Acquired immunodeficiency syndrome (AIDS) is a serious secondary immunodeficiency disorder caused by the retrovirus, human immunodeficiency virus (HIV). Both diseases are characterized by the progressive destruction of cell-mediated (T-cell) immunity with subsequent effects on humoral (B-cell) immunity because of the pivotal role of the CD4+helper T cells in immune reactions. Immunodeficiency makes the patient susceptible to opportunistic infections, unusual cancers, and other abnormalities.
AIDS results from the infection of HIV which has two forms: HIV-1 and HIV-2. Both forms have the same model of transmission and similar opportunistic infections associated with AIDS, but studies indicate that HIV-2 develops more slowly and presents with milder symptoms than HIV-1. Transmission occurs through contact with infected blood or body fluids and is associated with identifiable high-risk behaviors.
Persons with HIV/AIDS have been found to fall into five general categories: (1) homosexual or bisexual men, (2) injection drug users, (3) recipients of infected blood or blood products, (4) heterosexual partners of a person with HIV infection, and (5) children born to an infected mother. The rate of infection is most rapidly increasing among minority women and is increasingly a disease of persons of color.
Nursing Care Plans
There is no cure yet for either HIV or AIDS. However, significant advances have been made to help patients control signs and symptoms and impair disease progression.
- Imbalanced Nutrition: Less Than Body Requirements
- Acute/Chronic Pain
- Impaired Skin Integrity
- Impaired Oral Mucous Membrane
- Disturbed Thought Process
- Social Isolation
- Deficient Knowledge
- Risk for Injury
- Risk for Deficient Fluid Volume
- Risk for Infection
- Other Possible Nursing Care Plans
Imbalanced Nutrition: Less Than Body Requirements
- Imbalanced Nutrition: Less Than Body Requirements
May be related to
- Inability or altered ability to ingest, digest and/or metabolize nutrients: nausea/vomiting, hyperactive gag reflex, intestinal disturbances, GI tract infections, fatigue
- Increased metabolic rate/nutritional needs (fever/infection)
Possibly evidenced by
- Weight loss, decreased subcutaneous fat/muscle mass (wasting)
- Lack of interest in food, aversion to eating, altered taste sensation
- Abdominal cramping, hyperactive bowel sounds, diarrhea
- Sore, inflamed buccal cavity
- Abnormal laboratory results: vitamin/mineral and protein deficiencies, electrolyte imbalances
- Maintain weight or display weight gain toward desired goal.
- Demonstrate positive nitrogen balance, be free of signs of malnutrition, and display improved energy level.
|Assess patient’s ability to chew, taste, and swallow.||Lesions of the mouth, throat, and esophagus (often caused by candidiasis, herpes simplex, hairy leukoplakia, Kaposi’s sarcoma other cancers) and metallic or other taste changes caused by medications may cause dysphagia, limiting patient’s ability to ingest food and reducing desire to eat.|
|Auscultate bowel sounds.||Hypermotility of intestinal tract is common and is associated with vomiting and diarrhea, which may affect choice of diet/route. Lactose intolerance and malabsorption (with CMV, MAC, cryptosporidiosis) contribute to diarrhea and may necessitate change in diet or supplemental formula.|
|Weigh as indicated. Evaluate weight in terms of premorbid weight. Compare serial weights and anthropometric measurements.||Indicator of nutritional adequacy of intake. Because of depressed immunity, some blood tests normally used for testing nutritional status are not useful.|
|Note drug side effects.||Medications used can have side effects affecting nutrition. ZDV can cause altered taste, nausea and vomiting; Bactrim can cause anorexia, glucose intolerance and glossitis; Pentam can cause altered taste and smell; Protease inhibitors can cause elevated lipids, blood sugar increase due to insulin resistance.|
|Plan diet with patient and include SO, suggesting foods from home if appropriate. Provide small, frequent meals and snacks of nutritionally dense foods and non acidic foods and beverages, with choice of foods palatable to patient. Encourage high-calorie and nutritious foods, some of which may be considered appetite stimulants. Note time of day when appetite is best, and try to serve larger meal at that time.||Including patient in planning gives sense of control of environment and may enhance intake. Fulfilling cravings for noninstitutional food may also improve intake. In this population, foods with a higher fat content may be recommended as tolerated to enhance taste and oral intake.|
|Limit food(s) that induce nausea and/or vomiting or are poorly tolerated by patient because of mouth sores or dysphagia. Avoid serving very hot liquids and foods. Serve foods that are easy to swallow like eggs, ice cream, cooked vegetables.||Pain in the mouth or fear of irritating oral lesions may cause patient to be reluctant to eat. These measures may be helpful in increasing food intake.|
|Schedule medications between meals (if tolerated) and limit fluid intake with meals, unless fluid has nutritional value.||Gastric fullness diminishes appetite and food intake.|
|Encourage as much physical activity as possible.||May improve appetite and general feelings of well-being.|
|Provide frequent mouth care, observing secretion precautions. Avoid alcohol-containing mouthwashes.||Reduces discomfort associated with nausea and vomiting, oral lesions, mucosal dryness, and halitosis. Clean mouth may enhance appetite and provide comfort.|
|Provide rest period before meals. Avoid stressful procedures close to mealtime.||Minimizes fatigue; increases energy available for work of eating and reduces chances of nausea or vomiting food.|
|Remove existing noxious environmental stimuli or conditions that aggravate gag reflex.||Reduces stimulus of the vomiting center in the medulla.|
|Encourage patient to sit up for meals||Facilitates swallowing and reduces risk of aspiration.|
|Record ongoing caloric intake.||Identifies need for supplements or alternative feeding methods.|
|Maintain NPO status when appropriate.||May be needed to reduce nausea and vomiting.|
|Insert or maintain nasogastric (NG) tube as indicated.||May be needed to reduce vomiting or to administer tube feedings. Esophageal irritation from existing infection (Candida, herpes, or KS) may provide site for secondary infections and trauma; therefore, NG tube should be used with caution.|
|Administer medications as indicated:|
||Reduces incidence of nausea and vomiting, possibly enhancing oral intake.|
||Given with meals (swish and hold in mouth) to relieve mouth pain, enhance intake. Mixture may be swallowed for presence of pharyngeal or esophageal lesions.|
||Corrects vitamin deficiencies resulting from decreased food intake and/or disorders of digestion and absorption in the GI system. Avoid megadoses and suggested supplemental level is two times the recommended daily allowance (RDA).|
||Marinol (an antiemetic) and Megace (an antineoplastic) act as appetite stimulants in the presence of AIDS. Oxandrin is currently being studied in clinical trials to boost appetite and improve muscle mass and strength.|
||Reduces elevated levels of tumor necrosis factor (TNF) present in chronic illness contributing to wasting or cachexia. Studies reveal a mean weight gain of 10% over 28 wk of therapy.|
||Inhibit GI motility subsequently decreasing diarrhea. Imodium or Sandostatin are effective treatments for secretory diarrhea (secretion of water and electrolytes by intestinal epithelium).|
||May be given to treat and prevent infections involving the GI tract.|
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