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30 Acquired Immunodeficiency Syndrome Independent

Nursing interventions are complex because of the many physical, psychological, and social effects that occur from HIV infection and AIDS. During the more acute stages of the illness, focus on maximizing the patient's health and promoting comfort. Educate the patient and significant others regarding self-care by keeping any lesions and the skin clean and dry. Diarrhea can limit activities and also cause pain, both abdominal and perianal, if any lesions are present. Keep the perianal area clean, and assist the patient to clean himself or herself immediately. Instruct the patient about the food substances that are GI irritants. Explain that diarrhea can cause dehydration, electrolyte disturbances, and malabsorption; provide the patient with ways to maintain fluid and electrolyte balance. All patients need to be instructed to perform frequent and thorough oral care. Teach patients to avoid toothbrushes. Tell them to clean the teeth, gums, and membranes with a soft gauze pad; to use mouthwashes without alcohol; to lubricate the lips; and to avoid foods that are spicy, acidic, thermally hot, and hard to chew. Also explain the need to seek treatment for Candida and herpes and to use lidocaine (Xylocaine) for discomfort.

Explain the mechanisms for HIV transmission and teach the patient and significant others the precautions regarding transmission by both casual and sexual routes. Explain that if the patient has spills of blood or secretion, they should be cleaned up with a 1:10 solution of bleach and water to limit the risk of infection to others. Use universal precautions whenever you are exposed to blood, body fluids, or secretions, and teach the patient's significant others to do the same.

Note that the best outcomes result from early intervention. Many times, the patient's family members are unaware of her or his bisexual or homosexual orientation, or women may be unaware that their partner had high-risk behavior that exposed them to HIV infection. The diagnosis of AIDS may increase the distance between friends and family members. Social isolation often occurs because others avoid the patient out of the fear of being infected. Allow the patient to talk about the diagnosis and isolation. Use touch and encourage others to touch, hug, hold hands, and give back rubs to the patient to help fulfill the patient's need for touch. Encourage the patient's participation in support groups and use of volunteer "friends." The patient may experience anger, denial, anxiety, hopelessness, and depression. Ensure that the needed support services are available for home healthcare; make sure the patient has support for meals, financial assistance, and hygienic care.

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