Question

Coordination of Care The patient is a 32-year-old Hispanic nurse from your unit who is admitted for surgery to repair a fractured wrist sustained in a fall while she was working at the hospital. She divorced her first husband, who was unfaithful to her, after 5 years. She recently remarried and is hoping to start a family in the near future. She tells you she has symptoms of a vaginal yeast infection and complains that this is her sixth yeast infection in 7 months even though she has treated herself each time with an over-the-counter antifungal product. Her preoperative blood work indicates a lower-than-normal total white blood count and a low lymphocyte count. 1. In view of the laboratory results and her yeast infections, what other assessment information should you obtain? 2. Should you inform this patient at this time about her laboratory results? Why or why not? 3. Should you inform the surgeon about these results? Why or why not? 4. What should you change with regard to providing care to this patient until you know her HIV status? 5. What questions should you ask about this patient's sexual activity? 6. How should you approach this patient about her HIV status? Legal/Ethical The patient had the same CBC results on a repeat blood test. After outpatient surgery, the surgeon tells her the result of the test and suggests she be tested for HIV. She agrees, and her test comes back positive. She is completely devastated and is worried about losing both her new husband and her job. She begs you not to tell your (and her) co-workers. In addition, she says she needs time before telling her husband. 1. Are her fears about her job realistic? Why or why not? 2. How should you handle her request not to tell her husband about her HIV status? 3. What specifically can you do to support her at this time?

Answer 1

COORDINATION OF CARE:

1) According to the laboratory results, other pre-assessment can be done regarding HIV test can be done.

2) If the HIV test is positive, the results can be disclosed to the patient due to the following reasons. The patient is medical professional and she will know what are the consequences going to occur in her life. But to inform the patient only after the surgery is the best practice to maintain her confidence level psychologically to cooperate in this surgery.

3) Definitely, the results should be informed to the surgeon who is performing surgery to the patient. Proper care must be taken while performing surgery and also necessary preparations can be done. Also in relation to the surgery, post-operative treatment can be provided based on this laboratory results.

4) Utmost care should be taken after the patient's HIV status is confirmed. Nursing care with positive thoughts should be provided the patient. After diagnosing a HIV-infection a person will be in a crisis. If a nurse is familiar with the process of a crisis, he/she can better understand and support the person. With empathy, therapeutic attitude and by recognizing own reactions a nurse will be able to meet the needs of the patients. The nursing plan helps a nurse to plan, to see the problems, to implement and to evaluate the nursing process of the patient with AIDS. The aim of the nursing process is to react to the unique needs of the patient with the HIV-infection. To be able to grow as a human being and as a professional nurse, one needs education about HIV-infection and its specific areas. During discussions and consultations, nurses are able to share their feelings and reactions caused by HIV-infection.

5) Questions relating to sexual behavior are 1) your own sexual behavior in the past exposure 2) your partner's past sexual behavior. 3) Have you had sexual intercourse (meaning penetrative vaginal or anal sex) during the last three months? 4) Why haven't you had sex during the last three months? 5) How many different partners have you had sexual intercourse with during the last three months? 6) Now I would like to ask you think about every time you had sexual intercourse with any partner during the past three months. I would like to ask about how frequently you and your partner[s] used condoms.

6) Utilization of equipment for individual protection while rending assistance to the HIV/AIDS patient. Dealing and disposing needles and related material within the context of being precautious. It is possible to verify that the care representation exposed refers mainly to self-protection, and not protection regarding the others, making it possible to envision that the protection notion spans the individual dimension (me) and the collective dimension (them). Upon the contents presented, it is possible to conclude that the nursing team members socially represent the nursing care provided to positive HIV test patients, essentially, based on elements that concern professional self-protection. To do so, they comprise contents regarding the standard precautions and the disease exposition ways when providing care.

LEGAL/ETHICAL:

1) The patient's fear about the job was realistic because as a HIV positive patient and being a nurse providing nursing care the patients with so many activities, the patients will be at higher risk of HIV. So the job will be higher risk for the HIV patient to define the duties.

2) Legally / Ethically, the HIV status of the patient should be informed immediately to the partner/husband. Because the partner should be HIV tested immediately to know the status. Also to prevent further spreading of HIV to other people either by accidentally, knowingly/ unknowingly.

3) Only help the nurse can do to the patient is holistic nursing care in relation to HIV. Professional and personal motivation to the patient.