Mr. Frank is a 42-year old male who presents to the free- clinic with complaints of a cough and fever. He reports cough and fever began 2 weeks ago. Symptoms initially were accompanied by dyspnea on exertion, but he is now short of breath even at rest. Upon taking history, the Nurse Practitioner discover that the patient lives in a homeless shelter and upon history admits to using IV heroin intermittently for many years. He denies any prior health problems. On review of systems, he admits to 12-month history of fatigue, weight loss, and diarrhea. The Nurse Practitioner discusses screening for HIV for which the patient consents.
Social History: Divorced 5 years ago without children, has lived in the homeless shelter for 5-years, does not smoke, drinks alcohol occasionally, prior marijuana abuse, now uses IV heroin “off and on” for more than 8 years.
Diagnostic Studies: CXR reveals diffuse, bilateral, interstitial infiltrates that look like “ground glass”. ELISA test positive.
Diagnosis: 1) Pneumocystis jiroveci 2) Probable HIV- ELISA Positive
Discuss the following:
1. Explain the physiological basis for pneumocystis jiuroveci in this patient with HIV.
2. Why did the Nurse Practitioner ask if the patient had symptoms of fatigue, weight loss, and diarrhea?
3. Explain the physiological basis of muscle wasting in the presence of HIV.
4. Discuss implications associated with HIV testing.
5. Discuss HIV screening test and explain subsequent HIV testing that is appropriate. Provide rationale.
6. The Nurse Practitioner expects this patient’s CD4+ T-cell count to be_________. Why?
7. Develop an evidence-based plan of care for this patient that includes rationale for each intervention.
8. Discuss appropriate patient education.
9. Discuss HIV as a reportable disease.
10. Discuss partner notification laws in your upcoming state of licensure.
11. Incorporate the Christian worldview in answering this assignment.
Document this assignment in a 3 pages word document, include 4 references published in the last five years.
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