1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 34Clients Coping with Acquired Immunodeficiency Syndrome (AIDS)

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Although the central feature of HIV infection involves collapse of the body’s ability to mount an appropriate cell-mediated immune response with attendant medical complications, neuropsychiatric phenomena can also be prominent. —Sadock & Sadock, 2008

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After studying this chapter, you should be able to Explain the etiology of acquired immunodeficiency syndrome (AIDS) Identify those groups of individuals at risk for AIDS Describe the psychosocial impact of AIDS Discuss the effects of AIDS on family dynamics

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) Recognize the clinical phenomena of each of the three phases of AIDS Formulate a plan of care for a client exhibiting clinical symptoms of the middle stage of AIDS Articulate the purpose of including interactive therapies in the plan of care for a client with AIDS Outline the types of community services available to provide continuum of care for clients with AIDS

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Epidemiology

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology of AIDS Groups at risk for AIDS –African Americans and Hispanics –Homosexual/bisexual men –Individuals with multiple sexual partners –Adolescents who do not practice safe sex –Heterosexual IV drug users –Homosexual/bisexual men using IV drugs –Heterosexuals who have had sex with one of the above groups –Persons with hemophilia and those who have received blood transfusions –Infants born to mothers with AIDS –Persons who are occupationally exposed (nurses, etc.) AIDS in adolescents AIDS in older adults

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychosocial Impact of AIDS HIV infection and psychiatric disorders The worried well Grief reaction to HIV/AIDS –First stage: shock, numbness, disbelief –Second stage: denial –Third stage: guilt, anger, homophobia –Fourth stage: resolution, acceptance

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Effects of AIDS on Family Dynamics Diagnosis of AIDS challenges the fragile balance of roles in the family. Adults who were independent now become dependent. Parents have change in newly retired lifestyles. Families assume financial responsibility. Families may become estranged from the member with AIDS.

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process Assessment Nursing diagnoses Outcome identification Planning interventions Implementation Evaluation

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Phases of assessment – Early phase – Middle phase – Late phase Transcultural considerations – Cultural beliefs and myths – Ethnic issues of homophobia and stigmatization Assessment for immune recovery syndrome Assessment as a secondary prevention

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses Ineffective health maintenance Disturbed thought processes Anticipatory grieving Death anxiety Hopelessness Impaired social interaction Ineffective coping Deficient knowledge Situational low self- esteem Spiritual distress

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Outcome Identification Outcomes should focus on the following: Address psychosocial issues such as living with a chronic illness and dying Empower the client to maintain a sense of control over his or her life during the progression of the disease Educate the client about HIV disease, infection control, available treatments, and medications Monitor health status and manage symptoms Promote adequate nutrition and other health-maintenance goals Provide palliative care

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Planning Interventions Planning includes the following: Using a holistic, multidisciplinary approach Augmenting available treatment and management options Improving palliative outcomes and enhancing overall well-being

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Early-phase planning and implementation Middle-phase planning and implementation –Assistance with meeting basic needs –Medication management –Assistance with emotional needs Late-phase planning and implementation Client and family education –Community support groups Continuum of care

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluation During evaluation Make needed adjustments due to the progression of the disease process and development or existence of comorbid mental illness Evaluate the continuum of care to determine if all possible support systems are in place

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Acquired immunodeficiency syndrome (AIDS) Homophobia Human immunodeficiency virus (HIV) Neuropsychiatric syndromes Stigmatization

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection According to the chapter-opening quote by Sadock & Sadock, clients with HIV infection may develop neuropsychiatric phenomena. Prepare an educational tool to inform HIV-infected clients and their families or significant others about the neuropsychiatric syndromes and psychiatric disorders associated with AIDS. ? What approach would you use? Would you provide the clients and other attendees an opportunity to interact with you and others during the discussion?