TARLAC STATE UNIVERSITY

COLLEGE OF SCIENCE
DEPARTMENT OF NURSING
Awarded Level III Status by the Accrediting Agency of Chartered Colleges and Universities in the Philippines

Sexually Transmitted Infections

COMMUNICALE DISEASES
NCM 112 CLINICAL LABORATORY
Clinical Case Analysis
June 22, 2021

Submitted by:
Carreon, Jemaica
Castaneda, Micah Lorraine
Corpuz, Alexandra Mari May
Fernandez, Dexter Ivan
Garcia, Maya Angelou
Gragasin, Alexandra Nicole
Magcalas, Jeremiah Earl
Nicolas, Jennifer
Ramos, Kaye Justine
Reyes, Angeline

Submitted to:
Ms. Bianca Camille Mercado, RN. MSN.
Clinical Instructor
 TARLAC STATE UNIVERSITY
COLLEGE OF SCIENCE
DEPARTMENT OF NURSING
Awarded Level III Status by the Accrediting Agency of Chartered Colleges and Universities in the Philippines

CLINICAL CASE ANALYSIS

Name of Client Nino Estadio Age: 29 Gender: Male

Address Northwest Pob., Paniqui, Tarlac Date Admitted: June 22, 2021
Diagnosis Acquired Immunodeficiency Syndrome

NURSING HISTORY:

Past Health History:

• He is a known HIV patient for 3 years with a CD4 lymphocyte count of 583, wherein he thinks
he got HIV when he had his tattoo at a local tattoo shop.
• He was taking Zidovudine as prescribed by his doctor which at first a compliant to this
medication, but eventually stopped taking it after 2 years.
• He also stopped returning to his doctor for follow-up.
• His weight went down from 72 kgs to 58 kgs over a year.
• 4 years ago, when he still not diagnosed with HIV, he claims to be a smoker (1/2 pack a day)
and an occasional drinker (approximately 2 times a month).
• He only had 1 sexual partner and has no previous STD’s.
• He has no known allergies to drugs and foods.
• He was completely vaccinated and immunized when he was young.
• He was hospitalized 20 years ago and underwent surgery for appendectomy.

Family Health History:

• On his maternal side they have history of diabetes and hypertension.
• On his paternal side they have no known history of any diseases but currently his father is a
known asthmatic patient with Seretide puff taken 2 puffs 2 times a day.

Present Health History:

• June 20, 2021: Three days ago, prior to the admission, Nino started to develop a productive
cough characterized as yellowish in color.
• June 21, 2021: One day prior to the admission, he claims to feel hot however he did not check
his temperature. He also feels weak and tired when going down the house.
• June 22, 2021: Day of admission, he checked his temperature and recorded it at 38.5 °C, he
also complaints of difficulty in breathing, wherein symptoms seem to worsen which prompted
his family to bring him to the hospital. Upon arriving at the hospital, a Physical Examination
was done to him by the nurse, he was pale, diaphoretic and in acute respiratory distress. Initial
vital signs were taken as follows: Temperature: 39 °C, HR: 112 BPM, RR: 30 CPM, BP: 110/70
mmHg. Moreover, oral thrush was also present. Examination of the lungs disclosed poor
inspiratory effort and bibasilar crackles 2/3 of the way up the posterior lung field. He had a
tachycardia but no murmurs. His abdomen was non-tender, and there was no enlargement of
the liver or spleen. Neurologic examination was normal.
• The physician ordered some laboratory test and advised for admission.
Pathophysiology

• HIV is commonly transmitted via unprotected sexual activity, blood transfusions, hypodermic needles,
and from mother to child. Upon acquisition of the virus, the virus replicates inside and kills T helper cells,
which are required for almost all adaptive immune responses. There is an initial period of influenza-like
illness, and then a latent, asymptomatic phase. When the CD4 lymphocyte count falls below 200 cells/ml
of blood, the HIV host has progressed to AIDS, a condition characterized by deficiency in cell-mediated
immunity and the resulting increased susceptibility to opportunistic infections and certain forms of cancer.
Only certain bodily fluids can transmit the virus: semen, pre-seminal fluid, blood, rectal fluid,
vaginal fluid and breast milk. To transmit HIV, one of these fluids must come into contact with a
mucous membrane (such as the mouth, vagina or rectum) or damaged tissue, or be directly
injected into the bloodstream. HIV is not transmitted through saliva, sweat or tears, and cannot
be spread by ticks or mosquitos, social contact, touch or sharing food with somebody who has
HIV. CD4 T-cell depletion and chronic inflammation are the two signature events that drive HIV
pathogenesis and progression to AIDS. Infection of the cells of the CNS cause acute aseptic
meningitis, subacute encephalitis, vacuolar myelopathy and peripheral neuropathy. Later it leads
to even AIDS dementia complex.

Modifiable Risk Factors: Non-modifiable Risk Factors:

-Sexually active individuals -History of other STI’s
-Individuals with multiple partners -weak immune system
-Unprotected sex -severity of partner’s infection
-unhealthy habits: smoking

Viral transmission through:

Contaminated Blood Sexual Intercourse Contaminated needle

Human Immunodeficiency Virus Infection spreads to different body cells and tissues

Immunosuppression

Decreased number of CD4+ T-cells

A B
 A B

body launches an immune system

response Production of more HIV Chronic Smoker
virus
Immune system tries to fight by
increasing temperature

Hyperthermia: 39 oC Host susceptible to other

infection
• Flushed skin
• Skin warm to Host acquired pathogen
touch through airborne: M.
• Weak in Tuberculosis
appearance Pathogen spreads to cells and
tissues through lymph and
blood
Pathogen spreads to cells and
tissues through lymph and
blood
Local response by alveolar epithelial cells

Accumulation of neutrophils and plasma

exudate from capillaries into alveoli

Irritation and attempted

clearance of airways

Fluid infiltrates are inside

alveoli, airway clearance
leads to phlegm production

Productive cough Alveolar sacs blocked by

fluid accumulation

• Pale Dyspnea
• Diaphoretic
• Poor inspiratory effort
DIAGNOSTIC PROCEDURES:

HEMATOLOGY REPORT
June 22, 2021
Indication/Purpose: To evaluate and count cells that circulate in the blood
Nursing Responsibilities:
Obtain informed consent.
Clean site of injection using wet cotton balls in circular motion.
Observe aseptic technique by wearing PPE like gloves, face mask and face shield
Use torniquet and obtain blood sample.
Dispose used needle to infectious trash bin.
Normal Values Result Remarks
WBC, Lymphocytes, Monocytes, CD4 and
M: 13 – 18 g/mL
Hemoglobin 12 Hemoglobin level
F: 12 – 16 g/mL
are Low
M: 39 – 50%
Hematocrit 43.5
F: 35 – 45%
Red Cell Count x 10^3/uL 4.95
4.5 – 10.5 × 109 /
WBC 2.9
L
Neutrophils 1.92-7.60 K/uL 2.54
1,000 and 4,800
Lymphocytes 66
u/L
1000 and 4500
Monocytes 18
u/L
0.01 – 0.05 (1 –
Eosinophils 0.03
5%)
Basophils 0 – 0.01 (0 – 1%) 0.1

CD4 600 to 1200 mml 189

MCV: 80 – 96 fL MCV: 94
MCH: 27.5 – MCH:
MCV, MCH, RDW
32.2 pg 28.2
RDW: 39 – 46 fL RDW: 43
F: 0 - 20 mm/h
ESR
M: 0 -15 mm/h
150,000 –
Platelets 203,000
450,000
FBS <100 mg/dL 89 mg/dL
Alkaline
35-130 U/L 78 U/L
Phosphatase
Blood Type AB+
Interpretation. Since client N is positive HIV for 3 years, his immune system weakens which causes
bone marrow to unable to produce white blood cells, lymphocytes, monocytes, and CD4 to fight
infection and low hemoglobin level which causes him to look and feel weak and tired.

CHEST X RAY
June 22, 2021
Indication/Purpose: Used to visualize abnormalities in the lungs and heart
Nursing Responsibilities: 
No preparation. Obtain informed consent, the client can eat and drink, however, instruct the client or
the client to remove all accessories if any, and wear loose clothing.

FINDINGS:  Haziness noted over both lower lungs

No focal infiltrates identified.
Heart is not enlarged.
Liver and spleen are not enlarged.
Hemidiaphragms and sulci are intact.
Osseous structures are unremarkable.

IMPRESSION: Pulmonary Tuberculosis

Interpretation. TB is an opportunistic infection that occur more often when a patient has weakened
immune systems since client N has is immunocompromised, it is possible that he is also positive for
pulmonary. tuberculosis
 DIGANOSTIC ANALYSIS AND
DATE NURSING
LABORATORY INDICATION RESULT INTERPRETATION OF
ORDERED/DONE RESPONSIBILITIES
PROCUDRES RESULTS
SPUTUM GENE JUNE 22, 2021 It is indicated for diagnosing Gene Expert Analysis and Interpretation: PRIOR THE
EXPERT pulmonary TB in patients with confirms TB or Opportunistic bacteria such as PROCEDURE:
a negative sputum AFB bacteria, or Mycobacterium Tuberculosis is • Maintain airborne
smear. The assay is faster Mycobacterium the causative agent of and droplets
than culture and can detect tuberculosis was tuberculosis. The sputum of the precautions such as:
rifampicin resistant strains of seen client has accumulations of • Advising client to
MTB. (Mycobacterium Mycobacterium Tuberculosis wear mask to
Tuberculosis) bacteria which presents that minimize spread of
Client has tuberculosis due to transmission.
client’s weakened immune • Wearing of complete
system and is immune PPE such as mask
compromised. and gloves
• Physical Distancing

DURING THE
PROCEDURE
• Collect the samples
of the sputum thru
asking the client to
take a deep breath
and cough sputum to
collect for samples
• Fill the Cup with
sputum until to its
marked line.
• Take the sample to
the laboratory as
instructed.
• Label the cup with
the name of the
client, date and time
performed, and type
of procedure.

AFTER THE
PROCEDURE
• Maintain airborne
and droplets
precaution with the
client
• Inform the patient
that a report of the
results will be made
available to the
requesting HCP, who
will discuss the
results with the
patient
• Instruct the patient in
the use of any
ordered medications.
• Explain the
importance of
adhering to the
therapy regimen.
Medical Management:
• Start venoclysis of Plain Normal Saline Solution to run at 30 gtts/minute
• Give Cefuroxime 750mg (IV Bolus) in 10 cc of sterile water after negative skin test every 8 hours
• Give multivitamins 1 capsule a day

MEDICAL DATE
GENERAL DESCRIPTION INDICATION CLIENT’S REACTION
MANAGEMENT PERFORMED
Plain Normal Saline June 22, 2021 Normal saline solution has an osmolality of This solution is used to supply The patient showed no signs
Solution 1L to run at 308mOsm/L. Because the osmolality is entirely water and salt to the body. and symptoms of infiltration,
30 gtts/minute contributed by electrolytes, the solution remains within Sodium chloride solution may phlebitis, or any skin
the extracellular fluid, it does not cause red blood cells also be mixed with other irritations. The patient
to shrink or swell. It is an isotonic concentration of medications given by injection consumed the intravenous
sodium chloride, which is best suited for nutrition and into a vein. fluid without adverse effects.
parenteral replacement of fluid loss.
Nursing Responsibilities:

Before Administration
• Obtain history of the client’s fluid and electrolyte (laboratory tests) status before therapy and reassess regularly
• Before giving the bottle, check for the correct client to be administered
• Check the doctor’s order for the correct fluid to be given
During Administration
• Upon inserting the chamber, make sure that it is inserted well
• Be alert of fluid overload such as rapid weight gain, noticeable edema in arms, legs, face, or abdomen, cramping, headache, stomach bloating,
shortness of breath, and high blood pressure.
• Check for the client’s comfort
After Administration
• Infuse the IV well to its prescribed rate
• Check for the presence of bubbles in the IV tube
 ROUTE,
DATE MECHANISM OF ADVERSE
NAME OF THE DRUG DOSAGE AND INDICATION NURSING RESPONSIBILITIES
ADMINISTERED ACTION EFFECTS
FREQUENCY
Drug Name: June 22, 2021 at 750mg IV Bolus Cefuroxime exerts Cefuroxime is Large doses can Always wash hands thoroughly,
Cefuroxime 11:00 AM in 10cc sterile its bactericidal indicated for the cause cerebral disinfect equipment (whirlpools,
water every 8 action by inhibiting treatment of a wide irritation and electrotherapeutic devices,
Brand Name: hours the activity of variety of bacterial convulsions; treatment tables, and so forth),
Ceftin, Zinacef, bacterial wall infections such as: nausea, vomiting, and perform other appropriate
Kefurox synthesis. It binds • Lower respiratory diarrhea, erythema infection control procedure such
itself to specific infections caused multiforme, as wearing of facemask, PPE
Drug Classification: penicillin – binding by S. pneumoniae, Stevens-Johnson and etcetera to help prevent the
Cephalosporin proteins found S. aureus, E. coli, syndrome, spread of microorganisms.
Antibiotics inside the bacterial Klebsiella, H. epidermal
cell wall. Penicillin influenzae, S. necrolysis. Before the administration, check
Pregnancy Category – binding proteins pyogenes the physician’s order and always
B are substances • Dermatologic Fatal: Anaphylaxis, observe 10 rights of drug
necessary for the infections caused nephrotoxicity, administration to promote safe
formation of by S. aureus, S. pseudomembranou medical care and to ensure that
bacterial cell wall. pyogenes, E. coli, s colitis. medications are administered
Hence, Cefuroxime Klebsiella, safely and accurately.
interferes the Enterobacter There are no signs
function of • UTIs caused by and symptoms of Prior to drug administration,
penicillin – binding E. coli, Klebsiella possible adverse perform skin test to assess for
proteins during cell • Uncomplicated and side effects contraindications and
wall synthesis and disseminated manifested by the hypersensitivity to drug.
which then lead to gonorrhea caused patient such as
bacterial cell death. by N. gonorrhoeae anaphylaxis, Observe patient for signs and
• Septicemia convulsion, nausea, symptoms of anaphylaxis (rash,
caused by S. vomiting and pruritus, laryngeal edema,
pneumoniae, S. diarrhea. wheezing). Discontinue the drug
aureus, E. coli, and notify physician or other
Klebsiella, H. health care professional
influenzae immediately if these symptoms
• Meningitis occur. Keep thromepinephrine,
caused by S. an antihistamine, and
pneumoniae, H. resuscitation equipment close by
influenzae, S. in the event of an anaphylactic
aureus, N. reaction.
meningitidis
• Bone and joint Avoid alcohol while taking this
infections caused drug and for 3 days after
by S. aureus because severe reactions often
occur.

Instruct patient to notify physician

immediately of signs of
superinfection, including black,
furry overgrowth on tongue,
vaginal itching or discharge, and
loose or foul-smelling stools.

Instruct patient and

family/caregivers to report other
troublesome side effects such as
severe or prolonged skin
problems (rash, hives, dermatitis)
or GI problems (nausea,
vomiting, diarrhea, cramps).
 ROUTE,
DATE MECHANISM OF CLIENT’S NURSING
NAME OF THE DRUG DOSAGE AND INDICATION
ADMINISTERED ACTION RESPONSE RESPONSIBILITIES
FREQUENCY
Multivitamins June 22, 2021 at 1 capsule a day Dietary supplement for Theragran is a Patient reported Always wash hands
6:30 PM Per Orem the treatment and multivitamin and feeling alert, well – thoroughly, disinfect
Brand Name: prevention of vitamin iron product rested and motivated. equipment (whirlpools,
Theragran deficiencies. It also used for the electrotherapeutic devices,
acts as coenzyme treatment and There are no signs treatment tables, and so
Drug Classification: which contributes to management of and symptoms of forth), and perform other
Therapeutic: the normal bodily vitamin possible adverse and appropriate infection control
Food supplement structure and function deficiency due to side effects procedure such as wearing of
of different body cells poor diet or manifested by the facemask, PPE and etcetera
Pharmacologic: through its involvement certain illnesses. patient such as rash, to help prevent the spread of
Multivitamins in the metabolism of fever, constipation, microorganisms.
cholesterol, amino diarrhea, and
Pregnancy Category acids, and fatty acids. stomach upset. Before the administration,
A check the physician’s order
and always observe 10 rights
of drug administration to
promote safe medical care
and to ensure that
medications are administered
safely and accurately.

Monitor and assess the

patient accordingly for signs
of vitamin deficiency before
and during the therapy.

Assess the nutritional status

of the patient by monitoring 3
to 7 days food record and
performing anthropometric
measurement

Instruct patient and

family/caregivers to report
other troublesome side
effects such as rash, hives,
itching, red, swollen,
blistered, or peeling skin,
fever, tightness in the chest
or throat, trouble breathing,
swallowing, or talking,
unusual hoarseness or
swelling of the mouth, face,
lips, tongue, or throat.
NURSING INTERVENTIONS
• Monitored the Client's vital signs, especially the respiratory rate and oxygen saturation using
a pulse oximeter. This is to evaluate the oxygen levels of the patient, making sure that it is
on the normal range.
• Applied cooling blankets and performed tepid sponge bath (TSB) regularly to alleviate
elevated temperature.
• Assisted and provided the Client with adequate rest periods in a quiet, dimly lit room with a
calm atmosphere.
• Instituted infection control precautions until 24 hours after initiation of antibiotic therapy (oral
and nasal discharge is considered infectious) such as placing the patient on a private room,
encourage wearing of face mask who enters the room, frequent handwashing, and cough
etiquette. Patients with HIV/AIDS are immunocompromised. It is essential that we protect
them from getting nosocomial infections.
• Elevated the head of the patient’s bed into semi-fowlers or high fowlers position. This is to
promote breathing, thus elevating the oxygen levels of the patient.
• Assisted the client in frequent change of position by turning side to side. This will stimulate
the lungs for proper expansion. Also, to avoid pressure ulcers.
• Encouraged and provided adequate oral fluid intake of 15.5 cups (3.7 liters) of fluids a day to
the client. This will prevent the client from being dehydrated due to fever-loss moisture, thus
increasing hydration.
• Provided and demonstrated proper oral care and hygiene. This is essential as the client
already has oral thrush, which impaired his mucosal membrane that can lead to other
problems such as imbalanced nutrition.
• Monitored daily weight accordingly, serum electrolytes; and urine volume, specific gravity,
and osmolality. The client already loss so much weight which compromised his immune
system. Monitoring the weight should provide data to evaluate hydration and nutrition.
• Provided appropriate client safety from injury secondary to altered LOC by raising the side
rails of the patient’s bed.
• Monitored laboratory values, especially, the hematology test, which includes the indicators
for immune function such as CD4 count.
• Provided frequent IV fluid replacement by administering IV fluids as prescribed, but care is
taken to prevent fluid overload.
• Provided sufficient information about the Client's disease process to the family members
such as the mode of transmission, appropriate care management measures, and the
corresponding infection control precautions such as:
- Proper hand hygiene
- Wearing of face mask when interacting with the patient, and observe for reverse
isolation.
- Avoid using or sharing of personal hygiene items with the patient.
- Frequent disinfection of the things that will be used by the patient to avoid transfer of
microorganism that might compromise the client’s health.
• Maintained standard precautions while handling or having contact with the patient that
includes:
- Hand hygiene
- Use of personal protective equipment such as gloves, aprons or gowns, mask or
respirators, and goggles or face shields.
- Safe injection practices such as do not uncover or unwrap the sharp object until it is
time to use it, keeping the object always pointed away from yourself and other
people, never recap or bend the needle, and keep the fingers away from the tip of
the needle.
 - Safe handling of potentially contaminated equipment or surfaces in the patient
environment such as proper disposal of infectious materials on a yellow bin.
- Respiratory hygiene/cough etiquette by covering the mouth while coughing.

Nursing Management
a) Health education. The healthcare worker must:
a) Know the patient,
b) Avoid fear tactics,
c) Avoid judgmental and moralistic messages,
d) Be consistent and concise,
e) Use positive statement, and
f) Give practical advice.
b) Practice universal/ standard precaution
a) There is a need for a thorough medical handwashing after every contact with patient
and after removing the gown and gloves, and before leaving the room of an AIDS
suspect or known AIDS patient.
b) Use of universal barrier or Personal Protective Equipment (PPE) e.g., cap, mask,
gloves, CD gown, face shield/goggles, is very necessary.
c) Prevention
a) Care should be taken to avoid accidental pricks from sharp instruments
contaminated with potentially infectious materials from AIDS patient.
a) Gloves should be worn when handling blood specimens and other body secretions
as well as surfaces, materials, and objects exposed to them.
b) Blood and other specimens should be labeled with special warning "AIDS
Precaution."
c) Blood spills should be cleaned immediately using common household disinfectants,
like "chlorox."
d) Needles should not be bent after use, but should be disposed into a puncture-
resistant container.
e) Personal articles, like razor or razor blades, toothbrush, should not be shared with
other members of the family. Razor blades may be disposed in the same manner as
needles are disposed.
f) Patients with active AIDS should be isolated.

The Four Cs in the Management of HIV/AIDS (DOH, p. 296)

1. Compliance - giving of information and counseling the client which result to the client's
successful treatment, prevention, and recommendation.
2. Counseling/ education
a) Giving instruction about the treatment
b) Disseminating information about the disease
c) Providing guidance on how to avoid contracting STI again
d) Sharing facts about HIV and AIDS
3. Contact tracing
a) Tracing out and providing treatment to partners
4. Condoms
a) Promoting the use of condom, giving instructions about its use, and giving away
available condoms
 Name of Student: Carreon, Jemaica
Castaneda, Micah Lorraine
Corpuz, Alexandra Mari May
Fernandez, Dexter Ivan
Garcia, Maya Angelou
Gragasin, Alexandra Nicole
Magcalas, Jeremiah Earl
Nicolas, Jennifer
Ramos, Kaye Justine
Reyes, Angeline
Date Submitted: June 22, 2021 C.I.'s Signature

Form No.: TSU-COS-SF-04 Revision No.: 00 Effectivity Date: June 22, 2016 Page 1 of 1

References:
Cheever & Hinkle. (2018). Brunner and Suddarth’s, Textbook of Medical-Surgical Nursing, 14th edition,
Vol. 1 & 2
Navales, Dionesia. (2011). Handbook of communicable and infectious diseases. 3 rd Edition. C & E
Publishing, Inc.