New fever, productive cough, dyspnea, or oxygen desaturation may signal PCP or another opportunistic infection that must be reported now.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client with renal colic from a ureteral stone reports severe, intermittent, sharp flank pain radiating to the groin. Which nursing intervention is the PRIORITY?
Answer: A. Renal colic causes excruciating pain, so prompt pain management (typically opioids and/or NSAIDs) is the priority along with antiemetics for the associated nausea. Adequate hydration is also encouraged to help the stone pass, and all urine is strained to capture the stone. Restricting all fluids is incorrect because hydration aids stone passage.
Question 2 of 3
A nurse is assessing a client with advanced AIDS. Which finding is consistent with Kaposi sarcoma, an AIDS-defining condition?
Answer: A. Kaposi sarcoma presents as purplish, reddish-brown, or dark non-blanching lesions on the skin and mucous membranes. White curd-like patches in the mouth suggest oral candidiasis, painful vesicles suggest herpes, and a productive cough suggests a respiratory infection rather than Kaposi sarcoma.
Question 3 of 3
The nurse reviews the CD4+ T-cell count of a client with HIV. Which result indicates the client has progressed to AIDS?
Answer: D. A diagnosis of AIDS is made when the CD4+ T-cell count falls below 200 cells/mm3 (or with an AIDS-defining opportunistic infection). Counts of 500 or above are within or near the normal range (500 to 1600), and a count of 350 indicates moderate immunosuppression but not AIDS.
Keep the streak going with more questions like these, each with a full rationale.
What is hiv/aids?
AIDS is the advanced stage, defined by a CD4 count below 200 or the presence of an AIDS-defining opportunistic infection. It is transmitted through blood, semen, vaginal/rectal fluids, and breast milk, NOT through casual contact, hugging, or sharing utensils. Antiretroviral therapy (ART) suppresses viral load and lets people live long lives, but adherence is everything.
Key points to remember
- HIV targets CD4 T-helper cells; as CD4 count falls, the patient becomes vulnerable to opportunistic infections.
- Acute (seroconversion) illness looks like flu or mononucleosis: fever, fatigue, sore throat, rash, and lymphadenopathy.
- AIDS is diagnosed when CD4 drops below 200 cells/mm3 or an AIDS-defining illness (PCP pneumonia, Kaposi sarcoma, esophageal candidiasis) appears.
- Opportunistic infections such as Pneumocystis jirovecii pneumonia, TB, cytomegalovirus, and toxoplasmosis are the major causes of death.
- Standard precautions are used for routine care; HIV alone does not require an isolation room.
- An undetectable viral load on consistent ART means the virus is effectively untransmittable sexually (U=U).
Nursing priorities
- Reinforce strict, lifelong ART adherence at the same times daily; skipped doses drive resistance.
- Apply standard precautions consistently and monitor for and prevent opportunistic infections.
- Monitor CD4 count and viral load trends to gauge immune status and treatment response.
- Promote nutrition, vaccination per protocol, and prophylaxis (such as TMP-SMX) when CD4 is low.
- Provide nonjudgmental emotional support and connect the patient to counseling and community resources.
Labs & values
Patient teaching
- Take antiretroviral medication exactly as prescribed every single day, even when feeling well, to keep the virus undetectable.
- Use condoms and do not share needles or razors; an undetectable viral load greatly lowers but should not replace barrier protection per provider guidance.
- Avoid raw or undercooked foods, unpasteurized products, and contact with reptiles or cat litter to reduce infection risk.
Red flags: report now
- New fever, productive cough, dyspnea, or oxygen desaturation may signal PCP or another opportunistic infection that must be reported now.
- New neurologic changes (confusion, headache, focal deficits, seizures) can indicate toxoplasmosis or CNS lymphoma and need urgent evaluation.
- A CD4 count falling below 200 demands prompt provider notification to start opportunistic-infection prophylaxis.
- Never breastfeed if HIV positive in settings where safe formula is available; transmission risk is real.
References
Clinical references for this topic
