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03.02 Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)

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Pathophysiology:

AIDS is caused by the human immunodeficiency virus (HIV). This virus infects and destroys T helper lymphocytes and decreases the immune system. With a decreased immune system infections and certain cancers can infect more easily.


Overview

  1. Condition caused by HIV Virus (late stage HIV infection)
  2. HIV Virus is treatable, though not curable

Nursing Points

General

  1. Interferes with and destroys T4 Lymphocytes
    1. Increases susceptibility to infection
  2. At risk for Opportunistic Infections/Conditions
    1. Tuberculosis
    2. Pneumonia
    3. Cancers
    4. Candidiasis

Assessment

  1. Frequent infections
  2. Wasting syndrome
  3. Skin breakdown
  4. Stomatitis
  5. Malnutrition
  6. Dehydration
  7. Leukopenia (↓WBCs)
  8. Kaposi’s sarcoma
    1. Tumor caused by herpes virus
    2. Purple/red lesions on skin and organs
  9. Candidiasis in mouth (thrush)

Therapeutic Management

  1. Respiratory support
  2. Nutritional support
    1. Small frequent meals
    2. Premedicate to avoid nausea
    3. Provide favorite foods
  3. Monitor fluid and electrolyte balance
  4. Assess for infection
  5. Provide skin care
  6. Initiate strict infection control precautions and observe hand hygiene
  7. Conserve energy

Nursing Concepts

  1. Infection Control
  2. Nutrition
  3. End of Life

Patient Education

  1. Take HIV medication as prescribed – this can prolong life by decades and prevent the development of AIDS
  2. Have CD4 and T cells checked regularly
  3. Monitor for s/s infection and report to provider
  4. Infection Control Precautions

***DISCLAIMER – In the video, it states that Kaposi’s Sarcoma is caused by the HPV virus. However, that information is incorrect. The correct virus that causes Kaposi’s Sarcoma is Herpes Simplex Virus***

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Nursing Care Plan for Acquired Immune Deficiency Syndrome (AIDS)

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Video Transcript

Okay guys, in this lesson we’re going to talk about Acquired Immune Deficiency Syndrome, or AIDS.

First, I want to clarify the difference between HIV and AIDS. HIV is Human Immunodeficiency Virus – it’s a retrovirus that affects immune cells in the body, specifically CD4 cells and lymphocytes. Now, these days, with medication, patients can live for decades after diagnosis – most of them live long, happy lives. We use HAART therapy, or Highly Active Antiretroviral Therapy for HIV and advances are being made every year to make HIV less and less of a death sentence. However, after a while, the body will wear out and the patient’s immune system can’t keep up. The patient will develop Acquired Immune Deficiency Syndrome. This is a set of symptoms or conditions – that’s what a syndrome is – a collection of symptoms – that indicate the patient is in the late stages of an HIV infection. It interferes and destroys T4 lymphocytes. If you remember from the Leukemia and Lymphoma lessons, Lymphocytes are responsible for our immune system. So without that, the patient becomes highly susceptible to infection, especially what are called opportunistic infections.

Opportunistic infections are ones that healthy patients could easily fight off. Even basic things like Tuberculosis or Pneumonia or a Urinary Tract Infection can be extremely problematic. But there are a couple of other opportunistic infections that are common with AIDS. The first is Kaposi’s Sarcoma. This is a cancer caused by the HPV virus and is a classic condition seen in AIDS. You see these purple raised lesions like what you see here. You may also see these in their mouth, on their face, and really anywhere on their skin. These purplish lesions are hallmark signs of Kaposi’s Sarcoma and they are almost exclusively present in AIDS patients. The other possible opportunistic infection is candidiasis, or yeast infections – specifically we can see thrush in their mouths – it’s these whitish lesions like you see here. Like I said before AIDS patients are more susceptible to contracting TB if they’re exposed, and they’re also at risk for other rare amoebas and parasites that healthy patients would normally be able to fight off without much issue. These things, plus their inability to heal or fight infection are going to wreak havoc in their body.

So we’re going to see those frequent infections and possible skin breakdown and ulcers in the mouth. And as you see here, they’re also at risk for tumors in their lungs, gut, and on their skin. But the other thing we see quite a bit in AIDS patients is what’s known as wasting syndrome. Their body begins to burn off their subcutaneous fat and their muscles begin to atrophy – they’ll be frail and thin and almost ghostly. They usually have a really poor appetite plus some nausea and vomiting, so that just complicates things and causes malnutrition and dehydration. That will make them weak and fatigued, they may have an increased heart rate. Their electrolytes and vitamin levels will be out of whack. And of course, we’ll see their white blood cell count almost completely wiped out.

So when we’re managing AIDS, we want to make sure we provide respiratory support, especially because we know they could contract tuberculosis or pneumonia. We also want to provide nutritional support. We know they’re going to struggle to eat, they have this wasting syndrome, and they’re going to be malnourished. We want to encourage small, frequent meals and encourage them to choose their favorite foods – whatever they like and will enjoy and keep down, they can have! Sometimes we could also give antiemetics before meals to help ease the nausea and help them to keep their food down. Then, of course, we focus on infection prevention. We use standard precautions and good hand hygiene and monitor for any signs that the patient could be developing an infection, both internal or external. Things like an increased heart rate, increased temp, possibly increased white blood cells if they aren’t in the later stages. We could also see redness, swelling, or drainage from infected wounds. And finally we want to focus on energy conservation. We should cluster our care and provide plenty of time for rest. This is a long road and can be distressing for the patient and their family.

So like we just talked about, our top priority nursing concepts for a patient with AIDS are going to be infection control and nutrition, but we also want to consider things like coping and end of life care, because this is the later stages of the disease.

So let’s recap quickly. Acquired Immune Deficiency Syndrome or AIDS is a condition that involves a collection of symptoms that indicates the patient is in the late stages of an HIV infection. It interferes with the patient’s T4 lymphocytes and destroys their immune system. This puts them at risk for infection, especially opportunistic infections and cancers like Kaposi’s Sarcoma, candidiasis, tuberculosis, and pneumonia. We want to make sure we support and protect their respiratory system and provide optimal nutrition. And we want to monitor for and prevent infection and help them to conserve what energy they do have. This is an exhausting and debilitating disease, especially in the later stages.

So, those are the basics of AIDS. Don’t miss all the resources we’ve attached to this lesson, including a care plan, case studies, flashcards, etc. They will help you learn and put the pieces together for these patients. Now, go out and be your best selves today. And, as always, happy nursing!

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