The patient with acquired immunodeficiency syndrome who has been noncompliant with highly active antiretroviral therapy (HAART) presents to the emergency department with a productive cough, fever, night sweats, and weight loss. The patient’s chest x-ray reveals diffuse infiltrates bilaterally and the CD4 count is 182 cells/µL. Which question by the nurse is most important?

“Are you allergic to sulfa drugs?”. The patient has Pneumocystis jirovecii pneumonia which usually only occurs in the immunocompromised. It is treated with trimethoprim/sulfamethoxazole (TMP/SMX), so it must be determined if the patient has a sulfa allergy. Although it is important to ask if the patient has been appropriately vaccinated, this does not specifically relate to the treatment plan. It is unimportant if the patient has recently been treated with penicillins. Asking if side effects are the reason for the patient’s noncompliance is not particularly conducive to open, therapeutic communication and does not address the patient’s need for TMP/SMX.

The patient with acquired immunodeficiency syndrome who has ...

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Pharmacological and Parenteral Therapies
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Category: Pharmacological and Parenteral Therapies
Difficulty: 9

Topics: Communication & Documentation Immunity Infection Inflammation Lifestyle Choices and High Risk Behavior Medication and Blood Products

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