Summary NURS 265 Exam 4 Study Guide

IMMUNE DEFICIENCIES

HIV
- Virus “retrovirus”, attacks CD4 T cell “helper T cell”
- HIV vs AIDS
o Based on # of CD4 T cells
o Presence of opportunistic infections
 Pneumocystis pneumonia, toxoplasmosis, tuberculosis, histoplasmosis
- Transmission
o Sexual (semen, vaginal secretions), caused by genital, anal or oral sex
o Parenteral (sharing of needles or equipment contaminated with infected blood
o Perinatal (placenta, contact with maternal blood and body fluids during birth,
breast milk
 No breastfeeding, on meds while pregnant to decrease viral load
- Prevention
o Condoms, cleaning/sterilizing drug paraphernalia, needle exchange programs,
blood products screened for the HIV antibody, drug therapy for pregnant
mothers, use of standard precautions with HCP
 May double glove
- Diagnostics
o Antibody test
 Elisa – most inexpensive, if positive they do western blot to confirm
 Western Blot – 4 antigens, if pt has 2/4 they are considered positive
 May be negative for up to 6 months
- Classifications
o Progression depends on health, age, risk factors
o A diagnosis of AIDS requires that the person be HIV positive and have either a
CD4+ T cell count of less than 200 or an opportunistic infection
o The person with HIV infection can transmit the virus to others at all stages of
disease, but the recently infected person with a high viral load and those at end
stage without drug therapy can be particularly infectious.
o Stage 1
 Confirmed HIV and CD4 count >500 or 29% or >
o Stage 2
 Confirmed HIV and CD4 count of 200-499 or 14-28%
o Stage 3
 Confirmed HIV, CD4 count <200 or <14%, and has a documented AIDS
defining illness
o Stage 4


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,  Confirmed HIV, no information about CD4 count and has an AIDS defining
illness
- Manifestations
o Early (4 weeks from infection): Fever, night sweats, chills, headache, muscle
aches, rash, sore throat
- Treatment
o Antiretroviral meds
 HAART (highly active retroviral therapy) – never miss a dose!
o Treat complications
 PCP “pneumocystis Carnii pneumonia
 Sulfamethoxazole/trimethoprim
o Pt can have adverse reaction such as nausea, comiting,
hyponatremia, rashes, fever, leukopenia,
thrombocytopenia, and hepatitis
 Bronchodilators
 Spread out activities, elevate HOB, give O2
 Pain
 Enlarged lymph nodes
o Compressing nerves
 Peripheral neuropathy
o Side effects of meds
 Reposition, distraction, breathing exercises, pressure relieving
mattress, hot and cold compress
 Imbalanced nutrition
 Thrush – don’t want to eat
o Give high calorie high protein diet. Give foods they like,
softer foods, and provide good oral care.
 Diarrhea
 Side effects of meds
o Provide skin care, use a flexoseal to stop diarrhea from
coming in contact with skin, give fluids to maintain
hydration, and avoid spicy food to prevent bowel
irritation
 Skin Integrity
 Kaposi’s sarcoma
o Lesions, can cause pain if large
o Anti-retrovirals, radiation, chemo, analgesics
 Herpes
o Anti-retrovirals
 Shingles – Varicella zoster

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, o If they had chicken pox or live vaccination


- Opportunistic Infections
o PCP (pneumonia that only people with aids acquire)
 One of most common infections in AIDS
 Dry cough, difficulty breathing, tachypnea, crackles
o Toxoplasmosis
 (Bird or cat feces) decreased LOC, headache, fever, possible seizure
o Cryptosporidiosis
 Intestinal infection (mild  severe wasting), electrolyte imbalances
o Fungal Infections
 Mouth, nails, yeast infections, assess ability to swallow, risk for
aspiration
 Early sign: food may taste funny
o Cryptococcosis
 Can cause meningitis, + brudinskis/kernigs, seizures, decreased LOC
o Histoplasmosis
 Respiratory infections (cause systemic problems)
 Fever, cough, weight loss
o Tuberculosis
 PPD may be false negative, chest x-ray positive + sputum culture
 If suspected TB put them in negative pressure room, private room
o Kaposi’s sarcoma
 Skin biopsy
- Patient teaching
o Don’t share anything with anyone
o Bathe daily with antimicrobial soap
o No eggs, undercooked meat, fish, wash all fruits and veggies, use proper
refrigeration
o Don’t drink or eat anything that has been left out over an hour
o Avoid gardening, no house plants, no reptiles or turtles
o Don’t change litter boxes
o Don’t touch animals or children
o Wash hands with antimicrobial soap
o Watch for signs and symptoms of infection
o Inspect mouth q8hrs for thrush  do good oral care
o TB/PCP
 Monitor temp q4hrs, WBC, CD4 count (will tell you how susceptible they
are)

3

, o Limit visitors to healthy adults
o Stay away from large crowds
o Use dedicated equipment on this patient


Lupus
- Autoimmune disease, possible link to genetic/environment cause, Onset age 20-40; 10x
more often in women, Pt may experience remission periods
- Manifestations r/t immune complexes
o Skin
 Dry, scaly raised rash “butterfly” rash on face
o CV
 Pericarditis (chest pain r/t ischemia from immune complexes
 Raynaud’s (extreme stress or cold temps, painful)
o Pulmonary
 Pleural effusion, Pneumonia or pleurisy
o Neurologic
 Seizures, migraine HA, peripheral neuropathies, memory issues
o GI, musculoskeletal, generalized weakness
o Renal
 Immune complexes cause lupus nephritis (sudden renal failure)
 Decreased urine output, decreased calcium, acidotic
 Increased BUN/Creatnine, Increased Mag/K+/Phos
o FEVER IS A CLASSIC SIGN OF EXACCERBATION!!!
- Diagnostics
o Skin bx
 Taken from the rash, confirms with large number of inflammatory cells
o CBC
 May reveal pancytopenia (all blood cells are low), or anemia
o ESR  generalized inflammation
o Kidney bx  checking for immune complexes
- Treatment
o Topical cortisone  butterfly rash
o Hydroxychloroquine  decreases absorption of UV rays, decreases risk for
getting more skin lesions
o Acetaminophen or NSAIDS  pain r/t polyarthritis
o Chronic steroids  to treat systemic disease
 May cause cushings syndrome (from too many steroids)
 Watch for hyperglycemia and infection
 Don’t stop taking abruptly

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