Chapter 18
Providing Care for People with HIV/AIDS, Hepatitis and Tuberculosis
GOALS
After reading this chapter, you will have the information needed to:
- Explain what HIV is and what AIDS is, and how they are related.
- Identify behaviors that can transmit HIV and those mistakenly thought to transmit HIV, HAV, HBV and HCV.
- Describe medical problems of people who have AIDS and principles of care.
- Explain the differences between HAV, HBV and HCV and their modes of transmission.
- Describe medical problems of people who have hepatitis.
- Describe how tuberculosis is transmitted and how to provide care.
Key Terms
Scenario: You assist Mary Hill, living with AIDS, who is exhausted, nauseated and caring for her infant. Gentle personal care, fresh linens and small sips of fluids (ice chips) bring relief, though fatigue persists.
Facts About AIDS
AIDS affects men, women and children worldwide. Myths persist; facts reduce fear:
- You cannot get AIDS from a drinking fountain, from sweat, or from hugging.
- Latex condoms help prevent the spread of HIV.
- HIV is not spread by casual contact.
- Abstinence is the most effective prevention.
- Donating blood does not spread HIV.
- There is no cure for HIV.
What is HIV?
HIV (human immunodeficiency virus) is transmitted via blood and certain body fluids (semen, vaginal fluids, breast milk, and fluids containing blood). Transmission paths:
- Sexual intercourse with an infected partner (oral/anal/vaginal). Condoms help prevent spread.
- From infected mother to baby during pregnancy, childbirth, or breast‑feeding.
- Exposure to infected blood (shared needles for drugs/tattoos/piercings).
- Transfusion risk is reduced by blood testing (since 1985).
How HIV is NOT transmitted
- Casual contact: hugging, closed‑mouth kissing, holding hands, sharing items, being in the same room.
Transmission in Health Care Settings
Occupational transmission is rare. Follow Standard Precautions: hand hygiene; barriers (gloves/goggles) with blood/body‑fluid exposure; careful sharps handling; sharps container disposal; activate exposure plan and consider post‑exposure prophylaxis when indicated.
Testing for HIV
- Antibody tests (blood/body fluid) indicate infection; confirmation follows with a second test.
- Testing may be anonymous (ID number) or confidential (name protected).
- Window period: antibodies may appear 6 weeks to 3 months post‑exposure—retest if needed.
- Negative test ≠ future protection; practice safer behaviors.
- Early diagnosis enables early treatment and better outcomes.
Counseling supports disclosure to partners and behavior change.
What is AIDS, and What Causes It?
AIDS (acquired immunodeficiency syndrome) results from HIV infection after progressive immune damage. People with AIDS are vulnerable to opportunistic infections (e.g., thrush, certain pneumonias) and cancers (e.g., Kaposi’s sarcoma). Drug combinations (“cocktails”) improve outcomes but are not a cure.
Symptoms of AIDS
- White mouth patches/vaginal discharge (candidiasis); recurrent diarrhea; dry cough/shortness of breath.
- Persistent swollen glands; fatigue; recurrent fevers; night sweats; unexplained weight loss (≥10 lbs).
- Memory loss/confusion; movement pain/difficulty; red/purple skin spots.
Providing Care for a Person Living with AIDS
Provide thoughtful, compassionate care; people may need extra emotional support. Care plans should adapt as symptoms change.
Principles of Care Emphasis
- Dignity: Respect, compassion and concern help restore self‑esteem.
- Communication: Listen actively; address fears and loneliness.
- Independence: Encourage control over daily life and conserve energy.
- Infection Control: Practice Standard Precautions to protect the immunocompromised person.
Common Symptoms and Care (Table 18‑1)
| Symptom & Description | Physical Care | Emotional Care |
|---|---|---|
| Mouth infection (candidiasis) Sores/white patches cause pain and difficulty eating/drinking. |
Frequent gentle mouth care (soft brush/sponge/special solution). Do not scrub lesions. Report dysphagia; offer easier‑to‑swallow foods; water if juices irritate. | Show empathy; recall your own discomfort with oral pain to guide compassion. |
| Diarrhea Frequent, watery stools; possible incontinence. |
Keep skin clean/dry; offer extra fluids; report frequency, color and consistency. | Reassure calmly; normalize assistance with toileting/clean‑up; invite expression of feelings. |
| Nausea/vomiting | Reduce odors; cool compress/wipe; mouth care as desired; wait before food/liquids; start with clear liquids; report episodes and intake. | Stay nearby; reassure you understand and are not upset by vomiting. |
| Breathing problems | Limit activity; upright positioning; avoid constrictive clothing; O2 per order; avoid smoke. | Remain calm and present; anxiety worsens dyspnea—your calmness helps. |
| Swelling (edema) | Cool compresses; elevate head/affected limbs; frequent skin checks; gentle lotion. | Be compassionate; encourage sharing feelings about appearance changes. |
| Chronic fatigue | Plan care with the person; assist ADLs to conserve energy; schedule frequent rests; align with desired activities. | Validate fatigue; offer help without undermining independence. |
| Fever/night sweats | Encourage fluids; lukewarm sponge baths without chilling; change linens/clothing; ice packs wrapped in cloth to axilla/groin if directed; monitor temperature with antipyretics. | Explore fears/anxiety. |
| Muscle loss Weight loss >=20%—loss of fat and muscle; risk for infection and skin problems. |
High‑calorie/high‑protein additions (butter, peanut butter, honey); aim 2000–2700 kcal/day as directed; ROM exercises; reposition q2h; meticulous skin care. | Support grooming/dress; clothing adjustments to fit new size. |
| Mental difficulties Confusion due to nervous system involvement. |
Safe, quiet environment; reduce clutter/noise; simple statements; memory cues (clock/calendar). | Maintain a tranquil presence. |
Bed‑bound care: Reposition at least q2h; monitor skin; maintain motion; offer comfort measures (backrub, call bell within reach).
Risks of Physical Contact / Food / Pets / Personal Items
- Avoid people with contagious illnesses (esp. chicken pox); follow timelines after exposure.
- Frequent handwashing; avoid contact if you have skin infections.
- Food safety: steam leftovers hot; separate raw/cooked foods; refrigerate promptly (<2 hours out); avoid deli foods, soft cheeses (e.g., Brie, Camembert, blue), unpasteurized milk; wash/peel produce; thorough cooking; separate cutting boards.
- No special dishes/utensils needed; person with AIDS may prepare food if not having infectious diarrhea and with proper hygiene.
- Avoid contact with litter boxes, droppings and fish‑tank water.
- Do not share razors, toothbrushes, tweezers, cuticle scissors, pierced earrings.
Providing Emotional Care
- Be a good listener; be trustworthy and respect privacy; be dependable and positive.
- Do not take anger personally; manage your own emotions with professional support.
When a Person with AIDS Dies
Health status may fluctuate (“roller coaster”). People may plan funerals earlier; discuss wishes openly. Continue personal care, communication, thermal comfort, positioning, mouth care and urinary monitoring. Follow employer policy in any setting and seek support for your own grief.
The Continued AIDS Crisis
Shifts in demographics have occurred over time; treatments reduced incidence and deaths. For current information: 1‑800‑CDC‑INFO / 1‑800‑232‑4636 (TTY 1‑800‑232‑6348), English/Español, 24 hours; see CDC HIV resources.
Providing Care for a Person with Hepatitis
Hepatitis is viral liver disease (A, B, C most common; D, E less common). HBV/HCV/HDV can cause severe, chronic disease, cirrhosis, liver failure or cancer.
Hepatitis A (HAV)
- Spread fecal‑orally via contaminated hands/food/water; risk: travel to poor sanitation, dirty needles, MSM, household/day‑care contact.
- Prevention: meticulous handwashing; HAV vaccine; immune globulin for short‑term pre‑exposure/post‑exposure protection.
Hepatitis B (HBV)
- Spread by blood, semen, vaginal fluids (same routes as HIV); risks: sexual contact, perinatal, sharing personal blood‑contaminated items, injection drug use, occupational exposure, endemic‑area origin.
- Not spread by casual contact/food/water.
- Symptoms may include jaundice, appetite loss, GI/joint pain, fever, profound fatigue; some become lifelong carriers.
- Prevention: HBV vaccine (3 doses) — highly recommended for health care workers (often employer‑provided).
Hepatitis C (HCV)
- Spread primarily by blood contact; sexual spread uncommon but safer sex advised.
- Not spread by breast‑feeding, casual contact, food/water, utensils, sneezing/coughing.
- Often chronic; some progress to cirrhosis/failure. No vaccine; treatments exist but no definitive cure referenced in this chapter context.
What is Tuberculosis (TB) Infection?
Bacterial lung infection. After exposure, bacteria may become inactive (latent TB infection): no symptoms, not contagious, positive skin test, but can progress later without preventive therapy.
How TB is Spread
Airborne spread from a person with infectious pulmonary/throat TB via coughs/sneezes. Bacteria settle in lungs; can disseminate to kidney/spine/brain (usually not infectious).
Signs and Symptoms
- Chest pain; cough >2 weeks; hemoptysis; weakness/fatigue; weight loss; anorexia; chills; fever; night sweats.
Providing Care for a Person with TB
- Follow Isolation Precautions; wear a mask during personal care; gown only if clothing may be contaminated.
- Teach cough etiquette (tissue + proper disposal); early in treatment, have person wear a mask around others.
- Use a window fan to bring fresh air into the room; practice handwashing; provide good nutrition and rest; plan rest periods.
Testing and Older Adults
- Mantoux skin test is the screen; positive requires chest x‑ray/labs to rule in active disease; common requirement for health‑care employment.
- Nursing homes are higher‑risk settings; programs should include screening for residents/staff and infection‑control measures.