IDENTIFICATION DATA

Name of Pt.– Gautam

Age/sex – 05 yr

Ward No. – M.M.W II

Bed No. – 15

Religion – Hindu

Education – 2ND Standerd

Occupation – nill

Date of Admission - 15/12/09

Dr. Consultant – Dr. Prjapati

Diagnosis – HIV/AIDS

FAMILY HISTORY
S.No. Name of Family Member Age/Sex Relation which Health History
patient
1. Bhanu Pratap 30 M Father No
2. Saroj 26 F Mother No
3. Kusum 04 M Sister No

FAMILY OF ILLNESS
Past History:

My pt. has history of recurrent T.B.

Present Illness:

 Low Grade fever

 Diarrhoea
 PHYSICAL EXAMINATION

Appearance

Nourishment - Under Nourished

Body Build - Thin

Activity - Dull

Mental Status

Consciousness - Semi-Conscious

Look - worried

Skin Condition

Color/Texture - Complex

Temperature - Low fever

Head Face - normal

Scalp - normal

Sutures - normal

Fontanels - normal

Eye

Eye brow - clean black

Eyelid - clean

Conjunctiva - Pale

Nose

Nostril - No DNS
Ear

External Ear - No discharge

Mouth

No any facial congenital Problem like Cleft lip & palate.

Tongue

No coated tongue.

Neck

Lymph node - No enlargement

Throat & Pharynx

No enlargement of tonsils.

Chest

Normal breathing sound

Abdomen - Normal

Back - Normal

Genitalia

No any congenital abnormality.

Extremities

Upper - Slowly flexed

Lower - Slowly flexed

Vital sign

Temperature - 35.4 C

Respiration - 22bt/min

Pulse - 90/min

B.P. - 95/80 mm of Hg

Anthropometry

Weight - 12Kg

Height - 95cm

Body Mass Index

(Weight /Height2 ) x 100

BMI = 12 (Malnourished)

MEDICATION

S.No. Name of Drug Route Time Action

1 Inj. Ziduvodine I/v BD Antiviral
2 Inj. Ceftriazone I/v OD Antibiotic
3 Inj. G.M. I/v BD Antibiotic
4 Inj.Ritonavire I/V OD Protease
Inhibitor
 ANATOMY OF THE CIRCULATORY SYSTEM
The human circulatory system is organized into two major circulations. Each
has its own pump with both pumps being incorporated into a single organ—
the heart. The two sides of the human heart are separated by partitions, the
interatrial septum and the interventricular septum. Both septa are complete
so that the two sides are anatomically and functionally separate pumping
units. The right side of the heart pumps blood through the pulmonary
circulation (the lungs) while the left side of the heart pumps blood through
the systemic circulation (the body).
The human heart is a specialized, four-chambered muscle that maintains the
blood flow in the circulatory system. It lies immediately behind the sternum,
or breastbone, and between the lungs. The apex, or bottom of the heart, is
tilted to the left side. At rest, the heart pumps about 59 cc (2 oz) of blood per
beat and 5 l (5 qt) per minute. During exercise it pumps 120-220 cc (4-7.3 oz)
of blood per beat and 20-30 l (21-32 qt) per minute. The adult human heart is
about the size of a fist and weighs about 250-350 gm (9 oz).

The human heart begins beating early in fetal life and continues regular
beating throughout the life span of the individual. If the heart stops beating for
more than 3 or 4 minutes permanent brain damage may occur. Blood flow to
the heart muscle itself also depends on the continued beating of the heart and
if this flow is stopped for more than a few minutes, as in a heart attack, the
heart muscle may be damaged to such a great extent that it may be
irreversibly stopped.

The heart is made up of two muscle masses. One of these forms the two atria
(the upper chambers) of the heart, and the other forms the two ventricles (the
lower chambers). Both atria contract or relax at the same time, as do both
ventricles.

An electrical impulse called an action potential is generated at regular

intervals in a specialized region of the right atrium called the sinoauricular (or
sinoatrial, or SA) node. Since the two atria form a single muscular unit, the
action potential will spread over the atria. A fraction of a second later, having
been triggered by the action potential, the atrial muscle contracts.

The ventricles form a single muscle mass separate from the atria. When the
atrial action potential reaches the juncture of the atria and the ventricles, the
atrioventricular or AV node (another specialized region for conduction)
conducts the impulse. After a slight delay, the impulse is passed by way of yet
another bundle of muscle fibers (the Bundle of His and the Purkinje system.)
Contraction of the ventricle quickly follows the onset of its action potential.
From this pattern it can be seen that both atria will contract simultaneously
and that both ventricles will contract simultaneously, with a brief delay
between the contraction of the two parts of the heart.

The electrical stimulus that leads to contraction of the heart muscle thus
originates in the heart itself, in the sinoatrial node (SA node), which is also
known as the heart's pacemaker. This node, which lies just in front of the
opening of the superior vena cava, measures no more than a few millimeters.
It consists of heart cells that emit regular impulses. Because of this
spontaneous discharge of the sinoatrial node, the heart muscle is automated.
A completely isolated heart can contract on its own as long as its metabolic
processes remain intact.

The rate at which the cells of the SA node discharge is externally influenced
through the autonomic nervous system, which sends nerve branches to the
heart. Through their stimulatory and inhibitory influences they determine the
resultant heart rate. In adults at rest this is between 60 and 74 beats a minute.
In infants and young children it may be between 100 and 120 beats a minute.
Tension, exertion, or fever may cause the rate of the heart to vary between 55
and 200 beats a minute.

Physiology of the Circulatory System

It is likely that your blood pressure is different right now from what it was
when you started reading this section. The difference may not be substantial,
but due to the complexity of factors that affect blood pressure, it constantly
changes in response to a number of physiological and environmental stimuli.
For example, drinking a caffeinated or alcoholic beverage could influence your
blood pressure while you read this page. Smoking a cigarette would have the
same result. Your blood pressure will also differ if you are watching television
while reading this page or if you are interacting with another person. Even the
simple act of reading affects your blood pressure. In fact, given the constant
adjustments in blood pressure that occur, we really should not refer to an
individual’s blood pressure as a stable medical parameter.

As depicted in Figure 1.1, blood pressure is jointly determined by the amount

of blood ejected into circulation (cardiac output) and the forces of the
circulatory system that impede blood flow (total peripheral resistance).
Increases in either cardiac output or total peripheral resistance will result in
increased blood pressure. Cardiac output, in turn, is determined by heart rate
and stroke volume (amount of blood ejected from the heart with each stroke).
Again, increases in either heart rate or stroke volume will increase cardiac
output, and thus blood pressure. Total peripheral resistance is comprised of
the degree of vasodilatation and vasoconstriction that occurs in the various
blood vessels that compose the entire peripheral circulation. All of these
hemodynamic parameters (heart rate, stroke volume, cardiac output, total
peripheral resistance) rarely operate in the same direction. Increased heart
rate, for example, is often accompanied by a reduction in stroke volume,
potentially resulting in no change in cardiac output or blood pressure at all.
However, all physiologic or psychological states that affect blood pressure will
do so by altering cardiac output, total peripheral resistance, or some
combination of the two.
Figure 1.1.Hemodynamic parameters that
affect blood pressure.

Several systems of the body directly influence

blood flow through the body and the magnitude
of blood pressure, including: (a) the metabolic
demands of the local tissue and associated blood vessels, (b) the autonomic
nervous system, (c) the neuroendocrine system, (d) the excretion of fluid by
the kidney, and (e) an extensive feedback system that involves central
nervous system activity. To illustrate these various interrelated systems, let’s
consider what happens to blood flow when a person engages in a bout of
moderate exercise, like jogging on a treadmill, riding a bicycle, or taking a
vigorous walk. Obviously, blood flow will need to increase to support the
metabolic demands of the leg muscles, delivering more oxygen and nutrients
while removing the waste by-products from the muscle cells of the legs.
Unusually, although heart rate increases significantly during moderate
exercise, very little change in diastolic blood pressure is typically observed
(Kasprowicz et al.,1990).

Figure 1.2. Major physiological systems

involved in the regulation of blood pressure
(dotted arrows represent local blood cell
auto regulation; solid arrows represent
neural influences; dashed arrows represent
neuro endocrine influences; SNS =
sympathetic nervous system).
Therefore, during exercise, the body must engage in a variety of regulatory
processes to maintain blood pressure in light of the increased cardiac activity.
To provide an exhaustive overview of the physical, chemical, and neural
elements involved in the regulation of blood pressure is clearly beyond the
scope of this section and site. The following sections are meant to represent
only an overview of the major systems involved in the regulation of blood
pressure illustrated in Figure 1.2. The interested reader is referred to Kaplan
(2002) for a more complete description of the physiological mechanisms that
affect blood pressure regulation.
 HIV/AIDS
Introduction: First AIDS causes in 1960 it transferred by sexual contact or I/V
infusion and direct contact with blood product.
In1985 it transferred from HIV infected mother and child who is receiving
blood transfusion.

Definition
It is and infectious disease of individual. AIDS is caused by HIV. It is suppress
the immune system causes immune deficiency syndrome.

Etiology:
HIV is transmitted by lymphocytes and monocytes it is two types:
1. HIV : it is transfer horizontal such as sexual contact I/V transfusion
direct contact with blood and body fluids like vaginal secretion semen,
breast milk.
2. Parental Transfusion: it transfers directly from HIC positive mother
passage the infection to her baby by placental rate.

Classification
Class P-O: in terminate infection children less 15 months of age they have
antibody of HIV.
Class P-1
 Normal immune function
 Abnormal immune function
 Immune function not known
Class P-2
 Non specific symptoms
 Neurological disease
 Lymphoid interstitial pneumon
 Sac infection or other disease
Pathophysiology
Due to etiological factor

HIV enter in to blood stream

It contact with T lymphocyte of monocytes (CO1+ T cell)

Virus attack over CO1+ T cell

CO1+ T cell dysfunction

Use amount CO1+ T cell

The amount CO1+ T cell

Immune system (Immunodeficiency)

Sign and symptoms:

 Continuous fever of diarrhea
 Malnutrition Cardiomegaly, illness
 Neuropsychological deficit
 Developmental disability
 Deficit motor skills
 Communication and behavior impaired
 Lymphadenopathy
 Hepato Splenomegaly
 Oral candiasis
 Peritonitis, fatigue, weakness
 Other infectious disease
 Slow wound healing
 Encephalopathy, weight loss
Elisa Test (Enzyme linked immune sorbent assay)
 Western blot – (seen presence of antibody – both test done more than
18 months)
 PCR – Polymerase chain reaction
 Virus culture
 P24 antigen defection
 CO1+ T cell lymphocyte count below 400/mm3

Therapeutic management
Prophylaxis: PCP (Pneumocystis carinii pneumonia) vaccine.
3-6 months of life

Immunization:
 Avoid chicken pox
 Administer influenza, pneumonia
 Administer MMR if HIV is not sever
 Anti-tuberculin drugs in case of mycobacterium avium intracellular
complex
 Trimethoprim sulfamethoxazole (TMD-SM2)
 If adverse effect of TMP-SM2 gives the dapsone or pentamidine can be
used.
1. Nucleoside transcriptase inhibitor :
Antiviral drug therapy – To prevent reproduction of function of virus
include – zidovudine, didnosine, stavudine, lamivudine
2. Non nucleoside reverse transcriptase inhibitor
 Nevirapine
 Delavirdine
3. Protease inhibitor:
 Indinavir
 Ritonavir
 This therapy cause severe bone marrow aspiration it leads
anemia with n 4-6 week of therapy.
Assessment:
 Assess the sign of infection
 Assess the vital sign
 Check the daily weight
 Assess the neurological function
 Assess the behavioral and communicational skills of the patient
 Assess the diagnostic test
 Assess the past history of the patient
 Assess the nutritional status of the patient
 Assess the bowel and bladder function
 Assess the lymphocyte count
 Assess the physical symptoms of the patient
 Asses the anxiety level of patient
 Assess the knowledge level of patient related to self care
Nursing Care Plan

S.N Nursing Nursing Interventions Rational Evaluation

o Diagnosis goal
1. Risk for To use  Assess the sign  To check Reduced
infection the risk of infection infection the
due to of chances of
 Blood test  Identify
impaired infectio infection
should be done systemic
immune n
to check the illness
system
organ infection
 To be
 Provide function of
antibiotics virus

 Provide  To prevent
antiviral other
therapy for infection
reduce the
 To
reproduction
maintain
of virus
safety
 Immunization precaution
should be done
in children
cause

 Prevent from
further injury
because in this
case low
wound healing
of high risk of
infection.
2. Altered To  Provide high  To prevent Maintaine
nutrition maintai colony high malnutritio d
less than n the protein diet in n nutritional
body nutritio case of status
 For rapid
requireme nal malnutrition
healing for
nt due to status
 Provide full quick
restricted
fluid diet recovery
feeding
 Vitamin c diet  To rapid
growth of
 Soft liquid diet
developme
provides
nt
glucose etc.
 To check
 Provide fruits
weight
like banana
orange milk  To
beat egg maintain
the
 Assess daily
malnutritio
weight
n
 Provide
parental
nutrition
3. Impaired To  To encourage  To Social
social improv the patient participat interaction
isolation e social family e with s is
related to interact member this patient improved
physical ion disease not
 To
limitation spread
reduced
social physically
patient
stigma of touch.
fear.
infection
 Never left the  To use
patient alone behavior
and
 Encourage the
communi
patient in
cation
participate
skills
daily activity
 To
 Observe the
provide
behavior of
safety and
family
attention
 Encourage the
 To
patient in
reduced
participate
patient
daily activity
anxiety
observe the
behavior of
family.

 Encourage the
member give
him proper
love and
attention.

 Reduced the
anxiety
BIBLIOGRAPHY:
1. Hocken berry, J. Marilyn and Wilson, David “(Text book of Wong’s
essentials of pediatric nursing)” 8th edition 1st print, publish by Mosby
Elsevier page no. 939-943
2. Ghai OP (1996) “(Text Book of Essential Pediatrics Nursing)” 4th edition,
published by inter print A-16 naraina 2nd new Delhi page no. 157-158
3. Pillitteri Adele (1999)” (Text Book of child health Nursing)” edition 1 st
published by Lippincott. Page no. 649-651
4. Tambul Wadekar “(Textbook of Pediatric Nursing)” page no. 47-49