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Acquired immunodeficiency syndrome 'AIDS'-PEDIATRIC and Its Assessment:Nursing Case Study

Saturday, 8 March 2014

Acquired immunodeficiency syndrome (AIDS) results from the human immunodeficiency virus (HIV) attacking helper T cells. Three main groups of children are infected with HIV: infants of HIV-infected mothers; adolescents who acquired the infection through sexual contact or I.V. drug abuse; and infants, children, and adolescents who acquired the virus via contaminated blood products. AIDS isn't spread by casual contact with an infected child; it's spread only by an exchange of body fluids, including breast milk.

Pathophysiology
The natural history of AIDS begins with infection by the HIV retrovirus. HIV strikes helper T cells bearing the CD4+ antigen. Normally a receptor for major histocompatibility complex molecules, the antigen serves as a receptor for the retrovirus and allows it to enter the cell. Viral binding also requires the presence of a coreceptor (believed to be the chemokine receptor CCR5) on the cell surface. The virus also may infect CD4+ antigen–bearing cells of the GI tract, uterine cervix, and neuroglia. HIV replication may lead to cell death or it may become latent. HIV infection leads to profound disease, either directly through destruction of CD4+ cells, other immune cells, and neuroglial cells, or indirectly through the secondary effects of CD4+ T-cell dysfunction and resulting immunosuppression.

Complications
■ Repeated opportunistic infections
■ Neoplasms
■ Premalignant diseases
■ Organ-specific syndrome

Assessment
Health perception and management

■ History of recurrent infections (including sexually transmitted diseases), amebiasis, or herpes simplex infections
■ Known exposure to HIV


Nutrition and metabolism
■ Anorexia or dysphagia
■ Episodic oral candidiasis (thrush) causing eating difficulties

Elimination

■ Diarrhea
■ Constipation
■ Urinary frequency

Activity and exercise
■ Exertional shortness of breath (with pulmonary involvement)
■ Displayed fatigue and malaise
■ Leg weakness

Cognition and perception
■ Sorrow, emptiness, heaviness

Sleep and rest
■ Night sweats
■ Disturbed sleep patterns

Self-perception and self-concept
■ Low self-esteem

Roles and relationships
■ Family strained due to illness and stigma

Coping and stress management
■ Signs of depression and potential suicidal ideation
■ Fear expressed regarding treatment regimen

Values and beliefs
■ Fear of death

PHYSICAL EXAMINATION
General appearance and nutrition

■ Fatigue
■ Cachexia or dehydration

Mental status and behavior
■ Depression
■ Withdrawal

Integumentary
■ Elevated temperature
■ Severe night sweats
■ Reddish or purplish lesions, macules, or papules, usually appearing first on the head and neck or mucous membranes (with Kaposi sarcoma)
■ Dermatitis
■ Lymphadenopathy
■ Herpes zoster or simplex
■ Diffuse dry skin
■ Butterfly rash on nose or cheeks
■ Tinea
■ Hypersensitivity to light touch
■ Molluscum contagiosum

Eyes, ears, nose, and throat
■ Parotitis
■ Thrush
■ Mucosal lesions

Respiratory
■ Shortness of breath
■ Dry cough
■ Crackles

Gastrointestinal
■ Diarrhea
■ Hepatomegaly
■ Splenomegaly
■ Diffuse abdominal tenderness

Neurologic
■ Decreased mental acuity
■ Impaired sense of position or vibration
■ Paresthesia or paralysis
■ Hyperreflexia
■ Retinal abnormalities
■ Diffuse retinal hemorrhage or exudates
■ Positive Babinski's sign

Musculoskeletal
■ Weakness
■ Pain
■ Stiff neck

Hematologic and immune
■ Lymphadenopathy

DIAGNOSTIC STUDIES
■ HIV antibody tests identify the HIV antibody: (enzyme‑linked immunosorbent assay); Western blot assay; radioimmunoprecipitation assay; oral antibody testing (OraSure).
■ Viral load tests detect changes in viral load, referred to in "logs."
■ Polymerase chain reaction technique estimates the virion population.
■ Branched-chain deoxyribonucleic acid amplification technique provides an estimate of HIV ribonucleic acid (RNA) levels.
■ Nucleic acid sequence-based assay quantifies HIV RNA in blood plasma.
■ Genotypic antiretroviral resistance testing detects mutations in reverse transcriptase and protease genes associated with resistance to antiretroviral agents.

The following laboratory findings represent characteristic values in children with AIDS but aren't specific to or diagnostic of AIDS:
■ Complete blood count (CBC) reveals leukocytopenia and anemia.
■ Total T‑cell count is reduced; CD4+ cell count commonly is less than 400 cells/ml.
■ CD4+ to CD8+ cell ratio is low; decrease depends on child's status, usually less than 1.0. (CD4+ cells are also known as helper or inducer T cells; CD8+ cells are also known as cytotoxic or suppressor T cells.)
■ Immunoglobulin (Ig) levels usually are elevated, especially IgG and IgA.
■ Platelet count shows thrombocytopenia.
■ Absolute neutrophil count may be low.
■ Skin test antigen studies reveal anergy.
■ Aspartate aminotransferase level may be elevated (associated with hepatitis).
■ Lactate dehydrogenase level may be elevated in Pneumocystis carinii pneumonia (PCP).
■ Hepatitis screen may demonstrate carrier state or active disease (hepatitis A, B, C, and others).
■ Stool culture and examination may reveal parasites or infection (such as cryptosporidiosis, salmonellosis, acid-fast bacilli, microsporidiosis, Clostridium difficile, mycobacterium avium complex, Isospora belli, or Giardia lamblia).
■ Bronchoscopy identifies PCP or other disorders such as fungus, cytomegalovirus, or Kaposi sarcoma.
■ Colonoscopy and endoscopy identify Kaposi sarcoma and other tumors.
■ Lesion culture may demonstrate Candida, toxoplasmosis, or other organisms.
■ Lesion biopsy may demonstrate Kaposi sarcoma or other cancers.
■ Gallium scan may show radio‑labeled gallium accumulation in white blood cells of infected areas; used to help establish early diagnosis of PCP, although test is nonspecific.
■ Lumbar puncture may reveal cryptococcal meningitis or HIV.
■ Sputum test for acid‑fast bacillus may indicate Mycobacterium.

Teaching checklist
■ Disease process and implications
■ Diagnostic tests and procedures
■ Modes of transmission and prevention of spreading the HIV virus
■ Signs and symptoms of infection
■ Immunizations and infection control
■ Purpose, dosage, administration schedule, and possible adverse effects of prescribed medications
■ Dietary needs
■ Community resources and support
■ Follow-up care
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