HIV/AIDS Care and Treatment A Clinical Course for People Caring for Persons Living with HIV/AIDS
b. Assessment • Take a full history and do a physical exam. • Assess level of dehydration. Clinical Features
Severe
Moderate
General appearance/condition
Restless/irritable
Usually conscious; cold, apprehensive, sweaty, cyanotic extremities
Pulse
Rapid
Rapid, feeble, sometimes impalpable
Respiration
Deep, may be rapid
Deep and rapid
Skin elasticity
Pinch retracts slowly
Pinch retracts very slowly (>2 seconds)
Eyes
Sunken
Deeply sunken
Mucous membranes
Dry
Very dry
Urine flow
Reduced amount and dark
None passed for 6 or more hours; bladder empty
• Investigate underlying causes and carry out appropriate laboratory tests. c. Causes of diarrhea • Infections: parasites, bacteria, viruses, protozoa • Malignancies such as KS or lymphoma • Idiopathic (possibly HIV infection) d. Management • The first priority is fluid replacement and maintaining adequate hydration, preferably by means of oral fluids. • Provide electrolyte supplements: Oral rehydration salt solution (ORS) Potassium found in oranges, bananas and other local fruits • Treat underlying causes of diarrhea with appropriate medication. • Give supportive treatment with antidiarrheal drugs.
6. Difficulty sleeping/insomnia a. Definition Insomnia and excessive daytime sleepiness are primary complaints regardless of the stage of disease. Insomnia includes difficulty falling asleep, difficulty staying asleep and early morning awakening. b. Assessment • Determine the pattern of the sleep problem (frequency, associated events, how long it takes to go to sleep and how long the patient can stay asleep).
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