HOME CARE PLAN FOR OI's

Understanding the Problem
Opportunistic infections occur when the immune system is not working properly. The infections occur in persons who have HIV/AIDS because they do not have the normal defenses to fight off organisms that cause infections. Opportunistic infections are more likely to occur when a special blood count, the CD4 or T4 count, is below 200. The CD4 count for normal healthy adults is between 700 and 1200. For the person with HIV/AIDS, the CD4 count usually decreases gradually over time.

The organisms that cause opportunistic infections are categorized as protozoa, fungi, viruses, and bacteria. These organisms are found widely in nature and often live in the human body. Persons with defective immune system are unable to fight off the growth and destructive action of these organisms within the body. Opportunistic infections are seldom spread to people who have normal immune systems and are healthy.

The information in this home care plan fits most situations, but yours may be different. If the doctor or nurse tells you to do something else, follow what he or she says, If you think there may be a medical emergency.

This may or may not be accompanied by a stiff neck, a headache, or a fever. The person you are caring for will seem less alert, confused at times, forgetful, more irritable, or somewhat clumsy. These symptoms may point to an infection either within the brain or within the layers that cover the brain (called the meninges); the latter infection is called meningitis.

Pneumonia is a very common infection for persons with HIV/AIDS. Pneumonia can be treated, but treatment must begin early. A delay will result in breathing problems that are frightening, incapacitating, and possibly life-threatening. The person with HIV/AIDS is also very susceptible to tuberculosis, a respiratory infection that is easily spread even to healthy adults and children.

Chronic diarrhea is often seen in persons with HIV/AIDS because the AIDS virus can affect the intestinal tract. Other organisms, such as salmonella, can also attack the digestive tract, causing symptoms such as abdominal cramping, uncontrolled diarrhea, and weakness. Although not all diarrhea is caused by opportunistic infections, it is important to report to health care professionals to determine the cause.

Chickenpox and shingles (a painful rash) are caused by the herpes zoster virus. People with HIV/AIDS are vulnerable to this virus, and caregivers can also become infected if they come into contact with the weeping blisters. Those who have not had chickenpox are susceptible to both chickenpox and shingles because the same virus causes both conditions. Those caregivers who have had chickenpox cannot get it again. As always, a caregiver should use precautions to prevent contact with body fluids.

Cytomegalovirus (CMV) infections, if left untreated, will result in blindness. The person with HIV/AIDS may complain of blurred vision, flashes of light, floating spots before the eyes, or blind areas within the visual field.

Candida albicans is the fungus that causes thrush infections in the mouth and throat. It can also infect the esophagus, causing inflammation and pain each time the person swallows.

Candida albicans often causes a yeast infection in the vagina of HIV-positive women that is difficult to get rid of.

It is important to know the person's CD4 count when describing symptoms. Symptoms become more of a concern when the CD4 count is low, for example, 20 as opposed to 500. Report the CD4 count along with the problems you are describing.

"I am Vijay shinde, Dinesh shah's caregiver. Dinesh is a patient of Dr. Joshi. Dinesh says his eyes are blurry and he only sees half of what he's looking at. Dinesh`s CD4 count, done 1 month ago, was 25."

Because the person with HIV/AIDS often has many medications to take, some of which can cause nausea and other side effects, the person you are caring for may be tempted to omit medications or to stop taking them altogether. Help the person you are caring for to stick to medication schedules. Remind him that missing doses will make the medicines less effective.

If the person you are caring for has difficulty remembering to take medicines, medication boxes (also called compliance packs) can be used. These plastic boxes, usually set up weekly, are divided into times of the day and days of the week. Using compliance packs is a way for the caregiver to verify whether the person has remembered to take medications at the prescribed times. If you can't find a plastic medicine box to suit your needs, an empty egg carton can work just as well; simply mark each slot with the name of the day of the week and the time that medicine is to be given that day.

Because certain treatments can be unpleasant (for example, pentamidine treatments administered monthly to prevent Pneumocystis carinii pneumonia), people with HIV/AIDS tend to omit them. Fatigue also interferes with how often the person with HIV/AIDS takes skin treatments and checks his or her temperature, and even how often he or she bathes and brushes teeth. Your assistance and encouragement are important. For example, you can put a checklist on the bathroom mirror or start a routine, such as brushing teeth after all meals.

Avoid preaching or scolding. These techniques are discouraging and offensive. Again, offering assistance and providing gentle reminders about the purpose and importance of certain treatments or medications is always more effective. Be creative. Assist the person you are caring for to manage treatments and medications himself or herself.

See that the immune system of the person you are caring for is supported through good nutrition, restful sleep, moderate exercise, good hygiene, stress management, and pleasurable experiences. Make sure that he or she avoids alcohol, "recreational drugs," tobacco, and "unsafe sex."

"This cough and headache are just from a cold I've picked up (or from my smoking). It should clear up in a few days if I take things easy."

Response: For a person with HIV/AIDS, a cough is often the first sign of a serious respiratory infection. If it is not treated quickly, it may become a life-threatening pneumonia that is much harder to treat. Smoking makes the cough and respiratory distress worse. Also, smoking promotes the progression of AIDS. Call health professionals about colds and headaches early rather than later.

"Headaches are a regular part of my life. When I get upset they come more often. This one will pass as soon as I relax."

Response: With HIV/AIDS, headaches that are persistent or hard to control or that cause changes in the person's ability to think may be a sign of a more serious problem that should not be ignored. Report such headaches, especially if the CD4 count is low or has not been measured recently.

Infections must be treated as soon as possible. In order to deal with opportunistic infections early, you must be alert for any changes in normal patterns. The body will give alerting signs that all is not well and that an infection is in progress.

If the person you are caring for is feeling better, you are making progress. Pay attention to which recommendations are working, and keep a "diary" of your progress. Continue to encourage him or her to keep taking the medications and treatments that will prevent further opportunistic infections.

Home Care Plan for Fever and Infections

Fever, defined as a temperature higher than normal, is the most common sign of an infection. Other common signs of infection include fatigue, swelling, shaking chills, cough, pain, and headache. Chronic fevers are common with HIV/AIDS, but when a new fever is noticed in a person with HIV/AIDS, it should be checked out by a doctor. Thereafter, chronic fevers should be watched carefully. Fevers may become persistent as the disease progresses, and such fevers are very physically taxing. A new fever that is higher than usual (greater than 101 °F [38.3 °C]) can be a sign of a new infection requiring treatment with new or different antibiotics. Untreated fevers also add to weakness and fatigue.

Infections are caused by organisms or germs, such as bacteria, viruses, and fungi, that invade the body and begin to grow. Persons who are HIV-positive or who have developed AIDS are more likely to get infections because their immune systems are not working to protect them. The AIDS virus attacks the immune system and destroys it. When the CD4 count (T4 lymphocyte count) is 200 or less, the person is especially susceptible to infections.

Call the doctor, nurse, or the "after hours" phone number immediately if any of the following occurs:

Most normal oral temperatures are around 98.6 °F (37 °C) and can rise to 100.4 °F (38 °C) in the evening, but some people can have "normal" temperatures that are higher or lower than these. Consult with the doctor or nurse to learn beforehand (before an emergency occurs) what the normal temperature is of the person you are caring for. Bear in mind that a person with HIV/AIDS may have a chronic or persistent fever of 99 °F to 101 °F most of the time and that a normal temperature will usually rise in the late afternoon hours. Check the temperature twice over a 2-hour period to be sure that there is a fever. A thermometer is the easiest to use and takes the guesswork out of taking a temperature:

Chills occur before a temperature goes up. Take the temperature after the chills and shaking have stopped unless they continue for more than 1 hour. Take a temperature during the chills if they last for more than 1 hour.

Painful urination indicates a urinary tract infection. Usually the person with this type of infection urinates in very small amounts. A person with a urinary tract infection feels a constant urge to pass urine even if little urine is in the bladder.

It is very important to report if the person you are caring for has not urinated in the last day or has urinated very little. This condition has a variety of causes and needs to be investigated. It may be a sign of dehydration and may indicate the need for increased fluids, even intravenous (IV) fluids. It may also be a sign that the kidneys are not functioning properly.

Report any problems with the respiratory tract, especially the feeling that it is hard to draw air into the lungs or release it. Labored or difficult breathing, with or without a fever, is important to report.

Some symptoms that should be reported during regular office or clinic hours, even though they do not indicate an emergency, include the following:

The person you are caring for has a fever and is too weak to drink fluids. Report if the person you are caring for has a fever and is drinking very little. Drinking fluids is very important in a person with a fever because the body loses water when the body temperature rises. Dehydration may occur if the fever causes severe sweating and fluids are not being replaced.

Any redness or swelling near the site of a venous access device (for example, an IV, etc). Venous access devices can become infected at any time after placement. This can happen even when great care has been taken to keep the site clean and free of contamination.

Any open wound on the skin can become infected when the immune system is not working normally. The area may become more red and more tender. The wound may look deeper or the drainage from it may have changed color.

Infections can develop quickly in the mouth or throat. Report these symptoms even if they are not accompanied by fever.

Menstrual abnormalities or irregularities have a variety of causes, including pregnancy, infection, tumors, and hormonal imbalances. Because the immune system of HIV-positive women is compromised, any potential sign of infection or cancer, such as a change in the menstrual pattern, should be reported.

Women with HIV/AIDS women tend to have more gynecologic infections than other women. Vaginal candidiasis, also known as a yeast infection, is the most common. Symptoms included vaginal itching and a white curd like discharge. This infection often persists in women with HIV/AIDS, despite the use of over-the-counter medicine, so report the symptoms.

Lower abdominal pain.

In women with HIV/AIDS, lower abdominal pain may be a symptom of pelvic inflammatory disease (PID), a serious infection. This infection is equally likely in women with or without HIV/AIDS.

"I am Vijay shinde, Dinesh shah's' caregiver. Dinesh is Dr. Joshi`s patient. An hour ago, he had shaking chills that lasted for more than 20 minutes, and he had a temperature of 102.5 °F. dinesh is also saying that he has a bad headache. What should I do? Do you think she has a new infection?"

Certain medicines such as aspirin reduce fevers. These drugs will not eliminate the cause of the fever, but they will make the person who is ill feel more comfortable.Make certain that all medications are taken that have been prescribed by the doctor for fever or infection.

Cooling the forehead brings some relief from the discomfort of fever by cooling the blood that flows through the head close to the surface of the skin.

If fever is accompanied by profuse sweating, the person you are caring for can get chills from the moisture. This adds to the discomfort brought on by the fever.

Unless the doctor has instructed that fluids be restricted, encourage the person who has a fever to drink 2 to 3 quarts of cool fluids over a 12-hour period. During a fever, more fluids than usual are being lost through the skin and lungs, which may lead to dehydration. Drinking 2 to 3 quarts of fluids reduces this risk.

If you have a cold, sore throat, or the flu, arrange for someone else to care for the person with HIV/AIDS until you are well.

If you cannot find anyone to fill in for you, make certain that you wash your hands carefully before caring for the ill person.

It is especially important that anything that is used orally (for example, a thermometer or toothbrush) not be shared.

Hand washing is the best way to limit the spread of germs. Both the person with HIV/AIDS and those who come in contact with him or her should wash their hands frequently and brush their teeth at least twice daily to help kill the germs that cause infections.

Infections can be caused by unwashed raw fruits and vegetables; raw or poorly cooked eggs, fish, meat, and poultry; and unpasteurized milk. This is because of the bacteria and parasites that these foods carry. Proper washing and cooking will destroy sources of infection in food. Proper food storage is also important.

Increased fluid intake will help prevent urinary infections. Urinary infections are less likely to occur when the kidneys, bladder, and urinary system are well flushed with plenty of fluids, especially water.

Encourage cleaning the rectal area thoroughly after bowel movements, especially if he or she has diarrhea.

Women especially should cleanse the rectal area from front to back to reduce the likelihood of a urinary tract infection. Also, keeping the rectal area clean, particularly when diarrhea is a problem, will help keep the rectal area from getting raw or sore.

You may need special immunizations and medicines to take with you.

Make sure that shoes fit well and do not rub or cause blisters. Wash cuts or sores immediately with soap and water. Even small cuts or sore areas on the feet can let bacteria into the body.

Lotions boost the ability of the skin to stay intact by keeping the skin moist. Bacteria can enter dry skin cracks, leading to infection.

Soil has bacteria that can cause infection when in contact with skin cuts.

Pet feces (stools) contain bacteria and fungi that can cause an infection in a person whose immune system is not functioning normally. If the person you are caring for is scratched or bitten by a pet, wash the site well and call the doctor or nurse if it begins to look infected. Stay up to date on routine vaccinations for your pets and tetanus boosters for yourself. Always wash your hands after handling pets, their toys, their hygiene items, their food and water, and their rugs and blankets. Be sure to have someone other than the person with HIV/AIDS wash fish tanks or reptile tanks.

Possible Obstacles to Care giving

Here are some common attitudes, fears, and misconceptions that may prevent you from carrying out your plan:

"High fevers can be controlled by medication."

Response: High fevers, especially if they are new fevers, may indicate an infection. Taking a few medication tablets is not the only action needed. Careful monitoring of the fever and associated symptoms and reporting the temperature to the doctor or nurse is very important. This will ensure that treatment is started early, before the condition worsens.

"I've had fevers before, and they didn't last long. This one will go away like the others."

Response: Fevers can be the sign of a serious infection in the body. Remind the person you are caring for that fever needs to be reported, especially if it is new, so the infection can be treated.

Identify additional roadblocks that could keep you from following the recommendations in this home care section:

Checking on results:

Check on how effectively you are controlling fevers and preventing infections. Are fevers and infections occurring less often? Pay attention to which recommendations are working for you and which ones the person with HIV/AIDS is following. (For example, is the person with HIV/AIDS avoiding situations that increase the risk of his or her getting an infection?) Keep a "diary" of your progress.