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7 E Spac… Heading Heading 2 Title Paragraph EX Styles K.D. is a 36-year-old high class professional man who has been human immunodeficiency virus (HIV) infected for years. He had been on antiretroviral therapy (ART) with Combivir (zidovudine and lamivudine) and nelfinavir (Viracept). He self-discontinued his medications 6months ago because of depression. The appearance of purplish spots on his neck and arms persuaded him to make an appointment with his physician. When he arrived at the physician’s office, the nurse performed a brief assessment. His vital signs (VS) were 138/86, 100, 30, 100.8° F (38.2° C). K.D. stated that he had been feeling fatigued for several months and was experiencing occasional night sweats, but he also had been working long hours, skipped meals, and had been particularly stressed over a project at work. The remainder of K.D.’s physical examination was within normal limits. The doctor ordered a chest x-ray, CBC, lymphocyte studies, including CD4 T-cell count, ultra-sensitive viral load, cytomegalovirus assay, and a tuberculin test. Over the next week, K.D. developed a nonproductive cough and increasing shortness of breath (SOB). Last night, he developed a fever of 102° F and was acutely short of breath, so his roommate. J.F., brought him to the emergency department. He was admitted with probable Pneumocystis jiroveci pneumonia (PJP), which was confirmed with bronchoalveolar lavage examination under light microscopy. K.D.’s admission WBC and lymphocyte studies demonstrate an increased pattern of immunodeficiency compared with earlier studies. K.D. is admitted to your medical unit and placed on nasal oxygen. IV fluids, and IV trimethoprim-sulfamethoxazole (Bactrim). o RE a Chp 1. What is PJP? 2. What is the significance of the purplish spots over K.D.’s neck and arms? 3. Differentiate between HIV-positive status and AIDS 4. Why is K.D’s development of KS and PJP of particular importance in light of his HIV status? 5.K.D. has been seropositive for several years, yet he has been asymptomatic for AIDS. What factors might have influenced K.D.’s development of PJP and KS? 6. Identify four problems you must manage regarding K.D. 7. What precautions will you need to use when caring for K.D.? 1 8. What is the focus of your ongoing assessment? 9. What major side effects of his antibiotic should you monitor K.D. for? # 10. What aspects of K.D.’s care can you delegate to the LPN? (Select all that apply.) a. Administering first dose of IV trimethoprim-sulfamethoxazole (Bactrim) b. Monitoring K.D.’s pulse oximeter readings, reporting values under 95% c. Developing a plan of care to improve K. D.’s oxygenation status d. Providing instructions about a high-calorie, high-protein diet I e. Reinforcing teaching with K.D. regarding good handwashing techniques f. Repositioning K.D. and having him deep breathe every 2 hours le ili 1 Normal 1 No Spac… Heading 1 Heading 2 Title Paragraph CASE STUDY PROGRESS Styles K.D. is responding well to treatment for PJP, and plans are being made for discharge. His ART regimen will be restarted, and he will be starting radiation treatments for Kaposi’s sarcoma. He will receive follow-up care at the outpatient clinic. 11. K.D. is kept on trimethoprim/sulfamethoxazole (Bactrim) two tablets once daily. He asks why he has to keep taking the drug “since the pneumonia is gone.” How would you respond? 1 12.K.D. was taught about disease transmission and safer sex and encouraged to maintain moderate exercise, rest, and dietary habits when he was first diagnosed as HIV positive. Give at least four additional topics that should be discussed with K.D. before he goes home x x x A A 三三三三, 1 Normal 1 No Spac. Heading 1 Heading 2 Title Font Paragraph 15 Styles 13. What laboratory data will most likely be monitored in K.D. in the future? 14. List at least five other opportunistic infections that KD is at risk for developing
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