HIV Case Study

K.D. is a 56-year-old man who has been living with human immunodeficiency virus (HIV) infection for 6 years. He had been on antiretroviral therapy (ART) with a regimen of tenofovir and emtricitabine (Truvada), with darunavir and cobicistat (Prezcobix). He stopped taking his medications 4 months ago because of depression. The appearance of purplish spots on his neck and arms persuaded him to make an appointment with his provider. At the provider's office, K.D. stated he was feeling fatigued and having occasional night sweats. He said he had been working long hours and skipping meals. Other than purplish spots, the remainder of K.D.'s physical examination findings was within normal limits.

The doctor took 3 skin biopsy specimens and obtained a chest x-ray examination, tuberculin test, and lab studies, including a CBC, CD4 T-cell count, and viral load. Over the next week, K.D. developed a nonproductive cough and increasing dyspnea. Last night, he developed a fever of 102°F (38.9°C) and was acutely short of breath, so his partner brought him to the emergency department. He was admitted with probable Pneumocystis jiroveci pneumonia (PJP), which was confirmed with bronchoalveolar lavage examination under microscopy. K.D. is on nasal oxygen, IV fluids, and IV trimethoprim-sulfamethoxazole. His current vital signs are: blood pressure 138/86, pulse 100, respiration 30, temperature 100.8 °F (38.2°C), and SpO2 92%.

Questions:

1. What type of isolation precautions do you need to use when caring for K.D.? (Select all that apply)
- Droplet
- Contact
- Standard
- Airborne

2. What immediate complication is K.D. at risk for experiencing?
- Your answer

3. To detect this complication, what will be the focus of your ongoing assessment?
- Your answer

4. Why was K.D. placed on trimethoprim-sulfamethoxazole? What major side effects do you need to monitor for in K.D.?
- Your answer

5. What aspects of K.D.'s care can you delegate to the licensed practical nurse (LPN)? (Select all that apply)
- Providing instructions about a high-calorie, high-protein diet
- Administering the first dose of IV trimethoprim-sulfamethoxazole
- Repositioning K.D. and having him deep breathe every 2 hours
- Developing a plan of care to improve K.D.'s oxygenation status
- Reinforcing teaching with K.D. about good hand washing techniques
- Monitoring K.D.'s pulse oximetry readings and reporting values under 95%

6. Recognizing that K.D. has multiple posthospital needs, you begin discharge planning. What type of assessment do you need to complete as part of K.D.'s discharge planning?
- Your answer

1.Airborne isolation precautions need to be used when caring for K.D. as he has Pneumocystis jiroveci pneumonia (PJP).

2. K.D. is at risk for experiencing respiratory failure due to his Pneumocystis jiroveci pneumonia (PJP).
3. The focus of ongoing assessment will be on monitoring K.D.'s respiratory status, including oxygen saturation levels and respiratory rate.
4. K.D. was placed on trimethoprim-sulfamethoxazole to treat his Pneumocystis jiroveci pneumonia (PJP). Major side effects to monitor for include skin rash, fever, and signs of anemia.
5. LPN can administer the first dose of IV trimethoprim-sulfamethoxazole, repositioning K.D. and having him deep breathe every 2 hours, and monitoring K.D.'s pulse oximetry readings and reporting values under 95%.
6. As part of K.D.'s discharge planning, a comprehensive assessment of his physical, psychological, and social needs will need to be completed to develop an appropriate posthospital plan of care. This may include referrals to social services, mental health providers, and support groups.

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