AIDS Case Study Essay

Client Profile Mr. doubting doubting doubting doubting doubting doubting doubting Thomas is a 42 year old mankind admitted to the hospital with complaints of shortness of breath, fever, fatigue and literal exam thrush. The wellness c atomic spell 18 provider reviews the laboratory and diagnostic tests with Mr. Thomas and informs him he has pneumonia and is human immunodeficiency virus positive. Mr. Thomas believes that he contracted human immunodeficiency virus time involved in an occasion with a nonher woman three geezerhood ago. He is afraid to enumerate his wife, sharp she get out be angry and that she albuminthorn leave him. Case Study The blow assigned to commission for Mr. Thomas reads in the medical record (chart) that he learn two daytimes ago he was human immunodeficiency virus positive. There is a handbill in the record that indicates that Mr. Thomas has non told his wife the diagnosis.To complete a utilitarian health pattern assessment, the bear as ks Mr. Thomas if he may ask him a few questions. Mr. Thomas is leave aloneing and in the course of their conversation sh atomic number 18s with the treasure that he believes that he contracted the human immunodeficiency virus during an role with an other woman. He states, How tolerate I range my wife to the highest degree this? I am so ashamed. It is bad sufficiency that I had an aff cable, solely to pass on to tell her in this modality I hardly dont think I derriere. She is not sick at all. I result vertical say I have pneumonia and take the medication my health bang provider gave me. I do not want my wife of anyone else to agnise. If she begins to understand signs of not feeling well, so I will tell her. I just f dismaypott tell anyone. What will mess think of me if they know I have inciteS?1. Briefly question how the human immunodeficiency virus is transmitted and how it is not. How canful Mr. Thomas prevent the contagious disease of human immunodeficiency virus to his wife and others?In infected people, infectious human immunodeficiency virus is present only in cells and in some bodily wanderings. human immunodeficiency virus can be isolated easily from inception, ejaculate and vaginal/cervical secretions (including menstrual fluids). rent and semen be the cells that be just about likely to protract human immunodeficiency virus. HIV has also been isolated from breast milk. With more than greater difficulty, the virus has on occasion, been isolated from saliva, tears, and urine. It is has not been isolated from perspiration or feces. The rate of flow scientific view is that body fluids other than blood, semen, vaginal/cervical secretions, and breastmilk, find out so little, if any, HIV that they are not of major importance in HIV transmission between individualists. HIV is actually fragile orthogonal of the body, so transmission system requires direct physical gain of two substances, fluid containing the HIV from a n infected person and amenable cells (usually via the blood stream) of another person. Casual contact includes all casefuls of ordinary every day, non-sexual contact between and among people. Shaking hands, hugging, kissing, sharing feeding utensils, sharing towels or napkins, using the said(prenominal) phone and using a faecal matter seat are all prototypes of mundane contact. Because HIV is quickly inactive outside the body, it cannot survive in turn out air or in water. (1) Methods that Mr. Thomas can transmit HIV to his wife and others would be any type of blood transmission or intimate sexual contact. epidemiologic data points to three modes of HIV transmission from person to person from blood, from birth, and from sex. Since Mr. Thomas is young-begetting(prenominal) we can cross out birth. Mr. Thomas can prevent transmission of HIV to his wife and others by only lovely in sexual activity with a condom, and even and then there is a risk of the condom breaking and th en universe feel forful with any types of cuts, open wounds, and contact with others and his own blood.2. Mr. Thomas stated, What will people think of me if they know I have AIDS? How can the nanny explain the difference between being HIV positive and having AIDS?The nurse can explain n that Mr. Thomas does not have AIDS. AIDs are a complication in one case the repellent system can no perennial handle fighting the HIV transmission system. HIV is the actual infection itself, AIDS is what happens once the immune system is compromised leading the way to other infections that may not match a normal wakeless(prenominal) bad or child, exactly become sprightliness threatening to a person with AIDs. This is caused by the weakened immune systems softness to fight off any infection.3. handle the ethical dilemmas inherent in this case.HIV disclosure is defined as a complex and multifaceted process of devising a voluntary or involuntary decision about whom to inform about ones sta tus,why, when, where and how . This is particularly challenge when it comes to informing perseverings sexual quislings, also referred to as partner observance. The three approaches to partner notification include i) source referral, whereby the health care provider encourages the patient ofs to alert their partners themselves ii) provider referral, whereby the health care provider notifies the partners with the consent of the patients while respecting the patients confidentiality and iii) set apartal referral, whereby the patients in agreement with the health care provider are sibyllic to inform their partners within a granted time frame otherwise the health care provider will do so (but without revealing the patients identity)(2)4. Does the health care provider have a profound obligation to tell anyone other than Mr. Thomas that he is HIV positive? If so, hold forth.licitly, the nurse cant tell anyone. In court notifying an HIV-positive patients partner can be argued in monetary value of breaching professional ethics because ethically it is prostitute to disclose your patients outcome or diagnosis to third parties without that individuals consent.5. Any loss, such as loss of ones health, results in a ruefulness response. Describe the distributor points of melancholy according to Kubler-Ross. Denial This cannot happen to me see red Why did this happen to me? Whos to damned for this?Bargaining Just let me live, and Ill do anythingDepression I am too sad to do anything take aimation Im at rest with what is coming.6. establish which stage of grief Mr. Thomas is most likely experiencing. furnish examples of Mr. Thomass behavior that fend for your decision.I believe that Mr. Thomas is experiencing twain denial and anger. In denial, he recognizes that this is so happening to him but he does not want his wife to know and that is his refusal to accept what is going on. The anger portion comes from him blaming his fight for it happening in whic h sense he blames both himself and the woman he had the occasion with.7. What laboratory tests are used to suffer the diagnosis of HIV infection in an adult?HIV is most commonly diagnosed by testing your blood or saliva for the presence of antibodies to the virus. A newer type of test checks for HIV antigen, a protein produced by the virus immediately after infection.8. address the function of CD4 T cells and provide an example of how the CD4 t cell amount guides the counsel of HIV. CD4 cells are a type of white blood cell thats specifically targeted and destroyed by HIV. A healthy persons CD4 count can vary from 500 to more than than 1,000. stock-still if a person has no symptoms, HIV infection progresses to AIDS when his or her CD4 count becomes less than two hundred. (3)9. Briefly explain the project of viral freight blood tests in monitoring the promotion of HIV.The viral load test measures the amount of virus in your blood. Studies have shown that people with higher viral loads generally fare more poorly than do those with a lower viral load.(3)10. Mr. Thomas expresses a hardening to learn more about HIV. Discuss the nurses initial hindrance when seed client teaching and then discuss the progression of the HIV disease, including an rendering of primary infection, A, B, and C and four principal(prenominal) types of expedient infections. There are unalike stages of HIV infection. Primary HIV infection can show symptoms that can be confused as the flu. These symptoms can closing for a couple days to a few weeks and then disappear. Stage 2 is an asymptomatic stage meaning that the patient probably shows little to no symptoms. This stage lasts for an average of ten years and, as its name suggests, is free from major symptoms, although there may be swollen glands. The take aim of HIV in the peripheral blood drops to very low levels but people remain infectious and HIV antibodies are detectable in the blood, so antibody tests will show a pos itive result. search has shown that HIV is not dormantduring this stage, but is very active in the lymph nodes. A test is available to measure the smallish amount of HIV that escapes the lymph nodes. This test which measures HIV RNA (HIV genetic material) is referred to as the viral load test, and it has an important role in the treatment of HIV infection. (4) Stage 3 is symptomatic HIV characterized by lymph nodes and tissues befitting permanently damaged and the virus beginning to mutate to AIDs due to the inability of the body keeping up with associate T cell rebuilding as the HIV virus kills off the avail T cells. Stage 4 is progression of HIV to AIDS. AIDS is diagnosed when any destine listed in clinical stage 4 is diagnosed and/or the CD4 count is less than 200 cells/mm3 or a CD4 percentage less than 15. (4) The ABCs of HIV areAbstinence for youth, including the delay of sexual entryway and abstinence until marriage Being time-tested for HIV and being faithful in marr iage and monogamous relationships Correct and coherent use of condoms for those who practice high-risk behaviours (4) The CDC has listed 24 types of opportunistic infections regarding HIV. As his nurse I would make sure Mr. Thomas had the study regarding all 24, but I would mop up on the 4 main ones since he is already exhibiting symptoms of those. Four main types of opportunistic infections in regards to HIV are Thrush fungal infection of the mouth, throat, or vagina. Herpes simplex virus can cause oral herpes (cold sores) or genital herpes. This is a fairly common infection but if you have HIV, the outbreaks can be much more frequent and more severe. mycobacterium avium complex (MAC or MAI) a bacterial infection that can cause hap fevers, general sick feelings, problems with digestion, and serious weight unit loss Pneumocystis pneumonia (PCP) a fungal infection that can cause a black-market pneumonia. (6)11. Following the nurses teaching, Mr. Thomas states, How stupid I w as to have that affair. non only could it ruin my marriage, but it gave me a death sentence. Share with Mr. Thomas what you know about long-term survivors, long-term non-progressors, and extremely active antiretroviral therapy (highly active antiretroviral therapy).HIV carriers can carry the virus for a decade showing little to no symptoms.There are many different types of maintenance medicine therapies to alleviate symptoms, and reduce the rate of progression. Antiretroviral therapy can help stall the progression of the disease, however, discontinuation of antiretroviral therapy may result in viral rebound, immune decomposition, and clinical progression of HIV. dangling of HAART is not recommended (7). With HAART, patients who have had a positive HIV test have gone as long as 30 years with little to no symptoms and no progression of AIDS (6). HAART is defined as a drug regimen to achieve sustained viral suppression. Simplified treatment regimens and decreasing the number of m edications that patients have to take each day has proven effective in patients adherence to their treatment. Drug companies are constantly finding new slipway to combine the inhibitors into 2-3 medications versus the extensive treatment regimens earlier used. Overall adherence rates are still only 30-50% in the US, so I would recommend extensive appraise up with Mr. Thomas and his health care providers to increase his adherence.12. Discuss how the nurse should suffice if Mr. Thomass wife approaches him in the hall and asks, Did the test results come back down yet? Do you know what is amiss(p) with my husband?The nurse must tell Mr. Thomass wife that she cannot discuss Mr. Thomass medical origin with her and that she must ask Mr. Thomas himself. Legally and ethically, the nurse cannot give Mr. Thomass wife any information regarding his condition and diagnosis if Mr. Thomas has specifically asked for no information to be disclosed, which he has.13. constitute five possible nu rsing diagnoses captivate to consider for Mr. Thomas.I chose these 5 for where Mr. Thomas is link up to his disease at this time.1. substandard knowledge related to HIV infection, convey of preventing HIV transmission, and self-care2. Risk for infection related to immunodeficiency.3. Activity intolerance related to weakness, fatigue, malnutrition, impairedfluid and electrolyte balance and hypoxia associated with pulmonary infections.4. well-disposed isolation related to stigma of disease, drug withdrawal of support systems, isolation procedures, and fear of infecting others.5. anticipatory grieving related t changes in lifestyle and roles and unfavorable prognosisReferences1) Conner, Ross F., & Fan, Hung Y., & Vilarreal, Luis P. Aids, wisdom and Society, Sixth Edition, 2011, Jones and Bartlett Publishers, LLC 2) http//www.biomedcentral.com/1472-698X/11/63) www.mayoclinic.com4) www.avert.org5) www.cdc.org6) www.aids.org7) Smeltzer, Suzanne C., & Hinkle, Janice L., & Bare, Bre nda G., & Cheever, Kerry H. Brunner & Suddarths Textbook of Medical-Surgical Nursing, (2010), Wolters Kluwer Health/Lippincott Williams & Wilkins