QUIMSON, CEDRIEL S.

HIV-MODULE 2
BSN-4B NCM 118A

1. Enumerate 5 appropriate discharge plan and health teaching for your patient. Provide
the rationale.
MEDICATION Integrase inhibitors (block an enzyme called integrase. Integrase
inhibitors are usually among the first HIV drugs used in people
who have recently contracted HIV.)
The following drugs are integrase inhibitors:

Generic Name: Raltegravir tablets

Brand Name: Isentress
Used along with other medications to treat human
immunodeficiency virus (HIV) infection in adults and children
who weigh at least 4.5 lbs (2 kg). ISENTRESS chewable tablets
may be chewed or swallowed whole. Maximum daily dose is 300
mg taken by mouth twice daily.
Generic Name: Elvitegravir tablets
Brand Name: Vitekta
The drug works against HIV's integrase protein, blocking its ability
to integrate its genetic code into human cells. It should be taken 85
mg orally once a day with food.
Protease inhibitors (block an enzyme called protease. Work by
binding to the enzyme protease. HIV needs protease to replicate in
the body.)
The following drugs are PIs used to treat HIV:
Generic Name: Ritonavir
Brand Name: Norvir
Ritonavir is in a class of medications called protease inhibitors. It
works by decreasing the amount of HIV in the blood. It usually
taken twice a day with meals. 300 mg orally twice a day.
Generic Name: Darunavir
Brand Name: Prezista
Upon oral administration, darunavir selectively targets and binds
to the active site of HIV-1 protease, and inhibits the dimerization
and catalytic activity of HIV-1 protease. Oral dose of PREZISTA
is 800 mg (one 800 mg tablet or 8 mL of the oral suspension) once
daily and with food.
Non-nucleoside reverse transcriptase inhibitors (They stop the
virus from replicating itself in the body.)
The following drugs are NNRTIs:
Generic Name: Rilpivirine
Brand Name: Edurant
An antiviral medicine that prevents human immunodeficiency
virus (HIV) from multiplying in your body. Usual adult dose for
HIV infection is 25 mg orally once a day and Pediatric dose for
HIV infection 12 years or older, weighing at least 35 kg: 25 mg
orally once a day.
Generic Name: Etravirine
Brand Name: Intelence
It blocks the virus from growing and infecting more cells.
Etraverine is used clinically for the treatment of human
 immunodeficiency virus type 1 (HIV-1) infection. 200 mg orally
twice a day after a meal, the same dosage is recommended for
adult and pregnant.

ENVIRONMENTAL To reduce your risk for infection, make sure to do the following:
• Limit your number of sexual partners.
• Always keep your private parts well cleaned.
• Safe sex. Use condom every time you have sex
• Get tested and treated for STDs.
• Make sure that your house and surroundings are neat and
clean.
TREATMENT The most effective treatment for HIV is antiretroviral therapy
(ART).
- Combination of several medicines (aims to control the
amount of virus in your body)
- Slow the rate at which the virus grows
- Reduce the amount of virus in your body and help you stay
healthy.
HEALTH Medication adherence- An essential part of effective HIV
TEACHINGS treatment is medication adherence. Medication adherence means
sticking to an HIV treatment regimen taking HIV medicines every
day and exactly as prescribed. If you continue to regularly take
your HIV medicines and treatments the effectivity of it will show
fast. It will also prolong your life.
Never share needles or other equipment for drug use- People
who inject drugs can spread viruses and diseases by sharing
needles or drug preparation equipment that has been contaminated
with infected blood. Viruses and diseases can be spread from
person to person even if someone only tried injecting drugs many
years ago
Practice safe sex- Use condoms correctly and use them every time
you have sex. Don't risk spreading your illness to non infected
people.
OPD FOLLOW UP Current HIV treatment guidelines recommend that most people
CHECK UP with HIV see their health care provider for lab tests every 6
months. Some people may see their provider more frequently,
especially during the first two years of treatment or if their HIV
viral load is high or detectable. So it is really recommended for a
patient with HIV/Aids to see their doctor regularly most especially
when you are experiencing severe fever, fatigue, night sweats,
rash, difficulty in breathing etc. Do not hesitate to call your doctor.
DIET Eat plenty of fruits and vegetables. They’re high in nutrients
called antioxidants, which protect your immune system. Choose
healthy options like lean beef, poultry, fish, eggs, beans, and nuts.
HIV patients should also Limit their sugar and salt because HIV
raises your chances of getting heart disease. Too much sugar and
salt can harm your ticker. Lastly, it’s not all about on your food
intake it is also important to have a healthy lifestyle, positive mind,
and healthy disposition in life.
 2. Provide 4 categories of Complementary and Alternative Modalities. Explain each one.
1) Spiritual or psychological therapies may include humor, hypnosis, faith healing, guided
imagery, and positive affirmations.
2) Nutritional therapies may include vegetarian or macrobiotic diets, vitamin C or beta-
carbonate supplements, and turmeric, which contains curcumin, a food spice
supplement. Chinese herbs, such as traditional herbal mixtures, are also used, in addition
to compound Q (a Chinese cucumber extract) and Mormordica charantia (bitter melon),
which is given as anenema.
3) Drug and biologic therapies include medications and other substances not approved by
the FDA. Examples are N-acetylcysteine, pentoxifylline (Trental), and I-chloro-2, 4-
dinitrobenzene. Also included in this category are oxygen therapy, ozone therapy, and
urine therapy.
4) Treatment with physical forces and devices may include acupuncture, acupressure,
massage therapy, relexology, therapeutic touch, yoga, and cystals.

3. Make a schematic diagram the pathophysiology of the condition and course of the
disease mentioned on the case. (Connect the signs and symptoms, laboratory and
diagnostic procedures as well as the prioritized problem/ nursing diagnosis)

Precipitating Factors: Predisposing Factors:

HIV can be transmitted via the exchange• ofhaving
a unprotected anal or vaginal sex;
variety of body fluids from infected people, such
• having another sexually transmitted
as blood, breast milk, semen and vaginal infection (STI) such as syphilis, herpes,
secretions. HIV can also be transmitted from a
chlamydia, gonorrhea and bacterial
mother to her child d uring pregnancy andvaginosis;
delivery. • sharing contaminated needles, syringes
HUMAN IMMUNODEFICIENCY VIRUS (HIV) and other injecting equipment and drug
solutions when injecting drugs

Exposure to infected body fluids

Infection with HIV retrovirus

HIV invades nucleus of helper T-lymphocytes

(CD4 surface antigen)

viral replication
occurs via reverse
transcriptase= retrovirus
 virus is released into Diagnostic tests:
circulation= viremia
causing acute or • Viral load
primary HIV • ELISA for antibodies
• Western blot for
Can present with confirmation
flu like symptoms
- rash, fever,
lymphadenopathy,
nonexudative
pharyngitis,
headache,
myalgia’s.

continue activation of cell-mediated and

humoral arms of immune system leading to
CD4 memory T cells proliferation.
This proliferation in turn provides
leads to long-term negative consequences for
virus with more cellular targets
CD4 cells:
apoptosis which shortens CD4 lifespan
reduced regenerative ability of T cell
Expanded target population enables
populations tissue destruction syncytia
infection to persist= chronic HIV
formation infection
CD4 T cell dysfunction

Destruction of
Tlymphocytes
virus induced cytolysis CD4 T
cell population

Helper HIC released from cell

Tlymphocytes
Immune Suppression Immune function continues to be
compromised until
Malaise
Opportunistic Infection

Fatigue
Oral-esophageal thrush

Fever
Herpes simplex
ACQUIRED
IMMUNODEFICIENCY SYNDROME
Weight loss (AIDS)
TB, CMV

Pneumocystis

T-cell retrovirus imported from German African

colonies into Germany

Retrovirus spreads to European populations

Retrovirus contaminates blood supply, injection

equipment

Retrovirus transmitted to premature infants in affected hospitals

T-cell deficiencies

PNEUMOCYSTIC PNEUMONIA

Clinical suspicion for PCP

 Patient evaluation

• Clinical assessment
• Chest radiograph
• Pulse oximetry or arterial blood gas

Empiric therapy if high degree of clinical

suspicion and

• Clinically severe disease (esp. room

air Po2 <70 mmHg)
• Rapid progression
• Diagnostic facilities unavailable
• Add prednisone if room air Po2<70
mmHg
Induced sputum examination for Pneumocystis
 Example for TB and routine bacteria if clinically
and epidemiology indicated

NEGATIVE

Broncho alveolar lavage

 Include trans bronchial biopsy with

initial procedure if sputum yield at
facility is high and severity of episode merits
biopsy
POSITIVE
Specific therapy for 21 days NEGATIVE
Prednisone if

 Room air Po2 <70 mmHg

Discontinue anti-PCP therapy

Consider hospitalization if
• Severe disease
• Rapid progression
• Intolerant of oral drug
• Compliance uncertain
• Consider diagnostic procedures for other
pathogens (culture, serology, biopsy)
• Consider observation alone if disease
mild and patient not deteriorating
• Consider empiric therapy for atypical
pneumonias

NURSING MANAGEMENT:

• Nutritional status. Nutritional status is assessed by obtaining a diet history and

identifying factors that may affect the oral intake.
• Skin integrity. The skin and mucous membranes are inspected daily for evidence
of breakdown, ulceration, or infection.
• Respiratory status. Respiratory status is assessed by monitoring the patient for
cough, sputum production, shortness of breath, orthopnea, tachypnea, and chest pain.
• Neurologic status. Neurologic status is determined by assessing the level of
consciousness; orientation to person, pace, and time; and memory lapses.
• Fluid and electrolyte balance. F&E status is assessed by examining the skin and
mucous membranes for turgor and dryness.
• Knowledge level. The patient’s level of knowledge about the disease and the modes of
disease transmission is evaluated.

MEDICAL MANAGEMENT:

• Treatment of opportunistic infections. For Pneumocystis pneumonia, TMP-SMZ is the

treatment of choice; for mycobacterium avian complex, azithromycin or clarithromycin
are preferred prophylactic agents; for cryptococcal meningitis, the current primary treatment is
IV amphotericin B.
• Prevention of opportunistic infections. TMP-SMZ is an antibacterial agent used to treat
various organisms causing infection.
• Antidiarrheal therapy. Therapy with octreotid e acetate (Sandostatin), a synthetic analog of
somatostatin, has been shown to be effective in managing severe chronic diarrhea.
• Antidepressant therapy. Treatment for depression in patients with HIV infection involves
psychotherapy integrated with imipramine, desipramine or fluoxetine.
• Nutrition therapy. For all AIDS patients who experience unexplained weight loss, calorie
counts should be obtained, and appetite stimulants and oral supplements are also appropriate.

ASSESSMENT AND DIAGNOSTIC

TESTS:

• Confirming Diagnosis
• CBC
• PPD
• Serologic
• Western blot test
• Viral load test
• STD screening test
• Cultures
• Neurological studies, e.g.,
electroencephalogram (EEG), magnetic
resonance imaging (MRI),
computed

tomography (CT) scans of the brain;

electromyography (EMG)/nerve
conduction studies.
• X ray
• Pulmonary function test
• Gallium scan
• Biopsies
• Bronchoscopy/tracheobronchial
washings
• Barium swallow, endoscopy,
colonoscopy