Question

Emma is a homeless 35-year-old African American mother of 4 children between the age of 4-10, diagnosed with HIV three months ago. Her HIV last test was five years ago, and she did not return for the results. Emma has a 15-year history of intravenous drug abuse. She stated that her last use of drugs was 12 hours ago. The highest grade Emma achieved in school was the10th and she has a history of Schizophrenia. Emma has had several close friends die of AIDS. She receives care at an urban community clinic where all her providers are of European descent. She is very cautious about starting any drug therapy for HIV because of the stories she has heard of other African Americans being used in an experimental way without their consent. She has not expressed her concerns to her provider. Her latest labs are as follows: CD4+ T cell count: 49 cells/mm3 HIV RNA: 88,000 copies/mL Discussion Questions What barriers to care are present in this case? How can these barriers be overcome? Should Emma's children be tested? How would you approach this topic with her? Based on the case study what strategies to address health literacy might you include in an active plan for Emma's care? Discuss other Cultural Competence issues that may impact retention into care and treatment. 1. 2. 3. 4. Please do a care plan on this patient and one drug sheet on an HIV drug or a Mental Health Drug for Schizophrenia.

Answer 1

Barriers to care

Incomplete perception of health care

Social stigma associated with the disease condition (HIV)

Cultural and social norms surrounding health behavior

Test for children

Yes the children should tested as Emma has 15 years history of intravenous drug abuse and her children are between 4-10.

Emma should be explained that it is important that children should be tested for HIV as early diagnosis helps in better treatment options and it is not necessary that children will be tested positive.

strategy to address health literacy

use simple terms

Give supportive psychotherapies

Explain importance of drug compliance and adverse effects of intravenous drug use.

Some of the Cultural competence issue

​​elderly people are given less importance in treatment than young

Poor are deprived from good treatment facilities as compared to rich

Drug sheet

Atypical antipsychotic like Resperidon, clozapine, clomazapine

Typical antipsychotic like Haloperidol.

Nursing Diagnosis

1) Anxiety related to treatment as manifested by Verbalisation

- Give assurance

- Explain importance of drug compliance

- Answer all queries

- give example of patients with similar conditions doing well

2) Risk for infection related to low CD4 count

- Explain importance of drug compliance

- Avoid crowded areas

- Eat cooked food rather than raw

- Regular health checkup.