Scenario for possible HIV Patient??

Im a student nurse and for part of my learning group at university we have been given a scenario to devise a kind of step-by-step guide for. Mine is: A homeless man who injects drugs regularly has been attacked and is taken for hospital. he is screened for HIV.... What are the steps to be taken if he is HIV+.....what are the steps if he is not HIV+ ((eg. prevention, psychologists etc..) I Am Thinking About making it into a chart like the arrows with the yes and no things, so any info is really helpful, especially if you are a medical professional!! I am also looking myself but really struggling!!!

thankyou!!!!

I cant choose the scenario, the lecturers chose it for us, believe me i wouldnt have chosen this one, its so difficult!!

tweetybird= this is britain, not america, we have the NHS, its free healthcare for all, its not an unreasonable scenario, Patients are often asked if they wish to be screened for HIV, it doesnt cost them.

busyintellignetartist = who are you talking to? NOBODY has suggested that someone who has HIV should be treated unfairly or with a judgemental attitude.

shouldnt caring for the patinet with HIV be not too far detached from caring for someone with C-diff/MRSA?

isnt it just a case of barrier nursing and being extra careful when dealing with bodily fluids?

the marsen manual says:

cover all wounds (staff and patient)

staff with fatigue and health problems should not be involved in the patients care.

aprons/gloves etc are only needed if the patinet is couching/sh1tting themselves etc.

psycho support is essential, nurses are to remain non judgemental, refer to support groups etc.

i guess if he's not HIV you just have to educate him and explain the dangers of needle sharing and refer him to a clinic or drug and alcohol team where he can get free needles.

i'd suggest looking at:
marsden manual of clinical nursing procedures.
online e-journals (blackwell synergie and RCN website)
prehaps visit your local drug and alchohol team.

try www.studentnurse.org.uk, the forums are helpful.

don't forget you have to get his permission first! No consent, no test.

i /feel/ being /a /student nurse/ this/ is/ something /you/ have /to/ find/ for yourself / good luck

I agree with the person above me. There's no "screening" for HIV. This isn't a routine test. There must be signed consent. Start with that. Now assuming he's been admitted and stays long enough for the test results to come back (you do know that the hospital's footing the bill for all this, so this is a highly unlikely scenario to begin with.) and he's found to be HIV+, then what are you going to do about it after the doctor informs him? You don't keep people admitted just because of HIV+ status. He can't pay his huge bill. He's homeless. How do you keep track of him? You can't hold him against his will and there's no justification to do so legally. He'd be discharged as soon as safely possible. Pick another patient, preferably one who is insured and has a home and family. Then, I'd be glad to help you out.

As a person who is HIV+ I can tell you that the most important thing is that you treat him just as kindly and with just as much respect as you treat any other patient--just because he is homeless and injects drugs doesn't give you as a nurse the right to treat him judgementally or with less compassion than anyone else!
Shame on your other answerers as well for the answers that imply less than that.

First of all, no extra precautions need to be taken if it is found that the patient is HIV+. That is why we have UNIVERSAL precautions which if you are a med student you should be familiar. Healthcare workers should be using universal precautions with all patients so no patient needs to be treated differently. Patients are not even required to inform healthcare workers of their infection) We have long past the time when HIV+ patients were isolated in bio hazzard rooms with biohazzard sybols on the doors.

Yes, informed consent is DEFINITELY required. A few questions....is this the first time the patient has received this diagnosis? If so, he should be given some post-test counselling from a public health nurse, or trained physician/nurse. You should provide a list of community resources for the person to access upon discharge (local AIDS Service Organizations, Subsidized housing, QUALITY shelters, etc.,.), provide locations where the patient can access clean needles and drug works -- with so many issues in the patients life asking him/her to quit using drugs at this point with so many other issues going on in their life is unethical.....because it may be impossible.

If he is not HIV+ then most of the above recommendations (minus the ASO) are still applicable.... post-test HIV counselling should still be done for those who are HIV-, as they can be counselled on how to stay negative.

Hope this helps.

Being stuck with a needle that has HIV infected blood, as has happened to thousands of health care workers, is a terrifying experience, but it very rarely results in HIV infection. Studies of such exposures find that only about 1 in 333 people who experience HIV-infected needle sticks seroconvert (Cardo 1997, Gerberding 1994, Henderson 1990), and that a total of only about 50 seroconversions from infected needles have been reported worldwide since HIV was targeted as the cause in 1984. This is an incredibly small number when compared to other blood borne diseases that are of similar prevalence.

This risk of seroconversion after a needle stick, 1 in 333, is less than the prevalence of HIV in the general population of the United States, which is about 1 in 250 people (Okie 1997). This raises the question whether these people really got HIV from the needle stick, since picking randomly from the population will result in more HIV positive people (1 in 240) than picking randomly from people who have been stuck by a needle (1 in 333). One could even argue, somewhat facetiously, that being stuck by a needle reduces your risk, just as using "dirty" needles for IV drug injections might reduce your risk. The 50 cases of seroconversion that are claimed to have occured in the world were reported in a multitude of small studies, with only one or two seroconversions per study. An in depth analysis of these studies would be quite revealing, but is unfortunately beyond the scope of this book. Instead, two of the largest and best controlled studies will be discussed, to serve as examples.

Gerberding (1994) found one case of seroconversion out of 327 cases of HIV-infected needle sticks. These all occurred over the space of 10 years in a clinic that specialized in HIV and AIDS. This single case of seroconversion was a woman who developed a flu-like illness about two weeks after the needle stick occurred, and then tested HIV positive two weeks after that. Another study by Henderson et al. (1990) reports a similar circumstance, where the HIV positive test occurred two weeks after a "severe mononucleosis-like illness, characterized by persistent fever, malaise, and weight loss". These types of anecdotal cases are what led to the conclusion that, at least in some cases, the initial stages of HIV seroconversion result in flu-like symptoms.

There is a completely different way to view this result, however.

Both the flu and mononucleosis have been found to cause false positives on HIV antibody tests (Cordes 1995, Challakeree 1993, MacKenzie 1992). False positives occur for all antibody tests, and are much more likely to occur after people have had an infectious illness, at which time there is a high quantity of many different types of antibodies present in a person's blood. No reports are made by Gerberding et al or Henderson et al of any repeat tests in the two health care workers who seroconverted to confirm the diagnosis, and thus it is not known whether these people may have converted back to HIV negative status after their levels of antibodies returned to normal, which can take a number of months. People who experience a needle stick from HIV infected blood experience several months of stress and social isolation, which people who are HIV positive experience on a permanent basis. This may have also weakened their immune system and made them more susceptible to the flu and other common infections, thus increasing their likelihood of a false positive result. False positives, and other problems with the antibody tests, will be covered in more detail in Problem#7: How Reliable Are HIV Antibody Tests?

A final aspect of Gerberding's findings presents another serious question about whether HIV can be transmitted via blood-contaminated needle sticks. They compared the extremely low rate of HIV antibody seroconversion to rates of hepatitis B seroconversion among the health care workers at their HIV-AIDS clinic. Hepatitis B is transmitted the same way that HIV is supposedly transmitted, via direct blood to blood contact or by intimate sexual contacts, and yet, in their own words, "the incidence of hepatitis B was 55 times greater than that of HIV, and 38 times greater than hepatitis C" (p. 1415). Since the setting of this study was a clinic specializing in HIV and AIDS, the prevalence of hepatitis B in the patients seen at the clinic was not expected to be much higher than the 25% to 40% prevalence of HIV positivity. Although not the subject of this paper, problems are also revealed with regards to Hepatitis C infectivity, and there are many other inconsistencies with this virus, as well (Duesberg 1996).

firstly, you need to look at pre-test counselling. try the genito urinary medicine nurses assosciation website or the aidsmap website. look at aspects involved in obtaining informed consent, confidentiality ect. look at data protection act. then bring in how he would be told the result. look at differing aspects of breaking bad news. if positive, it would depend on his immune system (cd4) and level of infection (viral load) tie in possible drug resistance, co-infection with syphilis or hepatitis (as he is an ivdu). look at risk-taking behaviour and sti/hiv stats in the choosing health paper. in respect of him being homeless, look at social excusion, possible malnutrition, infection risks. bring in other members of the multi-disciplinary teams. e.g: infection control, dietetics, social care. if positive and he is injured, bring in the health authorities infection control policies, universal precautions, immuno-suppresion management. don't forget the patient education and prevention. tie in some health promotion aspects too. good luck, hope this has helped.

This pt needs individualised care. He needs a key worker & counselling re what is happening to him. No pt I have ever known will fit into any protocol. I'm sure there will be a local one. Look for NICE guidelines. There will also be 'drug' teams who will help & lots of other organisations & specialist resources. A team approach is called for in order to reduce harm. Usually these are led by GUM consultants.
There are such things as universal precautions so healthcare staff do not become infected but you should already know these.
Don't forget that he will be discharged from hospital & require long term support whether HIV+ or not. A multidisciplinary approach is necessary.