Nursing Assessment or Management or Intervention of HIV / AIDS

Nursing Assessment or Management or Intervention of HIV / AIDS According to Nursing Process:

The nursing care of patients with HITV/ADS is challenging because of the potential for any organ system to be the target of infections or cancer.

Nursing management of HIV
Fig: Nursing management of HIV

1. Nursing Assessment:

Nursing assessment includes identification of potential risk factors, including a history of risky sexual practices or IV/injection drug use.

  • Nutritional status,
  • Skin integrity,
  • Respiratory status,
  • Neurologic status,
  • Fluid and electrolyte balance,
  • Knowledge level.

2. Diagnosis:

The list of potential nursing diagnoses is extensive because of the complex nature of the disease:

  • Impaired skin integrity related to cutaneous manifestations of HIV infection, excoriation, and diarrhea.
  • Diarrhea related to enteric pathogens of HIV infection.
  • Risk for infection related to immunodeficiency.
  • Activity intolerance related weakness, fatigue, malnutrition, impaired F&E balance, and hypoxia associated with pulmonary infections.
  • Disturbed thought processes related to shortened attention span, impaired memory, confusion, and disorientation associated with HIV encephalopathy.
  • Ineffective airway clearance related to PCP, increased bronchial secretions, and decreased ability to cough related to weakness and fatigue.
  • Pain related to impaired perianal skin integrity secondary to diarrhea, KS, and peripheral neuropathy.
  • Imbalanced nutrition, less than body requirements related to decreased oral intake.

3. Planning & Goals:

Goals for a patient with HIVIAIDS may include:

  • Achievement and maintenance of skin integrity,
  • Resumption of usual bowel pattern,
  • Absence of infection,
  • Improve activity intolerance,
  • Improve thought processes,
  • Improve airway clearance,
  • Increase comfort,
  • Improve nutritional status,
  • Increase socialization,
  • Absence of complications,
  • Prevent/minimize development of new infections,
  • Maintain homeostasis,
  • Promote comfort,
  • Support psychosocial adjustment,
  • Provide information about disease process/prognosis and treatment needs.

4. Nursing Interventions:

The plan of care for a patient with AIDS is individualized to meet the needs of the patient.

  • Promote skin integrity: Patients are encouraged to avoid scratching; to use nonabrasive, nondrying soaps and apply non perfumed moisturizers; to perform regular oral care, and to clean the perianal area after each bowel movement with nonabrasive soap and water.
  • Promote usual bowel patterns: The nurse should monitor for frequency and consistency of stools and the patient’s reports of abdominal pain or cramping.
  • Prevent infection: The patient and the caregivers should monitor for signs of infection and laboratory test results that indicate infection.
  • Improve activity intolerance: Assist the patient in planning daily routines that maintain a balance between activity and rest.
  • Maintain thought processes: Family and support network members are instructed to speak to the patient in simple, clear language and give the patient sufficient time to respond to questions.
  • Improve airway clearance: Coughing, deep breathing, postural drainage, percussion and vibration is provided for as often as every 2 hours to prevent stasis of secretions and to promote airway clearance.
  • Relieve pain and discomfort: Use of soft cushions and foam pads may increase comfort as well as administration of NSAIDS and opioids.
  • Improve nutritional status: The patient is encouraged to eat foods that are easy to swallow and to avoid rough, spicy, and sticky food items.

5. Evaluation:

Expected patient outcomes may include:

  • Achieved and maintained of skin integrity,
  • Resumption of usual bowel pattern,
  • Absence of infection,
  • Improved activity intolerance,
  • Improved thought processes,
  • Improved airway clearance,
  • Increased comfort,
  • Improved nutritional status,
  • Increased socialization,
  • Absence of complications.

6. Discharge an d Home Care Guidelines:

Before discharge, the nurse should educate the patient and the family about precautions and the transmission of HIV/AIDS.

  • Patients and their families or caregivers should receive instructions about how to prevent disease transmission, including hand-washing techniques and methods for safely handling and disposing of items soiled with body fluids.
  • Patients are advised to avoid exposure to others who are sick or who have been recently vaccinated.
  • Medication administration. Caregivers in the home are taught how to administer medications, including IV preparations.
  • The patient’s adherence to the therapeutic regimen is assessed and strategies are suggested to assist with adherence.
  • Infection prevented/resolved.
  • Complications prevented/minimized.
  • Pain/discomfort alleviated or controlled.
  • Patient dealing with current situation realistically.
  • Diagnosis, prognosis, and therapeutic regimen understood.
  • Plan in place to meet needs after discharge.

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