Alan is 34 years old. He works as a salesman and travels extensively. He is admitted to hospital for investigation of acute abdominal pain. He has a 6 week history of nausea and vomiting and is feverish with abdominal pain and tenderness on admission. He says that he had a chest infection 4 months ago, and on examination he is found to have oral thrush.
Following tests and investigations, Alan’s abdominal pain is found to be caused by cytomegalovirus (CMV) colitis.
After counselling, he is tested for HIV and found positive. He is to start on anti-viral treatment.
You are providing Alan’s nursing care during this hospital admission. Alan’s wife visits and asks you to explain his condition and treatment.
Another patient in the ward asks you if Alan has AIDS and expresses concern about Alan being in the next bed.
How is CMV diagnosed?
What alerted medical staff to a possible diagnosis of HIV?
How are patients prepared for testing for HIV and disclosure of test results?
How is HIV spread?
What infection control precautions will be required for Alan’s hospital care?
How is patient confidentiality maintained in hospital?
What are the attitudes of staff and patients to HIV?
ASPECTS OF TOPIC TO BE INVESTIGATED
• Presentation of HIV – when do HIV patients seek health care and why?
• Conditions associated with HIV
• Methods of transmission
• Infection control measures
• Testing – when, where and how?
• Diagnosis of HIV – what proportion of people know their HIV+ status?
• Concept of blame related to health status – the ‘innocent’ patient/ how disease transmitted
• Disclosure of HIV status, who needs to know?
• Treatment – who gives it, where and when?
• Equality and diversity
• Non- judgemental attitudes
Students will be able to:
Discuss why patients who are HIV + are admitted to hospital.
Explain the clinical conditions caused by HIV infection
Explain why people with HIV may be unaware of their status
State the methods of transmission for HIV
Describe infection control procedures that reduce the risk of HIV infection
a) in the clinical area
b) in the community
Discuss fears of patients and staff regarding HIV transmission
Explain the nurse’s duty of confidentiality
Discuss when disclosure of HIV status is advisable
Describe the care of a patient admitted to hospital with acute abdominal pain
REFERENCES: INFORMATION ON HIV
Also has links to other organisations and resources
National Aids Trust - NAT
Reasons why HIV patients are admitted to hospital, New York Bronx, 2007
Nicola, the scenario is excellent, I like the trigger questions and the learning outcomes, awesome piece of work.
With your permission I would like to use it for my class next Fall.
Thank you for posting the web links
Thank you Violet, I would be delighted if it is useful. I don't think it's complete yet, I think we need more discussion of the issues around talking to the wife and the patient in the next bed. I haven't got any references for that yet. Also, would the website references be appropriate for your students? Or would you give them articles and book titles?
I have posted an abstract from an article published in 2008 on the Nurse Educators' Group discussion. It shows that PBL does improve students' critical thinking skills.
Can you access it?
I look forward to seeing your comments on this scenario.
I just read the scenario and yes like what Violet has said its a nice now that would let students and others health workers in the clinical to think . As these things can occur and is happening in some set ups. Additionally, I think it would be necessary to add the following trigger questions
1. what will the nurse do [its a dilemma [to tell or
not to tell] - truth telling] as the nurse need to
have to think about professionalism and safe
guarding the patient's rights.
2. should the nurse seek permission or discuss with
Alan first before responding to the wife's request?
3. should the nurse cousel the wife first?
4. how will be wife react to the news about Alan's
We agreed yesterday that we need more information about Alan's treatment. here it is.
Alan's CMV is diagnosed after an endoscopy and tissue biopsy.
He will be treated with Ganciclovir 5mg/Kg IV every 12 hours for 14 days.
Prophylactic maintenance therapy is not required, but Alan is advised to seek further advice about managing his HIV.