Other High Risk Women

5. 3. AIDS
      1. General aspects—AIDS is a serious condition affecting the immune system. Heterosexual females are considered at risk if they or their sexual partners:
         1. Are HIV positive.
         2. Are IV drug users (50%).
         3. Received blood between 1977 and 1985 (9%).
         4. Are homosexual or bisexual males (39%).
         5. Are hemophiliacs.
      2. Assessment—general symptoms:
         1. Malaise.
         2. Chronic cough; possible tuberculosis.
         3. Chronic diarrhea.
         4. HIV positive.
         5. Weight loss: 10 lb in 2 mo.
         6. Night sweats; lymphadenopathy.
         7. Skin lesions; thrush.
         8. PID; STDs; vulvovaginitis (usually, yeast [Candidiasis]), often refractory and severe.
         9. Cervical cytologic abnormalities; often infected with human papillomavirus (HPV).
      3. Analysis/nursing diagnosis:
         1. Altered nutrition, less than body requirements, related to general malaise.
         2. Fatigue, related to altered health status, weight loss.
         3. Fear related to progressively debilitating disease.
         4. Knowledge deficit related to disease progression, treatment, life expectancy.
         5. Ineffective individual coping related to disease progression.
      4. Nursing care plan/implementation:
         1. Identify women at risk.
         2. Protect confidentiality.
         3. Implement standard precautions.
         4. Use proper gloves, gown, hand washing.
         5. Use protective eyewear and mask in labor, birth.
      5. Evaluation/outcome criteria:
         1. No further transmission of virus.
         2. Woman’s confidentiality maintained.
         3. Standard precautions implemented
         4. Emotional support implemented.
         5. Supportive groups contacted.
      6. HIV-positive women—pregnancy management:
         1. Antepartum
            1. Increased incidence of other STD (gonorrhea, syphilis, herpes, HPV).
            2. Increased incidence of cytomegalovirus (CMV).
            3. Differential diagnosis for all pregnancy-induced complaints.
            4. Counsel regarding nutrition.
            5. Advise about risk to infant.
            6. Counsel regarding safer sex.
         2. Intrapartum
            1. Focus on prevention of transmission.
            2. External electronic fetal monitoring (EFM) preferred.
            3. Mode of birth not based on disease.
            4. Avoid use of fetal scalp electrodes or sampling.
         3. Postpartum
            1. No remarkable alteration in disease progression.
            2. Breastfeeding contraindicated.
            3. Implement standard precautions for mother and infant.
            4. Refer to specialists in AIDS care and treatment.
      7. Newborn or neonate:
         1. General aspects: Neonatal AIDS—transmission may be transplacental, contact with maternal blood at birth, or postnatal exposure to infected parent (, breastfeeding). Classic signs evident in adult often not present. Common signs: lymphadenopathy, hepatosplenomegaly, oral candidiasis, bacterial infections, failure to thrive.
         2. Implement standard precautions for all invasive procedures. Wear gloves for all contact before first bath.
         3. Provide supportive nursing care (thermoregulation, respiratory).
         4. Encourage parent-infant contact.
         5. Provide opportunities for sensory stimuli and touch.