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ANDREA SIGRIST HIV CASE 36. PATIENT Client Terry Long Sex: Male Ethnicity: African American DOB: 5/12 Age: 32 Height: 6’1” Weight: 151 lbs Reason for.

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Presentation on theme: "ANDREA SIGRIST HIV CASE 36. PATIENT Client Terry Long Sex: Male Ethnicity: African American DOB: 5/12 Age: 32 Height: 6’1” Weight: 151 lbs Reason for."— Presentation transcript:


2 PATIENT Client Terry Long Sex: Male Ethnicity: African American DOB: 5/12 Age: 32 Height: 6’1” Weight: 151 lbs Reason for Admittance HIV positive (diagnosed 4 years ago) Exhausted all the time Sore mouth Sore throat Significant weight loss Possible pneumonia per referring physician

3 Patient HistoryPhysical Exam  Stereopositive for HIV-1, confirmed by ELISA and Western Blot 4 years ago  Unknown contraction  Not currently undergoing treatment  Tonsillectomy at age 6  Appendectomy at age 18  Current medications; multivitamin, vitamin E, vitamin C, ginseng, milk thistle, echinacea  Quit smoking 5 years ago  Family history: father with angina, heart problems, high blood pressure (CAD, HTN) General Appearance: Thin African American in no acute distress Vitals: Temp 98.6F, BP 120/84, HR 92bpm, RR 18bpm Heart: regular rate and rhythm Nose: Mucosa pink without drainage Throat: erythematous with white, patchy exudate Extremities: good pulses, no edema Skin: warm, with flaky patches Chest/lungs: Rhonchi in lower left lung Abdomen: nondistended, nontender, hyperactive bowel sounds

4 LAB VALUES MeasureNormal ValueTerry’s ValueReason for Concern Albumin3.6 – 53.6Low levels are a sign of malnutrition Prealbumin19 – 436.0Low levels are a sign of malnutrition Transferrin200 – 40017Low levels are a sign of malnutrition Viral Load029000Elevated levels are a sign of an immune disorder CD4325 – < 200 defines AIDS BUN8 – 2611Low levels are a sign of malnutrition

5 PATIENT DIAGNOSIS AND TREATMENT DIAGNOSIS HIV for four years AIDS Clinical Cate Oral thrush No clinical evidence of pneumonia TREATMENT Antiretroviral regimen AZT (zidovudine) 200 mg every 8hr Crixivan (indinavir) 800mg every 8hr 3TC Epivir (lamivudine) 150 mg every 12hr

6 WHAT IS HIV? Infection caused by the human immunodeficiency virus which destroys the immune system and makes it hard for the body to fight off infections Transmitted through sexual contact, blood, and mother to child People infected may not show symptoms for up to ten years, but can still infect others Progresses to AIDS There is no cure, but it can be treated People infected with HIV will develop AIDS if not treated A small amount of people develop AIDS slowly or not at all Is a preventable infection

7 HIV TESTS Western Blot Uses gel electrophoresis to separate specific HIV proteins being detected After separation, the proteins are transferred to a membrane to be identified using antibodies that target a specific protein ELISA HIV antigens are added to a sample of blood and antibodies react with the HIV virus An enzyme linked to an antibody is added and reacts with the HIV antigen/antibody A catalyst is added to change the color of the enzyme-linked complex

8 RISK FACTORS FOR CONTRACTING HIV Common Risk Factors Sexual contact with an infected person Unprotected sex Coming in contact with blood of an infected person Sharing needles Blood transfusions Mother to child by blood during delivery or breast milk Terry’s Risk Factors Worked as a nurse in a dialysis clinic Numerous sexual partners Use of recreational drugs

9 PROGNOSIS HIV is a chronic condition It will eventually completely destroy a person’s immune system Progression depends on each individual There are treatment options, but no cure Can prevent complications and delay the progression of AIDS Almost all people infected will develop AIDS Lack of treatment is fatal HAART (highly reactive antiretroviral therapy) dramatically increases how long an infected person lives, but is not a cure The weakened immune system makes individuals more susceptible to infections and cancers

10 TREATMENT FOR HIV Treatment Medications used in combination is the only way to control the virus It is best to use three different medications from two different classes of drugs to avoid creating strains of HIV that are immune to single drugs When to Start Symptoms become severe CD4 count is below 500 Become pregnant Have HIV-related kidney disease Being treated for Hep- C

11 MEDICATIONS Types of Medications NNRTIs ( Non-nucleoside reverse transcriptase inhibitors): disables proteins HIV needs to copy itself NRTIs ( Nucleoside reverse transcriptase inhibitors): faulty versions of building blocks HIV needs to copy itself PIs (Protease Inhibitors): disable protease, which HIV uses to copy itself Entry or fusion inhibitors: block HIV’s entry into CD4 cells Integrase inhibitors: disables integrase which HIV uses to insert genetic material into CD4 cells Terry’s Medications 200 mg of zidovudine (AZT) every 8 hours 800 mg of indinavir (Crixivan) every 8 hours 150 mg of lamivudine (3TC Epivir) every 12 hours

12 SUPPLEMENTS SupplementProposed use in HIV/AIDSPotential Risk Vitamin C Improve antioxidant capacity, increases iron absorption from non-heme sources Increases urinary losses of oxalate and calcium Vitamin E Vitamin E may protect against toxicity and side effects from AZT (antiretroviral medications) Can interfere with blood clotting. Cause nausea, diarrhea, muscle weakness, fatigue Ginseng Has anti-stress and anti-fatigue effects; May contain a protein with anti-HIV activity morning diarrhea, insomnia, nervousness, depression, confusion, skin rashes and high blood pressure Milk thistle May prevent liver damage caused by HIV medications Upset stomach, diarrhea, bloating, gas Echinacea Anticancer, immunostimulatory; stimulate immune system and promote CD4 cell activation May inhibit metabolism of drugs using the cytochrome P 450 enzyme pathway Multivitamin Slows disease progression, increases CD4 count, lowers viral load values None

13 NUTRITION WITH HIV Terry’s Diet before Mouth Sores Breakfast/Lunch: 1-2 cups of cold cereal with ½ cup of whole milk Dinner: Meat, potatoes or rice, tea or soda Snacks: Pizza, candy bar, or cookies with tea or soda 1-2 beers or glasses of wine several times a week Suggested HIV Nutrition Consume a healthy and balanced diet like healthy individuals Calories should be 10% higher if untreated Calories should be 30% higher during recovery Take a daily multivitamin If suffering from loss of appetite: Eat several small meals Exercise to stimulate appetite Consume nutrition supplement beverage Terry’s 24-hour Diet Recall Sips of apple juice, 1 cup of yogurt, 1 cup of rice and gravy, sips of iced tea with sugar throughout the day

14 ALCOHOL AND HIV Studies show regular alcohol consumption is associated with an increase in the progression of HIV The immunosuppressive effects of alcohol may cause CD4 count to fall below 200 cells Still being researched, not a fact

15 MAIN CONCERNS FOR TERRY Problems Not eating enough Consumes a lot of sugar and soda Alcohol consumption Not taking medications Suggestions Place on pureed or soft food diet Add nutritional supplement beverage Vegetable juices Soy or almond milks Educate about programs that help pay for medications

16 GOALS Main goal is to get Terry his medications and get him taking them every day as directed Educate about healthy diet and consequences of malnutrition and not taking medications Get back on a normal diet Start exercise routine COURSE OF ACTION Have him meet with a Medication Assistance program Create diet plan Begin with soft/liquid diet Progress to normal diet Have Terry keep a food journal Join a gym or fitness group Join a support group


18 REFERENCES AIDS (2012). AIDS Information, Education, Action, Awareness | CD4 (T-CELL) TESTS. AIDS Information, Education, Action, Awareness | HIV, AIDS Facts. Retrieved from background-information/what-is-aids/hiv-testing/cd4-t-cell-tests/ (2012). AIDS Information, Education, Action, Awareness | How is HIV Transmitted? AIDS Information, Education, Action, Awareness | HIV, AIDS Facts. Retrieved from transmitted/ Boskey, Ph. D., E. (2011, September 6). HIV Testing - How Does a Western Blot HIV Test Work? Sexually Transmitted Diseases - STDs. Retrieved from Carter, M., & AIDS Map (2010, May 17). HIV & AIDS Information :: Frequent alcohol use hastens HIV disease progression. HIV & AIDS Information :: Home. Retrieved from hastens-HIV-disease-progression/page/ / Cooper, C. L., & Cameron, D. W. (2005). Effect of Alcohol Use and Highly Active Antiretroviral Therapy on Plasma Levels of Hepatitis C Virus (HCV) in Patients Coinfected with HIV and HCV. Oxford Journals | Medicine | Clinical Infectious Diseases. Retrieved from FitDay. (2012). FitDay - Free Weight Loss and Diet Journal. Retrieved from ogSummaryTabs-Focus=Nutri Mayo Clinic (2011, August 11). HIV/AIDS: Treatments and drugs - Mayo Clinic. Retrieved from Medline Plus (2012, May 30). HIV infection: MedlinePlus Medical Encyclopedia. National Library of Medicine - National Institutes of Health. Retrieved from The Body (2005, January). Herbs, Supplements and HIV - The Complete HIV/AIDS Resource - Retrieved from WebMD (2007). HIV & AIDS Symptoms: Weight Loss, Lack of Energy, Fever, and More. WebMD - Better information. Better health. Retrieved from Web MD (2012). Drug Search from WebMD. WebMD - Better information. Better health. Retrieved from etailsTop.y=0&source=2

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