ACQUIRED

IMMUNODEFICIENCY
SYNDROME (AIDS)

DESCRIPTION

AIDS is the final stage of HIV infection that occurs when your immune system is badly
damaged and you become vulnerable to opportunistic infections.

RISK FACTORS

1. Racial and ethnic groups

- African Americans, Asians, Hispanics/latinos, native Hawaiians, American
Indian)
2. Gender ( far more affected: men, gay, bisexual)
3. Age (13-24)
4. unprotected sex
5. contact with bodily fluids that is HIV (+)
6. Hepatitis and Tuberculosis

ASSESSMENT

Early stage of HIV:

1. Fever
2. Chills
3. Rash
4. Night sweats
 5. Muscle aches
6. Sore throat
7. Fatigue
8. Swollen lymph nodes
9. Mouth ulcers

Progression to AIDS:
10. Rapid weight loss
11. Recurring fever or profuse night sweats
12. Extreme and unexplained tiredness
13. Prolonged swelling of the lymph glands in the armpits, groin, or neck
14. Diarrhea that lasts for more than a week
15. Sores of the mouth, anus, or genitals
16. Pneumonia
17. Red, brown, pink, or purplish blotches on or under the skin or inside the mouth,
nose, or eyelids
18. Memory loss, depression, and other neurologic disorders.

LABORATORY/DIAGNOSTICS TEST

1. CD4 count and percentage

 CD4 is a type of WBC that is destroyed by HIV.
 normal COUNT: 500 cells/mm3 to 1,600 cells/mm3.
 200 cells/mm3: progressed to Stage 3 (AIDS)
2. Viral Load(VL)
 also called HIV RNA
 tracks how many HIV particles are in a sample of your blood.
 helps guide the choice of HIV medications and tracks the response to HIV
treatment
3. CBC
 reveal any infections, anemia, and other medical issues.
4. STD screening
 screening tests to check for syphilis, gonorrhea, and Chlamydia
 If STDs can also increase your risk of transmitting HIV to others.
5. Pap Smear (cervical and anal)
 For women living with HIV, abnormal cell growth in the cervix is common and
may become cancerous if not treated.
PATHOPHYSIOLOGY
NURSING DIAGNOSIS

1. Diarrhea related to enteric pathogens or HIV infection

Nursing Responsibilities:

 Assess patient’s normal bowel habits. Provides baseline for evaluation.

 Obtain stool cultures and administer anti microbial therapy. identifies
pathogenic organisms therapy targets specific organisms
 Maintain food and fluid restrictions as prescribed Suggest BRAT diet.
Reduces stimulation of bowel
 Avoid bowel irritants such as fatty or fried foods. Offer small, frequent meals.
Prevents stimulation of bowel and abdominal distention and promotes
adequate nutrition.
2. Risk for infection related to immunodeficiency
Nursing Responsibilities:
 Monitor WBC count and differential. Allows early detection of infection.
 Instruct patient in ways to prevent infection such as cleaning hands.
Minimizes exposure to infections and transmission of HIV infection to
others.
 Maintain aseptic technique when performing invasive procedures.
Prevents hospital acquired infections
3. Imbalanced nutrition, less than body requirements, related to decreased oral
intake
Nursing Responsibilities:
 Assess for malnutrition with height, weight, age, BUN, serum proteins,
albumin, transferring levels, hemoglobin, hematocrit, and cutaneous anergy.
Provides objective measurement of nutritional status.
 Assess factors that interfere with oral intake. Provides basis and directions for
interventions.
 Reduce factors limiting oral intake such as encouraging patient to rest before
meals. Addresses factors limiting intake.
DRUGS

1) Anti-retroviral
Nursing Responsibilities:
 Monitor blood pressure. Anti-viral agents such as abacavir may cause a
significant decrease in blood pressure.
 Monitor HIV RNA, CD4 counts, liver function, kidney function, CBC, blood
glucose, and serum amylase, and triglyceride levels. These will determine
effectiveness and toxicity of drug.
 Monitor for neurological side effects such as numbness and tingling of the
extremities. Many NRTI agents cause peripheral neuropathy.
2) Trimethoprim-sulfamethoxazole (TMP-SMZ)
Nursing Responsibilities:

 Perform culture and sensitivity tests before beginning drug therapy. To

determine if the medication is beneficial,
 Protect the 200mg tablets from exposure to light. It loses some efficacy of the
medication when exposed to the sunlight.
 Discard any medication that is outdated or no longer needed. Intake of
expired medications may cause potential complications.
3) Antidepressant
Nursing Responsibilities:
 Monitor vital signs, especially pulse and blood pressure, especially when
initiating treatment. Imipramine may cause orthostatic hypotension.
 Administer accurately. Give TCAs at bedtime to aid in sleep and minimize
daytime drowsiness. Always practice safe techniques of medication
administration. Giving medication at bedtime will minimize the side effect of
drowsiness.
  Observe for signs and symptoms of improved mood, keeping in mind that it
may take 2 to 4 weeks to achieve therapeutic effectiveness. The risk of
suicide may increase as energy levels rise.

4) IV amphotericin B
Nursing Responsibilities:
 Monitor patient closely during test dose and the first 1– 2 hr of each dose for
fever, chills, headache, anorexia, nausea, or vomiting. Premedicating with
antipyretics, corticosteroids, antihistamines, meperidine, and antiemetics may
decrease these reactions. Febrile reaction usually subsides within 4 hr after
the infusion is completed.
 Assess injection site frequently for thrombophlebitis or leakage. Drug is very
irritating to tissues.
 Monitor vital signs every 15 min during test dose and every 30 min for 2– 4 hr
after administration. Meperidine and dantrolene have been used to prevent
and treat rigors. Assess respiratory status (lung sounds, dyspnea) daily. If
respiratory distress occurs, discontinue infusion immediately; anaphylaxis
may occur. Equipment for cardiopulmonary resuscitation should be readily
available.
5) Anti-infectives- treatment for infections such as herpes simplex, esophageal
candidiasis
Nursing Responsibilities:
 Monitor BUN, serum creatinine, and CCr before and during therapy. BUN and
serum creatinine levels, CCr may indicate renal failure.

 Assess bowel pattern daily; if severe diarrhea occurs, drug should be

discontinued; may indicate pseudomembranous colitis
 Take oral drug with meals to decrease GI upset.
6) Octreotide acetate- treatment for diarrhea
Nursing Responsibilities:
 Monitor quantitative 72-hr fecal fat and serum carotene determinations
periodically for possible drug-induced aggravations of fat malabsorption.
 Assess patient’s fluid and electrolyte balance and skin turgor for dehydration.
 Administer injections between meals and at bedtime to avoid GI side effects.