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Chapter 21

Care of Patients with HIV Disease and Other Immune

Deficiencies

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Acquired Immune Deficiency Syndrome

The most common secondary immunogenicity disease in the world

Identified in 1981 Serious worldwide epidemic

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Prevalence of HIV Infection by Country

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HIV Infectious Process

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Life Cycle of HIV

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Effects of HIV Infection

Everyone who has AIDS has HIV infection. However, not everyone who has HIV infection has AIDS.

The distinction rests with the number of CD4+ T-cells the patient has and whether any opportunistic infections have occurred.

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Virus Infection

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HIV Classification

Clinical categories: Clinical category A Clinical category B Clinical category Co

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Health Promotion and Maintenance

Education is the best hope for prevention. HIV is transmitted most often in three

ways: Sexual Parenteral Perinatal

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Transmission and Health Care Workers

Needle stick or “sharps” injuries are the primary means of HIV infection for health care workers.

Workers can also be infected through exposure of nonintact skin and mucous membranes to blood and body fluids.

The best prevention for health care providers is the consistent use of Standard Precautions for all patients as recommended by the CDC.

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Collaborative Management

Assessment History Physical assessment and clinical

manifestations: Infections—opportunistic, protozoal, fungal,

bacterial, viral Malignancies—Kaposi’s sarcoma, malignant

lymphomas Endocrine complications

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Other Clinical Manifestations

AIDS dementia complex AIDS wasting syndrome Skin changes

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Laboratory Assessment

Lymphocyte counts CD4+ T-cells and CD+ T-cells Antibody tests Enzyme-linked immunosorbent assay

(ELISA) Western blot, viral load Quantitative RNA assays Others

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Drug Therapy

Nucleoside analog reverse transcriptase inhibitors

Non-nucleoside reverse transcriptase inhibitors

Protease inhibitors Fusion inhibitors Entry inhibitors Integrase inhibitors Immune enhancement

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Nursing Diagnoses

Pain Imbalanced Nutrition: Less Than Body

Requirements Diarrhea Impaired Skin Integrity Disturbed Thought Processes Chronic Low Self-Esteem Social Isolation

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Community-Based Care

Home care management Health teaching Psychosocial preparation Health care resources

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Therapy-Induced Immune Deficiencies

Drug-induced immune deficiencies Radiation-induced immune deficiencies

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Other Immune Deficiencies

Congenital (primary) immune deficiencies Bruton’s agammaglobulinemia Common variable immune deficiency Selective immunoglobulin A deficiency