Critical Analysis of HIV - Case Study Example

Case Study on HIV Total Number of Words 280 Q What else would you like to ask this patient about her history of present illness and past medical history? Other than learning that the patient has a 5-day history of fever, dyspnea, productive cough, right-sided pleuritic chest pain, and recurrent pneumonia during the past 3 years; it is best to ask the patient about the number of incidents she had participated in unprotected sex and the number of men she had sexual contact with. Since the patient is taking oral contraceptive, the health care professionals should determine whether she is purely relying on the use of contraceptive. The use of oral contraceptive is useful only in preventing the risk of unplanned pregnancy but not enough to protect her from sexually transmitted diseases. Since the patient has recurrent pneumonia, it is also advisable to know whether or not the patient has been receiving IVDU or blood transfusion including possible drug addiction and vaccination history since HIV virus can be transmitted through the use of needle via blood contact. Other information should include asking whether or not the patient has been diagnosed with hepatitis B or C, neoplasms, night sweats, adenopathy, pharyngitis, mouth and anal pain, depression, and significant changes in sleeping patterns. All these factors increases the chances that the patient will have low immune system making her easily infected with HIV virus. Q.2 What about her history concerns you, and what else would you like to ask her now? It concerns me that the patient has a history of recurring pneumonia, had a smoking history, fatigue, 7-lbs unintentional weight loss during the past six months, and has a long history of an abnormal vaginal yeast infection. Since the patient has recurring pneumonia and has 5-day history of fever, dyspnea, and right-sided pleuretic chest pain, I would like to ask whether or not the patient is experiencing shortness of breath and cough since these symptoms together with the patient’s health complaints are associated with opportunistic infections like Pneumocystis carinii pneumonia (PCP) – the most common type of respiratory infection, and Myocobacterium avium complex (MAC) / Mycobacterium avium intracellular (MAI) which is the common bacterial infection among the patients with acquired immunodeficiency syndrome (AIDS) / HIV infection (Johnson, 2004, p. 2). With regards to fatigue and 7-lbs unintentional weight loss during the past six months, I would like to ask whether the patient is experiencing loss of appetite, nausea, oral and esophageal candidiasis which is often characterized by painful white patches when swallowing food, oral lesions, or retrosternal pain (Johnson, 2004, p. 2). All these additional questions are necessary since HIV infection can affect the patient’s gastrointestinal functions. In fact, excessive involuntary weight loss of 10% of the body weight is a wasting syndrome (cachexia) of HIV. Concerning abnormal vaginal yeast infections, I would like to ask whether the patient is experiencing menstrual abnormalities such as amenorrhea or bleeding between periods, persistent and recurring pruritus vulvae and vaginal discharge as common symptoms of vaginal candidiasis (Denning, 1995), painful ulcers with pus and open sore in genital area which as associated with STDs like chancroid, syphilis, and herpes, the presence of genital warts, and the signs and symptoms of pelvic inflammatory disease (PID) (Johnson, 2004, p. 4). Q.3 What do you think of her additional history and her examination findings? The patient’s additional history particularly with regards to having four sexual partners and occasional unprotected sex increases her chances of getting HIV infection. In fact, having occasional night sweats and having a mild anorexia are among the signs and symptoms of HIV infection. A high temperature of 39oC suggest that the patient has constant fever whereas a respiratory rate of 25 breaths per minute suggest that the patient is experiencing tachypnea caused by lowered oxygen concentration probably because of an increased altitudes (Kozier et al., 2004, p. 506) or possibly as a positive sign of having pneumonia (Johnson, 2004, p. 630). Depending on the patient’s normal BP, a BP of 110/70 could suggest anemia. Given the patient’s medical history, the presence of productive cough suggests that the patient is still suffering from pneumonia. The presence of seborrhea around nose, cheeks, and scalp also indicates the possibility that the patient is suffering from HIV infection. In line with this, Usatine (2003) revealed that a high prevalence of 36% is seen on HIV infected persons. Patient’s pharynx revealing thick cheesy exudates on the soft palate and tongue indicates that the patient is suffering from pharyngitis which is a common symptom of HIV infection whereas dullness to percussion in lungs, increased tactile fremitus, inspiratory crackles, and egophony over the right lower lobe suggest that the patient has a serious lung problem as a result of weak immune system caused by recurrent pneumonia. On the other hand, the presence of a palpable inguinal adenopathy together with erythema, and mild excoriation of the perineum, and thick white vaginal discharge suggest that the patient is suffering from a sexually transmitted disease. Q.4 What diagnostic tests would you like to obtain? To determine whether or not the patient is infected with human immunodeficiency virus (HIV), it is necessary to measure the patient’s anti-HIV antibodies since this method of screening and diagnostic test for HIV is commonly used for this purpose. The enzyme-linked immunosorbent assay (ELISA) test can also be used but this method can give “false positive” because this method has low specificity. Therefore, the use of ELISA should be combined with Western blot test since this particular diagnostic method has higher specificity as compared with the ELISA test. Q.5 How would you interpret these laboratory results and what would you do next? Patient’s HIV ELISA positive suggest that the patient has a strong tendency to suffer from HIV infection. To verify the ELISA test, it is necessary to use Western blot test since the use of ELISA test has low specificity. The patient’s WBC, Hct, and PLTs is within the normal range. However, the patient’s chest radiography test which reveals right lower lobe infiltrate consistent with lobar pneumonia is confirmed with the sputum culture positive for S. pneumonia and sputum gram-positive for numerous PMSs and gram-positive diplococci. For this reason, it is necessary to inform the patient to have her physician administer the right antibiotic as a pharmacological intervention for S. pneumonia. With p < 0.05, the study of Umeh & Umeakanne (2010) presence of vaginal yeast infection is highly correlated with HIV infection. Since the patient’s laboratory results on oral and vaginal smear revealed KOH positive for yeast infection with pap smear revealing an inflammation and mild dysplasia, it is necessary to advice the patient to seek the professional assistance of a gynecologist. Q.6 What additional laboratory tests would you order now? Since the patient responded positively on antibiotics and hydration, there is a strong need to subject the patient to additional laboratory tests including sputum test combined with chest x-ray or chest radiograph test. This strategy is best in determining whether the health care professionals have successfully treated infection related to bacteria, viruses, fungi, or parasites causing pneumonia. Likewise, it is also advisable to let the patient undergo another process of smear test and vaginal smear test to ensure that the patient is free from yeast infection or any forms of pelvic inflammation. Since the patient’s Western blot test is positive, there is a strong need to make the patient undergo a laboratory test for CD4 cell count. Basically, there are three stages of HIV infection. To determine the type of medication to be prescribed and administered to the patient, there is a strong need to determine the patient’s CD4 cell count. By doing so, health care professionals will be able to directly treat and cure the type of HIV infection the patient is suffering. Q.7 How should this patient be managed? Before subjecting the patient to receive antiretroviral therapy, it is best to consider the patient’s HIV RNA levels and CD4 cell counts. In general, antiretroviral therapy should not be given to patients with CD4+ T cell counts of more than 350 cells / mm3 and plasma HIV RNA of less than 100,000 copies / mL. Since the patient’s HIV RNA PCR is equal to 25,000 copies / mL and CD4+ T cell count is 400 / mm3, health care professionals defer the patient from receiving antiretroviral therapy. *** End *** References Denning, D. (1995). BMJ. Retrieved June 27, 2010, from Education and debate. Fortnightly Review: Management of genital candidiasis. BMJ. 1995, 310, 1241-1244: http://www.bmj.com/cgi/content/abstract/310/6989/1241. Johnson, J. (2004). Medical-Surgical Nursing. 10th Edition. Lippincott Williams & Williams. Kozier, B., Erb, G., Berman, A., & Snyder, S. (2004). Fundamentals of Nursing.7th Edition. Pearson Education South Asia Pte. Ltd. Umeh, E., & Umeakanne, B. (2010). HIV/vaginal candida coinfection: Risk factors in women. Journal of Microbiology and Antimicrobials , 2(3), 30-35. ISSN 1996-0875 © 2010 Academic Journals. Usatine, R. (2003, September). Bnet. Retrieved June 27, 2010, from A red rash on the face. Journal of Family Practice. : http://findarticles.com/p/articles/mi_m0689/is_9_52/ai_107996910/. Read More