Acquired Immunodeficiency Syndrome

(AIDS)

A Case Presentation

Presented to

The Faculty of the College of Nursing

PHINMA University of Pangasinan

Dagupan City

In Partial Fulfillment

Of the Requirements for the

Fundamentals of Nursing Practice & Health Assessment

by

Block 01 - Group 1

2023
1. Introduction

Scientists believe that HIV (Human Immunodeficiency Virus) originally came

from a virus particular to chimpanzees in West Africa during the 1930s and was initially
transmitted to humans through the transfer of blood through hunting. Over the decades,
the virus spread through Africa and to other parts of the world. However, it was not until
the early 1980s, when rare types of pneumonia, cancer, and other illnesses were reported
to doctors, that the world became aware of HIV and AIDS (Acquired Immunodeficiency
Syndrome). This timeline highlights some of the significant events and discoveries in
HIV and AIDS since this time. Globally, an estimated 8–10 million persons are HIV
positive. According to the World Health Organization, AIDS is the leading killer in
Africa and the fourth leading cause of death globally. Since the beginning of the
epidemic, it is believed that there are 33 million individuals living with HIV, and 14
million people have died from AIDS.

The human immunodeficiency virus (HIV) is an infection that targets the body's immune
system, particularly the CD4 cells, which are white blood cells. As a result of HIV's
destruction of these CD4 cells, a person's resistance to infectious diseases like
tuberculosis and fungal infections, severe bacterial infections, and several malignancies is
weakened. HIV is transmitted through contact with certain bodily fluids of an
HIV-positive person, most frequently during unprotected intercourse (sex performed
without using a condom or an HIV medication to prevent or treat HIV) or through
sharing of injection equipment. AIDS (acquired immunodeficiency syndrome) can
develop from HIV without treatment.

According to recent reports, extraordinarily high rates of rare kinds of cancer and
pneumonia are diagnosed in Young homosexual men in the USA. It is believed that
exclusively gay males are afflicted by the illness hence the former name of Gay-Related
Immune Deficiency (GRID). By the end of the year, cases are also documented among
injection drug users. In March, Canada announced its first AIDS case. It is understood
that HIV can transfer the infection through sexual activity. It has been discovered that the
heterosexual sex can transmit the AIDS virus to females, through blood transfusion and
from mother to child through breastfeeding.

WHO advises getting tested for HIV for everyone who may be at risk. People more likely
to contract HIV should look for comprehensive and efficient services for HIV prevention,
testing, and treatment. HIV infection can be identified with quick, low-cost diagnostic
tests and self-tests. The 5Cs, which stand for consent, confidentiality, counseling,
accurate results, and connection to treatment and other services, must all be observed by
HIV testing services. A person with advanced HIV disease (AHD) has a CD4 level of
 less than 200. The amount of virus in the blood is measured by HIV viral load. This test
is used to track viral replication and the effectiveness of ART. (Milstein, 2015).

According to the World Health Organization's global health sector HIV plan 2022-2030,
HIV infections will be reduced from 1.5 million in 2020 to 335 000 by 2030, and
mortality will be reduced from 680 000 in 2020 to under 240 000 in 2030. HIV cannot be
eliminated by the human body, and there is no effective HIV cure. If you have HIV, you
will be infected for the rest of your life. People with HIV who observe HIV treatment
instructions and achieve and maintain an undetectable viral load can live long and healthy
lives and will not transmit HIV to HIV-negative partners through sex.

2. Disease Process

> Description

Acquired Immune Deficiency Syndrome (AIDS) is the “full-blown” syndrome,

also called “frank” AIDS. AIDS is technically the final, terminal (progressing to death)
state of HIV infection. The last and most deadly stage of HIV infection is AIDS. HIV has
significantly debilitated the immune system, rendering it incapable of protecting the body
from opportunistic diseases. A diagnosis of AIDS is given to an individual with HIV if
their CD4 count is fewer than 200 cells/mm3 or if they contract specific opportunistic
illnesses.

AIDS is a progressive illness where a person who has the virus initially displays no
obvious symptoms. Immune system cells start waging a war against the virus, which are
constantly proliferating, despite the fact that the individual can transfer the virus to
others. The immune system weakens over time, typically ten years or more. Many
symptoms that might endure for a very long time and are either significant or not may
manifest. The disease eventually develops into AIDS. This stage is marked by several
potentially fatal illnesses, like pneumonia, as well as frequently by nervous diseases,
malignancies, and extreme weight loss.

AIDS is spread through bodily fluids that include free virions and CD4+ T cells that are
infected. Blood, seminal fluid, vaginal secretions, amniotic fluid, and breast milk are
some examples of these fluids. The likelihood that HIV exposure would result in
infection is raised by inflammation and tears in the skin or mucosa. The likelihood that an
infection may occur is correlated with the quantity of HIV and infected cells in the bodily
fluid. AIDS can be passed from mother to child during pregnancy, during delivery, or
during nursing, but most perinatal infections are likely to develop after exposure after
birth. AIDS cannot be spread by simple contact
Young adults who are often preoccupied with forming close relationships, making
personal goals, pursuing careers, and having and caring for children are many
AIDS-infected children. Their focus changes as they come across a condition that
endangers their lifespan and for which there is no cure. However, people could feel
obligated to tell their family, friends, coworkers, and medical professionals about their
secret lives or activities. As a result, those who have HIV could experience
overwhelming feelings of fear, remorse, and shame. Also, they may face a number of
obstacles to their financial security, such as those affecting their ability to carry out their
daily responsibilities and functions and sell their physical functions.

When AIDS occurs, the patient's immune system has already sustained severe damage.
The patient may be more prone to sickness than someone with a strong immune system.
They include opportunistic tumors or infections. Some of the signs and symptoms of
some of these infections include sweating, chills, recurrent fever, chronic diarrhea,
swollen lymph nodes, persistent white spots or unusual lesions on the tongue or in the
patient's mouth, persistent, unexplained fatigue, weakness, weight loss, and skin rashes or
bumps.

Diseases Common to AIDS

Pneumonia caused by pneumocystis (PCP). caused by the fungus Peumocystis carini,

also known as parash, which is widely identified worldwide. Pri to AIDS was discovered
in kidney transplant recipients whose immune systems had been chemically suppressed

Sarcoma of Kaposi (KS). cancerous skin cancer. AIDS patients typically have pink,
purple, or brown lesions that first appear on their arms and/or legs before spreading
throughout their bodies

Toxoplasmosis. caused by toxoplasmosis, which infects blood and a large number of

domesticated and wild animals. Humans are susceptible to infection from cat waste and
undercooked meat, particularly mutton in AIDS patients

Candidiasis. In AIDS patients, a fungus known as the Candle species, which is common
to human skin, mouth, and gastrointestinal tract, typically manifests as white spots or
patches on the sheral sides of the tongue or inside the mouth on the mucous membrane of
the cheeks. It is also known to lodge under nail beds and on the skin around the armpits,
groin, and rectum.
> Anatomical Presentation

HIV infection spreads in phases and worsens without therapy. Acquired

immunodeficiency syndrome (AIDS) is the result of HIV's slow destruction of the
immune system. Primary Infection is the period between HIV infection and the
development of anti-HIV antibodies.

There are three stages of HIV infection:

1. Acute HIV Infection

Primary Infection is the period between HIV infection and the

development of anti-HIV antibodies. During this period, HIV spreads widely and
undergoes potent viral replication, leading to high levels of HIV in the blood and
an abrupt drop in CD4 T cell numbers. Symptoms such as fever, swollen lymph
nodes, rash, muscle aches, and headaches may occur. The viral set point is the
equilibrium between the body's immune system and the amount of HIV present,
with the rate of viral clearance equal to the amount of virus circulating and the
number of infected cells.

2. Chronic HIV Infection

The number of CD4 T cells gradually decreases over time. The symptoms
that HIV-infected patients experience during this stage is known as chronic HIV
infection, and are not among the AIDS-related symptoms. The illness is brought
on by HIV infection, a flaw in cellular immunity, or it must be assumed that it will
progress clinically. Chronic HIV infection would be used to describe a person's
 condition if they had previously received treatment for it and were now
symptom-free but had not yet developed AIDS.

3. AIDS (Acquired Immune Deficiency Syndrome)

When CD4 T-cells levels drop below 200 cells/mm³ of blood, patients are
said to have AIDS. A patient who has had AIDS will continue to have it. This
classification affects entitlements because AIDS diagnoses are frequently
associated with these programs. The revised classifications still allow for CD4+
percentages even though they emphasize CD4+ T-cell counts. The absolute CD4+
T-cell count is more susceptible to variation than the CD4+ percentage is. Less
than 14% of the total lymphocytes that are CD4+ T-cells are in line with an AIDS
diagnosis. The late stage of HIV infection is at this point.

> Physiological Affectation

Physiological Affection
Macrophages are likewise infected by HIV, although they are not killed by it. Thus, the
macrophage acts as a Trojan horse, concealing the intruder and transporting it to safe areas like
the bone marrow, which is where T-cell and B-cell production occurs, and the brain, where
HIV-infected macrophages are thought to impair brain cell function.

VISUAL
A component of the eye called the retina may potentially become infected with HIV.

DIGESTIVE SYSTEM
Cells from the rectum and colon appear to be infected by HIV as well (at least in a laboratory
setting). Large intestine in essence, the colon is. The anus is directly surrounded by the rectum,
the lowest portion of the large intestine. Due to its capacity to infect colon and rectal cells, HIV
may contribute to the explanation of why anal sex is more successful at transmitting HIV than
other forms of sexual contact.

CARDIOVASCULAR SYSTEM
HIV also raises the risk of developing lung cancer. This results from weakening lungs brought on
by multiple respiratory problems linked to a compromised immune [Link] cancer is more
common in those with HIV than in those without it, according to the available researchTrusted
[Link] blood pressure is more likely to occur in people with HIV. Pulmonary arterial
hypertension (PAH) is also made more likely by HIV. A kind of high blood pressure known as
PAH affects the arteries that carry blood to the lungs. Over time, PAH will put stress on the heart,
which may result in heart [Link] is more prone to tuberculosis (TB) if they have HIV and a
low CD4 level.

IMMUNE SYSTEM
The immune system shields the body against infections and disorders that come its way. White
blood cells protect the body from viruses, bacteria, and other pathogens that might cause illness.
HIV symptoms can be ignored in the early stages if they are moderate enough. A person with
HIV may develop a flu-like illness that lasts a few weeks after being introduced to the virus a
few days later. This is connected to the acute infection stage, also known as acute HIV, which is
the first stage of the HIV infection.

CNS (Central Nervous System)

Although HIV seldom affects nerve cells directly, it can affect the cells that surround and support
nerves in the brain and other parts of the body.
While the relationship between HIV infection and neurological damage is not fully known, it is
likely that HIV-infected support cells are a factor in nerve [Link] HIV infection
can result in neuropathy, or damage to the [Link] most typical effects of this are pain and
numbness in the hands and feet.

MENTAL HEALTH
Mood, anxiety, and cognitive impairments are more likely to manifest in HIV-positive people.
For instance, one of the most prevalent mental health issues that HIV-positive people experience
is depression. It's critical to keep in mind that mental illnesses can be treated. Mentally ill people
can get well.

> Nursing Analysis

AIDS is a disease that is the last and most lethal stage of HIV infection. The
immune system has been severely weakened by HIV, making it incapable of defending
the body against pathogenic illnesses. The immune system worsens or is insufficient
when a virus infects cells. After the virus has impaired our immune system, diseases of
various kinds, including rare ones that normally do not affect healthy people, can easily
persist.
A person with AIDS is diagnosed through CD4 count with less than 200 cells/mm3. They
may also have visible signs in the face, mouth, head, and neck and may have symptoms
of oral candidiasis, herpes zoster blisters, or oral hairy leukoplakia which are the most
common. In addition, they may also experience weight loss without significant reasons,
cough, fever, fatigue, sore throat, diarrhea, skin diseases and fungal infection. However,
during the first contact with the virus, signs and symptoms may be vague and sometimes
asymptomatic thus diagnosing HIV/AIDS with symptoms alone is difficult.

The transmission of the said disease is not by touching or being in a room with an
infected person, there is no need to avoid someone who has AIDS. Simple contact is not
enough to transmit AIDS. Only through the exchange of specific body fluids, which
contain HIV, can the disease be transferred. Through intimate intercourse, a person
infected with HIV which is a sexually transmitted infection (STI) that leads to AIDS, can
pass the virus to another person. While heterosexual intercourse predominates globally,
this includes both homosexual and heterosexual intercourse. The greatest risk of infection
is also present when exposed to blood or blood products. Furthermore, it is expected that
the majority of perinatal illnesses will manifest after exposure soon after birth. During
pregnancy, childbirth, or nursing, AIDS can be passed from mother to kid.

In conclusion, Aids, or Acquired Immunodeficiency Syndrome is a life-threatening disease

caused by HIV which is transmitted through body fluids but is limited to blood, pre-seminal
fluid, semen, rectal fluids, vaginal fluids, and breast milk. The virus attacks the immune
system resulting in increased susceptibility to various diseases and illnesses. Safety
precautions such as using condoms and sterile drug injections prevent the transmission of the
disease. It is also recommended to get tested for HIV daily, especially for those who are
sexually active

> Health Promotion & Disease Prevention Techniques

AlDS health promotion is the use of knowledge and education to change the
attitudes and behaviors of individuals and communities in order to prevent the spread of
the human immunodeficiency virus (HIV), which is the root cause of acquired
immunodeficiency syndrome.

All national AIDS prevention and control efforts ought to include it as a fundamental
component. In order to bring about long-lasting improvements in behaviors that are
essential to public health, health promotion employs a variety of communication channels
as well as health and social services. Although health promotion is the most important
factor in halting the spread of HIV, it requires the assistance of other program activities
and initiatives. It cannot make up for inadequate services and supplies or bad planning. It
cannot make up for a lack of comprehension of the epidemiology of AIDS and all
behaviors connected to it. It is unable to address all healthcare issues.

AIDS health promotion's objectives are:

➢ Make AIDS prevention a top priority for planners and decision-makers;

➢ Make AIDS prevention a top priority for individual health systems and
educational systems;
➢ To educate the public, especially those who are most at risk, about AIDS in their
native tongue and in manners that are appropriate for their culture;
➢ To encourage the behavioral adjustments required to stop the spread of HIV; to
encourage social acceptance of appropriate behavioral changes; encourage proper
use of health and education services, especially by those who are most at risk;
➢ To garner public support for the institutional and community actions required for
AIDS prevention and control;
➢ To encourage the training of staff members in AIDS prevention initiatives within
the health and educational sectors.

Strategies to lower your risk:

➢ When having any kind of sex, whether vaginal, anal, or oral, and use of latex
condoms (rubber) the right way every time you have sex.
➢ Encourage this person to adopt safer sexual practices at all times and alter their
sexual behavior and encourage the patient for counseling.
➢ Avoid using condoms made of leather or other animal products.
➢ Use lotion or other water-based lubricants.
➢ Don't ever share a needle when doing narcotics.
➢ Have other STIs tested for and treated. You run a larger chance of contracting
AIDS if you have several STIs.
➢ Avoid drinking or using drugs. People who are drunk may be less willing to
defend themselves.
➢ Following your treatment schedule is the greatest approach to take care of
yourself while living with AIDS.
➢ Watch out for taking your prescriptions on schedule and as directed.
➢ Attend all scheduled appointments so the medical staff can keep track of how
you're feeling and determine whether your therapy needs to be changed.
➢ Pay attention to your doctor's advice on how to stay healthy in the future.
In order to combat the spread of AIDS, health advocates have a unique duty to:

-Know their facts. Information is evolving, and new findings give rise to fresh rumors,
worries, and hopes. Health advocates need to stay up to date on new research and have a
thorough understanding of AIDS in order to explain the findings to the public in a
manner that they can accept.

- Teach the patient about the transmission of HIV and AIDS and what he or she may do
to protect themselves. People need to be urged to adopt new sexual habits and engage in
safe sex at all times.

➢ Be brave. In order to confront their own preconceptions about sexuality, locate

new resources, and collaborate with people they did not previously consider to be
essential, health advocates must move beyond their preconceptions. AIDS cannot
be eradicated by a single group.
➢ Be precise. No confusing language, half-truths, or technical jargon should be used
to mislead the general people. If people are to change their current behavior and
prevent AIDS infection, health promoters must speak to them honestly, openly,
and directly.
➢ Avoid blaming and stereotyping. Some have sought to place blame on others
since the AIDS pandemic's inception as if a segment of the human race was
purposefully spreading the disease. There are no racial, ethnic, or sexual
preferences for the AIDS virus.
➢ Focus your efforts on changing the way the target groups behave.
➢ General appeals and comprehensive teaching strategies can diminish fear and
debunk falsehoods, but they have little influence on behavior. It is insufficient to
inform the public so that 90% are aware that AIDS can be fatal when only 5% of
those at risk engage in safer sex.
➢ Take a broad approach. Even having a change-oriented mindset is insufficient.
There are many smokers around the globe who are aware of the harm smoking
causes to their health but nevertheless choose to smoke. A far larger approach is
necessary to change people's behaviors; health advocates must first identify the
causes behind people's behavior maintenance, then locate and propose alternatives
that are acceptable to the population.
➢ Knowing how AIDS spreads and taking precautions while participating in specific
activities are the greatest ways to lower your chance of contracting it. The most
typical methods for the spread of AIDS are sharing needles during drug use and
having sex without using a condom.
3. Nursing Assessment (Focused)

In assessing the patient’s respiratory system, gathering baseline data such as vital
signs will be the first step to assessing the patient. Doing so gives the nurse a basis for the
patient’s general health condition.

Note his breathing and discomfort through observation. Respirations should be regular at
a normal rate of 12 to 20 breaths per minute. Normally, inspiration is half as long as
expiration, and chest expansion is symmetrical. The nurse must also check the patient’s
facial expressions and physical gestures. If your patient appears anxious or exhibits nasal
flaring, cyanosis of the lips and mouth, intercostal retraction, or use of accessory muscles
of respiration, he may be in respiratory distress.

A comprehensive respiratory assessment includes inspection, palpation, percussion, and

auscultation as well as a thorough health history. Comparing results between the left and
right lung using a systematic approach will allow the patient to act as his own control.

I. INSPECTION

The nurse will inspect the respiratory system of the patient. Inspecting includes assessing
the breathing, facial expression, and skin color of the patient. For skin color, changes of
color from head to toe should also be checked by the nurse. Any breathing pattern by the
patient must be observed. Uncover his chest and inspect the shape and configuration.
Normally, the thorax is symmetrical and the anterior-posterior diameter is less than the
transverse diameter. (Equal diameters may signal chronic obstructive pulmonary disease
in an adult.) Note any structural deformity such as a pigeon chest (pectus carinatum) or
funnel chest (pectus excavatum).

II. PALPATION

Palpating the patient's suprasternal notch base of the trachea should be done slowly and
surely so that it cannot cause a negative result. The nurse can also use the palmar surface
of the finger to palpate the anterior and posterior of the adult patient. Through palpation,
the volume, symmetry, and rhythm of each breath is being asses.
 III. PERCUSSION

Percussing the chest wall by placing the middle finger on the non-dominant finger. The
tip of the dominant middle finger is used to strike the distance phalanx of the middle
finger between the cuticle and the first joint. Percussing will increase the clearance of the
airways by transferring secretions from one or more lung regions to the central airways.

IV. AUSCULTATION

Auscultate the patient’s chest walls, posteriorly and anteriorly by using the diaphragm of
the stethoscope in a ladder-like pattern. Instruct the patient to slowly breathe and deeply
open their mouth while doing it. Listen to each with a full breath. This is to assess the
patient’s airflow through the tracheobronchial tree; identify patterns of breath sounds,
noting their intensity, pitch, and duration; and the duration of the patient’s inspiratory and
expiratory phases

Overall, A focused respiratory objective assessment includes interpretation of vital signs;

inspection of the patient's breathing pattern, skin color, and respiratory status; palpation
to identify abnormalities; and auscultation of lung sounds using a stethoscope; These
type of assessment is needed to use in assessing the patient to distinguish what part of
the patient has a problem, particularly for the patient that’s experiencing a persistent and
unresolved difficulty of breathing as seen that the patient’s laboratory test result
conducted by a physician concluded that the patient has an AIDS.

As the immune system weakens due to AIDS, increasing disease susceptibility of organs
also increases especially with the lungs. Lungs are the most commonly involved organ in
HIV/AIDS-related diseases. Additionally, pulmonary infections are the main reason for
the increasing death rate from AIDS. Thus, assessing the respiratory system is a vital part
of the assessment.

4. Possible Nursing Interventions

Any action that helps treat a patient and strives to improve their health and comfort
qualifies as a nursing intervention. These interventions are necessary steps that nurses
carry out to implement a plan of care in enhancing, preserving, and improving patient
conditions. They could consist of treatments, procedures, or learning opportunities.

Independent interventions are the ones solely done by the nurse, these include routine
tasks such as monitoring vital signs as baseline measurements for noting any changes and
repositioning the patient, especially an AIDS patient with an ineffective breathing pattern
where implementing bed head elevation may increase the risk of sacral pressure.

Monitor the respiratory status of the patient through auscultation of lungs, administration
of additional oxygen as needed, and monitoring oxygen therapy. Elevation of the bed
head (semi fowler’s position), and guiding the bed rest of the patient to effectively
conserve energy and allotment for more demanding physiological needs (eating).

Fluid loss is facilitated by severe vomiting, diarrhea, fever, and sweating. Keep an eye
out for dehydration and electrolyte imbalance signs and symptoms. Control and strictly
monitor fluid intake and output, measure urine output, and assess level of consciousness.
Also, monitor skin turgor, observe dry skin, dry mucous membranes, examine presence of
cough, sputum and assess thirst.

Pay special attention to any pain signals presented nonverbally. Examine the oral cavity
for lesions and examine the capacity for chewing, tasting, and swallowing and investigate
the causes to further assist the patient. To boost appetite and lessen dental discomfort,
encourage and give routine oral care.

Encourage and inform patients and caregivers of the need to lower the risk of infection.
Maintain and provide a clean environment to ensure patient safety from possible
infections. A weakened immune system merits various opportunistic infections that an
AIDS patient is highly susceptible to. Promote maintaining clean nails, and proper hand
hygiene, educate patients about the risk of contamination, and avoid sharing syringes.

Encouraging the patient to correct lifestyle habits that could lead to a worsening of
symptoms or the spread of disease. Through education on nutrition and lifestyle, advising
the patient to avoid using illegal drugs, and teaching the patient healthy eating habits that
will improve immune system performance. Healthy eating habits will include monitoring
food safety and advising patients to avoid eating foods that may cause food-borne
illnesses such as raw products.

Education is the most essential aspect of HIV transmission prevention because anyone
can contract HIV/AIDS regardless of age, gender, race, or sexual orientation. In order to
lessen worry and increase interaction with the client, family members, and close
companions are provided with information on HIV transmission and the use of basic
precautions. Numerous people with HIV/AIDS use treatment techniques such as guided
imagery, distraction, progressive relaxation, and biofeedback to control their suffering.

Physical examinations and laboratory testing should both be examined for signs of
infection by the patient and the caregivers.
5. References (APA Format)

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Diagnoses, Prioritized Interventions, and Rationales (16th Edition ed.). [Link]

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Guide to planning health promotion for AIDS prevention and control. (n.d.). World

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[Link]

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&ccb=1-7&_nc_sid=0cab14&_nc_eui2=AeGp4jQUOU_FTqd1P-Kt16dLWfyP5qTg7hd

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[Link]

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[Link]

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6. Block Members

Agbuya, Christine Joyce P.

Agdeppa, Myka Ilonah F.

Aguilan, Fatima Grace O.

Agustin, Joseph B.

Agustin, KC Y.

Al-Rashidi, Mariam Ibrahim G.

Alaba, Reigna Melody R.

Alavazo, Jeuness M.

Alberva, Abigail Rose M,

Alcaide, Marly Ann T.

Alcaraz, Katrina Kyla C.

Aldana, Sharvanah Wrote S.

Alibat, Eunesse L.

Alipio, Jeanellen F.

Alonzo, Dencil Jane O.

Ancheta, Queen Aubrey P.

Andrade, Cheysser Lyne G.

Andrade, Reanne P.

Angeles, Janna Fe S.

Angud, Dixie Therese M.

Ayson, Jielyn Grace D.

Barreto, Beatrice Ishi C.

Bautista, Paula Eunice C.

Carbonell, Erika Mae L.