PHAR 6263 HIV Patient Counseling Activity HIV Patient Worksheet

2/7/23, 6:05 AMSession 23: HIV Patient Counseling Simulation (Tubb / Jenkins): Infects Disease/Immun Mod II (01) 2023SP
Session 23: HIV Patient Counseling
Simulation (Tubb / Jenkins)
To-Do Date: Feb 16 at 8:00am
HIV Patient Counseling Learning Objectives
Utilize appropriate patient-centered communication strategies.
Recommend appropriate first-line antiretroviral therapy for a treatment-naïve patient.
Provide patient education on the proper dose, administration, and adverse effects of antiretroviral
agents.
Explain in nontechnical terms the surrogate markers and their use in monitoring HIV disease.
Identify potential barriers to medication adherence.
Discuss potential strategies to overcome identified barriers and maximize treatment adherence.
Demonstrate professionalism in discussing potentially sensitive and private issues with the
patient that ensures nonjudgmental interactions.
HIV Point-of-Care Testing Learning Objectives
Utilize appropriate patient-centered communication strategies.
Explain in nontechnical terms what the test is for and how it will be performed.
Perform HIV point-of-care testing using an oral sample.
Analyze results of an HIV point-of-care test.
Explain in nontechnical terms the results of an HIV point-of-care test and the implications.
Demonstrate professionalism in discussing potentially sensitive and private issues with the
patient that ensures nonjudgmental interactions.
Simulation Notes
Resources are NOT permitted in the room in which you are counseling the patient.
Session Materials
HIV Simulation Student Guide (https://cedarville.instructure.com/courses/13966/files/2106564?
wrap=1)
(https://cedarville.instructure.com/courses/13966/files/2106564/download?
download_frd=1)
HIV Patient Simulation Worksheet
(https://cedarville.instructure.com/courses/13966/files/2002003?wrap=1)
(https://cedarville.instructure.com/courses/13966/files/2002003/download?download_frd=1)
($CANVAS_COURSE_REFERENCE$/file_ref/g7e8d34ad42ba9ecd7d46ff85ae057571/download?
wrap=1)
https://cedarville.instructure.com/courses/13966/pages/session-23-hiv-patient-counseling-simulation-tubb-slash-jenkins?module_item_id=681851
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2/7/23, 6:05 AM
Session 23: HIV Patient Counseling Simulation (Tubb / Jenkins): Infects Disease/Immun Mod II (01) 2023SP
HIV Counseling Patient Case (https://cedarville.instructure.com/courses/13966/files/2068061?
wrap=1)
(https://cedarville.instructure.com/courses/13966/files/2068061/download?
download_frd=1)
HIV Point of Care Testing Rubric (https://cedarville.instructure.com/courses/13966/files/2002006?
wrap=1)
(https://cedarville.instructure.com/courses/13966/files/2002006/download?
download_frd=1)
HIV Therapeutic Plan and Counseling Rubric
(https://cedarville.instructure.com/courses/13966/files/2002007?wrap=1)
(https://cedarville.instructure.com/courses/13966/files/2002007/download?download_frd=1)
Reading
Required: None
Supplemental: None
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PHAR 6263: HIV PATIENT COUNSELING ACTIVITY
PATIENT CASE – GUIDE
LEARNING OBJECTIVES
•
Recommend appropriate first-line antiretroviral therapy for a treatment-naïve patient.
•
Provide patient education on the proper dose, administration, and adverse effects of antiretroviral agents.
•
Explain in nontechnical terms the surrogate markers and their use in monitoring HIV disease.
•
Identify potential barriers to medication adherence and discuss potential strategies to overcome those barriers and
maximize treatment adherence.
•
Demonstrate sensitivity in discussing potentially sensitive and private issues with patient that ensures nonjudgmental
interactions.
PATIENT PRESENTATION
Chief Complaint: “I am here for regular follow-up care and am ready to discuss therapy.”
HPI
JB is a 34 yr old that was diagnosed with HIV infection 2 years ago during a routine exam. At the time of diagnosis, the patient was
asymptomatic. Patient is currently antiretroviral therapy naïve, and since diagnosis, has been following up regularly every 4
months.
PMH
HIV infection diagnosed 2 years ago; risk factor IV drug user
Bronchitis
Asthma
GERD
FH
Noncontributory
SH
History of crack cocaine use, last used 1 month ago
History of heroin use, last used 1 year ago
Smokes marijuana once per week mainly as an appetite enhancer
Tobacco 1 ppd, EtOH drinks on weekends: 3-4 drinks
Unemployed, lives with partner
Sexually active with stable partner; partner is HIV (-) and is aware of HIV status
Medications
Multivitamin tablets QD
Tums PRN
Albuterol HFA, 2 puffs Q 6 h PRN
Allergies
Bactrim (rash)
Physical Exam
•
•
Gen – thin, well-developed in NAD, alert and oriented x 3
VS – BP 110/64 mm Hg, P 80 bpm, RR 18, T 35.9⁰C, Wt 58 kg, Ht 5’ 8”
•
•
Skin – Anicteric, has large tattoo on back. No other skin lesions noted.
HEENT – (+) Oral lesions and white plaques, sinuses non-tender, PERLA, ears and nose clear
•
•
•
•
•
•
•
Neck – Supple, no thyromegaly, R neck lymph node 0.7 cm in diameter
Chest – Lungs clear
CV – Normal
Abd – (+) BS, soft, non-tender, without HSM; (+) Bilateral inguinal lymph nodes 0.5 cm in diameter
GU – Normal. Perineum and perianal areas are free of grossly visible lesions. Guaiac (-) stools.
Ext – No wasting, no CCE
Neuro – No focal deficits
Labs
Parameter (units)
2 years ago
Today
Parameter (units)
2 years ago
Today
Weight (kg)
65
58
BUN (mg/dL)
5
10
Hgb (g/dL)
10.9
11.1
SCr (mg/dL)
0.8
0.9
32.9
33.6
T. bili (mg/dL)
0.5
1.6
234
287
Alb (g/dL)
3.3
3.8
WBC (x10 /mm )
7.1
5.7
AST (IU/L)
17
19
Lymphs (%)
47.3
45.5
ALT (IU/L)
12
13
Monos (%)
6.4
6.6
Fasting Glucose
115
93
Eos (%)
3.5
0.9
T. Cholesterol
–
162
Basos (%)
0.3
0.2
Triglycerides
–
53
42.5
46.8
LDL
–
45
3.0
2.7
Hct (%)
3
3
Plt (x10 /mm )
3
3
Neutros (%)
3
3
ANC (x10 /mm )
CD4 (%)
HBV Ab
Negative
38
25
HBV core Ab total
Negative
CD4 (cells/mm )
689
477
HBV Ag
Negative
CD8 (%)
48
48
HCV Ab
Negative
HIV RNA (copies/mL)
25,000
155,000
HAV Ab
Positive
Antiviral resistance test
(genotypic resistance
test)
L63P
3
ASSESSMENT
A 34-year-old with HIV infection, ART-naïve, shows steady decline in CD4 count and rising levels of HIV viremia since initial diagnosis
2 years ago, now ready to discuss ART therapy (not previously open to starting).
STUDENT PROMPT
You are an APPE student in a HIV clinic, your preceptor instructs you to do the following for the patient:
1.
Propose an appropriate antiretroviral regimen for this patient (drug, dosage, schedule and duration of therapy, major side
effects) and counsel them appropriately.
2.
Explain any monitoring (clinical & laboratory) that patient will need to have completed.
3.
Explain the surrogate markers and their use in monitoring HIV disease to patient.
4.
When counseling the patient, identify any potential barriers to medication adherence and discuss potential strategies
with patient to overcome these barriers and maximize treatment adherence.
Adapted from Burgos, Rodrigo M., Thomas D. Chiampas, and Keith A. Rodvold. “Case 147: HIV Infection.” Pharmacotherapy Casebook: A Patient-focused Approach. 9th ed. New York:
McGraw-Hill, Medical Pub. Div., 2005. 377-79. Print.
PHAR 6263: HIV PATIENT COUNSELING ACTIVITY
HIV PATIENT WORKSHEET
Please respond to the following based on the HIV Patient Case. You must upload a copy of this worksheet with your
answers on Thursday, Feb 25th by no later than 8:00am.
1. Explain your choice of antiretroviral regimen for this patient (drug, dosage, schedule and duration of therapy,
major side effects, and any major counseling points).
2. Explain what monitoring (clinical & laboratory) that patient will need to have completed bases on your ART
choice.
3. Explain surrogate markers and how are they used to monitor a patient’s response to therapy (using language
patient will understand).