Sallie Jefferies, 28-year-old patient, is at the obstetric clinic for a pregnanc

Question

Sallie Jefferies, 28-year-old patient, is at the obstetric clinic for a pregnancy visit. The physician informs the patient that her HIV screen test is positive. The patient has no evidence of AIDS. The nurse provides patient education regarding what HIV is and what the clinical management entails. a. What clinical management is recommended for the patient during the pregnancy to help decrease the risk of transmitting HIV to the unborn child? b. The patient asks the nurse how zidovudine (Retrovir) will help her unborn child from getting HIV. How should the nurse respond? c. What explanation about Retrovir should the nurse provide? d. The patient asks the nurse if it will be safe to breast-feed her infant after the delivery. The nurse should provide what explanation? e. The patient asks the nurse what testing schedule for the HIV antibody is needed after her baby is born. How should the nurse respond?

Explanation / Answer

a.Clinical management recommended for the patient during pregnancy to help minimize the risk of transmitting HIV to child is:

1. Pregnant women is treated with anti HIV drugs to minimize the load of virus during pregnancy. The patient is given either zidovudine twice daily for prophylaxis with zidovudine or nevirapine for 6 weeks. If breastfeeding is done then NVP is given up to 1 week after end of breastfeeding. OR prophylactic regimen of three drugs combination (AZT, TC, NVP or EFV or FTC) in standard dose given during pregnancy and breastfeeding and child given treatment for 6 weeks.

2. After birth, child is also given anti HIV medicine for 4 to 6 weeks.

3. Breastfeeding is avoided in such case as transmission can take place from milk of mother.

b. Zidovudine is used to treat HIV. It helps in preventing transmission of HIV infection from mother to unborn child. Zidovudine acts by showing its antiviral action towards HIV and preventing its load although HIV cannot be fully cured, it reduces the chances of transmission from mother to child. It brings down the risk of transmission to 1%.

c. Retrovir (Zidovudine) shows its action by inhibiting enzyme involved in replication of virus thus reduces viral load. It is also used in combination therapy with other anti HIV drugs. The medicine is swallowed with plenty of water. The capsules can be taken with or without food. The side effects may include headache, dizziness, diarrhea, and anemia etc. Doctor should be reported if any allergic reaction or pain in muscle, joint pain and numbness in extremities occurs.

d. Breastfeeding increases the chance of transmission of infection from mother to child, so it is recommended that breastfeeding should not be done. If breastfeeding is done proper regimen of antiretroviral therapy is followed but it involves some risk of transmission.

e. The infant is tested up to 14 days, then a test is performed after baby is 1 month old, then tested after baby is 4 months old. At least two reports should have negative result. Then the child is tested when one and half year old. If report is negative child does not have HIV.

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