HIV/AIDS Primer for Nurse Practitioners Nursing is Attending to Meaning. Bill Wade R.N June 21,2005.
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1 HIV/AIDS Primer for Nurse Practitioners Nursing is Attending to Meaning Bill Wade R.N June 21,
2 Goals of this presentation Offer minimum content levels to enhance your learning needs around HIV/AIDS Help you to develop and realize personal learning goals in relation to HIV/AIDS care Contribute to a global and national understanding of this epidemic Encourage you to become involved in reading, research and self-directed learning 2
3 Role of Nurse Practitioners To promote health of individuals and communities and To prevent and manage illness 3
4 HIV/AIDS Statistics More than 9 new infections every minute More than 50% aged years 2,000 are under 15 years of age 1 out of every 83 adults in the world is HIV positive 39.4 million people affected worldwide 4.9 million new infections last year and 3.1 million deaths Half of those now affected are women and girls U.N Secretary General Kofi Annan June 2,2005 4
5 HIV in Canada 50,000 living with HIV (1 in 620) 1/3 unaware of their infection ~ 4,200 new infections per year Changing demographics Increased Survival Patient Empowerment Greater Treatment options Out Patient vs. Hospital Care 5
6 Testing for HIV Antibody -Elisa -Western Blot -Rapid HIV tests (OraSure: blood; OraQuick: Oral fluid) 6
7 Pre-Screening Blood work CBC.,CD3,CD3+CD4,CD4+CD8 CXR Urines Hepatology screens Vaccinations: Hep A -- 0 and 6 months Hep B-- 0,1, 6 months Tetanus every 10 years Influenza annually Complete history including sexual history HIV serology (Elisa/immuno blot) VDRL Syphillis Pap smears annually Present meds including homeopathic Complete physical Weight 7
8 Sexual History Non-judgemental with permission to discuss these issues Usually not discussed until problems arise Years sexually active Married/divorced/single Oral/vaginal/anal sex? Condom use Drug use? Type Gay/Straight/Bi/trans Sexual practices Ability to communicate in fortright, comfortable manner Be familiar with terminology in gay community: i.e., MSM,Rimming, Fisting, Barebacking 8
9 Multidisciplinary Approach Nurse Practitioner Medical Doctor Nurses Social Worker Dietitian Dentist Pharmacist Pharmaceutical reps Clinic staff Chaplain 9
10 General Principles Multidisciplinary approach Maximum suppression of VL Patient as partner Community partnerships Health Promotion Hope 10
11 Primary Infection Primary or acute infection HIV replicates quickly Antibodies not yet produced so test will be negative This is window period May have flu like symptoms Seroconversion, when antibodies are being produced, happens 1-3 months after infection 11
12 Asymptomatic Infection Few or no symptoms Can last for many years Long-term non-progressors ~ 6-10% who have been infected for 10 or more years show no symptoms 12
13 Symptomatic Infection Chronic Fatigue Weight loss Skin problems Diarrhea 13
14 Reporting Legally notifiable in all provinces and territories. All offer at least one of three forms of testing: Nominal/name-based Non-nominal/non-identifying Anonymous not available in all provinces 14
15 HIV Related Symptoms Chronic fatigue Weight loss Skin problems Diarrhea Swollen lymph nodes Fevers Night sweats Headaches Cough Neuropathy Dysphagia/ Odynophagia 15
16 Opportunistic Infections Dermatologic conditions Oral manifestations Fungal infections Viral Protozoan Bacterial Malignancies 16
17 Factors affecting Progression Strength of virus Nutrient level Mental status and stress level Access to care,treatments and support Exposure to infections Socio-economic factors, i.e. access to housing 17
18 Hepatitis Hepatitis A Hepatitis B Hepatitis C 18
19 Co-Infections Hepatitis C T.B. 19
20 AIDS Indicator Conditions Pneumocystis carinii pneumonia Pneumonia,recurrent Progressive multifocal leukoencephalopathy Salmonella septicemia,recurrent Toxoplasmosis of brain Wasting syndrome due to HIV Herpes simplex,chronic Histoplasmosis Kaposi s sarcoma Lymphoma Mccobacterium avium complex Mycobacterium tuberculosis 20
21 HIV and Pregnancy Prenatal Counselling and testing Prenatal team N.P.,physician, ID specialist, Obstetrician, nurses,pharmacist,social worker, chaplain Antiretroviral therapy during pregnancy Antiretroviral therapy during labour AZT,AZT+3TC,Nevirapine ARV s for baby No breast feeding Testing for baby 21
22 Psycho-Social Issues Anxiety Body image Depression Guilt Hopelessness Social isolation Stigma Poverty Homelessness Family functioning Powerlessness Support systems 22
23 Treatment Counselling ARV therapy Prophylactic therapies Treatment of OI s Symptom control Complementary therapies Non-pharmacologic therapies 23
24 Treatment Counselling Picture sheet of meds Medication schedule sheets Dosette boxes Concomitant meds Track medication history 24
25 Medications Side Effects Nausea Vomiting Diarrhea Metabolic cardiac bone Liver blood lipids (cholesterol; triglycerides) mitochondria lipodystrophy,adiposity (osteoporosis, osteopenia) 25
26 Goals of Treatment Reduction in viral load as much as possible for as long as possible. Restore/preserve immune function Improve quality of life. Reduce HIV-related morbidity and mortality. Prevent/reduce resistant variants 26
27 Evaluating HIV Treatment Viral load testing CD4+(T cell) counts opportunistic infections, survival Resistance testing 27
28 HIV Prevention 28
29 Essential Prevention Package Widespread public education about HIV Promotion of prevention skills Condom availability (male and female) with consistent use Correctly using a condom Diagnose and treat STD s Early sex education If HIV- stay negative If HIV+--prevent transmission to others Be faithful Treatment for drug and alcohol abuse 29
30 HIV Nursing Toolkit ANAC Core Curriculum HIV Care: A primer and Resource Guide for Family Physicians Handbook of HIV Drug Therapy and CPS Lab Handbook Health Assessment Skills Photo card of HIV medications Support of colleagues 30
31 Nursing Practice Attending to Meaning Caring Clinical Skills Compassion Communication Counselling 31
32 Internet Resources English/French fact sheets with Nursing resources English/French/Spanish Treatment guidelines
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