Case Study: Miss Chan and Comorbid Conditions
Case Study: Miss Chan
Background
Miss Chan is a 45-year-old woman experiencing homelessness and intravenous heroin use. She is HIV positive, malnourished, and has a history of bipolar disorder and seizures during drug withdrawal. She presents at an outreach clinic for regular wound care and is currently experiencing withdrawal symptoms.
HIV/AIDS
What is HIV?
HIV (human immunodeficiency virus) attacks the body’s immune system, making individuals more susceptible to infections and diseases. It spreads through contact with certain bodily fluids, primarily during unprotected sex or sharing injection drug equipment.
Pathophysiology
- Depletion of CD4+ T lymphocytes (helper T cells)
- Increased risk of opportunistic infections and cancers
Signs and Symptoms
- Nausea, vomiting, diarrhea
- Fatigue, weight loss
- Respiratory issues
- Fever, chills, night sweats
- Skin rashes, sores, or lesions
Risk Factors
- Unprotected sex
- Sexually transmitted infections (STIs)
- Intravenous drug use
Complications
- Tuberculosis, meningitis
- Dementia, muscle loss
- Opportunistic infections, candidiasis
HIV vs. AIDS
HIV is a virus that can lead to AIDS (acquired immunodeficiency syndrome), a condition characterized by severe immune system damage.
Bipolar Disorder
What is Bipolar Disorder?
Bipolar disorder, formerly known as manic depression, is a mental health condition causing extreme mood swings between emotional highs (mania or hypomania) and lows (depression).
Pathophysiology
- Alternating episodes of mania and depression
- Exact cause unknown, but likely involves genetics, neurotransmitter imbalances, and psychosocial factors
- Triggers include substance abuse and stress
Signs and Symptoms
- Elevated mood, increased energy, agitation
- Euphoria, decreased need for sleep
- Racing thoughts, distractibility, poor decision-making
Malnourishment
What is Malnourishment?
Malnourishment results from a diet lacking essential nutrients or containing excessive amounts, leading to health problems.
Signs and Symptoms
- Loss of appetite, fatigue, irritability
- Inability to concentrate, feeling cold
- Loss of fat, muscle mass, and body tissue
- Increased susceptibility to illness and slow healing
Causes
- Cancer, liver disease, digestive disorders
- Conditions affecting eating or swallowing
- Medications causing nausea
- Mental health conditions, social issues
Risk Factors
- Older adults, social isolation, low income
- Chronic illness, nutrient absorption issues
- Eating disorders
Drug Withdrawal
What is Drug Withdrawal?
Drug withdrawal refers to the symptoms experienced upon stopping or reducing intake of drugs.
Signs and Symptoms of Heroin Withdrawal
- Watery eyes, runny nose, sweating
- Muscle cramps, loss of appetite, chills
- Tremors, panic
Causes of Drug Addiction
- Environmental factors (family, peers)
- Genetics
Risk Factors for Addiction
- Family history, mental health disorders
- Peer pressure, lack of family involvement
- Early drug use, highly addictive drugs
Complications of Drug Use
- Overdose, seizures, death
- Brain damage, organ damage
- Mental health issues
Nursing Interventions for Miss Chan
- Administer medications as prescribed
- Monitor for withdrawal symptoms and electrolyte imbalances
- Provide wound care and seizure precautions
- Encourage proper hygiene, nutrition, and self-care
- Offer emotional support and active listening
Patient Teaching
- Educate about medications, side effects, and withdrawal
- Promote safe injection practices and HIV prevention
- Emphasize the importance of a balanced diet and protein intake
- Teach about signs and symptoms of infection and withdrawal
Organization Plan
- Review patient chart and care plan
- Gather supplies for assessment, hygiene, wound care, etc.
- Introduce yourself, explain the plan, and obtain consent
- Perform a comprehensive assessment, including vital signs, head-to-toe examination, mental health evaluation, and wound assessment
- Provide wound care, administer medications, and implement seizure precautions
- Assist with hygiene, grooming, and dressing
- Educate the patient and address any concerns
- Document care and ensure patient comfort and safety