CHAPTER 56: CARE OF THE PATIENT WITH HIV/AIDS Acute Interventions to Outlook For The Future.

CHAPTER 56: CARE OF THE PATIENT WITH HIV/AIDSAcute Interventions to Outlook For The Future

Acute Interventions

Acute Interventions

Early intervention after detection of an HIV infection can promote health and limit or delay disability

Assessment is of primary importance because the course of HIV is extremely variable

Nursing interventions will be based on and tailored to any patient needs noted during assessment

Nursing assessment of HIV disease should focus on the early detection of constitutional symptoms, opportunistic diseases, and psychosocial problems

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Box 56-6: Conducting a Risk Assessment

Conducting a Risk Assessment

Risk assessment specific to HIV and sexually transmitted diseases (STDs), as well as blood borne diseases, is crucial in health care delivery today. Risk assessment should be done on a regular basis with all patients and performed with the evaluation of any new patient. Sexual and drug use risks should be determined along with other risks during routine history taking.

Key Questions To Ask

Any “yes” responses require further assessment and evaluation:

Have you ever had a blood transfusion? Have you ever received any other kind of blood product? Before 1985?

Do you now or have you ever shared injection equipment?

Are you now or have you ever been sexually active?

Key Points to Consider

Begin by assuring confidentiality and telling the patient why asking these questions is important:

“I am going to ask some personal questions. I ask all my patients these questions so I can provide better care. All of your responses will be kept confidential. Is it OK to proceed?”

Key Points to Consider (cont)

Ask direct questions about specific behaviors:

“When was the last time you….?” “How often do you….?” “Have you ever exchanged sex for

money or drugs?”

Key Points to Consider (cont)

Exploratory questions may help (especially with adolescents and young adults):

“Do your friends use condoms?” “What happens at parties?” “How easy is it to get drugs?”

Key Points To Consider (cont)

Honest responses may be more forthcoming if the behaviors are normalized:

“Some of my patients who use drugs inject them. Do you inject drugs or other substances?

“Sometimes people have anal intercourse. Have you ever had anal intercourse?”

Drug Use Assessment

It is important to be nonjudgmental and nonmoralistic:

Injection drug use is illegal in the U.S. and many patients are afraid to be honest unless trust is established

Drug Use Assessment (cont)

Start with less threatening questions: “What over-the-counter (OTC) or

prescription medications are you taking?”

“How often do you use alcohol? Tobacco?”

“Have you ever used drugs from a nonmedical source?”

“Have you ever injected any kind of drug?”


Do not assume anything: Drug use occurs in all socioeconomic

strata. Do not forget that people inject substances such as insulin, steroids, and vitamins. Any sharing, even one time, can result in HIV exposure


Look for other clue in the history and physical exam:

Antisocial behavior, recurrent criminal arrests, needle tracks


If there is a positive history of drug injection use, get more information:

“Do/Did you share needles/other equipment?”

“Is/Was the equipment you use(d) clean? How did you know it was clean?”

“What drugs did you inject?”

Sexual Risk Assessment

Direct and nonjudgmental questions work best: “Do you have sex with men, women, or both?” “Do you have oral sex? Vaginal sex? Anal sex?” “What do you know about the sexual activities of

your partners?” “What do you do to protect yourself during sex? “Do you use condoms? How often?” “Have you ever had sex with someone you didn’t

know or just met?”

Sexual Risk Assessment (cont)

Ask for an explanation of sexual practices: “When you say you had sex, what

exactly do you mean?” “I don’t know what you mean; could you

explain….?”


Do not assume anything: Marriage does not always mean an

individual is monogamous or heterosexual

People who identify as homosexual may also have heterosexual sex


Use specific terms: Use “men who have sex with men” or

“women who have sex with women” instead of gay. Some men do not consider themselves “gay” if they practice anal insertive intercourse, but their receptive partners are considered to be gay (can be culturally related).

Clinical Risk Assessment

Assess the patient for constitutional signs, history of chronic infection and HIV, and associated problems:

Headaches; diarrhea; fatigue; shingles; history of STD, hepatitis, or TB; fever, chills, night sweats; skin lesions; weight loss; oral thrush; generalized lymphadenopathy

continuation

Acute Interventions

Acute Interventions

HIV disease progression may be delayed by promoting a healthy immune system

Useful interventions for the HIV infected patient include the following: Nutritional changes that maintain lean body mass,

increase weight, and ensure appropriate levels of vitamins and micronutrients; Elimination of smoking and drug use; Elimination or moderation of alcohol intake; Regular exercise; Stress reduction; Avoidance of exposure to new infectious agents; Mental health counseling; Involvement in support groups; Safer sexual practices

Acute Interventions (cont)

Nurse needs to help patients gain control of the situation and their emotions

Facilitating empowerment is particularly important, because the individual with an HIV infection often experience loss, including an overwhelming feeling of loss of control Empowerment is facilitated through

education and honest discussions about the patient’s health status


Patient should be taught to recognize clinical manifestations that may indicate progression of the disease This will ensure that prompt medical care is

initiated Early manifestations that need to be

reported: Unexplained weight loss, night sweats,

diarrhea, persistent fever, swollen lymph nodes, oral hairy leukoplakia (OHL), oral candidiasis (thrush), persistent vaginal yeast infections


Patients should also report: Unusual headaches, changes in vision,

nausea and vomiting, numbness and tingling in the extremities

Patient should be given as much information as needed to make health care decisions Decisions will dictate the appropriate

medical and nursing interventions


Nursing interventions become more complicated as the patient’s immune system deteriorates and new problems arise to compound existing difficulties

Nursing focus should be on quality-of-life issues and symptom management, rather than on issues regarding a cure


When opportunistic diseases develop, symptomatic nursing interventions, education, and emotional support are necessary Example: acute case of PCP

Interventions include monitoring the respiratory status, administering medications and oxygen, positioning the patient to facilitate breathing, managing anxiety, promoting nutritional support, and helping the patient conserve energy to decrease oxygen demand

Because the potential for death is associated with advanced HIV disease, emotional support for the patient, caregiver, or significant other is particularly important

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Nursing Care Plan Box

Nursing Diagnosis #1

Risk for caregiver role strain, r/t advancing disease in care receiver, lack of caregiver

Patient Goals/Expected Outcomes: Caregiver will use available community and

personal resources Caregiver will have the ability to complete

necessary care giving tasks Effective support for caregiver

Nursing Diagnosis #1 (cont)

Nursing Intervention: Assess needs and capabilities of patient

and caregiver Assess factors that contribute to caregiver

strain (unrealistic expectations, poor insight, inability to use resources, unsatisfactory relationship with care receiver, insufficient financial and psychosocial resources)

Develop supportive and trusting relationship with caregiver


Nursing Interventions (cont): Enlist help of other family members or

friends to assist Teach caregiver to perform care activities in

a safe, efficient, and energy-conserving manner

Teach stress-reduction techniques Encourage caregiver to attend to own

personal and health needs


Evaluation: The caregiver:

Provides safe, supportive care to the HIV-infected patient

Acknowledges need for personal support and accesses resources in family and community

Shares frustrations about difficulty of care for significant other

Receives assistance from family members and/or professional caregivers


Imbalanced nutrition: less than body requirements, r/t chronic infections and/or malabsorption, nausea/vomiting/diarrhea, fatigue, or side effects of medications as e/b 10% or greater loss of ideal body mass

Patient Goals/Expected Outcomes: Patient’s weight will remain stable Patient’s nutritional intake will exceed

metabolic needs Patient will regain lost weight


Nursing Intervention: Assist with diagnosis of underlying

opportunistic infections Assess patient’s knowledge of optimal

nutritional intake Increase protein, calorie, and fat intake Offer nutritional supplements (Carnation

Instant Breakfast, Boost, Sustacal, etc.)


Nursing Intervention (cont): Schedule procedures that are painful,

stressful, or nauseating so they do not interfere with mealtimes

Eat several small meals throughout day as opposed to three larger meals

Provide referrals to dietitians, social workers, and case managers

Weigh patient daily


Evaluation: Weight will remain stable or increase Patient reports increased energy level Patient able to complete ADLs Patient experiences increase in lean muscle

mass

continuation

Acute Interventions

Acute Interventions

Nursing interventions for diarrhea, which is a long-term problem for HIV-infected people include: Recommending dietary interventions Encouraging adequate fluid intake to prevent

dehydration Instructing the patient about skin care Managing excoriation around the perianal area In some cases, nurse must administer antidiarrheals

to help control and prevent further complications Recommend use of incontinence products to prevent

soiling of the clothes and bed linens

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Table 56-11: Nutritional Management for HIV Infection

Dietary Recommendation

Diarrhea Lactose-free, low-fat, low-fiber, and high-

potassium foods Constipation

High-fiber foods Nausea and Vomiting

Low-fat foods Candidiasis

Soft or pureed foods

Dietary Recommendation (cont)

Fever High-calorie, high-protein foods

Altered Taste Diet as tolerated

Anemia High-iron foods

Fatigue High-calorie foods

Intervention

Diarrhea Avoid dairy products, red meat, margarine,

butter, eggs, dried beans, peas, raw fruits and vegetables. Cooked or canned fruits and vegetables will provide needed vitamins. Eat potassium-rich foods such as bananas and apricot nectar. Discontinue foods, nutritional supplements, and medications that may make diarrhea worse (Ensure, antacids, stool softeners). Avoid gas-producing foods. Serve warm, not hot foods. Plan small, frequent meals. Drink plenty of fluids between meals.

Intervention (cont)

Constipation Eat fruits and vegetables (beans, peas), cereal, and

whole wheat breads. Gradually increase fiber. Drink plenty of fluids. Exercise.

Nausea and Vomiting Avoid dairy products and red meat. Plan small,

frequent meals. Prepare nonodorous foods. Eat dry, salty foods. Serve food cold or at room temperature. Drink liquids between meals. Avoid gas-producing, greasy, spicy foods. Eat slowly in a relaxed atmosphere. Rest after meals with head elevated. Take antiemetics 30 minutes before meals.

Intervention (cont)

Candidiasis Serve moist foods. Drink plenty of fluids.

Avoid acidic and spicy foods. Use straw and tilt head back and forth when drinking. To decrease discomfort, eat soft foods, such as puddings and yogurt.

Fever Use nutritional supplements. Increase fluid

intake.

Intervention (cont)

Altered Taste Try herbs and spices. Marinate meat,

poultry, and fish. Serve food cold or at room temperature. Drink plenty of fluids. Add salt or sugar. Introduce alternative protein sources.

Anemia Eat organ meats and raisins. Drink orange

juice when taking iron supplements to facilitate absorption.

Intervention (cont)

Fatigue Cook in large quantities and freeze in meal-

size packets. Use microwave and convenience foods. Use easy-to-fix snack foods. Use social support system to assist with meal planning and preparation. Access in-home homemaker services. Access community Meals on Wheels programs.

Wasting and Lipodystrophy Syndromes

Acute Intervention

Wasting and Lipodystrophy Syndromes

AIDS wasting has been a common clinical manifestation of HIV disease since early in the epidemic

Wasting is due to disturbances in metabolism, which interferes with the effective use of nutrients, resulting in the loss of lean (muscle) body mass

Wasting is characterized by depletion of lean body mass, without reduction of body fat This loss of lean body mass is a primary cause of

functional decline in wasting

Wasting and Lipodystrophy Syndromes (cont)

Loss of lean body mass increases the risk for opportunistic infections, reduces quality of life, and reduces survival

Causes of Wasting Most likely multifactorial Food intake may be inadequate because of mechanical

difficulties Loss of appetite Psychological factors such as depression and anxiety Decreased absorption in intestines due to infections and

a damaged mucosal barrier Some patients just stops eating to decrease the number

of bowel movements per day


Wasting causes disturbances in self-concept and self image Useful interventions for these disturbances

Creating an atmosphere of acceptance and reassurance

Encouraging a focus on past accomplishments and personal strengths

Facilitating the use of positive affirmation Decreased levels of testosterone have

been reported in 35 to 50% of HIV-infected men

Wasting and LipodystrophySyndromes (cont)

Testosterone has two distinct biologic properties: Virilizing activity (androgenic effect) Protein building (anabolic effect)

A deficiency of testosterone may cause a loss of body cell mass, contributing to HIV wasting Due to testosterone being an anabolic hormone

Women Lose a significant amount of body fat, but body cell

mass is not significantly decreased Men

Tend to lose a significant amount of lean body mass (skinny arms and legs) with the preservation of fat


With the advances in HIV treatment and opportunistic infection prophylaxis, serious malnutrition is less evident However, nutrition does not return to

normal after anti-HIV treatment begins, and a syndrome of increased truncal obesity (abdomen), and metabolic abnormalities are developing


Characteristic alterations in body composition of both men and women include: Development of truncal (visceral,

abdominal) obesity Subcutaneous fat loss on the extremities

and face Also called lipoatrophy

Hyperlipidemia Insulin resistance


3 hypotheses to explain the mentioned changes: Changes are a side effect of either protease

inhibitors or nucleoside reverse transcriptase inhibitors (AZT, d4T)

Changes may represent an altered stress response, with mild chronic hypercortisolism in some patients

Changes are part of long-term HIV disease and have only been noticed in recent years because of increased survival time


The management of wasting and lipodystrophy is difficult Requires multiple interventions

Nurse can assist by assessing for and documenting the presence of diminished appetite and weight

Nursing interventions include: Encouraging nutritional supplementation; increasing

protein intake; providing enteral supplements (through nasogastric or gastric tubes if necessary); and, assisting with total parenteral nutrition (TPN)


May use appetite stimulants such as Megestrol (Megace) or Dronabinol (Marinol) These medications tend to increase body fat and

not lean muscle mass unfortunately Testosterone (anabolic steroid) can be

administer PO, IM, or transdermally to increase lean body mass and weight

Effect of testosterone can be enhanced by the addition of a low-weight resistance-training program (weightlifting) because it maintains muscle tone and improves appetite


Nutritional counseling is vital to ensure that individuals with HIV disease maintain a well balanced diet and include supplements if necessary

Teaching about food safety is of paramount concern because enteric infections (cryptosporidiosis, microsporidiosis, and amebas) in HIV diseases are often not treatable or are relapsing

In some cases, enteral and parenteral feeding becomes necessary


Management of elevated triglycerides and lipids (cholesterol) is becoming common in HIV disease

These elevations can lead to: Cardiac and vascular diseases Some cases, diabetes

Lipid-lowering agents such as the statins may be effective in treating this complication

A program of diet control, exercise, and medications can safely lower lipids and reduce the chances of a cardiovascular event occurring


Insulin resistance and/or diabetes sometimes responds to oral hypoglycemic agents Some cases, anti-HIV therapy needs to be

changed to a protease-sparing combination Managing diet, stopping smoking, weight

loss, and exercise can help control the elevated blood sugars that can occur with the use of anti-HIV medication


Metabolic needs of the HIV-infected individual increase by as much as 40% Results in the need for a higher energy

expenditure than is provided by the number of calories taken in by the patient

Malnutrition, weight loss, and generalized wasting are common problems in patients with HIV disease

Estimated that as many as 70 to 90% of patients with HIV disease will experience wasting


When a patient’s weight is reduced to 60% of his or her ideal body weight, death can occur, regardless of the underlying condition

Malnutrition may influence morbidity and mortality in several ways Malnutrition contributes to wasting, and wasting hastens

the negative immune consequences of HIV infection. HIV wasting contributes to slower recovery from infection, impaired wound healing, increased risk of secondary infection and decreased cardiac and respiratory function, and can lead to death

Although typically seen in later stages HIV disease, malnutrition and wasting can occur in the early stages of HIV infection

Neurological Complications

Acute Intervention

Neurological Complications: AIDS Dementia

HIV-associated cognitive motor complex (previously known as AIDS dementia) is the term preferred by the WHO and the American Academy of Neurology (AAN) to describe a common CNS complication of HIV disease

Frequency: Being anywhere between 20 and 33% of all

adults and up to 50% of children with end-stage disease

Neurological Complications: AIDS Dementia (cont)

This condition is a complex combination of signs and symptoms: Dementia; impaired motor function; and, at times,

characteristic behavioral changes that resemble an injury similar to a stroke or head trauma

Generally does not cause alterations in the level of consciousness or psychiatric disturbances

Usually described as a triad of cognitive, motor, and behavioral dysfunction that slowly progresses over a period of weeks to months


Cognitive changes: Primarily involve a mental slowing and

inattention. Patients typically lose their train of thought and complain of a slowness of thinking.

Motor dysfunction: Develops after those of cognitive

impairment. Includes poor balance and coordination (falling and tripping, dropping things); slower hand activities (writing, eating); and ultimately, leg weakness that can limit ambulation


Diagnosis of this type of dementia can be made by conducting a simple physical examination, neurological testing, MRI/CT exams, and CSF analysis

Nursing interventions for the treatment of neurocognitive dysfunction: Administration of anti-HIV medications and psychotropic

medications (cautiously); supervise patient (this includes a home safety assessment); ensure that orientation cues such as clocks and calendars are present, hallways and living areas are brightly lit, walkways are clear of electrical cords or throw rugs, and potentially dangerous objects (knives, poisons) are safely stored away


Caring for patients with dementia is a collaborative effort between health care provider and family

It is advisable to seek advise from a social worker, home health care department, and a psychologist in developing a plan to care for an impaired individual

AIDS-dementia complex (ADC), caused by HIV infection in the brain, is a common neurological disorder associated with HIV


Dementia symptoms are sometimes reversible if a treatable cause can be diagnosed

Treatable causes include: Dehydration Depression Medication toxicity or side effects

Clinical manifestations Cognitive, behavioral, and motor

abnormalities


Symptoms: Decreased ability to concentrate, apathy,

depression, social withdrawal, personality changes, confusion, hallucinations, altered levels of consciousness, slowed response rates

ADC can lead to coma Nursing interventions are focused on

patient safety and caregiver support

Neurological Complications: Peripheral Neuropathy

Diseases that affect the peripheral nervous system

They can affect sensory, motor, or autonomic nerves

Cause of neuropathies can be related to HIV disease itself, or more frequently, the side effects of many anti-HIV medications

Symptoms: Numbness, localized tingling, hypesthesia

(diminished sensitivity to stimulation) or anesthesia, loss of vibration and position sense (proprioception), and decreased or increased sensitivity to pain

Neurological Complications: Peripheral Neuropathy (cont)

Most cases, patient complains of numbness in the fingers, hands and feet, and pain on walking

May also experience autonomic neuropathy

Symptoms such as mild positional hypotension to cardiovascular collapse, as well as chronic diarrhea, are suggestive of autonomic neuropathy

Neurological Complications: Management of OIs

With the advent of effective antiretroviral therapy and better understanding of OI prophylaxis, the frequency of OIs has decreased dramatically

OIs still occur in the severely immunocompromised patients Nurses must be familiar with the recognition,

treatment, and prophylaxis of these diseases OIs typically seen in:

Those who are not adherent to their antiretroviral therapy, not adherent to OI prophylactic regimens, or at the end stage of HIV and in those who do not consistently access the health care system

Neurological Complications: Health Promotion

Because patients with HIV disease are living longer, more productive lives, attention to the promotion of health and healthy behaviors is important

Patients should be encouraged to: Eat well-balanced meals, stop or at least reduce the

number of cigarettes smoked, get adequate sleep and rest periods, use stress-reduction modalities (biofeedback, referral for counseling), obtain dental care regularly, keep scheduled appointments with all health care providers, get all immunizations and keep them up to date, female patients should regularly receive gynecologic care, participation of the patient and significant others in treatment decision making and arrange for home care follow-up if indicated

Neurological Complications: Health Promotion Considerations (p 2048)

Patient infected with HIV Remind patients that a positive diagnosis is not an

immediate “death sentence”. Patients are living increasingly longer after diagnosis because of medications, more specialized care, and decreased morbidity and mortality related to opportunistic diseases

Stress the importance of health-promoting behaviors to reduce the risk of comorbidity

Encourage patients to maintain good nutritional status by eating regular, well-balanced meals that are high in protein and calories. Increased protein is necessary for cell and tissue repair- especially in patients who may be hypermetabolic

Neurological Complications: Health Promotion Considerations (cont)

Encourage patients to limit their intake of alcoholic beverages and avoid the use of illicit or recreational drugs

Encourage patients to maintain an adequate sleep schedule

Encourage patients to use stress reduction practices such as biofeedback, massage, or progressive relaxation. Engage in relaxing or pleasurable activities

Encourage patients to use safer sexual practices to avoid reinfection and exposure to other sexually transmitted diseases

Neurological Complications: Health Promotion Considerations (cont)

Encourage patients to establish an exercise regimen that includes aerobic activity as well as low-resistance weightlifting of possible

Most important, support patients in setting short- and long-term goals and assist them in achieving those goals

HIV Testing and Counseling to Other Methods to Reduce Risk

Prevention of HIV Infection


HIV disease is preventable Prevention takes cooperation and efforts of public

health care providers, medical providers, nurses in all specialties, families, communities, churches, and schools

Education on prevention is the only truly effective “vaccine” available to curb the HIV pandemic

Nurses have a responsibility to assess each patient’s risk for HIV infection and counsel those at risk about HIV testing and the behaviors that put them at risk, and about how to reduce or eliminate those risks


Today, every nurse is in an HIV nurse, implying that all nurses are responsible for teaching methods to reduce risk of transmission

Nurse must be able to discuss the details of behaviors relating to sexual activity and drug use in a forthright, relaxed, and nonjudmental manner

Nurse must be able to establish rapport before asking sensitive, explicit questions and one must be comfortable with the discussion of risk-reduction techniques

Harm-reduction education is a fundamental element of HIV prevention methods


Harm reduction does not completely eliminate the risk of HIV transmission. Instead, it focuses on minimizing the personal and social harms and costs associated with these activities

HIV Testing and Counseling

This is an integral part in the prevention of HIV transmission

Patients should not be pressured to be tested Test decision counseling is the process of assisting

patients in making decisions about when, if, and how to be tested

It is important that the nurse takes every opportunity to provide pretest counseling

Aside from providing the testing information, the nurse must also explain and obtain an informed consent before actually drawing blood This involves explaining the purpose, possible uses,

limitations, and meaning of the test results


Consent policies are established by state laws and vary from state to state

The most common and acceptable policy is to obtain informed written consent before HIV antibody testing

All states have some exceptions to informed consent, usually relating to critical or emergency situations

However, these situations are rare and every effort should be made to obtain consent


When obtaining consent, explain the applicable limits of confidentiality in the office, clinic, or hospital setting where the patient is being tested

Patient should be told who will have access to the test results, such as the health department or insurance company, and what will be done with that information Ex: contact tracing or partner notification

HIV antibody testing may take place in a physician’s office or at a designated HIV counseling and testing sites


Nurses must be aware of the various options for HIV antibody testing in their state or community in order to advise patients appropriately

HIV testing can be done in one of two ways: confidentially or anonymously Confidential testing: individuals are asked

to provide identifying information, including a name, address, and often demographics such as sex, age, race, and occupation


Anonymous testing: individuals are not asked to provide identifying information. Records are kept through assigned numbers, and the patient must retain this number to obtain results

In either form of testing, pretest and posttest counseling can be performed by the nurse

Risk Assessment and Risk Reduction

Nurse should encourage early detection of HIV infection

Testing for HIV is important part of the public health response to HIV disease

Risk assessment should be patient centered, a joint process between nurse and patient

Patient should take “ownership” of the risk for HIV infection

Patients need to be assessed for manifestations that would be indicative of risky behaviors, such as STDs


Basic Questions Have you ever had a transfusion or used

clotting factors? Was it before 1985? Have you ever shared needles, syringes, or

other injecting equipment with anyone? Have you ever had a sexual experience in

which your penis, vagina, rectum, or mouth came into contact with another person’s penis, vagina, rectum, or mouth?


Positive response to any of the mentioned questions will require the nurse to investigate further with the patient

Nurse should be prepared to refer patient to centers that provide testing and counseling services

Barriers to Prevention

There are numerous barriers to HIV prevention, not the least of which is a denial of risk, an attitude that “it won’t happen to me”

Fear, misunderstanding, and the potential for social stigma are significant barriers

Cultural and community attitudes, values, and norms can affect the success of prevention efforts

Prevention of HIV transmission requires a commitment to change behaviors that put one at risk

Education to alter behaviors is a long-term process


Nurses need to take every opportunity to educate their patients on how to avoid or reduce the risk for HIV infection

Collective efforts will have the greatest effect

Fear of alienation and discrimination are significant additional barriers to prevention

Reducing Risks Related to Occupational Exposure

Risk of acquiring HIV through occupational exposure is quite rare

CDC and OSHA have instituted policies to ensure that employees are protected from exposure to blood and other potentially infectious fluids

Use of standard precautions and body substance isolation have been shown not only to reduce the risk of bloodborne pathogens, but also to reduce the risk of transmission of other diseases between patient and health care worker This also reduces the risk of transmission between patients

Handwashing still remains the single most effective means of preventing the spread of infection


Recommendations for an occupational exposure is to begin antiretroviral therapy with at least 2 or 3 medications

Exposed health care worker should begin therapy within 1 to 4 hours following a high-risk exposure

For best prophylactic effect, initiation of postexposure prophylaxis must occur within 36 hours

Completion of a 4 week course of therapy after an occupational exposure is essential


Hospitals or agencies should have policies in place that specifically address occupational HIV exposure because instituting chemoprophylaxis needs to occur immediately

Optional HIV testing may be done at 6 wks and 3 months after exposure

Maintaining of confidentiality for both exposed health care worker and source patient is of utmost importance

Appropriate counseling and necessary referrals should be made for the health care worker and patient when HIV testing is indicated

Outlook for the Future

Outlook for the Future

As we enter the third decade of the HIV pandemic, much has been learned about transmission and ways to prevent infection

With no cure in sight, prevention of infection through education, prevention of mother-to-child transmission, and in some cases postexposure prophylaxis can limit the effect this disease has on the human population

The field of HIV and AIDS nursing changes frequently, and nurses must constantly refresh their base of knowledge

As new therapies emerge, the nurse will be in the unique position to educate patients and the public regarding what is undoubtedly the most challenging infectious disease discovered in the 20th century

CHAPTER 56: CARE OF THE PATIENT WITH HIV/AIDS Acute Interventions to Outlook For The Future.

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Transcript of CHAPTER 56: CARE OF THE PATIENT WITH HIV/AIDS Acute Interventions to Outlook For The Future.