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1
Care for people living with HIV
HAIVN Havard Medical School AIDS
Initiative in Vietnam
2
By the end of this session, participants should be able to:
List the 7 most common symptoms in patients with HIV/AIDS
Propose appropriate nursing interventions for each symptom
Learning objectives
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Cachexia Dyspnea Fatigue Fever
Diarrhea Pain Dermatologic
disease
The most common symptoms relating to HIV
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Is a systemic illness, characterized by:• malnutrition• weight loss• weakness & fatigue
Accompanied by rapid progression of disease
Seen in a majority of patients
Cachexia: Overview
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Lack of sufficient intake of nutrients due to:• Anorexia, nausea, oral ulcers, taste
disturbances
• Depression or dementia
• Pain
• Poverty (economic difficulties) Loss of nutrients (diarrhea, vomiting)
Cachexia: Causes (1)
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Changes in metabolism (hypermetabolism)
Opportunistic infections (OIs) are not diagnosed and treated, especially tuberculosis
Side effects of medications
Cachexia: Causes (2)
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Eat frequent, small meals consisting of foods rich in protein and energy
Comprehensive dental care
Combination of gentle exercises
Cachexia:Nursing interventions
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Dyspnea is the subjective sensation felt by the patient
Signs (observed by HCW): shortness of breath, tachypnea…
Related to:• Pulmonary infection• Lung tumor• Anemia
Dyspnea: Overview
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Subjective: Patient’ s level of daily activity is minimized
Objective: observe patient• Increased respiratory rate• Irritation• Difficulty speaking• Labored breathing• Cyanosis
Dyspnea: Nursing assessment
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Change position frequently:• Elevate head or• Sit with head bent forward• Ensure position is steady
Loosen patient’s clothing Maintain adequate hydration
Dyspnea: Nursing interventions (1)
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Have the patient’s room ventilated and avoid exposure to stimuli from the environment:• Cigarette smoke• Smoke from fireplace, kitchen
Light exercises Instruct patient to relax and practice
breathing with puffed cheeks / pursed lips
Dyspnea: Nursing interventions (2)
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Feeling unusually tired, level of exhaustion disproportionate to level of activity
Related to: • Progression of HIV disease• Anemia • Depression • Malnutrition
Fatigue: Overview
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When does the patient feel the healthiest and when does the patient feel the most tired?
Schedule of daily activity:• sleep and daily activities?• diet?
Vital signs and appearance Assess hemoglobin (Hb) values Associated symptoms
Fatigue: Nursing assessment
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Encourage patients to seek treatment, including treatment of depression (if any)
Plan activities appropriately taking into consideration need for energy conservation
Perform light exercises Maintain adequate hydration and
nutritional intake
Fatigue:Nursing interventions
15
Fever is a condition of abnormally high temperature
Related to infection, cancer, drug reactions…
Increases energy expenditure, accelerates disease progression
Fever: Overview
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Place ice packs Give a quick shower with cool water
when temperature is above 40⁰C Keep the patient's body dry, clean
and warm Maintain adequate hydration Use antipyretics
Fever: Nursing interventions
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Diarrhea is an increase in the number and frequency of bowel movements
Related to infection, malignancy, malabsorption (electrolyte disorders…)
Leads to:• dehydration• malnutrition • dermal lesions• social isolation, depression
Diarrhea: Overview
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Eat frequent, small meals Eat diet rich in protein and energy, decrease
fat intake, and increase fiber intake Maintain adequate hydration Store food, prepare food using safe hygiene
practices Practice good skin hygiene Wash hands thoroughly before eating, when
preparing food, after using the bathroom...
Diarrhea: Nursing interventions
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Pain is the feeling of discomfort and restlessness / irritability, sensitivity
Each person perceives and experiences pain differently
Very common in patients with HIV/AIDS
Often untreated
Pain: Overview
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Common causes of pain in patients with HIV:Headache: can be caused by HIV, tumors, infectious diseases, AZTPeripheral neuropathy: can be caused by HIV, treatment (e.g. d4T)Dermatologic disease / lesions: ZonaOral: herpes, candida, CMV, HIVWithdrawal syndrome
Pain: Causes
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Ask about the frequency and extent of pain
Assess pain by standard “pain scale” Trust patient’s report Explain and reassure patient Assess pain and other vital signs at
each patient visit
Pain: Nursing interventions
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Pain intensity assessment using a numeric scale:
Level of pain is estimated on a scale from 0-10:• 0: no pain• 10: the greatest pain patient has ever
experienced
Pain scale
0 5 10
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Manage pain with analgesic ladder of the World Health organization (WHO):Step 1: Non-opioid pain medications:
• aspirin, • NSAIDs and• acetaminophen
Step 2: Opioids: codeine, oxycodoneStep 3: Opioids: morphine, methadone
Pain: Management (1)
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Pain management without drugs:
Acupuncture
Hypnosis
Relaxation techniques
Pain: Management (2)
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There are many manifestations of skin disease
Appear in different stages of HIV disease
Related to HIV, infection, malignancy and drugs
Improve with ARV treatment
Dermatologic disease: Overview
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Eosinophilic:• Rash on the body, head, neck, arm and
leg• Treated with antifungal creams, light
therapy Bacterial:
• Treated with antibiotics
Dermatologic disease: Folliculitis
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Red, shiny, may be itchy Sebaceous gland in face, scrotum,
arms and legs Treat with:
• Low potency steroids and • Oil-based products
Dermatologic disease: Seborrheic dermatits
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The most common cause is candida Often lead to disease of nail and
integumentary system Intervention:
• Keep skin dry and clean, especially in areas of legs and arms
• Use antifungal medication for topical and systemic use
Dermatologic disease: Fungal skin infections
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The common cause is zona which can be disseminated
Intervention:• Hand washing and skin hygiene• Can apply a bandage but do not cover
skin completely as to keep it too moist/ damp
• Analgesics as necessary
Dermatologic disease: Ulcerative skin disease
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Taking good care of AIDS patients means providing good
nursing care
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Symptoms discussed may be caused by HIV, opportunistic infections, or drug side effects
Care plan: assess patient’s difficulties / challenges, assess care needs and reassess frequently
Instruct patient and family how to provide care
Key points
32
Thank you
Questions?