New nursing student and AIDS patient

herecomestrouble · Oct 17, 2007

I'll start by saying I am an HIV+ nurse,we don't use the term "full blown AIDS" anymore.Now repeat after me"HIV is found in blood,semen,lady partsl fluid and breast milk"Nothing else.Find out your pt's CD4(Tcell)count.If it's between 500-1500 he's WNL,below 500 and especially below 200 you will need to be careful that you don't expose him to anything you may have.You should also check into opportunistic infections(OI's).These are things that we are all exposed to on a daily basis but with a low CD4 count they can quickly overrun an already taxed immune system.These include but are not limited to pneumocystis carinii pneumonia(PCP),cryptosporidiosis(sometimes found in tap water)histoplasmosis,toxoplasmosis,cytomeglia virus(CMV)which can cause blindness if not treated promptly.

Most of the drugs used for HIV can cause many different side effects including the ever present diarrhea,nausea and vomiting,lethargy,vivid dreams and many other fun things.You will need to be very careful about giving the meds,some need to be given on an empty stomach and others with food,double check the time on the meds too.If something needs to be given q 12 or q8 it's really important to give it then.Taking meds at the wrong time over just a short time can cause resistance to that med.Once a pt becomes resistant to a med they're viral load can quickly increase and they will not be able to use that drug again,with some drugs it may wipe out a whole class of meds that they cant use.HIV drugs come in different classes-NRTI,NNRTI,PI and FI-a pt should never be on drugs from just one class,it's important to take meds from more than one class.

You can find more info at www.nlm.nih.gov/medlineplus/aidslivingwithaids.html

caroladybelle, BSN, RN · Oct 17, 2007

Hi. I am a fairly new nursing student in my 2nd semester and in the first part of Med Surg. Tonight, at the beginning of clincials, I was assigned a patient with full blown AIDS and Bacteremia. Is this typical for a fairly new RN student?? Another student got someone with active TB in isolation. She has to gear all up before she goes in. Is this typical?? This seems a little extreme to me for only being in my second semester. And since I am pretty new and dealing with an AIDS patient, what advice do you have to protect myself?? Your thoughts and advice are greatly appreciated. Epona :uhoh21:

Why would it be a problem?

Caring for an AIDs patient is no different than caring for any other sick patient. You look up the appropriate interventions and handle accordingly.

And as far as the pt with active TB - if the family can gear up to see them, nursing care associates of all types can do the same.

Many nurses get those patients in first semester.

There is this "stigma" attached to AIDs that is not present with other diseases of like nature and they are seen to be as somehow more "unstable" and riskier, when they really are not. We need to not perpetuate it. It also ignores the risks that are out there in the general public....often riskier than the hospital.

caroladybelle, BSN, RN · Oct 17, 2007

You have much more to fear from hep-C and MRSA than you do from AIDS, honey. AIDS is uncurable, but MRSA and hep-C will kill you a lot faster.

Not to mention much more transmittable.

time4meRN · Oct 17, 2007

Ummm, did you learn about a little thing called universal precautions ? Look at it this way, you have the advantage of knowing the DX. Are you saying you would take lesser precautions with other pt's ? Because if so you need to read about precautions once again. If you take care of a little old lady, would you then feel free to be less active using precautions. Hope not because the little old lady enjoys " swing" clubs at the home and has full blown AIDS. Even though she's dressing in a pretty pink pj's. It's the ones you don't know about that you have to worry about. How a'bout the homeless guy you care for with a cough in the ER. Come to find out he has TB. Don't think it doesn't happen. I hate to sound like a mean old nurse but, do your job like you were taught .You are going to be the RN, start learning now !

SuesquatchRN, BSN, RN · Oct 17, 2007

What scared me the most when I started Nursing wasn't who actually had full blown HIV, but rather it was who you didn't know that had full blown HIV.
Hope that makes sense. If not, it will in the future.
My Best.

Universal precautions.

Thanks to those who care for people with AIDS. I remember when it was called GRID, for gay related immune deficiency, and was nicknamed "gay plague" among the gay community. I lost a dozen friends to it.

I just watched an old "Designing Women" episode in which a young man asks the gals to help him plan his funeral, back when a diagnosis of HIV infection WAS an automatic and swift death sentence.

Daytonite, BSN, RN · Oct 17, 2007

Hmmm. You might want to reconsider whether this a career you can tolerate. When I was hiring people I was always on the lookout for people with a positive attitude, flexibility, the ability to adapt to any situation because things change in the hospital at a minutes notice and initiative. We take our patients as we find them. I've seen a fair number of nurses sitting around in the report room complaining about the patients, the patient assignments and the other nurses they had to work with. I'm wondering if they started out by complaining about their first patient assignments.

Elvish, BSN, DNP, RN, NP · Oct 17, 2007

I remember when I got my first HIV+ patient as a first-semester nursing student; he wasn't @ the hospital for anything r/t the HIV but it still terrified me. I'm not really sure why; I'd already befriended people with end-stage AIDS and knew how you could & couldn't get it. Maybe it was the fact that I really didn't know my head from my butt as a first-semester nsg student & was afraid of sticking myself?? It's been a long time, and I'm not sure why. Still, I was scared to death & wanted to put on all kinds of protective stuff.

My instructor, a very experienced FNP, allowed as how SHE too had been terrified the first time she had an HIV+ patient, but like other posters have said, univeral precautions are really all you need.

I have taken care of and developed relationships with numerous HIV+ folks since then. And I have to say, the disease they have is the least interesting part of them. HIV is a pretty hard disease to catch; you almost have to be trying.

I worry more about: HepC, Creutzfeld-Jakob disease, and the bird flu.

You will do fine, and you do indeed have an appropriate assignment.

leslie :-D · Oct 17, 2007

HIV is a pretty hard disease to catch; you almost have to be trying.

very true.

as someone else stated, my concern is what they can/will catch from me.

esp those with very low cd4 cts.

even if i am only colonized (vs infected), this population is soooo susceptible to bugs we take for granted every day.

personally, i find the disease fascinating, challenging and so very humbling.

it has been my experience, they are highly sensitized to those who embrace or reject them.

so when i gown up, they know i'm doing so, to protect them, and not vice-versa.

they will either accept my neurotic practice, or tell me to knock it off.

leslie

czyja, MSN, RN · Oct 17, 2007

I worry more about: HepC, Creutzfeld-Jakob disease, and the bird flu.

.

Indeed. Although I think one has to come into contact with nervous tissue to get CJD. Is this not so?

Although I am one of those pre-nursing groupies on this site may I observe the following? The OP expressed that she was frightened. She did not say why. Many respondents took this to mean that she was frightened about getting HIV. She many in fact be frightened that she is not yet competent to give quality care to a pt with complex needs. Either way it strikes me that she is acting in a healthy way by expressing her fears.

Some posters responded to the OP's fears in a demeaning and sarcastic way (not you Arwen_U, but others). This tells us more about the them than the OP. Have they never been afraid in their work?

I volunteer in a free clinic and I am petrified at times of MDR TB. It is in the population we see so there is a very small but very real risk. Recognizing my fear enables me to work through it.

For me, the internal dialogue goes like this "Uh oh, homeless person with a cough. Yikes! MDR-TB!!! Now wait a minute....that's your fear talking...a perfectly natural and protective fear... but hey, I don't need to listen to it, the pt has a mask on on like everybody else that walks through our door with a cough, no biggie...I'll get the blood drawn done now"

caroladybelle, BSN, RN · Oct 18, 2007

The problem with that theory is, that there is no indicator in the OP's post that she is worried about the pt being "too complicated regarding meds/tests/etc"...the patient has bacteremia, a very common admission diagnosis as is TB. The treatment of TB and of bacteremia in and of themselves are relatively simple, more so than many other diseases/disorders that her patients might have. It is made fairly clear that she is worried spread of disease as she discusses the TB gear used.

As such many posters are going to understandably interpret it as "fear of full blown AIDs" which is an attitude that is not very compatible with working as a nurse.

Compound this with the fact that most nursing schools require microbiology, and often a bloodbourne disease orientation. This is done, so that we know the basics of common diseases and their spread. These classes are done so that you are prepared at the outset of nursing school to handle these very common illnesses.

She also talks about "protecting herself"...there really isn't a need to "protect" herself in any manner other than for any patient. She isn't likely to contract bacteremia nor AIDs, unless she forgoes universal precautions, or neglects her handwashing.

I to this day have nurse techs (students from the local school) that will not handle a urinal of an HIV+ patient with out getting the old fashioned chemo gloves - you know the triple strength "playtex dishwashing" style. Or who are pregnant and want to be reassigned, even if the pt is fully cognitive, continent and in the hospital for something completely unrelated. And I have a feeling many of the other posters here have also dealt with the same issues. Thus, perhaps, the sarcasm.

bagladyrn, RN · Oct 18, 2007

For the younger nurses and students who may not understand the defensive attitude of some of the posters, and for a very good overview of the history of the development of the AIDS epidemic, I'd suggest seeing if your video store has a copy of the program "And the Band Played On". It was originally an HBO special, and is rather dated in some aspects, but it really brings home how people reacted and the discrimination in the "early days".

I insisted that my son and all the teens who hung out at my house watch and discuss this when they were growing up.

czyja, MSN, RN · Oct 18, 2007

many posters are going to understandably interpret it as "fear of full blown AIDs" which is an attitude that is not very compatible with working as a nurse.

On further reflection I think you are correct. Sorry to have been on my high horse in my post.

Last I checked "full blown AIDs" was not a diagnosis. It is striking that a student in a nursing program in 2007 would be concerned about contracting HIV from patient care. The data are mighty clear, patient to provider transmission is a rare event indeed when universal precautions are followed. And even if a possible exposure happens then post exposure prophylaxis is available.

No job is without its risks known and unknown. Some jobs are riskier than others. If one cannot handle risk then one should seek lower risk employment. If you dont want to get shot at then dont join the army.

The "heroic" days of nursing come to mind - I am thinking of the pre-antibiotic and vaccination era of infectious disease. Nurses cared for people with TB because it was the right and decent thing to do. Many of them caught the disease and wound up in sanatoria then died alongside their former patients. Ditto for Typhoid, polio and everything else. Even in the modern era SARS, Ebola, and Marburgh have taken the lives of hcp's. These women and men are saints by reckoning - they gave all that they could, including their own life for goodness sake. The OP may wish to reflect on their sacrifice for a while.

If the OP is afraid of contracting HIV one wonders why s/he did not think of this prior to nursing school. :uhoh3: Good grief. Was micro not required at her nursing school?