If you were caring for someone with AIDS, you could get infected. Methodological development for independent work of students. "Nursing process in family planning for HIV-positive patient status." General characteristics and description of the human immunodeficiency virus,

What is this disease?

AIDS is characterized by a progressive weakening of the immune system, leaving a person unable to resist infections. In addition, people with AIDS often develop unusual forms of cancer.

Gay and bisexual men with multiple partners are at greatest risk of developing AIDS. In addition, drug addicts who give themselves intravenous injections and hemophiliacs are at risk. Recently, they have included heterosexual partners and children of people with AIDS or people at high risk, as well as those in need of multiple blood transfusions. Drug therapy, preventive measures, and treatment of infections caused by opportunistic microbes can slow the progression of HIV infection and prolong the patient's life.

What are the reasons for the development AIDS?

The causative agent of AIDS is a retrovirus, which is called the human immunodeficiency virus (HIV). The retrovirus infects cells that carry the so-called T4 antigen, but can also infect cells in the digestive tract, cervix and some types of nerve cells.

Having penetrated the cell, HIV begins to multiply. Recent studies have shown that the virus is especially active in the first weeks after infection. It eventually causes severe illness by suppressing the immune system's ability to fight disease.

There are three forms of the disease:

immunodeficiency state - infections caused by opportunistic microbes and rare forms of cancer develop;

autoimmune reaction - the body begins to react against its own tissues;

damage to the nervous system - dementia develops as a result of damage to the peripheral nervous system.

Methods of transmission

HIV is transmitted through sexual intercourse (especially intercourse through the anus, since it is characterized by the greatest degree of trauma to the mucous membranes), transfusion of infected blood or blood components and the use of unsterile needles, as well as from an infected mother to her child (during childbirth or through breastfeeding). milk). Practice has shown that HIV is not transmitted through household and social contacts (see CARE FOR AIDS PATIENTS AT HOME).

What are the symptoms of the disease?

Some people with AIDS may have no symptoms until they suddenly develop an opportunistic infection or Kaposi's sarcoma, a type of cancer associated with AIDS.

However, nonspecific symptoms such as fatigue, fever, night sweats, weight loss, diarrhea and cough are more common. Usually, several infections soon begin to develop simultaneously.

In children with AIDS, the time between infection and the onset of symptoms tends to be shorter (on average 8 months). Signs and symptoms are similar to those seen in adults, except those associated with sexually transmitted diseases. In addition, the most common cause of death in children is not pneumonia, caused by Pneumocystis carinii , as in adults, but diffuse interstitial pneumonitis.

How is the disease diagnosed?

Laboratory blood tests are ordered to check for the presence of HIV.

How is AIDS treated?

There is currently no cure for AIDS. However, to suppress the replication of HIV, retrovir is used in combination with hivid . If the patient cannot tolerate retrovir or has stopped responding to it, it may be prescribed videx.

Supportive care aims to reduce the risk of infection, treat existing infections and cancers, and provide adequate nutrition and emotional support.

Additional medicines

Many of the diseases caused by opportunistic microbes can be treated with medications, but they tend to return when treatment is stopped. For pneumonia caused by Pneumocystis carinii , Bactrim (or septra ) - orally or intravenously.

Kaposi's sarcoma is treated with chemotherapy, in addition, interferon alpha is used. Radiation therapy and laser radiation can improve the condition of the affected skin, but do not cure sarcoma.

CARE TIPS

Caring for AIDS patients at home

When caring for a patient, it is necessary to ensure conditions under which none of the family members will come into contact with the blood, seminal fluid or vaginal secretions of the patient. Although the virus that causes AIDS can be found in saliva, urine, stool, mucus, sweat and other body fluids, there have been no documented cases of AIDS contracting from exposure to them.

To prevent getting AIDS at home, follow these safety precautions:

Hand washing

Wash your hands and other parts of the body that come into contact with the sick person before and after contact with him and before preparing food or feeding.

Do not touch your body or mouth while caring for a patient. Remind the patient to wash their hands frequently, especially before eating and after using the toilet.

Gloves, gown and masks

Wear gloves whenever you will touch someone's secretions, such as when cleaning the mouth, wound, or nose, or when caring for a woman who is menstruating or giving birth.

Wearing gloves, handle diapers, sheets or clothes of the patient soiled with vomit or urine, as well as sores and pustules in the genital area and anus. Do not forget to wash your hands after the procedure, when you have already taken off your gloves.

Wear a gown if there is a possibility that you will be splashed with the patient's secretions. If a person with AIDS has tuberculosis, wear a mask and eye protection to prevent vomit and saliva from getting into the eyes, nose, or mouth.

Dishes

Wash the AIDS patient's plates in hot soapy water and dry them after washing. There is no need to keep them separate from other plates.

Sanitary equipment

A person with AIDS can use the same toilet as other family members without special precautions, unless the patient is incontinent, has diarrhea, or has cold sores.

In the latter cases, disinfect the toilet with bleach.

Cleaning

If blood, urine or other secretions get on the floor, wash it thoroughly with hot water and soap. Then disinfect the washed surface with bleach.

Sponges, brushes and other cleaning equipment should also be disinfected in bleach. Do not wash them in kitchen sinks or use them in areas where you prepare food.

Pour the water you used to wash your brushes into the toilet.

Clean your kitchen and bathroom frequently using soap and cleaning powder. Clean your refrigerator regularly.

Disinfect the floor in the bathroom and shower with a bleach solution in a ratio of 1:10. Pour a small amount of concentrated bleach into the toilet.

Wash

Wear gloves before handling dirty laundry. Before washing, store laundry stained with secretions in tightly sealed, durable double plastic bags. First soak it in cold water with a detergent containing enzymes, then wash it in hot water with bleach added. Dry your clothes in the machine on a hot dry setting. Wash the patient's underwear separately from other underwear.

Garbage

Place used items (gloves, diapers, oilcloths, linen, rags and other items intended for disposal) in durable double plastic bags that are hermetically sealed.

injection needles

Discard needles immediately in a metal container or securely sealed plastic container that is strong enough that needles cannot pierce it. Follow waste disposal regulations carefully.

Personal items

Never use a patient's toothbrushes or razors, as they may be stained with their blood.

Glass thermometers can be used if you first take care of their cleanliness. Wash them in cold water and soap, then keep them in 70-90% ethyl alcohol for 30 minutes, then rinse in running water.

The reform of nursing, which has been taking place in Russia since the 90s, has led to a qualitative change in the professional and social status of the nursing profession, increased responsibility of nurses and a change in their attitude towards their profession. It is recognized that nursing staff play a key role in providing patient care, which is particularly evident in palliative care.

Patient care is a system of therapeutic, preventive and sanitary-hygienic measures to alleviate the patient’s condition, correctly and timely implementation of treatment prescriptions, preparation and conduct of a number of diagnostic procedures, competent observation of the patient and monitoring of his condition, provision of first aid and preparation of appropriate medical documentation .

The goal of care is to achieve the highest level of adaptation of the patient to the health situation, and thereby achieve the highest quality of life for the patient. The area of clinical application of care is the issues of maintaining health, adaptation to conditions of acute and chronic illness, and the palliative process. In a narrow sense, the term “care” is a set of manipulative interventions performed by a nurse independently or as prescribed by a doctor and aimed at meeting the basic needs of the patient. General care - activities carried out regardless of the nature of the disease. Special care - measures used for certain diseases (lung disease, heart disease, gastrointestinal tract disease, HIV infection, etc.). Modern principles of caring for patients have undergone changes. Previously, care professionals believed that the less their clients did themselves, the better. Therefore, they sought to provide maximum comfort to the patient in bed, fed and washed them. Each patient received a standard package of services, without taking into account individual characteristics and needs. Recently, nursing professionals have come to realize that people feel better and recover more quickly when they are encouraged to participate in their own care. The recovery period goes faster. It was observed that when people in their care had the opportunity to do what they were able and willing to do at the moment, people accepted care better, especially if their condition was explained to them and they were given the opportunity to participate in care planning. “Do not do for the patient what he can do himself” is one of the main principles of modern nursing care. This discovery changed professional nursing practices. Specialists must remember that now their task and even responsibility is to involve the patient himself in the process of care as much as possible. The patient must become a full member of the nursing team. And not just a member, but its center, its core.

When caring for a patient, it is important to focus on their personality and individual needs. Daily care should not become routine or automatic; on the contrary, care should always be individualized. To achieve this, the nurse can use all her creative abilities. The person-centered approach involves focusing on the needs of the patient. The patient is considered as an individual with his thoughts, fears, expectations and assumes a lively response from the nurse.

The nurse takes into account the living conditions in the family, the influence of culture and religion, stimulates the patient’s independence, provides information, and involves him in decision-making. It is important to be able to select and evaluate the information obtained during the history taking, and use this information when drawing up a plan of care, taking into account the following principles:

Sequences of appointments;

Maintaining tolerance in case of failure to achieve results;

Ability to make decisions in emergency situations;

Observation and identification of new symptoms of the disease;

Establishing a nursing diagnosis based on identified problems.

Nursing care involves the implementation of an integrated approach to the provision of medical care. We must learn to work with a patient who presents a large number of complaints and has several diseases - acute and chronic, and learn to encourage a healthy lifestyle, prevention, treatment and adherence to it.

An important competency of a nurse providing palliative care is a holistic view of the patient and his condition, taking into account the biopsychosocial model, cultural and existential aspects of people's lives. A tolerant attitude towards the life experiences, beliefs, values and expectations of the sick person. Often spiritual and existential experiences are a serious source of clinical problems. To implement nursing care for HIV-infected people, it is necessary to develop the patient's commitment to treatment. For HIV infection, the main component of treatment is highly active antiretroviral (ARV) therapy aimed at suppressing the process of HIV replication. Adherence to treatment is manifested in taking medications according to the regimen prescribed by the doctor, at a certain time and in a certain dosage, while observing the recommended diet. Forming adherence to treatment is a complex multi-stage process. It goes through several stages: formation of adherence to accepting help - formation of adherence to treatment - formation of adherence to taking ARV therapy.

Motivating patients to accept medical care very much depends on “presence therapy” (communication, support, understanding).

Six principles of patient care:

1. Security.	Caregivers must protect the patient by preventing possible injury.
2. Confidentiality.	Personal information about the patient, details of his personal life must remain confidential, and strangers should not be allowed to see or hear anything that the patient would not want.
3. Respect (maintaining a sense of dignity).	Respect the patient as an individual, recognize his right to choice and decision-making.
4. Communication.	Remember that the word heals. When talking with a patient, you need to pay attention to his feelings. Talk with the patient about the upcoming manipulations, obtain his consent to this or that intervention. Report to management about patient problems.
5. Independence.	Encourage the patient to be as independent as possible in the specific situation.
6. Infection safety.	Carry out measures to ensure infection safety. Care can be provided to the patient in medical institutions (specialized hospitals, where the patient is being treated for a particular disease and at the same time needs care, hospitals (nursing homes), in social institutions and at home.

General characteristics and description of the human immunodeficiency virus, its sources and routes of infection. Etiology and pathogenesis of this disease, stages of its development and risk factors, clinical manifestations and symptoms. Diagnosis and treatment regimen.

Send your good work in the knowledge base is simple. Use the form below

Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.

Posted on http://www.allbest.ru/

1. Etiology

The causative agent of the disease is human immunodeficiency virus (HIV)- belongs to the family Retroviridae. The name retrovirus is due to the presence in the virus of a unique enzyme - reverse transcriptase, with the help of which genetic information is read from RNA to DNA. HIV has a tropism for helper T lymphocytes (T4). T4 cell cultures were tested to cultivate HIV. However, unlike other retroviruses, which only cause cell malignancy, infection with HIV led to their death. Only obtaining a clone of leukemic T4 cells resistant to HIV made culturing the virus possible. HIV is genetically heterogeneous and has a high degree of variability. The virus is sensitive to heat, ether, ethanol, beta-propiolactone, and is inactivated quite quickly under the influence of conventional disinfectants, as well as at a temperature of 56 ° C.

2. Epidemiology

The virus can be transmitted through direct contact of damaged mucous membranes or damaged skin of a healthy person with the biological fluids of an infected person: blood, pre-seminal fluid (released throughout sexual intercourse), sperm, vaginal secretions and breast milk. Transmission of the virus can occur through unprotected anal, vaginal or oral sex.

Intact, undamaged skin is an effective barrier to infection because there are no cells in the skin that can be infected with HIV. Successful infection requires direct contact with the circulatory system or with the membranes of mucosal cells. The mucous membranes of the genitals and rectum often receive minor damage during sexual intercourse, through which the virus can enter the blood. Such lesions are more likely to occur in the presence of sexually transmitted diseases, such as herpes. On the other hand, infection is also possible in the case of intact mucous membranes, since the latter contain a significant number of dendritic cells (including Langerhans cells), which can play the role of “carriers” of viral particles to the lymph nodes. Therefore, unprotected anal sex is a particularly dangerous form of sexual intercourse for the receiving partner, since this form causes the largest number of minor and major injuries.

Transmission of the virus is more likely to occur through the use of contaminated needles and syringes (especially by injection drug users), as well as through blood transfusions (if medical personnel violate established procedures for testing donated blood). Also, transmission of the virus can occur between mother and child during pregnancy, childbirth (infection through the mother’s blood) and during breastfeeding (both from an infected mother to a healthy child through breast milk, and from an infected child to a healthy mother through biting the breast during feeding).

The virus is not transmitted by airborne droplets, household contact, contact with intact skin, insect bites, tears and saliva (due to the fact that the concentration of HIV virions in these liquids is lower than the infectious dose, and also due to the fact that saliva - an aggressive environment that destroys HIV virions with its enzymes).

3. Pathogenesis

HIV infection is characterized by a long-term course with a progressive decrease in immunity, leading to the development of severe forms of opportunistic diseases and cancer. Until now, it is believed that in the vast majority of cases, HIV infection has one single outcome - the death of the HIV-infected organism. However, the general theory of the infectious process allows for the existence of both less infectious or defective strains of HIV, as well as patients resistant to infection.

The pathogenesis of AIDS has been developed primarily at the level of hypotheses. The leading link in pathogenesis is the damage to lymphocytes - T-helper cells (T4). HIV enters cells through receptors on their outer membrane. With the help of reverse transcriptase, the RNA of the HIV genome enters the genome of the target cell, where it represents a provirus. Thus, a latent infection occurs.

A latent infection can turn into an active one, which leads to illness. HIV also infects macrophages and other cells that have receptors in common with T4. The virus can persist in macrophages for a long time. With macrophages crossing the blood-brain barrier, HIV enters the spinal cord and brain, causing their damage.

Due to the destruction of T4, the helper/suppressor ratio changes - the T4/T8 ratio decreases significantly and does not exceed 0.6-0.5 (the norm is 1.8-2). The defeat of T4 is accompanied by an increase in T8 activity, which is characteristic of immunodeficiency. At the same time, this causes activation of B-lymphocytes, an increase in the number of immune complexes and other profound changes in almost the entire system of immunological homeostasis with a predominant disruption of its cellular component. Deep damage to the immune system leads to opportunistic infections caused by opportunistic flora. They aggravate the course of AIDS and often cause the death of patients.

Malignant neoplasms characteristic of AIDS arise due to the oncogenic effect of the virus, which causes the transformation of latent cancer genes of normal cells (pro-oncogenes) into oncogenes. The development of malignant neoplasms is also due to a profound disruption of immunological homeostasis. This is what is associated with the frequent occurrence of Kaposi's sarcoma in AIDS. There are hypotheses that explain the high susceptibility of homosexual men to HIV. According to one of them, alloimmunization of homosexuals with sperm contributes to the production of antibodies against spermatozoons, which cross-react with T-lymphocytes and negatively affect their functional activity. Thus, it is believed that increased susceptibility to HIV is also due to autoimmune processes. In addition, sperm can contribute to the development of immunosuppression due to the activity of transglutaminase and the action of polyamines (spermine, spermazine). Drugs and medications that suppress the immune system can affect susceptibility to HIV.

In recent years, a hypothesis has been put forward that sensitivity to HIV is genetically determined. This assumption was made on the basis that in patients with AIDS, a unique soluble immunosuppressive factor produced by peripheral blood mononuclear cells was identified. It is believed that under the influence of HIV, the production of this factor increases and this contributes to the development of the disease. The study of the pathogenesis of AIDS continues.

In people who died of AIDS, multiple inflammatory foci are found in almost all internal organs. It is typical that AIDS patients lose the ability to localize the infectious process and to form granulomas. Atypicality of many cells and an increase in the number of immature lymphoreticulocytes are observed. Various other changes occur, due to the characteristics of secondary infections or the nature of malignant neoplasms.

Figure 1. Artificial (artificial) mechanism of pathogen transmission

Figure 2. Ways to implement the artificial (artificial) mechanism of HIV transmission

4. Clinical manifestations

During HIV infection, several periods can be distinguished: incubation period; period of early clinical manifestations; latent period; the period of development of secondary diseases and the terminal period. It should be noted that an infected person is contagious at all stages of the disease, but especially during the acute period and the stage of AIDS, when the virus multiplies intensively in the body.

As with any other infection, after HIV infection there is an incubation period - the period from infection to the appearance of clinical signs of the disease. It can vary widely: from 2-4 weeks to a year, on average - 3 months. Since during HIV infection, sometimes the only sign of the body’s response to the introduction of the pathogen is the appearance of antibodies to HIV, the incubation period can also represent the time interval between infection and the appearance of antibodies. During the incubation period, the diagnosis of HIV infection can be established by detecting the virus itself, its antigens or its genetic material. The incubation period in the classic course of HIV infection ends with acute primary infection.

The duration of early clinical manifestations of “acute HIV infection” in 50-70% of patients is 1-2 weeks and is expressed by symptoms similar to acute respiratory infection: swollen lymph nodes, fever, drowsiness, malaise, headache, pain in the orbit, photophobia, various types of rashes, cough, runny nose. This painful condition goes away after 2-4 weeks without any treatment (spontaneously), after which the so-called latent period of HIV infection begins. Often the stage of primary manifestations is asymptomatic or the symptoms are not paid attention to.

After the primary manifestations subside, in most cases a period of stabilization begins. This latent period lasts for many years. The average life expectancy of an infected person is now estimated at 12 years (10-15 years). But it is known that a small part of homosexuals infected at a young age (in the United States) live with HIV infection for more than 20 years without experiencing significant health problems, however, there is no reason to say that they will not get sick in the near future. At the same time, cases of death from AIDS have been described within 7 months from the moment of infection. The only typical clinical manifestation of HIV infection at this stage may be an enlargement of several groups of lymph nodes. Patients' health is usually not affected, but HIV-infected people are contagious to healthy people. The majority of people with HIV infection in our republic are now at this stage, and many may not know that they have a hidden disease, because it is impossible to determine whether a person is infected with HIV or not by appearance.

The next period is the period of secondary diseases. This is a period of development of immune deficiency, clinically manifested by the appearance of opportunistic diseases (infections that, with a healthy immune system, do not harm the body, but against the background of immunodeficiency cause serious consequences). The appearance of certain opportunistic diseases is associated with the level of CD4 lymphocytes; the lower it is, the more these diseases progress. AIDS itself is the most severe form of the disease. This last stage of HIV infection lasts from 6 months to 2 years. It can occur in various forms, among which the most common are pulmonary, intestinal, damage to the central nervous system, skin, and mucous membranes. In all these cases, the mechanism is the same: taking advantage of the fact that HIV infection has destroyed the body’s defenses - its immune system - the causative agents of other diseases (bacteria, viruses, fungi, protozoa) are activated, that is, a secondary infection occurs, from which the AIDS patient in the end he dies.

Most often, AIDS occurs in the pulmonary form (in 50-80% of patients), which manifests itself in the development of pneumonia, which is much more severe than in those uninfected with HIV, in a special form - Pneumocystis.

Many patients develop the intestinal form, which manifests itself in the form of prolonged (several months), but not very intense diarrhea, which leads to a loss of body weight by more than 10% and dehydration of the patient. Gastrointestinal diseases in AIDS are usually caused by yeast-like fungi of the genus Candida (candidiasis), tuberculosis bacteria, salmonella, and cytomegaloviruses. The chronic form of dysentery may worsen. The manifestations of these diseases can be very diverse.

In 15-20% of cases, AIDS occurs in the form of a secondary infection that affects the central nervous system (meningitis, encephalitis, brain abscesses, etc.), and in another 2-3% of cases a brain tumor occurs. Patients' body temperature rises, headaches appear, memory and intelligence decrease, they become lethargic and lethargic. Reproduction of the virus in brain cells and cerebrospinal fluid causes brain atrophy. Consequences: personality disintegration, dementia, progressive memory loss, epileptic seizures. The ability to infect the human brain gives the virus a completely new quality. According to French scientist Luc Montagnier, the virus's invasion of the brain means that the 5-10 million virus carriers who are not yet aware of their disease will ultimately suffer from brain atrophy even if a cure for AIDS is found. In 50-60% of patients with AIDS, lesions of the skin and mucous membranes (long-term non-healing erosions) are observed. In this case, various multiple tumors often develop, including Kaposi's sarcoma - cancer of the walls of blood vessels. With AIDS, activation of yeast, bacterial, fungal and viral infections is observed on the skin and mucous membranes. Infections caused by staphylococci and streptococci are often observed. These lesions are one of the earliest and most sensitive signs of HIV infection.

The prognosis is unfavorable. Most patients die in the first two years after the onset of clinical manifestations of AIDS. Only 20-25% of patients live longer than three years.

5. Diagnosis

The main symptoms of the clinical diagnosis of AIDS are frequent infectious processes caused by opportunistic pathogens, in particular Pneumocystis pneumonia, recurrent respiratory infections, prolonged fever of unknown origin, weight loss of up to 10% or more, prolonged severe diarrhea, generalized lymphadenopathy, Kaposi's sarcoma, lymphomas CNS, prolonged unexplained lymphopenia. One of the nonspecific, but important laboratory indicators is a decrease in the number of T-helpers and their ratio with T-suppressors (T4/T8 0.6). The possibility of AIDS is indicated by the severe and long-term course of all diseases associated with immunodeficiency (for example, herpes zoster, candidiasis, etc.), as well as leukopenia, lymphopenia due to T-helper cells, thrombocytopenia. Thus, an important sign of AIDS can be all clinical and immunological manifestations indicating a violation of the immune system. Epidemiological history data are important.

Patients with various infections and malignant neoplasms among groups at increased risk of AIDS are subject to mandatory screening for AIDS.

Specific diagnosis of AIDS. Isolation of HIV from blood, cerebrospinal fluid, saliva, semen and other material is important for the diagnosis of seronegative AIDS, i.e. in cases where it is not possible to detect antibodies against HIV in patients with an AIDS-like symptom complex. However, the complexity of the virological research method makes its widespread use impossible at present. The standard method for laboratory diagnosis of HIV infection is the determination of antibodies/antigens to HIV using ELISA. There are a large number of domestic and foreign test systems, but they all quite often give false positive answers. Confirmatory tests (immune, line blot) are used to confirm results regarding HIV.

This method detects the core and surface proteins of HIV.

Differential diagnosis is carried out with all immunodeficiency conditions.

6. Treatment

Treatment of AIDS patients includes the use of antiviral drugs that suppress viral reproduction.

After confirmation of the diagnosis, approaches to further management of patients are determined.

The approach to choosing therapy should be individualized, based on the degree of risk. The decision about when to start antiretroviral therapy should be made depending on the risk of progression of HIV infection and the severity of immunodeficiency. If highly active antiretroviral therapy is started before immunological and virological signs of disease progression appear, its beneficial effect may be most pronounced and lasting.

Antiviral therapy is prescribed to patients, starting from the stage of acute infection. The main principle of treatment for AIDS, as well as other viral diseases, is timely treatment of the underlying disease and its complications, primarily Pneumocystis pneumonia, Galoshi's sarcoma, and DNS lymphoma.

The main problems that doctors faced in treating HIV infection were the high toxicity of drugs and the high adaptability of the virus to these drugs. Therefore, combination therapy has been proposed for treatment. Highly active antiretroviral therapy (HAART) involves the use of three (at least two) drugs that stop HIV from reproducing. Currently, three groups of drugs are known: the first and second are drugs that act on the enzyme reverse transcriptase and prevent the transfer of information from the RNA of the virus to the DNA of the host cell; the third group is drugs that act on another HIV enzyme - protease, preventing the formation of full-fledged HIV particles.

If you take medications in strict accordance with your doctor's instructions, the amount of HIV in your body will decrease to a minimum. To make sure that the drugs are working, special blood tests are used: a viral load test determines the amount of virus in one milliliter of blood; An immune status test determines how strong the immune system is (CD4 cell count).

For timely prescription of HAART, it is necessary that the patient undergo regular clinical and laboratory examinations. About a third of HIV-infected people remain healthy for 10 years without any treatment. Most patients in countries where therapy is available begin treatment 4–5 years after infection. In a small number of people, the disease progresses much more quickly and requires treatment much earlier. If during clinical observation there is a decrease in the CD4 cell count to 300 or below, as well as a stable increase in the viral load of more than 60 thousand copies/ml, this means that the disease is progressing, the patient is recommended to start treatment.

Sooner or later, most people with HIV will need treatment, but when this happens depends on many factors. HIV progresses to AIDS at different rates - faster for some people, slower for others. Drug use is considered one of the factors that leads to the progression of HIV infection to the AIDS stage. Firstly, the effect of the drugs themselves weakens the immune system, and secondly, while taking drugs, antiretroviral therapy is ineffective, drugs can interact with the drug, causing poisoning and death.

Unfortunately, the use of HAART has its own difficulties. Firstly, side effects of a number of drugs have been noted, and intolerance to some components included in the drugs has occurred. In such cases, the drugs are changed to more suitable ones. Secondly, this therapy is very expensive (from 600 to 1000 US dollars per month). And although, according to the Law of the Russian Federation “On preventing the spread in the Russian Federation of the disease caused by the human immunodeficiency virus (HIV infection),” persons infected with HIV have the right to free lifelong treatment, in reality 3-4 regions of the Russian Federation treat their patients. Third, prescribing HAART requires strict adherence to medication regimen. The virus can develop resistance to a particular drug if it is taken irregularly or in insufficient doses. This stability is called resistance. If you take too small a dose or skip a dose, the level of the drug in your blood will decrease and become less than optimal. This will allow the virus to begin to multiply again, and, having multiplied in the presence of a certain number of drugs, those variations of the virus that are resistant to these drugs are more likely to survive. When drug doses are missed, resistance does not necessarily occur, there is simply a risk that it will happen, and the more often the missed doses occur, the higher the risk that this will happen. In principle, a few missed doses in one month are sufficient for resistance to occur. Not everyone is able or willing to follow the doctor's strict instructions, which leads to the emergence of drug-resistant HIV strains, thereby reducing the effectiveness of therapy.

Adequate therapy consists of creating a favorable psychological environment for the patient, timely diagnosis and treatment of underlying diseases, careful clinical observation and timely initiation of specific therapy and treatment of opportunistic infections and cancer.

It is believed that treatment of opportunistic infections, Kaposi's sarcoma in patients with AIDS should be carried out with sufficiently high doses of antibiotics and chemotherapy drugs. A combination of these is preferable. When choosing a drug, in addition to taking into account sensitivity, it is necessary to take into account the patient’s tolerability, as well as the functional state of his kidneys due to the danger of drug accumulation in the body. The results of therapy also depend on the careful adherence to the technique and the sufficient duration of treatment.

Despite the fairly large number of drugs and methods of treating AIDS patients, the results of therapy are currently very modest and cannot lead to complete recovery, since clinical remissions are characterized only by suppression of the process of virus replication and, in some cases, a significant reduction in the morphological signs of the disease, but by no means complete their disappearance. Therefore, only by preventing the replication of the virus will it be possible to give the body resistance to opportunistic infections and the development of malignant tumors by restoring the functions of the immune system or replacing destroyed immune cells.

7. Prevention

immunodeficiency clinical treatment

Patients and virus carriers are under constant monitoring. They are warned of criminal liability for knowingly spreading the disease in accordance with current legislation. The main effective means of preventing AIDS is health education aimed at informing the population about the ways of spreading and means of preventing AIDS. Using condoms prevents sexual transmission of HIV. To prevent blood transfusion infection, donors are screened for antibodies against HIV. Prevention of infection by parenteral routes in medical institutions involves the provision of disposable medical instruments and strict adherence to the sterilization regime.

To actively identify patients and virus carriers, it is necessary to conduct preventive examinations in groups at high risk of infection, as well as among the sexual partners of patients and virus carriers. Anonymous examination rooms are important for identifying HIV carriers and patients.

Pre- and post-test counseling as prevention

HIV transmission

FBUN Central Research Institute of Epidemiology of Rospotrebnadzor has developed Methodological recommendations “Pre- and post-test counseling as the prevention of HIV transmission.”

HIV infection is a disease whose spread is associated with human behavior. Therefore, disease prevention is based on changing people's behavior.

To help change people's behavior towards HIV infection, it is necessary to:

· draw attention to the problem of HIV infection;

· make it meaningful for specific people;

· evoke an emotional response to the problem of HIV infection;

· improve knowledge about HIV infection;

· help assess the individual risk of this disease;

· show ways of less dangerous behavior;

· stimulate decision-making to change behavior;

· provide support.

The main method of detecting HIV infection is testing for HIV antibodies with mandatory pre- and post-test counseling. The presence of HIV antibodies is evidence of HIV infection. A negative HIV antibody test result does not always mean that a person is not infected, since there is a “seronegative window” period (the time between HIV infection and the appearance of antibodies, which is usually about 3 months).

What does counseling and testing for HIV antibodies provide?

The one who passed the test.

If the result is positive:

· access to necessary medical care (determination of the stage of HIV infection, prescription of ART, prevention of opportunistic diseases, vaccination, screening for other STIs and tuberculosis, other medical procedures);

· a conscious opportunity to change your behavior in order to protect other people from infection;

· a chance to intelligently replan your life based on new circumstances.

If the result is negative:

· motivation to change behavior to prevent future HIV infection;

· medical care for other diseases not related to HIV;

· the opportunity to receive counseling on the problem of HIV infection and associated risk behavior.

To another person:

· If a pregnant woman tests positive for HIV, special preventative measures can reduce the risk of infection of the unborn child. Voluntary testing and counseling of pregnant women makes it possible to promptly offer them the preventive treatment necessary to preserve the health of the unborn child.

Public health:

· testing for HIV antibodies contributes to the safety of donated blood and organs;

· epidemiological data on current risk behaviors in relation to HIV transmission are necessary for the development of effective programs for the prevention and treatment of HIV infection.

The listed possibilities can only be realized if effective pre- and post-test counseling is carried out.

Pre-test counseling for testing for HIV antibodies as a prevention of HIV transmission

Pre-test counseling is a confidential dialogue between a client and a health care professional to discuss an HIV antibody test and the possible consequences of knowing one's HIV status. Such counseling

Leads to making an informed decision about testing

· or refusal to take the test .

Counselors should be able to communicate the basics of HIV testing to the patient, as well as

· routes of HIV transmission;

· ways to protect against HIV infection;

· types of medical and psychosocial care that people infected with HIV can receive.

Post-test counseling for testing for HIV antibodies as a means of preventing HIV transmission

Post-test counseling is a confidential dialogue between the applicant and a health care worker with the aim of:

· discussion of the results of the HIV antibody test,

· providing relevant information,

· providing support and referrals to other specialists,

· and to encourage behavior that reduces the risk of infection (if the test results are negative), or reduces the risk of transmitting HIV to others if they are positive (ie the patient is infected).

Post-test counseling should be carried out when:

· negative result (patient from low and high risk groups);

· uncertain result;

· positive result.

A few simple rules will help you avoid problems in the future:

· taking care of your health, preventing injuries and accidents, following safety rules also represents the prevention of HIV infection through the parenteral route (through blood);

· preventing the spread of HIV infection among injection drug users;

· use of personal or disposable instruments; for all medical and cosmetic problems, contact specialized institutions where all norms and requirements of the sanitary and epidemiological regime are observed.

· timely initiation of antiretroviral therapy for HIV-positive women preparing to become mothers. All women, when registering for pregnancy at antenatal clinics and before giving birth, must undergo an HIV test. When HIV infection is detected in late pregnancy, more intensive treatment regimens are used.

· If an HIV-infected woman decides to give birth to a child, she should be prepared for the fact that after childbirth the viral load on her body may increase sharply and her general health may deteriorate. Added to this are psychological problems: uncertainty about the child’s HIV status, the inability to breastfeed, etc.

Specific prevention of AIDS has not been developed.

8. Nursing care for HIV/AIDS

The main goal of nursing care is to help the patient adapt as much as possible to his condition, taking into account the identified problems throughout the entire period of HIV and AIDS.

Nursing interventions are aimed at addressing both the patient's existing and potential health problems.

One of the problems is mental disorders at the stage of reporting the diagnosis of HIV infection, which can occur as psychogenic reactions, such as concerns about life expectancy and its quality, financial stability and employment; fears about future loneliness, expected social isolation, sexual tension. The patient at this stage is characterized by a state of depression, anxiety, irritability with simultaneous indecision and uncertainty.

Due to the lack of full-time psychologists, the problems of patient adaptation fall on the shoulders of doctors and nurses. Therefore, the nurse must have good communication skills, master the techniques of psychoanalysis, and nursing pedagogy.

Nurses have the following tasks:

Elimination of factors that impede adaptation processes throughout the entire period of HIV infection and stages of AIDS;

Tactfully informing the patient about the disease and health status;

Training adult patients in self-care and monitoring their condition; relatives and close people - caring for patients in serious condition and prevention issues;

Providing qualified nursing care, including accurate implementation of the diagnostic process (interdependent nursing interventions) and timely implementation of medical prescriptions (dependent nursing interventions).

The role of the nurse is especially important when providing complex individual treatment for HIV-infected people. The plan of care includes dependent, interdependent, and independent nursing interventions. When conducting dependent (following doctor's orders) and interdependent (diagnostic, laboratory tests) interventions, nurses must ensure self-protection, as well as take measures to prevent both the spread of HIV infection and the infection of the HIV-infected or AIDS patient himself.

Conducting independent nursing interventions for HIV-infected people at home has certain features.

An integral component of specialized care for HIV-infected patients is palliative care. Palliative care is a relatively new area of healthcare and, as defined by the World Health Organization, is aimed at improving the quality of life of patients and their loved ones facing the hardships of a life-threatening illness. The main goal of palliative care is to prevent and relieve suffering caused by a progressive, incurable disease. Early identification, careful assessment and effective treatment of pain and other symptoms, as well as psychological, social and spiritual problems, are integral to quality palliative care. One of the important components of palliative care is nursing care.

Nursing care for patients with HIV infection consists of a number of activities, each of which is not something special for the nurse:

Communication with the patient;

Healing procedures;

Compliance with anti-epidemic measures;

Elements of general care.

However, a number of features make caring for a patient with HIV infection special and quite complex. What are these features?

1) The nurse is dealing with an infectious patient, whose care requires special care and strict infection control. This is compliance with the rules of sanitary-hygienic and anti-epidemic regime, the use of aseptics, proper storage, processing, sterilization and use of medical products and care items.

Basic infection control requirements for home care:- maintaining cleanliness;

Preventing the possible spread of infection;

Ensuring your own safety.

2) In patients with HIV infection, especially in the stage of deep immunodeficiency, sensitivity to microorganisms (from yeast to viruses), widespread and normally harmless, increases. Therefore, HIV-infected patients need enhanced protection from microorganisms contained in the environment, careful care and isolation. Those who suffer from any infectious diseases should not work with HIV-infected patients.

3) HIV infection is a chronic disease with a long progressive course and a huge variety of clinical manifestations. When caring for HIV-infected patients, the nurse deals with a large number of different diseases, accompanied by damage to the anatomical and physiological systems of the body and various organs in various combinations. Therefore, a nurse must have the skills to care for different categories of patients: infectious, therapeutic, urological, gynecological, oncological, etc.

4) HIV-infected patients inevitably have social and psychological problems. When caring for such patients, the nurse is constantly in contact with strong and painful emotions, predetermined circumstances in which the dying person and his loved ones find themselves.

All these features require nurses to have professional knowledge, extensive life experience, and the ability to see all the patient’s problems entirely in a single complex. Such qualities of a nurse as mercy, goodwill and human understanding become especially necessary.

Antiretroviral therapy and the role of the nurse in the management of therapy

Medicines used to treat HIV are called antiretroviral drugs (ARVs). They are designed to target the virus and preserve the patient's immune system. To date, it cannot be said that ARV therapy cures HIV infection. However, ART can enable patients to live longer, healthier lives, prevent the development of many AIDS-related diseases, and improve their quality of life.

Medicines are prescribed by a doctor after discussion with the patient, based on existing recommendations, the individual characteristics of the patient’s body, lifestyle, availability of drugs and the possibility of receiving them regularly. When choosing ART regimens, the following factors are taken into account:

Side effect;

Opportunities for future maintenance therapy;

The patient's expected adherence to the course of treatment (including taking into account the views of parents or caregivers);

Concomitant conditions (for example, co-infections, nutritional disorders, metabolic disorders);

Concomitant use of other drugs (i.e. potential pharmacological interaction);

Possible infection with a strain of the virus with reduced susceptibility to one or more ARV drugs;

Availability of ARV drugs and cost-effectiveness of ART.

Prescribing medications is the responsibility of the doctor. However, in a hospital, nurses are responsible for the safe storage and correct administration of medications, bearing both legal and professional responsibility for this. Even if the patient is self-administering medication, nursing staff in the hospital and outpatient settings play a role by educating/counseling the patient and monitoring medication adherence and effectiveness.

Dispensing medications is not just a “delegated” medical function. In the very recent past, the functions of the nurse in relation to the patient’s medication intake were reduced to a simple formula, namely, to give:

The right medicine

To the right patient

In the right dose

In the right way

At the right time.

Although this principle continues to be important as a basis today, the responsibilities of the nurse today go beyond simply ensuring that medications are taken as prescribed.

Medication management is such an important element of modern health care, and modern medicines are so powerful, that nurses, along with their physician and pharmacist colleagues, participate in a system of monitoring and making trade-offs to achieve the highest possible level of quality care. Nurses directly monitor their patients' conditions and may be the first to observe reactions to medications. Thus, in order to be able to take the correct action, the nurse must know the nature of the possible reaction.

Responsibilities of the nurse in organizing the receptionmedicines

1) The nurse must be able to recognize errors in prescriptions and question incorrect or “unusual” prescriptions.

2) The nurse must actively monitor the occurrence of adverse reactions and side effects of medications, draw the attention of medical personnel to such cases and monitor the correctness of medications.

3) When a patient takes medications, the nurse serves as the patient's last line of defense against possible errors.

Carrying out your nursing responsibilities professionally means not simply “doing” something, but always doing it thoughtfully. To perform this role in relation to the administration of medications to a patient and monitoring their beneficial and undesirable effects in any situation, nurses need knowledge of the nature of the medications and the person to whom they are prescribed.

Knowledge of the drug should include the following aspects:

The main pharmacological action of the drug;

Usual Dosage Limits;

Reception interval;

Mode of application;

Desired effect;

Contraindications to its use:

Potential adverse reactions or side effects;

Interaction with other drugs.

Analysis of the patient's condition

Before prescribing any medication, the nurse, along with the doctor, must assess the patient's condition. This assessment should be made regardless of the fact that the doctor has already checked everything, since the patient may provide the nurse with additional or different information. Analysis of the patient's condition should include a study of his medical history, drug history, as well as an analysis of the current condition. Although such anamnesis may be perceived by both the nurse and the patient as an unnecessary repetition of what has been covered, some questions, for example, regarding allergies, are really not superfluous.

The effect of a drug on a person’s physiological and emotional state depends not only on the pharmacological properties of the drug. Wide variations in the response of different people to the same drug may be due to both individual characteristics and the social and cultural environment. All these factors can enhance or weaken the effect of drugs.

It is important to collect and analyze the following information:

1) Initial data necessary for assessing the therapeutic and undesirable effects of taking medications. This data is necessary when taking ARV drugs that reduce the number of copies of the virus. Without knowing the initial “viral load” numbers, we will not be able to assess the effect of treatment.

2) The presence of any “risk factors”. For example, increased sensitivity to drugs.

3) The patient's ability to self-help. It may change during treatment and should therefore be constantly monitored.

4) A person’s understanding of his condition and the prescriptions made to him, his reaction and related feelings.

5) The patient's ability to safely store or administer their own medications, if available.

In the drug therapy of a patient, the nurse plays as important a role as the drug itself.

The nurse must monitor how the medicine is taken and whether the doctor's prescriptions are being followed correctly. This is also very important for developing in the patient a certain confidence in the success of treatment, in the fact that he is not alone in facing the disease.

Assessing the effectiveness of medical monitoring of the implementation of a therapeutic program (medication intake)

1) Does the patient comply with the prescribed drug therapy regimen, and, if not, then for what reason:

Skipping medications.

Skipping a dose of some medications will reduce the amount of drug in your body and the effect of the medication may be reduced.

Cancellation of drug therapy.

Stopping drug therapy on your own can lead to unpredictable problems.

Non-compliance with medication regimen.

Non-compliance with medication regimens is often associated with insufficient patient awareness and misunderstanding of the need to adhere to prescription regimens.

Errors when taking medications.

The time of taking the drug, the dose and method of administration may be changed, or the medicine may not be taken at all. If such an error occurs, you should monitor the patient's condition and notify the doctor or nurse if there is a change in the patient's condition. The degree of harm caused to a patient when an error is made may vary. The most serious consequence is death.

2) Effects of prescribed medications (positive and negative).

The effect of any drug on a person (general drug effect) depends not only on its pharmacological properties, but also on a number of factors, including the following:

Characteristic features of the drug itself (taste, shape, color, smell).

Personal qualities of the patient taking the drug (treatment experience, education, personality, level of responsibility, adherence to therapy).

Personal qualities of the health worker prescribing the drug (professional status, authority).

The conditions in which the drug is taken (doctor’s office, everyday situation).

Since the overall effect in each specific case depends on a combination of these factors, the reaction of patients to the same drug can be completely different. Considering that nurses are responsible for the correct use of prescribed medications by the patient, they must be well aware of the features of use, action and side effects of the drugs taken by the patient. That is why health care workers - both doctors and nurses - must regularly improve their knowledge regarding medications.

To organize a timely treatment process, nurses are recommended to use pill boxes in their work. These are special cases for medications, which have separate sections for medications for each appointment. According to a number of international studies, the use of a pill box to organize daily doses of ARV therapy significantly improves patient adherence to treatment. In hospitals, pill boxes are used to structure the layout and dispense medications at the nurse’s station. For this purpose, as a rule, tablet boxes are used with the ability to indicate your full name. sick. In addition, to make the nurse’s work easier, there are special cassettes for laying out 10-20, etc. individual pill boxes at the post.

Tablet boxes can also be recommended for individual use by a patient during long-term and careful use of medications. Placing pills in segmented pill boxes helps patients notice missed doses. In addition, some types of pill boxes are equipped with a timer that reminds the patient when to take the medication with an audible signal. It is also important that the compact tablet box is convenient to carry with you and this frees a person from the need to take several bottles of medications with him. Numerous studies in a variety of chronic diseases (hypertension, coronary heart disease, HIV infection, etc.) convincingly show that the use of tablets by patients significantly improves adherence to therapy and is associated with greater treatment effectiveness. Having a pill box, especially one with a timer, can significantly affect the minimization of missed doses of medications, vitamins, etc.

conclusions

Having studied all the literature data, I come to the conclusion that the role of the nurse in the prevention of HIV infection is enormous, because people from different walks of life are confident that this will not affect them. In addition, with the growing number of drug addicts and among them, it is also necessary to conduct conversations about individual syringes when taking drugs. The role of the nurse in prevention also applies to school-age children from the very first grades, so that they know that any unprotected sex can be dangerous for contracting HIV infection.

The role of the nurse in diagnosis is invaluable, because... During pre-test counseling, she tells the patient about the purpose and procedure of testing, as well as about the possibilities of treating HIV infection and the availability of various types of social support. Explains to the patient why it is necessary to repeat the tests after 3-6 months if the result is uncertain, and invites the patient to undergo this study in different clinics, emphasizing that these highly sensitive tests are carried out by people, where the human factor cannot be excluded.

The role of the nurse in treatment. Having studied the methods of treating VAAR with drugs, I realized the main feature is that all these drugs, with all their reliability, require timely administration, because Missing even one dose can lead to mutation of the virus, which in turn leads to the selection of new drugs for treatment and loss of precious time.

Literature

1. HIV: prevention of mother-to-child transmission: Proc. Manual/V.I. Kulakov, I.I. Baranov - M.: VEDI, 2003.

2. M.A. Nikitina, O.Yu. Egorova, G.A. Batrakova “The role of the nurse in providing care for HIV-infected patients” Guide for nurses. Volume 3. ROO "AIDS infocommunication", 2008

3. Palatova N.M., Egorova O.Yu. "HIV infection. Clinical manifestations and forms. Features of the nursing process. Prevention of occupational infections." Methodological manual, Moscow, 2010.

4. Rakhmanova A.G., Prigozhina V.I. Infectious Diseases: A Handbook (3rd ed.). - - St. Petersburg: Peter, 2002.

5. Nursing in infectious diseases and the course of HIV infection and epidemiology/R.V. Titarenko.-Rostovr/D: Phoenix, 2009.

6. Pre- and post-test counseling as prevention of HIV transmission - Methodological recommendations. - M.: Federal Service for Supervision of Consumer Rights Protection and Human Welfare, 2013.

Posted on Allbest.ru

...

AIDS symptoms

Not only do people with AIDS have different symptoms, but even within the same person, symptoms and conditions can change from day to day. As a person's HIV infection progresses and their immune system weakens, some or all of the following symptoms may occur:

Some of these symptoms are also seen in other diseases, so they do not always indicate AIDS. But if a person experiences any of these symptoms for more than a month, he should consult a doctor as the possibility of AIDS is very high.

Routes of HIV transmission:

To a husband or wife through sexual intercourse from a spouse infected with HIV.
Through a syringe, razor or any other cutting and stabbing instrument from a person infected with HIV, if the instrument is not properly handled and/or used together for injections, shaving, tattooing, ear piercing, etc.
From a mother infected with HIV to her fetus or newborn baby during pregnancy or childbirth.
From a mother infected with HIV to a newborn baby while breastfeeding.
During transfusion of blood and drugs obtained from blood containing HIV.
When a medical worker comes into contact with infected blood (surgeons, resuscitators, anesthesiologists, dentists, nurses of various specialties, patient care staff, etc.).
When exposed to a patient in a healthcare facility undergoing certain procedures, if infection control rules are not followed by health care workers.
When a medical worker comes into contact with the biological fluids of an HIV-infected patient.
Through the blood or other biological fluid of one patient infected with HIV to another patient. In this case, infection occurs through the hands of a hospital employee or diagnostic and treatment equipment.
Through instruments contaminated with HIV and used to pierce skin or mucous membranes, and through the hands of people using this equipment.

General rules for caring for patients with AIDS

A person with AIDS needs the same caring care as any other patient. He needs help with what he cannot do for himself. Since his illness is incurable and often isolates him from other people, he may need special moral support, warmth and kindness from you.

It must be remembered that AIDS is a syndrome, a collection of different symptoms that can change from day to day. You must change the nature of care as the patient's condition changes and the patient develops different specific needs related to the disease.

Cleaning the premises

The room (apartment) where the patient lives must be wet cleaned daily using any household detergents. If furniture, furnishings, or floors become contaminated with blood, semen or vaginal discharge, they must be thoroughly disinfected. To do this you need (be sure to wear rubber gloves):

Remove contamination with a paper napkin, which is then placed in a plastic bag or soaked in any disinfecting solution for 1 hour, after which you can throw it in the trash.
Wipe the contaminated areas with a damp cloth with a disinfecting solution or rinse thoroughly with hot water and any household detergent recommended for treating surfaces or washing clothes.
Wash off any remaining disinfectant or detergent with clean water.
Soak the rags used for treatment for 1 hour in a disinfecting solution or boil for 30 minutes. You can also soak the rags for 2 hours in a solution of any detergent for washing clothes.
After treatment, rubber gloves must be soaked for 1 hour in a disinfecting solution or for 2 hours in a solution of any detergent for washing clothes.
Hands are washed thoroughly with soap and dried with a towel. If there are wounds or abrasions on your hands, they should be covered with an adhesive bandage before cleaning.

Four principles of caring for people with AIDS

All principles of care are important when caring for someone with AIDS, but four require special consideration.

Respect. The person you are caring for may have experienced unfair and hostile treatment because of their illness. His dignity, self-respect and sense of self-worth may have been damaged. You can help him regain his dignity by being respectful, compassionate, and sensitive to his feelings and needs while caring for him.

Communication. People with AIDS may be isolated from their friends and family because of the disease or the way others treat them. Maybe they need to talk to someone about their fears and feelings of loneliness. One of the most important services you can provide as a caregiver is being a good listener.

Independence. Often a person with AIDS loses a lot in his life. Because of his illness, he may lose his job, his home, his friends, his family, and many of his physical abilities. The patient should be cared for in such a way as to encourage him to remain as independent as possible. You can help him maintain maximum control over his daily life while conserving as much energy as possible. He will need them to fight secondary infection.

Infection control. Some people who work with AIDS patients are afraid of getting infected. To prevent this from happening, it is necessary to follow infection control rules specifically designed to protect caregivers and the people they care for from exposure to body fluids that are infected. You must follow infection control guidelines closely when caring for someone with AIDS, just as you would follow them when caring for any patient. When caring for someone with AIDS, you should behave in the same way as if you were caring for someone else. You can safely touch a person, help him, hug him, and laugh and talk with him. Due to the weakened immune system of an AIDS patient, fighting infections is very important to his well-being. You cannot care for a sick person if you yourself suffer from colds or other contagious diseases. You must be especially careful not to infect the patient.

Basic rules of infection control when working with patients with AIDS:

The patient must observe the rules of personal hygiene. Contaminated material (bandages, cotton wool, sanitary tampons, pads, etc., contaminated with blood and other secretions dangerous for infection) after use should be placed in a plastic bag and destroyed, used disposable syringes should be collected in containers made of tin or thick plastic with a disinfectant solution, then dispose of it.
Wearing double latex gloves whenever there is a possibility of contact with any kind of secretions (body fluids) of a sick person. Removed gloves are not reused. During work, gloves should be treated with 70% alcohol or appropriate disinfectant solutions.
In case of accidental damage to the skin, gloves should be immediately treated with a disinfectant solution and removed. Squeeze the blood out of the wound, wash your hands thoroughly with soap and running water, treat them with 70% alcohol, lubricate the wound with a 5% iodine solution.
If your hands are contaminated with blood, you should immediately treat them for at least 30 seconds with a cotton swab moistened with an approved skin antiseptic (70% alcohol, 3% chloramine solution, iodopirone, sterillium, octeniderm, octenisept, chlorhexidine, etc.), wash Wipe them twice with warm running water and soap and wipe dry with an individual towel or napkin.
If blood or other biological fluids get on the mucous membranes (eyes, mouth, etc.), they should be treated immediately by rinsing the eyes with water or a 1% boric acid solution, the nasal mucosa with a 1% protargol solution, and the oral mucosa with 70% solution. alcohol solution or 0.05% solution of potassium permanganate (potassium permanganate) or 1% solution of boric acid.
When caring for a patient, you should wash your hands frequently.
You should avoid touching the patient and his personal belongings if you have a skin infection.
You should not communicate with someone with AIDS if you currently have chickenpox.
You should not communicate with someone with AIDS if you have recently had chickenpox.
You should not communicate with a person with AIDS if you have not previously had chickenpox, but have recently been in contact with someone with chickenpox.
You cannot communicate with an AIDS patient if you are suffering from the viral disease herpes.
Food prepared for the patient must be of good quality.
It is advisable not to use ready-made culinary products.
You should not give a patient raw milk to drink or eat products made from it unless they are pasteurized.
You should not give food that has expired.
Wash fruits and vegetables thoroughly.
The meat must be well cooked.
The patient should not share a razor, toothbrush, tweezers, scissors, earrings or other reusable items that may cause skin damage or bleeding.

Memo on teaching the patient and his relatives about infection control (how to behave correctly if one of your family members is HIV-infected)

The leaflet was compiled by the Sverdlovsk Regional Center for the Prevention and Control of AIDS and Infectious Diseases.

Observe the rules of personal hygiene: regularly wash your hands, take a shower, use individual toothbrushes, combs, razors, and use only disposable syringes when treating at home.
Take special care of parts of the body with a high level of microbial contamination (groin folds, armpits, perineum, genitals).
Take preventive measures when administering drugs - use only disposable syringes and do not throw them away after use.
Used bandages, napkins, hygiene bags, disposable syringes should be disinfected or destroyed.
Maintain cleanliness in common areas (bathrooms, showers, toilets).
Carefully follow all doctor's recommendations and prescriptions.
It is imperative to complete the full course of prescribed anti-retroviral and antibacterial therapy even after discharge from the hospital.
Immediately contact your doctor if any disease appears or the condition of an HIV-infected person worsens.
Follow a work-rest schedule and eat right.
When caring for an HIV-infected person at home, rubber gloves should only be used in case of contact with his blood, semen or other potentially dangerous secretions.
Disinfect furniture if it is contaminated with blood, semen or other potentially dangerous secretions of an HIV-infected person.

Education for family members of an HIV-infected person and caregivers is necessary because:

If the basic rules of behavior in the family are not followed, there is a risk of infection among family members.
For weakened people with HIV infection (in the later stages of the disease), relatives and visitors (guests) can become a source of various infections with adverse consequences.

Symptomatic care for patients with AIDS

Patient care is carried out in accordance with the symptoms that are currently present in the patient and the problems that concern him.

Prolonged bed rest

As the patient's condition worsens, he will spend more time in bed. Due to this:

Change the patient's position in bed frequently.
Monitor the condition of his skin and prevent bedsores.
Try, if possible, to maintain the patient’s physical activity; if necessary, perform gentle passive exercises within the limits of possibility.
Do simple things to make your ward feel better, for example, rub his back, place a bell next to him so that he can ring when he needs to call you.
For more details, see the section Bedridden patient.

Oral infection

If you have stomatitis (the appearance of ulcers, plaque in the mouth, pain that makes it difficult to eat and drink), it is necessary to provide repeated oral care using a toothbrush with soft bristles, a disposable sponge for oral care, and a special solution prescribed by a doctor. Do not touch sores or white deposits. Attempts to scrape them off may cause bleeding. Tell the doctor if your child has problems swallowing food. He may prescribe a gentle diet that includes foods that are easy to chew and swallow. Offer your client water if the oral mucosa is irritated by drinking juices or carbonated water.

Diarrhea

Take good care of your perineal skin. Keep your skin clean and dry. Encourage your client to drink more often to replenish lost fluids. Tell your doctor about the frequency of your stools, as well as their color and consistency. Since your client is experiencing discomfort and shame due to his inability to hold his chair, you need to reassure him that you are sympathetic to his problems and are not angry with him for it. Keep a low profile and tell him that it would be easy for you to help him get to the toilet or help him clean up after the incident. If you behave calmly, this will help your ward feel calm and experience less discomfort.

Nausea and vomiting

Intoxication resulting from an infectious disease, as well as from taking medications, causes nausea and vomiting. If possible, provide the ward with comfortable conditions. Ask him what you can do and how you can help him to make him feel comfortable. If possible, eliminate unpleasant odors in the patient's room. After vomiting, wipe his face with a tissue lightly moistened with water. Give water to rinse your mouth. Before serving food or liquid to your client, wait until he is ready for it. Give him cool liquids in small portions when he is ready to eat again. Report to the physician if your client experiences nausea or vomiting so that appropriate drug therapy can be prescribed. Also, be especially careful when counting and recording the amount of liquid taken by your ward. Come to the rescue when a patient first contacts you.

Respiratory dysfunction

The patient may experience difficulty breathing (shortness of breath), a painful cough, suffocation, and become very nervous because of this. Reduce the patient's physical activity if he or she develops shortness of breath or cough. Check his body position in bed frequently. Give his body an elevated position (sitting) to make breathing easier. Make sure that nothing obstructs or restricts the breathing movements of the chest. Recommend your ward to avoid places where people smoke. Stay with the patient for as long as he or she has trouble breathing. Sit or stand next to him calmly. Your calmness will help him calm down. Remember that any upset or anxiety can make shortness of breath worse. Anxiety and fear of suffocation cause difficulty breathing, and difficulty breathing leads to even greater fear.

Edema

Swelling can be observed in various parts of the body, including the face. Apply cold compresses to swollen areas. Raise the head of the bed. Place several pillows under your back if there is swelling in your face. If there is swelling in your legs, elevate the foot end of the bed. Check with a specialist about places to place pillows if the patient has swollen arms and legs, feet and hands. Raising swollen parts of the body above the level of the heart helps reduce swelling. Monitor your client's skin regularly. The skin over the swollen area may stretch or crack. Carefully care for the skin of your ward, gently treating it in swollen areas with lotion. This can keep your skin from becoming dry and prevent cracks from forming.

Chronic fatigue

Feeling unwell and chronic fatigue are the most common symptoms of AIDS. Ask the patient how you can help him. Make him interested in taking care of himself. Ask him what personal care activities he would like to receive your help with, and what activities you should include in your care plan. Whenever possible, offer the patient as much personal care as possible to maintain his energy and strength. Offer him frequent rest during walks and bathing. Plan your care so that the patient is rested and alert while participating in enjoyable activities (such as visiting friends).

Fever

Many opportunistic infections cause low-grade fever during the day or evening and may be accompanied by night sweats (heavy sweats). Recommend that the patient take plenty of fluids to compensate for the fluid lost by the body during sweating. Offer your client a sponge moistened with water at room temperature to reduce high fever. At the same time, make sure that the ward does not become hypothermic. Cover it with a light blanket while drying. Change bedding and clothing frequently if your client is sweating profusely. Use an ice pack (as directed by your doctor). Apply the bladder, wrapped in a soft cloth or towel, to the patient's armpit or groin area, or to both areas at the same time. Never apply an ice pack directly to your skin. Take the patient's temperature frequently if they are taking antipyretic medications.

Weight loss

Many patients lose up to 20% or more of body weight, including muscle and fat tissue. This can contribute to infection, damage to the skin and mucous membranes. Provide your ward with high-calorie foods high in protein, such as cottage cheese, butter, margarine. Spread butter on apple and banana slices and add honey to tea. Maintain the patient's calorie level between 2000 and 2700 per day. A healthy diet is very important to maintain the patient’s immune system and to prevent loss of body weight and muscle mass. In order to maintain muscle tone and strengthen your client's muscles, help him do physical exercises. Since there may be a thin layer of fat and muscle tissue between the patient's skin and bones, you will need to change the patient's body position every 2 hours to prevent the formation of bedsores, as well as provide him with careful skin care.

Mental (mental) disorders (brain dysfunction)

Because HIV often affects the nervous system, a person may experience confusion, memory loss, and other symptoms. Ensure that the caretaker's environment is safe and conducive to relaxation and rest. Reduce background noise and eliminate harsh sounds. Use short, easy-to-understand phrases when speaking. Help your client navigate time and environment by using items such as clocks and calendars to assist them. When communicating with a patient, always remain calm, as your calmness has a beneficial effect on the patient.

Moral support for an AIDS patient

Moral support is essential for someone with AIDS, but it can be difficult to provide. You may find the following tips useful:

Be a good listener. No matter how important what you are doing, stop to listen to what the patient has to say. This conversation may be the most important thing to him at the moment.
Be trustworthy. Don't gossip about the sick person with your family or friends. Living with AIDS is not easy. Respect your client's privacy.
Be a reliable person. Keep your promises and be punctual. There is a lot of uncertainty in the life of an AIDS patient. It is very important for him that he can count on you.
Be optimistic. Always try to draw the attention of your ward to any improvement in his condition, appearance, activity or ability to do something. At the same time, if he cares about something, respect his feelings. Do not try to belittle or embellish something that is very important and serious to the patient.
Don't let your client's aggressiveness fool you. Remember that the person you are caring for may be angry at their illness, not at you. Don't take his anger personally and don't let it affect the quality of your care for him.
Don't allow yourself to get emotional. While caring for someone with AIDS, you may develop strong personal feelings. Before your eyes, a person can melt away and die. You may feel sad, confused or angry that someone should be in such pain, but you should not show your feelings. Find someone you can talk to. Stop caring for the patient for a while if you feel that you no longer have the strength.

The patient's impaired needs: drink, eat, excrete, communicate, work, maintain body temperature, safety.

Patient's problem: high risk of opportunistic infections.

Goals of care: The risk of infection will decrease if the patient follows certain rules.

Nursing intervention plan:

1. Observe the sanitary and anti-epidemic regime in the ward (disinfection, quartz treatment, ventilation).

2. Provide a good night's sleep of at least 8 hours.

3. Provide adequate nutrition (proteins, vitamins, microelements).

b avoid contact with infectious patients; visitors with respiratory infections should wear masks;

ь avoid crowds of people;

b avoid contact with the biological fluids of another person;

ь do not use shared razors;

b Shower regularly using antibacterial soap;

b wash your hands after using the toilet, before eating and preparing food;

Don’t touch your eyes, nose, mouth with your hands;

b maintain oral hygiene;

b keep your fingernails and toenails clean;

b reduce contact with animals, especially sick ones, wash your hands thoroughly after interacting with animals;

b thoroughly wash and clean food, thoroughly cook meat, eggs, fish, avoid contact of cooked and uncooked food, do not drink raw water;

b get flu vaccinations;

b monitor the patient’s temperature and respiratory rate;

b teach the patient to monitor the symptoms of HIV disease - fever, night sweats, malaise, cough, shortness of breath, headache, vomiting, diarrhea, skin lesions;

b teach the use of anti-infective and special preventive medications, avoid taking immunosuppressive medications.

Patient's problem: difficulty eating due to damage to the oral mucosa.

Goals of Care: The patient will take the required amount of food.

1. Avoid very hot and cold, sour and spicy foods.

2. Include soft, moist, high-protein and fortified foods in your diet.

3. Rinse your mouth before eating with a 0.25% solution of novocaine, after eating with boiled water or a solution of furatsilin.

4. Talk about alternative methods of nutrition (through a tube, parenteral nutrition).

5. To brush your teeth, use soft toothbrushes that prevent gum trauma.

6. Use anti-infective medications as prescribed by a doctor (local and general treatment).

Patient's problem: diarrhea associated with opportunistic infections, a side effect of medications.

Goals of care: Diarrhea will decrease.

1. Assess which foods increase or decrease diarrhea and adjust your diet.

2. Provide a diet rich in protein and calories, low in dietary fiber.

3. Ensure sufficient fluid intake (water, juices, electrolyte solutions).

4. Apply infection precautions when preparing and eating food.

5. Ensure timely intake of antidiarrheal medications 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. Monitor weight, water balance, tissue turgor.

Patient's problem: a feeling of depression associated with changes in appearance (Kaposi's sarcoma, hair loss, weight loss, etc.) and the negative attitude of others. Option: low self-esteem.

Goals of care: The patient's mental status will improve.

1. Allow fears about lifestyle changes to be expressed in a supportive, non-judgmental environment.

2. Encourage relatives to communicate with the patient.

3. If necessary, refer the patient for consultation with a psychotherapist.

4. Teach relaxation methods.

Patient's problem: nausea, vomiting associated with opportunistic infections, side effects of medications.

Goals of care: The patient will experience decreased nausea and no vomiting.

1. Ventilate the room to eliminate odors that cause nausea.

2. Give dietary recommendations: eat small portions often, avoid hot foods, avoid foods with a strong smell and taste, drink 30 minutes before meals and not during meals, eat slowly and rest for 30 minutes after eating in a position with the head raised.

3. Teach to take medications prescribed against nausea and vomiting (medicines are given 30 minutes before meals).

4. Emphasize the need for careful oral care.

5. Provide the patient with a glass of water, a container for vomiting in case of vomiting and help the patient if it occurs.

Patient's problem: risk of weight loss.

Goals of care: The patient will receive adequate nutrition and will not lose weight.

1. Clarify the patient’s taste preferences and dislikes regarding food.

2. Provide the patient with high-protein and high-calorie nutrition.

3. Determine the patient’s body weight.

4. Determine the amount of food eaten at each meal.

5. Consultation with a nutritionist if necessary.

Patient's problem: cognitive impairment.

Goals of care: The patient will be adjusted to the level of his mental abilities.

1. Assess the initial level of mental abilities.

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 disagreements with the patient, as this may lead to the development of anxiety in the patient.

4. Prevent possible injuries 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 family support and instruct the caregiver (family) on the above interventions.

Caring for a person with dementia

Dementia is a syndrome of impairment of memory, thinking, orientation, understanding, calculation, learning, speech, judgment and other higher functions of the cerebral cortex, caused by a disease of the brain, usually of a chronic and progressive nature. It should be noted that in this case:

· consciousness is clear;

· impairment of cognitive functions (the ability to recognize, perceive, feel, etc.) is often accompanied (and sometimes preceded) by deterioration in control of emotions, social behavior, or impairment of motivation.

If symptoms (forgetfulness, impaired concentration, speech and thinking, mood swings, antisocial behavior) appear for the first time, then the tactics to help the patient should be as follows:

1. The patient should remain in his usual environment for as long as possible;

2. Things should be kept in their place so that the patient can easily find them;

3. You should stick to your usual daily routine;

4. Remove dangerous objects;

5. When communicating with the patient, use simple phrases, make sure that 2 people do not speak at the same time;

6. Mute extraneous sounds (TV, radio);

7. Provide constant supervision of the patient.

Most of the problems observed in patients with HIV infection are well known to nurses, although the underlying causes may vary. The following is a list of problems and their causes, examples of nursing diagnoses and appropriate nursing interventions.

Table 1 Nursing Diagnosis #1: Diarrhea Associated with Opportunistic Diseases

Possible reasons
	Perianal skin care: After each bowel movement, wash the area with warm water and soap. Apply a soft cloth and dry it gently to prevent tearing of the weakened skin. If Vaseline is available, apply it to the perianal area to protect the skin. * Examine areas that cause the patient discomfort, as well as areas that show abrasions or signs of inflammation. * Advise the patient to take fluids, such as broths and juices, to replace fluids and electrolytes (potassium; sodium) lost by the body. * Encourage the patient to eat a small amount of low-fiber food every two hours. *Make sure you take antidiarrheal medications as prescribed by your doctor. One of the common characteristics of HIV infection and AIDS is malnutrition. Anorexia may be based on factors such as nausea, vomiting, intoxication syndrome, and diarrhea often complicates the problem of weight loss.
Mycobacterium avium intracellulare
Cytomegalovirus infection (CMV infection)
Kaposi's sarcoma
Medicines of unknown etiology

Table 2 Nursing Diagnosis No. 2: Changes in feeding patterns - the body's nutritional needs are not being met due to nausea and vomiting.

Possible reasons	Nature of nursing intervention
	If vomiting occurs after fasting for 2 hours, offer the patient ice cubes and clear liquids. After this, you should gradually (as tolerated) switch to a gentle diet. * Ensure the most thorough oral hygiene, as this helps prevent painful sensations and loss of appetite. Dry mouth can be prevented by always having drinking water at the patient's bedside. * As prescribed by the doctor, the patient should be given antiemetics 30 minutes before meals.
Cryptococcal meningitis
CMV infection
Mycobacterium avium intracellulare
Pneumocystis pneumonia

Table 3 Nursing diagnosis No. 3: Increased body temperature due to HIV infection, bacterial infections, tuberculosis or opportunistic infections.

Table 4 Nursing diagnosis No. Dyspnea - changes in the nature of respiratory functions associated with hypoxemia and impaired gas exchange.

Possible reasons	Nature of nursing intervention
Pneumocystis pneumonia	Every two hours, assess the patient’s breathing condition, and it is necessary to pay attention to such parameters as the frequency and quality of breathing, the presence of cough, and the color of the skin. * Teach the patient the following ways to help with breathing: o Raising the head of the bed or spending more time sitting up in bed (as tolerated). o A special breathing technique with lips folded into a tube, which allows you to reduce the breathing rate. Teach the patient to form a tube with his lips, as if he wants to whistle, exhale slowly, making a slow whistling sound, trying not to puff out his cheeks and feel how his stomach drops. * Teach the patient to use (as needed) oxygen and other medications. * Determine whether the patient and family understand the plan of action if symptoms worsen, such as transferring the patient to a hospital or providing palliative care at home.
Kaposi's sarcoma
Tuberculosis
Pneumonitis caused by cytomegalovirus