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• Introduction
• Chapter 1. Main Aspect s of the nursing process in HIV- infections
• 1.1 Characteristics of the nursing process
• 1.3 The role of nursing staff in counteracting the spread of HIV infection
• Chapter 2 nursing process for HIV - infections
• 2.1 Characteristics of the object of study
• Conclusion
• Application

Introduction

More than 20 years have passed since the registration of the first cases of HIV infection in the world. During this relatively short period, the disease swept the population of almost all continents. The disease has become the most important medical, social, political problem, i.e. has taken on a global dimension.

The main goal of nursing care is to help the patient adapt as much as possible to his condition, taking into account the identified problems throughout the entire period of HIV / AIDS.

Nursing interventions are aimed at solving both existing and potential health problems of the patient. In this regard, the nurse has the following tasks:

Tactful informing the patient about the state of his health;

Elimination of factors that impede the patient's adaptation to his new condition. First of all, this concerns his mental health, because. the stress received during the initial communication to the patient of his diagnosis can lead to unpredictable consequences.

Often an HIV-infected person begins to abuse alcohol, drugs, he has suicidal thoughts. Therefore, the task of the nurse is to adapt the patient to his new condition as best and as quickly as possible:

Teaching the patient self-care, control over their condition;

· as well as training relatives and close people to care for a patient in serious condition and preventive measures.

With the further development of HIV infection in a patient, physiological problems come to the fore. In this regard, it is very important to teach the patient and his relatives the correct actions for some manifestations of concomitant diseases.

A special place in the work of a nurse is occupied by the issues of HIV / AIDS prevention in people around the patient; provision of qualified nursing care, including the precise implementation of independent, interdependent (preparation of the patient for diagnostic procedures) and dependent (medical prescriptions) nursing interventions.

All these, as well as many other tasks, the nurse will be able to solve by resorting to the nursing process, as an integral part of the modern model of nursing.

The purpose of this work is to determine the features of the nursing process in HIV infection.

The object of the study is the professional activity of a nurse.

The subject of the study is the nursing process in HIV infection.

Research objectives:

1. Describe the nursing process;

2. To study the features of nursing care for HIV infection;

3. Determine the role of nursing staff in counteracting the spread of HIV infection;

4. In the process of practical research, to study the features of the nursing process in HIV infection.

Chapter 1. Key aspects of the nursing process in HIV infection

1.1 Characteristics of the nursing process

In the late 1940s American scientist E. Deming, who is often called the father of the Japanese economic miracle, developed his own version of the theory of quality management of any technological process(as well as any kind of activity).

To improve the quality, E. Deming proposed to improve all processes using a cycle. At the same time, the improvement achieved was based on a scientific approach and the human factor.

The essence of the scientific approach was that management should be carried out not on the basis of intuition and sensations, but on the basis of firmly established facts and their scientific analysis. And this requires carefully collected and comprehensively studied reliable and complete information. The human factor lies in the fact that W. Shewhart suggested using this approach to manage people.

Nickle Dsming-Shewhart's universal model later formed the basis for the development of an innovative technology of nursing care, which was called the nursing process.

According to modern ideas, nurses in their activities should act as an equal subject of the healthcare system, performing their specific functions, which include not only providing care for patients, but also solving problems that arise within the framework of existing nursing standards and their competence.

Nursing competence includes professional skills, human care, the ability to take responsibility for decisions and actions, the desire to constantly improve. Today, more than ever, patients need a qualitatively new type of nursing care, which becomes possible in the implementation of the nursing process.

The nursing process consists of 5 steps:

The first step in the nursing process. Collecting information about the patient (examination) and assessing the initial level of knowledge and skills of the patient or his relatives.

At each contact with the patient, starting with the primary one, the nurse receives some information about him. Thus, the collection of information about the patient is continuous. All this information is analyzed and evaluated by the nurse.

The nurse determines whether the patient has knowledge and skills regarding his condition, whether he or his relatives want to acquire the appropriate knowledge and skills, whether the patient is capable of learning, whether he is able to learn, etc.

The second stage of the nursing process. Identification of patient problems.

After collecting and evaluating the information, the nurse identifies a nursing problem: a lack of knowledge about the water balance and the technique for determining it. After that, she must determine how to solve this problem, which will be the content of the next stages of training.

The third stage of the nursing process. Definition of learning objectives, planning of its content.

Before drawing up a training plan, a nurse should set certain goals for herself. The formulation of learning objectives should focus on three areas: cognitive, emotional and psychological. Goals reflect what the patient needs to do in order to achieve the result.

A well-set goal should contain three components (aspects):

1) what the patient needs to do (what he should be able to do, understand, etc.), i.e. learning outcome;

2) time frame - the time interval (or a specific date) during which the learning goal will be achieved (by the 3rd day, in a week, by the end of the month);

3) with the help of whom or what the goal will be achieved (on their own, with the help of relatives, with the help of crutches).

In any case, goals should be specific, realistic and achievable.

The nurse should involve the patient and / or his relatives in the preparation of an individual training plan, taking into account his personal characteristics, social conditions, interest in the issues being studied and physical condition.

Once the training has been determined, the nurse plans the content and methods of the training. The plan includes the time (in the morning, before lunch, after dinner) and the duration of training (10 minutes during 3 days, 20 minutes every other day, etc.).

The fourth stage of the nursing process. Implementation of the training plan.

To implement the planned plan of the nursing process, the nurse, together with the patient and / or his relatives, creates an environment conducive to learning, choose the time for it. If the microclimate of the room is unfavorable (poor lighting, low temperature, the presence of strangers) or the patient's condition leaves much to be desired (the patient is upset, his pain has increased, shortness of breath), then it is better to postpone training.

For successful learning, you can use the following methods:

* demonstration -- the nurse demonstrates skills in self-care or mutual care (brushing teeth, using crutches, injections, measuring blood pressure, etc.); a clear, repetitive demonstration of each stage of a skill is an important means of achieving learning objectives;

* counseling - the nurse observes from the outside how the patient performs a specific skill and, in case of difficulty or at difficult stages, provides him with advisory assistance;

* role-playing -- very effective method learning, especially social skills; with this method, the patient’s capabilities and the difficulties of self-care in a domestic environment are better understood, new skills are developed (the ability to start a conversation, behave confidently in a particular environment), the level of self-awareness increases, and new solutions to the problem are found.

The training scheme consists of five stages:

1) presentation of the necessary information;

2) repetition by the patient of everything that he remembered;

3) showing (demonstrating) what the patient must master;

4) repetition by the patient independently or together with the nurse of the skill;

5) independent explanation and demonstration by the patient of the skill from beginning to end.

Each step of this scheme can be repeated several times until the patient learns the planned material. The nurse should strive to move from the transfer of knowledge to the development of skills, and then to a sustainable skill.

In the learning process, it is necessary to constantly maintain the interest of the trainees, ask them leading questions or build a conversation according to the question-answer principle, emphasize information important to the patient. At the end of the conversation, it is important to briefly repeat all the basic information.

The nurse needs to make sure that the trainees correctly understand the information being conveyed. To do this, she systematically checks and evaluates their knowledge and skills.

The fifth stage of the nursing process. Evaluation of learning outcomes.

After the implementation of the training plan, the nurse evaluates the result, i.e. relates it to the goals. The score might be:

1) the patient is aware of the importance and significance of the information and can independently perform the skill;

2) the patient has not sufficiently learned information and skills (confuses indicators, is unsure of answers and actions, sequences of manipulations); in this case, the nurse needs to analyze the correctness of goal setting and planning, make appropriate adjustments;

3) the patient did not learn the information and/or did not develop the skills. In the latter case, the nurse built the entire learning process incorrectly, did not take into account the patient's condition, his interest, did not decide on goals, or made an unrealistic and impracticable training plan. The entire learning process needs to be re-evaluated.

In any case, the nurse informs the patient about the results of the training, because he needs to know how successfully he coped with the task. In turn, it is also important how the patient himself evaluates the result of training. Self-assessment can be:

* adequate, coinciding with the assessment of the nurse;

* inflated;

* reduced;

* unstable (yesterday I was dissatisfied, today I am satisfied, or vice versa).

In any assessment, the patient should be rewarded and thereby maintain his interest in learning.

Thus, to achieve high learning outcomes, it is necessary:

1) a clearly defined learning goal;

2) convincing motivation for the patient to acquire knowledge;

3) benevolent attitude towards patients and their relatives;

4) creation of an associative link between new information and past experience and knowledge of the patient and his family;

5) obligatory practical development of useful knowledge;

6) effective (therapeutic) communication;

7) the ability to listen;

8) patience and perseverance;

9) encouragement for success in learning;

10) taking into account the patient's condition during training.

From this it follows that the nurse's understanding of the goals, objectives and principles of education, the ability to use a variety of methods, methods and means of education will contribute to the effective education of patients and their loved ones and, consequently, improve their quality of life.

1.2 nursing care with HIV infection, AIDS

Disturbed patient needs: drink, eat, excrete, communicate, work, maintain body temperature, safety.

Patient problem: high risk opportunistic infections.

Goals of care: the risk of infections will decrease if the patient follows certain rules.

Nursing Intervention Plan:

1. Observe the sanitary and anti-epidemic regime in the ward (disinfection, quartz treatment, ventilation).

2. Provide a good night's sleep for at least 8 hours.

3. Provide good nutrition (proteins, vitamins, trace elements).

avoid contact with infectious patients, visitors with respiratory infections should wear masks;

Avoid crowds of people

avoid contact with the body fluids of another person;

Do not use shared razors

shower regularly with antibacterial soap;

wash hands after using the toilet, before eating and preparing food;

Do not touch your eyes, nose, mouth;

Maintain oral hygiene

Monitor the cleanliness of fingernails and toenails;

Reduce contact with animals, especially sick ones, wash hands thoroughly after contact with animals;

Thoroughly wash and clean food, thoroughly boil meat, eggs, fish, avoid contact of cooked and uncooked food, do not drink raw water;

get vaccinated against the flu;

To control the patient's temperature, respiratory rate;

· teach the patient to monitor the symptoms of HIV disease - fever, night sweats, malaise, cough, shortness of breath, headache, vomiting, diarrhea, skin lesions;

· to teach the use of anti-infective and special preventive drugs, to avoid taking immunosuppressive drugs.

Patient's problem: difficulty in eating due to damage to the oral mucosa.

Goals of Care: The patient will take required amount food.

1. Avoid very hot and cold, sour and spicy foods.

2. Include soft, moist, high-protein and fortified foods in the diet.

3. Rinse your mouth before eating with a 0.25% solution of novocaine, after eating with boiled water or a solution of furacilin.

4. Tell about alternative methods of nutrition (through a tube, parenteral nutrition).

5. To brush your teeth, use soft toothbrushes that prevent gum injury.

6. Use anti-infective drugs as prescribed by the doctor (local and general treatment).

Patient problem: diarrhea associated with opportunistic infections, side effect medicines.

Goals of care: diarrhea will decrease.

1. Assess which foods increase or decrease diarrhea and adjust your diet.

2. Provide a diet rich in protein and calories, low in dietary fiber.

3. Ensure adequate fluid intake (water, juices, electrolyte solutions).

4. Apply infectious precautions when preparing and eating food.

5. Ensure timely intake of antidiarrheals prescribed by the doctor.

6. Provide skin care in the perianal area: wash after each bowel movement with warm water and soap, dry it in order to prevent rupture of weakened skin. Apply an emollient cream to the perianal area to protect the skin.

7. Monitor weight, water balance, tissue turgor.

The patient's problem: feeling of depression associated with a change in appearance (Kaposi's sarcoma, loss of hair, weight, etc.) and negative attitudes of others. Option: low self-esteem.

Goals of care: The patient's mental state will improve.

1. Allow fears to be expressed about lifestyle changes in a supportive, nonjudgmental environment.

2. Encourage relatives to communicate with the patient.

3. If necessary, refer the patient for a consultation with a psychotherapist.

4. Teach relaxation techniques.

Patient problem: Nausea, vomiting associated with opportunistic infections, drug side effect.

Goals of care: the patient will have reduced nausea, no vomiting.

1. Ventilate the room to eliminate odors that cause nausea.

2. Provide dietary advice: eat small meals often, avoid hot foods, avoid strong smelling and pungent foods, drink 30 minutes before meals, not during meals, eat slowly and rest for 30 minutes after food in a position with a raised head.

3. Teach to take drugs prescribed against nausea, vomiting (medications are given 30 minutes before a meal).

4. Emphasize the need for careful oral care.

5. Provide the patient with a glass of water, a container for vomit in case of vomiting and help the patient if it occurs.

Patient problem: risk of weight loss.

Goals of care: the patient will receive an adequate amount of food, his weight will not decrease.

1. Clarify the patient's taste preferences and dislikes for food.

2. Provide the patient with high-protein and high-calorie nutrition.

4. Determine the patient's body weight.

5. Determine the amount of food eaten at each meal.

6. Consultation of a nutritionist if necessary.

Patient problem: cognitive impairment.

Goals of care: the patient will be adjusted to the level of his mental abilities.

1. Assess the initial level of mental abilities.

2. Talk to the patient calmly, give him no more than one instruction at a time and, if necessary, repeat the information provided.

3. Avoid disagreements with the patient, as this can lead to the patient developing feelings of anxiety.

4.Prevent possible injury by removing hazards from the patient's environment.

5. Use techniques that facilitate memorization, for example, associative links with familiar objects, calendar entries.

6. Provide family support and educate the caregiver (family) about the above interventions.

1.3 The role of nursing staff in countering the spread of HIV infection

The HIV epidemic continues to grow throughout the world. The pandemic has already claimed about 18.8 million lives and today there are 34.3 million HIV-infected people on the planet.

The situation changed dramatically in 1996, when the virus entered the environment of drug addicts. Everyone should remember that HIV infection is like a nuclear explosion.

Psychologists are confident that the psychological problems of HIV-infected patients are no less important than medical ones. How to overcome the fear, which, of course, is experienced by everyone who is faced with this terrible disease - both the patient, and his relatives, and medical workers? Doctors are primarily responsible for strategy, while nurses are primarily responsible for tactics. And not a single battle will be won if tactical tasks are not solved. A patient comes to us with fear of loneliness, death, anxiety, guilt. The doctor has his own fears: will I be able to help, reassure, the likelihood of getting infected. Touching, their fears give rise to misunderstanding, aggression. To cope with the emotions of anxiety and fear, one should respect the boundaries of personal space. It is very important to know that the patient's aggression is not personally related to you.

There are clear instructions on how and what to do to avoid infection. If doctors, for example, are ordered to work with gloves, they have no right to put patients and themselves at risk by working without them. Specific recommendations were received not only by physicians, but also by educators and representatives of military organizations.

Actions of a medical worker in an emergency:

In case of cuts and injections, immediately remove gloves, wash hands with soap and water under running water, treat hands with 70% alcohol, lubricate the wound with 5% alcohol solution of iodine;

If blood or other biological fluids get on the skin, this place is treated with 70% alcohol, washed with soap and water and re-treated with 70% alcohol;

If blood and other biological fluids of the patient come into contact with the mucous membrane of the eyes, nose and mouth: rinse the mouth with plenty of water and rinse with 70% ethyl alcohol solution, rinse the mucous membrane of the nose and eyes with plenty of water (do not rub);

If blood and other biological fluids of the patient get on the dressing gown, clothes: remove work clothes and immerse in a disinfectant solution or in a bix (tank) for autoclaving;

Start taking antiretroviral drugs as soon as possible for post-exposure prophylaxis of HIV infection.

All medical personnel are very afraid of contracting HIV infection. To find out in which cases the risk of infection is high, extensive studies have been carried out. It turned out that the greatest risk of infection occurs in the case of an injection. Specific measures were developed to protect against a possible infection: doctors were ordered to remove the glove, turning it inside out, wash their hand under running water, and then, pouring a little special alcohol for hands into the other palm, carefully wipe their hands, including the nails, where huge amount of bacteria. You can’t wipe your hands, you need to wait until the alcohol evaporates: this time is enough for the alcohol to kill the infection.

After that, the nurse must write a memorandum to the management of her unit, detailing the causes of the incident and the measures taken by her.

A memo has been developed to help the paramedical worker during the initial contact with a patient with suspected HIV infection

Ways of transmission of HIV infection:

parenteral;

Sexual;

Vertical.

Groups of people who are more likely to get HIV:

intravenous drug users;

People who are promiscuous and have a large number of sexual partners;

Patients with diseases requiring frequent transfusions of blood and its components.

Symptoms to suspect HIV infection:

Prolonged increase in body temperature (subfebrile, febrile);

Generalized lymphadenopathy (enlarged cervical, occipital, axillary (except inguinal) lymph nodes);

diarrhea for more than 1 month;

Unexplained weight loss;

Respiratory infections (more than 4 times a year - for adults and 6 times for children);

Prolonged weakness.

Laboratory studies to which the patient must be referred:

Blood test for HIV;

Immunogram.

Prevention of HIV infection in medical institutions

HIV is transmitted from person to person through sexual contact, blood transfusion (or the accidental transfer of an infected blood HIV from person to person with cutting or stabbing instruments). The virus can also be transmitted from an HIV-infected mother to her child during pregnancy, childbirth and breastfeeding.

In other ways, HIV is not transmitted from person to person.

According to the WHO Regional Office for Europe, the number of nosocomial infections(HI) includes not only diseases that appear in patients as a result of providing them with medical care in hospitals and outpatient clinics, but also infections of medical workers resulting from their professional activities. The risk of contracting infections transmitted by blood contact is especially high. More than 30 infections can be transmitted to healthcare workers through contact with the blood of patients.

Of the occupational infections in medical personnel, viral hepatitis B and C are most common.

The problem of infectious safety for medical workers is extremely relevant. The purpose of this lecture is to raise awareness of occupational exposure and care for patients with HIV infection and viral hepatitis B and C.

Medical personnel should especially observe the prevention of nosocomial infections.

It includes:

1. Compliance with the established requirements for disinfection, pre-sterilization cleaning, sterilization of medical devices, as well as for the collection, disinfection, temporary storage and transportation of medical waste generated in healthcare facilities.

2. Equipping with the necessary medical and sanitary equipment, modern atraumatic medical instruments, means of disinfection, sterilization and personal protection (special clothing, gloves, etc.) in accordance with regulatory and methodological documents. Single-use products after use in manipulations with patients are subject to disinfection / neutralization, their reuse is prohibited.

3. If a case of nosocomial infection with HIV infection is suspected, a complex of preventive and anti-epidemic measures is carried out in health care facilities.

4. An unscheduled sanitary and epidemiological investigation is carried out in order to identify the source, transmission factors, establish a circle of contact persons, both among staff and among patients who are in equal conditions, taking into account the risk of possible infection, and implement a set of preventive and anti-epidemic measures to prevent infection in LPO conditions.

Thus, in the field of nursing in infectious diseases with a course of HIV infection and epidemiology, it is important to remember the following:

Know the risk factors, epidemiological features, main clinical manifestations, complications and prevention of infectious diseases: the duties of a sister in the performance of treatment and diagnostic measures for infectious diseases;

Be able to carry out the stages of the nursing process: conduct an initial assessment, identify patient problems, plan nursing care, conduct ongoing and final assessment of care outcomes;

Be able to ensure the infectious safety of the patient and staff;

Be able to apply universal and standard precautions;

Be able to prepare the patient for diagnostic procedures and take biological material for research;

To be able to carry out anti-epidemic measures in the focus of infections;

Be able to perform nursing manipulations (provide medical services);

Be able to advise the patient, family on the prevention of infectious diseases and their complications;

Know how to provide first aid.

sister infection disease

Chapter 2. Practical study of the features of the nursing process in HIV infection

2.1 Characteristics of the object of study

Consider an example in which a patient went to a family planning office knowing her HIV positive status. She is 25 years old and works as a tour operator. Married for about 10 months, husband is not infected. I found out about my status by accident. 2 months ago she got into an accident, after which she was taken by an ambulance to the trauma department, where, after examination, she found out about the infection. The husband is aware of his wife's infection, accepted calmly and supported her. The woman said that the next of kin did not know about her problem.

Objectively: the patient is asthenic, height is 175 cm, weight is 59 kg, her skin is pale pink.

From the anamnesis: she often suffered from infectious diseases in childhood.

Gynecological status: menstruation from the age of 14, established immediately, 4-5 days later, after 30 days, gynecological pathology denies. R-0, B-0.

He is reluctant to talk about the mechanism of infection, but admits the fact of casual sexual intercourse about a year ago, before meeting her husband.

Both spouses are on antiretroviral therapy.

At the time of the application, she was concerned about the following questions:

1. How to protect your husband from infection, are there any other methods of contraception, in addition to refusing to have sexual contact.

2. Can healthy children be born to an HIV-infected mother?

3. If the spouses decide to have a child, will she be denied medical care in the obstetric and gynecological hospital?

4. Can she infect her parents too?

The psycho-emotional state of the patient: anxiety, fear, depression of mood, a sharp change in mood.

2.2 Development of a program of activities

Let's highlight the problems of the patient:

Real:

Ш fear for your life and loved ones;

Ø fear of discrimination;

o desire to have children in marriage,

o fear of the birth of a sick child;

Ø lack of knowledge about HIV infection, about their rights as a patient;

Ø lack of knowledge about contraceptive methods for HIV;

Potential:

The likelihood of infection of the spouse;

Development of AIDS;

Priority issue:

Lack of knowledge about contraceptive methods for HIV-positive status of one of the sexual partners;

Fear of discrimination and the birth of a sick child.

Short term goal:

The patient will note that she is able to distinguish between many types of contraception by the end of the first week of classes with a nurse (after 2 sessions in the PS office), her psycho-emotional state will improve as a result of the joint actions of the PS office nurse, the patient's husband, a nutritionist, workers of the AIDS Center and the patient herself, the patient will be motivated to continue the classes.

Long-term goal of nursing intervention:

The patient will note the replenishment of knowledge about HIV infection, personal hygiene and nutritional hygiene of an HIV-infected person, about the daily routine, about the drugs used for antiretroviral therapy and about the possibility of having a healthy child, subject to all the requirements for the regimen, as a result of classes with a nurse of the PS office to end of lessons.

All interventions in this case can be divided into independent and interdependent.

Since the patient has a special status and psychological imbalance, the work of a nurse will be reduced mainly to nursing pedagogy and psychology, and the main task is to teach the patient to live with HIV without feeling different, not like everyone else, to know her civil rights.

Table 1 Short-term goal

		1. Monitoring compliance with the regime of the day. 2. With the participation of the patient's husband, control over the duration of sleep with access to fresh air. 3. With the participation of the patient's husband, monitor compliance with the regime of work, rest (excluding the impact of harmful environmental factors that suppress immunity).
	Ensuring observation of the patient (interdependent), (independent).	1. Observation of the patient. 2. Together with a specialist from the AIDS Center where the patient is observed, monitor the monitoring of blood pressure and body temperature, the patient's appetite and weight, skin color.
	Ensuring the sanitary and epidemiological regime. (independent.)	1. Control compliance with the regime of personal hygiene and epidemiological. activities in common areas of the house (toilet, bathroom). 2. Explain to the patient and her husband the need to comply with these measures.
	Provision and adherence to dietary therapy (interdependent)	1. Pay special attention to food intake, its quality, and quantity.
	Provision of psychological assistance (independent)	1. Provide psychological support.
		1. Assess the patient's level of knowledge about HIV / AIDS, and obtain the patient's informed consent to receive additional information, including those of direct interest to her. 2. Pay special attention to the observance of the epidemiological regime at home, as a prevention of infection of relatives. 3. Pay attention to the issue of compliance with the diet, the quality of food. 4. Pay special attention to the regime of the day and issues of valeology. 5. A conversation with a woman about the need to punctually follow the doctor's prescriptions for the use of antiretroviral drugs. 6.Together with the woman, evaluate the results of the lesson. 7. Assess the patient's motivation to continue teaching her about family planning for HIV.

Efficiency mark:

OBJECTIVE ACHIEVED if the patient notices an improvement in her psycho-emotional state, gets motivated to conduct further classes with her on family planning for HIV, notes an increase in knowledge about her disease and methods of contraception.

Nursing care:

1. Journal of outpatient admission of patients form 025 / y

2. Journal of patronage form 039 - 1 / y

3. Tonometer, thermometer.

4. Gynecological chair

5. A set of disposable instruments for examination by a doctor, sterile gloves, protective screens.

6. A set of PCR tubes for taking blood for hormones, for infections, and other laboratory glassware.

7. Thematic developments for conducting interviews with patients on the topics of family planning, brochures, posters and leaflets.

8. Videos on the topics: “Contraception”, “HIV myths and reality”, “Life or death”, “In vitro fertilization”.

Develop a plan for nursing interventions

Table 2 Long-term goal

	Planning	Implementation
	Ensuring the medical and protective regime (independent)	1. With the joint efforts of honey. sisters, the patient's husband to create psychological peace. 2. To exercise control over the observance of the daily routine. 3. By joint actions of the patient's husband and the patient herself, ensure the patient's long sleep with access to fresh air. 4. Teach the patient how to properly rest and relax, some methods of hardening and maintaining immunity.
	Ensuring monitoring of the patient's condition (independent), (interdependent)	1.Together with the doctor of the PS office, and the employees of the AIDS Center, carry out dynamic monitoring of the patient's immune system. (Interdependent). 2. Exercise joint control over weight, skin color, ovarian-menstrual cycle (regularity of menstruation, duration, amount of discharge) (interdependent.) 3. Monitor the mood of the patient. (Independent)
	Provision of psychological assistance (independent), (interdependent)	1. Increase the time of communication with the patient from 2 sessions per week to 3, up to 1.5 hours in duration 2. Organize leisure. (independent) 3. Conduct joint conversations with the patient's husband (independent) 4. Together with a psychologist, teach the patient to avoid stressful situations that affect the immune system and the hypothalamic-pituitary system. (Interdependent)
	Ensuring the sanitary and epidemiological regime (independent), (interdependent).	1.To train and supervise, together with the patient's husband, the frequent cleaning of residential and utility rooms using disinfectants (independent). 2. To train and supervise, together with the employees of the Central Bank with AIDS, how to properly handle underwear and bed linen, personal hygiene items after use, in order to avoid infection of the husband with HIV. (mutually dependent).
	Provision and adherence to dietary therapy (independent), (interdependent)	Together with a nutritionist, pay attention to the patient's knowledge about the characteristics of nutrition for HIV, and taking antiretroviral therapy, when planning conception. (interdependent) Pay attention to the quality of the food taken by the patient, its multiplicity, vitamin and mineral composition. (Independent)
	1. Drug (dependent), (interdependent)	1. Introduce the patient to antiretroviral drugs, their effect on the virus, on the reproductive system, on the developing fetus while continuing antiretroviral therapy after conception. (dependent), (interdependent). 2. Introduce the patient to the possible options for fertilization without contact with her vaginal environment containing HIV. (Dependent). 3.Together with the staff of the AIDS Center, to implement the effects of ART. 4. Teach herbal medicine methods to strengthen immunity and reproductive health.
	Preparation for additional research methods	1. Explain to the patient that when planning a pregnancy, it is necessary to be tested for other sexually transmitted infections (HPV, CMV, HSV, chlamydia, myco-ureaplasmosis, gonorrhea and trichomoniasis, which are background diseases in HIV. (Moreover, both spouses are tested). 2. Explain to the patient the specifics of testing for sex hormones FSH, LH, prolactin, testosterone and the need for this examination for IVF. 3. Explain to the patient the need to control the titer of the virus in the blood.
	Ensuring consultations of specialists as prescribed by a doctor (dependent), (interdependent).	1.Psychologist, 3.Genetics, 4.Gynecologist-endocrinologist, 5. virologist-immunologist
	Nursing pedagogy (independent)	1. Assess the level of knowledge of the patient after the implementation of the short-term goal about her disease, identify her motivation for obtaining further information. 2. Pay special attention to adherence to a healthy lifestyle and diet and taking antiretroviral drugs on a strictly scheduled basis to achieve maximum effect of treatment 3. Conversations with the patient and her husband about HIV infection, methods of contraception for HIV in one of the sexual partners, the selection of the most successful methods of contraception for HIV, the method of using a condom. 4. Conducting trainings to evaluate the results of classes. 5. Conducting classes and conversations to prepare the patient for IVF. 6. Conducting conversations with showing videos about the rights of an HIV-infected person, about the possibility of motherhood with HIV, about the possibility of having a healthy child while observing the regimen of taking antiretroviral therapy.

Efficiency mark:

The goal is achieved if, as a result of the joint actions of a family planning office nurse, a family planning office doctor, specialists from the AIDS center, a psychologist, a nutritionist, as well as a patient and her husband, the patient will know the methods of preventing HIV / AIDS in the family by the end of the month , she will be selected a method of contraception that is safe for her sexual partner, the patient will not experience internal discomfort due to her HIV status, will know their rights as a patient, will be aware of the possibility of having a healthy child, subject to all doctor's prescriptions when taking antiretroviral therapy.

2.3 Characteristics of ongoing activities

Taking material from the cervical canal for bacteriological examination of the purpose:

1. Determine the flora of the inflammatory process of the female genital organs.

2. Determine the sensitivity of pathogens to a number of antibiotics.

Indications:

1. Inflammatory diseases of the reproductive system.

2. Preoperative examination for operations on the genitals.

Condition: compliance with the rules of asepsis and antisepsis, as well as personal medical protection when working with human biological fluids.

3. Obtained informed consent from the patient for the manipulation.

Equipment: gynecological chair, Cusco mirror, sterile test tube with a loop and ground stopper, forceps, long tweezers, des. solution for treating the external genital organs, sterile cotton balls, gloves, dry alcohol, a saucer, a box of matches, a referral to the laboratory.

1. Prepare dry alcohol and a box of matches.

2. Put on sterile gloves.

3. Treat the external genital organs of the patient with a disinfectant solution.

4. Insert a Cuzco speculum into the vagina and expose the cervix.

5. Remove the discharge from the surface of the cervix with a cotton ball.

6. On a saucer, set fire to dry alcohol.

7. Take a special sterile tube, open the stopper and remove the loop with cotton wool.

8. Quickly draw a loop over the flame of burning alcohol.

9. Insert the loop into the cervical canal to a depth of 1 cm and make a rotational movement inside.

10. Quickly pass the edges of the test tube over the flame of dry alcohol.

11. Insert the loop with the obtained material into the test tube without touching its edges.

12. Check that the cork tightly closes the test tube.

13. Remove the mirror from the vagina.

14. Extinguish the flame!

On the referral form to the laboratory, indicate the last name, first name, patronymic, age, clinical diagnosis of the patient, case history number, purpose of the study, place of sampling, name of the organization that sent the analysis, doctor's name and date.

Tests of functional diagnostics of the female reproductive system in various phases menstrual cycle. Definition of a symptom of "Pupil".

Purpose: diagnosis:

Estrogen saturation of the patient's body on different days of the menstrual cycle;

Ovulation.

Indications:

1. Endocrinopathy: uterine fibroids, endometriosis, neuroendocrine syndromes (ovarian scleropolycystosis, premenstrual syndrome, hyperprolactinemia, adrenogenital syndrome).

2. Infertility. Condition: the “pupil” symptom is evaluated on certain days of the menstrual cycle - at 7, 14.21.

Equipment: gynecological chair, vaginal mirror, diaper, sterile gloves, forceps sterile cotton balls.

The essence of the “pupil” phenomenon.

During the menstrual cycle, under the influence of estrogens and gestagens, a change in cervical mucus occurs. The amount of mucous secretion in the cervical canal depends on the estrogen saturation of the body. Its greatest amount is observed during ovulation. The test is evaluated visually and in points (1-3), one point corresponds to the indicator

(+). The “pupil” phenomenon is based on the expansion of the external opening of the cervical canal and the appearance of transparent vitreous mucus in it in the 1st phase of the menstrual cycle, maximum during ovulation (3 points = +++). It is determined by examining the cervix in the mirrors. The accumulation of mucus in the external pharynx resembles a pupil. The test is not typical for pathological changes in the cervix.

manipulation technique.

1. Insert a speculum into the vagina and expose the cervix.

2. Carefully inspect the external os of the cervix for the presence of mucus in it.

3. Mark the diameter in points and in millimeters.

4. Remove the mirror from the vagina.

5. Fix the indicator in the document.

Since the patient turned to the family planning office with the desire to have a full-fledged family in the future, plan a pregnancy and have a healthy child, the medical worker has the right to recommend such a family to turn to the IVF program.

Conclusion

The HIV/AIDS epidemic has now grown into a global crisis and poses one of the most serious threats to development and social progress. In countries where the disease is most prevalent, the epidemic is destroying decades of development gains, undermining the economy, threatening the security and stability of society. In sub-Saharan Africa, where the epidemic has already had a devastating impact, the crisis has created an emergency.

While bringing suffering to the sick and their loved ones, HIV/AIDS simultaneously deeply affects the socio-economic structures of society and poses a significant threat to the world of work. The disease affects the most productive part of the workforce, forcing enterprises in all sectors of the economy to bear enormous costs caused by lower productivity, higher production costs and an increase in the loss of skills and production experience. In addition, HIV/AIDS leads to violations of fundamental labor rights, which are expressed in discrimination and stigmatization of workers and people living with or affected by HIV/AIDS. The epidemic and its consequences are most severely affecting socially vulnerable categories of the population, including women and children.

In gynecological practice, medical workers increasingly began to encounter HIV-positive patients. If in the 90s of the last century the appearance of such a patient in a hospital or in a antenatal clinic was tantamount to an “state of emergency”, then in last years this problem no longer surprises anyone.

HIV is spreading across the country by leaps and bounds, and only in recent years the Government has begun to take serious measures to combat AIDS and its prevention. Only in recent years have they begun to properly finance AIDS centers, programs have appeared to finance the treatment of AIDS patients and HIV-infected people, holistic programs have been developed to protect the rights of HIV-positive people, to educate them in matters of family planning, the safety of others, and to develop behavior during receiving antiretroviral therapy.

What is the most common problem faced by healthcare professionals?

As a rule, women who go to a family planning office or antenatal clinic find out about their HIV status after they have been tested for this infection, or after they are taken to a hospital for emergency reasons, with rare exceptions after a medical examination at the time of employment. (Until now, testing for infections is not mandatory for some categories of workers). And it is at this moment that the nursing process becomes especially important, aimed at teaching patients the new rules of life with their own diagnosis. The success of the further life of the infected person depends on the effectiveness of this process.

List of sources used

1. Adler M., ABC of AIDS; M.: Mir, 2001.

2. Belozerov E.S. et al. Immunodeficiency states.//Alma-Ata, 2001, - 118s.

3. Belozerov E.S., Mashkevich V.S., Shortanbaev A.A. Clinical immunology and allergology (textbook)// Alma-Ata, 2003, - 267 p.

4. Zmushko E.I. et al. Some aspects of the diagnosis of HIV infection // Topical issues of HIV infection - St. Petersburg-2004, pp. 73-74.

5. Lysenko A.Ya., Tur'yanov M.Kh., Lavdovskaya M.V., Podolsky V.M. HIV infection and AIDS-associated diseases. M.: 1996. - 624 p.

6. ILO. Materials of the pilot project “Issues of HIV/AIDS prevention in the world of work”, Moscow, 2005

7. Pokrovsky V. "HIV / AIDS - myths and reality." Documentary. - 2006

8. Ryabchikov T.V., Nazarova N.A. Nursing process. - 2000. - 40 p.

Application

Prevention of HIV infection

The development of AIDS can be prevented if a person with HIV takes antiviral therapy. Antiviral therapy - a scheme for the use of special drugs that block the reproduction of HIV in the body and do not allow the immune system to collapse. These drugs cannot destroy the virus itself, but they can significantly prolong the period from HIV infection to the development of AIDS, feel practically healthy and keep working.

Ways to prevent HIV infection are based on knowledge of how the virus is transmitted.

Ways of HIV transmission:

1. Blood to blood.

2. Sexual transmission.

3. To a child from a mother during pregnancy, childbirth and breastfeeding.

Methods of prevention: the use of individual sterile needles and syringes for injections, piercings, tattoos. Permanent non-HIV partner with mutual fidelity, use of condoms. Antiretroviral treatment of a woman during pregnancy and childbirth, caesarean section, artificial feeding.

To protect yourself from HIV, you must: do not have unprotected sex with people infected with HIV, with representatives of high-risk groups.

Although there is currently no vaccine for HIV, early access to medical care will increase the effectiveness of treatment, which includes not only medication, but also counseling and support for people living with HIV/AIDS.

Diseases of the female reproductive system associated with HIV infection.

There are some disorders and diseases that are associated with HIV infection in women.

Menstrual irregularities occur in about a third of all women with HIV. These include:

Amenorrhea (lack of menstruation). Amenorrhea is more common in women with a low immune status (CD4 below 50), as well as in the use of alcohol, drugs, and malnutrition.

Long, irregular, painful periods and bleeding between periods are also more common in women with HIV than in HIV-negative women.

These disorders, as a rule, are not associated with the activity of the ovaries, but with hormonal disorders caused by HIV infection.

oral and vaginal candidiasis - fungal infection mouth or vagina. Oral candidiasis often appears with a low immune status and with smoking.

With HIV infection, the risk of the appearance or development of malignant neoplasms on the cervix increases by 3-8 times. AIDS-associated tumors of the reproductive system include cervical intraepithelial tumor and invasive cervical cancer. Etiologically, this type of tumor is associated with the human papillomatosis virus (HPV). To date, quite a few types of HPV have been identified, HPV6 and HPV11 are associated with viral warts or with mild dysplastic changes (cervical intraepithelial neoplasia -1) and do not contribute to the development into a malignant tumor. At the same time, HPV types 16,18, 31, 33 are found in most cases in cells of invasive carcinomas, and the DNA of the virus is integrated into the DNA of tumor cells. The HPV types that cause cervical cancer form certain viral proteins, called E6 and E7, which are fundamental in the malignant transformation of cells. E6 binds to the p53 suppressor gene, inactivating its function, and E7 binds to another tumor suppressor, the retinoblastoma (Rb) gene. As a result, both p53 and Rb proteins inhibit the atypical progression of cell cycles, and inactivation of these proteins leads to cell cycle dysregulation.

Co-factors in the development of cervical carcinoma due to HPV are early sexual activity, a large number of sexual partners, smoking, immunosuppression.

In HIV-infected women (2015 people), HPV in PCR is detected in 58%, in control (577 HIV-negative women) - in 28%.

Tumors of the cervix are diagnosed according to cytological examination cervical canal smears (atypical squamous cells) or colposcopy with biopsy.

Treatment of cervical intraepithelial tumors depends on the stage of development of cytological changes. In stage I, spontaneous regression is possible, but in stages II and III, treatment is necessary in order to prevent the process into invasive cervical cancer. Combination therapy is effective, including cryotherapy, laser, electrotherapy of those lesions that are visible during colposcopy and do not affect the endocervix. With more extensive lesions - surgical treatment - resection. In non-HIV-infected women, relapses occur in 5-10% in a year, in HIV-infected women - in half of the cases. Therefore, patients are additionally prescribed 5-fluorouracil in the form of an ointment and difluoromethylornithine by mouth, as well as the HPV vaccine.

...

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The reform of nursing, which has been taking place in Russia since the 1990s, has led to a qualitative change in the professional and social status of the nursing profession, an increased responsibility of sisters and a change in their attitude towards their profession. It is generally recognized that nursing staff play a key role in the provision of patient care, which is especially evident in palliative care.

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When caring for a patient, it is important to focus on their personality and individual needs. Daily care should not become a routine or become automatic, on the contrary, care should always be individualized. To realize this, the nurse can use all her creative abilities. A person-centered approach involves focusing on the needs of the patient. The patient is seen as a person with his thoughts, fears, expectations and expects a lively response from the sister.

The nurse takes into account the conditions of life in the family, the influence of culture and religion, stimulates the independence of the patient, provides information, involves in decision-making. It is important to be able to select and evaluate the information obtained during the collection of anamnesis, to use this information when drawing up a care plan, taking into account the following principles:

Sequences of appointments;

Maintaining tolerance in case of failure to achieve results;

Ability to make decisions in emergency situations;

Observation and identification of new symptoms of the disease;

Making a nursing diagnosis based on identified problems.

Nursing care involves the implementation of an integrated approach to the provision of medical care. It is necessary to learn how to work with a patient who presents a large number of complaints and has several diseases - acute and chronic, learn how to encourage a healthy lifestyle, prevention, treatment and adherence to it.

An important competence of a nurse providing palliative care is a holistic view of the patient and his condition, taking into account the biopsychosocial model, cultural and existential aspects of people's lives. Tolerant attitude towards life experience, beliefs, values ​​and expectations of a sick person. Often spiritual and existential experiences are a serious source of clinical problems. To provide nursing care HIV infected people need to build patient adherence to treatment. In HIV infection, the main component of treatment is highly active antiretroviral (ARV) therapy aimed at suppressing the process of HIV reproduction. Adherence to treatment is manifested in taking drugs according to the scheme prescribed by the doctor, at a certain time and in a certain dosage, while observing the recommended diet. Formation of adherence to treatment is a complex multi-stage process. It goes through several stages: the formation of adherence to the acceptance of care - the formation of adherence to treatment - the formation of adherence to the acceptance of ARV therapy.

The formation of patients' motivation to accept medical care depends very much on "presence therapy" (communication, support, understanding).

Six principles of patient care:

1. Security.	Caregivers must protect the patient from possible injury.
2. Privacy.	Personal information about the patient, details of his personal life must remain secret, and outsiders should not be allowed to see and hear what the patient would not like.
3. Respect (maintaining a sense of dignity).	Respect the patient as a person, recognize his right to choose and make decisions.
4. Communication.	Remember that the word heals. When talking with a patient, it is necessary to pay attention to his feelings. Talk with the patient about the upcoming manipulations, get his consent to this or that intervention. Report to management about patient problems.
5. Independence.	Encourage the patient to be as independent as possible in a particular situation.
6. Infectious safety.	Take measures to ensure infection safety. Care can be provided to the patient in medical institutions (specialized hospitals where the patient is treated for a particular disease and at the same time needs care, nursing care hospitals (houses), social institutions and at home.

The main and often the first sign of the progression of HIV infection is the dementia complex related to AIDS, also known as HIV encephalopathy (develops in 70-90% of patients). The dementia complex includes:

Changes in consciousness (loss of concentration, forgetfulness, confusion and slowing down of mental processes);

Changes in movement (impaired balance and coordination, weakness in the legs, loss of handwriting);

Behavioral changes (apathy, withdrawal, depressed mood, depression, psychosis, violent tendencies).

Depending on the affected area of ​​the brain, headaches, paroxysms, or loss of vision may occur.

HIV wasting syndrome is defined as profound involuntary weight loss of more than 10% of basal body weight. The HIV wasting syndrome has many causes: reduced food intake, malnutrition syndrome, altered metabolism, anorexia, nausea, vomiting, infections and fungal infections of the mouth and esophagus, medication, lack of money for good nutrition.

Precautions when working with an HIV-infected patient.

1. All manipulations in which hands may be contaminated with blood or other biological fluids should be carried out with rubber gloves, and in order to avoid splashing of blood, in face masks and goggles.

2. Cover all injuries on the hands with adhesive tape, waterproof bandages.

3. In all medical facilities where resuscitation may be necessary, breathing bags should be available.

4. Instead of mouth-to-mouth artificial respiration, newborns should use mechanical and electrical devices.

5. Before transportation, blood samples and other biological fluids should be placed in containers with hermetic lids, the outer parts of the container should be treated with disinfectants.

6. Disassembly, washing and rinsing of instruments, laboratory glassware, devices and everything in contact with blood or biological fluids should be carried out only after disinfection and in tight rubber gloves.

7. Used needles should not be bent, broken by hand or recapped.

8. Disposable instruments should be immediately placed with the syringe in a durable, non-leaking container for destruction.

9. Sharp objects to be reused should be placed in a durable container for processing.

10. If it is necessary to transfer sharp instruments, you should put them in a neutral zone, without touching the same objects at the same time, avoid pricks, cuts with sharp instruments, broken dishes.

Nursing care for HIV infection, AIDS.

Disturbed patient needs: drink, eat, excrete, communicate, work, maintain body temperature, safety.

Patient problem: high risk of opportunistic infections.

Goals of care: the risk of infections will decrease if the patient follows certain rules.

Nursing Intervention Plan:

1. Observe the sanitary and anti-epidemic regime in the ward (disinfection, quartz treatment, ventilation).

2. Provide a good night's sleep for at least 8 hours.

3. Provide good nutrition (proteins, vitamins, trace elements).

avoid contact with infectious patients, visitors with respiratory infections should wear masks;

Avoid crowds of people

avoid contact with the body fluids of another person;

Do not use shared razors

shower regularly with antibacterial soap;

wash hands after using the toilet, before eating and preparing food;

Do not touch your eyes, nose, mouth;

Maintain oral hygiene

Monitor the cleanliness of fingernails and toenails;

Reduce contact with animals, especially sick ones, wash hands thoroughly after contact with animals;

Thoroughly wash and clean food, thoroughly boil meat, eggs, fish, avoid contact of cooked and uncooked food, do not drink raw water;

get vaccinated against the flu;

To control the patient's temperature, respiratory rate;

Teach the patient to monitor the symptoms of HIV disease - fever, night sweats, malaise, cough, shortness of breath, headache, vomiting, diarrhea, skin lesions;

· to teach the use of anti-infective and special preventive drugs, to avoid taking immunosuppressive drugs.

Patient problem: Difficulties in eating due to damage to the oral mucosa.

Goals of care: The patient will take the required amount of food.

1. Avoid very hot and cold, sour and spicy foods.

2. Include soft, moist, high-protein and fortified foods in the diet.

3. Rinse your mouth before eating with a 0.25% solution of novocaine, after eating with boiled water or a solution of furacilin.

4. Tell about alternative methods of nutrition (through a tube, parenteral nutrition).

5. To brush your teeth, use soft toothbrushes that prevent gum injury.

6. Use anti-infective drugs as prescribed by the doctor (local and general treatment).

Patient problem: diarrhea associated with opportunistic infections, a side effect of medications.

Goals of care: diarrhea will decrease.

1. Assess which foods increase or decrease diarrhea and adjust your diet.

2. Provide a diet rich in protein and calories, low in dietary fiber.

3. Ensure adequate fluid intake (water, juices, electrolyte solutions).

4. Apply infectious precautions when preparing and eating food.

5. Ensure timely intake of antidiarrheals prescribed by the doctor.

6. Provide skin care in the perianal area: wash after each bowel movement with warm water and soap, dry it in order to prevent rupture of weakened skin. Apply an emollient cream to the perianal area to protect the skin.

7. To exercise control over weight, water balance, tissue turgor.

Patient problem: a feeling of depression associated with a change in appearance (Kaposi's sarcoma, loss of hair, weight, etc.) and the negative attitude of others. Option: low self-esteem.

Goals of care: The patient's mental state will improve.

1. Allow fears to be expressed about lifestyle changes in a supportive, nonjudgmental environment.

2. Encourage relatives to communicate with the patient.

3. If necessary, refer the patient for a consultation with a psychotherapist.

4. Teach relaxation techniques.

Patient problem: nausea, vomiting associated with opportunistic infections, a side effect of drugs.

Goals of care: the patient will have reduced nausea, there will be no vomiting.

1. Ventilation of the room in order to eliminate odors that cause nausea.

2. Give dietary advice: eat small meals often, avoid hot foods, avoid strong smelling and pungent foods, drink 30 minutes before meals, not during meals, eat slowly and rest for 30 minutes after food in a position with a raised head.

3. Learn to take drugs prescribed against nausea, vomiting (medications are given 30 minutes before meals).

4. Focus on the need for careful oral care.

5. Provide the patient with a glass of water, a container for vomit in case of vomiting and help the patient if it occurs.

Patient problem: risk of weight loss.

Goals of care: the patient will receive an adequate amount of food, his weight will not decrease.

1. Clarify the patient's taste preferences and his dislikes for food.

2. Provide the patient with high-protein and high-calorie nutrition.

4. Determine the patient's body weight.

5. Determine the amount of food eaten at each meal.

6.Consultation of a nutritionist if necessary.

Patient problem: cognitive impairment.

Goals of Care: The patient will be adjusted to their mental capacity.

1. Assess the initial level of mental abilities.

2. Talk to the patient calmly, give him no more than one instruction at a time and, if necessary, repeat the information provided.

3. Avoid disagreements with the patient, as this can lead to the patient developing feelings of anxiety.

4.Prevent possible injury by removing hazards from the patient's environment.

5. Use techniques that facilitate memorization, for example, associative links with familiar objects, calendar entries.

6. Provide family support and educate the caregiver (family) about the above interventions.

GENERAL INFORMATION ABOUT HIV INFECTION, AIDS

HIV infection is a disease caused by the human immunodeficiency virus; characterized by a slowly progressive defect in the immune system, which leads to the death of the patient from secondary lesions (infectious and neoplastic processes) described as acquired immunodeficiency syndrome (AIDS) or from subacute encephalitis.

CLINICAL CLASSIFICATION OF HIV INFECTION

I. stage of incubation.

From the moment of infection to the appearance of antibodies.

The diagnosis can be confirmed by polymerase chain reaction by detecting HIV antigen-RNA. Isolation of the HIV antigen by enzyme immunoassay has low specificity.

II. Stage of primary manifestations.

It is characterized by a relative balance between the immune response of the body and the action of the virus. Duration from 2-3 to 10-15 years.

II A. Acute infection.

Usually lasts 2-3 weeks. Accompanied by fever of varying severity, lymphadenopathy, enlargement of the liver, spleen, skin rashes, meningeal phenomena are possible. Then it goes into stage II B or II C.

II B. Asymptomatic infection.

It is characterized by the absence of clinical manifestations. There may be a moderate increase in lymph nodes. In contrast to the stage of incubation, antibodies to HIV antigens are determined.

II B. Persistent infection.

It is characterized by persistent generalized lymphadenopathy, which is a clinical manifestation at this stage.

III. Stage of secondary manifestations.

With the progression of the disease, clinical symptoms develop, which indicate a deepening of immunity damage, which characterizes the beginning of the III stage.

III A. It is characterized by a loss of body weight of less than 10%, bacterial, fungal, viral lesions of the mucous membranes and skin, inflammatory diseases.

ІІІ B. It is characterized by a loss of body weight of less than 5%, skin lesions, which are of a deeper nature. Damage to internal organs develops; localized Kaposi's sarcoma.

III C. It is characterized by cachexia, generalization of infectious diseases, disseminated Kaposi's sarcoma, severe CNS lesions of various etiologies.

IV. Terminal stage.

It is characterized by irreversible damage to organs and systems. Even the therapy of secondary diseases, which is carried out adequately, is ineffective and the patient dies within a few months.

The root cause of HIV infection in a surgical hospital is professional exposure to HIV-positive biological media patients.

Most of the registered cases of occupational infection occur as a result of accidental damage to the skin of medical personnel with sharp objects (injection needles, blades), which are accompanied by parenteral contact with the patient's biological media; the ingress of these media on the mucous membrane of the eyes, oral cavity, on open areas of the skin that have a broken epidermis (cuts, scratches, etc.). Instead, the so-called suboperative damage to the integrity of surgical gloves(SPR), which make up from 25 to 75% of cases during surgical interventions. In addition, surgeons are able to visually notice only a third of such injuries and take the necessary preventive measures.

Prevention of HIV infection of surgeons is based on the following principles:

Increased doctor's alertness regarding HIV-infected patients.

Occupational exposure prevention measures:

a) barrier means of protection;

b) reducing the likelihood of occupational exposure - "remote surgery".

Timely detection of cases of occupational exposure, if any.

Prevention of the consequences of contact with the patient's biological media - post-exposure prophylaxis.

Doctrine of HIV heightened awareness of HIV-infected patients

During the initial examination, based on the history and physical examination, patients are identified who have or had a risky lifestyle in relation to AIDS and (or) belong to risk categories:

parenteral drug addicts.

Persons who are promiscuous or provide sexual services for profit.

Persons who shared a syringe with another person.

Persons who lived or live in AIDS-endemic regions (Africa) .

Persons who have often received blood transfusions or drugs that are made from donated blood.

Children of HIV-infected parents.

Sexual partners of persons who belong to the listed risk categories.