Care of patients with HIV depending on the stage of the disease. Introduction. topic: the role of a nurse in the implementation of prevention and care for HIV infection. Weight loss

Nursing process in HIV infection: definition, etiology, epidemiology, clinical picture, diagnosis, principles of treatment, prevention .

HIV infection- a progressive anthroponotic disease characterized by a specific lesion of the immune system with the development of severe immunodeficiency, which is manifested by opportunistic infections, malignant neoplasms and autoimmune processes.

Etiology:

The causative agents are retroviruses. HIV is not persistent in the external environment; inactivated at a temperature of 56°C for 30 minutes, when boiled - after 1 minute, dies under the influence of chemical agents approved for disinfection. Relatively resistant to ionizing radiation, ultraviolet radiation and freezing at minus 70°C.

Epidemiology:

The source of HIV infection is a sick person.

The transmission mechanism is parenteral: sexual, blood transfusion, vertical (transplacental - during pregnancy, childbirth, breastfeeding), non-sterile instruments.

Risk groups: homosexuals, bi- and heterosexual contacts with patients (carriers), blood recipients, drug addicts.

Transmissible transmission of HIV is practically impossible, since the pathogen does not multiply in the body of bloodsuckers. Household transmission of the virus during normal human contact has not been established. HIV is not transmitted through air, drinking water or food.

Clinical picture:

Clinical manifestations are extremely varied.

In the prodromal period: fever of unknown origin, lymphadenopathy, diarrhea, weakness, skin rashes, increased night sweats.

The course of opportunistic infections in HIV infection can be acute. So, acutely, pneumonia develops in a few days. In some cases, the dynamics of the disease can be gradual.

The main clinical criteria for the presence of HIV infection, developed in the United States, are: Kaposi's sarcoma in people under 60 years of age, brain lymphomas and opportunistic infections, among which SARS is the most common.

An advanced HIV infection is preceded by a latent period that lasts from 4 months to 5-6 years. The prodromal period is from 3 months to 5 years.

Stages of HIV infection:

I. Stage of incubation.

II. Stage of primary manifestations:

A - acute febrile phase;

B - asymptomatic phase;

B - persistent generalized lymphadenopathy.

III. Stage of secondary diseases:

A - weight loss less than 10%, superficial fungal, bacterial, viral lesions of the skin and mucous membranes, herpes zoster, repeated pharyngitis, sinusitis;

B - weight loss of more than 10%, unexplained diarrhea or fever for more than 1 month, repeated or persistent bacterial, fungal, protozoal lesions of internal organs (without dissemination) or deep lesions of the skin and mucous membranes, recurrent or disseminated herpes zoster, localized Kaposi's sarcoma;

IV. Terminal stage.

Of the group of symptoms suspected of AIDS, the most common symptom is fever, characterized by a rise in temperature above 38 ° C and variability in the course (intermittent, constant, irregular). Most often, fever is combined with night sweats, lymphadenopathy of unknown origin, general malaise, weight loss, and depression. Often there is a fever, after a long period of satisfactory well-being. Fever may be associated with a purulent infection of the urinary tract, biliary tract, with an infection of the respiratory system.

Chronic diarrhea with weight loss is common among risk groups and AIDS patients. Diarrhea takes on a severe, chronic character, leading to emaciation, mucosal and skin ulcers. The use of antibiotics in this case is ineffective, and their immunosuppressive effect aggravates the general condition of the patient.

Diagnostics:

Enzyme-linked immunosorbent assay (ELISA) method for detecting antibodies to the virus

With a positive result, ELISA puts an immunoblotting reaction (allows you to detect antibodies to specific HIV proteins).

PCR (polymerase chain reaction).

Antibodies to HIV during the acute phase, as a rule, are not detected. In the first 3 months after infection, antibodies to HIV are detected in 96-97% of patients, after 6 months. - in the remaining 2-3%, and in later periods - only in 0.5-1%. In the AIDS stage, a significant decrease in the content of antibodies in the blood is recorded. The first weeks after infection represent the “seronegative window period” when antibodies to HIV are not detected. Therefore, a negative HIV test result during this period does not mean that a person is not infected with HIV and cannot infect others.

In Russia, when making a diagnosis of HIV infection, pre-test and post-test counseling of the patient is carried out, and the basic facts about the disease are explained. The patient is invited to register with the territorial center for the prevention and control of AIDS for free dispensary observation by an infectious disease doctor: once every six months it is recommended to take tests (for immune status and for viral load) to monitor the state of health. In the event of a significant deterioration in these indicators, antiretroviral drugs are taken (the therapy is free, available in almost all regions).

Treatment:

To date, no treatment has been developed for HIV infection that could eliminate HIV from the body.

Antivirals: zidovudine (azidothymidine-AZT, retrovir)

Earlier treatment of secondary infections with antiviral, antibacterial drugs, fungicides, deworming agents, etc.

Immunomodulators - alpha-interferon, thymalin, thymagen, interleukin-2, etc.

Non-drug treatment (proper nutrition, healthy sleep, avoidance of severe stress and prolonged exposure to the sun, healthy lifestyle) and regular (2-4 times a year) health monitoring by HIV specialists.

Prevention:

Educate the population on proper sexual behavior: limiting the number of sexual partners and using condoms.

In medical institutions - strict compliance with the rules for the use and sterilization of syringes, needles and other instruments, as well as the use of syringes, transfusion systems, and other disposable

Examination of patients with clinical signs of immunodeficiency

All medical workers should perform all manipulations with biological materials in rubber gloves, and if there is a risk of splashing, in a mask and goggles

Refusal to use drugs

How to help a person caring for a sick person not be afraid to get infected from a patient

Caregivers should be taught that the only risk of infection is through unprotected sex, or if HIV-infected blood enters a cut or wound in the skin. However, they must use some protective gear, such as disposable gloves or a plastic bag, when changing dirty linen or handling blood. You should also protect yourself by using a waterproof bandage for cuts and wounds. Blood-stained clothing, underwear, diapers or paper waste must be boiled, burned or buried.

Nurses can show or teach family members some basic simple nursing techniques that can be done at home. This will bring relief and comfort to the patient, as well as satisfaction and greater confidence to the person caring for him.

This includes the following:
1. Prevention of bedsores in a bedridden patient
Pressure sores can be avoided if the skin is clean and dry (i.e., after involuntary bowel movements and urination, the contaminated skin of the patient should be wiped, dried and, if possible, treated with petroleum jelly or a protective cream, rubbing it with light massage movements); also change the position of the patient's body, turning it regularly (every 2-4 hours).

2. Eye care
It is necessary to prepare a solution of boiled water with salt, the amount of which should be no more than in tears. Sterile cotton swabs should be prepared. First, one eye is treated with a cotton swab dipped in saline and slightly squeezed, then the second eye is also washed with another swab. After the procedure, cotton swabs are thrown away. Moisturize your eyes with eye drops every 4 hours. Important for people with advanced AIDS: the eyes become dry and easily infected, which can lead to conjunctivitis (eye infection).

3. Oral care
It is best when the patient can brush their teeth and use a mouthwash solution (a small amount of potassium permanganate (potassium permanganate) in boiled water or baking soda with a little lemon juice).
But with the approaching death, when the patient becomes weaker, it may be impossible for him to carry out such procedures. In the oral cavity, stomatitis may form on the cheeks and gums, and if the patient is unable to swallow, his mouth may also dry out. To moisten the mouth, the patient should be given the liquid in small sips, or from time to time sprinkle the mouth with boiled water with a little lemon juice and, if possible, glycerin, which will help keep the mouth moist. If there is stomatitis, treat with Nystatin, Miconazole, Cotrimazol or other oral medications. Difficulty or pain in swallowing requires a medical examination and treatment with appropriate antibiotics or antifungals. Teeth should be brushed gently with a small soft toothbrush or a finger wrapped in a soft cloth. If there is gum bleeding, then gloves should be worn before performing the procedure and all used material should be thrown into a reliable container to be boiled or burned later.

4. How to prevent muscle pain and suffering.
You can do a simple massage of the shoulders and back, arms and legs, which will help reduce muscle pain and headache. Massage also improves blood circulation. However, be careful with a patient whose skin is damaged by Kaposi's Sarcoma, as these lesions may be prone to ulceration or be sensitive to touch, avoid ulcerated areas of the skin. Rotate the patient regularly and use pillows for comfort and neck support.

5. How to treat a wound or ulcer
Wear gloves before treating the wound. You can wash the wound using a prepared saline solution (as for eye care). If the previous dressing is stuck, soak it in saline solution for 15 minutes before trying to remove it. Use sterile cotton swabs soaked in saline solution to gently clean the wound. Weeping or ulcerated Kaposi's Sarcomas must be handled very carefully and appropriately to keep them clean and free from infection. Any damaged surface of the skin with eczema or ulcers is a good breeding ground for bacteria, so there is always the possibility of bacterial infection of the skin, the appearance of boils, abscesses and sepsis (blood poisoning). Dispose of contaminated dressings and used cotton in the incinerator. Bandage the wound with a new sterile dressing and secure it with a soft bandage, not a plaster. A wound that smells bad is most likely infected. Some antibiotics, such as Metronidazole, can help here. Applying charcoal powder in a gauze bag to the wound will help remove excess moisture. Pure honey applied to the wound will promote healing.

6. How to prevent swelling associated with Kaposi's Sarcoma or heart failure
Cutaneous Kaposi's sarcomas, especially on the lower extremities or genitals, often cause swelling that can be uncomfortable. This is not easy to deal with as it is caused by Sarcoma infiltration of the skin and subcutaneous tissues. However, if you put the limb on a pillow and cover it with a cloth, this will give some relief. A light massage, starting at the toes and working your way up the leg, will also help, although the skin can be very sensitive to touch. Diuretic drugs usually do not help this condition. If the patient suffers from heart failure and has swelling of the feet and ankles, then treatment can be carried out with suitable diuretic drugs, but under the supervision of a physician. Also, the patient is advised to keep the legs elevated on a low chair while sitting.

7. How to feed a patient who has difficulty eating or swallowing
As the patient gets weaker, it will become more and more difficult for him to eat or drink. First of all, you need to check if the patient has stomatitis, remembering that he may also have esophageal candidiasis. If possible, treatment with Ketaconazole tablets (or other available antifungals) or Nystatin Suspension, Miconazole, Cotrimazole, or other oral agents can be considered. The patient can dissolve Cotrimazole tablets twice a day for two to three days, which will help eliminate stomatitis quite quickly. The mouth rinses described above will also help. After solving this problem, attention should be paid to the drinks and food offered to the patient. If the mouth is inflamed, then food and drinks should be cold or warm, but not hot. Food should be soft, not spicy. Try to balance meals with a small amount of protein, such as boiled beans, meat sauce, fish, or eggs served with mashed potatoes, rice, or another side dish. Add some green vegetables or tomatoes. The patient will be able to eat a small amount at a time, so portions should be small. Offer food a little every few hours. If possible, give the patient milk or another drink with added sugar or honey. Soft foods like ice cream or protein cream are good for a person with a sore mouth. If the patient cannot eat solid food, give him meat-broth soup with vegetables, rice, cereals, or noodles. An egg beaten in a glass of milk with a spoonful of sugar is a nutritious cocktail. You can make a milkshake by adding ice cream to milk, or you can make a delicious mashed banana with milk by sprinkling sugar on top. Freshly squeezed juices from orange, lemon are rich in vitamins C and A and contribute to recovery. Avoid very sugary drinks, such as sugary sodas. Be aware that odors can cause nausea.

8. How to help the patient sit up from a lying position, stand up or walk
Handle with care - the patient may have painful areas, the skin is sensitive anywhere. Never pull the patient by the arm or leg.
To seat the patient from the supine position: if possible, with the help of two people, use the right hand for the right side of the patient and the left for the left; put your hand under the elbow and lift the patient together, holding him under the arms; seat him and support his back and neck with pillows; try not to hurt your own back.
To help the patient lie down from a sitting position: if possible, with the help of two people, supporting the back with one hand, place the other under the patient's knees and lift him; keep your back straight, rise from your hips.

9. How to change dirty bedding under a bedridden patient
Wet or dirty sheets should always be changed - NEVER leave a patient lying in a wet bed. Turn the patient on his side, pressing his palm on his shoulder and thigh, and remove the wet/dirty linen; clean your skin. Roll the wet/dirty sheet against the patient's back; put a clean folded sheet against your back; turn the patient on the other side. Remove the dirty sheet and straighten the clean one. Help the patient lie down in a comfortable position.

10. How to help an anxious or frightened patient
Patients usually become anxious or frightened when they are not aware of what is happening to them or when they experience pain or trouble breathing. Anxiety and fear aggravate pain or other symptoms, so it is necessary to calm the patient in order to alleviate his suffering. Do not leave the patient alone, hold his hand, talk to him in a low, soft voice; reassure him by telling him that you will not leave him, or if you need to go get help, ask someone to sit with him. Some patients enjoy having a church minister or spiritual leader sit with them to pray with them or read scriptures. One should be meek and respectful of the patient's wishes and not try to impose one's beliefs or views on him. You can pray for your patient quietly in your heart and invite him to pray with you if he wants to. He is in God's hands, and His Spirit will do His work in the patient's heart. Your role is to show your love and support to the sick person and be a conduit for God's love.

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• Introduction
• Chapter 1. Main Aspect s of the nursing process in HIV- infections
• 1.1 Characteristics of the nursing process
• 1.3 The role of nursing staff in counteracting the spread of HIV infection
• Chapter 2 nursing process for HIV - infections
• 2.1 Characteristics of the object of study
• Conclusion
• Application

Introduction

More than 20 years have passed since the registration of the first cases of HIV infection in the world. During this relatively short period, the disease swept the population of almost all continents. The disease has become the most important medical, social, political problem, i.e. has taken on a global dimension.

The main goal of nursing care is to help the patient adapt as much as possible to his condition, taking into account the identified problems throughout the entire period of HIV / AIDS.

Nursing interventions are aimed at solving both existing and potential health problems of the patient. In this regard, the nurse has the following tasks:

Tactful informing the patient about the state of his health;

Elimination of factors that impede the patient's adaptation to his new condition. First of all, this concerns his mental health, because. the stress received during the initial communication to the patient of his diagnosis can lead to unpredictable consequences.

Often an HIV-infected person begins to abuse alcohol, drugs, he has suicidal thoughts. Therefore, the task of the nurse is to adapt the patient to his new condition as best and as quickly as possible:

Teaching the patient self-care, control over their condition;

· as well as training relatives and close people to care for a patient in serious condition and preventive measures.

With the further development of HIV infection in a patient, physiological problems come to the fore. In this regard, it is very important to teach the patient and his relatives the correct actions for some manifestations of concomitant diseases.

A special place in the work of a nurse is occupied by the issues of HIV / AIDS prevention in people around the patient; provision of qualified nursing care, including the precise implementation of independent, interdependent (preparation of the patient for diagnostic procedures) and dependent (medical prescriptions) nursing interventions.

All these, as well as many other tasks, the nurse will be able to solve by resorting to the nursing process, as an integral part of the modern model of nursing.

The purpose of this work is to determine the features of the nursing process in HIV infection.

The object of the study is the professional activity of a nurse.

The subject of the study is the nursing process in HIV infection.

Research objectives:

1. Describe the nursing process;

2. To study the features of nursing care for HIV infection;

3. Determine the role of nursing staff in counteracting the spread of HIV infection;

4. In the process of practical research, to study the features of the nursing process in HIV infection.

Chapter 1. Key aspects of the nursing process in HIV infection

1.1 Characteristics of the nursing process

In the late 1940s the American scientist E. Deming, who is often called the father of the Japanese economic miracle, developed his own version of the theory of quality management of any technological process (as well as any type of activity).

To improve the quality, E. Deming proposed to improve all processes using a cycle. At the same time, the improvement achieved was based on a scientific approach and the human factor.

The essence of the scientific approach was that management should be carried out not on the basis of intuition and sensations, but on the basis of firmly established facts and their scientific analysis. And this requires carefully collected and comprehensively studied reliable and complete information. The human factor lies in the fact that W. Shewhart suggested using this approach to manage people.

Nickle Dsming-Shewhart's universal model later formed the basis for the development of an innovative technology of nursing care, which was called the nursing process.

According to modern ideas, nurses in their activities should act as an equal subject of the healthcare system, performing their specific functions, which include not only providing care for patients, but also solving problems that arise within the framework of existing nursing standards and their competence.

Nursing competence includes professional skills, human care, the ability to take responsibility for decisions and actions, the desire to constantly improve. Today, more than ever, patients need a qualitatively new type of nursing care, which becomes possible in the implementation of the nursing process.

The nursing process consists of 5 steps:

The first step in the nursing process. Collecting information about the patient (examination) and assessing the initial level of knowledge and skills of the patient or his relatives.

At each contact with the patient, starting with the primary one, the nurse receives some information about him. Thus, the collection of information about the patient is continuous. All this information is analyzed and evaluated by the nurse.

The nurse determines whether the patient has knowledge and skills regarding his condition, whether he or his relatives want to acquire the appropriate knowledge and skills, whether the patient is capable of learning, whether he is able to learn, etc.

The second stage of the nursing process. Identification of patient problems.

After collecting and evaluating the information, the nurse identifies a nursing problem: a lack of knowledge about the water balance and the technique for determining it. After that, she must determine how to solve this problem, which will be the content of the next stages of training.

The third stage of the nursing process. Definition of learning objectives, planning of its content.

Before drawing up a training plan, a nurse should set certain goals for herself. The formulation of learning objectives should focus on three areas: cognitive, emotional and psychological. Goals reflect what the patient needs to do in order to achieve the result.

A well-set goal should contain three components (aspects):

1) what the patient needs to do (what he should be able to do, understand, etc.), i.e. learning outcome;

2) time frame - the time interval (or a specific date) during which the learning goal will be achieved (by the 3rd day, in a week, by the end of the month);

3) with the help of whom or what the goal will be achieved (on their own, with the help of relatives, with the help of crutches).

In any case, goals should be specific, realistic and achievable.

The nurse should involve the patient and / or his relatives in the preparation of an individual training plan, taking into account his personal characteristics, social conditions, interest in the issues being studied and physical condition.

Once the training has been determined, the nurse plans the content and methods of the training. The plan includes the time (in the morning, before lunch, after dinner) and the duration of training (10 minutes during 3 days, 20 minutes every other day, etc.).

The fourth stage of the nursing process. Implementation of the training plan.

To implement the planned plan of the nursing process, the nurse, together with the patient and / or his relatives, creates an environment conducive to learning, choose the time for it. If the microclimate of the room is unfavorable (poor lighting, low temperature, the presence of strangers) or the patient's condition leaves much to be desired (the patient is upset, his pain has increased, shortness of breath), then it is better to postpone training.

For successful learning, you can use the following methods:

* demonstration -- the nurse demonstrates skills in self-care or mutual care (brushing teeth, using crutches, injections, measuring blood pressure, etc.); a clear, repetitive demonstration of each stage of a skill is an important means of achieving learning objectives;

* counseling - the nurse observes from the outside how the patient performs a specific skill and, in case of difficulty or at difficult stages, provides him with advisory assistance;

* role-playing is a very effective method of teaching, especially social skills; with this method, the patient’s capabilities and the difficulties of self-care in a domestic environment are better understood, new skills are developed (the ability to start a conversation, behave confidently in a particular environment), the level of self-awareness increases, and new solutions to the problem are found.

The training scheme consists of five stages:

1) presentation of the necessary information;

2) repetition by the patient of everything that he remembered;

3) showing (demonstrating) what the patient must master;

4) repetition by the patient independently or together with the nurse of the skill;

5) independent explanation and demonstration by the patient of the skill from beginning to end.

Each step of this scheme can be repeated several times until the patient learns the planned material. The nurse should strive to move from the transfer of knowledge to the development of skills, and then to a sustainable skill.

In the learning process, it is necessary to constantly maintain the interest of the trainees, ask them leading questions or build a conversation according to the question-answer principle, emphasize information important to the patient. At the end of the conversation, it is important to briefly repeat all the basic information.

The nurse needs to make sure that the trainees correctly understand the information being conveyed. To do this, she systematically checks and evaluates their knowledge and skills.

The fifth stage of the nursing process. Evaluation of learning outcomes.

After the implementation of the training plan, the nurse evaluates the result, i.e. relates it to the goals. The score might be:

1) the patient is aware of the importance and significance of the information and can independently perform the skill;

2) the patient has not sufficiently learned information and skills (confuses indicators, is unsure of answers and actions, sequences of manipulations); in this case, the nurse needs to analyze the correctness of goal setting and planning, make appropriate adjustments;

3) the patient did not learn the information and/or did not develop the skills. In the latter case, the nurse built the entire learning process incorrectly, did not take into account the patient's condition, his interest, did not decide on goals, or made an unrealistic and impracticable training plan. The entire learning process needs to be re-evaluated.

In any case, the nurse informs the patient about the results of the training, because he needs to know how successfully he coped with the task. In turn, it is also important how the patient himself evaluates the result of training. Self-assessment can be:

* adequate, coinciding with the assessment of the nurse;

* inflated;

* reduced;

* unstable (yesterday I was dissatisfied, today I am satisfied, or vice versa).

In any assessment, the patient should be rewarded and thereby maintain his interest in learning.

Thus, to achieve high learning outcomes, it is necessary:

1) a clearly defined learning goal;

2) convincing motivation for the patient to acquire knowledge;

3) benevolent attitude towards patients and their relatives;

4) creation of an associative link between new information and past experience and knowledge of the patient and his family;

5) obligatory practical development of useful knowledge;

6) effective (therapeutic) communication;

7) the ability to listen;

8) patience and perseverance;

9) encouragement for success in learning;

10) taking into account the patient's condition during training.

From this it follows that the nurse's understanding of the goals, objectives and principles of education, the ability to use a variety of methods, methods and means of education will contribute to the effective education of patients and their loved ones and, consequently, improve their quality of life.

1.2 Nursing care for HIV infection, AIDS

Disturbed patient needs: drink, eat, excrete, communicate, work, maintain body temperature, safety.

Patient problem: high risk of opportunistic infections.

Goals of care: the risk of infections will decrease if the patient follows certain rules.

Nursing Intervention Plan:

1. Observe the sanitary and anti-epidemic regime in the ward (disinfection, quartz treatment, ventilation).

2. Provide a good night's sleep for at least 8 hours.

3. Provide good nutrition (proteins, vitamins, trace elements).

avoid contact with infectious patients, visitors with respiratory infections should wear masks;

Avoid crowds of people

avoid contact with the body fluids of another person;

Do not use shared razors

shower regularly with antibacterial soap;

wash hands after using the toilet, before eating and preparing food;

Do not touch your eyes, nose, mouth;

Maintain oral hygiene

Monitor the cleanliness of fingernails and toenails;

Reduce contact with animals, especially sick ones, wash hands thoroughly after contact with animals;

Thoroughly wash and clean food, thoroughly boil meat, eggs, fish, avoid contact of cooked and uncooked food, do not drink raw water;

get vaccinated against the flu;

To control the patient's temperature, respiratory rate;

· teach the patient to monitor the symptoms of HIV disease - fever, night sweats, malaise, cough, shortness of breath, headache, vomiting, diarrhea, skin lesions;

· to teach the use of anti-infective and special preventive drugs, to avoid taking immunosuppressive drugs.

Patient's problem: difficulty in eating due to damage to the oral mucosa.

Goals of care: The patient will take the required amount of food.

1. Avoid very hot and cold, sour and spicy foods.

2. Include soft, moist, high-protein and fortified foods in the diet.

3. Rinse your mouth before eating with a 0.25% solution of novocaine, after eating with boiled water or a solution of furacilin.

4. Tell about alternative methods of nutrition (through a tube, parenteral nutrition).

5. To brush your teeth, use soft toothbrushes that prevent gum injury.

6. Use anti-infective drugs as prescribed by the doctor (local and general treatment).

Patient problem: diarrhea associated with opportunistic infections, a side effect of medications.

Goals of care: diarrhea will decrease.

1. Assess which foods increase or decrease diarrhea and adjust your diet.

2. Provide a diet rich in protein and calories, low in dietary fiber.

3. Ensure adequate fluid intake (water, juices, electrolyte solutions).

4. Apply infectious precautions when preparing and eating food.

5. Ensure timely intake of antidiarrheals prescribed by the doctor.

6. Provide skin care in the perianal area: wash after each bowel movement with warm water and soap, dry it in order to prevent rupture of weakened skin. Apply an emollient cream to the perianal area to protect the skin.

7. Monitor weight, water balance, tissue turgor.

The patient's problem: feeling of depression associated with a change in appearance (Kaposi's sarcoma, loss of hair, weight, etc.) and negative attitudes of others. Option: low self-esteem.

Goals of care: The patient's mental state will improve.

1. Allow fears to be expressed about lifestyle changes in a supportive, nonjudgmental environment.

2. Encourage relatives to communicate with the patient.

3. If necessary, refer the patient for a consultation with a psychotherapist.

4. Teach relaxation techniques.

Patient problem: Nausea, vomiting associated with opportunistic infections, drug side effect.

Goals of care: the patient will have reduced nausea, no vomiting.

1. Ventilate the room to eliminate odors that cause nausea.

2. Provide dietary advice: eat small meals often, avoid hot foods, avoid strong smelling and pungent foods, drink 30 minutes before meals, not during meals, eat slowly and rest for 30 minutes after food in a position with a raised head.

3. Teach to take drugs prescribed against nausea, vomiting (medications are given 30 minutes before a meal).

4. Emphasize the need for careful oral care.

5. Provide the patient with a glass of water, a container for vomit in case of vomiting and help the patient if it occurs.

Patient problem: risk of weight loss.

Goals of care: the patient will receive an adequate amount of food, his weight will not decrease.

1. Clarify the patient's taste preferences and dislikes for food.

2. Provide the patient with high-protein and high-calorie nutrition.

4. Determine the patient's body weight.

5. Determine the amount of food eaten at each meal.

6. Consultation of a nutritionist if necessary.

Patient problem: cognitive impairment.

Goals of care: the patient will be adjusted to the level of his mental abilities.

1. Assess the initial level of mental abilities.

2. Talk to the patient calmly, give him no more than one instruction at a time and, if necessary, repeat the information provided.

3. Avoid disagreements with the patient, as this can lead to the patient developing feelings of anxiety.

4.Prevent possible injury by removing hazards from the patient's environment.

5. Use techniques that facilitate memorization, for example, associative links with familiar objects, calendar entries.

6. Provide family support and educate the caregiver (family) about the above interventions.

1.3 The role of nursing staff in countering the spread of HIV infection

The HIV epidemic continues to grow throughout the world. The pandemic has already claimed about 18.8 million lives and today there are 34.3 million HIV-infected people on the planet.

The situation changed dramatically in 1996, when the virus entered the environment of drug addicts. Everyone should remember that HIV infection is like a nuclear explosion.

Psychologists are confident that the psychological problems of HIV-infected patients are no less important than medical ones. How to overcome the fear, which, of course, is experienced by everyone who is faced with this terrible disease - both the patient, and his relatives, and medical workers? Doctors are primarily responsible for strategy, while nurses are primarily responsible for tactics. And not a single battle will be won if tactical tasks are not solved. A patient comes to us with fear of loneliness, death, anxiety, guilt. The doctor has his own fears: will I be able to help, reassure, the likelihood of getting infected. Touching, their fears give rise to misunderstanding, aggression. To cope with the emotions of anxiety and fear, one should respect the boundaries of personal space. It is very important to know that the patient's aggression is not personally related to you.

There are clear instructions on how and what to do to avoid infection. If doctors, for example, are ordered to work with gloves, they have no right to put patients and themselves at risk by working without them. Specific recommendations were received not only by physicians, but also by educators and representatives of military organizations.

Actions of a medical worker in an emergency:

In case of cuts and injections, immediately remove gloves, wash hands with soap and water under running water, treat hands with 70% alcohol, lubricate the wound with 5% alcohol solution of iodine;

If blood or other biological fluids get on the skin, this place is treated with 70% alcohol, washed with soap and water and re-treated with 70% alcohol;

If blood and other biological fluids of the patient come into contact with the mucous membrane of the eyes, nose and mouth: rinse the mouth with plenty of water and rinse with 70% ethyl alcohol solution, rinse the mucous membrane of the nose and eyes with plenty of water (do not rub);

If blood and other biological fluids of the patient get on the dressing gown, clothes: remove work clothes and immerse in a disinfectant solution or in a bix (tank) for autoclaving;

Start taking antiretroviral drugs as soon as possible for post-exposure prophylaxis of HIV infection.

All medical personnel are very afraid of contracting HIV infection. To find out in which cases the risk of infection is high, extensive studies have been carried out. It turned out that the greatest risk of infection occurs in the case of an injection. Specific measures were developed to protect against a possible infection: doctors were ordered to remove the glove, turning it inside out, wash their hand under running water, and then, pouring a little special alcohol for hands into the other palm, carefully wipe their hands, including the nails, where huge amount of bacteria. You can’t wipe your hands, you need to wait until the alcohol evaporates: this time is enough for the alcohol to kill the infection.

After that, the nurse must write a memorandum to the management of her unit, detailing the causes of the incident and the measures taken by her.

A memo has been developed to help the paramedical worker during the initial contact with a patient with suspected HIV infection

Ways of transmission of HIV infection:

parenteral;

Sexual;

Vertical.

Groups of people who are more likely to get HIV:

intravenous drug users;

People who are promiscuous and have a large number of sexual partners;

Patients with diseases requiring frequent transfusions of blood and its components.

Symptoms to suspect HIV infection:

Prolonged increase in body temperature (subfebrile, febrile);

Generalized lymphadenopathy (enlarged cervical, occipital, axillary (except inguinal) lymph nodes);

diarrhea for more than 1 month;

Unexplained weight loss;

Respiratory infections (more than 4 times a year - for adults and 6 times for children);

Prolonged weakness.

Laboratory studies to which the patient must be referred:

Blood test for HIV;

Immunogram.

Prevention of HIV infection in medical institutions

HIV is transmitted from person to person through sexual contact, blood transfusion (or the accidental transfer of HIV-infected blood from person to person with cutting or stabbing instruments). The virus can also be transmitted from an HIV-infected mother to her child during pregnancy, childbirth and breastfeeding.

In other ways, HIV is not transmitted from person to person.

According to the definition of the WHO Regional Office for Europe, nosocomial infections (HAIs) include not only diseases that appear in patients as a result of their medical care in hospitals and outpatient clinics, but also infections of healthcare workers resulting from their professional activities. The risk of contracting infections transmitted by blood contact is especially high. More than 30 infections can be transmitted to healthcare workers through contact with the blood of patients.

Of the occupational infections in medical personnel, viral hepatitis B and C are most common.

The problem of infectious safety for medical workers is extremely relevant. The purpose of this lecture is to raise awareness on the issues of occupational infection and care for patients with HIV infection and viral hepatitis B and C.

Medical personnel should especially observe the prevention of nosocomial infections.

It includes:

1. Compliance with the established requirements for disinfection, pre-sterilization cleaning, sterilization of medical devices, as well as for the collection, disinfection, temporary storage and transportation of medical waste generated in healthcare facilities.

2. Equipping with the necessary medical and sanitary equipment, modern atraumatic medical instruments, means of disinfection, sterilization and personal protection (special clothing, gloves, etc.) in accordance with regulatory and methodological documents. Single-use products after use in manipulations with patients are subject to disinfection / neutralization, their reuse is prohibited.

3. If a case of nosocomial infection with HIV infection is suspected, a complex of preventive and anti-epidemic measures is carried out in health care facilities.

4. An unscheduled sanitary and epidemiological investigation is carried out in order to identify the source, transmission factors, establish a circle of contact persons, both among staff and among patients who are in equal conditions, taking into account the risk of possible infection, and implement a set of preventive and anti-epidemic measures to prevent infection in LPO conditions.

Thus, in the field of nursing in infectious diseases with a course of HIV infection and epidemiology, it is important to remember the following:

Know the risk factors, epidemiological features, main clinical manifestations, complications and prevention of infectious diseases: the duties of a sister in the performance of treatment and diagnostic measures for infectious diseases;

Be able to carry out the stages of the nursing process: conduct an initial assessment, identify patient problems, plan nursing care, conduct ongoing and final assessment of care outcomes;

Be able to ensure the infectious safety of the patient and staff;

Be able to apply universal and standard precautions;

Be able to prepare the patient for diagnostic procedures and take biological material for research;

To be able to carry out anti-epidemic measures in the focus of infections;

Be able to perform nursing manipulations (provide medical services);

Be able to advise the patient, family on the prevention of infectious diseases and their complications;

Know how to provide first aid.

sister infection disease

Chapter 2. Practical study of the features of the nursing process in HIV infection

2.1 Characteristics of the object of study

Consider an example in which a patient went to a family planning office knowing her HIV positive status. She is 25 years old and works as a tour operator. Married for about 10 months, husband is not infected. I found out about my status by accident. 2 months ago she got into an accident, after which she was taken by an ambulance to the trauma department, where, after examination, she found out about the infection. The husband is aware of his wife's infection, accepted calmly and supported her. The woman said that the next of kin did not know about her problem.

Objectively: the patient is asthenic, height is 175 cm, weight is 59 kg, her skin is pale pink.

From the anamnesis: she often suffered from infectious diseases in childhood.

Gynecological status: menstruation from the age of 14, established immediately, 4-5 days later, after 30 days, gynecological pathology denies. R-0, B-0.

He is reluctant to talk about the mechanism of infection, but admits the fact of casual sexual intercourse about a year ago, before meeting her husband.

Both spouses are on antiretroviral therapy.

At the time of the application, she was concerned about the following questions:

1. How to protect your husband from infection, are there any other methods of contraception, in addition to refusing to have sexual contact.

2. Can healthy children be born to an HIV-infected mother?

3. If the spouses decide to have a child, will she be denied medical care in the obstetric and gynecological hospital?

4. Can she infect her parents too?

The psycho-emotional state of the patient: anxiety, fear, depression of mood, a sharp change in mood.

2.2 Development of a program of activities

Let's highlight the problems of the patient:

Real:

Ш fear for your life and loved ones;

Ø fear of discrimination;

o desire to have children in marriage,

o fear of the birth of a sick child;

Ø lack of knowledge about HIV infection, about their rights as a patient;

Ø lack of knowledge about contraceptive methods for HIV;

Potential:

The likelihood of infection of the spouse;

Development of AIDS;

Priority issue:

Lack of knowledge about contraceptive methods for HIV-positive status of one of the sexual partners;

Fear of discrimination and the birth of a sick child.

Short term goal:

The patient will note that she is able to distinguish between many types of contraception by the end of the first week of classes with a nurse (after 2 sessions in the PS office), her psycho-emotional state will improve as a result of the joint actions of the PS office nurse, the patient's husband, a nutritionist, workers of the AIDS Center and the patient herself, the patient will be motivated to continue the classes.

Long-term goal of nursing intervention:

The patient will note the replenishment of knowledge about HIV infection, personal hygiene and nutritional hygiene of an HIV-infected person, about the daily routine, about the drugs used for antiretroviral therapy and about the possibility of having a healthy child, subject to all the requirements for the regimen, as a result of classes with a nurse of the PS office to end of lessons.

All interventions in this case can be divided into independent and interdependent.

Since the patient has a special status and psychological imbalance, the work of a nurse will be reduced mainly to nursing pedagogy and psychology, and the main task is to teach the patient to live with HIV without feeling different, not like everyone else, to know her civil rights.

Table 1 Short-term goal

Efficiency mark:

OBJECTIVE ACHIEVED if the patient notices an improvement in her psycho-emotional state, gets motivated to conduct further classes with her on family planning for HIV, notes an increase in knowledge about her disease and methods of contraception.

Nursing care:

1. Journal of outpatient admission of patients form 025 / y

2. Journal of patronage form 039 - 1 / y

3. Tonometer, thermometer.

4. Gynecological chair

5. A set of disposable instruments for examination by a doctor, sterile gloves, protective screens.

6. A set of PCR tubes for taking blood for hormones, for infections, and other laboratory glassware.

7. Thematic developments for conducting interviews with patients on the topics of family planning, brochures, posters and leaflets.

8. Videos on the topics: “Contraception”, “HIV myths and reality”, “Life or death”, “In vitro fertilization”.

Develop a plan for nursing interventions

Table 2 Long-term goal

Efficiency mark:

The goal is achieved if, as a result of the joint actions of a family planning office nurse, a family planning office doctor, specialists from the AIDS center, a psychologist, a nutritionist, as well as a patient and her husband, the patient will know the methods of preventing HIV / AIDS in the family by the end of the month , she will be selected a method of contraception that is safe for her sexual partner, the patient will not experience internal discomfort due to her HIV status, she will know her rights as a patient, she will know about the possibility of having a healthy child, subject to all doctor's prescriptions when taking antiretroviral therapy.

2.3 Characteristics of ongoing activities

Taking material from the cervical canal for bacteriological examination of the purpose:

1. Determine the flora of the inflammatory process of the female genital organs.

2. Determine the sensitivity of pathogens to a number of antibiotics.

Indications:

1. Inflammatory diseases of the reproductive system.

2. Preoperative examination for operations on the genitals.

Condition: compliance with the rules of asepsis and antisepsis, as well as personal medical protection when working with human biological fluids.

3. Obtained informed consent from the patient for the manipulation.

Equipment: gynecological chair, Cusco mirror, sterile test tube with a loop and ground stopper, forceps, long tweezers, des. solution for treating the external genital organs, sterile cotton balls, gloves, dry alcohol, a saucer, a box of matches, a referral to the laboratory.

1. Prepare dry alcohol and a box of matches.

2. Put on sterile gloves.

3. Treat the external genital organs of the patient with a disinfectant solution.

4. Insert a Cuzco speculum into the vagina and expose the cervix.

5. Remove the discharge from the surface of the cervix with a cotton ball.

6. On a saucer, set fire to dry alcohol.

7. Take a special sterile tube, open the stopper and remove the loop with cotton wool.

8. Quickly draw a loop over the flame of burning alcohol.

9. Insert the loop into the cervical canal to a depth of 1 cm and make a rotational movement inside.

10. Quickly pass the edges of the test tube over the flame of dry alcohol.

11. Insert the loop with the obtained material into the test tube without touching its edges.

12. Check that the cork tightly closes the test tube.

13. Remove the mirror from the vagina.

14. Extinguish the flame!

On the referral form to the laboratory, indicate the last name, first name, patronymic, age, clinical diagnosis of the patient, case history number, purpose of the study, place of sampling, name of the organization that sent the analysis, doctor's name and date.

Tests of functional diagnostics of the female reproductive system in different phases of the menstrual cycle. Definition of a symptom of "Pupil".

Purpose: diagnosis:

Estrogen saturation of the patient's body on different days of the menstrual cycle;

Ovulation.

Indications:

1. Endocrinopathy: uterine fibroids, endometriosis, neuroendocrine syndromes (ovarian scleropolycystosis, premenstrual syndrome, hyperprolactinemia, adrenogenital syndrome).

2. Infertility. Condition: the “pupil” symptom is evaluated on certain days of the menstrual cycle - at 7, 14.21.

Equipment: gynecological chair, vaginal mirror, diaper, sterile gloves, forceps sterile cotton balls.

The essence of the “pupil” phenomenon.

During the menstrual cycle, under the influence of estrogens and gestagens, a change in cervical mucus occurs. The amount of mucous secretion in the cervical canal depends on the estrogen saturation of the body. Its greatest amount is observed during ovulation. The test is evaluated visually and in points (1-3), one point corresponds to the indicator

(+). The “pupil” phenomenon is based on the expansion of the external opening of the cervical canal and the appearance of transparent vitreous mucus in it in the 1st phase of the menstrual cycle, maximum during ovulation (3 points = +++). It is determined by examining the cervix in the mirrors. The accumulation of mucus in the external pharynx resembles a pupil. The test is not typical for pathological changes in the cervix.

manipulation technique.

1. Insert a speculum into the vagina and expose the cervix.

2. Carefully inspect the external os of the cervix for the presence of mucus in it.

3. Mark the diameter in points and in millimeters.

4. Remove the mirror from the vagina.

5. Fix the indicator in the document.

Since the patient turned to the family planning office with the desire to have a full-fledged family in the future, plan a pregnancy and have a healthy child, the medical worker has the right to recommend such a family to turn to the IVF program.

Conclusion

The HIV/AIDS epidemic has now grown into a global crisis and poses one of the most serious threats to development and social progress. In countries where the disease is most prevalent, the epidemic is destroying decades of development gains, undermining the economy, threatening the security and stability of society. In sub-Saharan Africa, where the epidemic has already had a devastating impact, the crisis has created an emergency.

While bringing suffering to the sick and their loved ones, HIV/AIDS simultaneously deeply affects the socio-economic structures of society and poses a significant threat to the world of work. The disease affects the most productive part of the workforce, forcing enterprises in all sectors of the economy to bear enormous costs caused by lower productivity, higher production costs and an increase in the loss of skills and production experience. In addition, HIV/AIDS leads to violations of fundamental labor rights, which are expressed in discrimination and stigmatization of workers and people living with or affected by HIV/AIDS. The epidemic and its consequences are most severely affecting socially vulnerable categories of the population, including women and children.

In gynecological practice, medical workers increasingly began to encounter HIV-positive patients. If in the 90s of the last century the appearance of such a patient in a hospital or in a antenatal clinic was tantamount to an “state of emergency”, then in recent years this problem has ceased to surprise anyone.

HIV is spreading across the country by leaps and bounds, and only in recent years the Government has begun to take serious measures to combat AIDS and its prevention. Only in recent years have they begun to properly finance AIDS centers, programs have appeared to finance the treatment of AIDS patients and HIV-infected people, holistic programs have been developed to protect the rights of HIV-positive people, to educate them in matters of family planning, the safety of others, and to develop behavior during receiving antiretroviral therapy.

What is the most common problem faced by healthcare workers?

As a rule, women who go to a family planning office or antenatal clinic find out about their HIV status after they have been tested for this infection, or after they are taken to a hospital for emergency reasons, with rare exceptions after a medical examination at the time of employment. (Until now, testing for infections is not mandatory for some categories of workers). And it is at this moment that the nursing process becomes especially important, aimed at teaching patients the new rules of life with their own diagnosis. The success of the further life of the infected person depends on the effectiveness of this process.

List of sources used

1. Adler M., ABC of AIDS; M.: Mir, 2001.

2. Belozerov E.S. et al. Immunodeficiency states.//Alma-Ata, 2001, - 118s.

3. Belozerov E.S., Mashkevich V.S., Shortanbaev A.A. Clinical immunology and allergology (textbook)// Alma-Ata, 2003, - 267 p.

4. Zmushko E.I. et al. Some aspects of the diagnosis of HIV infection // Topical issues of HIV infection - St. Petersburg-2004, pp. 73-74.

5. Lysenko A.Ya., Tur'yanov M.Kh., Lavdovskaya M.V., Podolsky V.M. HIV infection and AIDS-associated diseases. M.: 1996. - 624 p.

6. ILO. Materials of the pilot project “Issues of HIV/AIDS prevention in the world of work”, Moscow, 2005

7. Pokrovsky V. "HIV / AIDS - myths and reality." Documentary. - 2006

8. Ryabchikov T.V., Nazarova N.A. Nursing process. - 2000. - 40 p.

Application

Prevention of HIV infection

The development of AIDS can be prevented if a person with HIV takes antiviral therapy. Antiviral therapy - a scheme for the use of special drugs that block the reproduction of HIV in the body and do not allow the immune system to collapse. These drugs cannot destroy the virus itself, but they can significantly prolong the period from HIV infection to the development of AIDS, feel practically healthy and keep working.

Ways to prevent HIV infection are based on knowledge of how the virus is transmitted.

Ways of HIV transmission:

1. Blood to blood.

2. Sexual transmission.

3. To a child from a mother during pregnancy, childbirth and breastfeeding.

Methods of prevention: the use of individual sterile needles and syringes for injections, piercings, tattoos. Permanent non-HIV partner with mutual fidelity, use of condoms. Antiretroviral treatment of a woman during pregnancy and childbirth, caesarean section, artificial feeding.

To protect yourself from HIV, you must: do not have unprotected sex with people infected with HIV, with representatives of high-risk groups.

Although there is currently no vaccine for HIV, early access to medical care will increase the effectiveness of treatment, which includes not only medication, but also counseling and support for people living with HIV/AIDS.

Diseases of the female reproductive system associated with HIV infection.

There are some disorders and diseases that are associated with HIV infection in women.

Menstrual irregularities occur in about a third of all women with HIV. These include:

Amenorrhea (lack of menstruation). Amenorrhea is more common in women with a low immune status (CD4 below 50), as well as in the use of alcohol, drugs, and malnutrition.

Long, irregular, painful periods and bleeding between periods are also more common in women with HIV than in HIV-negative women.

These disorders, as a rule, are not associated with the activity of the ovaries, but with hormonal disorders caused by HIV infection.

Oral and vaginal candidiasis is a fungal infection of the mouth or vagina. Oral candidiasis often appears with a low immune status and with smoking.

With HIV infection, the risk of the appearance or development of malignant neoplasms on the cervix increases by 3-8 times. AIDS-associated tumors of the reproductive system include cervical intraepithelial tumor and invasive cervical cancer. Etiologically, this type of tumor is associated with the human papillomatosis virus (HPV). To date, quite a few types of HPV have been identified, HPV6 and HPV11 are associated with viral warts or with mild dysplastic changes (cervical intraepithelial neoplasia -1) and do not contribute to the development into a malignant tumor. At the same time, HPV types 16,18, 31, 33 are found in most cases in cells of invasive carcinomas, and the DNA of the virus is integrated into the DNA of tumor cells. The HPV types that cause cervical cancer form certain viral proteins, called E6 and E7, which are fundamental in the malignant transformation of cells. E6 binds to the p53 suppressor gene, inactivating its function, and E7 binds to another tumor suppressor, the retinoblastoma (Rb) gene. As a result, both p53 and Rb proteins inhibit the atypical progression of cell cycles, and inactivation of these proteins leads to cell cycle dysregulation.

Co-factors in the development of cervical carcinoma due to HPV are early sexual activity, a large number of sexual partners, smoking, and immunosuppression.

In HIV-infected women (2015 people), HPV in PCR is detected in 58%, in control (577 HIV-negative women) - in 28%.

Tumors of the cervix are diagnosed by cytological examination of smears of the cervical canal (atypical squamous cells) or colposcopy with biopsy.

Treatment of cervical intraepithelial tumors depends on the stage of development of cytological changes. In stage I, spontaneous regression is possible, but in stages II and III, treatment is necessary in order to prevent the process into invasive cervical cancer. Combination therapy is effective, including cryotherapy, laser, electrotherapy of those lesions that are visible during colposcopy and do not affect the endocervix. With more extensive lesions - surgical treatment - resection. In non-HIV-infected women, relapses occur in 5-10% in a year, in HIV-infected women - in half of the cases. Therefore, patients are additionally prescribed 5-fluorouracil in the form of an ointment and difluoromethylornithine by mouth, as well as the HPV vaccine.

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GENERAL INFORMATION ABOUT HIV INFECTION, AIDS

HIV infection is a disease caused by the human immunodeficiency virus; characterized by a slowly progressive defect in the immune system, which leads to the death of the patient from secondary lesions (infectious and neoplastic processes) described as acquired immunodeficiency syndrome (AIDS) or from subacute encephalitis.

CLINICAL CLASSIFICATION OF HIV INFECTION

I. stage of incubation.

From the moment of infection to the appearance of antibodies.

The diagnosis can be confirmed by polymerase chain reaction by detecting HIV antigen-RNA. Isolation of the HIV antigen by enzyme immunoassay has low specificity.

II. Stage of primary manifestations.

It is characterized by a relative balance between the immune response of the body and the action of the virus. Duration from 2-3 to 10-15 years.

II A. Acute infection.

Usually lasts 2-3 weeks. Accompanied by fever of varying severity, lymphadenopathy, enlargement of the liver, spleen, skin rashes, meningeal phenomena are possible. Then it goes into stage II B or II C.

II B. Asymptomatic infection.

It is characterized by the absence of clinical manifestations. There may be a moderate increase in lymph nodes. In contrast to the stage of incubation, antibodies to HIV antigens are determined.

II B. Persistent infection.

It is characterized by persistent generalized lymphadenopathy, which is a clinical manifestation at this stage.

III. Stage of secondary manifestations.

With the progression of the disease, clinical symptoms develop, which indicate a deepening of immunity damage, which characterizes the beginning of the III stage.

III A. It is characterized by a loss of body weight of less than 10%, bacterial, fungal, viral lesions of the mucous membranes and skin, inflammatory diseases.

ІІІ B. It is characterized by a loss of body weight of less than 5%, skin lesions, which are of a deeper nature. Damage to internal organs develops; localized Kaposi's sarcoma.

III C. It is characterized by cachexia, generalization of infectious diseases, disseminated Kaposi's sarcoma, severe CNS lesions of various etiologies.

IV. Terminal stage.

It is characterized by irreversible damage to organs and systems. Even the therapy of secondary diseases, which is carried out adequately, is ineffective and the patient dies within a few months.

The root cause of HIV infection in a surgical hospital is professional exposure to HIV-positive biological media patients.

Most of the registered cases of occupational infection occur as a result of accidental damage to the skin of medical personnel with sharp objects (injection needles, blades), which are accompanied by parenteral contact with the patient's biological media; the ingress of these media on the mucous membrane of the eyes, oral cavity, on open areas of the skin that have a broken epidermis (cuts, scratches, etc.). Instead, the so-called suboperative damage to the integrity of surgical gloves(SPR), which make up from 25 to 75% of cases during surgical interventions. In addition, surgeons are able to visually notice only a third of such injuries and take the necessary preventive measures.

Prevention of HIV infection of surgeons is based on the following principles:

Increased doctor's alertness regarding HIV-infected patients.

Occupational exposure prevention measures:

a) barrier means of protection;

b) reducing the likelihood of occupational exposure - "remote surgery".

Timely detection of cases of occupational exposure, if any.

Prevention of the consequences of contact with the patient's biological media - post-exposure prophylaxis.

Doctrine of HIV heightened awareness of HIV-infected patients

During the initial examination, based on the history and physical examination, patients are identified who have or had a risky lifestyle in relation to AIDS and (or) belong to risk categories:

parenteral drug addicts.

Persons who are promiscuous or provide sexual services for profit.

Persons who shared a syringe with another person.

Persons who lived or live in AIDS-endemic regions (Africa) .

Persons who have often received blood transfusions or drugs that are made from donated blood.

Children of HIV-infected parents.

Sexual partners of persons who belong to the listed risk categories.

The reform of nursing, which has been taking place in Russia since the 90s, has led to a qualitative change in the professional and social status of the nursing profession, the responsibility of sisters has increased and their attitude towards their profession has changed.

It is generally recognized that nursing staff play a key role in the care of the sick. This is especially evident in palliative care and the hospice movement, where the dying need to be cared for.

Nurses with higher education led the departments and services of nursing care. New concepts of nursing have emerged:

nursing concept,

nursing care model,

nursing process,

Nursing diagnosis.

The concept of nursing is the basic idea of ​​nursing.

The model of nursing care is the implementation of the concept of nursing, that is, the model by which we act; this is a tool that helps to imagine what the nurse's attention should be focused on when examining a patient, what nursing interventions should be.

The nursing process is a method of organizing and delivering nursing care.

Nursing diagnosis refers to the formulation of the patient's problems.

In the practice of Russian public health care, the model proposed by Virginia Henderson (1966) is used in the implementation of the nursing process. It is implemented in accordance with the recommendations of the European Regional Office of the World Health Organization. The essence of the W. Henderson model is to help a person meet his fundamental biological, psychological and social needs with his direct participation in the planning and implementation of care.

In the world of nursing practice, there are many models of nursing care. These models are based on an assessment of the basic vital needs of a person, which in different models can be up to 10 or more. In all the models proposed to the sisters, the vital needs of a person include physiological, psychological and social needs:

1. Breathe normally;

2. Eat enough food and fluids;

3. Isolate waste products from the body;

4. Move and maintain the desired position;

5. Sleep and rest;

6. Dress and undress;

7. Maintain body temperature within normal limits by choosing appropriate clothing and changing the environment;

8. Observe personal hygiene, take care of appearance;

9. Ensure your own safety and not endanger other people;

10. Maintain communication with other people, expressing their emotions and opinions;

11. Do what you love;

12. Satisfy your curiosity, develop normally.

We can provide the patient with professional medical care, assist in meeting his vital needs, solve his social problems, surround him with care and attention, but there will remain a part of his personality that will not be realized and not in demand. This part is related to the life of the soul.

Spiritual needs are outlined only in separate models and are defined as: to have life values;

perform religious rites in accordance with their faith (W. Henderson).

For us, Orthodox sisters of mercy, the listed vital needs of a person are not enough to care for the sick, because from the experience of religious life and professional activity we know how important spiritual needs are, especially for patients with life-long and as yet incurable diseases. We also know that there is a constant connection and interaction between the body and the spirit.

“Everything that happens in a person’s soul during his life is important and necessary only because every life of our body and soul, all thoughts, feelings, volitional acts that originate in sensory perceptions, are closely connected with the life of the spirit. It is imprinted in the spirit, it is formed, all the acts of the soul and body are preserved in it, ”the surgeon St. Luke (Voino-Yasenetsky) teaches us.

Therefore, when planning work and conducting our nursing process, we take into account the totality of the vital needs of our patient, and, most importantly, we try to accept him into our hearts and stand with him before God, knowing from experience that before treating the patient, you must love him. This is where we see the main idea of ​​nursing.

By adopting Virginia Henderson's nursing process as the basis of our care model, we prioritize our patient's need to be loved, and we see our nursing goal of care in caring not only for his physiological and social needs, but also in care for his soul.

To implement nursing care for HIV-infected people, it is necessary to form a patient's commitment to accepting treatment. In HIV infection, the main component of treatment is highly active antiretroviral therapy (HAART), aimed at suppressing the process of HIV reproduction. Adherence to treatment should be manifested in taking HAART drugs according to the scheme prescribed by the doctor: at a certain time and in a certain dosage, while observing the recommended diet. Formation of adherence to treatment is a complex multi-stage process. It goes through several stages: the formation of adherence to the acceptance of care - the formation of adherence to treatment - the formation of adherence to the adoption of HAART. The formation of patients' motivation to accept medical care depends very much on "presence therapy" (communication, moral support).

It must also never be forgotten that at the heart of nursing is compassion for the sick. A physician without compassion is not a physician, the patient does not need it.

All of the above features of nursing palliative care for HIV-infected people are taken into account when developing a plan for the provision of medical care.

Nursing Care Plan

process

The nursing process ensures the systematic provision of appropriate and quality individualized care to patients. Proper planning of this care requires long-term and continuous monitoring of the patient to identify his personal characteristics and needs. At the same time, the patient and his family should take an active part in determining what kind of medical needs of the patient should be given attention. When nursing care planning is done in collaboration with the patient and family, the chances of setting realistic goals and achieving a successful clinical outcome are increased. The nursing process includes the following steps:

Assessment of the patient's condition;

Interpretation of the data obtained during the evaluation;

Nursing diagnosis;

Planning for the provision of appropriate assistance;

Implementation of the set plan;

Evaluation of the effectiveness of the assistance provided.

Assessment of the patient's condition. The assessment requires the collection of information related to both the physical and psychosocial aspects of the patient's health. This information must be factual and specific. Assessment activities include:

Medical examination: recording the most important vital signs of the body and listening to the patient's breathing with a stethoscope.

Questioning: taking an anamnesis and recording existing symptoms and behaviors that are dangerous to health.

Observation: with the help of the senses (sight, smell, touch, hearing), all kinds of information should be collected, and then the meaning of the collected observations should be analyzed. So, for example, if the nurse noted that the patient's breathing was shallow and labored, this could be explained by the patient having pain or respiratory problems. It is very important that when determining the cause of certain signs, the nurse fully relied on her professional knowledge.

Data interpretation. After collecting and analyzing information, it is necessary to determine the actual and potential problems of the patient, the solution or prevention of which should be directed by the nurse.

Nursing diagnosis (problem definition). The main task of nursing diagnosis is fixing the external manifestations of the disease and indicating the probable cause of such manifestations. A nursing diagnosis might look, for example, as follows: "impaired mobility associated with pain" or "nutrition that does not meet the needs of the body, due to the patient's social isolation." The various nursing diagnoses and their corresponding nursing interventions are described in detail in the next subsection.

Planning appropriate nursing care. Once a nursing diagnosis has been made, the identified problems should be classified according to their importance and relevance. For each problem, the objectives to be achieved are written down. These goals need to be achievable in practice. You also need to set a period of time to achieve your goal. This will allow future progress to be assessed.

As a next step, a plan for the delivery of nursing care is drawn up, which indicates the existing problems, the nature of the nursing intervention and the expected results.

Implementation of a plan. When implementing the nursing care plan, follow the guidelines given in the nursing care plan.

Evaluation of results. Evaluation may be based on a review of expected results and recording of their achievement. If the goals are achieved and the problem is solved, the nurse must certify this by signing under this goal and putting down the appropriate date. If the problem is not solved, then the nature of the nursing intervention may need to be changed to make it more effective. On the other hand, the goal itself can be changed to make it more realistic. Sometimes the interventions provided are adequate in nature and simply need to be carried out over a longer period of time. Care outcomes should be assessed both at pre-determined times set in the nursing plan and on a daily basis in order to make appropriate adjustments to the nature of interventions that do not achieve the desired goal.

Characteristic problems in AIDS patients and related nursing

intervention

Most of the problems observed in patients with HIV infection are well known to nurses, although the underlying causes may be different. Below is a list of problems and their causes, examples of nursing diagnosis and appropriate nursing interventions.

Nursing diagnosis: Changes in the nature of the excretion of toxins from the body - diarrhea associated with opportunistic infections.

One of the common characteristics of HIV infection and AIDS is malnutrition. Anorexia can be caused by factors such as nausea and vomiting, and diarrhea often complicates the problem of weight loss.

Nursing diagnosis: Changes in eating habits - the body's nutritional needs are not met due to nausea and vomiting.

Nursing diagnosis: Changes in body temperature - hyperthermia due to HIV or opportunistic infections (fever)

Mycobacteriuw avium give him an ice pack, or cover him with a blanket.

Tuberculosis

Pneumocystis pneumonia of unknown etiology

Nursing diagnosis: Changes in the nature of respiratory functions - due to hypoxemia, gas exchange disorders (shortness of breath)

Nursing diagnosis: Myalgia due to immobility.

Nursing diagnosis: Changes in the nature of the thought process - confusion associated with neurological changes or stress.

Possible reasons: Nature of nursing intervention

Nursing diagnosis: Changes in self-care habits - inability to take care of oneself due to fatigue and weakness.

Nursing diagnosis: Violations of physical integrity - damage to the skin associated with immobility of the patient.

Possible causes Nature of nursing intervention

Nursing diagnosis: Changes related to the meaning of life of a person - a feeling of hopelessness associated with the approach of death (depression).

Features of nursing care at home

As the number of HIV patients increases, hospitals may not be able to meet the demand for treatment. Therefore, many patients will be assisted at home. The advantage of such care is lower cost, and, in addition, patients prefer this type of treatment because of the possibility of being in the family circle. At home, the nurse can evaluate the role that each family member will play in caring for the patient, as well as the living conditions of the patient.

Another benefit of establishing or expanding home visitation services is to provide essential medical care to people with chronic illnesses. Since it is nurses who provide most of the services for such patients, the need for nursing leadership in this area is not in doubt. In many parts of the world, home nursing services are being introduced and expanded to ease the burden on local hospitals and improve the quality of care provided to patients.