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PHAR 6263 HIV Patient Counseling Activity HIV Patient Worksheet
xplain 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 1/2 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 https://cedarville.instructure.com/courses/13966/pages/session-23-hiv-patient-counseling-simulation-tubb-slash-jenkins?module_item_id=681851 2/2 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).