Host Agent Environment

Assessments found in the host Etiologic Agent (Predisposing factors present

contributing to the in the host contributing to the
Development of the disease Development of the disease

Demographic data: Human Immunodeficiency Place of patient’s

Name: Mr. P Virus employment:
Single
Works at call Center Call Center
(demographic category which
in which HIV is most common,
filled by MSM/Men-having
sex-with men)

Medical Data: Probable Ethical issues:

Past Medical History:
- Prior blood transfusions Medical Doctor performed HIV
-Illicit drug use Antibody without the patient’s
- Needle stick injury knowledge and consent

On initial positive tests,

in-death explanations and
Past sexual history: counseling was apparently not
-Multiple sexual partners done

Patient-Doctor confidentiality
(Hence, another Doctor
cannot disclose the HIV
antibody result to the
patient’s sister without the
patient’s consent)
Clinical History
Hx of fever of unknown
origin, unexplained
generalized malaise,
anorexia

Hx of chronic infection
(Diarrhea of 2 mos
duration)
Hx of u Usual/uncommon
infections
(Colonial fungal
infection)
Physical Examination
Prolonged fever
Generalized lymphadeno-
pathy
Connect the pertinent Nursing care and medical - surgical management to the various
signs and symptoms presented by the client
Signs/Symptoms Presented Nursing Care Intervention/s Remarks
Undernutrition (Anorexia with Assess the patient’s ability to Oropharyngeal lesions,
weight loss) taste, chew, swallow changes in taste may reduce
appetite
Auscultate bowel sounds Increasedmay affect nutrients
serially absorption

Limit floods that may induce

nausea and vomiting

Schedule medications Gastric fullness may decrease

between meals (if possible) patient appetite

Provide regular oral care and

hygiene

Weigh the patient regularly Weight gain to achieved target

weight
Administer medications as
indicated (as per medical
doctor’s orders)
Fatigue Assess sleeping patterns Sleep patterns can be affected
by fatigue, medicines, stress
*maybe secondary to
catabolic state of the patient Establish realistic physical Provides feelings/sense of
coupled with overwhelming activity goals accomplishments
psychological/emotional
needs Identify and perform energy Weakness/Fatigue may affect
conservation techniques activities of Daily living

Monitor vital signs

physiological responses to
activity

Provide supplemental oxygen Anemia may reduce oxygen

Diarrhea, and other risk
factors For volume deficit
as indicated
Monitor VS, including input
and output, as well as CVP (if
available)
available for cellular uptake
and contributed to fatigue
Tachycardia and hypotension
maybe indicators of circulating
fluid volume

*Risk factors for volume Administer fluids and It maybe needed to replenish
depletion may include electrolytes via feeding tube the effective circulating
diarrhea, excessive sweating, and /or IV volume thru PO or IV
and poor oral fluid intake
Eliminates foods which may May aid in reducing frequency
cause diarrhea and severity of diarrhea
Fever Note temperature elevation
and duration of fever.

Psychological effects of
chronic disease
Risk for Infection
*HIV patients maybe immuno-
compromised and prone to
developing opportunistic
infections
Feelings of anxiety/depression
*Patient may have feelings of
tension, feelings of
helplessness/hopelessness,
and may have suicidal
ideations
Administer tepid sponge baths
as indicated
Wash hands before and after
all patient contact, instruct
patient and watcher to wash
hands as indicated
Assess patient knowledge and
ability to maintain
prophylactic regimen
Assess Respiratory rates and
breath sounds
Wear gloves and gowns during
direct contact with bodily
fluids. Practicing universal
precautions
Dispose of needles and sharps
in puncture-resistant
containers
Label all body fluid containers,
soiled linens and dressings for
proper disposal
Maintain frequent and
personable contact with the
patient
Be observant of signs of
denial, anger, depression. And
to be able to provide an
environment in which the
patient feels safe to verbalize
said feelings
Explain procedures and
medications given
Refer for psychological
counseling as indicated
Reduces risk of
cross-contamination
Prolonged patient compliance
to medicine intake is difficult
to maintain
Immunocompromised
patients are prone to develop
opportunistic respiratory
infections
Use of gloves, masks, and
gowns is required for direct
contact with body fluids
Prevents accidental infection
of caregivers. Recapping is not
advised. And needle stick
injuries should be reported
immediately
Prevents cross-examination
and alert the appropriate
personnel to proper handling
and disposal of hazardous
materials
Makes the patient feel that he
is not alone, communications
promotes trust
Aids the patient in accepting
current condition, and allows
him to begin to deal with the
situation
Information may reduce fear
of the known (compared to
the unknown)
If the patient’s condition
requires further and more
specialized assistance in
dealing with psychological
disturbances
Salient Features/Notes: (Summary)

Mr. P
Tested HIV antibody test
Private clinic
Wants confirmation of test results

Mr. P. Is in his thirties, single, worked at a call Center

Symptoms: Diarrhea of two months duration
Diagnosed to have “chronic inflammation in the colon”, given antibiotic
He becomes anorexic, with fatigue, weight loss, and low grade fever
Some unrecalled medications tiered for two months but ineffective

Stool culture positive for fungus. Possible colonial fungal infection

Medical doctor discontinued antibiotic since it was a possible cause of fungal infection
MD checked HIV antibody test without the patient’s knowledge
The result is positive, MD disclosed the test result to Mr. P and his elder sister.
No other explanations or no counseling were done
The MD refers the patient to a General hospital

Physical Examination on his first visit:

Generalized lymphadenopathy and low grade fever
Complains of generalized fatigue and discomfort in the lower abdomen
Dr. D repeated HIV antibody test upon Mr. P’s request
Advised to follow-up after two weeks to See test result

Mr. P did not follow-up after two weeks

Dr. D checked HIV antibody test result (positive)
Mr. P’s sister went to hospital but since Dr. D was out of the hospital, another doctor explained
that he could not disclose to her the test result

He has not visited again despite his sister’s encouragement

2. Based on the scenario:

- Develop a graph based on:
a. Demographics data
B. Medication adherence of the patient
 DEMOGRAPHIC SEX
MALES 7
FEMALES 11

AGE 16-27 YEARS 28-39 YEARS 40-50 YEARS

MALE 2 2 3
FEMALES 7 3 1
TOTAL 9 5 4
 SEX MEDICAL DRUG TAKE W/ NO
CONSULT COMPLIANCE MD AND CONSULTATION
MEDS AND NO MEDS
MALES 7 1 2 2 2
FEMALES 11 1 0 3 7