HIV INFECTION Patient Profile J.N., a 35-year-old African Am

HIV INFECTION Patient Profile J.N., a 35-year-old African American… HIV INFECTIONPatient ProfileJ.N., a 35-year-old African American woman, was admitted to the hospital in respiratory distress. AIDS and Pneumocystis jiroveci pneumonia (PCP) were both diagnosed 2 days ago. Subjective Data•Seen by a physician 6 years ago for pain behind the sternum and difficulty swallowing, diagnosed as esophageal candidiasis; positive HIV-antibody test at that time•Has consistently refused ART because “We can’t afford it”•Married to Jim, a former IV drug user, for 15 years until his recent death from AIDS-related complications•Has two children, ages 8 and 10; neither has been tested for HIV infection•Experiences fatigue and frequent oral and vaginal candidiasis outbreaks•Expresses concern about the welfare of her children, who are at home with her sister, and says, “Maybe I should take better care of myself for them” Physical Examination•5 ft 6 in tall, 100 lb, temperature 100.4° F (38° C), O2 saturation 92% on 3 L of O2 via nasal cannula Laboratory Studies•CD4+ T cell count 185 cells/µL•Viral load 55,328 copies/µL•Hematocrit 30% Collaborative Care•Trimethoprim/sulfamethoxazole•Combination antiretroviral therapy: tenofovir and emtricitabine (Truvada), darunavir (Prezista), ritonavir (Norvir) DISCUSSION S1. Why did J.N.’s initial medical problem (esophageal candidiasis) lead to an HIV test?2. Why was trimethoprim/sulfamethoxazole ordered, and what are its common side effects?3. What diagnostic criteria for AIDS are present in J.N.?4. Is there a potential advantage to J.N.’s refusal to take antiretroviral drugs in the past? If so, why or why not?5. Women often put their children’s welfare first. What barriers could this cause for J.N.’s treatment? How can these problems be resolved?6. What priority teaching needs should be covered before J.N. is discharged from the hospital to return home? What referrals need to be made?7. How can J.N. be helped to adhere to her medication schedule?8. What are the priority nursing interventions? What plans need to be made for continued nursing care after discharge?9. J.N. asks you if her kids should be tested. She is afraid of what the results may be. How should you respond? ADDITIONAL S10. Transmission of HIV from an infected individual to another most commonly occurs as a result ofa. unprotected anal or vaginal sexual intercourse.b. low levels of virus in the blood and high levels of CD4+ T cells.c. transmission from mother to infant during labor and delivery and breastfeeding.d. sharing of drug-using equipment, including needles, syringes, pipes, and straws. 11. Which statements accurately describe HIV infection (select all that apply)?a. Untreated HIV infection has a predictable pattern of progression.b. Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS).c. Untreated HIV infection can remain in the early chronic stage for a decade or more.d. Untreated HIV infection usually remains in the early chronic stage for 1 year or less.e. Opportunistic diseases occur more often when the CD4+ T cell count is high and the viral load is low. 12. A diagnosis of AIDS is made when an HIV-infected patient hasa. a CD4+ T cell count below 200/µL.b. a high level of HIV in the blood and saliva.c. lipodystrophy with metabolic abnormalities.d. oral hairy leukoplakia, an infection caused by the Epstein-Barr virus. 13. Which strategy can the nurse teach the patient to eliminate the risk of HIV transmission?a. Using sterile equipment to inject drugsb. Cleaning equipment used to inject drugsc. Taking zidovudine (AZT, ZDV, Retrovir) during pregnancyd. Using latex or polyurethane barriers to cover genitalia during sexual contact 14. What is the most appropriate nursing intervention to help an HIV-infected patient adhere to a treatment regimen?a. “Set up” a drug pillbox for the patient every week.b. Give the patient a video and a brochure to view and read at home.c. Tell the patient that the side effects of the drugs are bad but that they go away after a while.d. Assess the patient’s routines and find adherence cues that fit into the patient’s life circumstances.Health Science Science Nursing NURS 250

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