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Case study of HIV/AIDS

Case study of HIV/AIDS

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An essay for the 2011 Undergraduate Awards Competition by Karen O'Brien. Originally submitted for Clinical Practice 6 at National University of Ireland Galway, with lecturer Toni Ui Chiardha in the category of Nursing & Midwifery
An essay for the 2011 Undergraduate Awards Competition by Karen O'Brien. Originally submitted for Clinical Practice 6 at National University of Ireland Galway, with lecturer Toni Ui Chiardha in the category of Nursing & Midwifery

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Published by: Undergraduate Awards on Aug 29, 2012
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10/27/2013

 
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In this case study the nursing management of HIV and AIDS will be discussed along with thepathophysiology and pharmacological interventions involved. To begin it is important thatan accurate description of the disease process be given so that the development of thisdisease is best understood.First and foremost, what is the difference between HIV and AIDS? The HumanImmunodeficiency Virus is the virus that causes AIDS (Osborne and Yeats, 2001) this viruslives in all bodily fluids but is most concentrated in the blood and is transmitted by theexchange of bodily fluids i.e. through unprotected sex, breastfeeding and needle use(Richardson, 1988). Its effect on the body is that it essentially stops the immune systemfrom working. Acquired Immune Deficiency Syndrome is the final stage of the infectionwhen the person is said to have one or more opportunistic infections.The pathophysiology of HIV is outlined in four steps, firstly; the virus enters the body andbegins to attack the immune system by taking over and destroying CD4 T cells. This primarystage is called seroconversion as the immune system recognises there is an infection andresponds by producing antibodies and lymphocytes (Porth and Matfin, 2010). This stage isaccompanied by flu-like symptoms that can last for a few weeks and occurs from two to fourweeks post exposure. This is due to a very high viral load as the virus is replicating at a rapidpace (Van Dyk, 2008).The second stage is known as the clinically asymptomatic stage. Sweet and Gibbs (2009)state that the viral load is reduced but the person still remains infectious although they haveno clinical symptoms of infection- this stage can last for up to ten years. In some cases theonly sign of infection is swollen lymph nodes as the virus is replicating most in the lymphnodes.
 
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Stage three is also known as symptomatic HIV infection. Symptoms begin to show as the HIvirus becomes stronger and more pathogenic causing greater destruction of T helper cellswhich the body cannot replace. Zuckerman et al (2009) state the early aspects of this stageare symptoms such as skin and oral lesions, eczema, fungal infections, fatigue, weight lossand night sweats. These symptoms progress to opportunistic infections as the immunesystem becomes weaker caused by the low number of CD4 cells and the increasing viral loadleading to infections such as tuberculosis, herpes zoster, and oral candidiasis. The immunesystem is failing and multiple infections begin to occur at the same time, affecting all areasof the body.The final stage is known as the progression of HIV to AIDS. AIDS is the end stage of theinfection, it is completely irreversible and palliative care becomes the main focus for thepatient (Crowe et al, 1996)There are many diagnostic tests that are used in each stage of the HIV infection. The firstand most effective test is a detailed ca
se history; the symptoms, how long they’ve had
them, previous history e.g. tuberculosis, sexually transmitted infections. Their sexualhistory, number of partners, partners health. Next a physical examination of the mouth andthroat, skin and lymph nodes and a blood test, where possible, should also be done (VanDyk 2008).
The use of measuring a person’s CD4 cell count is also a method of diagnosing
which stage they are at and how significant a stage of immunosuppression they have. Anormal CD4 cell count is anything from 500 to 1600, greater than 500 (per mm
) is notsignificant, 350-499 is mild, 200-349 is advanced and less than 200 is severe and classed asAIDS (African Region, 2005)
 
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The nursing priorities for patients with HIV/AIDS will now be looked at. There are manynursing priorities for patients with HIV/AIDS and these vary depending on the stage of HIVthey are at, for instance, preventing electrolyte imbalances, patient education with regardto adherence to medications and ongoing prevention of the spread of HIV are all importantin the beginning stages. Providing top quality palliative care for when they reach end-of-lifestages and treating any present opportunistic infections and dealing with associatedconditions such as respiratory problems like T.B. respiratory tract infections and pneumoniaas well as other conditions such as avascular necrosis (AVN) and wasting syndrome. Thethree main nursing priorities that will be discussed are: Treating opportunistic infections,nutrition and psychological care.For the purpose of this case study the patient that is being dealt with is a patient who wasadmitted with tuberculosis who is at stage 3 HIV. The first nursing priority is managing theseopportunistic infections.
Opportunistic Infections (OI’s)
are infections that a normal healthy immune system can fightoff; these infections take advantage of an immune suppressed patient such as a HIV patient(Mera, 1997). According to Bonnet et al (2005) People with HIV rarely die of the virus itself but most
commonly of OI’s, this is why treating these infections is a major nursing priorit
y.
The most common opportunistic infections (OI’s) are pneumonia, tuberculosis (TB)
andtoxoplasmosis; however, TB is the infection which will now be dealt with.Tuberculosis is an airborne disease that is spread from one infected person to the next andusually affects the lungs (Rees, 1997). People with a low immune system are more likely todevelop TB disease after exposure to infection more so than a healthy person, i.e. HIVinfected people. The effect that this has on HIV is that according to Harries et al (2004) the

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