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CNA250 Nursing Practice 2

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1.Case Study: HIV/AIDS


You are working as an independent nurse at a local physician’s office. You have been hired to work alongside the physician to offer patients more education, counseling and follow-up to the care provided at this office. During one of your shifts, you become involved in a patient’s case. The patient is a 40 year old woman who is in the counseling room. The patient, Sheila, has been divorced for over 5 years and has two children ages 10 and 6 years of age. Three weeks ago she had visited the physician’s office and asked for a routine physical examination and an HIV test to be conducted. Sheila was in a serious relationship and was considering marriage. Her main reason for asking for the HIV test was that she was uncertain about her partner, as he has had many girlfriends prior to proposing marriage. As well, she was contemplating buying a new house with her boyfriend and the insurance company required her to have the HIV test.   The physical examination results were unremarkable. The blood work performed included routine blood chemistries, hematology, studies and an enzyme-linked immunosorbent assay (ELISA) test also referred to as the enzyme immunoassay (EIA) test. 

Sheila is waiting for her results at the physician’s office. Prior to informing Sheila of her blood tests results, the physician firstly informs you that Sheila’s EIA was positive. 

  1. Does a positive EIA mean that Sheila definitely has HIV?

  2. You inform Sheila that one of the tests needs to be repeated and that you need to draw another blood sample…why would you not tell Sheila that her first result was positive and that another test is needed before the diagnosis can be confirmed?

  3. The physician tells you that Sheila’s western blot test results confirm that she is HIV positive. He requests that you are with him when he informs Sheila. As well, you are to provide Sheila with the local HIV/AIDS support groups, and help Sheila call a friend to accompany her home. What are the local AIDS resources available in your community? What support do these local resources offer?

  4. Sheila is in tears as she tells you, “I have never had sex with anyone since my divorce. My boyfriend told me I had nothing to worry about. I can’t believe he would do this to me.” Sheila’s statement to you is based on three assumptions. What are they?

  5. Based on your readings and past knowledge of HIV infection, how would you approach her statement and counsel her?

  6. What do you consider your most critical role in Sheila’s care at this point?

  7. Applying your knowledge from your literature review, what are some issues related to Sheila’s care?

  8. Sheila has had a positive EIA test and is sero-positive for HIV. Why does she not have any signs and symptoms of AIDS?

  9. What are some of the acute signs and symptoms of an HIV infection that a patient may present with? What are some of the blood and body fluid precautions that health professionals must take to ensure safe nursing care?

  10. Why is it a good recommendation to have someone that Sheila trusts escort her home after the news is delivered?

  11. Has Sheila’s right to privacy been violated by calling her friend? Explain the rationale for your answer.

  12. Does Sheila have a legal responsibility to inform her boyfriend of her HIV status?

Understanding the relationship side of HIV/AIDS

Sheila comes back for her appointment at the physician’s office. She informs you in private that she was going to blame her boyfriend for “giving her AIDS”. Sheila states she was so upset after the initial news of being HIV positive that she was certain her boyfriend was cheating on her. She states that her boyfriend confessed that he was afraid of telling her about his hemophilia condition and thought she might leave him. Her boyfriend had been tested on a regular basis for HIV and his last test was about 6 months ago and came back negative. He was re-tested recently and this test was positive for HIV. His physician discussed the possibility of transmission through a recombinant Factor VIII product. Sheila informs you that they are still going to get married and live their life together supporting each other.

  1. Outline what you think their nursing needs are at this point?

  2. What changes are likely to happen in the nursing approach if one of them develops AIDS?

2.Gastrointestinal Disease

Using the files in this session and the resources in the course introduction below, prepare a care plan for a client who is in an acute stage of a gastrointestinal disease. You may pick any disease you wish to prepare this case study.

The case study must include information on the following:

  1. Demographic and biographical details of the client.
  2. Signs and symptoms of the disease
  3. Information on drugs commonly prescribed to alleviate symptoms or cure the illness.
  4. Other forms of treatment for the illness.
  5. A full care plan, addressing the nursing needs during the acute illness.
  6. A teaching and learning plan for the client and his/her family/significant others when preparing for discharge.
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