Coping with AIDS: Impact and Care

1. Chapter 34Clients Coping withAcquired ImmunodeficiencySyndrome (AIDS)

2. Although the central feature of HIV infection involves collapse of the body’s ability to mount an appropriate cell-mediated immune response with attendant medical complications, neuropsychiatric phenomena can also be prominent. —Sadock & Sadock, 2008

3. Learning Objectives After studying this chapter, you should be able to • Explain the etiology of acquired immunodeficiency syndrome (AIDS) • Identify those groups of individuals at risk for AIDS • Describe the psychosocial impact of AIDS • Discuss the effects of AIDS on family dynamics

4. Learning Objectives (cont.) • Recognize the clinical phenomena of each of the three phases of AIDS • Formulate a plan of care for a client exhibiting clinical symptoms of the middle stage of AIDS • Articulate the purpose of including interactive therapies in the plan of care for a client with AIDS • Outline the types of community services available to provide continuum of care for clients with AIDS

5. Epidemiology

6. Etiology of AIDS • Groups at risk for AIDS • African Americans and Hispanics • Homosexual/bisexual men • Individuals with multiple sexual partners • Adolescents who do not practice safe sex • Heterosexual IV drug users • Homosexual/bisexual men using IV drugs • Heterosexuals who have had sex with one of the above groups • Persons with hemophilia and those who have received blood transfusions • Infants born to mothers with AIDS • Persons who are occupationally exposed (nurses, etc.) • AIDS in adolescents • AIDS in older adults

7. Psychosocial Impact of AIDS • HIV infection and psychiatric disorders • The worried well • Grief reaction to HIV/AIDS • First stage: shock, numbness, disbelief • Second stage: denial • Third stage: guilt, anger, homophobia • Fourth stage: resolution, acceptance

8. Effects of AIDS on Family Dynamics • Diagnosis of AIDS challenges the fragile balance of roles in the family. • Adults who were independent now become dependent. • Parents have change in newly retired lifestyles. • Families assume financial responsibility. • Families may become estranged from the member with AIDS.

9. The Nursing Process • Assessment • Nursing diagnoses • Outcome identification • Planning interventions • Implementation • Evaluation

10. Assessment • Phases of assessment – Early phase – Middle phase – Late phase • Transcultural considerations – Cultural beliefs and myths – Ethnic issues of homophobia and stigmatization • Assessment for immune recovery syndrome • Assessment as a secondary prevention

11. Ineffective health maintenance Disturbed thought processes Anticipatory grieving Death anxiety Hopelessness Impaired social interaction Ineffective coping Deficient knowledge Situational low self-esteem Spiritual distress Nursing Diagnoses

12. Outcome Identification Outcomes should focus on the following: • Address psychosocial issues such as living with a chronic illness and dying • Empower the client to maintain a sense of control over his or her life during the progression of the disease • Educate the client about HIV disease, infection control, available treatments, and medications • Monitor health status and manage symptoms • Promote adequate nutrition and other health-maintenance goals • Provide palliative care

13. Planning Interventions Planning includes the following: • Using a holistic, multidisciplinary approach • Augmenting available treatment and management options • Improving palliative outcomes and enhancing overall well-being

14. Implementation • Early-phase planning and implementation • Middle-phase planning and implementation • Assistance with meeting basic needs • Medication management • Assistance with emotional needs • Late-phase planning and implementation • Client and family education • Community support groups • Continuum of care

15. Evaluation During evaluation • Make needed adjustments due to the progression of the disease process and development or existence of comorbid mental illness • Evaluate the continuum of care to determine if all possible support systems are in place

16. Acquired immunodeficiency syndrome (AIDS) Homophobia Human immunodeficiency virus (HIV) Neuropsychiatric syndromes Stigmatization Key Terms

17. According to the chapter-opening quote by Sadock & Sadock, clients with HIV infection may develop neuropsychiatric phenomena. Prepare an educational tool to inform HIV-infected clients and their families or significant others about the neuropsychiatric syndromes and psychiatric disorders associated with AIDS. What approach would you use? Would you provide the clients and other attendees an opportunity to interact with you and others during the discussion? ? Reflection