Group #3: K.D. is a 56-year-old gay professional man who has
Group #3: K.D. is a 56-year-old gay professional man who has been… Group #3:K.D. is a 56-year-old gay professional man who has been human immunodeficiency virus (HIV) infected for 6 years. He had been on antiretroviral therapy (ART) with Combivir (zidovudine and lamivudine) and nelfinavir (Viracept). He stopped taking his medications 6 months ago because of depression. The appearance of purplish spots on his neck and arms persuaded him to make an appointment with his physician.At the physician’s office, K.D. stated he had been feeling fatigued for several months and was experiencing occasional night sweats. He also related he had been working long hours, skipping meals, and was stressed over a project at work. Other than the purplish spots, the remainder of K.D.’s physical examination findings were within normal limits. The doctor took three skin biopsy specimens and ordered a chest x-ray examination, a complete blood count (CBC), lymphocyte studies including CD4 T-cell count, an ultrasensitive viral load, a cytomegalovirus (CMV) assay, and a tuberculin test. The skin biopsies indicate Kaposi sarcoma (KS).Over the next week, K.D. developed a nonproductive cough and increasing dyspnea. Last night, he developed a fever of 102 ° F and was acutely short of breath, so his roommate brought him to the emergency department. He was admitted to the medical unit with probable Pneumocystis jiroveci pneumonia (PJP), which was confirmed with bronchoalveolar lavage examination under light microscopy. K.D.’s admission white blood cell count (WBC) and lymphocyte studies demonstrate an increased pattern of immunodeficiency compared with earlier studies. K.D. is on nasal oxygen, intravenous (IV) fluids, and IV trimethoprim-sulfamethoxazole (Bactrim). His current vital signs (VS) are 138/86, 100, 30, 100.8° F (38.2° C) and Spo2 92%. What is Pneumocystis jiroveci pneumonia (PJP) and Kaposi sarcoma (KS) and what is the significance of K.D. developing KS and PJP?K.D. has been seropositive for several years, yet he has been asymptomatic for acquired immunodeficiency syndrome (AIDS). What factors might have influenced K.D.’s development of PJP and KS?What type of isolation precautions do you need to use when caring for K.D.?Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List at least three.Identify three teaching points for K.D. including discharge teaching on medications and how to prevent infections.Health Science Science Nursing NURSING NUR 265
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