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
Disturbed Thought Process
May be related to
- Hypoxemia, CNS infection by HIV, brain malignancies, and/or disseminated systemic opportunistic infection, cerebrovascular accident (CVA)/hemorrhage; vasculitis
- Alteration of drug metabolism/excretion, accumulation of toxic elements; renal failure, severe electrolyte imbalance, hepatic insufficiency
Possibly evidenced by
- Altered attention span; distractibility
- Memory deficit
- Disorientation; cognitive dissonance; delusional thinking
- Sleep disturbances
- Impaired ability to make decisions/problem-solve; inability to follow complex commands/mental tasks, loss of impulse control
- Maintain usual reality orientation and optimal cognitive functioning.
|Assess mental and neurological status using appropriate tools.||Establishes functional level at time of admission and provides baseline for future comparison.|
|Consider effects of emotional distress. Assess for anxiety, grief, anger.||May contribute to reduced alertness, confusion, withdrawal, and hypoactivity, requiring further evaluation and intervention.|
|Monitor medication regimen and usage.||Actions and interactions of various medications, prolonged drug half-life and/or altered excretion rates result in cumulative effects, potentiating risk of toxic reactions. Some drugs may have adverse side effects: haloperidol (Haldol) can seriously impair motor function in patients with AIDS dementia complex.|
|Investigate changes in personality, response to stimuli, orientation and level of consciousness; or development of headache, nuchal rigidity, vomiting, fever, seizure activity.||Changes may occur for numerous reasons, including development or exacerbation of opportunistic diseases or CNS infection. Early detection and treatment of CNS infection may limit permanent impairment of cognitive ability.|
|Maintain a pleasant environment with appropriate auditory, visual, and cognitive stimuli.||Providing normal environmental stimuli can help in maintaining some sense of reality orientation.|
|Provide cues for reorientation. Put radio, television, calendars, clocks, room with an outside view if necessary. Use patient’s name. Identify yourself. Maintain consistent personnel and structured schedules as appropriate.||Frequent reorientation to place and time may be necessary, especially during fever and/or acute CNS involvement. Sense of continuity may reduce associated anxiety.|
|Discuss use of datebooks, lists, other devices to keep track of activities.||These techniques help patient manage problems of forgetfulness.|
|Encourage family and SO to socialize and provide reorientation with current news, family events.||Familiar contacts are often helpful in maintaining reality orientation, especially if patient is hallucinating.|
|Encourage patient to do as much as possible: dress and groom daily, see friends, and so forth.||Can help maintain mental abilities for longer period.|
|Provide support for SO. Encourage discussion of concerns and fears||Bizarre behavior and/or deterioration of abilities may be very frightening for SO and makes management of care or dealing with situation difficult. SO may feel a loss of control as stress, anxiety, burnout, and anticipatory grieving impair coping abilities.|
|Provide information about care on an ongoing basis. Answer questions simply and honestly. Repeat explanations as needed.||Can reduce anxiety and fear of unknown. Can enhance patient’s understanding and involvement and cooperation in treatment when possible.|
|Reduce provocative and noxious stimuli. Maintain bed rest in quiet, darkened room if indicated.||If patient is prone to agitation, violent behavior, or seizures, reducing external stimuli may be helpful.|
|Decrease noise, especially at night.||Promotes sleep, reducing cognitive symptoms and effects of sleep deprivation.|
|Maintain safe environment: excess furniture out of the way, call bell within patient’s reach, bed in low position and rails up; restriction of smoking (unless monitored by caregiver/SO), seizure precautions, soft restraints if indicated.||Provides sense of security and stability in an otherwise confusing situation.|
|Discuss causes or future expectations and treatment if dementia is diagnosed. Use concrete terms.||Obtaining information that ZDV has been shown to improve cognition can provide hope and control for losses.|
|Administer medications as indicated:|
||Shown to improve neurological and mental functioning for undetermined period of time.|
||Cautious use may help with problems of sleeplessness, emotional lability, hallucinations, suspiciousness, and agitation.|
|Refer to counseling as indicated.||May help patient gain control in presence of thought disturbances or psychotic symptomatology.|
Recommended nursing diagnosis and nursing care plan books and resources.
- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
- Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
- NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
- Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
- Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
- Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
- Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
- All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other care plans related to communicable and infectious diseases: