Assignment:
THE CARDIOVASCULAR SYSTEM &THE BLOOD
Level of difficulty: Moderate
Overview: The nurse in this case is caring for a client who has recently learned that he is positive for the human immunodeficiency virus (HIV). Laboratory testing to monitor the progression of HIV is reviewed. The ethical and legal concerns regarding the client's decision not to disclose his HIV status to his wife or others are discussed.
THE CARDIOVASCULAR SYSTEM & THE BLOOD
Mr.Thomas is a 42-year-old man admitted to the hospital with complaints of shortness of breath, fever, latigue, and oral thrush. The health care provider reviews the laboratory and diagnostic tests with Mr. Thomas and informs him that he has pneumonia and is HIV positive. Mr. Thomas believes that he contracted HIV while involved in an affair with another woman three years ago. He is afraid to tell his wife, knowing she will be angry and that she may leave him.
Client Profile
The nurse assigned to care for Mr. Thomas rcads in the medical record (chart) that he learned two days ago that he is HIV positive. There is a note in the record that indicates hat Mr. Thomas has not told his wife the diagnosis. To complete a lunctional health pattern assessment, the nurse asks Mr. Thomas if he may ask him a few questions. Mr. Thomas is willing and in the course of their conversation shares with the nurse that he believes that hec contracted the HIV durCase Study ing an affair with another woman. He states, "How can I tell my wife about this?
I am so ashamed. It is bad enough that I had an affair, but to have to tell her in this way-Ijust don't think I can. She is not sick at all. I will just say I have pineumonia and take the medication my hcalth care provider gave me.I do not want my wife or anyone else to know. If she begins to show signs of not feeling well, then I will tell her. I just can't tell anyone. What will people think of me if they know I have AIDS?"
Questions
1. Briefly discuss how HIV is transmitted and how it is not. How can Mr. Thomas prevent the transmission of HIV to his wife and others?
2. Mr. Thomas stated, "What will people think of me if they know I have AIDS?" How can the nurse explain the difference between being HIV positive and having AIDS? when beginning client teaching, and then discuss the progression of the HIV disease, including an explanation of primary infection, categories (groups) A, B, and C, and four main types of opportunistie infections.
3. Discuss the ethical dilemmas inherent in this case.
4. Does the health care provider have a legal obligation to tell anyone other than Mr. Thomas that he is HIV positive? If so, discuss.
5. Any loss, such as the loss of one's health, results in a gricf response. Describe the stages of grief according to Kubler-Ross.
6. Discuss which stage of grief Mr. Thomas is most likely experiencing. Provide examples of Mr. Thomas's behavior that support your decision.
7. Wlhat are the laboratory tests used to confirm the diagnosis of HIV infection in an adult?
8. Discus the function of CD4 T cells and provide an example of how the CD4* T-cell count guides the management of HIV.
9. Briefly explain the purpose of viral load blood tests in monitoring the progression of HIV.
10. Mr. Thomas expresses a readiness to learm more about HIV. Discuss the nurse's iniual intervention
11. Following the nurse's teaching, Mr. Thomas states, "How stupid I was to have that affair. Not only could it ruin my marriage, but it gave me a death sentence." Share with Mr. Thomas what you know about long-term survivors, long-term nonprogressors, and Highly Active Antiretroviral Theratpy (HAART).
12. Discuss how the nurse should respondif Mr. Thomas's wife approaches him in the hall and asks, "Did the test results come back yet? Do you know what is wrong with my husband?"
13. List five possible nursing diagnoses appropriate to consider for Mr. Thomas.