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HIV/AIDS | 마이메르시 MyMerci
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HIV/AIDS

NCLEX Review Guide: HIV/AIDS Management

HIV Pathophysiology & Transmission

Disease Process

  • HIV attacks CD4+ T-helper cells, progressively weakening the immune system over time. Normal CD4+ count is 800-1200 cells/mm³, with AIDS diagnosis occurring when count drops below 200 cells/mm³.
  • Viral load measures HIV RNA copies in blood - undetectable levels (<50 copies/mL) indicate effective treatment and prevent transmission.

Memory Aid: HIV Transmission Routes

"BUNS" - Blood, Unprotected sex, Needle sharing, Sharing contaminated equipment

Key Points

  • HIV cannot be transmitted through casual contact, saliva, tears, or sweat
  • Window period: 2-8 weeks when tests may be negative despite infection

Antiretroviral Therapy (ART)

Medication Management

  • ART typically combines 3+ medications from different drug classes to prevent resistance development. Common classes include NRTIs, NNRTIs, PIs, and INSTIs.
  • Adherence is critical - missing doses can lead to viral resistance and treatment failure.

Common ART Drug Classes

ClassExampleKey Side Effect
NRTIZidovudine (AZT)Bone marrow suppression
NNRTIEfavirenzCNS effects, vivid dreams
PIRitonavirGI upset, lipodystrophy

Key Points

  • Monitor for drug interactions - many ART medications affect liver enzymes
  • Goal: undetectable viral load within 6 months of starting therapy

Opportunistic Infections

Common AIDS-Defining Conditions

  • Pneumocystis jirovecii pneumonia (PCP) is the most common opportunistic infection, presenting with dry cough, dyspnea, and fever in patients with CD4+ <200.
  • Kaposi's sarcoma appears as purple/brown lesions on skin or mucous membranes, caused by HHV-8 infection.

Clinical Scenario

Patient with HIV presents with white patches in mouth that cannot be wiped off. This suggests oral candidiasis (thrush) - treat with antifungal medications like nystatin or fluconazole.

    PCP Prophylaxis Protocol

  1. Start when CD4+ count <200 cells/mm³
  2. First-line: Trimethoprim-sulfamethoxazole (Bactrim)
  3. Alternative: Dapsone or atovaquone if sulfa allergy
  4. Continue until CD4+ >200 for >3 months on ART

Key Points

  • Monitor for signs of CNS toxoplasmosis: headache, confusion, focal neurologic deficits
  • Cytomegalovirus (CMV) retinitis can cause blindness - requires immediate ophthalmologic evaluation

Nursing Care & Patient Education

Priority Interventions

  • Use standard precautions for all patient care - HIV is not transmitted through routine nursing care activities.
  • Assess nutritional status regularly as HIV wasting syndrome can develop, requiring high-calorie, high-protein interventions.

Memory Aid: HIV Patient Education

"SAFE HABITS" - Safe sex, Adherence to meds, Follow-up care, Exercise, Hand hygiene, Avoid sick contacts, Balanced nutrition, Immunizations, Take temperatures, Stress management

Key Points

  • Encourage pneumococcal and annual influenza vaccines (avoid live vaccines)
  • Provide emotional support and connect with HIV support groups
  • Teach importance of regular lab monitoring (CD4+ count, viral load)

Commonly Confused Concepts

HIV vs AIDS Distinction

AspectHIV InfectionAIDS
CD4+ Count>200 cells/mm³<200 cells/mm³
SymptomsMay be asymptomaticOpportunistic infections present
PrognosisNear-normal lifespan with treatmentLife-threatening without treatment

Common Pitfalls

  • Don't confuse HIV testing methods - ELISA screens, Western blot confirms, but newer 4th generation tests detect both antibodies and antigens
  • Remember - undetectable viral load means untransmittable (U=U concept)

Quick Check Self-Assessment

  • ☐ Can identify HIV transmission routes and prevention methods
  • ☐ Understand difference between HIV infection and AIDS diagnosis
  • ☐ Know common opportunistic infections and their presentations
  • ☐ Familiar with ART medication classes and side effects
  • ☐ Can describe appropriate nursing interventions and patient education
  • ☐ Understand prophylaxis protocols for opportunistic infections

Remember: You're preparing to save lives and provide compassionate care. HIV patients need knowledgeable, non-judgmental nurses who understand both the medical and psychosocial aspects of this condition. You've got this! 💪

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