourage the pt. not to use over the counter drugs and herbal therapy
suh as St. joh’s ort
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6. Reverse transcriptase inhibitors
a. NRTI- block development of HIV DNA
i. Zidovudine, didanosine, stavudine
b. NtRTI-block process needed to convert HIV RNA
i. Tenofovir(Truvada)
1. Used for prevention of HIV transmission in
uninfected individuals
2. Used w/ safe sex practice, risk reduction counseling,
and regular HIV testing
c. NNRTI- inhibit action of reverse transcriptase
i. Efavirenz(Sustiva)
1. If pregnant, can be used after first 8 wks of
pregnanty.
2. Should be taken at night to help w/ SE of dizziness
and confusion
3. May have bizarre or vivid dreams
7. Entry inhibitors- prevent entry of HIV
a. Enfuvirtide (Fuzeon) & Maraviroc (Selzentry)
8. Integrease inhibitors- prevent HIV entering host cell
a. Raltegravir(Isentress), elvitegravir, dolutegravir (Tivicay)
9. Protease inhibitor- prevent development of HIV
a. Saquinavir(Fortovase), indinavir(Crixivan), ritonavir(Norvir)
10. Fixed-dose combination products- mixture of tables
h. Interventions
i. Educate about safe sex, decrease equipment sharing among IV drug users,
recommend HIV testing, individual behavior change
ii. Get normal vaccines including Hep B, Flu, and Pneumonia
iii. Educate about drug adherence and consistent lab check ups
iv. If mother w/ HIV will typically get C-section and education not to breastfeed
v. Provide support and coping skills
vi. Monitor for infection and acute exacerbation
vii. End of life education may be necessary
B. Organ Transplant
a. General information
i. Most common types of transplants: skin, bone marrow, heart valve, bone,
connective tissue, cornea
ii. Many times organs are transplanted together
1. Diabetic patients typically get the pancreas and kidneys because they
typically have kidney failure as well.
iii. Organs can be taken from two sources: deceased (cadaver) or living donors
1. Also known as allograft
iv. Ee ou hae siged the door ard it is still up to the perso’s legal et of ki
to sign the consent once deceased
v. Patients are matched based on:
1. ABO blood (Table 30-8 pg. 627) Rh does not matter
2. HLA typing- human leukocyte antigen
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Document Summary
Will take agai(cid:374) if still positi(cid:448)e the(cid:374) (cid:449)ill get a western blot or ifa test: rapid hiv-antibody test, highly accurate and can be done at home. Is an oral fluid sample and screens for antibodies not antigens. If (+) then follow up with western blot or ifa test will need to be done: western blot, detects specific serum hiv antibodies. Integrease inhibitors- prevent hiv entering host cell: raltegravir(isentress), elvitegravir, dolutegravir (tivicay, protease inhibitor- prevent development of hiv, saquinavir(fortovase), indinavir(crixivan), ritonavir(norvir, fixed-dose combination products- mixture of tables. 627) rh does not matter: hla typing- human leukocyte antigen only a, b, and dr antigens are matched. If antigen matches 5 of 6 and certain 4-antigen matches have been found to have a good outcome: kidney and bone marrow screening is very important as opposed to cornea screening, panel of reactive antibodies. Indicates the recipients sensitivity to various hla before receiving a transplant.
