Question

NPN 125 Spring 2019 Assignment is due 4/1/19 Please submit your answers via email to me on the due date. Ms. Adeyemi is a 33 year-old Nigerian woman who recently returned to the US from Africa after a sx- month vacation. She is 3 % months pregnant. She has an 8-year-old son from a previous marriage. She was diagnosed with HIV 3 years ago. She has no income and she is living with friends who are unaware of her HIV status. She says she practiced safe sex and tested regularly; however, she had one incident where the condom broke. Her CD4+T cell count is 1130 cellis/mm3 and she has an undetectable viral load. She feels there is no need for her to take medicine because she is afraid that her friends will find out that she is HIV+ and she will have no place to stay. She feels guilty about this situation and reports feelings of worthlessness and fatigue all the time. She has not informed the baby's father her pregnancy and her HIV status Discussion Questions 1. How do you evaluate her further for possible depression? 2. How will you evaluate her risk of self-harm? 3. What can you tell her about HIV medications and pregnancy? 4 Which HIV medication(s) should she avoid? 5. What advice would you give her about HIV related stigma? 6. What may account for her undetectable status without the use of antiretroviral? 7. What ethical considerations, if any, should be considered? 8. Discuss other Cultural Competence issues that may impact retention into care and treatment

Answer 1

Human immuno deficiency virus belongs to retro virus group resulting from unprotected sex relationship with infected persons,intravenous drug abusers , people who received infected blood or blood products from HIV infected individuals are the main etiologic factors for AIDS(acquired immuno deficiency syndrome).

The virus destroys the immunity of the person making them immuno-compromised which ends up in catching all other opportunistic infections(candidiasis, mycobacterium tuberculosis, pneumonia, diarrhea, etc) leading to declined quality of life .

HIV and AIDS can only be provided with supportive care and it cannot be cured completely. This itself will lead to depression and suicidal thinking for the patients and also they feel stigmatised .

1. For evaluating her possible depression ,the following should be assessed:

• Mood
• Daily activities
• Behavior
• Appetite
• Sleep pattern
• Activity level
• Social interaction
• Family interaction

These factors may be very helpful in assessing in evaluation of her depression.

2. To evaluate the risk of self harm is by communicating with her. Assess whether she has positive thoughts like she will get treatment for HIV . Assess her interest in taking care of her child and the fetus. Assess how she feel about herself (whether she feels useless or having lack of interest in all activities ).

3. We have to explain her that her fetus can be HIV negative , if she starts taking treatment .Taking combination of anti- HIV drugs during pregnancy and also during delivery may prevent her from passing the infection to her unborn child.

Anti- HIV medications contribute by prolonging the quality of life and can decrease some risk of passing the virus to others.

The medications may attribute to some side effects but also contribute to healthy life for long period.

4. Anti-retroviral therapy is recommended for pregnant mothers. Tablet . Stavudine is not recommended in pregnant mothers.

5. Communication is the very necessary element in counselling. First advice Ms. Adeyemi to inform about her infection to her partner and also encourage him to take prophylaxis treatment. Advice her to take treatment and also tell her that her identity wont be revealed until she gives permission to do so. Encourage her to come out of self stigma .Explain her that there are many more patients out on rehabilitation treatment for HIV, introduce some patients of her age to her . Advice her to communicate with those patients and improve her peer relationships.