Posted: September 6th, 2023

AIDS (Acquired Immunodeficiency Syndrome)

Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition
AIDS (Acquired Immunodeficiency Syndrome)
Case Studies
The patient, a 30-year-old homosexual man, complained of unexplained weight loss, chronic
diarrhea, and respiratory congestion during the past 6 months. Physical examination revealed
right-sided pneumonitis. The following studies were performed:
Studies Results
Complete blood cell count (CBC), p. 156
Hemoglobin (Hgb), p. 251 12 g/dL (normal: 14–18 g/dL)
Hematocrit (Hct), p. 248 36% (normal: 42%–52%)
Chest x-ray, p. 956 Right-sided consolidation affecting the posterior
lower lung
Bronchoscopy, p. 526 No tumor seen
Lung biopsy, p. 688 Pneumocystis jiroveci pneumonia (PCP)
Stool culture, p. 797 Cryptosporidium muris
Acquired immunodeficiency syndrome
(AIDS) serology, p. 265
p24 antigen Positive
Enzyme-linked immunosorbent assay
(ELISA)
Positive
Western blot Positive
Lymphocyte immunophenotyping, p. 274
Total CD4 280 (normal: 600–1500 cells/L)
CD4% 18% (normal: 60%–75%)
CD4/CD8 ratio 0.58 (normal: >1.0)
Human immune deficiency virus (HIV)
viral load, p. 265
75,000 copies/mL
Diagnostic Analysis
The detection of Pneumocystis jiroveci pneumonia (PCP) supports the diagnosis of AIDS. PCP is
an opportunistic infection occurring only in immunocompromised patients and is the most
common infection in persons with AIDS. The patient’s diarrhea was caused by Cryptosporidium
muris, an enteric pathogen, which occurs frequently with AIDS and can be identified on a stool
culture. The AIDS serology tests made the diagnoses. His viral load is significant, and his
prognosis is poor.
The patient was hospitalized for a short time for treatment of PCP. Several months after he was
discharged, he developed Kaposi sarcoma. He developed psychoneurologic problems eventually
and died 18 months after the AIDS diagnosis.
Case Studies
Copyright © 2018 by Elsevier Inc. All rights reserved.
2
Critical Thinking Questions
1. What is the relationship between levels of CD4 lymphocytes and the likelihood of
clinical complications from AIDS?
2. Why does the United States Public Health Service recommend monitoring CD4
counts every 3–6 months in patients infected with HIV?
3. This is patient seems to be unaware of his diagnosis of HIV/AIDS. How would you
approach to your patient to inform about his diagnosis?
4. Is this a reportable disease in Florida? If yes. What is your responsibility as a
provider?
.This Week’s Topics: Case Studies 1 & 2
Suggested Reading Material
• Jarvis, C. (2016). Physical examination & health assessment. Seventh edition. St. Louis, Mo.: Elsevier
• Mosby’s manual of diagnostic and laboratory tests (6th ed)
CSLO’s
• Apply knowledge to differentiate subjective and objective information to construct an accurate and thorough past medical history (PMH). history of present illness (HPI) and physical examination (PE)
• Formulate accurate differential diagnoses to promote health, prevent disease, and manage acute and chronic illness in adult and geriatric population
• Employs screening and diagnostic strategies in the development of diagnoses.
• Critically analyze data and evidence for improving health outcomes
EPSLO’s
• Integrate nursing and related sciences into the delivery of care to clients in diverse healthcare settings.
• Apply practice guidelines to improve practice and health outcomes
• Evaluate the effectiveness of clinical prevention interventions that affect individual and population based-health outcomes, perform risk assessment, add design plans or programs of care.
Instructions
Students must review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.
Case Study 1 & 2 topics change every semester. Topic TBD
The answers must be in your own words with reference to the journal or book where you found the evidence to your answer. Do not copy-paste or use past students’ work as all files submitted in this course are registered and saved in turn it in the program.
Answers must be scholarly and be 3-4 sentences in length with rationale and explanation. No Straight forward / Simple answer will be accepted.
Turn it in Score must be less than 25 % or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 25 %. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.
All answers to case studies must have reference cited in the text for each answer and a minimum of 2 Scholarly References (Journals, books) (No websites) per case Study
Late Assignment Policy
Assignments turned in late will have 1 point taken off for everyday assignment is late, after 7 days assignment will get a grade of 0 (zero). No exceptions

_________________________

CD4 lymphocytes are a type of white blood cell that play a key role in the immune system. They help the body fight off infection. People with HIV have a low number of CD4 lymphocytes, which makes them more susceptible to opportunistic infections. Opportunistic infections are infections that are usually not a problem for people with a healthy immune system, but can be serious or even fatal for people with HIV.

The United States Public Health Service recommends monitoring CD4 counts every 3–6 months in patients infected with HIV because it is a way to track the progression of the disease. A low CD4 count is an indicator that the immune system is being damaged by HIV, and it can be a sign that the person is at increased risk for developing opportunistic infections.

The patient in this case study is unaware of his diagnosis of HIV/AIDS. It is important to be sensitive and compassionate when informing someone of their HIV status. The best way to approach the patient is to start by building rapport and creating a safe and confidential environment. Once the patient feels comfortable, you can then explain the results of their tests and answer any questions they may have. It is important to provide the patient with accurate information about HIV/AIDS and to offer them support and resources.

Yes, HIV/AIDS is a reportable disease in Florida. This means that healthcare providers are required to report cases of HIV/AIDS to the Florida Department of Health. The purpose of reporting is to track the incidence of HIV/AIDS in the state and to identify populations that are at high risk for the disease. Reporting also helps to ensure that people with HIV/AIDS have access to care and treatment.

References:

Centers for Disease Control and Prevention. (2022, February 15). HIV/AIDS. Retrieved from https://www.cdc.gov/hiv/basics/whatishiv.html
National Institutes of Health. (2022, March 8). What is HIV? Retrieved from https://www.nichd.nih.gov/health/topics/hiv/conditioninfo/Pages/default.aspx

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