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.
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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.
Diagnostic Studies – AIDS Nursing Care Plans
- 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 Plans
- 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 Plans
- 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.
13 Acquired Immunodeficiency Syndrome (AIDS) Nursing Care Plans
- Imbalanced Nutrition: Less Than Body Requirements — AIDS
- Acute/Chronic Pain — AIDS
- Impaired Skin Integrity — AIDS
- Impaired Oral Mucous Membrane — AIDS
- Fatigue — AIDS
- Disturbed Thought Process — AIDS
- Anxiety/Fear — AIDS
- Social Isolation — AIDS
- Powerlessness — AIDS
- Deficient Knowledge — AIDS
- Risk for Injury — AIDS
- Risk for Deficient Fluid Volume — AIDS
- Risk for Infection — AIDS
Acquired immunodeficiency syndrome (AIDS) is the final result of infection with a retrovirus, the human immunodeficiency virus (HIV).
Risk for Infection
Risk factors may include
- Inadequate primary defenses: broken skin, traumatized tissue, stasis of body fluids
- Depression of the immune system, chronic disease, malnutrition; use of antimicrobial agents
- Environmental exposure, invasive techniques
Possibly evidenced by:
[Not applicable; presence of signs and symptoms establishes an actual diagnosis.]
- Achieve timely healing of wounds/lesions.
- Be afebrile and free of purulent drainage/secretions and other signs of infectious conditions.
- Identify/participate in behaviors to reduce risk of infection.
AIDS Nursing Care Plan: Risk for Infection
|Assess patient knowledge and ability to maintain opportunistic infection prophylactic regimen.||Multiple medication regimen is difficult to maintain over a long period of time. Patients may adjust medication regimen based on side effects experienced, contributing to inadequate prophylaxis, active disease, and resistance.|
|Wash hands before and after all care contacts. Instruct patient/SO to wash hands as indicated.||Reduces risk of cross-contamination.|
|Provide a clean, well-ventilated environment. Screen visitors/staff for signs of infection and maintain isolation precautions as indicated.||Reduces number of pathogens presented to the immune system and reduces possibility of patient contracting a nosocomial infection.|
|Discuss extent and rationale for isolation precautions and maintenance of personal hygiene.||Promotes cooperation with regimen and may lessen feelings of isolation.|
|Monitor vital signs, including temperature.||Provides information for baseline data; frequent temperature elevations/onset of new fever indicates that the body is responding to a new infectious process or that medications are not effectively controlling noncurable infections.|
|Assess respiratory rate/depth; note dry spasmodic cough on deep inspiration, changes in characteristics of sputum, and presence of wheezes/rhonchi. Initiate respiratory isolation when etiology of productive cough is unknown.||Respiratory congestion/distress may indicate developing PCP (the most common opportunistic disease); however, TB is on the rise and other fungal, viral, and bacterial infections may occur that compromise the respiratory system. Note: CMV and PCP can reside together in the lungs and, if treatment is not effective for PCP, the addition of CMV therapy may be effective.|
|Investigate reports of headache, stiff neck, altered vision. Note changes in mentation and behavior. Monitor for nuchal rigidity/seizure activity.||Neurological abnormalities are common and may be related to HIV or secondary infections. Symptoms may vary from subtle changes in mood/sensorium (personality changes or depression) to hallucinations, memory loss, severe dementias, seizures, and loss of vision. CNS infections (encephalitis is the most common) may be caused by protozoal and helminthic organisms or fungus.|
|Examine skin/oral mucous membranes for white patches or lesions. (Refer to ND: Skin Integrity, impaired, actual and/or risk for, and ND: Oral Mucous Membrane, impaired.)||Oral candidiasis, KS, herpes, CMV, and cryptococcosis are common opportunistic diseases affecting the cutaneous membranes.|
|Clean patient’s nails frequently. File, rather than cut, and avoid trimming cuticles.||Reduces risk of transmission of pathogens through breaks in skin. Note: Fungal infections along the nail plate are common.|
|Monitor reports of heartburn, dysphagia, retrosternal pain on swallowing, increased abdominal cramping, profuse diarrhea.||Esophagitis may occur secondary to oral candidiasis, CMV, or herpes. Cryptosporidiosis is a parasitic infection responsible for watery diarrhea (often more than 15L/day).|
|Inspect wounds/site of invasive devices, noting signs of local inflammation/infection.||Early identification/treatment of secondary infection may prevent sepsis.|
|Wear gloves and gowns during direct contact with secretions/excretions or any time there is a break in skin of caregiver’s hands. Wear mask and protective eyewear to protect nose, mouth, and eyes from secretions during procedures (e.g., suctioning) or when splattering of blood may occur.||Use of masks, gowns, and gloves is required by Occupational Safety and Health Administration (OSHA, 1992) for direct contact with body fluids, e.g., sputum, blood/blood products, semen, vaginal secretions.|
|Dispose of needles/sharps in rigid, puncture-resistant containers.||Prevents accidental inoculation of caregivers. Use of needle cutters and recapping is not to be practiced. Note: Accidental needlesticks should be reported immediately, with follow-up evaluations done per protocol.|
|Label blood bags, body fluid containers, soiled dressings/ linens, and package appropriately for disposal per isolation protocol.||Prevents cross-contamination and alerts appropriate personnel/departments to exercise specific hazardous materials procedures.|
|Clean up spills of body fluids/blood with bleach solution (1:10); add bleach to laundry.||Kills HIV and controls other microorganisms on surfaces.|