HIV care. Infectious Diseases and Nursing
With this type of infection, the immunodeficiency virus enters the human body. The disease leads to the destruction of lymphocytes, the development of AIDS and related diseases. The main symptoms of the manifestation of the disease are: fungal infections, diarrhea, cough, swollen lymph nodes, increased sweating, weight loss, herpes, spots on the skin.
If a patient is diagnosed with HIV infection, he should be cared for at the appropriate level. What are the general rules for caring for HIV-infected patients? A person with AIDS needs nursing care. The disease is incurable, so patients need special moral support and warmth.
The disease is manifested by a set of symptoms that are constantly changing, therefore, caring for a patient with HIV (AIDS) must correspond to the well-being and needs of the patient. It is necessary to carry out daily wet cleaning with detergents in the room where the HIV-infected person spends a lot of time. If any of the items are contaminated with blood, saliva or other biological secretions, then it is necessary to disinfect everything with gloves by soaking in solutions. There are 4 main principles of caring for HIV-infected patients, which must be followed with extreme rigor.
- Respect... Usually such people experience an angry and unfair attitude towards themselves. Respect and compassion must be shown in caring for an HIV-infected person to enable the person to regain their self-esteem.
- Communication... People with AIDS are often isolated from family and friends and feel lonely and withdrawn. Therefore, one must learn to be a good listener.
- Independence... Often, sick people lose everything that surrounded them before. Firing from work, loss of friends and sometimes family leads the patient to fear of the world around him. When caring for people living with HIV, it is important to encourage them to remain independent and in control of their lives.
- Infection control... During nursing care for a patient with HIV infection, many are afraid of becoming infected. In order to prevent this from happening, there is a need to comply with infection control. To do this, you need to help the patient, protecting yourself from contact with his biological fluids. It is forbidden to care for HIV-infected patients with colds or any other infectious diseases.
Basic control rules:
- observance of personal hygiene;
- use of double latex gloves during nursing care of HIV-infected patients;
- in case of violation of the skin, it is necessary to squeeze out the blood from the wound and lubricate it with iodine, if blood gets on your hands, immediately treat the place with alcohol (at least thirty seconds) and rinse twice with running water;
- in case of skin infection while caring for an HIV-infected person, do not touch him and his personal belongings;
- if the caregiver is sick with chickenpox or has been in contact with the sick person, in no case should you take care of the HIV patient;
- you should not give raw milk to a patient with the immunodeficiency virus, you need to cook high-quality food and not use public catering, boil meat, and wash fruits and vegetables thoroughly;
- the patient is not allowed to use objects that can cause bleeding.
The peculiarity of caring for HIV-infected people is that the patient's symptoms are constantly changing. With prolonged bed rest, it is recommended to frequently change the position of the patient, to prevent bedsores, to maintain minimal physical activity.
In case of infections of the oral cavity, it is necessary to provide multiple care: use a soft toothbrush, do not touch ulcers and plaques (this can lead to bleeding), give the patient more water.
During diarrhea, you will need to thoroughly care for the skin of the perineum. It is recommended to constantly replenish the body's fluid supply and help the patient to cope with discomfort.
In case of vomiting or nausea, it is necessary to wipe your face with water, eliminate odors in the room, feed cool food in minimal portions.
During respiratory disorders, it is necessary to reduce motor activity, establish a sitting position for the patient, check the freedom of the chest.
In case of edema, it is recommended to do cold compresses, lift the swollen parts of the body with pillows.
If chronic fatigue is observed, help should be provided in everything: to give time to rest during a walk and water procedures, to help awaken the desire for self-care.
During a fever, the patient will need to drink plenty of fluids, wiping with water at room temperature. It is necessary to avoid hypothermia, more often to change the bed and clothes of the infected. Ice can be used with the permission of a doctor.
When losing weight, it is necessary to provide the patient with a high-calorie diet. Also, do not forget about moral support during nursing care of AIDS patients.
riches of bacterial infections and oncological diseases leading to the death of the patient.
The disease was first described in 1981, when in the USA there were registered cases of young homosexual men in the form of pneumocystis pneumonia and Kaposi's sarcoma, which ended in death. The first information about the causative agent of the disease was obtained in 1983 in France by L. Montenier, and in 1984 in the USA
R ... Gallo isolated the virus in pure culture.
E t and o l o g and i. The human immunodeficiency virus (HIV) belongs to the retrovirus family, the lenti-
viruses (slow viruses), i.e. RNK - containing viruses that cause slow infections. Retroviruses owe their name to the enzyme revertase (reverse transcriptase), which makes it possible to synthesize DNA, which is necessary for the reproduction of the virus, on the basis of its own RNK.
Mature virions are spherical. The heart on the virion is oval, it contains the genome of the virus - double-stranded RNK and enzymes: reverse transcriptase, integrase and protease. The envelope consists of a double layer of lipids with the inclusion of m glycoproteins g p l 2 0 and gp41, the detection of which is of diagnostic value. There are three types of viruses: HIV-1, HIV-2 and HIV-3, which differ in the structure of surface glycoproteins. They are characterized by high antigenic variability, which makes it difficult to develop a vaccine.
HI CH is not resistant in the external environment: when heated to 70 - 80 ° C it is inactivated after 10 minutes, when boiled - instantly. Under the influence of disinfectants in normal concentrations, it dies after 10 minutes. Resistant to ultraviolet radiation and ionizing radiation, drying and freezing.
E p and d e m i ol o g and I. The only source of illness is an HIV-infected person. HIH is found in various biological fluids of an infected person: blood, semen, vaginal and cervical secretions, breast milk, saliva, cerebrospinal fluid, as well as biopsies of various tissues. The greatest epidemiological danger is posed by sperm, blood, vaginal secretions.
The main route of transmission is sexual, which is realized during heterosexual contact in the form of vaginal, oral and anal ceftca, as well as in homosexual contact in the form of anal and oral sex. The risk of infection increases with sexual perversions (perversions), often accompanied by trauma to the mucous membranes, intercourse during the menstrual period, and promiscuous sexual intercourse with frequent change of partners.
The second route of transmission - vertical - can be realized during pregnancy (transplacental), during childbirth and breastfeeding - in the presence of ulcers, cracks in the nipples and in the oral cavity of the child. The probability of infection of a child during pregnancy and childbirth is 2 5 - 5 0%.
The parenteral route of HIV transmission can be medical: transfusion of infected donor blood, use of insufficiently processed medical instruments and transplantation of infected organs and tissues, as well as injecting drugs with syringes containing the remains of infected blood ...
It should be borne in mind that during the production of immunoglobulins, the virus is inactivated.
Everyday communication with HIV-infected or infected people does not lead to infection.
Groups at increased risk of HIV infection are men - homosexuals, intravenous drug users, prostitutes, people with a large number of sexual partners, frequent recipients of blood, children born to HIV-infected mothers.
Among healthcare workers, there is a high risk of infection for surgeons, obstetricians-gynecologists, dentists, procedure nurses, etc.
Currently, there is a pandemic of HIV infection in the world: the number of HIV-infected people is more than 40 million people, of which about 10 million have died. More than 7000 HIV-infected people have been registered on the territory of the Republic of Belarus.
development of the pathological process. Determined that
the remaining 50% of those infected live for the first 5 years without any clinical manifestations of the disease, although the virus is found in their blood.
viral receptors (g p l 2 0 and gp41), which have an affinity for host cells, the surface of which is equipped with a protein receptor (CD4). This includes T4 - lymphocytes, i.e. T-helpers, monocytes - macrophages, neuroglial cells of the CNS, etc. Specifically adsorbed on the surface of the cell containing the CD4 receptor, HIH merges with its membrane and, freed from the membrane, penetrates inside, where the viral RNA is released. With the help of viral reverse transcriptase (reverse transcriptase), the viral RNC is “rewritten” (transformed) into viral DNA. After that, the viral DN K with the help of integrase is “embedded” into the host cell's DNA, into its genetic apparatus (genome), producing new viral particles - copies and RNA - of the containing virus (proviruses), which remain in the cell for life. ... When the viral virus is activated in an infected cell with the help of the protease enzyme, there is an intensive accumulation of new viral particles, which leads to the destruction of cells and damage to new ones with subsequent dysfunction of the immune system.
The pathogenetic nature of the disease is the time
In general lymphopenia, there is a sharp decrease in the number of T4-helpers, the ratio of T4-helpers (CD4) and T8 - suppressors (inhibitors, C D 8) changes. At a normal T 4: T 8 = 1, 8 - 2, 2 due to a sharp decrease in the number of T4 cells in combination with a normal or increased number of T8 cells, their ratio reaches 0.3 - 0.5 ...
Once in the T4 helper cells, the virus can remain in a latent state indefinitely, usually until
until, in connection with any infection, immune stimulation of T - lymphocytes begins. This leads to the activation of HIV, its rapid multiplication and damage to the T4-helpers up to their complete death. As a result of the sharp decrease in the number of T4-helpers, irreversible disturbances occur in the system of cellular regulation of the immune response, and a person becomes defenseless against accidental, including "opportunistic" infections, which in normal conditions are harmless to humans, being conditionally pathogenic flora. Under conditions of immunodeficiency, a person is unable not only to respond to antigenic stimuli with infectious agents, but also to destroy tumor cells.
Along with damage to the immune system, HIV has a pathological effect on the central nervous system as a result of damage to glial and nerve cells, which leads to impaired brain activity with the development of dementia (AIDS dementia).
K l and n and k a. The incubation period lasts from 2 - 3 weeks to 3 months and rarely lasts up to a year. The period from the moment of infection to the death of the patient is different, but without treatment it averages 1 0 - 12 years.
Here is the classification of HIV infection:
1) asymptomatic stage;
2) AIDS - associated complex;
3) AIDS (terminal stage).
Asymptomatic stage It is subdivided into acute infection, asymptomatic infection (seroconversion), and persistent generalized lymphadenopathy.
Acute infection. After the incubation period, about 50% of those infected develop an acute illness (acute retroviral syndrome) resembling infectious mononucleosis or influenza, which is accompanied by the appearance of antibodies to HIV in the blood. The manifestations of acute retroviral syndrome are fever, sore throat, headache, myalgia and arthralgia, nausea, vomiting, diarrhea, swollen lymph nodes, liver and spleen. Angina can be catarrhal, follicular, lacunar. A frequent clinical manifestation at this stage is spotty
papular exanthema. From the peripheral blood, moderate leukopenia, lymphopenia, thrombocytopenia are noted. These symptoms go away, but the virus remains in the body.
Asymptomatic infection. It is characterized by the absence of clinical manifestations. During this period, a person feels completely healthy, leads a normal life, including sex, but is a virus carrier and can infect the skin. This stage lasts from 3-6 months to 3-5 years, which is one of the reasons for the rapid spread of HIV infection in different countries. The number of T-helpers (CD4) during this period is more than 800 cells in 1 μl of blood.
Persistent generalized lymphadenopathy (PGL). Currently, PGL is classified as an asymptomatic stage, since most often it is detected only during a medical examination. The definition of this syndrome is as follows: an increase in lymph nodes of at least 1 cm in diameter in two or more non-contiguous groups (excluding inguinal) in the absence of another disease that could cause lymphadenopathy. Most often, the posterior cervical, submandibular and axillary lymph nodes are enlarged. On palpation, they tight-elastic chesky consistency, painless, not welded to the underlying tissues, with a diameter of 1 to 3 cm. For lymphadenopathy, subfebrile condition, enlargement of the liver and spleen are often found. number T-helpers (CD4) - from 400 to 800 cells in 1 μl of blood. The duration of this period varies from 2 to 3-5 years old.
AIDS-associated complex (SAK, pre-SP ID).
This is the early symptomatic stage of HIV infection, in which opportunistic infections develop. In the group of opportunistic infections, it is customary to include all those infections caused by opportunistic flora, which manifest themselves in patients with immune deficiency of one nature or another. Infections that lead to the terminal stage of HIV infection,
AIDS indicator (or AIDS - associated). Of the large number of opportunistic infections in the
The most common AIDS indicator includes diseases caused by protozoa, fungi, bacteria and viruses.
First group: „
1) candidiasis of the esophagus, trachea, bronchi;
2) extrapulmonary cryptococcosis;
3) cryptosporidosis with diarrhea lasting more than a month;
4) cytomegalovirus infection with damage not only to the liver, spleen, lymph nodes, but also to other organs;
5) infections caused by the herpes simplex virus, manifested by ulcers on the skin and mucous membranes;
6) Kaposi's sarcoma in persons under 60 years of age;
7) primary lymphoma in people younger than 60 years old;
8) lymphocytic interstitial pneumonia and (or) pulmonary lymphoid hyperplasia in children under 12 years of age;
9) disseminated infection caused by atypical mycobacteria with extrapulmonary localization;
10) pneumocystis pneumonia;
11) progressive multifocal leukoencephalo-
12) toxoplasmosis with brain damage, lay down
kih, eyes in a patient older than 1 month. In the second group:
1) bacterial infections, combined or recurrent, in children under 13 years of age (more than two cases in 2 years of observation): septicemia, pneumonia, meningitis, damage to bones or joints, abscesses caused by hemophilus influenzae, streptococci;
2) coccidioidomycosis, disseminated with extrapulmonary localization;
3) HIV encephalopathy;
4) histoplasmosis, disseminated with extrapulmonary localization;
5) isosporosis with diarrhea lasting more than a month;
6) Kapos sarcoma and in people of any age;
7) B-cell lymphomas (with the exception of Hodgkin's disease) or lymphomas of unknown immunophenotype;
8) extrapulmonary tuberculosis;
9) recurrent salmonella septicemia;
10) HIV - dystrophy.
The stage of pre-AIDS, apart from enlarged lymph nodes, is characterized by the presence of constitutional criteria and secondary diseases.
C o n s t t u c i n al c o n c e s:
Weight loss of 10% or more; Unexplained subfebrile and febrile famously
Radka for three months or more;
unmotivated diarrhea lasting more than 1 month;
chronic fatigue syndrome;
night sweats.
IN t o r i n s:
About fungal, viral, bacterial lesions
to about and and mucous membranes;
recurrent or disseminated herpes zoster, localized Kaposi's sarcoma;
hairy leukoplakia;
repeated sinusitis and pharyngitis;
pulmonary tuberculosis;
repeated or persistent viral, bacterial, fungal, protozoal lesions of internal organs.
The number of T - helpers (CD4) in the pre - AIDS stage is from 200 to 400 cells in 1 μl of blood. This stage can last for several years, sometimes there are periods of improvement.
AIDS. The terminal stage of HIV infection is characterized by the development of generalized forms of opportunistic infections and tumors. The polymorphism of clinical manifestations is explained not only by a variety of probable pathogens, but also by possible damage to all organs and systems of a person. For clinical practice, four types of the disease are conventionally distinguished - pulmonary, gastrointestinal, cerebral and disseminated.
The pulmonary type is characterized by the development of infiltrative pneumonia, predominantly of pneumocystis etiology.
Gastrointestinal the type proceeds with severe chronic diarrhea caused by protozoa, mainly cryptosporidium.
Cerebral type most often it manifests itself as dementia (dementia) as a result of atrophy of the cerebral cortex and damage to the cerebral vessels.
Disseminated type characterized by persistent fever of unknown origin, which is accompanied by increasing weakness, weight loss, and damage to various organs.
Among tumor AIDS - indicator diseases, Kaposi's sarcoma is recorded in persons under 60 years of age. Kaposi's sarcoma (KS) is a tumor of the blood vessels (angioreticuloendotheliosis), which in the “pre-dospid” era was most often recorded in Africa in people over 60 years of age in the form of symmetrical lesions of the legs and feet. With AIDS, KS is diagnosed in young people with localization on the head, trunk, extremities and mucous membranes of the oral cavity, and with dissemination of the tumor - in the internal organs (lungs, esophagus, stomach, intestines). On the skin and mucous membranes, multiple spots and nodules of a bluish-purple or brownish-brown color are found, prone to ulceration.
The number of T-helpers (CD4) in the AIDS stage is less than 200 cells in 1 μl of blood. This stage is called terminal because it is irreversible and ends lethal.
All these stages of the clinical course of HIV infection may be inconsistent and not in all infected people.
L a b about r and to rn and I d and a gn about s t and k and. The simplest and most accessible method of serological diagnostics is the detection of specific antibodies to HIH using the enzyme-linked immunosorbent assay I FA. Antibodies to the virus appear no earlier than a month after infection, and at an early stage they are detected in 9 0 - 9 5% of the infected, and in the terminal stage - in 6 0 - 70% of patients. When setting the IFA, if a positive result is obtained, the study is carried out twice more in laboratories of a higher level using test systems from different manufacturers.
To check the specificity of the results of the detection of total antibodies, the reaction is most often used
"Immune blotting" ("Western blot"), allowing to detect antibodies to individual HIV proteins. With the help of this method, the type of virus is determined (HIV-1, HIV-2, HIV-3). Only after a positive result in immune blotting, it is possible to conclude that a person is infected with HIV.
Apart from IFA, RNIF and radioimmunoprecipitation are used. These methods are highly sensitive and specific, although they are rather laborious and expensive.
IN recently for diagnosis HIV infection
In addition to the diagnostic value, “viral load” determines the severity of HIV infection and is taken into account when choosing an antiretroviral therapy regimen.
For indirect laboratory confirmation of the diagnosis, general immunological reactions can be used to detect disorders in the immune system caused by HIV. This is the determination of the total number of lymphocytes and T-helpers (CD4); both indicators are reduced in HIV infection. The calculation of the ratio of T-helpers (CD4) and T-suppressors (CD8) is also carried out, which in healthy people is 1.8-2.2, and in patients with HIV infection - less than 1.0. A decrease in the number of T-helpers (CD4) to 500 cells in 1 μl indicates immunosuppression.
S sstrinsky pro cess, about the peculiarities of the exit. An important component in the treatment of HIV-infected patients is the creation of a protective psychological regime, since many patients are aware of the outcome of the disease.
The nursing process begins with an examination of the patient
disease, possible staging of the pathological process. Epidemiological data should take into account sexual intercourse, transfusion of blood and blood products, parenteral medical manipulations, and intravenous drug use. In the anamnesis of life, the transferred infectious diseases and the peculiarities of their course are clarified.
With an objective examination, attention is paid to the general appearance of the patient, body weight, the presence of exanthema on the skin, and enlargement of the lymph nodes.
If the serological blood test is positive, the health worker (doctor) informs the patient about this, who has numerous problems, mainly of a psychological nature.
Patient's problems: stressful condition; fear of losing a loved one about a person, family, friends; negative attitude of others; alertness of the nursing staff; difficulty in obtaining medical care; changes in appearance (loss of body weight, skin rash, severe sweating, visible enlargement of lymph nodes); hyperthermia; diarrhea; cough and shortness of breath with pneumonia; a change in your assessment of your health; lack of confidence in the implementation of plans for the future; fear of death.
Examples of nursing diagnoses: "Change in appearance due to immunodeficiency and confirmed by the patient's complaints of weight loss and profuse hemorrhagic exanthema"; "Fever associated with the activation of the secondary bacterial flora and confirmed by the patient's complaints of general weakness, sweating"; "Profuse hemorrhagic rash caused by Kaposi's sarcoma and confirmed by the patient's complaints of itching and burning in the area of the rash."
The goals of nursing care are: relief of the patient's condition; influence on concomitant pathology; elimination or reduction of psychological problems; improvement of basic body functions; ensuring the patient's infectious safety.
The patient is placed in a box, individual care items are isolated, the room is ventilated, quartz, and wet cleaning is carried out using disinfectants.
After examining the patient, clarifying his problems, the nurse performs independent and dependent interventions.
Unnecessary equipment is mainly aimed at providing psychological assistance:
Informing the patient about the mechanisms of HIV infection and the main manifestations of the disease;
ABOUT instilling in him the belief in prolonging life while maintaining a healthy lifestyle (giving up bad habits, playing sports, hardening);
ABOUT informing the patient about the availability of effective antiretroviral drugs, significantly prolonging
u and x life;
P a story about safe forms of sexual activity (erotic dreams, sexual fantasies, reading books, watching films, masturbation (manual stimulation of one's genitals) and mutual masturbation, cheek-to-cheek kisses, etc.);
encouraging the patient to inform his family about his condition;
drawing the patient's attention to the fact that he is criminally liable for creating a threat of infecting healthy persons, in accordance with the articles of the Criminal Code of the Republic of Belarus concerning the problem of HIV / AIDS;
adherence to professional secrecy about the patient's illness, which will help him keep his job, circle of friends;
Explaining to people the safety of everyday communication
from HIV - infected;
ABOUT explaining to the patient and his wife that HIV is transmitted to the fetus during childbirth;
Explaining to the population that HIV - infected are full members of society.
Z in and out of the box:
ABOUT ensuring correct and regular medication intake;
Carrying out parenteral interventions with strict adherence to safety rules;
Blood sampling for serological testing; Help your doctor when performing complex medicine
interventions (intubation, lumbar puncture and
Preparing the patient for instrumental examination methods - ECG, ultrasound, I M R T, etc.
Medical personnel working with a patient and HIV infection must strictly observe the anti-epidemic regime.
Transmission of HIV infection in a healthcare facility can occur from patient to patient and from patient to health worker. Transmission from patient to patient can occur through contaminated blood left on needles, syringes, and other instruments if they have not been sufficiently processed before reuse. Transmission from patient to health care worker can occur through contact with blood and other biological material of an HIV-infected person.
Treatment. Patients with HIV infection are subject to hospitalization in infectious diseases hospitals for clinical and epidemiological indications. Persons with suspected HIV infection are examined on an outpatient basis in specialized centers. Virus carriers do not need hospitalization and isolation. Patients with AIDS are hospitalized in the box unit of an infectious diseases hospital to prevent their infection with other infectious diseases and to provide antiretroviral therapy.
There are three main directions of treatment measures in relation to patients with HIV infection at the stage of pre-AIDS and AIDS: 1) etiotropic (antiretroviral) therapy; 2) immunomodulatory therapy; 3) treatment of opportunistic infections and tumors.
Currently, three classes of antiretroviral drugs are used as etiotropic drugs that inhibit the replication of HIH at different stages of its life cycle: two classes of reverse transcriptase (RT) - nucleoside and non-nucleoside RT inhibitors, the third class - inhibitors of the viral protease enzyme. RT inhibitors disrupt the work of reverse transcriptase, which converts viral RN K into DNA. Nucleoside RT inhibitors include azidothymidine (AZT), didanosine (videx), zalcitabine (hivid), etc., non-nucleoside inhibitors - nevirapine (viramune), delaverdine (rescriptor), lorivid, etc. Inhibitors of the viral protease enzyme act at the stage of assembly of new viral particles of virions capable of infecting other cells of the body; these include saquinavir (invirase), nelfinavir (virasept), indinavir (crixivan), etc.
Currently, etiotropic monotherapy, as a rule, is not carried out and should be replaced by a complex of antiretroviral drugs. The best option is to use three agents simultaneously: two RT inhibitors (nucleoside and non-nucleoside) and a protease inhibitor.
Indications for starting antiretroviral therapy are a decrease in the level of CO4 - lymphocytes less than 500 cells in 1 μl and an increase in the amount of RN K virus in plasma (viral load), determined by PCR, more than 10 000 copies in 1 ml (the threshold concentration of the virus that shares the risk of progression and its absence). The goal of therapy is to achieve complete suppression of the pH K virus in plasma.
The dose and duration of drug intake are determined individually, taking into account the stage of the disease and under
are toxic and (mainly for the bone marrow), are used in short and in cycles, indefinitely, practically lifelong, which makes it possible to prolong the patient's life. One of the extremely important conditions for tritotherapy is adherence to the treatment regimen: skipping drugs or violating the treatment regimen sharply reduces their effectiveness, leading to the development of resistant strains of the virus. The nurse plays an important role in adherence to the treatment regimen.
Simultaneously with antiretroviral therapy, immunocorrective therapy is carried out in the form of replacement and immunostimulating therapy. Immunosubstitution therapy involves transfusion of lymphocyte mass, bone marrow transplantation. Immunostimulating therapy is carried out using thymalin, T-activin, recombinant interferons (reaferon, intron-A, rofenon), interleukin preparations ( interleukin-2, roncoleukin, etc.).
Antibiotics and chemotherapy drugs are used to target opportunistic infections, depending on their etiology. So, for the treatment of pneumocystis pneumonia, biseptol, pentamidine, clindam-
zinc, with cryptosporidiosis diarrhea - spiramycin, azithromycin (sumamed), with ToxoplaEmose - pyrimethamine (chloridine), with cytomegalovirus infection - ganciclovir. For the treatment of herpesvirus infection, acyclovir (virolex, zavirax) is prescribed, fungal infections - nizoral, diflucan (fluconazole). The standard treatment for HIV-related tuberculosis is a combination of three drugs: rifampicin, isoniazid, and pyrazinamide. For Kaposi's sarcoma, radiation therapy and antitumor therapy with prospidin are used.
There are no special rules for discharging patients from the hospital. Discharge is carried out after additional examination, selection of antiretroviral therapy and improvement of the patient's condition.
Patients are under dispensary observation for life, regardless of the stage of the disease. The main task of dispensary observation is regular laboratory and clinical observation of the course of the infectious process and the functional state of the immune system. The results of medical observation of adults are recorded in the medical record of an outpatient patient, and observations of children - in the history of the child's development. A dispensary observation card is filled in for each HIV-infected person.
P r about f and l and to t and to and. Specific prophylaxis with vaccines is under development. The complexity of solving this problem depends on the high genetic variability of the virus.
Promotion of healthy lifestyles and correct sexual behavior (limiting the number of sexual partners and using condoms) is important in preventing the spread of HIV infection.
In order to prevent the parenteral route of infection, the sources of HIV are regularly identified: examination of blood donors, organs, sperm, as well as people from the risk group (foreigners who come to the country for more than three months, citizens of the Republic of Belarus who have returned from frontier, patients with sexually transmitted diseases, homosexuals, drug addicts, forgive
t u t about k). Medical institutions should carefully sterilize instruments, use disposable syringes and needles.
For drug addicts, the ideal option is to stop using drugs. Since this is difficult for them, it is necessary to teach them how to use an individual syringe, disinfect shared syringes, or provide disposable and syringes. An alternative may be to switch to oral drug use.
During the stay of an HIV-infected person in the family, it is necessary to maintain a sanitary and hygienic regime: wet cleaning should be carried out more often; common areas (toilet, bathroom) must be treated with washing and cleaning agents and agents with the addition of disinfectants; soiled laundry must be boiled; scissors and other cutting objects are washed with water, detergents and agents, if possible, treated with 70% alcohol after each use.
Health care workers should carefully observe measures to prevent infection with HIV during parenteral treatment and diagnostic procedures.
It is necessary to take measures to prevent occupational infection of medical workers. When performing manipulations related to the violation of the integrity of the skin and mucous membranes, medical workers and technical personnel should use personal protective equipment (surgical gown, mask, goggles, waterproof apron, arm sleeves, double rubber gloves) to avoid avoid contact with blood and other body fluids. The approach to the use of protective clothing should be differentiated taking into account the risk of HIV infection. In the process of work, gloves must be treated with 70% alcohol or other disinfectants.
A medical worker with injuries (wounds) on the hands, exudative skin lesions and are removed from medical care for patients, contact with items of care for them.
Health care workers must observe precautions when handling cutting and prongs and tools (needles, scalpels, scissors, etc.), as well as when opening bottles, vials, test tubes with blood or serum. and to prevent damage (pricks, cuts) to gloves and hands.
It is unacceptable to take blood from a vein through a needle directly into a test tube. All manipulations on blood sampling should be performed using rubber bulbs, automatic pipettes, and dispensers. In order to avoid injuries when taking blood and other biological fluids, glass objects with broken edges must not be used. Blood (serum) samples should be delivered to the laboratory in hermetically sealed rubber or cotton-gauze tubes, vials placed in racks and packed in containers. It is not allowed to place blanks or other documentation inside the container.
Disassemble, wash and rinse medical instruments, pipettes, laboratory glassware that have come into contact with human blood or serum, after preliminary disinfection and wearing rubber gloves.
Any damage to the skin, mucous membranes, contamination with biological materials of patients during the provision of medical care should be regarded as possible contact with material containing HIV.
In case of contact with blood or other biological materials with a violation of the integrity of the skin and (injection, cut), the victim must remove the gloves with the working surface inward, squeeze out the blood from the wound, treat the damaged area with 70% alcohol or 5% tincture of iodine for cuts, 3% hydrogen peroxide solution with injections. Then you need to wash your hands with soap under running water and wipe with 70% alcohol, apply a plaster on the wound, put on a fingertip and, if necessary, continue to work, putting on new gloves.
In case of contamination with blood or other biological fluid without damaging the skin, it should be treated with one of the disinfectants (70% alcohol, 3% water
peroxide, 3% chloramine solution), and then wash the site of contamination with soap and water and re-treat with alcohol.
If biological material gets on the mucous membranes of the oral cavity, it is necessary to rinse the mouth
albucid. For the treatment of the nose and eyes, a 0.05% solution of potassium permanganate can be used.
If biological material gets on the gown, the clothes are disinfected, then the clothes are removed and soaked in a disinfectant solution or placed in a polyethylene bag for autoclaving. The skin of the hands and other parts of the body under the place of contamination on the clothes is wiped with 70% alcohol, then washed with soap and water and wiped again with alcohol. Contaminated shoes are wiped twice with a rag soaked in a solution of one of the disinfectants.
If the surface of the work table is contaminated with blood or serum, it should be immediately treated twice with disinfectants and agents: immediately after contamination, and then after 15 minutes.
In medical and other institutions where HIV - infected people are assisted and work with infected material (blood and other biological fluids) is carried out, an accident log is kept.
In case of accidents, the blood is sent to the arbitration laboratory with the mark “profavaria”; the results are only communicated to the person injured in the accident. During the observation period, the employee is prohibited from donating donated blood (tissues, organs).
If, due to damage to the skin and or mucous membranes of a health worker, there has been contact with blood and railways and an infected organism, it is necessary to resort to post-traumatic prophylaxis with antiretroviral drugs from the group of RT inhibitors in combination with inhibitors proteases.
Combined chemoprophylaxis is required for four weeks: taking three drugs - two RT inhibitors (azidothymidine and lamivudine) and one protease inhibitor (indinavir or saquinavir).
14.2. P S I H O L O G I Ch E S K I E A S P E K T S V And Ch - I N F E K Ts I
The spread of the human immunodeficiency virus raises a number of new problems in the field of medical ethics
and deontology.
IN Currently, there are no legally defined persons who would be assigned the right to inform a patient about HIV infection. Until the final diagnosis of HIV infection is established, the patient should not be informed about the progress of the research and the findings; when communicating with him, such definitions as "HIV - infection", "P & D", "positive result of a test for HI", etc. should not be used. In case of receiving a preliminary
It is advisable to use the terms "re-examination", "rearrangement", "refinement of the result," the property of outsiders, since their failure to comply with the rules of anonymity can create an unfavorable environment around the subject.
An infected person is obliged to inform the doctor about his illness, otherwise he will put medical workers at risk of infection during invasive procedures, operations and other manipulations associated with contact with biological fluids and tissues of the infected person. When referring an HIV-infected person for examination or consultation with other specialists, it is necessary to notify them of this.
The duty of the doctor is to inform the patient about the objective state of his health, opportunities and limitations in life, behavioral features and the need for timely periodic examination and treatment to prolong life.
Only a doctor can inform relatives about the condition of an HIV-infected patient; the average medical worker has no right to give information to any patient; nor to his relatives.
The principle of mercy requires that all actions of the Medical Workers be performed in the interests of the Patient. The patient must be sure that he is sincerely
from about the fact that they will not leave him and stay with him from the end, and will also make every effort to alleviate his bodily suffering and prolong his life. Relationships with patients should be friendly, caring, while maintaining self-control, calmness and self-control. It is necessary to observe the behavior of such patients, most closely - for silent patients,
from depressed mood.
The task of medical workers is to weaken the psychological barrier between a person infected with HIV and society. HIV - infected people suffer not only from the disease itself, but also from loneliness.
Between society as a whole, individual citizens and
discrimination against HIV - infected, on the other - provoking a response - AIDS terrorism. Quite often I come to meet with negative attitudes towards HIV-infected people, including in some cases medical workers and students of secondary and higher medical educational institutions. But most of the people with a deep understanding of the problem of V I P / S P I D.
According to the legislation of the Republic of Belarus, legal and social protection of persons infected with HIV is provided. Dismissal from work, refusal to hire, to medical institutions, to admit children to children's institutions, as well as infringement of other rights of citizens only on the basis of the fact that they are carriers of HIV or have AIDS, are not allowed. On the other hand, according to the Criminal Code of the Republic of Belarus, punishment is imprisonment for knowingly infecting another person with HIV.
The problem of V & M / S P & D is currently relevant in the Republic of Belarus. This is not only a medical problem, it affects all aspects of the life of our society: economic, social, political. Therefore, in addition to medical structures, other ministries, departments, institutions, organizations and the general public should be involved in organizing and carrying out activities on the HIV / STI problem.
Every year on December 1, by the decision of the WHO, the world celebrates World AIDS and Prevention Day. In our country, on this day, many events are usually held on the prevention of HIV infection. The international symbol of the fight against AIDS is the red ribbon worn by an increasing number of people around the world. Everyone can wear a red linen dot, by this he demonstrates his concern, concern for people, women with HIV and AIDS, the hope that someday the epidemic will be stopped.
TO control questions and tasks
1. What microorganism is caused by HIV infection? What is its structure?
2. How does HIV get infected?
3. What cells does HIV attack?
4. Name the stages of HIV infection.
5. What are opportunistic infections?
6. List the stages of laboratory diagnostics HIV infection.
7. What are the features of the nursing process in HIV infection?
8. Give an example of a nursing diagnosis.
9. What are the groups of antiretroviral drugs?
10. What is prevention HIV infection?
11. What precautions should be taken when coming into contact with a patient's biological material?
12. What are the psychological aspects HIV infection.
13. Complete the Infectious Disease Emergency Notice.
14. Apply for a referral to the laboratory for a serological examination of the patient's blood.
15. Zoonoses
fifteen . one . CH U M A
Plague is an acute infectious disease characterized by severe intoxication, damage to the lymph nodes, lungs and other organs. Plague belongs to the group of especially dangerous (quarantine) infections.
Nursing care for HIV infection, AIDS.
Violated patient needs: drink, eat, excrete, communicate, work, maintain body temperature, safety.
Patient problem: high risk of opportunistic infections.
Care goals: The risk of infection will decrease if the patient adheres to certain rules.
Nursing intervention plan:
1. Observe the sanitary and anti-epidemic regime in the ward (disinfection, quartzing, ventilation).
2. Ensure a full night's sleep for at least 8 hours.
3. Provide adequate nutrition (proteins, vitamins, trace elements).
· Avoid contact with infectious patients, visitors with respiratory infections must wear masks;
· Avoid crowds of people;
· Avoid contact with body fluids of another person;
· Do not use shared razors;
· Take a shower regularly using antibacterial soap;
· Wash hands after using the toilet, before eating and preparing food;
· Do not touch eyes, nose, mouth with your hands;
· Observe oral hygiene;
· Monitor the cleanliness of nails on hands and feet;
· To reduce contact with animals, especially sick, wash hands thoroughly after contact with animals;
· Thoroughly wash and clean food products, thoroughly cook meat, eggs, fish, avoid contact between cooked and uncooked food, do not drink raw water;
· Get flu shots;
· To monitor the temperature, NPV of the patient;
· Teach the patient to monitor the symptoms of HIV disease - fever, night sweats, malaise, cough, shortness of breath, headache, vomiting, diarrhea, skin lesions;
· To teach to take anti-infectious and special preventive drugs, to avoid taking immunosuppressive drugs.
Patient problem: Difficulty eating due to lesions of the oral mucosa.
Care goals: The patient will eat the required amount of food.
1. Eliminate very hot and cold, sour and spicy foods.
2. Include soft, moist, high-protein and fortified foods in the diet.
3.Rinse your mouth before eating with 0.25% novocaine solution, after eating with boiled water or furacilin solution.
4. Describe alternative feeding methods (tube feeding, parenteral nutrition).
5.Use soft toothbrushes to brush your teeth, excluding trauma to the gums.
6.Use anti-infectious medications (local and general treatment) as prescribed by a doctor.
Patient problem: diarrhea associated with opportunistic infections, a side effect of medications.
Care goals: diarrhea will decrease.
1. Evaluate which foods increase or decrease diarrhea and adjust the diet.
2. Provide a diet rich in protein and calories, low in dietary fiber.
3. Ensure sufficient fluid intake (water, juices, electrolyte solutions).
4.Take infectious precautions when preparing and eating food.
5. Ensure the timely intake of antidiarrheal drugs prescribed by the doctor.
6. Provide skin care in the perianal area: wash after each bowel movement with warm water and soap, dry it in order to prevent rupture of weakened skin. Apply an emollient cream to the perianal area to protect the skin.
7. To exercise control over weight, water balance, tissue turgor.
Patient problem: feeling of depression associated with a change in appearance (Kaposi's sarcoma, hair loss, weight loss, etc.) and negative attitudes of others. Option: low self-esteem.
Care goals: The patient's mental health will improve.
1.Allow to voice fears about lifestyle changes in a supportive and non-judgmental environment.
2. Encourage family members to interact with the patient.
3. If necessary, refer the patient for a consultation with a psychotherapist.
4. Teach relaxation techniques.
Patient problem: nausea, vomiting associated with opportunistic infections, a side effect of medications.
Care goals: The patient will have less nausea and no vomiting.
1. Airing the room to eliminate odors that cause nausea.
2.Give dietary recommendations: eat often in small portions, avoid hot food, refuse food with a pungent smell and taste, drink 30 minutes before meals, not while eating, eat slowly and rest for 30 minutes after eating with the head up.
3.To teach to take medicines prescribed against nausea, vomiting (medicines are given 30 minutes before meals).
4. To focus on the need for careful oral care.
5. Provide the patient with a glass of water, a container for vomit in case of vomiting and help the patient if it occurs.
Patient problem: risk of weight loss.
Care goals: The patient will receive an adequate amount of food, his weight will not decrease.
1. To clarify the patient's taste preferences and his aversions to food.
2. Provide the patient with a high-protein and high-calorie diet.
4. Determine the patient's body weight.
5. Determine the amount of food eaten at each meal.
6. Consultation with a nutritionist, if necessary.
Patient problem: cognitive impairment.
Care goals: The patient will be adapted to their mental capacity.
1. Assess the initial level of mental ability.
2. Talk to the patient calmly, give him no more than one instruction at a time and, if necessary, repeat the information provided.
3. Avoid disagreement with the patient, as this can lead to the development of the patient's feelings of anxiety.
4.Prevent possible injury by removing hazardous factors from the patient's environment.
5. Use techniques that facilitate memorization, for example, associative connections with familiar objects, entries in the calendar.
6. Provide support from the family and instruct the caregiver (family) about the above interventions.
The main and often the first sign of the progression of HIV infection is the AIDS-related dementia complex, also known as HIV encephalopathy (it develops in 70 -90% of patients). Dementia complex includes:
Changes in consciousness (loss of concentration, forgetfulness, confusion, and slowing down of mental processes);
Changes in movement (imbalance and coordination, weakness in the legs, loss of handwriting);
Behavioral changes (apathy, detachment, depressed mood, depression, psychosis, violent tendencies).
Depending on the area of the brain affected, headaches, seizures, or loss of vision may appear.
HIV wasting syndrome is defined as profound, involuntary weight loss of more than 10% of the body weight. The syndrome of HIV depletion has numerous causes: a decrease in the volume of food intake, a syndrome of insufficient absorption, altered metabolism, anorexia, nausea, vomiting, infectious and fungal lesions of the mouth and esophagus, medication, and a lack of money for adequate nutrition.
Precautions for handling HIV-infected patients.
1. All manipulations in which hands can be contaminated with blood or other biological fluids should be carried out with rubber gloves, and in order to avoid splashing blood - in face masks and goggles.
2. Cover all injuries on the hands with adhesive plaster, waterproof bandages.
3. Breathing bags should be available in all healthcare facilities where resuscitation may be required.
4. Mechanical and electrical devices should be used instead of mouth-to-mouth resuscitation in newborns.
5. Before transportation, samples of blood and other biological fluids should be placed in containers with sealed lids, the outer parts of the container should be treated with disinfectants.
6. Disassembly, washing and rinsing of instruments, laboratory glassware, devices and everything in contact with blood or body fluids should be carried out only after disinfection and wearing thick rubber gloves.
7. Used needles should not be bent, broken by hand, or re-capped.
8. Disposable instruments are immediately placed with the syringe in a strong, leak-proof container for disposal.
9. Sharp objects to be reused should be placed in a sturdy container for processing.
10. If it is necessary to hand over sharp instruments, put them in a neutral zone, without touching the same objects at the same time, avoid pricks, cuts with sharp instruments, broken dishes.
GENERAL INFORMATION ABOUT HIV INFECTION, AIDS
HIV infection - a disease caused by the human immunodeficiency virus; characterized by a slowly progressive defect of the immune system, which leads to the death of the patient from secondary lesions (infectious and neoplastic processes) described as acquired immunodeficiency syndrome (AIDS) or from subacute encephalitis.
CLINICAL CLASSIFICATION OF HIV INFECTION
І. Incubation stage.
From the moment of infection until the appearance of antibodies.
The diagnosis can be confirmed by the polymerase chain reaction method when the antigen HIV-RNA is detected. Isolation of HIV antigen by enzyme-linked immunosorbent assay has low specificity.
II. Stage of primary manifestations.
It is characterized by a relative balance between the body's immune response and the action of the virus. Duration from 2-3 to 10-15 years.
II A. Acute infection.
Usually lasts 2-3 weeks. It is accompanied by fever of varying severity, lymphadenopathy, enlargement of the liver, spleen, skin rashes, meningeal phenomena are possible. Then it goes to stage II B or II C.
II B. Asymptomatic infection.
It is characterized by the absence of clinical manifestations. There may be a moderate swelling of the lymph nodes. In contrast to the incubation stage, antibodies to HIV antigens are determined.
II B. Persistent infection.
It is characterized by persistent generalized lymphadenopathy, which is a clinical manifestation at this stage.
III. Stage of secondary manifestations.
With the progression of the disease, clinical symptoms develop, which indicate a deepening of the damage to the immune system, which characterizes the beginning of the third stage.
III A. Characterized by a loss of body weight less than 10%, bacterial, fungal, viral lesions of the mucous membranes and skin, inflammatory diseases.
III B. Characterized by a loss of body weight less than 5%, skin lesions that are of a deeper nature. Lesions of internal organs develop; localized Kaposi's sarcoma.
III V. Characterized by cachexia, generalization of infectious diseases, disseminated Kaposi's sarcoma, severe lesions of the central nervous system of various etiologies.
IV. Terminal stage.
It is characterized by irreversible damage to organs and systems. Even the therapy of secondary diseases, which is carried out adequately, is ineffective and the patient dies within a few months.
The root cause of HIV infection in a surgical hospital is professional exposition to HIV-containing biological environments patients.
Most of the registered cases of occupational infection occur as a result of accidental damage to the skin of medical personnel with sharp objects (injection needles, blades), which are accompanied by parenteral contact with the patient's biological media; contact of these media on the mucous membrane of the eyes, oral cavity, on open skin areas that have a disturbed epidermis (cuts, scratches, etc.). Instead, much more of the surgeon's daily unconscious risk potential is made up of so-called suboperative damage to the integrity of surgical gloves(SPR), which account for 25 to 75% of cases during surgery. In addition, only a third of such injuries are visible to surgeons and take the necessary preventive measures.
Prevention of HIV infection by surgeons is based on the following principles:
Increased vigilance of the doctor regarding HIV-infected patients.
Occupational Exposure Prevention Measures:
a) barrier protection means;
b) reducing the likelihood of occupational exposure - "distant surgery".
Timely identification of cases of professional exposure, if any.
Prevention of the consequences of contact with the patient's biological media - post-exposure prophylaxis.
Doctrine of increased HIV alertness to HIV-infected patients
During the initial examination, on the basis of anamnesis data and an objective examination, patients are identified who have or had in the past a risky lifestyle with respect to AIDS and (or) belong to the risk categories:
Parenteral drug addicts.
Persons who are sexually promiscuous or who provide sex work for a fee.
Persons who shared a syringe with another person.
Persons who have lived or are living in AIDS-endemic regions (Africa).
Individuals who have often received blood transfusions or drugs that are made from donated blood.
Children of HIV-infected parents.
Sex partners of persons who belong to the listed risk categories.