Peculiarities Of Working With HIV Patients

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HIV Nursing Interventions

The human immunodeficiency virus, also known as HIV, is still a prevalent issue in today’s society. The lack of understanding along with no family support causes an increase in the disease’s progression. From the advance in technology pharmacology will soon have a cure for these patients. In the meantime, the most beneficial treatment for any patient with HIV is the nursing care they receive from their nurse and the team members. The nurse has a better understanding of the patient since they spend the most time with them on a day-to-day basis. They establish a trustworthy relationship with the client, which enables them to quickly detect and react to any subtle changes in the patient’s health status. Maintain a stress-free environment is the key goal to improving the overall health of these patients. This paper will discuss the major nursing interventions with HIV: prevention of all infections, educating people, improving the nutrition imbalance, and improving their skin integrity.

Background History

HIV is an autoimmune disorder, which results in the body’s immune system attacks itself. The body begins attacking itself because of the alteration of the genetic material embedded into certain cells. The main cells involved in this disease are the CD4 cells responsible for the activation of certain B and T lymphocyte molecules. HIV is a retrovirus because of fact that it carries genetic variants for ribonucleic acid (RNA) instead of deoxyribonucleic acid (Hinkle 2018). It also contains a specific enzyme reverse transcriptase that allows it to alter the genetic makeup of the host so it can embed itself into it and replicate. The disease has four progression stages that differ by the number of CD4 cells in the bloodstream.

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Initially, the most important intervention to implement on any HIV patient is the prevention of all infections due to their weakened immune system. These patients are at risk for various types of infections and many types of cancers. To prevent infections from occurring in these patients, the nurse must continuously monitor the patient’s white blood cell count and their vital signs. Any elevation or decrease in the white blood cell count can indicate an infection. The nurse must also be able to recognize the signs and symptoms associated with infections. The earlier the nurse detects the infection the recovery process is a lot faster for the patient. Thus, it is very significant for a nurse to always monitor these patients’ status because they can’t fight infections for themselves. For example, a specific type of respiratory infection that occurs in these patients is Pneumocystis pneumonia. The most common symptom of this respiratory infection is fever followed by hypoxemia (Hinkle, 2018). Fever is often the first sign of any infection followed by chills and fatigue. It is also necessary for the nurse to continue monitoring the patient’s CD4 levels because lower levels can show signs of infection. For instance, a study was done on the prevalence of opportunistic infections in relation to death rates. The results of the study showed that the risk of death is 5.33 times much greater for any HIV patient that contracts over three opportunistic infections. Also, the use of prophylactic treatment on these types of infections results in a decrease in the morbidity and mortality rates for these patients (Correia Paiva Leadebal et al., 2019). Likewise, the most common type of cancer seen in these patients is Hodgkin lymphoma and Kaposi sarcoma. Hodgkin’s lymphoma occurs from various infections such as helicobacter pylori infection or Epstein–Barr virus infection. By recognizing these signs and symptoms associated with infections the nurse can prevent further decline of the patient’s overall health status.

In addition, educating people about HIV will lessen the isolation and fear associated with it. HIV is a serious public health problem and the lack of knowledge and negligence by people causes many health and emotional concerns for these patients. Insufficient knowledge and society’s defiance put them at a higher risk for further progression toward full-blown AIDS or acquired immunodeficiency virus (Freire et al., 2018). During the 1980s people would discriminate against the HIV population and scorn them from entering restaurants or even allowing them to touch them. The lack of understanding about the transmission of the disease causes a lot of social isolation and mental issues among these patients. For example, a study was conducted on HIV patients to look at their mental status using various scales. The results from the study show the on the depression scale out of 108 participants, 53% had mild to moderate depression. On the hope and self-concept, the results showed that 74 % felt that they were a failure to society, family, and friends. Also, 58% felt that they were worthless and 52.8% had negative self-thoughts about themselves (Freire et al., 2018). This study shows the importance of nurses being important and vital educators in the life of HIV patients. Nurses further play a key role in motivating and improving the overall health status of these patients. They are there t teach the patient valuable information in regards to their disease process so they have a better understanding of it. Likewise, nurses educate the family members too so they can be another support system the patient can lean on when times get tough. They teach them the proper way the disease is transmitted so the family does not have fear when around the patient. Support is the best thing for these patients and nurses plays a key role in making sure these patients feel accepted and their anxiety level are lessen. An HIV patient at a UK hospital showed just how important the nurse-to-patient relationship is in the overall care of their disease. For instance, the patient showed that the motivation and support from his team lessen the fear and isolation of his disease, and the education he received from his nurse team motivated him to continue life (Carter, 2020). This experience with this patient shows that nurses really are very valuable to HIV patients. Education from the nurse goes a long way into the treatment of the disease process for these patients.

Furthermore, improving the nutritional status of HIV patients is another important intervention by the nurse. HIV causes damage to the intestinal lining of the digestive tract resulting in decrease nutrient absorption or uptake. The wasting syndrome occurs when the patient loses more than one-tenth of their total body weight followed by symptoms of diarrhea and fever that can last more than a few days. It also causes the loss of muscle mass and fat in HIV patients (Hinkle, 2018). The nurse must understand that nutrition plays an important role in the health of HIV patients and their emotional status. If patients are undernourished, they are at a higher risk for infections because of the lack of nourishment in the body and their altered immune system. The goal of the nurse is to regulate the fluid and electrolyte imbalances that correlate with the nutritional status of these patients. By improving these patients’ nutritional status, it will impact their physical activity levels. To do this, the nurse needs to inform patients about taking in the proper amounts of fiber and protein beneficial for muscle building. By increasing the fiber in HIV patients it will decrease the risk for diarrhea and skin breakdown. For instance, a study was conducted using the Pender model to compare the various factors that affect the health of an HIV patient. The results of the study showed that with nursing intervention and education there was an increase in the overall health status of many HIV patients (Khani et al., 2018). By using these results from the study it shows that incorporate the proper nutritional diet, it will slow down the prognosis of the disease. Furthermore, the nurse must understand that many nutrients contain many important vitamins that can help boost the immune system for these patients.

Finally, improving the overall skin integrity of these patients is another crucial intervention the nurse can implement for these patients. Nutrition, physical activity, and electrolyte imbalance are beneficial for the skin integrity of HIV patients. For patients who are immobile, the nurse must reposition the patient every two hours to increase skin circulation and prevent the development of ulcers. Pressure ulcers can develop quickly in patients who are immobile or confined to a bed. HIV patients are further at risk for self-body image disorders because of the progression and side effects associated with their disease. Pain is one of the factors that these patients suffer from because of lesions and sores that can occur anywhere on the body. The nurse will administer analgesics at specific time intervals for the pain associated with Kaposi sarcoma (Khani et al., 2018). By implementing this routine, the nurse can better control the patient’s pain level and reduce the risk for immobility. HIV patients are further prone to having chronic diarrhea, it is very important for the nurse to maintain normal bowel patterns. Diarrhea can cause the breakdown of the skin and repeated friction for wiping on moist skin. Whenever the skin contains breaks it increases the risk of infection for these patients. This also increases the chance of these patients developing opportunistic infections. The nurse needs to make sure that these patients avoid foods that can trigger diarrhea and focus on foods that can prevent it. On the other hand, it is very important for the nurse to do a full assessment of the patient’s risk for developing pressure sores if they are fully immobile. The nurse will use the Braden scale to see the risk factors for the patient so they can implement the proper precautions for the patient. The nurse must further educate the HIV patient about not scratching their lesions as that could lead to infection. In addition, the nurse must also make sure the patient’s oral cavity is kept clean. Candidiasis is a fungal infection that can occur in the mouth of HIV patients. The nurse should apply the proper ointments so the patients can eat properly and assess their risk for aspiration.

In conclusion, there are many interventions for nurses to implement when taking care of HIV patients. The main goal that the nurse should focus on is educating the patients about the disease and establishing a patient-centered relationship. By establishing that nurse-to-patient relationship enables the nurse to better care for and understand their patient. The goal of nursing interventions is to help the patient and to protect them from whatever diseases could harm their overall health status. The trust and bond that forms between the patients are beneficial and it is ultimately the best treatment for any patient living with HIV.  


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