Question

Case Study #13 - HIV

Darrin Olmstead is a 42-year-old man admitted to the hospital with complaints of shortness of breath, fever, fatigue, and oral thrush. The physician reviews the lab and diagnostic tests with Mr. Olmstead and informs him that he has pneumonia and has tested positive for HIV. Mr. Olmstead believes that he contracted HIV while involved in an affair with another woman three years ago. He is afraid to tell his wife, knowing she will be angry and that she may leave him.

You are the nurse assigned to care for Mr. Olmstead and you read in his medical record that he learned two days ago that he is HIV positive. There is a note in the record that indicates that hehas not yet informed his wife of the diagnosis.  In confiding with you, he states, “How can I tell my wife about this? It’s bad enough that I had an affair, but to have to tell her in this way…I just don’t think I can. I will just say I have pneumonia and take the medication my doctor prescribed for me. If she begins to show signs of not feeling well then, I will tell her.   I just can’t tell anyone. What will people think of me if they know I have AIDS?”

Discussion Questions

1. Describe the progression of HIV infection at the cellular level. What symptoms did Darrin have that correlated with the clinical presentation of a patient with HIV infection?

2. Briefly discuss how HIV is transmitted and how it is not. How can Darrin prevent the transmission of HIV to his wife and others?

3. Darrin stated, “What will people think of me if they know I have AIDS?” Explain the difference between being HIV positive and having AIDS.

4. What are the laboratory tests used to confirm the diagnosis of HIV infection in an adult?

5. Discuss the function of CD4+ T cells and provide an example of how the CD4 T cell count guides the management of HIV.

6. Identify and describe medications and treatment options available for Darrin. What are the major side effects and complications of these medications?

7. Briefly explain the purpose of viral load blood tests in monitoring the progression of HIV.

8. Darrin expresses a readiness to learn more about HIV. Discuss the nurse’s initial intervention when beginning patient teaching, and then discuss the progression of HIV disease, including an explanation of primary disease, categories A, B and C, and four main types of opportunistic infections.

9. Provide and discuss the contents of at least three authentic websites that describe and teach Mr. Olmstead and his family about healthy living with HIV, so they can continue patient and family research after his discharge from the hospital.  

10. Describe at least two things you learned because of the research you did on this case and how you feel it will impact your future actions in healthcare.

Answer 1

1. HIV would be progressing in 3 stages at the cellular level:

• the stage of acute infection
• the stage of chronic infection
• AIDS

in the stage of acute infection, the virus would be multiplying in a rapid manner. As the acute form will go on to the chronic form, the virus would be multiplying in a less rapid manner. Though, with the progression of the levels of HIV, there would be an advancement of infection. This also leads to a reduction of CD4 levels in the cell.

2. HIV would only be spreading through some of the body fluids. These would only be transmitting from a person to another, who is having HIV. The fluids that would be transmitting are rectal fluids, vag-inal fluids, or even through the bre-ast milk. Darrin could prevent transmission to his wife there should be protection taking, and the se-xual behaviors that are less risky should be taken up.

3. AIDS is identified as the last stage of HIV. AIDS is identified as a condition, and will only be developing as HOV would be acquiring the chronic form and would be causing severe damage to the immune system of a person.

4. The tests that are used for the confirmation of HIV are:

• ELISA: Enzyme linked immunosorbent assay

if ELISA would be testing positive, there would be further confirmation with the use of western blot. This would be confirming the diagnosis.