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HIV Case Study Learning Activity

LY, a 45-year-old male, returns to the infectious disease clinic for a 1-week follow-up visit for results of his confirmatory testing. He has continuing complaints of fatigue, cough, and lymphadenopathy. A buccal HIV test was done a week ago and found to be positive. Data obtained from the nursing assessment include the following:

Vital signs: temperature, 99.1°F; pulse, 70; respiration, 16; blood pressure, 110/88

Reports progressively becoming more fatigued over the past 6 months

Divorced

States “burning the candle at both ends” by working overtime

Cough with onset 5 days before the first visit

Denies previous medical problems

Physical examination within normal limits except for palpable lymph nodes on the posterior neck, in both axilla and bilateral inguinal areas

Viral load: 10,000; CD4 T-cell count: 550 cells/mm3

CBC, chemistry panel, and UA all within normal limits

Buccal HIV test positive 1 week ago; confirmed with Western blot test, and those results given at this visit

Chest x-ray negative

The plan for this visit is aimed at allowing Mr. Young to ventilate his feelings as well as providing referral to the local health department for informational classes. Mr. Young will return to the clinic in 1 month. There is no current drug therapy. At the follow-up visit, the nursing assessment included the following:

Complains of continued fatigue

Reports cough has resolved

Physical examination is unchanged.

Viral load: 300,000

CD4 T-cell count: 399 cells/mm3

Question 1

The doctor is planning to discuss the use of antiretroviral drugs with this newly diagnosed HIV positive patient (Acute HIV disease)
According to the current standard of care in the management of HIV infection at the current time: Should this patient be started on antiretroviral therapy? What are the benefits or rationale for doing so?

Question 2

After reviewing the assessment data in the previous question, are there any contraindications or precautions that would eliminate the use of antiretroviral drugs for this particular patient? In other words, is there evidence that he is not a candidate for treatment at this time and why or why not? This is worth one point, so a lengthy answer is not required.

Question 3

How would response to the medications be assessed?

What would be signs that drug therapy is effective? Give at least 2 desired outcomes.

Question 4

This is a chronic disorder-what should the nurse teach the patient to do to help himself remain as healthy as possible? Identify the essential teaching points for this patient.

This is worth 3 points, so it needs to be more than a couple sentences.

Question 5

A diagnosis of HIV is difficult. Looking at his history and situation, what should the nurse discuss or review or suggest to the patient to help him adjust to the diagnosis and the continuing stigma associated with HIV. Is there something else the nurse needs to ask about that might be important. This is really about how the nurse can support the psychosocial effects of this diagnosis.

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