Exam 3 Material
Rasmussen - NUR2571
KNOW DIABETES MANAGEMENT!!!
DKA AND HHNS
Inflammation and Immunity
HIV/AIDS (Review chart 19-3 in Iggy)
Transmitted via blood or body fluids.
HIV inserts in genetic material into host cells.
o HIV enzyme reverse transcriptase coverts HIV RNA into DNA, making the viral genetic
material he same as human DNA.
Nucleoside reverse transcriptase inhibitors work on this level to prevent viral
replication.
o HIV enzyme intergrase gets the viral DNA into the CD4 T-Cell and inserts it into the host
DNA.
Integrase inhibitors work here to prevent viral DNA from integrating into host
DNA.
Signs and symptoms
o Flu-like symptoms
o Low WBC and CD4 counts.
CD4 <200
Non – HIV person will have 800-1000
o Poor wound healing
o Lesions
o Weight loss
o Night sweats
o Seizures.
HIV only becomes AIDS when CD4 cell count drops below 200.
o Medications target viral replication to increase CD4 count, however the person still has
HIV!
o HIV cocktail, each medication acts on a different portion of the viral lifecycle.
o Review chart 19-6 for antiretroviral therapies. (cHART/HHART)
Nucleoside Reverse Transcriptase Inhibitors (Remember Reverse Transcriptase
is an HIV enzyme that converts viral RNA to viral DNA)
Act as fake DNA bases for viral DNA to bind to, this inhibits viral DNA
synthesis.
Avoid fatty and fried foods.
Non-Nucleoside Reverse Transcriptase Inhibitors
Work by binding to Reverse Transcriptase and suppressing viral
replication.
Anemia and liver toxicity are the most common side effects.
, Protease inhibitors
Block the HIV protease enzyme, preventing viral replication and release
of viral particles.
DO NOT CRUSH
Integrase inhibitors
Inhibit the HIV enzyme integrase which is responsible for inserting viral
DNA into human DNA.
GI side effects such as N/V/D are common.
Fusion inhibitors
Block the fusion of HIV with a host cell by fusing to the CD4 host cells
surfaces.
SubQ injection
Entry inhibitors
Prevent cellular infection with HIV by blocking receptors on the CD4 T
cell.
DO NOT CRUSH
o Knowing specific drugs is not necessary but know the concept for why the patient is on a
cocktail.
Decreases chance of drug resistance.
CDC recommends the use of HIV assays to detect HIV antibodies and antigens. HIV assays
provide more accurate and early diagnosis. Earlier generations tests include the ELISA and
Western Blot.
Education
o Pneumonia is the most common infection; push education about the benefits of
vaccination in infected persons.
o Adhere to medication regimen to avoid resistance!
Decreased CD4 count and increased VL (viral load) indicate likely non-
compliance.
Once HIV has progressed to AIDS (CD4 count is now > 200) complications occur such as
opportunistic infection, cancer, TB, etc.
o Review chart 19-1 in Iggy
Multiple bacterial infections
Recurrent fungal infections
Encephalopathy
Lymphoma
Pneumonia
Septicemia
Wasting syndrome
o Low CD4, high VL.
o Know S/S of TB and pneumonia.
Contact precautions for AIDS patient?
o Standard precautions.
, Nurse is stuck with a needle from and HIV patient, what is the procedure?
o Within 3 days of exposure start 28-day regimen of Tenofovir, Emtricitabine, and
Raltegravir.
o Review 19-4 in Iggy for post-exposure prophylaxis. Test question!
o Exposed worker is given first dose of postexposure prophylaxis (PEP) while
evaluation of exposure is underway.
o Initiation of PEP should begin within 24-36 hours.
o Tenofovir 300 mg PO daily, Emtricitabine 200 mg PO daily, and raltegravir 400
mg PO daily.
o HIV testing of exposed worker should be complete within 3 days of initiating
PEP.
Give appetite stimulants and nutritional support for weight loss.
Which part of the HIV infection process is disrupted by the antiretroviral drug class of entry
inhibitors?
A. Activating the viral enzyme “integrase” within the infected host's cells
B. Binding the virus to the CD4+ receptor and either of the two co-receptors
C. Clipping the newly generated viral proteins into smaller functional pieces
D. Fusing the newly created viral particle with the infected cell's membrane
Hypersensitivity and Autoimmunity
Type 1 Hypersensitivities (Anaphylaxis!!)
o Most common; results from increase of IgE.
o Angioedema, anaphylaxis, allergic asthma, bees, peanuts, iodine, shellfish, drugs.
S/S r/t anaphylaxis
o Drop in bp
Initiate fluids
o Rapid, weak pulse
o Closing airways
o Urticaria
o Angioedema
o Seizures
o Chest pain
o Iggy page 363
Assess respiratory status and maintain patent airway STAT
Call rapid response
Have intubation equipment ready
Apply oxygen with high-flow nonrebreather mask at 90-100%
Discontinue drug
Start IV and initiate fluid therapy NaCl
Be ready to administer epinepherine
Elevate HOB if BP is WNL
If pt is hypotensive raise feet and legs (Tredelenburg)
Rasmussen - NUR2571
KNOW DIABETES MANAGEMENT!!!
DKA AND HHNS
Inflammation and Immunity
HIV/AIDS (Review chart 19-3 in Iggy)
Transmitted via blood or body fluids.
HIV inserts in genetic material into host cells.
o HIV enzyme reverse transcriptase coverts HIV RNA into DNA, making the viral genetic
material he same as human DNA.
Nucleoside reverse transcriptase inhibitors work on this level to prevent viral
replication.
o HIV enzyme intergrase gets the viral DNA into the CD4 T-Cell and inserts it into the host
DNA.
Integrase inhibitors work here to prevent viral DNA from integrating into host
DNA.
Signs and symptoms
o Flu-like symptoms
o Low WBC and CD4 counts.
CD4 <200
Non – HIV person will have 800-1000
o Poor wound healing
o Lesions
o Weight loss
o Night sweats
o Seizures.
HIV only becomes AIDS when CD4 cell count drops below 200.
o Medications target viral replication to increase CD4 count, however the person still has
HIV!
o HIV cocktail, each medication acts on a different portion of the viral lifecycle.
o Review chart 19-6 for antiretroviral therapies. (cHART/HHART)
Nucleoside Reverse Transcriptase Inhibitors (Remember Reverse Transcriptase
is an HIV enzyme that converts viral RNA to viral DNA)
Act as fake DNA bases for viral DNA to bind to, this inhibits viral DNA
synthesis.
Avoid fatty and fried foods.
Non-Nucleoside Reverse Transcriptase Inhibitors
Work by binding to Reverse Transcriptase and suppressing viral
replication.
Anemia and liver toxicity are the most common side effects.
, Protease inhibitors
Block the HIV protease enzyme, preventing viral replication and release
of viral particles.
DO NOT CRUSH
Integrase inhibitors
Inhibit the HIV enzyme integrase which is responsible for inserting viral
DNA into human DNA.
GI side effects such as N/V/D are common.
Fusion inhibitors
Block the fusion of HIV with a host cell by fusing to the CD4 host cells
surfaces.
SubQ injection
Entry inhibitors
Prevent cellular infection with HIV by blocking receptors on the CD4 T
cell.
DO NOT CRUSH
o Knowing specific drugs is not necessary but know the concept for why the patient is on a
cocktail.
Decreases chance of drug resistance.
CDC recommends the use of HIV assays to detect HIV antibodies and antigens. HIV assays
provide more accurate and early diagnosis. Earlier generations tests include the ELISA and
Western Blot.
Education
o Pneumonia is the most common infection; push education about the benefits of
vaccination in infected persons.
o Adhere to medication regimen to avoid resistance!
Decreased CD4 count and increased VL (viral load) indicate likely non-
compliance.
Once HIV has progressed to AIDS (CD4 count is now > 200) complications occur such as
opportunistic infection, cancer, TB, etc.
o Review chart 19-1 in Iggy
Multiple bacterial infections
Recurrent fungal infections
Encephalopathy
Lymphoma
Pneumonia
Septicemia
Wasting syndrome
o Low CD4, high VL.
o Know S/S of TB and pneumonia.
Contact precautions for AIDS patient?
o Standard precautions.
, Nurse is stuck with a needle from and HIV patient, what is the procedure?
o Within 3 days of exposure start 28-day regimen of Tenofovir, Emtricitabine, and
Raltegravir.
o Review 19-4 in Iggy for post-exposure prophylaxis. Test question!
o Exposed worker is given first dose of postexposure prophylaxis (PEP) while
evaluation of exposure is underway.
o Initiation of PEP should begin within 24-36 hours.
o Tenofovir 300 mg PO daily, Emtricitabine 200 mg PO daily, and raltegravir 400
mg PO daily.
o HIV testing of exposed worker should be complete within 3 days of initiating
PEP.
Give appetite stimulants and nutritional support for weight loss.
Which part of the HIV infection process is disrupted by the antiretroviral drug class of entry
inhibitors?
A. Activating the viral enzyme “integrase” within the infected host's cells
B. Binding the virus to the CD4+ receptor and either of the two co-receptors
C. Clipping the newly generated viral proteins into smaller functional pieces
D. Fusing the newly created viral particle with the infected cell's membrane
Hypersensitivity and Autoimmunity
Type 1 Hypersensitivities (Anaphylaxis!!)
o Most common; results from increase of IgE.
o Angioedema, anaphylaxis, allergic asthma, bees, peanuts, iodine, shellfish, drugs.
S/S r/t anaphylaxis
o Drop in bp
Initiate fluids
o Rapid, weak pulse
o Closing airways
o Urticaria
o Angioedema
o Seizures
o Chest pain
o Iggy page 363
Assess respiratory status and maintain patent airway STAT
Call rapid response
Have intubation equipment ready
Apply oxygen with high-flow nonrebreather mask at 90-100%
Discontinue drug
Start IV and initiate fluid therapy NaCl
Be ready to administer epinepherine
Elevate HOB if BP is WNL
If pt is hypotensive raise feet and legs (Tredelenburg)
