drugs since receiving hiv diagnosisdenies recent travel H e a l t h M e d i c a l

drugs since receiving hiv diagnosisdenies recent travel H e a l t h M e d i c a l

– Answer the discussion questions based off the patient profile.

Ch. 14 Human Immunodeficiency Virus Infection

Patient Profile

A.D. is a 37-year-old man who has been positive for human immunodeficiency virus (HIV) for 6 years. He went to the outpatient clinic today, stating that he has a cough that will not go away and increasing shortness of breath. He is being admitted as an inpatient on the medical unit of the hospital. He is taking:

  • Efavirenz (Sustiva) 600 mg PO daily at bedtime
  • Tenofovir DF and emtricitabine (Truvada) 1 tablet PO daily at bedtime

Subjective Data

  • Has had increasing fatigue and shortness of breath over the past week
  • States, “I can’t even walk to the bathroom without stopping to catch my breath”
  • Has had a nonproductive cough for two weeks and pain with coughing
  • Has lost 13 lb over the past 2 months
  • States he is taking his ART medications as prescribed
  • Has had multiple sexual partners; is currently in a monogamous relationship
  • Denies tobacco use
  • Has history of IV drug use but has not used any drugs since receiving HIV diagnosis
  • Denies recent travel out of the country

Objective Data

Physical Examination

  • Vital signs: blood pressure 115/70, pulse 112, temperature 102°F, respiration 20
  • Cachectic
  • Crackles at bases of lungs, left side greater than right
  • Heart rate and rhythm regular, no murmurs
  • Nonproductive cough
  • Pulse oximetry is 90% on room air
  • One anterior cervical lymph node on left side is palpable

Diagnostic Tests

  • CD4+ lymphocyte count 76 cells/µL
  • Chest x-ray shows probable pneumonia in left lower lobe

Discussion Questions

  1. What is the likely medical diagnosis for A.D.? What assessment data leads you to this conclusion?
  2. What are the priority nursing diagnoses for A.D. currently?
  3. What are the priority nursing interventions in A.D.’s plan of care
  4. Is A.D. now considered to have AIDS?
  5. A.D. has been HIV positive for 6 years, yet he has not developed AIDS. What factors might have delayed A.D.’s transitioning to AIDS?
  6. A.D is continuing therapy with trimethoprim–sulfamethoxazole (TMP-SMX) after discharge. Why?
  7. What areas should you address in A.D.’s discharge teaching?