Question

HIV/Immunodeficiency A 31-year-old HIV-infected woman presents with severe diarrhea and dizziness. She has long- standing HIV disease and her most recent CD4 count was 24 cells/mm3. For approximately 2 years, she has not taken any medications related to her HIV disease. The diarrhea began about 10 days ago and now she is having 10 to 15 watery stools per day, abdominal cramping, and nausea. Physical examination shows a thin female with a temperature of 38.1℃ blood pressure of 86/60 mmHg, and minimal diffuse abdominal tenderness with deep palpation. A modified acid-fast stain on a stool sample is presumptively identified as Cryptosporidium species Describe the causative agent of HIV infection and the mode of transmission for this infectious agent. 1. hat is the major consequence of un-treated HIV infection in terms of the immune system? Which cell population is primarily lost (def our patient); and, what is the normal role for this immune cell population? What is the impact of the loss of this cell population in terms of opportunistic infections? Define opportunistic infections in your response How does the information that our patient has not taken her medicine for about 2 years relate to the loss of this cell population? What is Cryptosporidium and how does this relate to the S/S that our patient is now experiencing? Explain the relationship between this infection and her temperature; and her blood pressure? What are treatment concerns and approaches to this patient both in terms of her underlying HIV infection and her Cryptosporidium infection? What are other supports this patient likely needs to keep her HIV in check after this issue is resolved? 2. W end your answer with lab values from 3. 4. 5. 6. 7. 8. 9. Discuss the mechanism of action of Zidovudine a NRTI 10. Discuss the nursing assessment and education related to Zidovudine 11. How do NNRTIs differ from NRTIs? 12. Identify the adverse effects associated with Protease Inhibitors and the patient education that the nurse should provide to her patient. 13. Discuss the new class of antiretroviral drugs: the chemokine receptor 5 antagonists. Include the pharmacokinetics, actions and adverse effects

Answer 1

Causative agent of HIV infection is Human Immunodeficiancy Virus and the mode of transmission were mainly Unprotected sexual activity, Through blood transfusion from the infected person, Mother to baby and using the same needle for the person with infection and the one not having infection can transfer to one person to another. Also in touch with patients blood, body fluids etc can transfer the infection to the person if the other peson had any cut in skin or wounds.

If the HIV infection is untreated CD4 count will be reuced, that is type of T lymphocyte. In this case the CD4 count is 24cells/mm³ and the normal value ranges between 500 to 1600 cells/mm³ and if it is below 200 the person is diagnosed as AIDS. They are the helper cells to send signals to killer cells about any infections

The cell groups are the responsible to inform the immune system that infection was arrived in the body, if these signals were not communicated then there is chance of getting infection from the causative agents which dont generaly had any issues. Oppertunitic infection can be defined as any infection which happends to the body with the orgnisms which were found in the body as a normal flora and usual conditions it is not infectious in nature.

If the patient donot taken medicine, the virus will atack on these cells and slowly the number of the cell will be reduced, that is evident in this case as a CD4 count of 24.

Cryptosporidium is a parasitic alveolates that can cause a respiratory and gastrointestinal illness. The person can have watery diarorea, and mild fever.

Mild fever and the blood pressure is towards the lower side of the grapgh as of 86/60.

For the person with HIV the treatment option were stregthen the immune system with Zidovidin and prevent the drehydation.

regular checking of the CD4 count is a must and always keep it above 200

Zidovidin acts on the HIV 1 reverse transcriptase via DNA chain termination after the incorporation of the nucleotide analogue.

Optimum time for the starting of the treatement will be based on the CD4 count of the patient. Regular blood tests to monitor for aneamea,

Patient teaching
- This medication needs to be taken regularly on a long-term basis to remain effective and the mmedicine were not act as cure for the disease but symptom control, patient has to report any signs of infection includes sore throat, swollen lymph glands. Educate regarding the safe sex practices because it will not cure the problem,

NRTIs work by competitively inhibiting reverse-transcriptase while NNRTIs work by non-competitive inhibition

Adverse drug reactions to protease inhibitors include gastrointestinal problems, rash and metabolic disturbances. The metabolic derangements associated with protease inhibitor therapy are the most problematic adverse events associated with therapy, and vary in incidence from drug to drug. These derangements include hyperlipidemia, abnormal fat distribution (lipodystrophy) and impaired glucose tolerance, which is believed to be due to peripheral insulin resistance. Clinicians caring for patients being treated with protease inhibitors must be vigilant for adverse events, notably those involving altered lipid and glucose metabolism.Educate about the adverse reaction to the patient and how to handle this can be educated