Question

The nurse is planning care for a 32-year-old male client diagnosed with HIV infection who has a history of chronic depression. Recently, the client's viral load has begun to increase rather than decrease despite his adherence to the HIV drug regimen. What should the nurse do first while taking the client's history upon admission to the hospital?

Answer 1

The nurse should assess the client's complete medical history, current symptoms, and medication adherence as a first step. It is important to check for issues such as drug resistance, co-infections, or interactions with other medications, as well as monitoring CD4 T cell counts through flow cytometry to manage the HIV treatment effectively.

Step-by-step explanation:

When planning care for a 32-year-old male client diagnosed with HIV infection who also has a history of chronic depression, and whose viral load is increasing despite adherence to the HIV drug regimen, the nurse should first assess the patient's complete medical history, current symptoms, and medication adherence. This will include evaluating potential reasons for the increase in viral load, such as drug resistance, co-infections, or other factors that might influence the effectiveness of treatment. The nurse should also check for adherence issues or potential interactions with other medications that the client might be taking for depression or other conditions that could affect the efficacy of the HIV treatment. Considering the client's history of depression is important, as mental health can significantly impact medication adherence and overall health outcomes.

Flow cytometry may be used to monitor CD4 T cell counts, which is critical for adjusting HIV treatment if the counts fall below 500 cells/µL. Furthermore, as the patient is currently in the clinical latency stage of HIV, indicated by CD4 T cell levels between 200 and 499 cells/µL, it is vital to manage the viral load proactively to prevent progression to AIDS and reduce the risk of opportunistic infections.