Aids

z's playa · Jan 23, 2005

Z'splaya, have you seen the movie Collateral? Tom Cruise shoots this guy and he falls out a window and dies. So he says he didn't kill the man, the bullet and the fall did. Sort of the same as the AIDS vs opportunistic illnesses debate:)

Yeah I know..same debate but hey..tomato tomawto

begalli · Jan 23, 2005

But would you diagnosis a patient with a flare up of their CHF as terminal?

Many HIV+ patients can go through many illnessess for a long time before finally one of the opportunistic illness makes them terminal.

I had a patient the other day who originally presented to ED with respiratory distress. Patient was intubated and sent to us. Turned out to be PCP. Tested for HIV, came back positive. Patient didn't know about the HIV, let alone that full blown AIDS had taken it's grasp. Labs looked crappy and patient remained intubated going on 2 weeks, but patient was improving and we all had some doubts at first, but then saw that the patient was recovering. I haven't been to work in a few days, so I don't know what's happened since I last saw this patient, but when I left on Thursday, we were all hopeful.

Tweety, BSN, RN · Jan 23, 2005

HIV infection and indeed AIDS can be a managable disease like diabeties.

It is not the death sentence it once was. I have a friend who has had HIV since 1983, over 20 years. :)

lapappey · Jan 23, 2005

I am certainly under the impression that if one contracts AIDS then one will die of it (including opportunistic infections ... KS, PCP, and what-have-you, as far as I'm concerned that's semantics) unless something totally different COD intervenes. Current therapy does a pretty good job of prolonging life (but is by no means comfortable, uncomplicated, or cheap) Does that make for "terminal?"

Terminal refers to an "active and progressive disease which cannot be cured." CD4=6 certainly qualifies as "active", AIDS is "progressive" if it's anything. And there isn't any cure as of yet.

For terminal illness, heroic attempts at a cure aren't indicated, but rather we should be giving comfort care. As far as this goes, current AIDS therapy doesn't really fall into either category, does it? Current therapies for AIDS can stave off the disease's progression and give a certain quality of life. But they are not curative!

I can see where people who want to define AIDS as nonterminal are coming from ... wishing to send the message that it is "not a death sentence", but rather something that can be lived with. Legitimate points. But in terms of a nursing diagnosis, ineffective coping, I think it's entirely appropriate.

And let us not forget, by the way, the difference between being HIV+ and having AIDS.

meownsmile, BSN, RN · Jan 23, 2005

I agree, the opportunistic diseases that these patients get usually cause death, not the virus itself. So no AIDS is not terminal.

leslie :-D · Jan 23, 2005

i don't know if it's semantics or not, but wouldn't HIV be considered chronic but AIDS terminal?

to me it reminds me of an end stage cancer patient- nurses hesitate to give mso4 because they think it will kill the patient when the reality is that it's the disease process that killed the patient and not the mso4.

i think i feel confused....not sure if i'm getting my point across.

LydiaNN · Jan 23, 2005

Yes, I do. It is becoming much more manageable, and patients are surviving much longer, but unless something else takes them first, they will still eventually die of AIDS.

ekalbab · Jan 26, 2005

I asked b/c I admitted a NEWLY diagnosed AIDS patient (never been dx w/ HIV) w/ a CD4 count of 6!!!!! So one of my nursing diagnoses for him was ineffective individual coping r/t newly diagnosed terminal illness.....
A Dr. read this........ (made me feel good they read our nursing notes LOL :chuckle ) but went to my head nurse so I could be corrected AIDS is no longer considered a terminal illness.
I consider it, especially under these circumstances terminal. If thats not terminal than WHAT IS???

With the advances that we are making today and as rapidly as the are occuring it won't belong until every one with aids will have a chance at a healthy life. who know maybe even a cure.

ekalbab · Jan 26, 2005

I wouldn't lose that nursing dx so quickly though. It's how that individual VIEWS the illness, not whether or not the illness will kill them physically that's the whole point of the dx. Besides, AIDS is certainly chronic, debilitating and life-changing even with the most optimistic viewpoint.
I don't know anyone who wouldn't have some adjustment problems with a dx like that. Do you?

I agree that the nursing Dx. is correct. But you do not have to have a terminal illness to suffer from innefective copein

ekalbab · Jan 26, 2005

That's just politics working its way into medicine. Yes, now patients with HIV can lead much longer lives, but since it can not be kept at bay forever, I do consider it to be a terminal illness.

It is like someone stated earlier. No one can escape dying not even a patient with aids. Even though it is true that it might reach a point where it is hard to fight. I think the doctors point is this. AIDs attacks the immune system and if he can help the pt. to avoid oppurtunistic infection then even a low CD-4 count can not kill.

begalli · Jan 26, 2005

I admitted a NEWLY diagnosed AIDS patient (never been dx w/ HIV) w/ a CD4 count of 6!!!!! So one of my nursing diagnoses for him was ineffective individual coping r/t newly diagnosed terminal illness.....
A Dr. read this but went to my head nurse so I could be corrected AIDS is no longer considered a terminal illness.
I consider it, especially under these circumstances terminal. If thats not terminal than WHAT IS???

Here's the original post.

I think what's being questioned is the r/t part.

Ineffective individual coping is probably appropriate if the person is not coping well, but the OP doesn't say how the patient is dealing with the dx. Denial? Acceptance? Grief? Angry? Crying? Knowwhatimean? I guess that would be the "as evidenced by" part.

But like Angie O Plasty said, who would handle a dx like this well?

ekalbab · Jan 26, 2005

Here's the original post.
I think what's being questioned is the r/t part.
Ineffective individual coping is probably appropriate if the person is not coping well, but the OP doesn't say how the patient is dealing with the dx. Denial? Acceptance? Grief? Angry? Crying? Knowwhatimean? I guess that would be the "as evidenced by" part.

yes your right