Download HIV infection - UM

Chapter 14
Communicable and Infectious
Disease Risks
Copyright © 2016 by Elsevier Inc.
Objectives
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Describe the natural history of human
immunodeficiency virus (HIV) infection and
appropriate client education at each stage.
Explain the clinical signs of selected
communicable diseases.
Evaluate the trends in incidence of HIV, STDs,
hepatitis, and tuberculosis, and identify groups
that are at greatest risk.
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Objectives (Cont.)
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Analyze behaviors that place people at risk of
contracting selected communicable diseases.
Evaluate nursing activities to prevent and control
selected communicable diseases.
Explain the various roles of nurses in providing
care for those with selected communicable
diseases.
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Human Immunodeficiency Virus
Infection
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Natural history of HIV
Transmission
Epidemiology of HIV/AIDS
HIV surveillance
HIV testing
Perinatal and pediatric HIV infection
AIDS in the community
Resources
Copyright © 2016 by Elsevier Inc.
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Natural History of HIV
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Three stages:
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Primary infection (within about 1 month of
contracting virus)
Clinical latency (when body shows no symptoms)
• Use of highly active antiretroviral therapy (HAART) has
greatly increased survival time of persons with HIV/AIDS
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Symptomatic disease (AIDS)
• CD4 T-lymphocyte count less than 200/mL with documented
HIV infection
• AIDS-related opportunistic infections
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Transmission
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Transmitted through exposure to blood, semen,
transplanted organs, vaginal secretions, and
breast milk
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Those who have had blood, sexual, or needle-sharing
exposure with an HIV-infected person are at risk for
contracting the virus.
NOT transmitted through casual contact
(touching or hugging someone) or through
mosquitoes or other insects
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Epidemiology of HIV/AIDS
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First cases of AIDS identified in 1981
Worldwide 35.3 million people live with HIV
infection
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Sub-Saharan Africa accounts for more than 70% of all
HIV infections
Epidemic also growing in central Asia, the Middle
East, and Eastern Europe
Treatment for HIV infection has been given
higher priority
Prevalence of AIDS has increased
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HIV Surveillance
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2008: confidential reporting of HIV-positive
status by name required in all 50 states and the
District of Columbia
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HIV Testing
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HIV antibody test
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Indicates the presence of the antibody to HIV
Enzyme-linked immunosorbent assay (EIA)
• Screens blood and other donor products
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Western blot
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Does not reveal whether individual has symptomatic
AIDS, nor does it isolate the virus
Confirmatory test minimizes false-positive results
Routine testing and voluntary screening
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Perinatal and Pediatric HIV Infection
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Perinatal transmission
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Recommendation
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Accounts for nearly all HIV infection in children and
can occur during pregnancy, labor and delivery, or
breastfeeding
Make HIV testing routine part of prenatal care.
Pediatric infection
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Despite having an HIV-infected mother, many children
do not acquire HIV/AIDS.
However, one or both parents may die, thus indirectly
affecting the health of the child.
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HIV Stage 3 (AIDS) in the Community
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Chronic disease
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Much care is provided in the home.
Nurses provide teaching to clients and families.
Adherence to HAART: critical
Americans with Disabilities Act of 1990
Mental health issues
HIV-infected children
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Should attend school
Impaired immunity to childhood diseases
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Quick Recall
What is the greatest challenge raised by
allowing children infected with HIV to attend
school?
A. These children are at higher risk for sports injuries.
B. Other children are put at risk of acquiring HIV
infection.
C. These children are more likely to develop
complications from childhood diseases.
D. Other children can tell they are different, which may
lead to social isolation.
Copyright © 2016 by Elsevier Inc.
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How’d You Do?
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HIV-infected children should attend school; no
case of HIV infection in the United States has
been transmitted in a school setting.
Instead, because of impaired immunity, children
with HIV infection are more likely to get
childhood diseases and suffer serious
sequelae.
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Resources
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Service organizations
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Voluntary
Faith-based
Toll-free numbers and websites
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Federal
Other
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Sexually Transmitted Diseases
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Gonorrhea
Syphilis
Chlamydia
Genital herpes
Human papillomavirus infection
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Gonorrhea
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Bacterium
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Transmission
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Genital-genital contact, oral-genital contact, and anal-genital
contact
Uncomplicated versus complicated
Highest incidence in United States
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Infects mucous membranes of the genitourinary tract, rectum,
and pharynx
African Americans, persons in the South, and women 15 to 24
years of age
Number of antibiotic-resistant cases rising
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Syphilis
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Treponemal spirochetes
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Direct contact
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Men having sex with men (MSM); recently, number of infected
women has increased
Clinical signs
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Sexual contact or mother-to-fetus
Blood transfusion (early-stage donor)
Highest rates
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Infect moist mucous/cutaneous membranes
Primary, secondary, tertiary
Congenital syphilis
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Chlamydia
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Bacterium
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Transmission
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Infects genitourinary tract and rectum of adults
Causes conjunctivitis and pneumonia in neonates
Mucous membrane contact with mucopurulent
discharge from infected site
Most common reportable infectious disease
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Genital Herpes
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Herpes simplex viruses 1 and 2
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No cure
Transmission
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Majority of cases caused by HSV-2
Increasing number of cases caused by HSV-1
Direct exposure; infects genitalia and skin
HSV-2 occurrence
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16.2% of American adolescents
Of particular concern to women and children
Linked with development of cervical cancer
Increased risk of fatal newborn infection
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Human Papillomavirus Infection
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HPV genital warts
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Transmission
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Direct contact with HPV-associated warts
FDA-licensed vaccines
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Mouth, genitals, and anus
Bivalent
Quadrivalent
Complications
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Link to cervical cancer
Other cancers: vaginal, anal, and oropharyngeal
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Hepatitis
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Hepatitis A virus
Hepatitis B virus
Hepatitis C virus
Non-ABC hepatitis
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Hepatitis A Virus (HAV)
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Most common transmission
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Vaccine available since 1995
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Fecal-oral route
Sources: water, food, feces, or sexual contact
Found worldwide
Incidence has declined 92%
Makes HAV completely preventable
High-risk groups
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Hepatitis B Virus (HBV)
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Spread through blood and body fluids
Remains alive outside body
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For at least 1 week
High-risk groups
Acute or chronic infections
Vaccine available
Occupational Safety and Health Administration
(OSHA) regulations
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Hepatitis C Virus (HCV)
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Most common chronic bloodborne infection
in United States
Transmission
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Blood or body fluids of an infected person enter an
uninfected person
High-risk groups
Spread rapidly during 1980s
Chronic liver disease from HCV
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12th leading cause of death in adults in United States
Most common reason for liver transplant
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Non-ABC Hepatitis
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Very uncommon in the United States
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Hepatitis D (HDV): chronic or acute, only occurs in
those already infected with HBV; no vaccine
Hepatitis E (HEV): acute infection transmitted by
fecal-oral route; no chronic carriers; no vaccine
Hepatitis G (GB virus C): does not cause acute or
chronic hepatitis; virus has been isolated in patients
with posttransfusion hepatitis
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Tuberculosis (TB)
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Transmission
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Common symptoms
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Cough, fever, fatigue, hemoptysis, chest pains, weight loss
Epidemiology
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Airborne droplets
WHO reports 12 million cases in 2012 and 1.3 million deaths due
to TB (WHO, 2013)
Drug-resistant TB
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Multidrug-resistant TB (MDRTB)
Extremely drug-resistant TB (XDRTB)
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TB: Diagnosis and Treatment
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Tuberculin skin test (TST)
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Previously, purified protein derivative (PPD) test
Used for initial screening
Followed by chest x-ray for persons with positive skin
reaction and pulmonary symptoms
Prompt treatment with multiple antimicrobial
drugs
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Treatment failure may be due to lack of client
adherence, which can result in drug resistance.
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Nurse’s Role in Providing Preventive
Care for Communicable Diseases
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Primary prevention
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Secondary prevention
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Testing and counseling for HIV
Posttest counseling
Partner notification and contact tracing
Tertiary prevention
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Education on how to avoid infection
Directly observed therapy
Standard precautions
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