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AIDS Case Study (45 min)

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Mr. Hernandez is a 33 year old male with a history of IV Drug Use, Hepatitis C, and HIV. He has previously been managed on HAART therapy, but has been having recurrent bouts of pneumonia in the last 6 months.  He presents to the Free Clinic today complaining of weakness and fatigue, shortness of breath, and a
persistent cough. He reports a 10 lb weight loss over the last 3 weeks. He says “I think I have pneumonia again”. 

Critical Thinking Check
Bloom's Taxonomy: Analysis

What further history questions and assessment data would you obtain at this time?

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Critical Thinking Check
Bloom's Taxonomy: Analysis

What laboratory or diagnostic tests do you anticipate the provider ordering?

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Upon further questioning, the patient reports fever, chills, and night sweats for the last few days. His coughing has been nonproductive. He has diffuse rhonchi through his right lung and scattered rhonchi on the left.  A Chest x-ray shows a nodular consolidation on the right side and diffuse infiltrates. The provider orders a CBC with Diff and a CD4 cell count.

Vital signs show the following:

HR 100

RR 20

BP 108/67

SpO2 90%

Temp 101.6°F

 

Critical Thinking Check
Bloom's Taxonomy: Analysis

What respiratory disease has Mr. Hernandez contracted?

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Critical Thinking Check
Bloom's Taxonomy: Analysis

What should your first nursing action be?

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The Complete Blood Count with Differential shows the following abnormal values:

RBC 3.9

H/H 8.1/24.3

WBC 7,000

Plt 104,000

CD4 <10 / mm3 

Critical Thinking Check
Bloom's Taxonomy: Analysis

What is going on physiologically with Mr. Hernandez? How do you know?

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Mr. Hernandez is sent straight to the hospital to be admitted. He is started on high-dose IV antibiotics and his HAART therapy dosages are increased.  He receives 2 units of Packed Red Blood Cells when his Hgb drops to 7.6 mg/dL. He continues to be weak and has fevers and night sweats, treated with PO Acetaminophen. He is flushed and his skin is warm. His vital signs in the morning are:

HR 110

RR 22

BP 88/47

SpO2 92% on 4 lpm nasal cannula

Temp 101.8°F

Critical Thinking Check
Bloom's Taxonomy: Analysis

What condition is Mr. Hernandez developing because of his infection?

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Critical Thinking Check
Bloom's Taxonomy: Application

What medications or treatments might he require to maintain his hemodynamics?

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Critical Thinking Check
Bloom's Taxonomy: Analysis

Could anything have been done differently for Mr. Hernandez?

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Reference:

Diagnostic Criteria for AIDS – https://www.ucsfhealth.org/conditions/aids/diagnosis.html

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