HIV Infection Case Study Paper

HIV Infection Case Study Paper
Patient Profile
J.N., a 35-year-old African American woman, was
admitted to the hospital in respiratory distress. AIDS
and Pneumocystis jiroveci pneumonia (PCP) were
both diagnosed 2 days ago.
Subjective Data
• Seen by a physician 6 years ago for pain behind
the sternum and difficulty swallowing, diagnosed
as esophageal candidiasis; positive HIV-antibody
test at that time
• Has consistently refused ART because, “We can’t afford it”
• Married to Jim, a former IV drug user, for 15 years until his recent death
from AIDS-related complications
• Has two children, ages 8 and 10; neither has been tested for HIV infection
• Experiences fatigue and frequent oral and vaginal candidiasis outbreaks
• Expresses concern about the welfare of her children, who are at home
with her sister, and says, “Maybe I should take better care of myself
for them”
Objective Data
Physical Examination
• 5 ft 6 in tall, 100 lb, temperature 100.4° F (38° C), O2 saturation 92%
on 3 L of O2 via nasal cannula
Laboratory Studies
• CD4 T cell count 185 cells/µL
• Viral load 55,328 copies/µL
• Hematocrit 30%
Collaborative Care
• Trimethoprim/sulfamethoxazole
• Combination antiretroviral therapy: tenofovir and emtricitabine (Truvada),
darunavir (Prezista), ritonavir (Norvir)
Discussion Questions
1. Why did J.N.’s initial medical problem (esophageal candidiasis) lead to
an HIV test?
2. Why was trimethoprim/sulfamethoxazole ordered, and what are its
common side effects?
3. What diagnostic criteria for AIDS are present in J.N.?
4. Is there a potential advantage to J.N.’s refusal to take antiretroviral
drugs in the past? If so, why or why not?
5. Women often put their children’s welfare first. What barriers could this
cause for J.N.’s treatment? How can these problems be resolved?
6. Priority Decision: What priority teaching needs should be covered
before J.N. is discharged from the hospital to return home? What referrals need to be made?
7. How can J.N. be helped to adhere to her medication schedule?
8. Priority Decision: What are the priority nursing interventions? What
plans need to be made for continued nursing care after discharge?
9. Evidence-Based Practice: J.N. asks you if her kids should be tested.
She is afraid of what the results may be. How should you respond?