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.
Skin 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.
Pain 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.
Pulmonary 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.
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