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CASESTU DY 5 Mr. Thomas uesgens

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GENDER SOCIOECONOMIC

Male Married for seventeen years; two

children (ages 14 and 11 years old); primary income provider for familyAGE

12 SPIRITUAL/RELIGIOUS

SETTING

Hospital PHARMACOLOGIC

ETHNICITY LEGAL

White American Infectious disease; client CULTURAL CONSIDERATIONS

confidentiality; partner notification

ETHICAL

PREEXISTING CONDITIONS a Partner notification of exposure

Pneumonia last year; unexplained fifteen-pound weight loss Over past

to HIV

six months ALTERNATIVE THERAPY

COEXISTING CONDITIONS PRIORITIZATION

Thrush; pneumonia; human

immunodeficiency virus (HIVV DELEGATION

COMMUNICATION

DISABILITY

Potential disability resulting from

chronic illness

THE CARDIOVASCULAR SYSTEM &THE BLOOD

Level of difficulty: Moderate

Overview: The nurse in this case is caring for a client who has recently

learned that he is positive for

the human immunodeficiency virus (HIV). Laboratory testing

to monitor the progression of HIV is

reviewed. The ethical and legal concerns regarding the client's decision not

to disclose his HIV status

to his wife or others are discussed.

11

! Part 1 » THE CARDIOVASCULAR SYSTEM & THE BLOOD

Mr.Thomas is a 42-year-old man admitted to the hospital with complaints of short-

ness of breath, fever, latigue, and oral thrush. The health care provider reviews

the laboratory and diagnostic tests with Mr. Thomas and informs him that he has

pneumonia and is HIV positive. Mr. Thomas believes that he contracted HIV while

involved in an affair with another woman three years ago. He is afraid to tell his

wife, knowing she will be angry and that she may leave him.

Client Profile

The nurse assigned to care for Mr. Thomas rcads in the medical record (chart) that

he learned two days ago that he is HIV positive. There is a note in the record that

indicates hat Mr. Thomas has not told his wife the diagnosis.

To complete a lunctional health pattern assessment, the nurse asks Mr. Thomas

if he may ask him a few questions. Mr. Thomas is willing and in the course of their

conversation shares with the nurse that he believes that hec contracted the HIV dur-

Case Study

ing an affair with another woman. He states, "How can I tell my wife about this?

I am so ashamed. It is bad enough that I had an affair, but to have to tell her in

this way-Ijust don't think I can. She is not sick at all. I will just say I have pineu-

monia and take the medication my hcalth care provider gave me.I do not want my

wife or anyone else to know. If she begins to show signs of not feeling well, then

I will tell her. I just can't tell anyone. What will people think of me if they know I

have AIDS?"

Questions

1. Briefly discuss how HIV is transmitted and how

it is not. How can Mr. Thomas prevent the transmis-

sion of HIV to his wife and others?

9. Briefly explain the purpose of viral load blood

tests in monitoring the progression of HIV.

10. Mr. Thomas expresses a readiness to learm more

about HIV. Discuss the nurse's iniual intervention 2. Mr. Thomas stated, "What will people think of

me if they know I have AIDS?" How can the nurse

explain the difference between being HIV positive and having AIDS?

when beginning client teaching, and then discuss

the progression of the HIV disease, including an

explanation of primary infection, categories (groups) A, B, and C, and four main types of opportunistie infections.

11. Following the nurse's teaching, Mr. Thomas states, "How stupid I was to have that affair. Not only could it ruin my marriage, but it gave me a death sentence." Share with Mr. Thomas what you know

about long-term survivors, long-term nonprogressors, and

Highly Active Antiretroviral Theratpy (HAART).

3. Discuss the ethical dilemmas inherent in this case.

4. Does the health care provider have a legal obli-

gation to tell anyone other than Mr. Thomas that he

is HIV positive? If so, discuss.

5. Any loss, such as the loss of one's health, results in a gricf response. Describe the stages of grief

according to Kubler-Ross.

6. Discuss which stage of grief Mr. Thomas is

most likely experiencing. Provide examples of

Mr. Thomas's behavior that support your decision.

7. Wlhat are the laboratory tests used to confirm the diagnosis of HIV infection in an adult?

8. Discus the function of CD4 T cells and provide an example of how the CD4* T-cell count guides the

management of HIV.

12. Discuss how the nurse should respondif Mr. Thomas's wife approaches him in the hall and

asks, "Did the test results come back yet? Do you

know what is wrong with my husband?"

13. List five possible nursing diagnoses aPpropriate to consider for Mr. Thomas.