AIDS patients

  1. Hi Fellow Nurses

    I have received my first AIDS patient in Hospice. He is very young.

    I wondered if you could give me some pointers apart from the obvious issues with standard precautions etc.

    I am eager to learn all I can from this experience to be better prepared if there is a next time.

    I thank you all ahead of time for your good imformative assistance.
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  2. 14 Comments

  3. by   donsterRN
    Sabby, God bless you for what you do. I think you are wonderful, and a true inspiration for working with the population you do, and for wanting to learn more.
  4. by   Sabby_NC
    Quote from Don3218
    Sabby, God bless you for what you do. I think you are wonderful, and a true inspiration for working with the population you do, and for wanting to learn more.

    Oh Don thank you so much for your sweet reply. You brought tears to my eyes. Oh if only I could tell you of my day but I am afraid it would take a few pages. I think we are all blessed to do what we do.
    I needed those kind words. :icon_hug:
  5. by   donsterRN
    Quote from Sabby_NC
    Oh Don thank you so much for your sweet reply. You brought tears to my eyes. Oh if only I could tell you of my day but I am afraid it would take a few pages. I think we are all blessed to do what we do.
    I needed those kind words. :icon_hug:
    Now YOU stop; I'm tearing up!

    Every once in a while, I remember people who were taken from us so long ago, way back before this even had a name. And I remember how alone and scared they were; how terrified we all were. I've said goodbye to way too many friends and acquaintances who struggled to get one word of compassion, one note of acceptance. I wish you had known them; they would have adored you, as I do!

    :kiss
  6. by   leslie :-D
    care of the aids pt is complex as it is unpredictable.
    you can count on close monitoring of acute physical and neurological changes.
    may receive complicated pharmaceutical therapies, which require close monitoring and adjustments.
    also likelihood of adv respiratory interventions
    adv wound care techniques.
    this is one population where every system can be involved and grossly failing simultaneously.

    don't try and understand it all.
    just observe s/s per system- neuro, dermal, resp, cv, etc
    and manage their total pain. (physical, psychosocial, mental/emotional, spiritual)
    can be challenging, heartbreaking.
    need team effort and support.

    i've cared for many in this population.
    but i need to get to bed.
    and everyone presents differently.

    there very well may be a chance when pt can no longer be effectively monitored at home.
    be alerted to this.
    and a gentle, gentle hug to this young man.

    leslie
  7. by   Sabby_NC
    Quote from Don3218
    Now YOU stop; I'm tearing up!

    Every once in a while, I remember people who were taken from us so long ago, way back before this even had a name. And I remember how alone and scared they were; how terrified we all were. I've said goodbye to way too many friends and acquaintances who struggled to get one word of compassion, one note of acceptance. I wish you had known them; they would have adored you, as I do!

    :kiss

    Ok that did it to me... Thank you.
  8. by   Sabby_NC
    Quote from earle58
    care of the aids pt is complex as it is unpredictable.
    you can count on close monitoring of acute physical and neurological changes.
    may receive complicated pharmaceutical therapies, which require close monitoring and adjustments.
    also likelihood of adv respiratory interventions
    adv wound care techniques.
    this is one population where every system can be involved and grossly failing simultaneously.

    don't try and understand it all.
    just observe s/s per system- neuro, dermal, resp, cv, etc
    and manage their total pain. (physical, psychosocial, mental/emotional, spiritual)
    can be challenging, heartbreaking.
    need team effort and support.

    i've cared for many in this population.
    but i need to get to bed.
    and everyone presents differently.

    there very well may be a chance when pt can no longer be effectively monitored at home.
    be alerted to this.
    and a gentle, gentle hug to this young man.

    leslie

    Thank you Leslie I appreciate your input and YES he is very complex with many major issues. I totally agree with the team effort. I can only do my best in observering any changes and act on them forthwith.
    I may need to call on your knowledge from time to time.
  9. by   leslie :-D
    Quote from Sabby_NC
    Thank you Leslie I appreciate your input and YES he is very complex with many major issues. I totally agree with the team effort. I can only do my best in observering any changes and act on them forthwith.
    I may need to call on your knowledge from time to time.
    anytime, sabby.
    these are always my hardest cases.

    i'll be watching out for your posts.

    leslie
  10. by   leslie :-D
    i can tell you sabby, the top 3 complaints are fatigue/weakness, anorexia/gi disturbances and pain.
    despite the various fungal and viral infections they get, it's the wt loss w/accompanying weakness that do many in.
    it's easier to treat the visceral pain than the neuropathic.
    even though the md will likely prescribe an anticonvulsant and a tricyclic for the neuropathy, latest studies show that opioids ARE the drug of choice, except at higher doses.
    and even then, when you've treated the visceral and neuropathy, then up pops the stomatitis, with fungus an inch thick lining the esophagus.
    it's never ending.
    when you ask about pain, do not overlook anything.
    do the most thorough pain assessment you've ever done.

    i have learned re: pain, that this population WILL talk about the malingering depression, isolation and hopelessness...if they don't have the aids dementia.
    ritalin is often prescribed.

    sorry, i'm babbling here.
    aids is all over the place.
    and i must warn you, it generally is not a peaceful death.
    they just learn to live, and die, with the pain...whatever form it takes.
    i'll try and be more organized in any further posts.

    leslie
  11. by   ElvishDNP
    Thank you so much for that post, Leslie.

    You reminded me of a friend of mine who died of AIDS while I was in highschool...he became my friend when my mom worked in hospice. And another young fellow who was nearing the end when I took care of him for several shifts in a row as a brand new nurse. No family, no partner, and very few staff that cared enough to spend time with him. And almost everything you described, these two men had.

    They were gentle spirits, and I think about them both still. Thanks.
  12. by   Sabby_NC
    Hi Leslie

    Popping in for an update.

    I think each time I go to see him he just looks at me thinking 'is this the day she won't touch me'. I always sit and hold his hand to chat before I do my assessment of him.

    I have him on a fentanyl pump with 5 min boluses. It is better for me now as I have larger volume bags FINALLY hahaha. This is doing a great job for his pain control.

    Yup fungus in the esophagus is an issue presently.

    On the anticonvulsants but the prob is getting the meds down!

    Getting IVI meds for his nausea and anxiety. His family are awesome as they are my 'nurses' giving him his meds and doing his CVC flushes.

    He has a great support base.

    He has some goals that he wants to achieve before he dies only prob is he has no energy. Can barely stand let alone anything else.
  13. by   leslie :-D
    meds become a major problem.
    when they get to the point where they can't swallow, then often, more decisions are made re dc'ing more meds or trying iv.
    even though i'm sure he's quite emaciated (or getting there), i would heartily recommend trying ritalin or another stimulant.
    it works wonders for the energy in completing goals.
    it's all a balancing act.
    these meds cause so many se's, you need to prioritize what is relevant in the here and now.

    i'm so pleased to hear he has a lot of loving support.
    that's half the battle right there.
    thanks for the update, sabby.
    you sound like you're in your element.

    leslie
  14. by   Sabby_NC
    Thanks for your input Leslie,

    Meds are few now.. IVI Phenergan and Ativan... Pain infusion...
    I shall ask about getting the Ritalin for him as anything that can help with the lack of energy would benefit his goals at this stage.

    I have talked about benefit versus burden in his care.
    He will not take much in the way of oral meds due to severe fungal infection mouth, back of throat and no doubt down the esophagus. It really is so nasty and sore for him.

    I had some good one on one with him today. I just asked the family to give me some private patient/ nurse time.

    I think 'Jack' was very appreciative of this as well.

    I have a gut feeling he is going to go down in health rather quickly. He looks worse each time I see him and the weight is just sliding off.

    He is talking more openly about death with me now and that has been beneficial. He does not fear death just does not want death to cheat him out of his goals but I don't know.

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