case study

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

 

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

 

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

 

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

 

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

 

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

 

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

 

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

 

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

 

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

 

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

 

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

 

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.

What is PJP?

Pneumocystis jiroveci pneumonia. Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue.

Pg 220

3. The skin biopsies return a diagnosis of Kaposi sarcoma (KS). What is KS?

Vascular lesions on the skin, mucous membranes, in this area with wide range of presentation: firm, flat, raise, or nodular; pinpoint to several centimeters in size; hyperpigmented, multicentric can cause lymphoedema and disfigurement. Usually not serious unless occurring in the respiratory or GI system.

Pg 220

4. What is the significance of K.D. developing KS and PJP in light of the CD4 count?

The development of PCP and Kaposi sarcoma along with his CD4 T cell count are indicative that our patient is progressing in his disease and is at risk for developing AIDS.

Pgs 219-220

5. K.D. has been seropositive for several years. What factors might have influenced his development of PJP and KS?

This could be due to a number of different factors associated with our patient. It is stated that he has depression and stopped taking his medication four months ago. This could cause a sudden relapse of his disease and he developed a flare up. Depression also causes a patient to not take care of themselves such as having a poor diet and not sleeping well. It is no doubt that stress has also been a contributing factor to this flare up.

Pgs 225-226

6. Name 4 problems you must manage at this time with K.D.

Our top priority at this time would be to maintain an airway for our patient. He is suffering from pneumonia which can cause him to not be able to breathe effectively. Another problem would be his fever due to his infection. We would probably anticipate the doctor ordering Tylenol to help decrease this Fever. a third problem we must manage is maintaining standard precautions when interacting with this patient. Though HIV cannot be transmitted through air or saliva, we will want to maintain standard precautions, especially when inserting any intravenous lines, or drawing blood. We would also want to consult nutrition to help our patient with his lack of appetite and increased nutritional needs.

7. What type of isolation precautions do you need to use when caring for K.D.?

1. Droplet
2. Contact
3. Standard
4. Airborne

8. What immediate complication is K.D. at risk for experiencing?

Due to his diagnosis of pneumocystis jiroveci pneumonia and Kaposi sarcoma, our patient is at an increased risk to develop mycobacterium tuberculosis. He already has a cough, fever, night sweats, and weight loss.

Pg 220

9. To detect this complication, what will be the focus of your ongoing assessment?

We will need to keep our patient connected to a continuous pulse oximetry monitor and watch his oxygen status. It should remain above 90. we will also want to continually monitor his breathing and respiratory status, which includes rate and rhythm of respirations, and any adventitious breath sounds in his lungs. We also want to keep a close eye on his temperature, and notify the doctor of any increase in his temperature.

10. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?

This is a medication that is used to treat a variety of bacterial infections. It is also used to treat and prevent pneumocystis pneumonia. We need to watch to see if any nausea, vomiting, diarrhea or loss of appetite occur, as our patient needs to maintain good nutrition with his diagnosis. This medication is also been known to result in oral thrush or a yeast infection. HLV patients are already prone to Candida infections, So what we would want to monitor our patients mouth and throat for this complication.

https://www.webmd.com/drugs/2/drug-3409-1071/sulfamethoxazole-trimethoprim-oral/sulfamethoxazole-trimethoprim-suspension-oral/details (Couldn’t find it in the book or our drug guide.)

11. What aspects of K.D.’s care can you delegate to the licensed practical nurse (LPN)? Select all that apply.

1. Providing instructions about a high-calorie, high-protein diet
2. Administering first dose of IV trimethoprim-sulfamethoxazole
3. Repositioning K.D. and having him deep breathe every 2 hours
4. Developing a plan of care to improve K.D.’s oxygenation status
5. Reinforcing teaching with K.D. about good hand washing techniques
6. Monitoring K.D.’s pulse oximetry readings and reporting values under 95%

12. K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for these lesions?

1. Keep each lesion covered with a clear, transparent dressing.
2. Place sterile, saline-soaked gauze over each lesion twice daily.
3. Keep the lesions dry, cleaning the affected areas gently as needed.
4. Apply topical antibiotic ointment twice daily to the affected areas.

13. Because of compromised immune function, K.D. is at risk for developing other opportunistic infections. List 5 infections.

1) Candida albicans; Thrush, esophagitis. why does yellow patches in mouth, esophagus, GI tract.

2) CNS lymphoma; cognitive dysfunction, motor impairment, aphasia, seizures, personality changes, headache.

3) cytomegalovirus; rhinitis: retinal lesions, blurred vision, loss of vision. Esophagitis; difficulty swallowing, colitis or gastritis, bloody diarrhea, pain, weight loss. neurologic disease; Central nervous system manifestations.

4) Cryptococcus neoformans; meningitis, cognitive impairment, motor dysfunction, fever, seizures, headache.

5) Hepatitis B&C virus; Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine.

Pg 220

14. Outline the assessment you need to perform to determine whether these problems are present.

For all of these conditions we will need to perform a complete history an physical assessment on our patient. A history assessment will be able to tell us if our patient has experienced any problems such as abdominal pain, loss of appetite, gastritis, weight loss, fatigue, blurred vision, Nausea or vomiting. A physical assessment can include inspecting our patients mouth for thrush, inspecting there CNS for cognitive dysfunction or motor impairment, inspecting their skin for jaundice, and many other things that will help us determine any opportunistic diseases.

Pg 220

15. What interventions can you use to help K.D. in managing his depression?

We could encourage the patient to discuss these feelings with his Primary Health provider. we could also refer him to a psychologist or therapist that would get him on the right track with correct medications to help him manage his depression. We could also offer him information about local support groups for people with HIV or AIDS. 

16. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.’s discharge planning?

We would want to conduct a discharge readiness assessment on our patient. We would need to evaluate any other educational needs he may need. This includes containment of his disease when it comes to interactions with his partner. It also includes instruction on importance of sticking with his medication regimen. We should be able to assess knowledge on the importance of his medicine and which medication he takes by having him read it back to us and providing him with written material. He needs to have a support person at home. We will ask if his partner will be able to support him, and if not, who could. He also needs to be educated on what to expect when he gets home, and when he needs to return to the hospital.

17. What other health care team members might you involve in K.D.’s discharge planning?

We will include many different health care team members in his discharge planning. We will need a referral to nutrition to educate him on the different foods he needs to consume in what heat does not need to consume. His doctor will be involved as they are the person to prescribe his medicines. If he is in the hospital long enough, he will need a physical therapy consult, to get him back on his feet, literally. Will also want to involve his caretaker or significant other, and make sure they are educated on what to look for and when to bring him back if it is needed.

CASE STUDY PROGRESS

K.D. is responding well to treatment for PJP and plans are being made for discharge. He will receive follow-up care at the outpatient clinic and soon begin radiation treatments for the KS. His ART regimen is changed to a fixed-dose combination regimen with emtricitabine-tenofovir-efavirenz (Atripla).

18. K.D. is kept on trimethoprim-sulfamethoxazole (Bactrim) 2 tablets once daily. He asks why he has to keep taking Bactrim “since the pneumonia is gone.” How would you respond?

We always insist that a patient completely finishes an antibiotic treatment to prevent do you mutation of the bacteria or Organism. We also want to be sure that the infection does not return.

19. What is the reason that K.D. receives combination ART therapy with emtricitabine-tenofovir-efavirenz (Atripla)?

1. Combination ART is only effective when CD4-positive T-cell counts are below 200/μL
2. Giving the drugs in a single pill reduces the incidence of cross-resistance between drugs
3. Using smaller doses of three different drugs reduces the incidence of side effects of each drug
4. Combination ART inhibits viral replication in different ways and decreases the chance of drug resistance

20 How can you help K.D. take Atripla as prescribed?

We can educate his caregiver/significant other on the times he must take the medication. We could also suggest he get a pill box that would separate all his medications by the time and day that it needs to be taken. We could also suggest he set his phone to alarm daily at the time he needs to take his medication.

Pg 225

21. What ongoing laboratory monitoring will K.D. need?

Our patient will need lifelong CD4 T-cell and viral load labs. Due to increased risk of infections, he will also need complete blood counts, white blood cell counts, and liver function test.

Pg 220

22. K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed with HIV infection. Give at least 3 additional topics to stress with K.D. before he goes home.

We would want to instruct our patient on appropriate coping mechanisms for stressful situations, enter avoid stressful situations when possible. The second would be to help him with his depression. This is something that needs to be discussed with the doctor to get him on the right depression medication to help manage it. Lastly, I would want to help him get into a support group four people with HIV, or a therapist for his depression to help him adjust to his new condition.