HIV Manifestation and AIDS Indicators
HIV and AIDS can be detected through routine blood work, but the indications of it aren't apparent until a condition occurs. Doctors can use some diseases to suspect AIDS since they rarely appear in people unless their immune system is compromised.
- Invasive cervical cancer
- Cryptococcosis (extrapulmonary)
- HIV associated dementia
- Kaposi's sarcoma
- Histoplasmosis (expulmonary)
- Toxoplasmosis (internal organs)
- Recurrent-bacterial pneumonia (2 times a year)
- Herpes Simplex with mucocutaneous ulcer lasting for one month or bronchitis, pneumonitis or esopagitis
AIDs is diagnosed by a T-cell count that is less than 200 cells/mm3, or when less than 14% of blood volume is white blood cells. These diseases are only one of many opportunistic infections that can occur. If a person experiences fatigue and sickness often, than it is wise to get it checked out.
Older patients need greater care than their younger counterparts. Older people have weaker immune systems as their thymus gland shrinks; on top of the human immunodeficiency virus, this means that they have a compounded susceptibility to disease. In some cases, this can bring back suppressed childhood illnesses, such as chicken pox. This can increase even more when diabetes is involved.
Practical Nursing Tips
Here are some practical nursing tips to help any HIV patient:
- Wash your hands before and after you care for your patient.
- Wear gloves if you are treating an open wound (beneficial for both parties).
- Disinfect areas, such as surfaces, bathrooms, food stands and hands often.
- If someone is sick limit contact with the patient.
- Prepare clean sheets for the clients regularly.
- Make sure the client is clean and dry.
- Promote good hygiene by caring for the patient's hands, feet and fingernails.
- Use toothbrushes that are soft so you don't create sores in the mouth. The mouth is usually teeming with bacteria.
- Move the patient every two hours to avoid bed sores, which can lead to deadly infections.
- Avoid diets that can complicate present illnesses. A high fiber diet will exacerbate diarrhea; big meals can increase nausea and vomiting. Patients will benefit from receiving several smaller meals throughout the day, but may be on a special care plan, so check often.
- Drink water as much as possible. Use either filtered water or tap water. Both are treated for viruses and bacteria. Natural sources of water, such as rivers and wells, are not treated.
- Offer bathroom trips as much as possible.
- Be sure to keep your patients hygiene products in their possession.
- TB patients should be kept away from HIV patients if an active infection is taking place.
- Most importantly, get your patient involved in their own personal health.
(Information provided by Hartman Publishing, Successful Nursing Assistant Care, 2nd Edition, 2008.)
Don't pretend to know nothing, do not hate HIV patients and don't get careless with care. If you can't answer questions, provide the means for the patient to find it, or find out the information yourself and teach your patient.
If you are stressed or burned out, make sure the patient is cared for and inform your supervisor about your immediate concerns. Your employer may have high expectations of you, but they are also legally responsible for preventing incidents. Burnout and abuse are connected.
- One of your most stressful situations will be maintaining a clean environment. It is important that you do not get carried away. The best advice is to keep things simple. Wash your hands and apply sanitizer as necessary.
- Sterilize your patient's hands with a sanitizing wipe before and after they eat. Otherwise, encourage independent hand washing and sanitation.
- Keep your area clean with spray bottles and disinfectant, as approved by your employer.
- Make sure your patient's clothes are clean and neat.
So long as there are reasonable precautions to prevent disease transmission you are not considered liable for any damage. Even the best circumstances can't totally prevent opportunistic infections. By wearing gloves you will prevent most infectious opportunities. Luckily, helping an HIV patient is not much different than working with any other patient. The only exception is that they are just more susceptible to disease. Your hardest task will be trying to help them cope with the disease.
HIV Physical and Psychological Side Effects
HIV patients suffer physically, as well as emotionally. They become depressed, lose income, housing, emotional support and work. They can also suffer from progressive mental side effects, which may make HIV patients confused and irritable.
HIV patients may experience one or more of the following things:
- Isolation Inability to face facts
- Stigma (especially if the person gets HIV from as a stereotyped group, i.e. homosexuals or drug users)
Be alert. HIV patients, if left on their own, may turn to destructive behaviors, such as drugs and alcohol. This may provide temporary relief but it exacerbates depression symptoms. Stress can diminish the HIV patient's immune system.
Other Things to Keep in Mind
In 90% of cases HIV patients get confirmation of their illness in their peak years. This can create a downhill effect. Support is the best way to keep up hope. Unfortunately, most HIV patients, even with medication, die before their time.
Uplifting Things to Note about HIV Family Life
Earlier we talked about how women have low percentage odds of transferring HIV to their children when they use anti-retroviral medication and c-section delivery, however, we did not explain if men can still safely sire children. Currently, HIV infected men can have children by using sperm washing and artificial insemination.
Sperm washing takes the males sperm and processes it to eliminate the majority of HIV presence in the specimen. This is in turn deposited in the female through an application device. Done correctly, the odds of HIV transference should be 0.09%, marginally higher than a 0% chance, according to the International AIDs society. However, this can differ depending on how long the virus has stayed in the host's body.
In 1990, the CDC issued warnings against using sperm washing in light of a patient receiving the virus. Documented cases are scarce. This stance has not changed, but it is not illegal to do this procedure. It is important to have sperm washing done by medically trained personnel.
In vitro fertilization combines sperm and eggs in a Petri dish and is later implanted in the woman's womb. This is an outside procedure which requires no sex. Sperm washing is used to decrease the odds of HIV transference.
Controversy about Birth Control and Spermicide
In recent years, there were allegations that HIV risk could increase through the use of birth control pills and spermicide.
The allegation: spermicide and birth control pills altered vaginal environments enough to raise the chances of HIV infection.
In order to get to the bottom of the allegation, the WHO did trial scenarios in Africa (particularly among African sex workers who use spermicide gels, and birth control users from various African countries to avoid bias).
Worldwide, the consensus is that the frequent use of spermicide can cause inflammation in the vaginal area, improving chances for HIV infection. In limited use, it can still be used as a backup method to prevent pregnancies that lead to children with HIV. Spermicide condoms were found to be better than nothing, but not optimal in comparison to a regular male condom, in terms of shelf life, cost and nonoxynol-9 exposure. Spermicide cannot kill HIV in a normal human environment.
Currently, spermicide should never be used alone, and if used, only with a condom. It is not recommended by the FDA to prevent HIV.
Birth Control Pills
Birth control pills are still risky, but are ideally preferred to spermicide by the WHO. The consensus is that a condom should be paired up with birth control, if the goal is to prevent transmission to a child. The main problem today is that birth control pills can be less effective if the patient is taking HIV medication (WHO, Hormonal Contraception and HIV, 2012).