Acquired immunodeficiency syndrome (AIDS) is the final result of infection with a retrovirus, the human immunodeficiency virus (HIV). HIV infection is a progressive disease leading to AIDS, as defined by the CDC (January 1994): “persons with CD4 cell count of under 200 (with or without symptoms of opportunistic infection) who are HIV-positive are diagnosed as having AIDS.” Research studies in 1995 showed that HIV initially replicates rapidly on a daily basis. The half-life of the virus is 2 days, with almost complete turnover in 14 days. Therefore, the immune response is massive throughout the course of HIV disease. Evidence suggests the cellular immune response is essential in limiting replication and rate of disease progression. Controlling the replication of the virus to lower the viral load is the current focus of treatment.
Persons with HIV/AIDS have been found to fall into five general categories: (1) homosexual or bisexual men, (2) injection drug users, (3) recipients of infected blood or blood products, (4) heterosexual partners of a person with HIV infection, and (5) children born to an infected mother. The rate of infection is most rapidly increasing among minority women and is increasingly a disease of persons of color.
- Imbalanced Nutrition: Less Than Body Requirements — AIDS Nursing Care Plan (NCP)
- Acute/Chronic Pain — AIDS Nursing Care Plan (NCP)
- Impaired Skin Integrity — AIDS Nursing Care Plan (NCP)
- Impaired Oral Mucous Membrane — AIDS Nursing Care Plan (NCP)
- Fatigue — AIDS Nursing Care Plan (NCP)
- Disturbed Thought Process — AIDS Nursing Care Plan (NCP)
- Anxiety/Fear — AIDS Nursing Care Plan (NCP)
- Social Isolation — AIDS Nursing Care Plan (NCP)
- Powerlessness — AIDS Nursing Care Plan (NCP)
- Deficient Knowledge — AIDS Nursing Care Plan (NCP)
- Risk for Injury — AIDS Nursing Care Plan (NCP)
- Risk for Deficient Fluid Volume — AIDS Nursing Care Plan (NCP)
- Risk for Infection — AIDS Nursing Care Plan (NCP)
Diagnostic Studies - AIDS Nursing Care Plan (NCP)
- CBC: Anemia and idiopathic thrombocytopenia (anemia occurs in up to 85% of patients with AIDS and may be profound). Leukopenia may be present; differential shift to the left suggests infectious process (PCP), although shift to the right may be noted.
- PPD: Determines exposure and/or active TB disease. Of AIDS patients, 100% of those exposed to active Mycobacterium tuberculosis will develop the disease.
- Serologic: Serum antibody test: HIV screen by ELISA. A positive test result may be indicative of exposure to HIV but is not diagnostic because false-positives may occur.
- Western blot test: Confirms diagnosis of HIV in blood and urine.
- Viral load test:
- RI-PCR: The most widely used test currently can detect viral RNA levels as low as 50 copies/mL of plasma with an upper limit of 75,000 copies/mL.
- bDNA 3.0 assay: Has a wider range of 50–500,000 copies/mL. Therapy can be initiated, or changes made in treatment approaches, based on rise of viral load or maintenance of a low viral load. This is currently the leading indicator of effectiveness of therapy.
- T-lymphocyte cells: Total count reduced.
- CD4+ lymphocyte count (immune system indicator that mediates several immune system processes and signals B cells to produce antibodies to foreign germs): Numbers less than 200 indicate severe immune deficiency response and diagnosis of AIDS.
- T8+ CTL (cytopathic suppressor cells): Reversed ratio (2:1 or higher) of suppressor cells to helper cells (T8+ to T4+) indicates immune suppression.
- Polymerase chain reaction (PCR) test: Detects HIV-DNA; most helpful in testing newborns of HIV-infected mothers. Infants carry maternal HIV antibodies and therefore test positive by ELISA and Western blot, even though infant is not necessarily infected.
- STD screening tests: Hepatitis B envelope and core antibodies, syphilis, and other common STDs may be positive.
- Cultures: Histologic, cytologic studies of urine, blood, stool, spinal fluid, lesions, sputum, and secretions may be done to identify the opportunistic infection. Some of the most commonly identified are the following:
- Protozoal and helminthic infections: PCP, cryptosporidiosis, toxoplasmosis.
- Fungal infections: Candida albicans (candidiasis), Cryptococcus neoformans(cryptococcosis), Histoplasma capsulatum (histoplasmosis).
- Bacterial infections: Mycobacterium avium-intracellulare (occurs with CD4 counts less than 50), miliary mycobacterial TB, Shigella (shigellosis),Salmonella (salmonellosis).
- Viral infections: CMV (occurs with CD4 counts less than 50), herpes simplex, herpes zoster.
- Neurological studies, e.g., electroencephalogram (EEG), magnetic resonance imaging (MRI), computed tomography (CT) scans of the brain; electromyography (EMG)/nerve conduction studies: Indicated for changes in mentation, fever of undetermined origin, and/or changes in sensory/motor function to determine effects of HIV infection/opportunistic infections.
- Chest x-ray: May initially be normal or may reveal progressive interstitial infiltrates secondary to advancing PCP (most common opportunistic disease) or other pulmonary complications/disease processes such as TB.
- Pulmonary function tests: Useful in early detection of interstitial pneumonias.
- Gallium scan: Diffuse pulmonary uptake occurs in PCP and other forms of pneumonia.
- Biopsies: May be done for differential diagnosis of Kaposi’s sarcoma (KS) or other neoplastic lesions.
- Bronchoscopy/tracheobronchial washings: May be done with biopsy when PCP or lung malignancies are suspected (diagnostic confirming test for PCP).
- Barium swallow, endoscopy, colonoscopy: May be done to identify opportunistic infection (e.g., Candida, CMV) or to stage KS in the GI system.
Nursing Priorities - AIDS Nursing Care Plan (NCP)
- Prevent/minimize development of new infections.
- Maintain homeostasis.
- Promote comfort.
- Support psychosocial adjustment.
- Provide information about disease process/prognosis and treatment needs.
Discharge Goals - AIDS Nursing Care Plan (NCP)
- Infection prevented/resolved.
- Complications prevented/minimized.
- Pain/discomfort alleviated or controlled.
- Patient dealing with current situation realistically.
- Diagnosis, prognosis, and therapeutic regimen understood.
- Plan in place to meet needs after discharge.
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