Patients who are weak and debilitated as a
result of chronic ill-ness associated with HIV infection typically require many
kinds of supportive care. Nutritional support may be as simple as pro-viding
assistance in obtaining or preparing meals. For patients with more advanced
nutritional impairment that results from decreased intake, wasting syndrome, or
GI malabsorption asso-ciated with diarrhea, parenteral feedings may be
required. Im-balances that result from nausea, vomiting, and profuse diarrhea
often necessitate IV fluid and electrolyte replacement.
breakdown associated with KS, perianal skin excoriation, and immobility is
managed with thorough and meticulous skin care involving regular turning,
cleansing, and applying medicated ointments and dressings.
associated with skin breakdown, abdominal cramping, peripheral neuropathy, or
KS is managed by analgesics given at regular intervals around the clock.
Relaxation and guided imagery may be helpful in reducing pain and anxiety.
symptoms, such as dyspnea and shortness of breath, may be related to infection,
KS, or fatigue. For these patients, oxygen therapy, relaxation training, and
energy conservation techniques may be helpful. Patients with severe respiratory
dys-function may require mechanical ventilation. Before placing a patient on
mechanical ventilation, the procedure is explained to the patient and the
caregiver. The patient may elect not to be placed on mechanical ventilation,
and the patient’s wishes should be followed. Ideally, the patient has prepared
an advanced direc-tive identifying preferences for treatments and end-of-life
care, including hospice care. If the patient has not identified prefer-ences in
advance, treatment options are described so that the patient can make informed
decisions and have those wishes respected.