Republic of the Philippines Camiguin Polytechnic State College Institute of Nursing Balbagon Mambajao Camiguin

A REPORT IN NCM 106 LEC

ACQUIRED IMMUNE DEFICIENCY SYNDROME

Submitted by: Mary Mae C. Magto Juvy Imee A. Ladesma Uzi D. Maghanoy

Submitted to: Leandro S. Sumalinog, RN

August 04, 2011

ACQUIRED IMMUNE DEFICIENCY SYNDROME

 

Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the Human Immunodeficiency Virus (HIV) This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors. The time between infection and the appearance of symptoms tends to be much longer, allowing more opportunities for these microorganisms to be transmitted to other hosts. The period between infection and the appearance of AIDS can take from 7 to 12 years. AIDS is now a pandemic. In 2007, an estimated 33.2 million people lived with the disease worldwide, and it killed an estimated 2.1 million people, including 330,000 children.

Signs and Symptoms

  

 

The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems Most of these conditions are infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of the immune system that HIV damages. A person may remain asymptomatic, feel, and appear healthy for even years even though he or she is infected with HIV. While he or she does not exhibit AIDS, the immune system starts to be impaired. The person may exhibit neurological symptoms such as memory loss, altered gait, depression, sleep disorders or chronic diarrhea. This set of symptoms is often called AIDS-related Complex (ARC) by clinicians. As the symptom progress, the patient becomes an AIDS patient.

Minor Signs: 1. Persistent Cough for one month 2. Generalized pruritic dermatitis 3. Recurrent herpes zoster 4. Oropharyngeal candidiasis 5. Chronic disseminated herpes simplex 6. Generalized lymphadenopathy Major Signs: 1. Loss of weight 10 percent of body weight 2. Chronic diarrhea for more than one month 3. Prolonged fever for one month Common Opportunistic Infections

1. 2. 3. 4. 5. 6.

Pneumocystis carinii pneumonia Oral candidiasis Toxoplasmosis of the CNS Chronic diarrhea/wasting syndrome Pulmonary/extra-pulmonary tuberculosis Cancers a. Kaposis sarcoma affects small blood vessels and internal organs

b. Cervical dysplasia and cancer. Researchers found out that women with HIV have higher rates of this type of cancer. Cervial carcinoma is associated with Human Papilloma Virus (HPV). c. Non-Hodgkins lymphoma cancerous tumor of the lymph nodes. This is usually a late manifestation of HIV infection.
TRANSMISSION:

Sharing infected injection drug used equipment. Having sexual relations with infected individuals (both male and female). Body fluids such as blood, seminal fluid, secretions, amniotic fluid, and breast milk. Inflammation or break in the skin or mucosa result in the increased probability the exposure will lead to infection. 5. Mother-to-child transmission.
GERONTOLOGIC CONSIDERATION:

1. 2. 3. 4.

1. Many older adults of are sexually active but do not used condoms, viewing them only as a means of unneeded birth control. 2. Many older adults do not consider themselves at risk for the infection. 3. Older gay men, who grew up and lived in an era where disclosure of their sexual orientation was not an acceptable and who have lost long time partners, may begin new relationship with young men. 4. Older adults may be intravenous (IV)/injection drug users. 5. Older adults may have received HIV/infected blood through transmission before 1985. 6. Normal age related changes include a reduction in immune system function, which put the older adults at high risk for infections, cancers and autoimmune disorders.
Diagnostic Examination: 1. ELA or ELISA Enzyme link immunosorbent assay 2. Particle agglutination (PA) test 3. Western blot analysis confirmatory diagnostic test 4. Immunofluorescent test 5. Radio immuno-precipitation assay (RIPA)  Many people are unaware that they are infected with HIV.  HIV tests are usually performed on venous blood.  Many laboratories use fourth generation screening tests which detect anti-HIV antibody (IgG and IgM) and the HIV p24 antigen.  The detection of HIV antibody or antigen in a patient previously known to be negative is evidence of HIV infection.  Individuals whose first specimen indicates evidence of HIV infection will have a repeat test on a second blood sample to confirm the results. The Four Cs in the Management of HIV/AIDS 1. Compliance giving of information and counseling the client which results to the clients successful treatment, prevention and recommendation. 2. Counseling/education

a. Giving instruction about the treatment b. Disseminating information about the disease c. Providing guidance on how to avoid contracting STD again d. Sharing facts about HIV and AIDS 3. Contact tracing a. Tracing out and providing treatment or partners 4. Condoms a. Promoting the use of condom, giving instructions about its use, and giving away available condoms
HEALTH PROMOTION:

1. 2. 3. 4. 5. 6. 7. 8. 9.

Advise patient to abstain from sharing sexual fluids. Advise patient to reduce the number of sexual partner to one. Advice patient used latex condom. Advise patient to used cervical caps or diaphragms without using a condom as well. Advise patient to always use dental dams for oral-genital or anal stimulation. Advise patient to avoid anal intercourse because this practice may injure tissues. Advise patients to avoid manual-anal intercourse (fisting). Advise patient not to ingest urine or semen. Educate patients about nonpenetrative sexual activities such as body massage, social kissing (dry), mutual masturbation, fantasy and sex films. 10. Advise patient to avoid using of needles, razors, toothbrushes, sex toys or blood contaminates articles.

Treatment Modalities:  AIDS Drugs are medicines used to treat but not to cure HIV infection.  These drugs are sometimes referred to as anteroviral drugs.  These work by inhibiting the reproduction of the virus. There are two groups of anteroviral drugs: 1. Reverse trancriptase inhibitors they inhibit the enzyme called reverse transcriptase which is needed to copy information for the virus to replicate. These drugs are: a. Zedovudine (ZDV) Retirvir b. Zalcitabine Havid c. Stavudine Zerit d. Lamivudine Epivir e. Nevirapine Viramune f. Didanosine Videx 2. Protease inhibitors. They work by inhibiting the enzyme protease which are needed for the assembly of viral particles. These drugs are: a. Saquinavir Invarase b. Ritonavir Norvir c. Indinavir Crixivan RECOMMENDATIONS FOR STANDARD PRECAUTIONS to health care providers:

1. Hand hygiene. 2. Personal protective health equipment.

3. 4. 5. 6. 7. 8.

Soiled patient care equipment. Environmental control. Textiles and laundry. Patient resuscitation. Patient placement. Respiratory hygiene/cough etiquette.

POSSIBLE NURSING DIAGNOSIS: 1. Impaired skin integrity related to cutaneous manifestations of HIV infection, excoriation, and diarrhea. 2. Diarrhea related to enteric pathogens or HIV infections. 3. Risk for infection related to immunodeficiency. 4. Activity intolerance related to weakness, fatigue, malnutrition, impaired fluid and electrolyte balance, and hypoxia associated with pulmonary infections. 5. Disturbed thought processes related to shortened attention span, impaired memory, confusion, and disorientation associated with HIV encephalopathy. 6. Ineffective airway clearance related to PCP, increased bronchial secretions, and decrease ability to cough related to weakness and fatigue. 7. Pain related to perianal skin integrity secondary to diarrhea, KS, and peripheral neuropathy 8. Imbalanced nutrition less than body requirements, related to decreased oral intake 9. Social isolation related to stigma of disease, withdrawal of support systems, isolation procedures, and fear of infecting others 10. Ancipatory grieving related to changes in lifestyle and roles and unfavorable prognosis 11. Deficient knowledge related to HIV infection, means of preventing HIV transmission, and self-care COLLABORATIVE PROBLEMS

1. 2. 3. 4.

Opportunistic infections Impaired breathing or respiratory failure Wasting syndrome and fluid and electrolyte imbalance Adverse reaction to medications

Sources:
   

Handbook of Common Communicable and Infectious Diseases, 2006 Ed http://wikipedia.org http://cdc.gov Brunners and Suddarths Medical Surgical Nursing 12th edition