Introduction
Infection by HIV causes damage to the immune system by attacking the immune cells called the CD+ cells. Before destroying the CD4+ cells, the virus utilizes the cells’ DNA to replicate. Destruction of the immune system means increased susceptibility to infection by bacteria and other viruses (Ricci et al., 2012).
Common Signs and Symptoms
The common signs and symptoms of HIV infection include chills, rash, night sweats, muscle aches, sore throat, swollen lymph nodes, fatigue, diarrhea, and mouth ulcers. The symptoms, however, depend on the stage of infection.
Potential Complications
Potential complications may include primary central nervous system lymphoma, chronic psychiatric disorders, endocarditis, cardiovascular diseases, chronic obstructive pulmonary disease, Kaposi sarcoma, and other HIV-related malignancies (Silvestri, 2017).
Head to Toe Physical Assessment
A head-to-toe physical assessment is mandatory for a patient’s condition evaluation. According to Silvestri (2017), the following checks are required to detect HIV symptoms:
- Assessment of gait and posture – possible to be normal;
- Check of the general skin condition – skin is expected to have a rash. In addition, blue discoloration of the skin or mucous membranes caused by cyanosis may be observed;
- Eyes check: conjunctivitis may be observed in the eyes;
- Nose, ears, mouth and throat assessment: possible purulent discharge from nose, ears, mouth, and throat;
- General check of vision and hearing – possible to be normal;
- Assessment of lymph nodes and thyroid gland: they may be swollen;
- Lungs assessment: abnormal lung sounds may be observed in case of lung infection;
- Hand check: possible change in the shape of nails;
- Chest and jugular venous pressure check: chest murmurs and abnormally high JVP might point to HIV;
- Abdomen area check: possibly tender abdomen and masses due to hepatomegaly and splenomegaly.
Diagnostic Studies
CD4+ count low below 200; Screening for infections: CrAg; HepBsAg; RPR or TPHA / FTA / rapid TP (TP specific tests). Abnormal levels of hemoglobin and WBC differentials. High viral load. Altered fasting lipid profile. TB test is possibly positive (Ricci et al., 2012).
All NANDA Nursing Diagnosis
According to Vera (2019), the following NANDA Nursing Diagnoses are attributed to HIV:
- Imbalanced nutrition; less than body requirements;
- Acute/chronic pain;
- Deficient knowledge;
- Anxiety;
- Disturbed thought process;
- Risk of situational low self-esteem;
- Powerlessness;
- Risk of infection;
- Risk of injury;
- Risk of deficient fluid volume;
- Fatigue;
- Impaired skin integrity;
- Impaired oral mucous membrane.
Three Priority NANDA Nursing Diagnoses
- Acute/chronic pain;
- Risk of infection;
- Social isolation/anxiety
Interventions
Vera (2019) proposes the following nursing interventions to NANDA Nursing Diagnoses:
Acute/chronic pain
- Intervention 1: Instruct the patient to report pain immediately instead of waiting for it to become severe;
- Intervention 2: Encourage the patient to openly express the feelings;
- Intervention 3: Administer the necessary medications depending on circumstances and symptoms.
Risk of infection
- Intervention 1: Make sure that the patient is acknowledged with the infection prophylactic measures;
- Intervention 2: Wash hands before and after all care contacts. Instruct patient to wash hands.
- Intervention 3: Provide a clean, well-ventilated environment.
Social isolation
- Intervention 1: Ascertain patient’s perception of the situation;
- Intervention 2: Talk to the patient as much as possible, treat the patient with dignity;
- Intervention 3: Allow visits, telephone calls, and social activities in reasonable amounts
Scientific Rationale
Vera (2019) provides the following scientific rationale for interventions mentioned above:
Acute/chronic pain
- For Intervention 1: Allows to notice the development of complications and evaluate the intervention’s effectiveness;
- For Intervention 2: Reduce anxiety and fear; reduce the perception of the pain intensity;
- For Intervention 3: Provides relief of pain and discomfort; reduces fever.
Risk for infection
- For Intervention 1: Adjustment of patient’s medication regimen;
- For Intervention 2: Reduction of cross-contamination risks.
- For Intervention 3: Reduction of the pathogens’ number
Social isolation
- For Intervention 1: Becoming sure, whether the isolation is self-imposed by the patient;
- For Intervention 2: Alleviating the possible isolation caused by the patient’s conditions;
- For Intervention 3: Participation with others can create a feeling of belonging and bolster patient’s spirit;
Evaluation of Care Plan
I would evaluate my plan based on the patient’s conditions, particularly successful addressing of HIV-related NANDA Nursing Diagnoses. I would pay special attention to three priority NANDA Nursing Diagnoses. In addition, I would reflect on how my interventions affect the patient and adjust them accordingly to current treatment results.
Medications
The list of medications appropriate for health conditions related to HIV/AIDS is highly individual, as well as their dosages and side effects. However, the U.S. Food and Drug Administration approved a special list of HIV medicines, which can be found on the government-related HIVInfo website. For example, medicines such as Ziagen (Abacavir) or Pifeltro (Doravirine) slow down the process of HIV’s self-copying by blocking certain enzymes. (HIVInfo, 2021). In certain cases, the patient needs to take combination medicines, such as Epzicom (a mixture of Abacavir and Lamivudine). The exact type of medicine and its dosage must be selected after the full medical assessment since HIV has various strains which affect different enzymes.
In addition, the Centers for Disease Control and Prevention provided a list of the most common side effects of HIV medications (Centers for Disease Control and Prevention [CDC], 2021), which is provided below:
- Nausea and vomiting,
- Diarrhea,
- Difficulty sleeping,
- Dry mouth,
- Headache,
- Rash,
- Dizziness,
- Fatigue, and
- Pain.
These lists can be used as the guidelines for HIV medication selection and side effects discovery.
References
Betz, C. (2018). Promoting excellence in pediatric nursing practice and science. Journal of Pediatric Nursing, 38, i-iii. Web.
Centers for Disease Control and Prevention. (n.d.). HIV Treatment. Web.
HIVInfo. (2021). FDA-approved HIV medicines. Web.
Ricci, S., Kyle, T., & Carman, S. (2012). Maternity and pediatric nursing (2nd ed.). Lippincott Williams & Wilkins.
Silvestri, L. (2017). Saunders comprehensive review for the NCLEX-RN® Examination. Elsevier.
Vera, M. (2019). 13 AIDS (HIV positive) nursing care plans. Nurseslabs. Web.