Case Study Questions Human Immunodeficiency Virus Infection At Risk for HIV Disease Patient Profile Emilio, a 20-year-old Hispanic male college student, comes to the student health center with pain on urination. Subjective Data Describes pain as, “Just like it felt when I had the clap last year” Provides a history of sexual activity since age 15, reports lifetime sexual partners as six women and two men Denies injected drug use, tobacco use, or corticosteroid therapy Uses alcohol (mainly beer) at weekend parties and has smoked marijuana, but not recently Recent sexual activity has been on weekends during or after beer parties Objective Data Physical Examination 5 feet 11 inches tall, 168 pounds, temp 100.4° F (38° C), purulent urethral discharge noted Laboratory Studies Urine test for Neisseria gonorrhoeae is positive Collaborative Care IM injection with 250 mg ceftriaxone (Rocephin) Doxycycline 100 mg PO bid for 7 days Critical Thinking Questions 1. Why should Emilio be encouraged to be tested for HIV? 2. How will you counsel Emilio about the testing process? How can you help him prepare for the test and the test results? 3. What further questions will you need to ask Emilio before you can determine his educational needs? 4. Ask a classmate to be “Emilio” and role-play HIV risk assessment, risk reduction counseling, and pretest and posttest counseling. 5. What are the main considerations to cover when teaching about barrier methods of protection? Are there components of Hispanic culture that may affect your approach to teaching about condoms? 6. How will you discuss the issue of partner notification with Emilio? 7. If Emilio’s HIV test is positive, what nursing diagnoses most likely apply? If his HIV test is negative, what nursing diagnoses most likely apply? Symptomatic HIV Disease Patient Profile Janelle, a 35-year-old African American single mother, was admitted to the hospital with AIDS and CMV retinitis that were diagnosed 2 days ago. Copyright © 2004, 2000, Mosby, Inc. All Rights Reserved Case Study Questions 2 Subjective Data Was initially seen by a doctor 6 years ago for pain behind the sternum and difficulty swallowing, diagnosed as esophageal candidiasis Had a positive HIV antibody test at that time Has consistently refused ART because “it’s poison, I’ve seen how sick it makes other people, and besides, we can’t afford it” Married to Jim, a former IV drug user, for 10 years until his recent death from AIDS-related complications Has two children, ages 8 and 11, who are both HIV-antibody negative Experiences fatigue and frequent oral and vaginal candidiasis outbreaks Expresses concern about welfare of children who are at home with her sister and says, “Maybe I should take better care of myself for them” Objective Data Physical Examination 5 feet 6 inches tall, 100 pounds, temperature 99.8° F (37.7° C) Laboratory Studies CD4+ T cell count 185/μl Viral load 25,328 (by bDNA) Hematocrit 30% Collaborative Care Insertion of central venous catheter to be used for CMV treatment Trimethoprim-sulfamethoxazole Triple antiretroviral therapy: zidovudine + lamivudine (Combivir) and indinavir (Crixivan) Critical Thinking Questions 1. Why was Janelle’s initial medical problem (esophageal candidiasis) unusual? 2. Why is Janelle taking trimethoprim-sulfamethoxazole, and what are its common side effects? 3. What drugs are used to treat CMV retinitis? What side effects do they have, and what problems are associated with their administration? 4. Is there a potential advantage to Janelle’s refusal to take antiretroviral medications in the past? 5. Women often put their children’s welfare first. What problems could this cause for Janelle’s treatment? How can these problems be solved? 6. What teaching needs to be done before Janelle is allowed to return home after this hospitalization? What referrals need to be made? How can Janelle be helped to adhere to her medication schedule? 7. What psychosocial and legal issues need to be assessed? What interventions might be appropriate? 8. What nursing interventions are immediately appropriate? What plans need to be made for continued nursing care after discharge? 9. Based on the assessment data presented, choose at least three appropriate nursing diagnoses. Are there any collaborative problems? Copyright © 2004, 2000, Mosby, Inc. All Rights Reserved