13 AIDS (HIV Positive) Nursing Care Plans

Imbalanced Nutrition: Less Than Body Requirements

A patient with HIV/AIDS may experience Imbalanced Nutrition: Less Than Body Requirements due to a variety of factors, including decreased appetite, malabsorption, diarrhea, nausea, vomiting, and metabolic changes caused by the disease or its treatments. Additionally, HIV/AIDS can weaken the immune system, making it more difficult for the body to absorb and utilize nutrients properly.

Nursing Diagnosis

• 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

Desired Outcomes

• The patient will maintain weight or display weight gain toward the desired goal.
• The patient will demonstrate positive nitrogen balance, be free of signs of malnutrition, and display improved energy levels.

Nursing Assessment and Rationales

1. Assess the 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 the patient’s ability to ingest food and reducing the desire to eat.

2. Auscultate bowel sounds.
Hypermotility of the intestinal tract is common and is associated with vomiting and diarrhea, which may affect the choice of diet/route. Lactose intolerance and malabsorption (with CMV, MAC, and cryptosporidiosis) contribute to diarrhea and may necessitate a change in diet or supplemental formula.

3. 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.

4. 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, and blood sugar increase due to insulin resistance.

5. Record ongoing caloric intake.
Identifies the need for supplements or alternative feeding methods.

Nursing Interventions and Rationales

1. Plan diet with the 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 a choice of foods palatable to the patient. Encourage high-calorie and nutritious foods, some of which may be considered appetite stimulants. Note the time of day when appetite is best, and try to serve a larger meal at that time.
Including patients in planning gives a sense of control of the 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.

2. Limit food(s) that induce nausea and vomiting or are poorly tolerated by the 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, and cooked vegetables.
Pain in the mouth or fear of irritating oral lesions may cause the patient to be reluctant to eat. These measures may be helpful in increasing food intake.

3. Schedule medications between meals (if tolerated) and limit fluid intake with meals, unless fluid has nutritional value.
Gastric fullness diminishes appetite and food intake.

4. Encourage as much physical activity as possible.
May improve appetite and general feelings of well-being.

5. Provide frequent mouth care, observing secretion precautions. Avoid alcohol-containing mouthwashes.
Reduces discomfort associated with nausea and vomiting, oral lesions, mucosal dryness, and halitosis. A clean mouth may enhance appetite and provide comfort.

6. Provide a rest period before meals. Avoid stressful procedures close to mealtime.
Minimizes fatigue; increases the energy available for work of eating and reduces chances of nausea or vomiting food.

7. Remove existing noxious environmental stimuli or conditions that aggravate the gag reflex.
Reduces stimulus of the vomiting center in the medulla.

8. Encourage the patient to sit up for meals
Facilitates swallowing and reduces the risk of aspiration.

9. Maintain NPO status when appropriate.
May be needed to reduce nausea and vomiting.

10. Insert or maintain a 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.

11. Administer medications as indicated:

• 11.1. Antiemetics: prochlorperazine (Compazine), promethazine (Phenergan), and trimethobenzamide (Tigan)
  Reduces the incidence of nausea and vomiting, possibly enhancing oral intake.

• 11.2. Sucralfate (Carafate) suspension; a mixture of Maalox, diphenhydramine (Benadryl), and lidocaine (Xylocaine)
  Given with meals (swish and hold in mouth) to relieve mouth pain, and enhance intake. The mixture may be swallowed for the presence of pharyngeal or esophageal lesions.

• 11.3. Vitamin supplements
  Corrects vitamin deficiencies resulting from decreased food intake and/or disorders of digestion and absorption in the GI system. Avoid megadoses and the suggested supplemental level is two times the recommended daily allowance (RDA).

• 11.4. Appetite stimulants: dronabinol (Marinol),  megestrol (Megace), oxandrolone (Oxandrin)
  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.

• 11.5. TNF-alpha inhibitors: thalidomide
  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.

• 11.6. Antidiarrheals:  diphenoxylate (Lomotil), loperamide (Imodium), octreotide (Sandostatin)
  Inhibit GI motility subsequently decreasing diarrhea. Imodium or Sandostatin are effective treatments for secretory diarrhea (secretion of water and electrolytes by intestinal epithelium).

• 11.7. Antibiotic therapy: ketoconazole (Nizoral), fluconazole (Diflucan)
  May be given to treat and prevent infections involving the GI tract.