Lecture # 407:
Care of the Person with HIV-AIDS or Cancer

copyright 2008 Cheryl K. Hosken, BSN, MS Psych.

Care of the Person with HIV-AIDS

Acquired Immunodeficiency Syndrome and Human Immunodeficiency Virus are inextricably linked, because it is HIV that sets the stage for AIDS. The retrovirus disables the body's immune system leaving its victims vulnerable to an array of deadly cancers and opportunistic infections. People do not die from the virus itself, but from the associated illnesses the body cannot fight.

HIV attacks the immune system's most valuable and versatile component: the t-lymphocyte helpers. Lymphocytes eradicate harmful invaders of the body that are called antigens. Lymphocytes also govern the entire immune process. The T-helper cells activate other T-cells and tell them to manufacture antibodies against diseases of the body. The antibodies stick onto antigens and mark them for destruction by other t-cells that attack the intruder antigen.

Meditate Word By Word On These Verses:
Luke 17:11-19.

HIV is transmitted primarily through unprotected sexual intercourse with someone who has the retrovirus. It is also spread by way of infected blood on a needle. When HIV enters the body, it infiltrates CD4 cells that make more of the viruses within the body. These virus cells spread throughout the body by way of the bloodstream and the lymphatic system. For the first few weeks, the virus reproduces itself unopposed and then the body launches an immune response.

HIV can take as long as 8-12 years to progress to AIDS. It attacks the immune system of the body from the moment of entry. Once the body counterattacks the virus, the virus and the immune system of the body fight one another like evenly matched boxers.

Question 1: Why is HIV so physically devastating to the body?

 

 

Ultimately, the tenacious retrovirus prevails. Little by little it kills off the CD4 cells. The number of T-helper cells also decreases and the body becomes more defenseless against the HIV. The body is unable to identify and destroy cancer cells and opportunistic infections. The bacteria, fungi, viruses, and protozoa, which ordinarily live harmlessly in the body, can turn deadly without the healthy immune system.

A person is diagnosed as having AIDS if he develops any of the illnesses listed below or if his CD4 cell count drops below 200 per cc. of blood. A normal level is approximately 1,000.

AIDS Illnesses from the most common to the least common:

  1. Pneumocystitis carnii pneumonia
  2. HIV wasting syndrome
  3. Esphogeal candidiasis
  4. Tuberculosis
  5. Kaposi's sarcome
  6. Mycobacterium, avium complex
  7. Recurrent pneumonia
  8. Encephalopathy
  9. Herpes Simplex
  10. Cytomegalovirus
  11. Cryptosporidiosis
  12. Candidiasis of bronchi, trachea, or lungs

Question 2: Why is the HIV positive person subject to so many diseases?

 

 

Here is a brief summary of some of these illnesses:

PCP (Pneumocystis pneumonia)
Usually one in five people with HIV-AIDS develops PCP at some point. There is cough, chest pain, fever, and shortness of breath. Usually, an infectious diseases specialist is helpful in diagnosing this disease. The best medication for treating PCP is trimethoprim-sulfamethoxazole (Sulfa), an antibacterial medication. The infection usually clears within three weeks time.

Tuberculosis
Tuberculosis is resurgient again due to HIV weakening the immune system so the bacteria begin setting up inflammation in the lungs. They produce a cough, chest pain, swollen lymph glands, and weight loss. Tuberculosis can also spread to the kidneys, brain, and bones.

Tuberculosis is communicable and even healthy people can get TB from inhaling contagious germs when a person coughs. Therefore, until we know what the infection is and it is treated, the caregivers must wear masks whenever coming in close contact with a person suspected of having tuberculosis. TB is treated with antibiotics and anti-TB agents.

Cryptosporidosis
Until 1980, this infection had never been reported in humans. It is a protozoal infection of the intestines that causes chronic diarrhea. Persons with the disease have watery, explosive stools 12 or more times a day. This disease leaves a person malnourished, dehydrated, and depleted of essential minerals needed for the body. To date, there is no proven medication to fight this organism. Drugs are prescribed to manage diarrhea and other gastro-intestinal symptoms. Also fluids, electrolytes, and nutrients need to be replaced.

Toxoplasmosis
Most of us have been unknowingly infected with toxoplasmosis, which is also a protozoal infection. However, our immune systems disarm the organisms before they do any harm. In persons with depressed immunity, toxoplasmosis can inflame the brain, and its symptoms include intense headaches that respond poorly to pain medication, fever, visual changes, confusion, hemiplegia, lethargy, and delusions.

There is an antiparasitic drug called pyrimethamine that kills the protozoa. Antibiotics are also given to assist fighting the infection.

HIV Dementia
As many as 4 out of 5 persons have complications that involve the central nervous system. Cryptococcosis causes meningitis. There are two cancers: Kaposi's Sarcoma and CNS Lymphoma that cause brain tumors. They cause altered intellect and personality changes.

Dementia can occur as the result of the HIV retrovirus affecting the brain. The changes are slow and not usually noticeable until they have been affecting the person for some time. There is no known treatment for this disease except for antiviral medications.

Kaposi's Sarcoma
This is the 5th most common manifestation of AIDS. It is an opportunistic cancer. Until the emergence of AIDS, it was very rare. This malignant cancer develops in the blood vessel walls and is virulent in attacking the circulation system. There are blue, brown, or purple lesions on the skin that block the flow of blood and cause swelling and edema. It is found mostly on the legs. It also invades the internal organs such as the lymph system and the gastrointestinal tract.

It is treated by radiation therapy. Chemotherapy drugs are used to fight the disease systemically, however, they must be used cautiously for the AIDS person is already without many defenses to fight disease.

Question 3: AIDS is:
(Only one of the following answers is correct.)
a syndrome that has many signs and symptoms.
a virus that affects only homosexual men and intravenous drug users.
a type of bacteria.
an air-borne illness.

 

 

HIV Wasting Syndrome
A number of HIV-related illnesses cause wasting of the body. Wasting refers to the shocking physical deterioration with the end-stage of cancer or AIDS. The person appears emaciated, listless, consumed by illness. When wasting occurs in the absence of underlying infection or cancer, persons are said to have HIV wasting syndrome. This is defined as a loss of at least 10% of body weight within approximately one month. Other symptoms include fever, diarrhea, and weakness that last for more than 30 days.

Wasting is managed by nourishment, which is no small challenge. Usually vitamins and minerals are given along with high calorie soft foods. These foods include cheeses, yogurt, high protein drinks that body builders drink, and ice cream. Think of ways to increase calorie intake by adding high calorie extras such as tvorog and butter to foods. Sometimes intravenous liquid nutrients are given. Another apart of treatment is physical activity to maintain muscle mass. These are the range of motion exercises we have already talked about.

Diagnosing AIDS
Usually, an alarming symptom brings a person to the doctor and screening for the AIDS virus. The two most frequent illnesses that bring a person to the doctor are oral cadidiasis (produces patchy white spots on the tongue and inner mouth) and herpes zoster (painful blisters). While neither of these diseases is AIDS, doctors often see a sharp drop in the CD4 levels soon after either infection.

The blood test used to diagnose HIV is enzyme-linked immunosorbent assay. This test detects the antibodies that the immune system manufactures after exposure to HIV. Another test called the Western blot is also conducted after the enzyme-linked immunosorbent assay. If the Western blot test is positive, there is no question that the person has HIV. The retrovirus may not be detected for the first 3-6 weeks in the body since a sufficient number of antibodies have not yet been produced in order to register on the test. It is usually best for a person to know his HIV status so that treatment can begin and so that others are not infected.

Treatment for AIDS
Doctors usually have a two-point plan: 1) give antiviral agents, 2) give other medications prophylactically to fight opportunistic infections. Treatment usually begins as the T-cell count lowers.

Question 4: An acquaintance tells you that he used drugs years ago. He thinks he should get an AIDS test, but he is afraid of the potential results. What could you do to help him?

 

 

There are principles of care associated with the symptoms of the disease. They are as follows:

Mouth infection
Sores in the mouth cause pain and make eating difficult. Provide mouth care often using s soft toothbrush or plastic swab. Do not try to scrub off the sores, this will cause bleeding. Change the diet to soft foods or cut up foods in smaller pieces. Be compassionate and think back about the pain you endured with a sore in your mouth..

Diarrhea
The diarrhea is uncontrollable. Give good skin care and try to keep it dry. Offer extra fluids to replace those that are lost. Being unable to control bowel movements is embarrassing, act calm and help the person to the toilet or clean up the mess. If you are calm, it helps the ill person remain calm.

Nausea and Vomiting
An infection or medication causes nausea and vomiting. Have the person clean or rinse his mouth. Give clear such as gelatin in small amounts until the person is ready to eat again. Give medication that may stop the symptoms. Clean up the person as necessary.

Swelling may occur in various parts of the Body
Apply cool compresses to the swollen area. Raise the head of the bed to decrease swelling in the head. Place a pillow under arms or legs that are swollen to reduce the size. Observe the skin over the swollen part of the body since it may become stretched a torn. Apply lotion gently if necessary. Change the person's position in bed to prevent skin breakdown.

Chronic Fatigue
Ask the person how you can best help. Try not to do every task at once - give some time for rest between activities. Offer as much help as possible so that the person can save his energy. Plan your care so that the person can rest before visitors come. Understand that the person's fatigue is part of the illness and be available to help as much as possible.

Mental Difficulties
Confusion is a symptom of the disease. Speak in short sentences and use simple cues. Use memory cues such as clocks and calendars to help the person know time and date. Do not be hurt by expressions of frustration and anger. The AIDS person is likely angry with his disease. He may also be embarrassed about the way he got the disease and that he faces death.

Websites for HIV-AIDS: www.s-info.ru, www.rusmedserv.com/aids.

Care of the Person with Cancer

The term cancer encompasses 115 separate diseases. Not matter where cancer takes hold in the body, it begins with a single errant cell. Normally millions of cells in our bodies divide to form identical new ones when old cells wear out, but this is a controlled process. But once in every one million replications, the daughter cell departs with a mutation of genetic material. Why this happens is not fully understood. However, it is probably traceable to carcinogens, cancer-causing culprits that include tobacco smoke, the sun's ultraviolet rays, and asbestos fibers.

Cancer cells proliferate uncontrollably until they eventually form a mass of excess tissue called a tumor. A malignant tumor can grow large enough to impair the function of major organs, rob them of essential nutrients, or burrow into adjacent organs. Or it may shed cells into the circulatory system that are carried to distant parts of the body where they latch onto tissue and start new tumors. These are called mestastasized tumors.

Question 5: Why is cancer seen as such a devastating disease?

 

 

Symptoms of Cancer
Early stage cancer rarely brings pain. Symptoms associated with cancer often suggest far less serious conditions. Blood in the stool: Is it a symptom of colon-rectal cancer or hemorrhoids? Any of the following should be a guide to get oneself to the doctor for investigation:

  1. Persistent changes in bowel or bladder habits
  2. A sore that does not heal
  3. Thickening in the breast or another part of the body
  4. Frequent indigestion and/or difficulty swallowing
  5. Persistent hoarseness or chronic cough
  6. Change in a wart or mole - change in color, size, edges
  7. Persistent flu-like symptoms or fatigue greater than normal

Cancer is diagnosed by non-invasive procedures such as x-ray studies, mammograms, ultrasound, MRI scan, and laboratory tests. Invasive procedures include endoscopic exam inserted through an opening in the body and biopsy. Once the cancer is diagnosed, other tests may be used to determine its progression or stage. Staging is usually expressed from 0-IV. 0 indicates that the cancer is confined to the original site. IV is the worst degree of proliferation. These classifications vary from cancer to cancer, but doctors need some means of labeling the cancers and giving prognoses.

In principle, the earlier the cancer is detected and treated, the greater the odds for remission. Each year that the disease lies dormant the outlook for survival brightens. With most cancers it is difficult to say there is a cure. The significance of the survival time varies tremendously. With colon cancer, survival beyond three years is encouraging. With breast cancer and melanoma, recurrence may be 20 years after the first episode. Cancer patients are always followed for life in tumor registries. Recurrent cancers may surface at the original site or in another part of the body. Generally, but not always, recurrent cancers are more aggressive and more difficult to treat.

Question 6: Early detection of cancer means:
(Only one of the following answers is correct.)
better survival.
a greater chance of healing and less recurrence.
the cancer will be dormant longer.

 

 

Treatment
Surgery, radiation therapy, and chemotherapy are the main forms of cancer treatment within the medical community. There are also homoeopathic treatments using herbs, diets, and powders from various types of trees and seeds. The goal may be to attempt a cure (therapeutic) or make the patient more comfortable by alleviating symptoms caused by the cancer (palliative). For example, a man with prostate cancer may also have tumor growing on his bladder and difficulty urinating. Radiation therapy is given to decrease the size of the tumor so that he can urinate more easily.

Today, adjuvant therapies are used most often - that is a combination of the above three therapies together. Sometimes a tumor is radiated before the planned surgery. Other therapies include hormonal therapy, bone marrow transplant, and biological therapy. However, surgery remains the primary treatment for cancer. The surgeon removes the tumor and a margin of tissue around the tumor to reduce the chance of having any malignant cells left in the area.

Question 7: What is adjuvant therapy for cancer?

 

 

Types of Treatment and Side Effects:

Radiation Therapy
Radiation therapy aims high-energy rays directly at cancer cells. It is the preferred treatment for Hodgkin's disease, laryngeal cancer, orophyngeal cancers, and is incorporated into the treatment of many other cancers. Usually the radiation treatments are daily. The weekend is free so that the body can grow healthy new cells and the dead cancer cells are cleaned out of the body.

As with any therapy that affects the body, there will be side effects to the treatment. With radiation therapy there are the following side effects: Head and Neck - Mouth redness and irritation, dry mouth, difficulty swallowing, changes in taste, nausea, earaches, swollen or sagging skin under the chin, stiff jaw, and hair loss.

Skin inflammation is the most likely result of radiation therapy. Usually people have redness, dryness, and tenderness comparable to a sunburn. These effects usually go away in a matter of weeks when therapy ends. There are more severe reactions such as damage to the hair follicles and sweat glands. The skin needs to be inspected daily. If there is bright red or purple color, blisters, or wetness on the surface of the skin, alert the doctor. For itching, irritated skin, we use a product called Aquafor.

Skin exposed to radiation needs tender care, therefore here is some advice:

Since fatigue is a side effect of therapy, we encourage the person to rest and get others to help around the house. When appetite is suppressed because of therapy, give him whatever he wants to eat if he can tolerate it. When I worked on the cancer treatment floor, our patients liked thick, creamy milkshakes.

Question 8: Why is there so much nausea and vomiting with radiation therapy?

 

 

Chemotherapy
Chemotherapy is a systemic treatment for cancer in that it goes throughout the whole body through the bloodstream. The agents used in chemotherapy block the cancer cell's ability to mature or reproduce itself. Most of the agents are too toxic to be taken orally so they are put directly into the blood stream. Usually, a plastic tube is inserted into a chest vein for a course of therapy so that the patient is not stuck by a needle every day. The medications are aimed at killing the most rapidly reproducing cancer cells, but the other rapid growing normal cells in the body are also affected - those in the lining of the digestive tract, white blood cells, and hair follicles. That is why there is nausea, vomiting, and hair loss associated with the use of these drugs for treatment. Often when the drugs are given for treatment, other drugs are given to counteract the effects of the drugs. For example, a person may receive chemotherapy and the counteracting drugs and then go home to sleep for 10-12 hours while the negative effect chemotherapy drugs wears away.

Since the blood is affected and the bone marrow that makes blood cells, they are most often suppressed to lower than normal levels. The red blood cells decrease transporting less oxygen throughout the body. Without sufficient numbers of red blood cells, patients become anemic. Symptoms of decreased red blood cells include fatigue, chills, shortness of breath, and dizziness.

There are five types of white blood cells that are the body's defense against disease. When their level decreases because of chemotherapy, a person has low levels of immunity against infections of the lungs (pneumonia), urinary tract, mouth, skin, reproductive tract, and colon. Symptoms include elevated temperature, diarrhea, sore throat, burning with urination, vaginal drainage.

Platelets prevent uncontrollable bleeding by making clots. At the same time they cause the blood vessel walls to constrict so there is less blood flow to the damaged area. Those with low platelets are prone to bleed and bruise easily from minor injuries. Be on the alert for unexplained nosebleeds, bleeding gums, and blood in the urine and stool. To fight these conditions, there are now drugs that stimulate the bone marrow during chemotherapy. Most important is to monitor the cell count of these blood components.

Special care for the chemotherapy patient:

Question 9: Foods that have much iron are:
(Only one of the following answers is correct.)
lean meat, raisins, carrots, egg yolks.
milk and milk products.
any salad from a salad bar.

 

 

Hair loss is most often a reminder to the person that he is fighting for his life. He may feel unattractive and experience depression, shock, and anger about hair loss that can occur anywhere on his body. It is good to forewarn visitors about the person's altered appearance. A shorter hairstyle can make hair look thicker. During this time, they should not have hair dyed, heat dried, or permed. Usually, women like to cover their heads with scarves, turbans, or a wig.

Infection control is important. Chemotherapy and radiation affect the immune system. Exposure to your cold or flu may mean increased symptoms and difficulty overcoming some infection passed on to this patient.

The most important thing you can do is to listen, and support the person emotionally. This may mean reading to them - the Bible or other literature the person likes such as poetry. Since the person is facing the possibility of death, there may be questions you can answer about why this disease happens and about life after death.

Perhaps you may be asked to help them talk with a friend or a relative about some incident in the past so that forgiveness is given and received. Perhaps funeral plans may need to be made.

The ways in which cancer brings death are as varied as the cancers themselves. A tumor may expand to such extent that it interferes with vital organs and brings death. Wasting can occur since the tumor may take strength away from the rest of the body. The person loses weight and the ability to fight infections causing death.

Question 10: Why is chemotherapy so destructive to the whole body?

 

 

Websites for cancer information: www.rosoncoweb.ru/advise, www.med.by./rehab/N001, www.bessmertie.ru.