the individual identified as hiv-seropositive is one who is asymptomatic and does not meet the centers for disease control and prevention (cdc) definition for aids. studies reveal that persons with hiv-positive status may remain asymptomatic for 10 or more years. during the period of asymptomatic infection, the individual has hiv in the blood and is contagious to others. patients may live longer without symptoms if receiving highly active antiretroviral therapy (haart) to reduce the viral load. after approximately a decade, especially in the undertreated individual, the immune system begins to decline and he or she develops symptoms of immune deficiency, a phase termed \u201csymptomatic hiv infection.\u201d the individual might then develop aids-defining diseases. with the inception of multiple drug regimens (using combinations of nucleoside reverse transcriptase inhibitors [nrtis], protease inhibitors [pis], or nonnucleoside reverse transcriptase inhibitors [nnrtis]), the cd8+ ctl (cytotoxic t-lymphocyte) and the cd4 count can be maintained at higher levels longer and the viral load minimized.controlling replication of hiv and lowering the viral load are the current focus of early intervention. although imminent death is not a realistic concern, the patient needs to make major behavioral and lifestyle changes to prolong life expectancy and may have significant problems that require information and assistance. the person who is well supported medically may lead a productive life for an extended period. at present the rate of new infections is rapidly increasing among people of color, women in general (with the most common mode of transmission being heterosexual activity), and resurgence among young homosexual men who did not experience the losses of their predecessors and have a misconception regarding the efficacy of medications and therefore are engaging in unsafe sexual practices.
fluid and electrolyte imbalances
psychosocial aspects of care
therapy; counts equal to/or below 200 define progression to aids. levels are measured immediately before and again 4\u20138 wk after initiation of antiretroviral therapy. thus, it is used to diagnose hiv infection and progression and to monitor effects of drug therapy. the role of cd4+ t-cells is unclear. cd4+ cells are a target for hiv infection and destruction. some researchers postulate cd4+ cells are eliminated early. they may not contribute to host defense substantially in the late stages of disease.
1. promote acceptance of reality of diagnosis/condition.
2. support incorporation of behavioral/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.
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.
life-threatening, stigmatized condition/disease
assault to self-esteem, altered locus of control
denial; incomplete/ongoing grieving
inadequate support systems
medication side effects (fatigue and depression)
verbalization of nonacceptance/denial of diagnosis
extended period of shock, disbelief, or anger regarding change in health status
failure to take action to prevent further health problems
failure to achieve optimal sense of control
verbalize reality and acceptance of condition.
demonstrate increased trust and participation in development of plan of action.
initiate lifestyle changes that will permit adaptation to present life situations.
encourage expression of feelings, denial, shock, and fears.
listen without judgment, accepting patient\u2019s expressions.
focus on positive outcomes.
challenge morbid thoughts and reframe into positive
statements, e.g., \u201cyou know why the virus is going to kill
me. i deserve to die for what i\u2019ve done.\u201d response: \u201cthe
virus may or may not kill you. it\u2019s not smart enough to
decide when you may die. the virus is \u2018just there.\u2019 it does
not have a mind to know what you have or have not
it is important to convey belief in commonality of
patient\u2019s fears/feelings. by focusing on positive outcomes,
patient is encouraged to take charge of those areas in
which changes can be made, e.g., managing medical
regimen and behavior.
interrupts morbid thoughts and challenges patient\u2019s self-
deprecating ideas. as with any potentially terminal
disease, this population is likely to experience depression
and is at increased risk for suicide, necessitating ongoing
addictive behaviors, ability of injection drug user to
obtain clean \u201cworks,\u201d sexual myths, and perceptions of
the need for condoms need to be addressed.
partners, friends, and families will have individual
responses depending on the individual\u2019s lifestyle,
knowledge of hiv transmission, and belief in myths.
long-term support is critical to dealing with and
effectively coping with the reality of frequent physician
visits for evaluation, medical treatments, and ongoing
fatigue and depression can be side effects of some
medications and of the infection itself. knowledge that it
is usually of short duration can support informed
choices/cooperation and promote hope.
patient is supported and given encouragement for past
effective behavior. positive reinforcement enhances self-
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