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Nightingale College

Immunity Simulation
Student Prep

1. Read articles referenced below.

2. Review the following medications (to include common doses, side effects and
associated lab values):

Common Doses Side Effects Associated Lab


Values
Acyclovir 200-400mg 3-5 times a day Nausea, diarrhea, Cr at baseline
(Zovirax) headache, vomiting
Zidovudine 300mg BID Headache, insomnia, Adolescent/Adult Pts:
(AZT) vomiting, constipation, CBC w/ diff, Cr, LFTs
URI sx at baseline, 2-8wk
after tx start or change,
then q3-6mo

Zalcitabine 0.75mg Q8* Fatigue, headache, CBC, serum amylase,


(Hivid) abdominal pain, liver function tests,
abnormal hepatic hemoglobin
function, peripheral
neuropathy
Didanosine Dose: 200 mg PO q12h; Alt: 400 Myalgia, peripheral Adolescent/Adult Pts:
(Videx) mg PO q24h neuropathy, nausea, Cr, LFTs at baseline,
dyspepsia, rash, 2-8wk after tx start or
diarrhea, headache, change, then q3-6mo;
arthralgia, consider ophthalmic
hyperuricemia exam

Rifadin 10 mg/kg PO/IV qd for at least 6mo, 600 mg Dizziness, tooth Cr, CBC, Plt at
(Rifampin) PO bid x2 days, 300 mg PO/IV q8h for at least discoloration, baseline; LFTs at
6wks ALT/AST elevation baseline, then if
hepatic impairment
cont. q2-4wk

Nystatin This drug has been discontinued in the


(Mycostatin) United States.

3. Review labs associated with HIV or Tuberculosis.


• CD4 count
• CD4 percentage
• Viral load
• CBC
• Drug resistant tests
• Serum chemistry panel
• STD screening
• PAP Test (cervical and anal)
• Hepatitis A, B & C tests
• TB test
• Toxoplasmosis screening
• Fasting lipid panel
• Fasting glucose
• Pregnancy test

4. What are common co-infections associated with HIV/AIDS? What are the
signs/symptoms of these co-infections? What is the appropriate treatment?

• TB
• Hep B and Hep C
• Cancer
• HIV-associated neurocognitive disorders (HAND)
• HIV and opportunistic infections
• cryptococcal meningitis
• toxoplasmosis
• PCP (a type of pneumonia)
• oesophageal candidiasis
• certain cancers, including Kaposi’s sarcoma

5. Review the ANA Scope of Practice for RNs. What are your responsibilities/choices
about caring for patients with HIV/AIDS?

Nurses are obliged to provide comprehensive and compassionate end-of-life


care. This includes recognizing when death is near and conveying that information to
families. Nurses should collaborate with other members of the health care team to
ensure optimal symptom management and to provide support for the patient and
family. Nurses and other health care providers have a responsibility to establish
decision-making processes that reflect physiologic realities, patient preferences, and
the recognition of what, clinically, may or may not be accomplished. Establishing
goals of care for this patient at this time may provide a framework for discussion
about what care should be provided. This process often involves collaboration with
experts in decisionmaking, such as ethics committees or palliative care teams.

6. Review isolation precautions. What is the difference between precautions with a patient
infected with Tuberculosis and one infected with HIV?

Isolation precautions for TB: Airborne precautions apply to patients known or


suspected to be infected with microorganisms transmitted by airborne droplet nuclei.

Isolation precautions for HIV: Patients with HIV in general do not need to be placed on
isolation precautions, however, if the HIV+ patient has respiratory symptoms (i.e., cough, shortness of
breath, coughing up blood, chest pain, etc.) they need to be placed on Airborne Precautions until an
alternative diagnosis can be confirmed.
References

Rodwell, T. C., Barnes, R. F. W., Moore, M., Strathdee, S. A., Raich, A., Moser, K. S., et al.
(2010). HIV tuberculosis coinfection in southern California: Evaluating disparities in
disease burden. American Journal of Public Health, 100, No. S1, S178-S185.

Chaisson, R. E., & Churchyard, G. J. (2010). Recurrent tuberculosis: Relapse, reinfection, and
HIV. The Journal of Infectious Diseases, 201(5), 653-654

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