Consumer Profile: Mister. Thomas is actually a 42 yr old man accepted to the medical center with complaints of shortness of breath, fever, fatigue and oral thrush. The health care provider reviews the laboratory and diagnostic checks with Mister. Thomas and informs him he provides pneumonia and it is HIV positive. Mr. Thomas believes that he caught HIV when involved in an affair with one other woman 3 years ago. He is afraid to share with his wife, knowing she is going to be furious and that your woman may keep him.
Example: The doctor assigned to care for Mr. Thomas reads in the medical record (chart) that this individual learned two days ago he was HIV positive. There is a be aware in the record that signifies that Mr. Thomas has not told his wife the diagnosis.
To complete a practical health pattern assessment, the nurse requests Mr. Thomas if he may ask him a few questions. Mister. Thomas is definitely willing and the span of their chat shares with the nurse that he thinks that this individual contracted the HIV during an affair with one more woman.
He says, “How am i able to tell my partner about this? I am ashamed. It really is bad enough i had an affair, but to need to tell her in this manner ” I just don’t think I will. She is not sick whatsoever. I will only say I have pneumonia and take the medication my physician gave me. I really do not want my wife of someone else to know. If perhaps she starts to show indications of not sense well, however will tell her. I just can’t tell any person. What will people think of me personally if they will know I have AIDS?
1 . In short , discuss how the HIV is transmitted and how it is not. How could Mr. Thomas prevent the tranny of HIV to his wife while others?
In infected people, contagious HIV is present only in cells and in some body fluids. HIV may be isolated quickly from bloodstream, semen and vaginal/cervical secretions (including monthly fluids). Blood vessels and sperm are the cells that are most likely to carry HIV. HIV has also been isolated from breast dairy. With much larger difficulty, the virus is wearing occasion, recently been isolated via saliva, tears, and urine. It is will not be isolated by perspiration or perhaps feces. The existing scientific view is that physique fluids besides blood, semen, vaginal/cervical secretions, and breastmilk, contain so very little, if any kind of, HIV they are not of major importance in HIV transmission among individuals. HIV is very delicate outside of the body, so transmission requires immediate contact of two substances, fluid containing the HIV from an infected person and vulnerable cells (usually via the bloodstream stream) of another person. Casual contact includes all types of common every day, non-sexual contact among and when it comes to. Shaking hands, hugging, getting, sharing ingesting utensils, posting towels or napkins, making use of the same mobile phone and using a toilet seat are all types of casual contact. Because HIV is quickly inactive outside of the body, this cannot endure in available air or perhaps in normal water. (1) Strategies that Mr. Thomas can easily transmit HIV to his wife and others would be almost any blood transmission or romantic sexual get in touch with. Epidemiological info points to 3 modes of HIV transmitting from person to person: by blood, coming from birth, and from sexual intercourse. Since Mister. Thomas is usually male we could cross away birth. Mister. Thomas can prevent transmission of HIV to his wife while others by only engaging in sexual acts with a condom, and even then we have a risk of the condom disregarding and then getting careful with any types of cuts, open pains, and connection with others great own bloodstream.
2 . Mr. Thomas explained, “What will people think of me if they find out I have ASSISTS? How do the registered nurse explain the difference between becoming HIV positive and having AIDS?
The nurse may explain and that Mister. Thomas would not have AIDS. AIDs certainly are a complication once the immune system cannot handle struggling with the HIV infection. HIV is the real infection on its own, AIDS is what happens after the immune system can be compromised leading the way to other infections which may not affect a normal healthy adult or child, but become life threatening to a person with AID’s. This is caused by the weakened resistant systems failure to protect against any disease.
3. Discuss the ethical dilemmas inherent in this case.
HIV disclosure is identified as a ‘complex and diverse process of making a voluntary or involuntary decision about whom to share with about one’s status, why, when, where and how’. This is especially challenging when it comes to informing patients’ sexual associates, also referred to as partner notification. Three approaches to partner notification contain: i) resource referral, where the health treatment provider encourages the patients to notify their companions themselves; ii) provider referral, whereby the care supplier notifies the partners with all the consent in the patients although respecting the patients’ privacy; and iii) conditional referral, whereby the patients in agreement with the health care provider are supposed to inform their partners within a given period of time otherwise the health care service provider will do and so (but without revealing the patients’ identity)(2)
4. Does the health care provider have got a legal responsibility to tell any person other than Mister. Thomas that he is HIV positive? If perhaps so , talk about.
Legally, the nurse won’t be able to tell any individual. “In the courtroom notifying a great HIV-positive person’s partner can be argued regarding breaching professional ethics since ethically it really is wrong to reveal your patient’s result or diagnosis to third parties without that person’s consent.
5. Virtually any loss, just like loss of your health, leads to a tremendous grief response. Identify the phases of grief according to Kubler-Ross. Refusal: “This are not able to happen to me!
Anger: “Why did this kind of happen to me? Who’s to blame for this?
Bargaining: “Just let me live, and Items do anything
Depressive disorder: “I i am too sad to do anything
Approval: “I’m by peace with what is coming.
6. Go over which stage of grief Mr. Thomas is most likely experiencing. Provide types of Mr. Thomas’s behavior that support your decision.
I believe that Mr. Jones is going through both refusal and anger. In denial, he recognizes that this is indeed happening to him nevertheless he will not want his wife to learn and that is his refusal to simply accept what is going on. The anger section comes from him blaming his affair for this happening by which sense this individual blames equally himself as well as the woman he had the affair with.
7. What laboratory tests are accustomed to confirm the diagnosis of HIV infection in an mature?
HIV is most commonly clinically diagnosed by testing your blood vessels or secretion for the presence of antibodies towards the virus. A newer type of check checks to get HIV antigen, a protein produced by the virus soon after infection.
almost 8. Discuss the function of CD4 To cells and give an example of how a CD4 big t cell rely guides the management of HIV. CD4 cells really are a type of light blood cell that’s specifically targeted and destroyed simply by HIV. A normal person’s CD4 count can differ from 500 to much more than 1, 500. Even if a person has no symptoms, HIV disease progresses to AIDS once his or her CD4 count turns into less than 2 hundred. (3)
on the lookout for. Briefly describe the purpose of virus-like load blood tests in monitoring the progression of HIV.
The viral weight test steps the amount of computer virus in your bloodstream. Studies have shown that people with higher viral loads generally fare more poorly than do individuals with a lower virus-like load. (3)
10. Mr. Thomas expresses a preparedness to learn more about HIV. Discuss the nurse’s initial intervention once beginning customer teaching and after that discuss the progression with the HIV disease, including an explanation of principal infection, A, B, and C and 4 main types of opportunistic infections. You will discover different phases of HIV infection. Primary HIV contamination can show symptoms that can be mixed up as the flu. These symptoms can last for a couple days to a couple of weeks and then disappear. Stage 2 is usually an asymptomatic stage meaning that the patient probably shows almost no symptoms. “This stage takes an average of 10 years and, as the name suggests, is free from major symptoms, although there could possibly be swollen glands. The level of HIV in the peripheral blood drops to suprisingly low levels yet people continue to be infectious and HIV antibodies are detectable in the bloodstream, so antibody tests will show a positive end result. Research has proven that HIV is not dormantduring this stage, yet is very mixed up in lymph nodes. A test is available to measure the little bit of HIV that escapes the lymph nodes. This check which steps HIV RNA (HIV genetic material) is called the virus-like load test out, and they have an important position in the treatment of HIV illness. (4) Stage 3 is systematic HIV seen as lymph nodes and cells becoming once and for all damaged and the virus beginning mutate to AIDs as a result of inability in the body maintaining helper To cell repairing as the HIV computer virus kills off the helper To cells. Stage 4 is progression of HIV to AIDS. HELPS is diagnosed when any condition classified by clinical stage 4 is definitely diagnosed and the CD4 count is less than 200 cells/mm3 or a CD4 percentage less than 15. (4) The ABC’s of HIV are:
Disuse for youngsters, including the hold off of intimate debut and abstinence until marriage Staying tested intended for HIV and being devoted in marriage and monogamous relationships Appropriate and regular use of condoms for those who practice high-risk behaviours (4) The CDC provides listed twenty four types of opportunistic infections regarding HIV. As his nurse I would make sure Mr. Thomas had the information with regards to all twenty four, but I would personally clarify within the 4 main ones since he is currently exhibiting symptoms of those. 4 main types of opportunistic infections in relation to HIV happen to be: “Thrush: infection of the oral cavity, throat, or perhaps vagina. Herpes simplex virus: can cause oral herpes (cold sores) or perhaps genital herpes. This can be a fairly common infection but since you have HIV, the outbreaks can be considerably more frequent and even more severe. Mycobacterium avium sophisticated (MAC or MAI) ” a bacterial infection which could cause recurring fevers, standard sick thoughts, problems with digestion, and critical weight loss Pneumocystis pneumonia (PCP) ” a fungal infection that can cause a perilous pneumonia. (6)
14. Following the nurse’s teaching, Mister. Thomas says, “How ridiculous I was to have that affair. Not only could it destroy my matrimony, but it gave me a death sentence. Share with Mister. Thomas the things you know about long-term survivors, long term non-progressors, and highly lively antiretroviral remedy (HAART).
HIV carriers can hold the virus for a 10 years showing minimal symptoms.
There are many different types of maintenance drug solutions to alleviate symptoms, and reduce the interest rate of progress. Antiretroviral therapy can help booth the progression of the disease, however , interruption of antiretroviral therapy can result in viral rebound, defense decomposition, and clinical advancement of HIV. Interruption of HAART is usually not recommended (7). With HAART, patients with had a great HIV test out have gone as long as 30 years with little to no symptoms and no development of HELPS (6). HAART is defined as a drug strategy to achieve sustained viral reductions. Simplified treatment regimens and decreasing the quantity of medications that patients use each day has proven effective in patient’s faith to their treatment. Drug businesses are constantly getting new ways to mix the inhibitors into two to three medications versus the extensive treatment regimens actually used. Overall adherence costs are still only 30-50% in the usa, so I would recommend comprehensive follow up with Mister. Thomas wonderful health care providers to enhance his faith.
12. Talk about how the registered nurse should respond if Mr. Thomas’s wife methods him inside the hall and asks, “Did the test benefits come back however? Do you know what is wrong with my husband?
The registered nurse must inform Mr. Thomas’s wife that she cannot discuss Mr. Thomas’s condition with her and that she must ask Mr. Thomas himself. Lawfully and ethically, the registered nurse cannot offer Mr. Thomas’s wife any information regarding his condition and diagnosis in the event Mr. Jones has especially asked for no information to be disclosed, which usually he provides.
13. List five possible nursing diagnoses appropriate to consider intended for Mr. Jones.
I chose these 5 for where Mister. Thomas is related to his disease at this time.
1 . Deficient knowledge related to HIV infection, method of preventing HIV transmission, and self-care
installment payments on your Risk for infection related to immunodeficiency.
three or more. Activity intolerance related to weak spot, fatigue, weakness, impaired
fluid and electrolyte equilibrium and hypoxia associated with pulmonary infections.
some. Social seclusion related to judgment of disease, withdrawal of support devices, isolation procedures, and fear of infecting others.
5. Anticipatory grieving related t within lifestyle and roles and unfavorable prognosis
References
1) Conner, Ross Farreneheit., & Fan, Hung Y., & Vilarreal, Luis G. Aids, Research and World, Sixth Release, 2011, Smith and Bartlett Publishers, LLC 2) http://www.biomedcentral.com/1472-698X/11/6
3) www.mayoclinic.com
4) www.avert.org
5) www.cdc.org
6) www.aids.org
7) Smeltzer, Suzanne C., & Hinkle, Janice L., & Bare, Brenda G., & Cheever, Kerry H. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing jobs, (2010), Wolters Kluwer Health/Lippincott Williams & Wilkins
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