14 Case study of a patient who has been diagnosed HIV positive
Patient profile
A definition of HIV was given in Chapter 1 and asked you to revise your anatomy and physiology (see Montague et al 2005). Before reading the case study, try to find out how HIV affects the immune system. What key issues did you discover for how HIV affects the immune system?
This comprehensive article may help you to research this:
Flannigan J (2008). HIV and AIDS: transmission, testing and treatment. Nursing Standard 22(34):48–56. Online. Available at: http://nursingstandard.rcnpublishing.co.uk/archive/article-hiv-and-aids-transmission-testing-and-treatment (accessed July 2011).
Assessment on admission
During your assessment discussion with Ms Chitalwa, using the Roper, Logan and Tierney (Roper et al 2000) model of activities of daily living, you note that she is normally totally independent in all activities of daily living (see Table 14.1).
Table 14.1 Assessment of Ms Chitalwa using the Roper, Logan and Tierney model
| Maintaining a safe environment | She requires assistance due to reduced mobility and lethargy. Local hazards include the oxygen tubing for her nasal specs and the drip stand and tubes for her intravenous co-trimoxazole |
| Communicating | She is fluent in English, which is her second language. Shortness of breath is reducing her sentence length. Recent HIV diagnosis has been a shock to her and she appears to be upset and withdrawn. She is very worried that her HIV status will be discovered by the other patients in her bay, as well as by her flatmates when they come to visit her. She seems reluctant to communicate about her HIV diagnosis. She has spent a lot of her time reading her bible. She is happy to be called Jessie |
| Breathing | Jessie becomes short of breath easily. She is receiving oxygen therapy via a humidification system and nasal specs. She finds it difficult to have a deep breath, and starts coughing |
| Eating and drinking | Her appetite has been reduced for the last week. She is a vegetarian. She feels nauseous when she tries to eat |
| Eliminating | She is too weak to walk to the bathroom, even with assistance |
| Personal cleansing and dressing | She is able to wash herself with a bowl at the bedside. She has been unable to bathe or shower for the last 3 days due to her lethargy and shortness of breath |
| Controlling body temperature | Currently no problems |
| Mobility | Severely reduced. Can barely manage five steps without becoming distressed. Oxygen and IV therapy are continuous so her range is already restricted due to the length of the tubes and IV lines |
| Working and playing | Does not want to discuss this right now |
| Expressing sexuality | Does not want to discuss this right now |
| Sleeping | Feels tired but has had a very unsettled night. Has not slept properly for several days, cannot remember how long |
| Dying | She is convinced that she is dying. The recent HIV diagnosis has made her resign herself to this fact. She has seen people die of HIV in Nigeria when she was younger and remembers the pain and suffering they went through, as well as the stigma for them and their families |
Ms Chitalwa’s problems
• Jessie is unable to independently maintain a safe environment.
See Appendix 4 in Holland et al (2008) for possible questions to consider during the assessment stage of care planning.
• Jessie has reduced communication ability, partly due to shortness of breath and partly due to her current psychological state and fear of her HIV diagnosis being discovered.
• Jessie has reduced blood oxygen saturation levels and is short of breath.
• Jessie has reduced appetite and is at risk of inadequate nutritional intake.
• Jessie has reduced mobility and is at risk of deep vein thrombosis and other hazards of prolonged immobility.
• Jessie is unable to walk to the bathroom.
• Jessie is tired but unable to sleep.
• Jessie is worried that she is going to die.
• Jessie has an intravenous cannula in situ, and is receiving intravenous therapy.
Jessie’s nursing care plans
1. Problem: Jessie is unable to independently maintain a safe environment.
Goal: To ensure a safe environment.
| Nursing action | Rationale |
|---|---|
| Ensure the call buzzer is within reach at all times | So Jessie is able to summon assistance as required and not attempt to do things beyond her current level of capability, potentially causing her condition to deteriorate or for her to fall |
| Ensure Jessie is aware that she should summon assistance and not try to push herself to do things which she is not currently capable of | To re-enforce to Jessie that she is unwell and that it is OK for her to ask for assistance |
Jessie’s environment remained safe throughout her hospital stay and recovery.
2. Problem: Jessie has reduced communication ability, partly due to shortness of breath and partly due to her current psychological state and fear of her HIV diagnosis being discovered.
Goal: To ensure optimum communication with Jessie.
Goal: To support Jessie psychologically with her recent HIV diagnosis.
| Nursing action | Rationale |
|---|---|
| Try to ask closed questions, if possible | To reduce the need for Jessie to feel she has to respond with long answers |
| Ensure privacy for discussions, taking Jessie to a private room as soon as this is feasible | Jessie will hopefully be more able to have conversations about HIV infection in a private setting, when she is aware that the rest of the patients will not be able to overhear |
| Make Jessie aware of the good prognosis and longevity for people with HIV infection | To reduce her fears of death or pain because of her HIV infection To enable Jessie to realise that she should recover and lead a normal life, but will have to take medicines every day |
| Refer to psychology service | To ensure an appropriately trained health professional is able to assess and support Jessie with her concerns and worries |
| Ensure all healthcare professionals are aware of Jessie’s concerns over confidentiality of her HIV infection | To reduce the risk of her HIV status being mentioned or discussed either in front of her, therefore disclosing to the other patients in her bay, or in public areas where the discussions could be overheard by other patients or visitors |
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