AIDS patient ?

pulling out an iv, goes beyond your basic restlessness.

to me, it indicates he was highly uncomfortable, as well as probably agitated.

my first question to him, would be why he pulled it out.

then i'd make sure he was medicated properly.

before i inserted another line, i'd make sure he understood why he was receiving iv meds, and make a verbal contract, to not pull it again.

but first and foremost, i would make certain all of his needs were being met.

it doesn't sound like they were.

leslie

I agree with earle58, in this scenario, they want to see that you are NOT as concerned with the AIDS dx as you are with pt assessment. Address the reason behind the pt pulling the IV out and that is most likely what they are looking for.

Stop the bleeding.

in this scenario, they want to see that you are NOT as concerned with the AIDS dx as you are with pt assessment.

i have a sinking feeling that many are concerned with the AIDS dx.

leslie

Leslie, I agree. I am continually amazed at how poorly educated many nurses and other health care workers are in regards to HIV and Hepatitis C.

in nsg school, i was the only student who volunteered to care for AIDS pts.

it was a segregated hallway on the unit.

our ci asked us if we would like to take on one of 'these' pts, but never delegated it, as she did with all others.

i had 3 of 'these' pts.

one pt had iv acyclovir running, in a huge glass bottle.

it smashed to the floor as he attempted ambulation to the br.

i was the only one who came running.

i assessed him, pulled his iv (since he was bleeding and it was partially out), cleaned him up and sat him on the toilet.

it was only when i had started to cleaning up the glass on the floor, my instructor stood in the doorway, trying to hand me 2 extra prs of gloves.

i will never, ever forget that day...

the dejection on my pt's face, as well as the gratitude for someone...anyone coming to help him.

even the lack of response to this thread, is disheartening.

dang it.

people, education and universal precautions...

it just doesn't get any simpler than that.

leslie

I could use a little help. I need a presentable answer for the following scenario:

An AIDS patient is restless due to muscle soreness. Upon entering the patient's room the nurse notes he has pulled out his peripheral IV and is bleeding. How should the nurse respond?

Short of using standard precautions and biohazard containment for anything soiled with blood, I'm not to sure what to say.

Thanks in advance for any input.

Mike... soon to be RN... pinning on cinqo de mayo.

stop the bleeding and assess the pt! find out why he pulled it..theres a ton of possible reasons! he may be in severe pain, it may be infiltrating, he may be hypoxic and disoriented, or he may have just rolled over on it and accidentally pulled it. the fact that the pt has AIDS doesnt really matter.....

Lesile, I blame your school. 1st asking for "volunteers" and referring to them as "these patients." AND even more important failing to educate students on the virility of the HIV virus is irresponsible.

As a nurse these students will not have the option of volunteering to care for "one of these." Our local schools where I work do not allow students to work in isolation rooms. That is understandable up to a point in terms of the school's risk management.

It too I believe is not particularly a good way to educate students as they are expected to know how to care for pts in iso. It is a hands on skill and knowing the theory without the practice is a disservice to the newly graduated nurse who will be expected to regularly care for iso pts.

Not only should the virility of HIV (or better the lack of virility) be discussed thoroughly in school but it should be pointed out these pts are not even in isolation. If they are it is for another reason.

It should also be emphasized that you are more of a risk to the AIDS patient than they are to you. THEIR immunity is compromized. Some how this is not emphasized in school.

Consequently the myth surrounding HIV/AIDS gets perpetuated. Yet, interestingly the pt in isolation for TB, MRSA, VRE, Versaella etc. tend to have their contageousness treated rather casually, by comparison.

If you are in school to learn to be a nurse where you will eventually come in contact with bugs then you should be learning in practice not just theory how to deal with it in school. You take a certain risk by going to nursing school. You are required by the schools to have certain immunizations before starting clinical. You are no more at risk as a student than as a professional. We allow visitors to these patients and they are far less educated about the risks etc than the nursing student.

Thanks to all of you for your input. I wish I had come across this forum a year and a half ago when I started the program. It is definitely on my favorites list now. The wealth of information available here is so helpful.

I will be able to put together a very intelligible, well thought out answer to this question for our presentation next week. You guys are awesome and I can't thank you enough.

Mike:bow:

Lesile, I blame your school. 1st asking for "volunteers" and referring to them as "these patients." AND even more important failing to educate students on the virility of the HIV virus is irresponsible.

This is very irresponsible. i don't think the education is failing it the fact that some people are teaching one thing in the classroom and another in the clinical setting. These kind of patients shouldn't be treated differently than you would a patient with the flu.

Mike, reassess your patient's alertness and orientation, vital signs, check the IV site, what meds (or lack of) is he on that could've made him become restless. Does he have another condition that could've caused this reaction?.

Please let us know how you did :)

Good luck

There's also this to consider:

http://www.ninds.nih.gov/disorders/aids/detail_aids.htm

I should have been more clear. This is just a case-study. Here are the details: HIV + 3 months ago. Admitted to unit for fever, chills, sweats, myalgias, malaise, chest pain, dry nonproductive cough, axillary adenopathy, N/V/D. VSs 108/84, 104,30,103.5. After aggressive dx workup, dx'd with AIDS complicated by PCP, cryptosporidiosis, oral thrush, and CMV.

My part of the presentation is 2 questions related to the above info.

1. why dx'd with AIDS and not complicated HIV infection?

2. IV pulled out and bleeding.... how do you respond?

The 1st question was easy for me to answer. The CDC has a list of criteria for diagnosing AIDS in a pt.

The 2nd question was a little more difficult since it requires more critical thinking skills to answer. This is something I have struggled with through the entire program and will probably always have some degree of difficulty with. It is not the easiest thing in the world to retrain your brain inn your late 30's. I will get it though.

Thanks again,

Mike