New nursing student and AIDS patient

[Epona]

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:

[czyja, MSN, RN]

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.

Good plan. I remember visiting and HIV+ friend in the hospital in Boston in about 1983. The cleaning staff would not clean his room. The meals he ate (during his last days mind you) were served on paper and plastic and left outside his door. And this was a major teaching hospital.

It was a horrid time that bought out the worst and the best in humanity.

[bagladyrn, RN]

Good plan. I remember visiting and HIV+ friend in the hospital in Boston in about 1983. The cleaning staff would not clean his room. The meals he ate (during his last days mind you) were served on paper and plastic and left outside his door. And this was a major teaching hospital.

It was a horrid time that bought out the worst and the best in humanity.

Yes, I remember those days too well. I was at that time working in a state psychiatric hospital and we had terminal HIV pos. patients there, spending their last days in such a place because no place else would accept them and family and "friends" had abandoned them. Their treatment was as you describe, though in fairness I should say that in the earliest days, all the modes of transmission and the degree of exposure needed to contract the disease were not fully understood.

[czyja, MSN, RN]

Yes, I remember those days too well. I was at that time working in a state psychiatric hospital and we had terminal HIV pos. patients there, spending their last days in such a place because no place else would accept them and family and "friends" had abandoned them. Their treatment was as you describe, though in fairness I should say that in the earliest days, all the modes of transmission and the degree of exposure needed to contract the disease were not fully understood.

Dark times. The was great suffering and great heroism.

The thing that stuck me was that even 1983 I knew the disease was blood born (and I was working in kitchen!). Gowns and gloves were required in his room, this made sense at the time. And I understood the fears of the support staff - they were understandably afraid. The thing that drove me nuts was that he was not served hot meals on proper china with proper flatware. These items can be either be tossed or autoclaved. Maybe its because I was a chef (as was my friend) but the thought of my taking my last bites of food from a plastic fork horrified me. Needless to say I brought my friend some decent food on china with flatware from the restaurant.

[SaderNurse05, BSN, RN]

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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"

Thanks for your post. I am glad you are getting good advice about how to keep yourself same and not humiliate a person for no reaaason. Of course you have to take care of yourself but always try to consider your patient's dignity. Once you get to clinicals, you will see that ever person has the potential to be scary- either from their illness, their family, whatever. Nursing students spend a lot of time looking stuff up with any disease. I could imagine a scenario where you get the patient that is a walkie talkie waiting for discharge until she has a seizure and gets sent to ICU. I prmise you your patient don't expect you to walk in that room and know everything about HIV. As another posted out, they can be very good authorities on their disease. Make eye contact, shake their and unless some sort of prcausrion are in place, look at them while you talk to them. I stand my grould on the fact it was a great oppotunity fir the OP.

[caroladybelle, BSN, RN]

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. Good grief. Was micro not required at her nursing school?

It is harsh to judge people for fearing AIDs....it is a very scary disease. But our issue is, no this is not "too hard" for a nursing student.

Most people are nervous when caring for "their first AIDs patient" - that is okay, but don't try to sidestep it.

I had a friend that was one of the first females to die of the disease, when they still placed in isolation and the words GRID and ARC were still used. I had friends with the disease - when the visiting nurses would not restart IVs on call during the night, and if a pt missed one or two night doses of ABX, they would possibly die. MDs taught some of us how to restart IVs and provided equipment, so that that would not happen.

The first time I did it, I was scared out of my mind. But I did it.

There is only one way to get over the fear and that is to just do it.

You mention Eboli/Marburg. To address them, they really are not that big a danger to health care workers, WITH stringent contact precautions/droplet precautions. While there is some theoretical risks from insect bites, the big problem is contact with bodily fluids, including respiratory secretions from sneezing. The big problem....the areas that develop these diseases do not have adequate resources to take those precautions - precautions that are commonplace in the USA and the first world - are rare and harder to come by in the third world. When I was in Africa, many of the locals used gloves, gowns, masks sparingly, because they just may not be there. They were having to routinely beg agencies for IV caths and needles - you had to hit that vein on the first try, because there was not the equipment to spare. You also have a population that does not have the advantages we do. They may have to bury their dead in places that contaminate the water supply, culture may forbid cremation - a safer alternative. And they may be doing all of the post mortem care on their own family member with bare hands.

People ignore the common dangers already present in nursing. HCWers worry about getting and dying of AIDs...but even with a HepB vaccine available, many more HCWers have gotten, been disabled and died of HepB infection from work than of AIDs. Chemo nurses have developed anemias, cancer and miscarried in the past because of mishandling chemo. I see people free priming gancyclovir, when pregnant....one of the more dangerous drugs, connected with development of cancers and causing birth defects and retina damage.

Yet people worry about AIDs.......

[Epona]

Thanks everyone. Those were some very good replies. Yes. I did worry a bit about needle sticks, AIDS, Hep., etc. before I started nursing school. It was a big hurdle for me to jump. See I am a heart patient and hypokalemic and acquired a devastating disease while working as a medical reporter some years back. I came into contact with someone who was highly infectious and I acquired this virus (which the docs. to this day cannot really pinpoint). I am better now, but it has taken me years to get over it. I was healthy as an ox one day and on life support within 3 days. No joke. Elevated liver enzymes, jaundice, fainting, etc. I almost died. So yeah.. I am a bit nervous about taking care of clients who have very serious diseases and rightfully so. I LOVE nursing and medicine. I love it, but I am still a bit scared none-the-less from my own previous experiences. And no... there is no microbiology in our nursing school studies. And the school I attend has one of the worst NCLEX pass rates in the state and we breezed over precautions so I know a little bit about it, but not a lot. You can see where I might be a bit nervous. Thanks for all the replies! E

[Susan9608]

multiple post, accidentally

[Susan9608]

multiple post, accidentally

[Susan9608]

There's no micro pre-req at your school? That's bizarre ... almost every program I've never heard of requires micro to some degree ... seems almost unbelievable that you've had NO micro.

And as for precautions, I can't believe that any school in this day and age brushes past the issue of precautions. Even if they did, most hospitals have some kind of orientation where they discuss precautions.

I think you ought to question whether or not you really want to graduate from a program that even you admit is not of great quality and obviously brushes over some of the basics of nursing