NURSING DIAGNOSIS: Knowledge deficit, Ineffective management of therapeutic regimen, or Altered health maintenance*

*The nurse should select the diagnostic label that is most appropriate for the client's discharge teaching needs.

Desired Outcome
The client will identify ways to prevent the spread of HIV.
Nursing Actions and Selected Purposes/Rationales
  1. Instruct client in ways to prevent spread of HIV to others:
    1. if a spill of blood or other body fluids occurs, cleanse area with hot, soapy water or a household detergent and then disinfect with a solution of 1 part bleach to 10 parts water
    2. dispose of water used to clean up body fluid spills in the toilet
    3. do not share eating utensils, toothbrushes, razors, enema equipment, or sexual devices
    4. if sexually active with a partner:
      1. avoid multiple sexual partners and partners with risky sexual behaviors
      2. be honest with desired partner about HIV infection
      3. modify techniques so that both partners are protected from contact with body fluids
      4. avoid unsafe sexual practices (e.g. sharing sex toys; allowing ejaculate to come in contact with broken skin or mucous membranes; intercourse without a condom; any activity that could cause tears in lining of vagina, rectum, or penis; mouth contact with penis, vagina, or anal area)
      5. avoid vaginal intercourse during menstruation (the contact with blood increases the risk of HIV transmission)
      6. use the following guidelines in relation to condom use:
        1. always use a condom during anal, vaginal, and oral penetration (condom should be applied prior to time a body orifice is entered because HIV is found in preseminal fluid)
        2. use latex condoms (HIV can penetrate other types of materials)
        3. use condoms with a receptacle tip to reduce the risk of spillage of semen; if that type is unavailable, create a receptacle for ejaculate by pinching tip of condom as it is rolled on erect penis
        4. lubricate outside of condom and area to be penetrated to minimize possibility of condom breakage
        5. avoid lubricants made of mineral oil or petroleum distillates such as Vaseline or baby oil (these products weaken latex)
        6. hold condom at base of penis during withdrawal and use caution during removal of condom to prevent spillage of semen (penis should be withdrawn and condom removed before the penis has totally relaxed)
        7. dispose of condom immediately after use (a new one should be used for subsequent sexual activity)
        8. store condoms in a cool place to prevent them from drying out and breaking during use
        9. do not use a condom if the expiration date on the package has passed, the package looks worn or punctured, or if the condom looks brittle or discolored or is sticky
      7. consult health care provider if exposed to or experiencing symptoms of a sexually transmitted disease (STDs increase the shedding of HIV); tell partner to also seek treatment of STD because of the decrease in mucosal resistance to HIV
    5. avoid getting pregnant but if pregnancy occurs, consult health care provider about antiretroviral therapy (e.g. zidovudine) to reduce the risk of perinatal transmission of HIV to infant
    6. do not breast feed infant
    7. do not donate blood, sperm, or body organs
    8. if an intravenous drug user:
      1. get involved in a needle and syringe exchange program
      2. do not share drug injecting equipment with others
      3. discard disposable needles and syringes after one use or clean them with household bleach and rinse thoroughly with water.
Desired Outcome
The client will identify ways to decrease the risk for developing opportunistic infections.
Nursing Actions and Selected Purposes/Rationales
  1. Instruct client in ways to decrease risk for developing an opportunistic infection:
    1. cleanse kitchen and bathroom surfaces regularly with a disinfectant to prevent growth of pathogens
    2. use a 1:10 solution of household bleach and water for cleaning and/or disinfecting areas soiled with blood or other body fluids
    3. wear gloves when gardening and when in contact with human or pet excreta (e.g. cleaning litter boxes, bird cages, and aquariums)
    4. avoid exposure to body fluids during sexual activity and use latex condoms during sexual intercourse
    5. avoid oral-anal sex
    6. avoid touching mucous membranes while handling raw meat, seafood, or poultry and wash hands and kitchen surfaces with hot, soapy water after contact with these foods
    7. prior to eating fruits and vegetables, wash them well
    8. do not eat raw or undercooked poultry, meat, or seafood; anything containing raw eggs or unpasteurized milk; or anything that has passed its expiration date
    9. consult health care provider about receiving immunizations (e.g. pneumococcal vaccine, influenza vaccine, hepatitis A and B vaccines)
    10. avoid swimming in lakes, rivers, and public pools
    11. if traveling to a developing country, consult health care provider about recommended immunizations and health care practices (e.g. drinking only bottled water; avoiding raw fruits and vegetables, unpasteurized dairy products, and undercooked eggs, fish, and meat)
    12. if a community "boil water" advisory is issued, boil water for a full minute
    13. do not share eating utensils, towels, washcloths, toothbrushes, razors, enema equipment, or sexual devices
    14. keep living quarters well ventilated and change furnace filters regularly to reduce exposure to airborne disease
    15. avoid contact with persons who have an infection and those who have been recently vaccinated
    16. maintain an adequate balance between activity and rest
    17. inform all health care providers of HIV infection so that drugs that further suppress the immune system (e.g. corticosteroids, immunosuppressants) will not be prescribed unnecessarily
    18. maintain an optimal nutritional status
    19. drink at least 10 glasses of liquid/day unless contraindicated.
Desired Outcome
The client will verbalize ways to maintain an optimal nutritional status.
Nursing Actions and Selected Purposes/Rationales
  1. Provide instructions regarding ways to maintain an optimal nutritional status:
    1. eat foods that are high in protein and calories
    2. try to eat a snack or a small meal or drink a nutritional supplement every 2-3 hours
    3. take prescribed vitamins, appetite stimulants (e.g. megestrol acetate), and anabolic agents (e.g. oxandrolone)
    4. participate in a progressive exercise program if possible.
Desired Outcome
The client will state signs and symptoms to report to the health care provider.
Nursing Actions and Selected Purposes/Rationales
  1. Stress importance of notifying the health care provider if the following signs and symptoms occur or if these existing signs and symptoms worsen:
    1. persistent fever or chills
    2. night sweats
    3. persistent headache or different type of headache
    4. swollen glands
    5. skin lesions or significant rash
    6. reddish-purple patches or nodules on any body area
    7. ulcerations or white patches in the mouth
    8. difficulty swallowing
    9. persistent diarrhea
    10. perianal or vulvovaginal itching and/or pain
    11. frequency, urgency, or burning on urination
    12. cloudy or foul-smelling urine
    13. dry cough or a cough productive of purulent, green, or rust-colored sputum
    14. progressive shortness of breath
    15. increasing weakness, fatigue, or weight loss
    16. change in vision
    17. decline in mental function or level of consciousness
    18. loss of strength and coordination in extremity(ies)
    19. numbness, tingling, or pain in extremity(ies)
    20. inability to maintain an adequate fluid intake.
Desired Outcome
The client will identify resources that can assist with financial needs and adjustment to changes resulting from the diagnosis of AIDS.
Nursing Actions and Selected Purposes/Rationales
  1. Provide information to client and significant others about state and federally funded financial program and resources that can assist in adjustment to the diagnosis of AIDS (e.g. American Foundation for AIDS Research, National Association of People with AIDS, hospice programs, community support groups, CDC National AIDS Hotline, Project Inform, counselors).
  2. Initiate a referral if indicated.
Desired Outcome
The client will verbalize an understanding of and a plan for adhering to recommended follow-up care including regular laboratory studies, future appointments with health care providers, and medications prescribed.
Nursing Actions and Selected Purposes/Rationales
  1. Reinforce the importance of keeping scheduled follow-up appointments for laboratory studies and with health care providers.
  2. Explain the rationale for, side effects of, and importance of taking medications prescribed (e.g. antiretroviral agents, antimicrobial agents, hematopoietic agents, anabolic agents, appetite stimulants). Inform client of pertinent food and drug interactions.
  3. Reinforce the importance of strictly adhering to the antiretroviral regimen prescribed (usually consists of a combination of at least 3 antiretroviral agents). Explain that not adhering to the prescribed regimen will limit the effectiveness of subsequent regimens.
  4. Explain the importance of taking the full dose of any antimicrobial agents prescribed. Reinforce the possibility that life-long treatment with antimicrobials (e.g. TMP-SMX) may be necessary to prevent some opportunistic infections if the CD4+ cell count is critically low.
  5. Implement measures to improve client compliance:
    1. include significant others in teaching sessions if possible
    2. encourage questions and allow time for reinforcement and clarification of information provided
    3. provide written instructions regarding scheduled appointments with health care providers and laboratory, medications prescribed, signs and symptoms to report, and ways to prevent infection.