Case Study
At Risk for Human Immunodeficiency Virus Disease
Patient Profile Mr. Emilio Chavez, a 20-year-old university student, comes to the student health centre with pain on urination.
Subjective Data
• Describes pain as “Just like it felt when I had the clap last year”
• Provides a history of sexual activity since age 15; reports lifetime sexual partners as six women and two men
• Denies injected-drug use, tobacco use, or corticosteroid therapy
• Uses alcohol (mainly beer) at weekend parties and has smoked marijuana, but not recently
• Recent sexual activity has been on weekends during or after beer parties
Objective Data Physical Examination
• 180 cm tall, 76 kg, temperature 38°C, purulent urethral discharge noted
Laboratory Studies
• Urine test for Neisseria gonorrhoeae yields positive result
Collaborative Care
• Intramuscular injection with ceftriaxone, 250 mg
• Doxycycline, 100 mg orally, twice daily for 7 days
Discussion Questions
1. Why should Mr. Chavez be encouraged to be tested for human immunodeficiency virus (HIV)?
2. How will the nurse counsel Mr. Chavez about the testing process? How can the nurse help him prepare for the test and the test results?
3. What further questions will the nurse need to ask Mr. Chavez before the nurse can determine his educational needs?
4. Ask a classmate to be “Mr. Chavez” and role-play HIV risk assessment, risk-reduction counselling, pretest and post-test counselling.
5. Priority Decision: What are the main considerations to cover when teaching about barrier methods of protection? Are there cultural components that may affect the nurse's approach to teaching about condoms?
6. How will the nurse discuss the issue of partner notification with Mr. Chavez?
7. Priority Decision: Mr. Chavez's HIV test result comes back positive. What are the priority nursing decisions? What psychosocial issues would the nurse consider? What are the most important things for Mr. Chavez to know at the first meeting with him after he gets his diagnosis? How might he react, and how should the nurse deal with it?