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Nursing care plan HIV positive client

Written by ncp nursing care plan on April 29th, 2012

I. Pathophysiology
a. Infection by a subgroup of retroviruses with a high affinity
for CD4 T-lymphocytes and monocytes, with viral DNA
incorporating itself into host DNA (Dubin, 2008)
b. Following successful transmission of HIV, the course of
subsequent infection is variable and dependent on a number
of factors.
c. Main consequence of infection is damage to the immune
system.

II. Stages: continuum with progression individually variable
(Health24, 2004; Highleyman, 2005)
a. Infection or initial incubation period lasts 2 to 4 weeks.
i. Individual asymptomatic
ii. HIV test negative but individual is infectious.
b. Primary infection or acute seroconversion stage usually
occurs 4 to 8 weeks after infection.
i. Individual may be asymptomatic or develop flu-like
symptoms—low-grade fever, sore throat, swollen lymph
nodes, rash, joint and muscle pain lasting 1 to 2 weeks
ii. HIV positive but immune system usually functional.
c. Latency or asymptomatic stage can last anywhere from
2 weeks to years.
i. Virus remains active.
ii. Individual may be unaware of HIV status.
d. Mild to moderate stage usually occurs between 5 to 7 years
after infection.
i. Immune system is compromised.
ii. Individual symptomatic—skin rashes; fatigue; night
sweats; weight loss; mouth ulcers; fungal skin and nail
infections, which progress to chronic oral or vaginal
thrush; recurrent herpes blisters on mouth or genitals;
ongoing fevers; persistent diarrhea
e. Severe or late stage HIV disease median occurrence is
11 years postinfection.
i. Viral load is very high; CD4 count is very low, thus
indicating full-blown AIDS.
ii. Severe immune system damage and development of
opportunistic infections (Refer to CP: AIDS for
information.)

III. Etiology
a. Infection results from one of two similar retroviruses—HIV-1
and HIV-2—that destroy CD4 lymphocytes and impair
cell-mediated immunity, thereby increasing the risk of certain
infections and cancers.
b. Mode of transmission
i. Sexual contact—deposition of HIV on mucosal surfaces,
especially the genital mucosa and intestinal epithelium
(most common mode)
ii. Direct inoculation into the blood through intravenous (IV)
needle sharing or use of contaminated blood products
(rare in United States)
iii. Mother-to-baby perinatal transmission
c. Worldwide, high-risk populations—sex workers, men who
have sex with men, injection drug users, and prisoners
(United Nations Programme on HIV/AIDS [UNAIDS] &
World Health Organization [WHO], 2006)
d. Risk and severity of opportunistic infections, AIDS,
and AIDS-related cancers are determined by the CD4
lymphocyte count and the client’s exposure to potentially
opportunistic pathogens.
e. Ability of virus to mutate has made disease management
challenging, which has hindered efforts at development of
a vaccine.

IV. Statistics
a. Morbidity: In 2005, there were an estimated 38.6 million
people worldwide with HIV (UNAIDS & WHO, 2006); in
2003, there were approximately 1 million with HIV/AIDS
in the United States (Glynn & Rhodes, 2005); annually,
40,000 Americans are newly infected (Armington, 2007);
new infections are still increasing in some age ranges
(e.g., 40–44), among males (white, black, and Hispanic),
and among female adolescent and adult injection drug
users (Centers for Disease Control and Prevention
[CDC], 2007).
b. Mortality: Associated with progression to AIDS; life
expectancy 2 to 3 years in untreated HIV progressing to
AIDS (Dubin, 2008); in 2002, AIDS-related deaths were
at a rate of 2.2%, with marked increase for non-HIV/
AIDS-related causes, such as diabetes, chronic hepatitis,
and cardiovascular disease (Highleyman, 2005).
c. Cost: In 2002, $36.4 billion estimated lifetime costs for
individuals newly diagnosed in the United States, with
$6.7 billion in direct medical costs and almost $30 billion
in productivity loss (Hutchinson et al, 2006).

Care Setting
Client is treated in a community setting, although development
of opportunistic infections may require occasional
inpatient acute medical care.

Related Factors
Acquired immunodeficiency syndrome (AIDS)
Extended care
Fluid and electrolyte imbalances
Pneumonia
Psychosocial aspects of care
Sepsis/septicemia

Nursing Priorities
1. Promote acceptance of reality of diagnosis and condition.
2. Support incorporation of behavioral and lifestyle changes
to enhance well-being.
3. Provide information about disease process, prognosis,
and treatment needs.
4. Assist in developing plan and strategies to meet long-term
medical, behavioral, and financial needs and enhancing
quality of life.

Goals of Care
1. Dealing with current situation realistically.
2. Participating in and appropriately managing therapeutic
regimen.
3. Diagnosis, prognosis, and therapeutic regimen understood.
4. Plan in place to meet medical, behavioral change, and
financial needs.

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Source Credits: Nursing Care Planning Guides: For Adults in Acute, Extended and Home Care Settings by S. P. Ulrich and S. W. Canale BSN MSN / Nursing Care Plans by M. Doenges MF Moorehouse Alice Murr