Nursing Care

Infection: There is an increased risk for nosocomial infections such as TB and central venous access device infections in those who are affected with HIV. The risk is greated when these patients are admitted with a fever. The higher risk for infection is related to the depression of the immune system. As nurses we must Identify/participate in behaviors to reduce risk of infection.

• Assess patient knowledge and ability to maintain opportunistic infection prophylactic regimen
• ongoing clinical assessment and monitoring, including vitals signs (especially temperature), Pulmonary and neurologic signs and symptoms, peripheral and central venous catheter sites, wounds and skin integrity, and changes in bowel and bladder management.

• meticulous compliance with infection control measures: intravenous site care and implementing institutional neutropenic precautions (single room assignment).
• administering antimicrobial agents.
• educating the patient and family regarding hand washing before and after toileting and for family before patient contact, avoid patient contact with children with viral illnesses, using a respirator mask for staff and family with respiratory or flu symptoms. and maintaining adequate fluid and nutritional intake.

Pain: Acute/chronic pain is significant for people with HIV. This can be due to procedures, medications, tissue damage. Nurses use analgesics or other techniques to prevent/control pain.

• ongoing assessment for the presence and characteristics of pain (location, quality, and intensity on a 0-10 scale, and its aggravating and relieving factors)
• administering analgesics and adjuvant agents and evaluating their efficacy
• advocating for around-the-clock dosing (versus as-needed dosing) of analgesics for chronic pain, preferably by the oral route
• evaluating and preventing untoward side effects (constipation from chronic opiate or tricyclic antidepressant use
• using nonpharmacologic techniques as appropriate, such as assuring adequate periods of undisturbed rest, positioning, heat and cold applications, warm baths, massage, and other relaxation techniques

• instruct and encourage patient to report pain as it develops rather than waiting until level is severe.

Impaired Gas Exchange: Despite prophylaxis for pneumocystis carinii pneumonia (PCP), it remains the most common AIDS-indicator opportunistic infection in adults across the country. Although, it is the most common cause of impaired gas exchange, people with HIV may have other respiratory condition that require hospitalization associated with problems of gas exchange.

Nursing management:

• ongoing respiratory assessment (reporting any increased shortness of breath, cough or chest pain) and pulse oximetry
• administering and titrating oxygen to a physician-prescribed oxygen saturation level
• administering antibiotics and monitoring for side effects.
• organizing care to provide maximal periods of rest.
• repositioning the patient as necessary to facilitate excursion and promote postural drainage.
• educating the patient regarding purse-lipped breathing to decrease tachypnea and anxiety.

Nutrition and fluid deficit: there are a number of disease and treatment related factors that contribute to nutritional and fluid deficits in people with HIV. This is a particular risk in the hospital. Many HIV infected patients in the hospital have fevers, secondary dehydration, and increased metabolic requirements. Nutritional deficit can manifest in weight loss and displaying weight gain is the desired goal. Fluid deficit can be related to excessive fluid loss and manifests as poor skin turgor. The goal here is to maintain hydration.

• Assessment and ongoing monitoring of weight, intake and output, ability to feed oneself, ability to swallow, symptoms interfering with food intake, orthostatic V.S., skin turgor, and cultural food preferences
• provide small, frequent meals and snacks of nutritionally dense food and non-acidic foods and beverages, with choice of foods palpable to patient.
• feeding the patient and encouraging oral intake
• administering intravenous hydration, appetite stimulants, antidiarrheals, and antiemetics as ordered.
• obtaining consultations from a dietician of specific diet prescriptions
• encouraging family and friends to bring patients favorite foods

• educating the patient regarding adequate fluid intake (at least 2 to 3 liters/day), the role of nutrition in acute illness recovery, and the clinically significant drug-nutrient interactions

Falls: Falls are a huge risk for patients with HIV, factors that contribute to falls are: weakness, fatigue, incontinence (urinary or fecal), urinary urgency, orthostatic hypotension (due to adrenal insufficiency, dehydration, medication side effects and sensory/perceptual problems), central nervous system lesions, and peripheral neuropathy. Nurses must be proactive when working with a fall risk.

• assess for fall risk factors (confusion, mobility problems, incontinence, orthostatic hypotension
• informing all other caregivers about patients at risk for fall
• instructing the patient and family to request assistance when transferring or ambulating
• Keep the call light, bedpan urinal and belongings within the patient’s reach
• keeping the bed in low position with side rails up
• increasing direct observations and if necessary moving the patient’s room nearer to the nurses station
• offering frequent assistance with ADLs
• using safety devices (bed alarms)
• consulting with the physician regarding need for sedation or physical restraints if the patient is a danger to himself or herself and one-on-one observation is impossible; providing the necessary care, support, and monitoring if physical restraints are used.