MED SURGE RUA PROJECT powerpoint 2022

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Chamberlain College of Nursing *

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Nov 24, 2024

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RUA-ADULT HEALTH CASE STUDY Group 3: Brooke Taylor, Christina Pasechnik, Iliana Ruiz, & Mikayla Leek

Health History Age: 24 years old Gender: Male Ethnicity: Hispanic/ P Past/ Current Medical History: Unknown Chief Complaint: Severe/ Debilitating Headaches - Diagnosis of Meningitis - Prognosis of Sexually Transmitted Disease - Syphilis - Chlamydia - HIV No Hx of Present Illness upon Admission

Laboratory/ Diagnostic Testing - Viral Load Test: ● Measures the amount of HIV copies in a sample of blood ● Goal: Decrease viral load. Why? B/c the greater the viral load the likely of becoming ill and transmitting HIV - CD4 Cell Count: ● CD4 cells are infection-fighting cells of the immune system. ● The progression of HIV results in a decrease of CD4 ● Healthy Range: 500 to 1,200 cells/ mm3 - Complete Blood Count: ● Measures RBCs, WBCs, & Platelets ● Risk of opportunistic infection r/t a suppressive immune system - Liver enzymes (AST & ALT) ● antiretroviral medications - Antigen/ Antibodies Test: ● Antibodies are produced by the immune system, when exposed to viruses, and antigens (foregein bodies) of HIV are called p24, which are produced before antibodies.

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Other Important Lab Tests - Drug Resistance Tests: ● HIV can change form, making it resistant to some HIV medicines. - Fasting Glucose Test: ● Some HIV medications can affect blood sugar levels, potentially leading to complications like diabetes. - STD screening: ● Screening for current or past infections of viral hepatitis - Hepatitis A, B, & C tests ● Checks for syphilis, gonorrhea and chlamydia.

INTERPROFESSIONAL COLLABORATION RESOURCE/SOCIAL WORKER: This interpersonal collaboration is imperative for the success of the patient. It is important that the social worker and other healthcare staff work together to help the patient get healthy while also maintaining that health lifestyle outside of the hospital. They can help with financial, food and house assistance as well as many other things. INTERPRETER: A Interpreter may be needed if the patient speaks a different language. It is important to make sure to understand and get an accurate assessment on your patient. INFECTIOUS DISEASE: These personnel are used to help manage HIV. Those who have HIV are more susceptible to get opportunistic infections, ranging from viral to bacterial diseases. The Infectious disease team helps monitor signs and symptoms as well as monitor the patient for any infection. RESPIRATORY THERAPIST: They can help manage a patients oxygen level, in the hospital or at home. This is more likely used in the later stages of HIV progression. DIETITIAN/NUTRITIONAL SERVICES : Nutrition is a vital part in any healing. Due to the destruction of the cells with HIV/AIDS patients malnutrition is very common in these patients. It is important that the patient is maintaining a healthy diet while increasing

MEDICATIONS MEDICATION/DOSE: BIKTARVY (Bictegravir 50 mg/emtricitabine 200mg/tenofovir alafenamide 25 mg ) DOSING: 1 tablet taken once daily with or without food INDICATION: Antiretroviral (HIV), BIKTARVY is indicated as a complete regimen for the treatment of HIV-1 infection in adult and pediatric patients weighing ≥25 kg who have no antiretroviral (ARV) treatment history (Gilead Sciences, 2021) NURSING IMPLICATION: Caution with patients who take Antiarrhythmics,anticonvulsants, herbal products, Antacids and Metformin, assess creatinine, urine protein and glucose due to renal impairment, take dose same time regularly to decrease resistance ADVERSE REACTIONS: Nausea, Diarrhea, fatigue, Headache, abnormal dreams, insomnia OUTCOME/POTENTIAL OUTCOME: Decrease in To learn more about Biktarvy: https://www.biktarvyhcp.co m/

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MEDICATIONS MEDICATION/DOSE: Doxycycline (tetracycline antibiotic) DOSING: 100mg PO BID INDICATION: Treat underlying infection and prevent the spread of growth, in the case of the patient it is for Syphilis and chlamydia NURSING IMPLICATION: Monitor signs for hypersensitivity reactions or anaphylaxis, notify doctor immediately if this occurs, administered one hour before or two hours after a meal, don't give within one hour of laying down (make sure culture/sensitivity have been done prior to administration) ADVERSE REACTIONS: Loss of appetite, Fever, flu-like symptoms (diarrhea,stomach ache), muscle aches, weakness, fatigue OUTCOME/POTENTIAL OUTCOME : Infection has resolved

MEDICATIONS MEDICATION/DOSE: Ondansetron/Zofran (antiemetic) DOSING: 4 mg /2 mL IV Push INDICATION: Nausea/vomiting NURSING IMPLICATION: Monitor for dizziness or drowsiness that affects gait, administer slowly at rate 2-5 minutes, assess for extrapyramidal symptoms, make to take proper steps to administer the IV Push medication ADVERSE REACTIONS: Headache, nausea, vomiting, diarrhea, dry mouth OUTCOME/POTENTIAL OUTCOME : Patient gets relief from medication by suppressing nausea and vomiting

TREATMENTS AND PROCEDURES ➔ Vital signs every 8 hours ➔ Ambulation is encouraged (sun exposure) ◆ Patient did not want to ambulate ➔ Regular diet ◆ BMI indicated underweight for age/height ● Nutrition deficit ➔ Antibiotic regimen for Acute HIV infection, Chlamydia and Syphilis ➔ Teaching on proper sex practices (condoms, limiting sexual partners, regular testing (blood work, STI testing) , proper medication regimen in relation to HIV and preventing onward transmission of HIV ➔ Mental health assessment

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Physiological Plan of Care Nursing Diagnosis: Acute pain related to tissue inflammation as evidenced by reports of pain, abdominal cramping, and guarding behavior. ● Short term goal: Patient will verbalize relief of pain and will verbalize feelings which will reduce anxiety and perception of intensity of pain. ● Long term goal: Patient will continue with prescribed medication which will provide relief of pain, inflammation, abdominal cramping, and discomfort. ● Teaching considerations: - Educate patient on following prescriptions carefully to prevent of overdose and risk of addiction. - Educate patient about knowing when to take their prescribed pain medication in order to avoid a stronger dose of pain medication and control pain and discomfort. - Advice patient to avoid any further exposure to others who are immunocompromised and to those that have been recently vaccinated.

Nursing Interventions ● Promote skin integrity. - Rationale: Patients are encouraged to avoid scratching, use non abrasive soaps, apply non perfumed moisturizers, perform oral care, and make sure to clean perineal area after each bowel movement with non abrasive soap and water. ● Promote usual bowel patterns. - Rationale: Monitor for frequency and consistency of stools and the patient’s reports of abdominal pain or cramping which can prevent future abdominal pain or cramping to avoid constipation. ● Improve activity intolerance. - Rationale: Assist the patient in planning daily routines that maintains a balance between activity and rest. ● Relieve pain and discomfort. - Rationale: Use of soft cushions and foam pads may increase comfort as well as administration of NSAIDS and opioids . ● Prevent infection. - Rationale: The patient and the caregivers should monitor for signs of infection and laboratory test results that indicate infection.

Evaluative Statements Based On Interventions ● Patient understands and follows to keep up with hygiene which also includes using soap and water rather than fragranced products. It is important to wash perineal area with soap and water after each bowel movement since stool may contain enzymes that causes skin breakdown. ● Monitoring bowel movements such as the frequency and consistency will help understand if the patient has an opioid induced constipation since opioids causes constipation by decreasing bowel peristalsis. ● Patient will have an improved activity intolerance. ● Patient will verbalize a decrease in pain and increased comfort. ● There will be no signs of infection and a continuation of any possible infections will be monitored.

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PSYCHOSOCIAL PLAN OF CARE Nursing Diagnosis: Knowledge deficit related to transmission of sexual infections as evidence by multiple STIs, lack of knowledge of symptoms of STIs, and multiple questions about the spread of STIs upon assessment. ●Short-Term Goal: Patient will verbalize that he is aware that he must abstain from sexual contact whenever an STI is present and remain abstinent until the infection has cleared in order to prevent the spread of the STI. ●Long-Term Goal: Patient will be free of all treatable STIs and will be able to verbalize prevention measures going forward. ●Teaching Considerations: ○Ensure that the patient understands how STIs are spread and what measures can be taken to prevent the spread of potential STIs. ○Ensure that the patient understands the symptoms of STIs. ○Ensure that the patient understands to always abstain from sex if there is a concern for and STI with any of the people involved. ○Ensure that the patient understand where they can get access to free STI testing and free condoms.

NURSING INTERVENTIONS ● Administer treatment medications as prescribed by the healthcare provider. ○ Rationale: This will help the patient start to feel better as well as minimize the risk of spread of STIs by the patient once discharged from the hospital. ● Educate the patient on symptoms of an STI. ○ Rationale: This will not only help the patient know when he must abstain from sexual contact with other but can also help him be able to identify when others he comes in contact with may have an STI and he should abstain from sex with that individual until they are tested and treated. ● Educate the patient on transmission of an STI. ○ Rationale: When educated the patient will be aware of the many routes (ex: vaginal, anal, oral) of transmission of STIs and knows to abstain from ALL sexual contact when infected or when a potential partner is infected. ● Help the patient compile a list of past sexual partners so they can be informed that they need to be tested and where to access free STI testing. ○ Rationale: This will prevent the further spread of infections by anybody this patient came in contact with that may also be infected. ● Provide the patient with resources for regular STI testing free of charge and access to free condoms. ○ Rationale: This will provide the patient means to safer sex in the future

EVALUATIVE STATEMENTS BASED ON INTERVENTIONS ● Patient is free of all treatable STIs. ● Using a teach back method, the patient will be able to verbalize symptoms of different STIs and what to look for on himself and potential partners. ● Using a teach back method, the patient will be able to verbalize how STIs are transmitted and prevention measures that should be taken. ● A list of past sexual partners is compiled by the patient and all people are contacted and informed of potential exposure to STIs. Resources for testing centers are also provided to all partners. ● Patient will be able to verbalize where he can access routine testing for STIs and access to condoms as well as when to utilize each resource.

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REFERENCES: ● Gilead Sciences. (2021). Components of BIKTARVY®: Official HCP Site . Components of BIKTARVY® | Official HCP Site. Retrieved August 9, 2022, from https://www.biktarvyhcp.com/about-biktarvy/components? utm_medium=cpc&utm_campaign=USA_GO_SEM_B_BM_Biktarvy-HCP-Generic %2BComponents-Standard&utm_content=Generic%2BComponents&utm_te ● HIV.gov. “Lab Tests and Results.” CDC , 7 June 2022, https://www.hiv.gov/hiv- basics/staying-in-hiv-care/provider-visits-and-lab-test/lab-tests-and-results#:~:text=The %20CD4%20count%20of%20an,most%20advanced%20stage%20of%20HIV. ● Puckey, M. (2022). Doxycycline: Uses, dosage, side effects, warnings . Drugs.com. Retrieved August 9, 2022, from https://www.drugs.com/doxycycline.html ● Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2021). Davis's drug guide for nurses (17th ed.). F.A. Davis.

MED SURGE RUA PROJECT powerpoint 2022

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