1 Care for people living with HIV HAIVN Havard Medical School AIDS Initiative in Vietnam

2 By the end of this session, participants should be able to: List the 7 most common symptoms in patients with HIV/AIDS Propose appropriate nursing interventions for each symptom Learning objectives

3 Cachexia Dyspnea Fatigue Fever Diarrhea Pain Dermatologic disease The most common symptoms relating to HIV

4 Is a systemic illness, characterized by: malnutrition weight loss weakness & fatigue Accompanied by rapid progression of disease Seen in a majority of patients Cachexia: Overview

5 Lack of sufficient intake of nutrients due to: Anorexia, nausea, oral ulcers, taste disturbances Depression or dementia Pain Poverty (economic difficulties) Loss of nutrients (diarrhea, vomiting) Cachexia: Causes (1)

6 Changes in metabolism (hypermetabolism) Opportunistic infections (OIs) are not diagnosed and treated, especially tuberculosis Side effects of medications Cachexia: Causes (2)

7 Eat frequent, small meals consisting of foods rich in protein and energy Comprehensive dental care Combination of gentle exercises Cachexia: Nursing interventions

8 Dyspnea is the subjective sensation felt by the patient Signs (observed by HCW): shortness of breath, tachypnea… Related to: Pulmonary infection Lung tumor Anemia Dyspnea: Overview

9 Subjective: Patient’ s level of daily activity is minimized Objective: observe patient Increased respiratory rate Irritation Difficulty speaking Labored breathing Cyanosis Dyspnea: Nursing assessment

10 Change position frequently: Elevate head or Sit with head bent forward Ensure position is steady Loosen patient’s clothing Maintain adequate hydration Dyspnea: Nursing interventions (1)

11 Have the patient’s room ventilated and avoid exposure to stimuli from the environment: Cigarette smoke Smoke from fireplace, kitchen Light exercises Instruct patient to relax and practice breathing with puffed cheeks / pursed lips Dyspnea: Nursing interventions (2)

12 Feeling unusually tired, level of exhaustion disproportionate to level of activity Related to: Progression of HIV disease Anemia Depression Malnutrition Fatigue: Overview

13 When does the patient feel the healthiest and when does the patient feel the most tired? Schedule of daily activity: sleep and daily activities? diet? Vital signs and appearance Assess hemoglobin (Hb) values Associated symptoms Fatigue: Nursing assessment

14 Encourage patients to seek treatment, including treatment of depression (if any) Plan activities appropriately taking into consideration need for energy conservation Perform light exercises Maintain adequate hydration and nutritional intake Fatigue: Nursing interventions

15 Fever is a condition of abnormally high temperature Related to infection, cancer, drug reactions… Increases energy expenditure, accelerates disease progression Fever: Overview

16 Place ice packs Give a quick shower with cool water when temperature is above 40 ⁰ C Keep the patient's body dry, clean and warm Maintain adequate hydration Use antipyretics Fever: Nursing interventions

17 Diarrhea is an increase in the number and frequency of bowel movements Related to infection, malignancy, malabsorption (electrolyte disorders…) Leads to: dehydration malnutrition dermal lesions social isolation, depression Diarrhea: Overview

18 Eat frequent, small meals Eat diet rich in protein and energy, decrease fat intake, and increase fiber intake Maintain adequate hydration Store food, prepare food using safe hygiene practices Practice good skin hygiene Wash hands thoroughly before eating, when preparing food, after using the bathroom... Diarrhea: Nursing interventions

19 Pain is the feeling of discomfort and restlessness / irritability, sensitivity Each person perceives and experiences pain differently Very common in patients with HIV/AIDS Often untreated Pain: Overview

20 Common causes of pain in patients with HIV: Headache: can be caused by HIV, tumors, infectious diseases, AZT Peripheral neuropathy: can be caused by HIV, treatment (e.g. d4T) Dermatologic disease / lesions: Zona Oral: herpes, candida, CMV, HIV Withdrawal syndrome Pain: Causes

21 Ask about the frequency and extent of pain Assess pain by standard “pain scale” Trust patient’s report Explain and reassure patient Assess pain and other vital signs at each patient visit Pain: Nursing interventions

22 Pain intensity assessment using a numeric scale: Level of pain is estimated on a scale from 0-10: 0: no pain 10: the greatest pain patient has ever experienced Pain scale 05 10

23 Manage pain with analgesic ladder of the World Health organization (WHO): Step 1: Non-opioid pain medications: aspirin, NSAIDs and acetaminophen Step 2: Opioids: codeine, oxycodone Step 3: Opioids: morphine, methadone Pain: Management (1)

24 Pain management without drugs: Acupuncture Hypnosis Relaxation techniques Pain: Management (2)

25 There are many manifestations of skin disease Appear in different stages of HIV disease Related to HIV, infection, malignancy and drugs Improve with ARV treatment Dermatologic disease: Overview

26 Eosinophilic: Rash on the body, head, neck, arm and leg Treated with antifungal creams, light therapy Bacterial: Treated with antibiotics Dermatologic disease: Folliculitis

27 Red, shiny, may be itchy Sebaceous gland in face, scrotum, arms and legs Treat with: Low potency steroids and Oil-based products Dermatologic disease: Seborrheic dermatits

28 The most common cause is candida Often lead to disease of nail and integumentary system Intervention: Keep skin dry and clean, especially in areas of legs and arms Use antifungal medication for topical and systemic use Dermatologic disease: Fungal skin infections

29 The common cause is zona which can be disseminated Intervention: Hand washing and skin hygiene Can apply a bandage but do not cover skin completely as to keep it too moist/ damp Analgesics as necessary Dermatologic disease: Ulcerative skin disease

30 Taking good care of AIDS patients means providing good nursing care

31 Symptoms discussed may be caused by HIV, opportunistic infections, or drug side effects Care plan: assess patient’s difficulties / challenges, assess care needs and reassess frequently Instruct patient and family how to provide care Key points

32 Thank you Questions?