Andrea Sigrist HIV Case 36 - PowerPoint Presentation

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Andrea Sigrist HIV Case 36 - PPT Presentation

Patient Client Terry Long Sex Male Ethnicity African American DOB 512 Age 32 Height 61 Weight 151 lbs Reason for Admittance HIV positive diagnosed 4 years ago Exhausted all the time ID: 731652

aids hiv http medications hiv aids medications http retrieved amp cd4 information www blood drugs diet webmd infected levels

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Slide1

Andrea Sigrist

HIV

Case 36Slide2

Patient

Client

Terry Long

Sex: Male

Ethnicity: African American

DOB: 5/12Age: 32Height: 6’1”Weight: 151 lbs

Reason for Admittance

HIV positive (diagnosed 4 years ago)

Exhausted all the time

Sore mouth

Sore throat

Significant weight loss

Possible pneumonia per referring physician Slide3

Patient History

Physical Exam

Stereopositive

for HIV-1, confirmed by ELISA and Western Blot 4 years ago

Unknown contraction

Not currently undergoing treatmentTonsillectomy at age 6Appendectomy at age 18Current medications; multivitamin, vitamin E, vitamin C, ginseng, milk thistle, echinacea

Quit smoking 5 years ago

Family history: father with angina, heart problems, high blood pressure (CAD, HTN)

General Appearance:

Thin African American in no acute distress

Vitals:

Temp 98.6F

, BP

120/84, HR 92bpm, RR 18bpm

Heart:

regular rate and rhythm

Nose:

Mucosa pink without drainage

Throat:

erythematous with white, patchy exudate

Extremities:

good pulses, no edema

Skin:

warm, with flaky patches

Chest/lungs:

Rhonchi in lower left lung

Abdomen:

nondistended

nontender

, hyperactive bowel soundsSlide4

Lab Values

Measure

Normal Value

Terry’s Value

Reason

for ConcernAlbumin3.6 – 53.6Low levels are a sign

of malnutritionPrealbumin

– 43

6.0

Low levels are a sign of malnutrition

Transferrin

200 – 400

Low levels

are a sign of malnutrition

Viral

Load

29000

Elevated

levels are a sign of an immune disorder

CD4

325 – 997

157

< 200 defines AIDS

BUN

8 – 26

Low levels

are a sign of malnutritionSlide5

Patient diagnosis and treatment

DIAGNOSIS

HIV for four yearsAIDSClinical Cate

Oral thrushNo clinical evidence of pneumonia

TREATMENT

Antiretroviral regimenAZT (zidovudine) 200 mg every 8hrCrixivan (indinavir) 800mg every 8hr3TC

Epivir (lamivudine) 150 mg every 12hr Slide6

What is Hiv?

Infection caused by the human immunodeficiency virus which destroys the immune system and makes it hard for the body to fight off infections

Transmitted through sexual contact, blood, and mother to childPeople infected may not show symptoms for up to ten years, but can still infect others

Progresses to AIDS There is no cure, but it can be treatedPeople infected with HIV will develop AIDS if not treated

A small amount of people develop AIDS slowly or not at allIs a preventable infection Slide7

HIV tests

Western Blot

Uses gel electrophoresis to separate specific HIV proteins being detectedAfter separation, the proteins are transferred to a membrane to be identified using antibodies that target a specific protein

ELISA

HIV antigens are added to a sample of blood and antibodies react with the HIV virus

An enzyme linked to an antibody is added and reacts with the HIV antigen/antibodyA catalyst is added to change the color of the enzyme-linked complexSlide8

Risk factors for contracting hiv

Common Risk Factors

Sexual contact with an infected person

Unprotected sexComing in contact with blood of an infected personSharing needles

Blood transfusions Mother to child by blood during delivery or breast milk

Terry’s Risk FactorsWorked as a nurse in a dialysis clinicNumerous sexual partnersUse of recreational drugsSlide9

Prognosis

HIV is a chronic condition

It will eventually completely destroy a person’s immune system

Progression depends on each individual

There are treatment options, but no cure

Can prevent complications and delay the progression of AIDSAlmost all people infected will develop AIDSLack of treatment is fatalHAART (highly reactive antiretroviral therapy) dramatically increases how long an infected person lives, but is not a cure

The weakened immune system makes individuals more susceptible to infections and cancersSlide10

Treatment for hiv

Treatment

Medications used in combination is the only way to control the virusIt is best to use three different medications from two different classes of drugs to avoid creating strains of HIV that are immune to single drugs

When to Start

Symptoms become severe

CD4 count is below 500Become pregnantHave HIV-related kidney diseaseBeing treated for Hep-CSlide11

Medications

Types of Medications

NNRTIs

(Non-nucleoside reverse transcriptase inhibitors): disables proteins HIV needs to copy itself

NRTIs (Nucleoside reverse transcriptase inhibitors): faulty versions of building blocks HIV needs to copy itself

PIs (Protease Inhibitors): disable protease , which HIV uses to copy itself Entry or fusion inhibitors: block HIV’s entry into CD4 cellsIntegrase inhibitors: disables integrase which HIV uses to insert genetic material into CD4 cells

Terry’s Medications

200 mg of

zidovudine

(AZT) every 8 hours

800 mg of

indinavir

(

Crixivan

) every 8 hours

150 mg of

lamivudine

(3TC

Epivir

) every 12 hoursSlide12

Supplements

Supplement

Proposed use in HIV/AIDS

Potential Risk

Vitamin C

Improve antioxidant capacity, increases iron absorption from non-heme sources

Increases urinary losses of oxalate and calcium

Vitamin E

Vitamin E may protect against toxicity and side effects from AZT (antiretroviral medications)

Can interfere with blood clotting. Cause nausea, diarrhea, muscle weakness, fatigue

Ginseng

Has anti-stress and anti-fatigue effects; May contain a protein with anti-HIV activity

morning diarrhea, insomnia, nervousness, depression, confusion, skin rashes and high blood pressure

Milk thistle

May prevent liver damage caused by HIV medications

Upset stomach, diarrhea, bloating, gas

Echinacea

Anticancer, immunostimulatory; stimulate immune system and promote CD4 cell activation

May inhibit metabolism of drugs using the cytochrome P 450 enzyme pathway

Multivitamin

Slows disease progression, increases CD4 count, lowers viral load values

NoneSlide13

Nutrition with hiv

Terry’s Diet before Mouth Sores

Breakfast/Lunch:

1-2 cups of cold cereal with ½ cup of whole milkDinner:

Meat, potatoes or rice, tea or sodaSnacks: Pizza, candy bar, or cookies with tea or soda

1-2 beers or glasses of wine several times a week Suggested HIV NutritionConsume a healthy and balanced diet like healthy individuals

Calories should be 10% higher if untreatedCalories should be 30% higher during recovery Take a daily multivitamin

If suffering from loss of appetite:

Eat several small meals

Exercise to stimulate appetite

Consume nutrition supplement beverage

Terry’s 24-hour Diet Recall

Sips of apple juice, 1 cup of yogurt, 1 cup of rice and gravy, sips of iced tea with sugar throughout the daySlide14

Alcohol and hiv

Studies show regular alcohol consumption is associated with an increase in the progression of HIV

The immunosuppressive effects of alcohol may cause CD4 count to fall below 200 cellsStill being researched, not a factSlide15

Main concerns for terry

Problems

Not eating enoughConsumes a lot of sugar and sodaAlcohol consumption

Not taking medications

Suggestions

Place on pureed or soft food dietAdd nutritional supplement beverageVegetable juicesSoy or almond milksEducate about programs that help pay for medications Slide16

GOALS

Main goal is to get Terry his medications and get him taking them every day as directed

Educate about healthy diet and consequences of malnutrition and not taking medications Get back on a normal diet

Start exercise routine

COURSE OF ACTION

Have him meet with a Medication Assistance programCreate diet planBegin with soft/liquid dietProgress to normal dietHave Terry keep a food journalJoin a gym or fitness groupJoin a support groupSlide17

Questions?Slide18

References

AIDS (2012). AIDS Information, Education, Action, Awareness | CD4 (T-CELL) TESTS.

AIDS Information, Education, Action, Awareness | HIV, AIDS Facts. Retrieved from http://www.aids.org/topics/aids-factsheets/aids-background-information/what-is-aids/hiv-testing/cd4-t-cell-tests

/AIDS.org

(2012). AIDS Information, Education, Action, Awareness | How is HIV Transmitted? AIDS Information, Education, Action, Awareness | HIV, AIDS Facts

. Retrieved from http://www.aids.org/topics/aids-faqs/how-is-hiv-transmitted/Boskey, Ph. D., E. (2011, September 6). HIV Testing - How Does a Western Blot HIV Test Work? Sexually Transmitted Diseases - STDs. Retrieved from http://

std.about.com/od/HIVTesting/f/How-Does-A-Western-Blot-Hiv-Test-Work.htmCarter, M., & AIDS Map (2010, May 17). HIV & AIDS Information :: Frequent alcohol use hastens HIV disease progression.

HIV & AIDS Information :: Home

. Retrieved from http://www.aidsmap.com/Frequent-alcohol-use-hastens-HIV-disease-progression/page/1438821/

Cooper, C. L., & Cameron, D. W. (2005). Effect of Alcohol Use and Highly Active Antiretroviral Therapy on Plasma Levels of Hepatitis C Virus (HCV) in Patients

Coinfected

with HIV and HCV.

Oxford Journals | Medicine | Clinical Infectious Diseases

. Retrieved from

http://

cid.oxfordjournals.org/content/41/Supplement_1/S105.full

FitDay

. (2012).

FitDay

- Free Weight Loss and Diet Journal

. Retrieved from http://www.fitday.com/fitness/FoodLog.html?_a_Date=1322611200.&_v_View_FoodL

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