Revista de Enfermería del IMSS Instituto Mexicano del Seguro Social

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ISSN: 0188-431X

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Evidence-Based Nursing: plan of care for patients with HIV/AIDS (part 2)

CLINICAL EXPERIENCE


How to cite this article:
López-Morales AB, Barrera-Cruz A, Alarcón-Morales C, Martínez-Ravelo R. Evidence-Based Nursing: plan of care for patients with HIV/AIDS (part 2). Rev Enferm Inst Mex Seguro Soc. 2017 Jan-Mar;25(1):71-4.

Evidence-Based Nursing: plan of care for patients with HIV/AIDS (part 2)


Ana Belem López-Morales,1 Antonio Barrera-Cruz,1 Claudia Alarcón-Morales,2 Rebeca Martínez-Ravelo2


1,2Instituto Mexicano del Seguro Social, Ciudad de México, México


1Coordinación de Unidades Médicas de Alta Especialidad, Coordinación Técnica de Excelencia Clínica, 2Hospital de Infectología del Centro Médico Nacional La Raza, Dirección de Enfermería


Correspondencia: Ana Belem López-Morales

Correo electrónico: ana.lopezm@imss.gob.mx


Received: May 13th 2016

Judged: Junio 13th 2016

Accepted: July 29th 2016


Abstract

With regards to nursing care for patients with HIV/AIDS, as well as their families and friends, in the Instituto Mexicano del Seguro Social we carried out a model that addresses the human and pathophysiological responses, in order to recover the welfare of these patients and reintegrate them in the best possible conditions into their sociocultural environments. For this we used two tools, the methodology of process and the standardized language, which are made explicit in the nursing care plan, by establishing a relationship between the nursing diagnosis, interventions and expected outcomes. The methodology used in developing the nursing care plan included the creation of nominal groups of experts, meetings, selection of the problem to be addressed, prioritization of diagnostic labels, search systematized information, defining the scope and objectives, adoption of taxonomy, critical analysis of scientific evidence, adoption and adaptation of recommendations of international guidelines and internal validation of the final document for peer reviewing.

Keywords: Evidence-based practice; Evidence-based nursing; AIDS serodiagnosis


Care plan for adults with HIV, hospitalized and in out-patient care
Nursing diagnosis Expected Results
Pattern 1:
Perception and management of health		 Expected Result Indicators Measuring scale
Non-compliance related to treatment factors affecting adherence. This non-compliance is brought on by not including the treatment regimen in daily life
Adherence: number of pills, frequency of dosing, dietary restrictions, adverse effects, pharmacological interactions and lifestyle impairment (NE-3)1		 Conduct of compliance; prescribed medication -Has a list of all medications, with dosage and frequency
-Follows the medication precautions		 -Never demonstrated
-Rarely demonstrated
-Sometimes demonstrated
-Frequently
demonstrated
-Always demonstrated
Problems cooperating
Risk of non-adherence due to low educational level; age-related changes (loss of vision, cognitive impairment); psychosocial status (depression, homeless condition, lack of social support, stress, dementia or psychosis); substance abuse (particularly in those with recent relapse); stigma, difficulty taking medications; complex schedules (frequent doses requiring specific foods); adverse effects caused by the regimen; or treatment fatigue.
Nursing interventions
-Provide detailed information about treatment risks and benefits (GRa)1
-Encourage compliance by informing the person of viral load and cd4 cell count results (GRa)1
-Adopt special help techniques for compliance, for example, medication diaries, alarms, or electronic messages (GRa)1
-Evaluate presence of risk factors that affect optimal adherence to treatment, in order to plan multifactorial and multidisciplinary interventions (GRa)2
-Explain to the patient appropriate antiretroviral treatment regimens and warning data for certain immediate adverse effects (GRa)2
-Identify characteristics of the patient, family and social environment that promote adequate adherence and design and implement strategies with multidisciplinary intervention (GRc)3
-Inform the patient about their illness and treatment. It is important that they understand the risk-benefit relationship and is motivated to comply with the treatment (GRa).2 When the patient is informed brings about awareness of his/her illness, of the objective of his/her antiretroviral treatment and that their active participation actively in the decision to begin and maintain it.
-Find allies among family and friends (GRa)1
-Introduce patients to civil organizations(GRa)1
-Suggest a system or network of help to remind the patient to take their antiretrovirals (PBP)
-Monitor adherence to treatment by a multidisciplinary team (GRa)2
-Follow-up periodically on antriretroviral treatment adherence to identify compliance failures (GRa)2
NE-3 = evidence level 3; GR (a/b/c) = grade of recommendation; PBP = point of good practice

Care plan for adults with HIV, hospitalized and in out-patient care
Nursing diagnosis Expected Results
Pattern 11:
Values and beliefs		 Expected Result Indicators Measuring scale
Mourning related to the loss of a significant thing (corporal processes),
manifested by altered immune function, guilt, alterations in the sleep pattern, anger, despair, disorganization, search for meaning of loss, pain, panic behavior, psychological distress and suffering		 Emocional balance -Conflicted ideas
-Depression
-Sleeping disorders		 -Never demonstrated
-Rarely demonstrated
-Sometimes demonstrated
-Frequently demonstrated
-Always demonstrated
Problems cooperating
Depression (NE-3)4 Secondary to mourning manifested by impaired immune function, guilt, alterations in sleep pattern, anger, despair, disorganization, search for meaning of loss, pain, panic behavior, psychological distress, suffering. 6
Nursing interventions
-Personalized care that responds to the need for emotional support (GRd)5
-Contribute to the patient’s free expression (GRc)5
-Foster collaboration with health care personnel, family members, and friends (GRc)5
-Give empathetic attention, without value judgement, in a respectful and understanding framework (GRc)5
-Offer support and training to the patient and their family, to develop coping strategies (GRb)6
-Inform patients about the existence of support organizations and reliable resources (GRa)4
-Pay attention and put importance on the verbal and nonverbal messages of the patient(PBP)
-Recommend physical exercise as a healthy life habit. It is essential that the patient is motivation and that they accept exercising according to their physical condition and their preferences. (GRb)4
-Consider collaborating with a psychologist and psychiatrist for psychotherapy (GRb)7
NE-3 = evidencia level 3; GR (a/b/c/d) = grade of recommendation; PBP = point of good practice

Care plan for adults with HIV, hospitalized and in out-patient care
Nursing diagnosis Expected Results
Pattern 2:
Nutritional metabolism		 Expected Result Indicators Measuring scale
Risk of deterioration of skin integrity related to side effects of antiretroviral drugs9 Tissue integrity: skin and mucous membranes -Skin lesions
-Abnormal pigmentation
-Erythema		 -Grave
-Sustancial
-Moderate
-Low
-None
Problems cooperating
Pharmacodermia caused by side effects of antiretroviral drugs, manifested by skin lesions, pruritus and rash (NE-4)9
Nursing interventions
-Observe and frequently ask about change in the skin to detect adverse effects of treatment (GRd)10
-Observe if there is redness, extreme heat, edema or secretion in the skin and mucous membranes (GRd)8
-Cleanse skin with antibacterial soap when opportune. (GRd)8
NE-4 = evidence level 4; GR (d) = grade of recommendation

References
  1. CENSIDA/Secretaría de Salud. Guía de manejo antirretroviral de las personas con VIH. Sexta edición, México: Centro Nacional para la Prevención y Control del VIH y SIDA; 2014. Available from: http://www.censida.salud.gob.mx/descargas/principal/Guia_ARV_2014V8.pdf
  2. Grupo de Estudio del SIDA (GENSIDA). Documento de consenso de GESIDA/Plan Nacional sobre el SIDA respecto al tratamiento antirretroviral en adultos infectados por el virus de la inmunodeficiencia humana. Gobierno de España, Ministerio de Sanidad, Servicios Sociales e Igualdad; 2015. Available from: http://www.msssi.gob.es/ciudadanos/enfLesiones/enfTransmisibles/sida/publicaciones/profSanitarios/RecomendacionesGesida_PNS26Enero2015.pdf
  3. Cabrera S, Arteta Z, Chiparelli H, Dutra A, Mancilla M, Mogadsy C. Guías para el diagnóstico, monitorización y tratamiento antirretroviral. Uruguay: Ministerio de Salud Pública (Uruguay)/Organización Panamericana de la Salud; 2011.
  4. Grupo de trabajo de la Guía de Práctica Clínica sobre el Manejo de la Depresión en el Adulto. Guía de Práctica Clínica sobre el Manejo de la Depresión en el Adulto. Ministerio de Sanidad, Servicios Sociales e Igualdad (España). Agencia de Evaluación de Tecnologías Sanitarias de Galicia (avalia-t); 2014. Available from: http://www.guiasalud.es/GPC/GPC_534_Depresion_Adulto_Avaliat_compl.pdf
  5. Ventura-Elías CD, González-Ortega Y. Cuidado de enfermería en pacientes con VIH: estigma y discriminación. Revista Científica de Enfermería. 2014;16(11):24-36.
  6. Fuster-Ruiz de Apodaca MJ, Molero F, Ubillos S. Evaluación de una intervención dirigida a reducir el impacto del estigma en las personas con VIH capacitándolas para afrontarlo. Anales de Psicología. 2016;32(1):39-48.
  7. Grupo de Expertos de la Secretaría del Plan Nacional Sobre el Sida (SPNS), Sociedad Española de Psiquiatría (SEP), Grupo de Estudio de Sida (GESIDA), Sociedad Española de Infectología Pediátrica (SEIP). Documento de consenso sobre las alteraciones psiquiátricas y psicológicas en adultos y niños con infección por el virus de la inmunodeficiencia humana. Enferm Infecc Microbiol Clin. 2016;34 (1):53.e1-53. DOI: doi: 10.1016/j.eimc.2015.07.018
  8. Bulechek GM, Dochterman JM, Butcher HK, Wagner CM. Clasificación de Intervenciones de Enfermería (NIC). Sexta edición. Barcelona, España: Elsevier España, 2013.
  9. Navarrete-Dechent C, Ortega R, Fich F, Concha M. Manifestaciones dermatológicas asociadas a la infección por VIH/SIDA. Rev Chil Infectol. 2015;32(1):57-71. Available from: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0716-10182015000100005
  10. European AIDS Clinical Society (EACS Guidelines), Clinical Management and Treatment of HIV Infected Adults in Europe. Prevention and Management of Non-Infectious Co-Morbidities in HIV. 2011.

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