Acquired Immune Deficiency Syndrome (AIDS)
(Care Plans)
AIDS
(Case Studies)
HIV / AIDS Pathochart
(Cheat Sheet)
Outline
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?
Complete Blood Count – with CD4 due to HIV history
Liver Function Tests due to Hepatitis C history
Chemistry Panel to evaluate for renal involvement or electrolyte abnormalities
Blood and/or sputum cultures to determine source of infection
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:
HR100
RR20
BP108/67
SpO290%
Temp101.6°F
Critical Thinking Check
Bloom's Taxonomy: Analysis
What respiratory disease has Mr. Hernandez contracted?
Isolate the patient. In this case, he is in a Free Clinic, so they may not have negative airflow rooms. In this case, close the door and prevent staff from entering without respirator masks. When the patient leaves the clinic, he must be wearing a surgical mask.
He will need to be transported safely to the hospital to place him in proper isolation
The Complete Blood Count with Differential shows the following abnormal values:
RBC3.9
H/H8.1/24.3
WBC7,000
Plt104,000
CD4<10 / mm3
Critical Thinking Check
Bloom's Taxonomy: Analysis
What is going on physiologically with Mr. Hernandez? How do you know?
He has developed AIDS. He is having recurrent infections (pneumonia), and now he has contracted Tuberculosis
Combine that with his extremely low CD4 cell count and that confirms that he has officially progressed to full blown AIDS
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:
HR110
RR22
BP88/47
SpO292% on 4 lpm nasal cannula
Temp101.8°F
Critical Thinking Check
Bloom's Taxonomy: Analysis
What condition is Mr. Hernandez developing because of his infection?
He may require vasopressors – meaning he also needs a central line placed
After 2 weeks of treatment and severe sepsis, Mr. Hernandez elects to stop all treatments. He decides to enter an inpatient hospice program to manage his pain and keep him comfortable. He passes away peacefully 5 days later.
Critical Thinking Check
Bloom's Taxonomy: Analysis
Could anything have been done differently for Mr. Hernandez?
As always, it’s hard to know for sure. It’s possible that he wasn’t taking his medications properly, or that his dosages could have been increased sooner
Given the fact that he is being seen at a free clinic, there’s a chance that he didn’t have one specific doctor following his case – otherwise they would have noticed recurrent pneumonia and could have made medication adjustments earlier
Unfortunately, there’s no cure for AIDS and it is a progressive disorder.
This nursing case study course is designed to help nursing students build critical thinking. Each case study was written by experienced nurses with first hand knowledge of the “real-world” disease process. To help you increase your nursing clinical judgement (critical thinking), each unfolding nursing case study includes answers laid out by Blooms Taxonomy to help you see that you are progressing to clinical analysis.We encourage you to read the case study and really through the “critical thinking checks” as this is where the real learning occurs. If you get tripped up by a specific question, no worries, just dig into an associated lesson on the topic and reinforce your understanding. In the end, that is what nursing case studies are all about – growing in your clinical judgement.
Miriam Wahrman, MSN/Ed, RNC-MNN 
Chance Reaves, MSN-Ed, RN 