Chapter 34Clients Coping with
Acquired Immunodeficiency
Syndrome (AIDS)
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Although the central feature of HIV infection
involves collapse of the body’s ability to
mount an appropriate cell-mediated immune
response with attendant medical
complications, neuropsychiatric phenomena
can also be prominent.
—Sadock & Sadock, 2008
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Learning Objectives
After studying this chapter, you should be able to
• Explain the etiology of acquired immunodeficiency
syndrome (AIDS)
• Identify those groups of individuals at risk for AIDS
• Describe the psychosocial impact of AIDS
• Discuss the effects of AIDS on family dynamics
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Learning Objectives (cont.)
• Recognize the clinical phenomena of each of the
three phases of AIDS
• Formulate a plan of care for a client exhibiting clinical
symptoms of the middle stage of AIDS
• Articulate the purpose of including interactive
therapies in the plan of care for a client with AIDS
• Outline the types of community services available to
provide continuum of care for clients with AIDS
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Epidemiology
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Etiology of AIDS
•
Groups at risk for AIDS
–
African Americans and Hispanics
–
Homosexual/bisexual men
–
Individuals with multiple sexual partners
–
Adolescents who do not practice safe sex
–
Heterosexual IV drug users
–
Homosexual/bisexual men using IV drugs
–
Heterosexuals who have had sex with one of the above groups
–
Persons with hemophilia and those who have received blood
transfusions
–
Infants born to mothers with AIDS
–
Persons who are occupationally exposed (nurses, etc.)
•
AIDS in adolescents
•
AIDS in older adults
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Psychosocial Impact of AIDS
• HIV infection and psychiatric disorders
• The worried well
• Grief reaction to HIV/AIDS
– First stage: shock, numbness, disbelief
– Second stage: denial
– Third stage: guilt, anger, homophobia
– Fourth stage: resolution, acceptance
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Effects of AIDS on Family Dynamics
• Diagnosis of AIDS challenges the fragile balance of roles
in the family.
• Adults who were independent now become dependent.
• Parents have change in newly retired lifestyles.
• Families assume financial responsibility.
• Families may become estranged from the member with
AIDS.
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The Nursing Process
• Assessment
• Nursing diagnoses
• Outcome identification
• Planning interventions
• Implementation
• Evaluation
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Assessment
• Phases of assessment
– Early phase
– Middle phase
– Late phase
• Transcultural considerations
– Cultural beliefs and myths
– Ethnic issues of homophobia and stigmatization
• Assessment for immune recovery syndrome
• Assessment as a secondary prevention
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Nursing Diagnoses
• Ineffective health
maintenance
• Impaired social
interaction
• Disturbed thought
processes
• Ineffective coping
• Anticipatory grieving
• Deficient knowledge
• Death anxiety
• Situational low selfesteem
• Hopelessness
• Spiritual distress
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Outcome Identification
Outcomes should focus on the following:
• Address psychosocial issues such as living with a chronic
illness and dying
• Empower the client to maintain a sense of control over his
or her life during the progression of the disease
• Educate the client about HIV disease, infection control,
available treatments, and medications
• Monitor health status and manage symptoms
• Promote adequate nutrition and other health-maintenance
goals
• Provide palliative care
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Planning Interventions
Planning includes the following:
• Using a holistic, multidisciplinary approach
• Augmenting available treatment and management
options
• Improving palliative outcomes and enhancing overall
well-being
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Implementation
• Early-phase planning and implementation
• Middle-phase planning and implementation
– Assistance with meeting basic needs
– Medication management
– Assistance with emotional needs
• Late-phase planning and implementation
• Client and family education
– Community support groups
• Continuum of care
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Evaluation
During evaluation
• Make needed adjustments due to the progression of the
disease process and development or existence of
comorbid mental illness
• Evaluate the continuum of care to determine if all
possible support systems are in place
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Key Terms
• Acquired immunodeficiency syndrome (AIDS)
• Homophobia
• Human immunodeficiency virus (HIV)
• Neuropsychiatric syndromes
• Stigmatization
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Reflection
According to the chapter-opening quote by Sadock &
Sadock, clients with HIV infection may develop
neuropsychiatric phenomena. Prepare an educational
tool to inform HIV-infected clients and their families or
significant others about the neuropsychiatric syndromes
and psychiatric disorders associated with AIDS.
• What approach would you use?
• Would you provide the clients
and other attendees an
opportunity to interact with
you and others during the
discussion?
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?