Assignment: HIV infection & treatment Care Plan

Assignment: HIV infection & treatment Care Plan

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Question Description
A 10-year-old girl by name of Lucy Johnson with HIV infection presented to an HIV treatment facility in Lusaka, Zambia, with fever, rash, and weight loss.

History

The patient is a 10-year-old Zambian girl who was brought by an aunt to the clinic in January 2006 for evaluation to begin antiretroviral therapy (ART). She is believed to have been infected with HIV congenitally, and was diagnosed at a private clinic in another town with a baseline CD4 count of 89 cells/µL (CD4 percentage: 19%). Her past medical history was otherwise notable for growth retardation, recurrent pneumonia, and pulmonary tuberculosis. She had no known drug allergies.

At her initial antiretroviral (ARV) clinic visit, she reported chronic diarrhea, painful feet, and subjective fevers. On examination, she was afebrile and her weight (18 kg) was low for her age. Her physical examination was significant for a fine papular pruritic rash, conjunctival pallor, crackles at the left lung base, and a soft but distended abdomen. Results of laboratory tests performed at that time included a hemoglobin level of 8.1 g/dL, white blood cell (WBC) count of 5,800 cells/µL, and platelet count of 409,000 cells/µL. She was prescribed trimethoprim-sulfamethoxazole (TMP-SMX, cotrimoxazole) as prophylaxis against Pneumocystis jiroveci pneumonia, mebendazole as empiric treatment of her diarrhea (to cover helminthic infections such as Strongyloides stercoralis), hydrocortisone ointment to suppress her rash, as well as multivitamins, vitamin B6, and folic acid as nutritional supplements.

She returned to the clinic 3 weeks later, reporting resolution of the diarrhea and the subjective fevers. She had gained 2 kg, but still had a pruritic rash that then was treated with a 2% sulfur ointment. She had not yet started the TMP-SMX regimen, but was instructed to do so and to return in 2 weeks for initiation of ART. At her clinic visit 2 weeks later, ARV initiation was postponed because of delays in obtaining laboratory results and the unavailability of her caregiver. By now she had begun the TMP-SMX regimen, and continued on this regimen. During the subsequent 6 weeks, her clinical status continued to improve and she maintained a stable weight. However, during a visit at the end of February, she complained of continued pruritic rash and recurrence of fevers and diarrhea. Records of treatment rendered at that visit are unavailable. A complete blood count (CBC) was requested. At a return visit in mid-March, she again reported improvement in the rash, and also the diarrhea. Fever was not noted in the chart. At this time, CBC results from her previous visit were available:

WBC count: 3,500 cells/µL
Hemoglobin level: 4.4 g/dL
Hematocrit: 14.7%
Additional laboratory results drawn at the patient’s mid-March visit revealed:

WBC count: 5,700 cells/µL
Hemoglobin level: 6.8 g/dL
Platelet count: 832,000 cells/µL
CD4 count: 141 cells/µL (CD4 percentage: 7.3%)
Alanine aminotransferase (ALT) level: 17 IU/L
Aspartate aminotransferase (AST) level: 37 IU/L
Creatinine level: 20 mg/dL
ARV initiation again was postponed. The reasons for ART deferral during this period are not entirely clear, but appear to be based on a combination of factors, including delays in obtaining the patient’s laboratory results and concerns that she had an underlying opportunistic infection (OI) that required diagnosis and treatment before ART initiation. The clinic treatment protocol defers ART initiation in patients with signs or symptoms of an active OI.

When the patient returned to the clinic in early April, she was afebrile and deemed clinically stable, so an ART regimen consisting of nevirapine, lamivudine, and stavudine was initiated. At that visit, her examination was notable for small (0.5 cm in diameter) papules on her face. Documentation in the patient’s chart does not indicate clearly whether this was a new rash, or whether she had other symptoms. A presumptive diagnosis of molluscum contagiosum was made.

She returned approximately 3 weeks later complaining of painful and pruritic nodules that had developed soon after she started ART, subjective fever, generalized weakness, and body aches.

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.