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Nursing care in Acquired Immuno Deficiency

Syndrome (AIDS)

Ns. Ahmad Hasyim W, M.Kep, MNg

Nursing program
Faculty of Medicine,
Brawijaya University
2016
HIV
1. Attachment
2. Uncoating
3. DNA synthesis
4. Integration
5. Transcription  mRNA
6. Translation  polyprotein
assembly
7. Cleavage  single protein
chain
8. Budding

Key enzymes: reverse transcriptase, integrase, protease

Mode of transmissions

 HIV is transmitted in body fluids that contain

virus and infected CD4+ T cells. These fluids
include blood, seminal fluid, vaginal secretions,
amniotic fluid, and breast milk

 Inflammation and breaks in the skin or mucosa

result in the increased probability

 The amount of HIV and infected cells in the

body fluid is associated with the probability that
the exposure will result in infection
Sexual transmission

 Is generally inefficient  0.04% for female-to-male transmission and

0.08% for male-to-female
 Male circumcision is associated with a lower risk of acquisition of HIV
infection for heterosexual men
 Oral sex is a much less efficient mode of transmission of HIV than
is anal intercourse or vaginal intercourse
TRANSMISSION THROUGH INJECTION
DRUG USE

 The per-act risk of transmission from injection drug use with a

contaminated needle has been estimated to be approximately
0.6%
 SC or IM injections can transmit HIV
 The risk of HIV infection increases with the duration of
injection
drug use; the frequency of needle sharing; the number of
partners
TRANSMISSION BY TRANSFUSED
BLOOD AND BLOOD PRODUCTS

 Transfusions of whole blood, packed red blood cells, platelets,

leukocytes, and plasma are all capable of transmitting HIV
 Gamma globulin, hepatitis B immune globulin, plasma-derived
hepatitis B vaccine have not been associated with
transmission of HIV infection. The procedures involved in
processing these products either inactivate or remove the
virus
OCCUPATIONAL TRANSMISSION OF HIV: HEALTH CARE WORKERS,
LABORATORY WORKERS, AND THE HEALTH CARE SETTING

 Estimated 600,000 to 800,000 health care workers are stuck with needles
or other sharp medical instruments in the United States each year.
 As of 2010, there had been 57 documented cases of occupational HIV
transmission to health care workers in the United States and 143 possible
transmissions
 Percutaneous injuries (e.g., a needle stick or cut with a sharp object) or
contact of mucous membrane or nonintact skin (e.g., exposed skin that is
chapped, abraded)
 The following fluids also are considered potentially infectious:
cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial
fluid, and amniotic fluid.
 Feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomitus
are not considered potentially infectious for HIV unless they are visibly
bloody
MOTHER-TO-CHILD TRANSMISSION OF
HIV

 HIV infection can be transmitted from an infected mother to her fetus

during pregnancy, during delivery, or by breast-feeding.
 Most commonly in the perinatal period.
 23–30% before birth, 50–65% during birth, and 12–20% via breast-feeding
 Without prophylactic antiretroviral therapy probability of transmission of HIV from
mother to infant/ fetus  15% to 25% in industrialized countries and from 25%
to 35% in developing countries
 Rare transmission by women with viral RNA levels <50 copies/mL
 Pathophysiology

 Primary Infection (Acute/Recent HIV Infection, Acute HIV Syndrome)

 window period After 2 to 3 weeks, antibodies to the glycoproteins of the HIV envelope
can be detected
 high levels of viral replication  highly infectious  destruction of CD4+ T cells
 acute retroviral syndrome characterized by fever, lymphadenopathy, pharyngitis, skin rash,
myalgias/arthralgias, and other conditions  viral set point
 HIV Asymptomatic (CDC Category A: More Than 500 CD4+ T
lymphocytes/mm3)
 chronic stage in which the immune system cannot eliminate the virus
 patients feel well and have few, if any, symptoms
 HIV Symptomatic (CDC Category B: 200 to 499 CD4+ T
Lymphocytes/mm3)
 Candidiasis, oropharyngeal (thrush) or vulvovaginal, Constitutional symptoms, such as
fever (38.5C) or diarrhea exceeding 1 mo in duration, Herpes zoster, Peripheral
neuropathy
Pathophysiology

 AIDS (CDC Category C: Fewer Than 200 CD4+ T

Lymphocytes/mm3)
 Candidiasis of bronchi, trachea, or lungs; esophagus
 Encephalopathy, Kaposi’s sarcoma, Mycobacterium, Pneumonia
 Toxoplasmosis of brain, Wasting syndrome
Medical management

Antiretroviral therapy (ART)

 When to start?
Medical management

 Types of ARTs
 nucleoside reverse transcriptase inhibitors (NRTIs)
 integrase strand transfer inhibitor (INSTI)
 non-nucleoside reverse transcriptase inhibitor (NNRTI),
 protease inhibitor (PI)
Reported side effects

 Hepatic Effects, Gastrointestinal Effects, Dyslipidemia

 Diabetes Mellitus/ Insulin Resistance, Cholelithiasis
 Cardiovascular Disease, Bone Marrow Suppression, Bone Density
Effects, Bleeding Events
 Stevens-Johnson Syndrome/Toxic Epidermal Necrosis, Renal Effects/
Urolithiasis,
Nursing care plan

Risk for infection

 Definition : Vulnerable to invasion and multiplication of pathogenic organisms, which may
compromise health.
 NOC: Infection Severity, Risk Control
 NIC : Infection Protection, Infection Control
 Provide clean, well-ventilated environment
 Monitor client’s visitors/caregivers for respiratory illnesses
 Provide or encourage balanced diet, emphasizing proteins to feed the immune system
 Proper management of after-used medical tools
 Proper management of infectious materials and body liquids
 Administer prophylactic antibiotics
 Review laboratory values
Nursing care plan

Imbalanced nutrition, less than body requirements

 Definition : Intake of nutrients insufficient to meet metabolic needs
 NOC : Nutritional Status
 NIC : Nutrition Management
 Calculate client’s energy and protein requirements
 Collaborate with interdisciplinary team
 Determine when client prefers or tolerates largest meal of the day
 Provide numerous small feedings as indicated; supplement with easily digested snacks
 Avoid foods that cause intolerances or increase gastric motility
Nursing care plan

Risk prone health behaviour

 Definition : Impaired ability to modify lifestyle/behaviors in a manner that improves health
status.
 NOC : Psychosocial Adjustment
 NIC : Teaching: Disease Process, Counseling
 Listen to the client’s perception of inability or reluctance to adapt to situations
 Assess effective climate within family system and how it determines family members’ response to adjustment
to major health challenge
 Provide an open environment encouraging communication
 Identify and problem-solve with the client
 Provide information about virus replication and its mode of transport
VCT

 3 core principles:
 Consent
 Confidentiality
 Counselling
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