Human Immunodeficiency Virus Infection, Acquired Immunodeficiency Syndrome - Essay Example

Human Immunodeficiency Virus infection/Acquired Immunodeficiency Syndrome (HIV/AIDS) Nursing Assignment February 6, 2015 Part 1 – The Chain of Infection Infectious Agent Human Immunodeficiency Virus infection/Acquired Immunodeficiency Syndrome (HIV/AIDS) is a viral infection that is brought about by the HIV virus. The HIV virus falls under retroviruses of the subgroup lentivirus (slow replicating viruses). A retrovirus is an enveloped virus that multiplies in the body of the host by the process of reverse transcription. The virus produces copies of DNA that are incorporated into the host genome and used to produce more viral proteins that create more viruses. Consequently, it is almost impossible to identify the virus until it has infected the host. The HIV virus damages the immune system by damaging CD4+ lymphocytes and marring cell-mediated immunity, which impedes the body’s ability to combat infections thereby rendering the body susceptible to diseases (McCutchan, 2013). As a result, when other viruses, bacteria or pathogens gain access to the body, they fail to get resistance from the host body immune system hence cause disease. Thereafter, a person with the HIV virus in his or her body is said to have AIDS when the immune system gets compromised. AIDS is a multiplex of signs and illnesses brought about by the effects of HIV on the immune system. From the name, an individual must come into contact with the virus to have an infection. Reservoir HIV virus thrives in biological fluids such as human blood, semen, and vaginal secretions. Breast milk also contains the virus. Other body fluids such as amniotic fluid surrounding a fetus as well fluids surrounding organs such as the brain or the spinal cord also contain the HIV virus. Portal of Exit HIV virus exits the host through various portals such as the mucus membranes, open wounds, bloodstream, and genital tract. The breasts also serve as a portal of exit for infected mothers who breastfeed their infants. Means of Transmission HIV virus moves from the reservoir to a new host through participating in unprotected oral, vaginal or anal sexual intercourse with an infected person. According to the World Health Organization, HIV/AIDS spreads mainly through sexual contact thereby making it classified as a sexually transmitted infection (2015). Sharing needles with a person who is infected with HIV also leads to transmission of the virus. Consequently, the abuse of injectable drugs such as heroine is associated with high rates of HIV transmission. Expectant mothers infected with the HIV virus can also transmit it to their babies in the course of the gestation period, during childbirth or while breastfeeding. However, recent advancements in the prevention of mother to child transmissions have seen a decline in the rates of mother to child transmission of HIV virus. Blood transfusions, as well as organ transplants from infected persons, can also lead to the transmission of the virus. However, this mode of transmission is rare because blood and other organs undergo thorough screening for all possible infections before being used. Though the HIV virus has been found in small quantities in certain secretions such as tears, saliva, urine or secretions from the respiratory tract, there is no recorded infection from contact with these fluids. Inadvertent needlestick injuries or making contact with broken skin or mucous membranes of infected individuals may also spread the virus. In addition, sharing of toothbrushes or sharp objects such as razor blades may spread the infection if infected blood deposits on the blade or brush and is passed into the bloodstream of another person. Portal of Entry HIV virus gains entry into the host through mucous membranes, open wounds, genital tract or the bloodstream for the case of blood transfusions. The alimentary canal is also a portal of entry for the case of infected breast milk. Susceptible Host The risk of contracting the HIV virus increases with certain attributes such as behavior and occupational hazard. Having unprotected sexual intercourse with multiple partners puts one at risk of HIV infection. The abuse of injectable drugs such as heroine elevates the risk of HI since such individuals are likely to share injections. The use of other drugs such as alcohol also increases the chances of HIV infection because once intoxicated, an individual is likely to make poor judgment regarding their sexual behavior or forget to use protection. Trauma to the portals of entry also increases the susceptibility of an individual to HIV infection. For example, physical injury to the mucosal membrane of the lower region of the rectum is associated with increased rates of HIV infection among men who practice homosexuality. The presence of other sexually transmitted illnesses particularly those that lead to the destruction of the integrity of the skin increase the chances of HIV infection. It has been reported that the presence of a concurrent ulcerative sexually transmitted infection facilitates HIV transmission. STIs that lead to the formation of genital ulcers elevate the chances of HIV infection by between 50 and 300 times for each encounter of unprotected sexual intercourse. A report from WHO asserts that approximately 74% of HIV infections in men living in Tanzania are because of the presence of herpes simplex virus type 2 (2015). Part 2 – Nursing Management Treatment Options Utilized To Break the Chain of Infection and Prevent HIV/AIDS Infectivity HIV/AIDS has no cure. However, recent developments have seen the development of anti-retroviral medications, which enable individuals living with HIV to have long useful lives (Enriquez & McKinsey, 2011). Anti-retroviral medication work by reducing the populations of HIV virus in the body (viral load), and is initiated once the level of CD4 cells fall below 350. Consequently, the immune system is able to rejuvenate and keep opportunistic infections at bay. The overall effect of antiretroviral drugs is to lower the viral load in the infected person and reduces the chances of spreading it to other people. Pregnant mothers who are HIV positive can prevent the spread of the virus to their babies by receiving antiretroviral medications during pregnancy. This program is called the prevention of mother-to-child transmission of HIV and involves the administration of a triple drug regimen at all the stages that may transmit the virus to the baby particularly during pregnancy, childbirth and breastfeeding. The new-born, on the other hand, receives a six-week dose of nevirapine (an anti-retroviral drug) (Avert, 2013). The mothers can breastfeed their babies exclusively for six months followed by the introduction of appropriate solid foods. It has been reported that other sexually transmitted infections facilitate the spread of HIV/AIDS. Therefore, prompt and effective treatment of other sexually transmitted infections can reduce the susceptibility of getting infected with the virus. Nurses can ensure that all patients visiting health facilities receive the required medication and follow-up care to ensure that their STIs are cured. The same can be ensured among high-risk populations such as sex workers and their clients. Adolescents are also vulnerable to HIV infection because they lack knowledge, skills and healthcare support as they undergo sexual development. Nurses can prevent HIV infection among the adolescents by working together with social workers to provide adolescents with sex education and guidance on safe sex. Though sexual intercourse is often consensual between two consenting parties, cases of rape may arise and put the rape victim at risk of contracting the HIV virus. Therefore, nurses can prevent incidences by putting rape victims on HIV post-exposure prophylaxis (PEP) medications to prevent the replication of the virus. However, the medications are only effective if administered within 72 hours of exposure. The public needs to be educated on the availability of these services. Additionally, health workers who may be exposed to accidental contact with infected biological fluids from patients need to undergo HIV prophylaxis treatment to break the cycle of HIV infectivity. Nursing Interventions When Managing Short-Term and Long-Term Consequences of HIV/AIDS People living with HIV/AIDS are required to use anti-retroviral drugs to keep their viral load under control. However, the use of these drugs may lead to long-term and short-term complications. Different blends of ARVs are effective in different people. Therefore, the drug combinations are tailored to suit the patient. At certain times, before the right combination is attained, the patient may have adverse reactions to the drugs, which may threaten the life of the patient. Nurses need to identify the symptoms of the adverse reactions to HIV drugs in patients and mount interventions to ensure that the patient gets the right medication. Additionally, ARVs may react with other medications that are available through general practitioners or obtained over-the-counter from pharmacies. Therefore, nurses can educate patients on ARVs on the possible drug interactions and advise them to seek advice before taking any other medications. A study by Sanne et al. (2010) has reported that nurses provide HIV patient care that is comparable to physician care and that more nurses should receive training for HIV care. One of the causes of failure of ARVs is non-adherence to the medication. Failure to take the prescribed dose at the correct time may cause the drug to fail thereby rendering an HIV patient susceptible to opportunistic infections. The use of ARVs may also cause side effects such as queasiness, vomiting, diarrhea, skin outbreaks and difficulties in sleeping. Other side effects include fatigue and sexual problems. In the long-run, the use of ARVs may also to renal and liver complications, impaired metabolism, lipodystrophy and peripheral neuropathy (AIDS.gov, 2015). Nurses can keep track of these side effects by educating patients on the possibilities of these consequences and carrying out routine tests among HIV patients on ARVs who may be suspected of developing certain side effects associated with ARV use. Other factors that affect adherence to HIV medication include psychosocial issues, financial factors, substance abuse, co-morbidities such as psychiatric illness and illiteracy (Enriquez & McKinsey, 2011). How Nurses Can Support Patient Adherence to HIV/AIDS Treatment Options Becoming adherent is a life-saving behavior change among HIV-positive individuals who are experiencing failure of HIV drugs due to suboptimal adherence. Nurses can facilitate adherence to HIV/AIDS treatment options by providing HIV patients with organizational skills and personal motivation, encouraging them to join support systems, as well as ensuring that the patients receive well-tolerated ARV medication course of therapy (Enriquez & McKinsey, 2011). Instilling a sense of self-worth is useful in curbing substance abuse hence preventing non-adherence due to the use of illicit drugs. For the case of non-adherence due to forgetfulness, nurse practitioners can promote the use of reminder tools such as pill organizers, and providing patients with ARV treatments that match their schedules (Simoni, Amico, Smith, & Nelson, 2010). The provision of once a day dosage of ARV drugs also lowers chances of forgetfulness. References AIDS.gov. (2015). Side effects. Retrieved from https://www.aids.gov/hiv-aids-basics/just-diagnosed-with-hiv-aids/treatment-options/side-effects/ Avert. (2013). World Health Organization (WHO) PMTCT Guidelines. Retrieved from http://www.avert.org/world-health-organisation-who-pmtct-guidelines.htm Enriquez, M. & McKinsey, D. S. (2011). Strategies to improve HIV treatment adherence in developed countries: Clinical management at the individual level. HIV/AIDS - Research and Palliative Care, 3(2011), 45-51. McCutchan, J. A. (2013). Human immunodeficiency virus (HIV) infection. The Merck Manual Professional Edition. Retrieved from http://www.merckmanuals.com/professional/infectious_diseases/human_immunodeficiency_virus_hiv/human_immunodeficiency_virus_hiv_infection.html Sanne, I., Orrell, C., Fox, M. P., Conradie, F., Ive, P., Zeinecker, J., Cornell, M., Heiberg, C., Ingram, C., Panchia, R., Rassool, M., Gonin, R., Stevens, W., Truter, H., Dehlinger, M., van der Horst, C., McIntyre, J., & Wood, R. (2010). Nurse versus doctor management of HIV-infected patients receiving antiretroviral therapy (CIPRA-SA): A randomized non-inferiority trial. The Lancet, 376(9734), 33-40. Simoni, J. M., Amico, K. R., Smith, L., & Nelson, K. (2010). Antiretroviral adherence interventions: translating research findings to the real world clinic. Current HIV/AIDS Reports, 7(1), 44-51. World Health Organization. (2015). Global strategy for the prevention and control of sexually transmitted infections: 2006–2015. Retrieved from http://www.who.int/hiv/pub/toolkits/stis_strategy%5B1%5Den.pdf Read More