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■ C H A P T E R 1 1■Fever is one of the few signs of infections in the immunosuppressed child who does not have a sufficient number of white blood cells.
■Pneumonia is a likely infection in the child with AIDS.
■Control of environmental factors helps prevent infection.
■Planning minimizes chances for infection.
■Rest periods allow the child to regain energy.
■Special recommendations consider the child’s decreased immune response and the danger of acquiring disease from certain live virus vaccines.
■Additional nutrition is required to rebuild the immune system.
■Unpleasant stimuli decrease the desire for food.
■Skin turgor reflects hydration status.
■Including favorite foods encourages intake.
NOC Suggested Outcome: Risk Control:Actions to eliminate or reduce actual, personal, and modifiable health threats.
The child has no fever and shows no other signs of infection.
NOC Suggested Outcome:
Nutritional Status:Nutrient value:
adequacy of nutrients taken into the body
The child eats frequent meals of adequate nutritional content.
NIC Priority Intervention: Infection Control:minimizing the acquisition and transmission of infectious agents.
■Assess the child every 2–4 hours for fever; lesions in the mouth; redness, inflammation, soreness, and lesions on the skin or around intravenous lines.
■Auscultate for changes in breath sounds every 2 hours. Perform pulmonary toilet (coughing, deep breathing, incentive spirometry) every 2–4 hours.
■Enforce strict handwashing. Allow no fresh flowers, fruits, or vegetables in child’s room. Screen visitors for colds or recent exposure to varicella. Use blood and body fluid precautions (refer to the Skills Manual). Practice strict asepsis for dressing changes and suctioning.
■Coordinate patient care assignments to avoid exposing the child to individuals with recent infections or immunizations.
■Organize patient care activities to allow for adequate period of rest.
■Follow recommendations of CDC and AAP for immunizing immunosuppressed children. Avoid live oral polio virus vaccine and live varcella vaccine. Perform annual TB testing.
NIC Priority Intervention: Nutrition Management:Assistance with or provision of a balanced dietary intake of food and fluids.
■Encourage frequent small meals to promote nutritional and fluid intake.
■Maintain nasogastric tube feeding, if ordered. Hyperalimentation may be necessary to ensure adequate nutrition.
■Eliminate unpleasant stimuli and odors from the environment during meals.
■Monitor skin turgor every shift.
■Involve a nutritionist in planning a diet for the child that includes
favorite foods. (continued)
N U R S I N G C A R E P L A N T h e C h i l d w i t h A c q u i r e d
I m m u n o d e f i c i e n c y S y n d r o m e
GOAL INTERVENTION RATIONALE EXPECTED OUTCOME
1. Risk for Infection related to immunosuppression
Risk factors for infection will be eliminated as evidenced by infection control.
2. Altered Nutrition: Less Than Body Requirements related to Loss of appetite and decreased absorption of nutrients
The child will demonstrate adequate nutritional status to meet metabolic needs.
Alterations in Immune Function ■
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■Skin care is important in the immunocompromised child. The skin may be the only intact defense the child has.
■Prevents breaking or cracking of skin.
■Candidal infection is frequently associated with immunodeficiency.
■Provides comfort and promotes healing.
■Pain relief adds to comfort of the child and family.
■Knowledge about the disorder and preventive measures is necessary to provide safe and effective home care for the child.
■Knowledge of rationale increases compliance.
NOC Suggested Outcome:Risk Control:Actions to eliminate or reduce actual, personal, and modifiable health threats.
The child is free of preventable skin breakdown.
NOC Suggested Outcome: Tissue Integrity:Structural intactness and normal physiologic function of mucous membranes.
The child has intact oral mucous membranes.
NOC Suggested Outcome: Comfort Level:Feelings of physical and psychologic ease.
The child shows evidence of pain relief.
NOC Suggested Outcome:
Knowledge, Treatment Regimen:
Extent of understanding conveyed about AIDS treatment.
The parent describes appropriate home care and preventive measures for a child with AIDS.
NIC Priority Intervention: Skin Surveillance:Collection and analysis of patient data to maintain skin integrity.
■Observe all pressure areas closely for signs of infection or breakdown.
■Keep skin clean and dry. Provide perineal care to minimize irritation from diarrhea.
NIC priority Intervention: Oral Health Restoration:Promotion of healing for a patient who has an oral mucosa lesion.
■Inspect mouth for sign of blistering or lesions.
■Provide mouth care with normal saline solution or lemon-glycerine swabs every 2–4 hours.
NIC Priority Intervention:Pain Management:Alleviation of pain or a reduction in pain to level of comfort that is acceptable to the patient.
■Observe for signs of pain and discomfort.
■Medicate for pain as ordered and document results.
■Implement general comfort measures (holding, rocking, etc).
NIC Priority Intervention: Teaching, Treatment:Preparing a patient and family to understand and mentally prepare for a treatment.
■Explain the importance of optimizing the child’s health status and reducing risk of complications through diet, rest, and meticulous personal hygiene. Be sure that parents and other family members understand how AIDS is spread and appropriate precautions.
■Discuss with the parents and the child reasons for protective
measures. (continued)
N U R S I N G C A R E P L A N T h e C h i l d w i t h A c q u i r e d
I m m u n o d e f i c i e n c y S y n d r o m e (continued)
GOAL INTERVENTION RATIONALE EXPECTED OUTCOME
3. Risk for Impaired Skin Integrity related to skin infection, immobility, or diarrhea
The child will have structural intactness and normal physiologic function of skin.
4. Risk for Altered Oral Mucous Membrane related to infection
The child will have intact oral mucous membranes.
5. Pain related to infections
The child will be free of pain or experience only mild pain/discomfort.
6. Knowledge Deficit (Parent) related to home care of child with AIDS
The parent(s) will demonstrate knowledge about home care, measures to prevent infection, and signs and symptoms to report to health care providers.
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■ C H A P T E R 1 1infants of infected mothers. Adequate testing, prophylaxis for HIV and PCP, and follow- up visits for evaluation of general health and development for all infants at risk of the dis- ease is advised. Recent guidelines from the American Academy of Pediatrics recommend that pediatricians offer HIV testing and counseling to adolescents who are sexually active or involved in substance abuse (Committee on Pediatric AIDS, 2001). There are also rec- ommendations for inclusion of HIV and AIDS education into comprehensive health edu- cation for students from kindergarten through 12th grade (Committee on Pediatric AIDS, 1998). (See Table 11-6.) Nurses can implement these policies and counsel teens about the dangers and prevention measures for HIV (St. Louis, Levine, & Wasserheit, et al., 1998).
If the child is diagnosed with HIV, close health supervision is needed to ensure medica- tions and examinations are carried out. When HIV progresses to AIDS, nursing care is sim- ilar to that of a child with any serious chronic, life-threatening disease. It centers on pre- venting infection, managing pain, promoting respiratory and other organ function,
■Prompt treatment improves outcome.
■Expression of fears helps to decrease anxiety.
■Provides additional support to help family cope with the child’s illness and the dying process, when needed.
NOC Suggested Outcome:
Caregiver Emotional Health:
Feelings, attitudes, and emotions of a family care provider while caring for the child over an extended period of time.
The parent states decreased anxiety.
■Inform the family about signs and symptoms of infection that should be reported promptly to the physician or nurse (fever, chills, cough, mild erythema).
NIC Priority Intervention: Caregiver support:Provision of the necessary information, advocacy, and support to facilitate primary patient care by someone other than a health professional.
■Encourage family members to express fears and concerns regarding the child’s prognosis.
■Advise family about support services or other resources available in the community.
N U R S I N G C A R E P L A N T h e C h i l d w i t h A c q u i r e d
I m m u n o d e f i c i e n c y S y n d r o m e (continued)
GOAL INTERVENTION RATIONALE EXPECTED OUTCOME
6. Knowledge Deficit (Parent) related to home care of child with AIDS (continued)
7. Caregiver Role Strain related to anxiety about child’s condition and demands of providing care
The parent(s) will demonstrate emotional health as evidenced by decreased anxiety related to the child’s condition and care.
TA B L E 1 1 - 6 Teaching About AIDS
The American Academy of Pediatrics recommends that HIV and AIDS education be part of health education in kindergarten through 12th grade. School nurses should be educated about HIV/AIDS, ethics, testing, and counsel- ing. The particular roles defined for nurses in school settings include:
1. participate in education programs for teachers
2. assist schools and other organizations to develop education programs 3. review, adapt, and develop educational materials
4. participate in public discussions about HIV/AIDS
5. take part in meetings with school administrators, staff, and parents 6. facilitate networking among parents and AIDS community groups
Note: Adapted From Committee on Pediatric AIDS (1998). Human immunodeficiency virus/acquired immunodeficiency syndrome education in schools. Pediatrics, 101,933–935.
