SCENARIO MO, a 27-year old, heterosexual female was brought by relatives to the EMS department. According to the relatives of the patient, the patient was experiencing fatigue, weight loss, fevers, chills, night sweats, and a productive cough for several weeks.  MO was diagnosed with HIV infection on September 2008 with P. carinii pneumonia as AIDS-defining illness. Her last HIV clinic visit was 2 months ago. She was also clinically diagnosed with depression since September 2008. She currently lives with her sexual partner who was also diagnosed with HIV infection. She works as an accountant. She is nonsmoker and drinks alcohol occasionally.   Medications: Nelfinavir, 1250 mg PO BID  Zidovudine 300 mg/lamivudine 150 mg (combination), 1 tablet PO BID  Trimethoprim/sulfamethoxazole, 1 DS tablet PO 3X/week  Sertraline, 50 mg PO QD  Oral contraceptive (30 pg ethinyl estradiol and 0.3 mg norgestrel), 1 tablet PO qD  Multivitamin with iron, 1 tablet PO qD  Allergies: NKDA    Physical Examination
: GEN: Thin female with productive cough  VS: BP 110/72, HR 90, RR 22, T 37.5C, Wt 50 kg  (Wt 2 months ago was 55 kg),        Ht 160 cm  HEENT: PERRIA, lymphadenopathy  COR: RRR  CHEST: Radiograph: apical fibrocavitary infiltrates  ABD: Nontender, no masses  GU: WNL
 RECT: WNL, guaiac negative  EXT: WNL
 NEURO: A and O X 4, no headache  Laboratory Examination Results in SI units (Conventional unit)   Na 137 (137) Hgb 100 (10) Plts 160 x 109 K 3.6 (3.6) RBC 3.6 x 1012 Glu 6.1 (110) Cl 98 (98) MCV 115 (115) Ca 2.2 (8.8) HCO3 26 (26) AST 0.37 (22) PO4 0.92 (3.0) BUN 3.6 (10) ALT 0.38 (23) Uric acid 190 (3.2) Cr 70.7 (0.8) Alk Phos 1.5 (90) T Bili 3.4 (0.2) Tot Chol 4.65 (180) Alb 36 (3.6) Mg 1.2 (2.5)  HDL 1.22 (47) LDH 1.7 (100)     Hct 0.30 (30) Lkcs 3.2 x 109                   Pregnancy test: Negative
 G6PD deficiency screening test: Negative (test result 9/08)  PPD tuberculin skin test: 8 mm  Three serial sputa for AFB stains and cultures were obtained AFB smear: Positive for mycobacteria  Culture and sensitivity: Pending  Blood, urine, and stool cultures and sensitivity: Pending  Induced sputum: Negative for Pneumocystis carinii pneumonia  Arterial oxygen: 90 mm Hg (on room air)  Assessment and therapy justification for each problem Health Care Problems Therapeutic Goal Therapeutic Recommendation Rationale

SCENARIO

MO, a 27-year old, heterosexual female was brought by relatives to the EMS department. According to the relatives of the patient, the patient was experiencing fatigue, weight loss, fevers, chills, night sweats, and a productive cough for several weeks. 

MO was diagnosed with HIV infection on September 2008 with P. carinii pneumonia as AIDS-defining illness. Her last HIV clinic visit was 2 months ago. She was also clinically diagnosed with depression since September 2008.

She currently lives with her sexual partner who was also diagnosed with HIV infection. She works as an accountant. She is nonsmoker and drinks alcohol occasionally.

Medications:

Nelfinavir, 1250 mg PO BID 

Zidovudine 300 mg/lamivudine 150 mg (combination), 1 tablet PO BID 

Trimethoprim/sulfamethoxazole, 1 DS tablet PO 3X/week 

Sertraline, 50 mg PO QD 

Oral contraceptive (30 pg ethinyl estradiol and 0.3 mg norgestrel), 1 tablet PO qD 

Multivitamin with iron, 1 tablet PO qD 

Allergies: NKDA 

Physical Examination
:

GEN: Thin female with productive cough 

VS: BP 110/72, HR 90, RR 22, T 37.5C, Wt 50 kg  (Wt 2 months ago was 55 kg),       

Ht 160 cm 

HEENT: PERRIA, lymphadenopathy 

COR: RRR 

CHEST: Radiograph: apical fibrocavitary infiltrates 

ABD: Nontender, no masses 

GU: WNL


RECT: WNL, guaiac negative 

EXT: WNL


NEURO: A and O X 4, no headache 

Laboratory Examination Results in SI units (Conventional unit)  

Pregnancy test: Negative


G6PD deficiency screening test: Negative (test result 9/08) 

PPD tuberculin skin test: 8 mm 

Three serial sputa for AFB stains and cultures were obtained

AFB smear: Positive for mycobacteria 

Culture and sensitivity: Pending 

Blood, urine, and stool cultures and sensitivity: Pending 

Induced sputum: Negative for Pneumocystis carinii pneumonia 

Arterial oxygen: 90 mm Hg (on room air) 

Assessment and therapy justification for each problem