Page 265 - Encyclopedia of Nursing Research

232 n HIV SyMpTOM MANAGeMeNT AND QUAlITy OF lIFe

metabolic complications such as body fat dis- opportunistic infections being Pneumocystis
tribution abnormalities, lactic academia, insu- carinii pneumonia and Kaposi’s sarcoma.
H lin resistance, and bone disease (corless et al., The development of more advanced medi-
2005). patients with untreated HIV infection cation regimes (e.g., ArV) in the mid-1990s
frequently experience cD4 immunity inca- resulted in the evolution of HIV into a
+
pacitation, causing viral spread and develop- chronic illness (Spirig, Moody, Battegay, &
ment of opportunistic infections. However, Geest, 2005). However, despite care innova-
for patients receiving ArV, the more pervasive tions and prospects for longer term survival,
challenges may be the advent of unwanted side individuals with HIV infection continue to
effects that can trigger anxiety and depressive experience a plethora of medication side
symptoms and lead to medication nonadher- effects, comorbidities, and opportunistic
ence (Wantland et al., 2008). Other researchers diseases. consequently, medication nonad-
concur that symptoms (e.g., nausea, diarrhea, herence continues to be pervasive and often
fatigue, depression, and confusion) often have results in exacerbation of symptoms and
profound effects on daily activities and med- development of resistant strains of the virus.
ication adherence, further exacerbating the Kremer et al. (2009) cited “the decision to
negative impact on health-related quality of take antiretroviral therapy requires a long-
life (HrQOl; Hudson, Kirksey, & Holzemer, term commitment, because patients inter-
2004; Hughes, 2004; Kremer, Ironson, & porr, rupting antiretroviral therapy compared
2009). Symptom management, including pro- to those continuing were at increased risk
viding clients with avenues to explore self-care of death, cardiovascular disease, metabolic
strategies, has become a significant part of the effects, and immune activation during viral
health care provider’s role. The focus of this rebound” (p. 127).
chapter is to provide information about select The literature is replete with citations
aspects of the symptom experience; the effects regarding how health care providers can
of ArV therapy, comorbidities, and opportu- optimally manage the care of HIV-infected
nistic infections upon HrQOl; and the symp- patients. As patients have become more
tom management strategies for those living Internet savvy and increasingly incorpo-
with HIV/AIDS. rate self-managed complementary modali-
Merriam-Webster (2010) defines a symptom ties, the need for additional patient-friendly
as “subjective evidence of disease or physical resources has emerged. The International
disturbance.” Symptom management is “care HIV/AIDS Nursing research Network,
given to improve the quality of life of patients based at the University of california at San
who have a serious or life-threatening dis- Francisco (UcSF) School of Nursing, devised
ease. The goal of symptom management is a handbook in 2004 titled The HIV/AIDS
to prevent or treat as early as possible the Symptom Management Manual. Information
symptoms of a disease, side effects caused on 21 commonly occurring symptoms was
by treatment of a disease, and psychologi- validated by clinicians working in HIV care
cal, social, and spiritual problems related to and corroborated by participants in several
a disease or its treatment” (National cancer Network-directed research studies around
Institute, 2010). Quality of life is a term defined the world (Wantland et al., 2008). The man-
as a patient’s general well-being, including ual is available for free download at http://
mental status, stress level, sexual function, www.aidsnursingucsf.org. Because of the
and self-perceived health status (Stedman’s vast numbers of symptoms and manage-
Medical Dictionary for the Health professions ment complexities, our discussion within
and Nursing, 2005, p. 1233). this chapter will be limited to one primary
Initial reports of HIV began to occur in symptom and its associations with other fre-
the early 1980s, with the most frequently cited quently reported sequelae. lipodystrophy