Diagnosis Management and Treatment of Patients with Human Immunodeficiency Virus - Essay Example

? Nursing Case Study HIV/AIDS Case Study Introduction: This paper is a self-reflection of the experiences that I have undergone during my HIV nursing employment at the outpatient service at a local hospital. The aim of this reflective essay is to understand diagnosis management and treatment of patients with HIV. The reason why I am reflecting on the subject matter is mainly because it is a procedure that almost every nurse experiences in his/her professional career, which in return enables professional development and conflict management. I have also experienced various treatment procedures of many AIDS patients and faced difficulties while handling these cases, as the professional methods are continuously changing along with the practices that are based on treatment skills. In order to reflect on the subject matter, I have chosen Gibbs reflective model of nursing. Gibbs model of nursing involves a description of the case, evaluation of the treatment experience, diagnostics of patient’s situation, a proposed action plan, and final recommendations (Jasper, 2003). I have also made use of NHIVNA competency to treat an outpatient of HIV/AIDS. Additionally, I have also employed the case study method to demonstrate learning and applications of nursing practices that I have experienced while treating an AIDS outpatient. Scenario/Description of the Incidence: One of the cases that I have dealt with is that of Mr. Jones David, a 52-year-old white American man, who visited the HIV clinic for the first time in his life. Looking at the diagnostics and tests undertaken, I recommended him to visit me in the clinic after diagnosing him with HIV during my visit to the central jail. For me as a professional nurse it was very important to note down his social interactions, because this has a direct impact on the patient’s health. I studied and gained knowledge regarding the relation of HIV and social interaction of patients during a seminar on HIV awareness. As I implemented the diagnostic approaches, I came to know about his background details that showed that he was recently released from the central jail, where he had spent almost 18 years of his life for murder and armed robbery. I diagnosed him with HIV when I visited the central jail with a nursing team of Royal College of Nursing. I and other nurses checked all prisoners and took blood samples in order to diagnose prisoners for different health related issues. When Mr. David was diagnosed with HIV, I tended to take his treatment as a challenge and began the investigation about his lifestyle and measure of health consciousness that have put him at a higher risk of HIV disease (RN.com, 2005). However, he kept on denying his involvement in activities such as sex with other men in jail or intake of abusive drugs while he was imprisoned. When I interviewed him, he told me that he was married before going to prison. However, his wife divorced him after six years of his imprisonment in jail. I also learned that he has two young kids with whom he is no more in contact after his divorce. This gave me a clear idea that he currently lacks a family lifestyle and thus he is less conscious about his well-being. Records of his family life and social circumstances helped me understand that he became home sick and victimized by isolation as he has spent 18 years in prison, where he never received proper assistance or health care facilities. This is a prime reason behind his declining health condition and psychological disturbance he faced due to family disorientation (RN.com, 2005). As I diagnosed his health conditions and social context of his illness, I discussed his case report with senior health practitioners, because I am still at learning stage and I am unable to treat HIV patients on my own. With the report I discussed with seniors, I obtained a summarized context of David’s case as to how a patient of HIV disease undergoes chronic mental disturbance. This situation is more evident in the case of David because he has no one who could support him morally and emotionally. Due to reading medical journals and about prior case treatments, I came to know that researchers and psychologists have identified that when patients come to know about the life-threatening virus, they start losing hope and gradually their personalities become totally shattered (NIAID, 2005). Mr. David was already suffering from depression due to isolation; untreated depression further led him to chronic psychological disturbance, and now he is at that stage of psychosomatic disturbance which can shorten his lifespan. When I visited the central jail to check prisoners, I notified that Mr. David is suffering from HIV/AIDS, and due to HIV, like every other such patient I have treated earlier, Mr. David also had a similar low level of testosterone in the body (blood test report shows) (Packer, 1998). Low level of testosterone is a key contributor of depression in HIV/AIDS patients. However, my experiences have given me insight into the fact that HIV patients should be checked for nutrient problems in the body. In my previous cases, I have noticed that patients suffering from HIV/AIDs start facing problems due to deficiencies of different minerals. I am very competent and dedicated in my professional career and I always intend to remember what I have learned from cases and how the procedure of one patient’s treatment can help me address the health issues of the patient I am current dealing with. So, on my suggestions, Mr. David was tested for the deficiencies of different minerals and vitamins in the body, and his report showed that he is suffering from severe deficiency of vitamin B6 and B12 (a common deficiency in HIV disease patients, highly responsible for causing depression among them) (Sonenklar, 2011). Currently, Mr. David is living in a short-term subsidized group residence, a place designed for newly released inmates. I faced difficulties while conducting an investigation of his background, as he was not willing to co-operate with me. This rather became a barrier for my diagnoses. As an alternative, the administration of the central jail gave me his background details. I considered that evaluating blood samples on a routine schedule is much needed. Thus, I recommended him to take blood tests. The laboratory test shows the following results: HIV Antibody, HCV Antibody and HBCAb (Antibody to Hepatitis B core Anti-gen were observed positive, although these should be negative); however, HBsAg (Hepatitis B surface Antigen was noted negative and, according to reference range, it should be negative) (RN.com, 2005). Laboratory Test Report Laboratory Test Result Reference Range CD4+lymphocytes 650 mm3 800-2500 mm3 HIV Viral Level Undetectable Undetectable RPR (Rapid Plasma Reagin) Negative Negative Hgb 16.5 g/dL 13.5 to 16.5 g/dL Hct 42.5% 41 to 50% WBC 7.5 x 103 /mm3 4.6 to 10.0 x 103 mg/dL Serum Glucose (fasting) 90 mg/dL 60 to 110 mg/dL Serum Triglycerides (fasting) 120mg/dL 45 to 165 mg/dL Total Cholesterol not test ? 220 mg/dL SGOT (AST) 24 IU/L < 35IU/L SGPT (ALT) 18 IU/L < 34 IU/L Serum BUN 8 mg/dL 7 to 20 mg/dL Serum Creatinine 1.2 mg/dL 0.5 to 1.4 mg/dL PPD 1x1 mm induration < 5 to 15 mm (Lacy, et al., 2002) Diagnosed Stages of HIV Disease: From the laboratory test report, I understood that Mr. David is suffering from AIDS and he is at the second stage of this deadly disease. I identified the stage of his disease with the guidance of senior practitioners and from the test results showing chronic asymptomatic HIV infection. Primary, acute infection description highlights that the first stage of this disease mostly lasts for several months and newly infected patients show symptoms such as fever, flu, and fatigue within the first month mainly because of burst of HIV viremia (Baveja and Rewari, 2004). While handling his case, I took reference from medical literature, which shows that after an interval of five to six months the immune system of the infected body stabilizes and the AIDS virus easily entrenches into the central nervous system of the patients (Dyk, 2008). The entrenchment of HIV disease inversely affects lymph nodes and peripheral blood mononuclear cells. However, in my previous cases I have noticed that patients suffering from HIV disease do not show clear symptoms at this level, but in case of Mr. David destruction of lymphocytes has been observed. For the destruction of CD4+ lymphocytes, literature highlights that every day HIV contributes to reproducing more than a billion of virions that kill billions of lymphocytes of the infected patient (Klossner, 2005). During the treatment procedure of Mr. David I kept on taking references from the medical literature. With the help of findings of the study by Zurline (2003), I understood that in most cases these cells are replaced within a short time, but in severe cases including that of Mr. David the body stops making new cells and the immune system gradually starts becoming weak. The patient under consideration was not able to receive any treatment during his time in jail, and this is the reason that a great number of CD4+ lymphocytes cells kept on declining with the passage of time and he gradually stood at the higher risk of opportunistic infections (OI) and opportunistic malignancies (OMs) (Sonenklar, 2011). This situation made the treatment procedure more critical, for which I had to make use of reference of surgeons’ medical journals at each level. In the case of David, it was also difficult for me to calculate how long he took to reach this crucial stage of AIDS – mainly because in my experience it highly depends on the amount of HIV in the blood stream and genetic makeup has a vital role in putting individuals at risk of HIV disease (Hanston and Horn, 2001). Mr. David’s blood contains higher amounts of HIV, which gives way to high level of tendency to develop opportunistic infections and opportunistic malignancies, and, therefore, he is at higher risk of mortality than other patients with less or undetectable amount of HIV in the body. I reviewed his tests reports to measure HIV disease level in his body. This test report is very important as it helped me select suitable nursing competencies and start antiretroviral treatment and also analyze whether treatment process is effective for Mr. David or not (Hanston and Horn, 2001). Nursing Competencies: Before recommending and implementing treatment methods for Mr. David, it seems most appropriate to me to discuss some basic nursing competencies designed by HIV nursing professionals and required to treat an HIV/AIDS patient (Sonenklar, 2011). This is because I believe that for a dedicated nurse it is essential at the first place to keep in consideration the generic nursing competencies that include assessment of health and well-being of a patient, management of antiretroviral therapy, health promotion, and working in partnership with clinical staff members. After understanding the entire scenario and condition of Mr. David, I created a proper plan for his treatment, which included assessment of health and well-being in order to meet the requirements of HIV positive patient (NHIVNA, 2007). Plans were to be monitored and reviewed to meet the needs of a patient with the demonstration of knowledge, signs, and symptoms that help at each stage of treatment. For physical well-being of Mr. David, I believed that it was compulsory to record new information regarding the assessment tools that are useful for providing for palliative and terminal care needs (NHIVNA, 2007). I considered a core responsibility of my own to identify and access David’s social care needs appropriately, as I possess good nursing competencies and I know my role as a nurse and as an emotional supporter very well. However, I could not take part in addressing his social needs, because he is an outpatient and would be visiting clinic once in a week (Matzo and Sherman, 2009). As it has been noticed, in the case of Mr. David, his health condition and his social circumstances have taken him towards severe depression, stress, anxiety and other cognitive disturbances due to which he has left the hope of living a healthy life. From a health practitioner’s viewpoint, particularly while dealing with HIV patient, I consider it highly pertinent to support a patient emotionally and morally to motivate him for a better life in the future (Matzo and Sherman, 2009). An emotional support helped minimize the impact of stigma on the patient and provided Mr. David with such a comfortable environment in which he started sharing his emotional and psychological needs with me (Matzo and Sherman, 2009). I attained success up to a considerable extent to help him with his psychological and social needs. Mr. David is an outpatient, so he cannot receive 24/7 assistance, but during his visits I tend to provide him with sufficient awareness and encouragement that can efficiently help me in his treatment. An assessment of patient’s moral, psychological, and spiritual needs has been included as an aspect of health care program designed for Mr. David with respect to his background, criminal, social and health history (Matzo and Sherman, 2009). Specialist HIV Nursing Competencies: Firstly, with respect to the designed competencies of the National Health Services for outpatient settings, I preferred to discuss and recognize my own role with my senior professionals during the entire treatment procedure of Mr. David. Secondly, I strongly believe that checks and balances are required for the identification of signs and symptoms that help follow up the progress of disease or cure in the body, and in such situtaion seniors can help in a better way (Stevens, 2009). This surely helps in fulfilment of the consideration that planning and monitoring of HIV patients are needed and considered as the most important responsibilities of a nurse (Stevens, 2009). It is also needed while handling the case of Mr. David that I carry out all suggested assessments in sequence, in accordance with the evidence-based practices, precautions, rules and legislations, and monitor the patient effectively. Moreover, because I always seek to work like a professional, I consider it important to follow teachings and guidelines of senior professionals of the related field. It has been observed that Mr. David is at the chronic stage of HIV disease, and he is living in a group of recently released prisoners. Therefore, it could be predicted that if he is not treated properly or informed regarding transferability of HIV as other individuals who are living with him, he will be at a higher risk of getting HIV/AIDS (NHIVNA, 2007). I consider it as my core responsibility to increase awareness and inform the managing team of inmate residents about the risks and transmission of HIV disease and for this purpose, I personally met the managers and other members of administrative body to specially take care of Mr. David and other inmates. Suggested Treatment Method and Interventions: From the medical literature and suggestions of senior practitioners, I consider that in the case of Mr. David, Highly Active Anti-Retroviral Therapy (HAART) can be suggested as it helps lower down the viral load to an unidentified stage and delays the viral growth for some coming years. However, the laboratory report has not confirmed permanent results that can sufficiently suppress the virus. HAART, which is considered as an aggressive therapy, has been suggested by me to Mr. David, because its positive outcomes are evident from previous researches (Rathbun, 2011). Review of prior compiled researches has indicated that in 1996 and 1997 researchers noted that the implementation of HAART method for treating HIV patients actually can significantly help decrease the rate of morality among them. Additionally, potential advantages of using HAART therapy include restoration of the immune system, a prominent reduction in the risk of HIV transmission and a quick suppression of viral replication (Rathbun, 2011). Procedure of HAART therapy that I carried out included the dose of three to four drugs that fight against HIV. HAART is essential for strengthening the immune system, and although this therapy is not recommended to every patient with HIV, Mr. David was at the stage where he needs assistance and a treatment method such as HAART. Four-drug combination was suggested to Mr. David including: (1) NRTIs (nucleoside and nucleotide transcriptase inhibitors) that infers the initial step HIV disease take in order to copy itself in body cells; (2) NNRTIs (non-nucleoside reverse transcriptase inhibitors; it also performs the same function as NRTIs but in a different manner) (Walton 2010); (3) Protease inhibitor that works to reduce the final step of HIV; and (4) Entry inhibitors also called as fusion inhibitor which blocks HIV entry in healthy cells. Although Mr. David will start taking recommended medicines to stop the growth of HIV disease in other cells, at the same time it will be needed to monitor the capability of the immune system of replacing CD4+ lymphocytes that are being destroyed by HIV. Mr. David will be advised to visit the clinic every week in order to keep me updated about his health condition and so that I will be able to check CD4 and HIV VL and their adherence (Cichocki, 2009). Food Recommended to Mr. David: Available medical literature helps me justify the recommended diet to HIV/Aids patients, and thus for Mr. David I recommend that he should increase his intake of high quality protein foods including pulses, lean meat, fish, nuts, and legumes (Food and Drug Administration, 2005). It should also be considered that Mr. David’s body is already going through chronic stress in order to fight against the growing disease, and, therefore, all of his body organs, particularly kidney, are making more effort than usual. That is why he should maintain his intake of protein: he should take 10 to 20 percent protein daily in his diet but no more than that (Stanfield and Hui, 2009). Due to my understanding of the HIV patient treatment with the aid of seminars that I attended, I suggest that he should take some fruits and vegetables, particularly such fruits as oranges, kiwi, and strawberries as these fruits contain antioxidant, which is an essential building block of the immune system. Fibre foods such as oatmeal, breads, and whole grain cereals are also good for controlling the cholesterol level in the body (Whitney, et al., 2010). Conclusion: On the basis of the above reflective work, my reflection skills and dedication to Mr. David’s case can be clearly identified. Gibbs model of reflection helps me pen down my experiences and thoughts for this particular case. My experience with Mr. David’s case contributed to suggesting that my clinical skills are still in the process of development and my services can surely be considered valuable for future patients with HIV. Furthermore, with the help of this reflection exercise I have understood that the reflection about our personal work helps us realize our own strengths and weaknesses and learn to improve further. Additionally, I have analyzed that there are many areas of nursing professionalism in which I need to obtain more experience and knowledge. While handling the case of Mr. David I have understood that guidance of senior professionals and reference to medical journals or studies is highly important at every level. Also, I strongly feel that despite tremendous advancements in medical sciences and technologies, the ability to utilize improved methods and surgical instruments is a foremost need of the hour. Complete command or knowledge concerning the use of advanced methods is one of my weaknesses, and during this course I seek to overcome this problem of mine with the assistance of my senior instructors. Reference list Baveja, U. and Rewari, B., 2004. 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Belmont: Cengage Learning. Zurlinden, J., 2003. Up close and clinical: black HIV and AIDS awareness day. The Nursing Spectrum, pp. 5–16. Read More