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 40⁰C 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, AZTPeripheral neuropathy: can be caused by HIV, treatment (e.g. d4T)Dermatologic disease / lesions: ZonaOral: herpes, candida, CMV, HIVWithdrawal 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

0 5 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, oxycodoneStep 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?