Question

Winninggham's Critical thinking Cases In Nursing 5th edition

K.D. is a 36-year-old bisexual 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 self-discontinued 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.

When he arrived at the physician's office, the nurse performed a brief assessment. His vital signs

(VS) were 138/86, 100, 30, 100.8 ° F (38.2 ° C). K.D. stated that he had been feeling fatigued for several

months and was experiencing occasional night sweats, but he also had been working long hours, skipped

meals, and had been particularly stressed over a project at work. The remainder of K.D.'s physical examination

was within normal limits. The doctor ordered a chest x-ray, CBC, lymphocyte studies, including CD4

T-cell count, ultra sensitive viral load, cytomegalovirus assay, and a tuberculin test.

Over the next week, K.D. developed a nonproductive cough and increasing shortness of breath

(SOB). Last night, he developed a fever of 102 ° F and was acutely short of breath, so his roommate, J.F.,

brought him to the emergency department. He was admitted with probable Pneumocystis jiroveci pneumonia

(PJP), which was confirmed with bronchoalveolar lavage examination under light microscopy.

K.D.'s admission WBC and lymphocyte studies demonstrate an increased pattern of immunodeficiency

compared with earlier studies. K.D. is admitted to your medical unit and placed on nasal oxygen, IV fluids,

and IV trimethoprim-sulfamethoxazole (Bactrim).

1)Describe the assesment you need to perform to determine if this problems are present ?

2) What interventions can you use to assist K.D in managing depression

3) What other healthcaere team members may you involve in K.D's discharge planning?

4) Recognizing that KD has multiple poshospital needs you may begin discharge planning what type of assessment do you need to complete as part of KD discharge planning ?