NCLEX RN Practice Question # 403

immunodeficiency virus

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NEWBORN OF A MOTHER WITH HUMAN IMMUNODEFICIENCY VIRUS (HIV)

 Description

  • The fetus of a client who is positive for HIV antibody should be monitored closely throughout the pregnancy.
  • Serial ultrasound screenings should be done during pregnancy to identify intrauterine growth restriction.
  • Weekly nonstress testing after 32 weeks of gestation and biophysical profiles may be necessary during pregnancy.
  • Newborns born to HIV-positive clients may test positive because the mother’s antibodies may persist in the newborn for 18 months after birth.
  • The use of antiviral medication, the reduction of newborn exposure to maternal blood and body fluids, and the early identification of HIV in pregnancy reduce the risk of transmission to the newborn.
  • All newborns born to HIV-positive mothers acquire maternal antibody to HIV infection, but not all acquire the infection.
  • The newborn may be asymptomatic for the first several months to years of life.

 Transmission

  • Across placental barrier
  • During labor and delivery
  • Breast milk
  • Assessment
  • Possibly no outward signs at birth
  • Signs of immunodeficiency
  • Hepatomegaly
  • Splenomegaly
  • Lymphadenopathy
  • Impairment in growth and development

 Interventions

  • Clean the newborn’s skin carefully before any invasive procedure, such as the administration of vitamin K, heel sticks, or venipunctures.
  • Circumcisions are not done on newborns with HIV-positive mothers until the newborn’s status is determined.
  • Newborn can room with mother.
  • All HIV-exposed newborns should be treated with medication to prevent infection by Pneumocystis jiroveci.
  • Antiretroviral medications may be administered as prescribed for the first 6 weeks of life.
  • Monitor for early signs of immunodeficiency, such as enlarged spleen or liver, lymphadenopathy, and impairment in growth and development.
  • Newborns at risk for HIV infection should be seen by the physician at birth and at 1 week, 2 weeks, 1 month, and 2 months of age.
  • Inform the client that HIV culture is recommended at 1 month and after 4 months of age.

 Immunizations

  • Immunizations with live vaccines, such as measles-mumps-rubella and varicella, should not be done until the newborn’s, infant’s, or child’s status is confirmed.
  • If infected, live vaccine will not be given.

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