Case study 5: Janet Janet is a registered nurse who is just completing a double shift totaling 16 hours. She volunteered for overtime work because of a bad snowstorm that prevented many of her colleagues from getting to work. Janet must give one more injection for pain before she goes off duty. Tired and in a hurry, Janet hastily pulls on a pair of latex gloves without noticing that one of the gloves has a small tear. She administers the injection and, before she can dispose of the needle and syringe, the glove rips. Startled, Janet’s hand trembles and she accidentally sticks herself with the used needle. Treatment of HIV infection There is currently no cure for HIV infection, nor is there a preventative vaccine. Treatment is based on a medication regimen called ART , or antiretroviral therapy. ART does not cure HIV infection but does help infected people to live longer and healthier lives and reduces the risk of HIV transmission. Standard ART includes a combination of antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease. Transmission of HIV is also suppressed by ART. HIV rates of death and infections have significantly decreased when ARV regimens are used, especially if taken in the early stages of the disease (Avert, 2020b). Regardless of CD4+ counts, the WHO recommends ART for all HIV-positive people (WHO, n.d.). HIV attacks and destroys the immune system’s infection- fighting cells (CD4+ cells). Destruction of such cells makes it difficult to combat/resist infections and certain cancers that are related to HIV infection. ART works by preventing HIV from multiplying and reduces the amount of HIV in the body. After effective ART is started, it usually takes three to six months for a person’s viral load to reach an undetectable level. Undetectable levels do not mean the patient is cured. However, such levels do indicate that ART is working effectively (Avert, 2020b). ART is beneficial for individuals with HIV, regardless of the disease stage, including those with AIDS. However, initiating treatment as early as possible after infection leads to more significant advantages and better outcomes. In patients who have not started ART, the clinical latency stage usually lasts around 10 years, but it can advance more quickly in some individuals. So, it is crucial to emphasize the importance of early detection and regular screening. When taken consistently and correctly, ART helps to do the following (Avert, 2020b). ● Reduce viral load. ● Improve immune system functioning by increasing CD4+ count. ● Reduce risk of opportunistic infections and other illnesses ● Reduce, but not eliminate, HIV transmission to others. ● Reduce, but not eliminate, the chances that a female will transmit the virus to her baby if pregnant or planning on becoming pregnant. Healthcare Consideration : HIV can change and develop variations that become resistant to current HIV medications. Failing to follow the prescribed ART regimen increases the likelihood of this resistance occurring. Resistant strains of the virus can continue to multiply despite treatment, which raises the chances of treatment not being successful.
Self-Assessment Quiz Question #5 In the given case study, what action should Janet have taken to prevent a needle stick injury during the injection process? a. Double-checking the condition of the gloves before administering the injection. b. Rushing through the injection due to being tired and in a hurry. c. Disposing of the needle and syringe immediately after administering the injection. d. Ignoring the tear in the glove and proceeding with the injection. The U.S. Department of Health and Human Services’ (HHS) treatment guidelines recommend that a person living with HIV begin ART as soon as possible after diagnosis. A delay in treatment allows continued damage to the immune system and increases the risk for acquiring opportunistic infections (CDC, 2020b). Some patients may be hesitant to start treatment after an HIV diagnosis and need time to process the diagnosis. The decision to begin treatment involves appropriate education and counseling from professionals. Persons infected with HIV may also need extensive counseling and emotional support. Common side effects of ART include (HIV.gov & NIH.gov, 2020b): ● Nausea and vomiting ● Diarrhea ● Difficulty sleeping ● Dry mouth ● Headache ● Rash ● Dizziness ● Fatigue ● Pain The extent and type of side effects can differ for each person, depending on the type of ART medicine administered. Some side effects are transient and only last a few days or a few weeks. However, side effects may last longer. If side effects are severe, patients should call their healthcare providers. There are medications to help reduce or eliminate side effects, or the type of ART may be changed (HIV.gov & NIH.gov, 2020b). Patient adherence to their ART regimen as prescribed is of utmost importance. Several factors, such as the cost of medications and potential side effects, can impact adherence. Additionally, the risk of adverse drug interactions with other HIV medications, prescription drugs, or over- the-counter medications is a strong possibility. Herbal preparations can also potentially interact negatively with ART drugs. Patients must be cautioned against adding any medications or supplements without first obtaining approval from their healthcare providers. It is crucial for providers to advise patients about potential side effects. Patients should also be educated about what actions to take in case these side effects or drug interactions occur. Financial assistance could be needed since therapies may cost thousands of dollars a month. A discussion with social services may be helpful. Providers should play a proactive role in referring patients to financial assistance resources when necessary.
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Book Code: MMD0724
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