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.
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.
agnus, i agree about my school's irresponsibility.
this particular school was reputed to be the best.
as i found out, "the best" really meant elitist, prestigious and downright snobby.
the sister hospital only catered to the wealthy.
it still does.
sadly, whenever someone finds out where i graduated, they immediately recognize the school (which has since, shut down), followed by "you got a superior education".
:stone
no, evidentally i did not.
a superior education is not revolved around didactics.
it involves clinical experiences, including pts from all walks of life.
i could have have gotten a job right after graduation, at this sister hospital-
top, top wages (starting at $30/hr, 12 yrs ago)- superb benefits;
and it would have looked impressive on my resume.
i ran like the dickens.
my ci's obvious paranoia that day, combined w/the lack of response from staff:
the fact that i didn't even get chewed out for pulling the iv, redressing the area....interventions that would have normally required the approval of my ci-
nothing i did w/this pt, was ever questioned.
just a couple of extra pr of gloves.
i think i was nearly as crushed that day, as my AIDS pts.
one of the reasons i took my current job at an inpt hospice, is because we deal w/many of those on the streets- public health.
our AIDS population is very high.
and i think it all goes back to that particular rotation at this leading boston hospital.
i will also disclose, that hubby would probably have an mi, if he knew that i hug and hold every single one of my pts.
always.
just goes to show you, excellence means different things to different people.
and even today, it remains a sad state of affairs.
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
i think that 2nd question is rather insulting, myself.
I wonder how an instructor would respond should I stand in front of the class and say that I can answer question number 2, as I find it insulting. That would go over like the proverbial turd in the punch bowl.
I wonder how an instructor would respond should I stand in front of the class and say that I can answer question number 2, as I find it insulting. That would go over like the proverbial turd in the punch bowl.
i wasn't suggesting that you should.
but, it wouldn't hurt to ask the purpose of the question...
It's possible that, with the second question, they are trying to determine if there is a learning need based on the answer. If a student answers with the oft heard paranoia, then the instructor can use that opportunity to correct any myths and unjustified fears.
Or, maybe it's a paranoid question on the instructors part. Either way, the OP should use it as a teaching point for others that still may not understand how to care for HIV patients (which is no different than anyone else).
"I do as I would do for any patient that has pulled out their IV andis bleeding, grab a pair of gloves, stop the bleeding, clean him up, and find out why he pulled out the IV."
I have learned not to question instructors too much about assignments. They tend to get defensive. It is better to just do it and not worry about it. An instuctor can make your life a living hell if they choose to to do so. If you dont rock the boat you dont have to worry about capsizing and drowning.
I would have to say I put on gloves for a bleeding IV, but I'm quick about it and that's for any patient, HIV, MRSA, Hepatitis, whatever.
The exception for me would be a code, I might not swab any ports and I might just willynilly stick IV's in without gloves- feel free to put the pt on antibiotics after the ABC's are in good order, the intubation's done, the drips you wanted are hanging, etc.
Thinking about it, I could see some situations where I might not put on gloves first to stop bleeding, that would be if the bleeding were severe enough that there isn't two seconds to put gloves on. With IV's there usually is time, just don't make a big deal about it.
With that second question i'd probably make a point by saying that i would use universal precautions before stopping the bleeding, as i would with ANY patient.
I do understand the fear of contracting HIV/HEPC for people who are new to nursing and may not have the knowledge and experience of working with HIV, HEPC patients. There is a lot of misinformation about HIV and other blood borne diseases and we shouldn't be too harsh on newbies if they are scared, we should be reassuring and giving them the right education. I can completely agree with comments here about caring for ward patients with AIDS etc..
However, Wwith newbies to theatre if they don't want to scrub for a patient with a known infectious status then that's fine with me (although i do tell them that anyone can have it and it may not have been picked up yet). Now some of you may think this is a bad attitude on their part but in the OR it's more risky, studies show we are a higher risk group then many other areas in nursing. You do need to be confident at the table because your going to be handling sharps etc, your gloves become soiled, the work is fast, the atmosphere can be tense, if someone has a bleed you may need to respond very quickly with a suture. If someone is too freaked out may easily make a mistake, someone could get hurt and i strongly believe OR nurses need to build up their confidence before being able to do scrub with confidence.
Sorry i've gone slightly off topic but this is something i feel very strongly about.
as with any patient, use universal precautions to stop the bleeding then assess the patient. after ensuring that the patient's abc's are in good order, it would be important to find out why the iv was pulled out. it may have become tangled and come out accidentally or the patient may have pulled it out purposefully. it may be necessary to provide further education as to why he is receiving iv therapy and obtain a verbal contract from the patient stating that he understands why he has an iv and that he will not pull it out again. should the patient be uncooperative, mittens may be required to prevent him from pulling out the iv again.
although aids is primarily an immune system disorder, it also affects the nervous system and can lead to a wide range of severe neurological disorders. the resulting inflammation may damage the brain and spinal cord and cause symptoms such as confusion and forgetfulness, behavioral changes, severe headaches, progressive weakness, loss of sensation in the arms and legs, cognitive motor impairment, or damage to the peripheral nerves. research has shown that the hiv infection can significantly alter the size of certain brain structures involved in learning and information processing.
additionally, the patient may be having difficulty accepting and coming to terms with his diagnosis. it may be necessary to provide information on social services, support groups, and pastoral care.
mikemay1969
9 Posts
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