DEIB Case Study: HIV and STI Prevention in a High Risk Client (Nursing)

00:01 Hi, I'm Jacqui. Let's do a case study.

00:04 I want to introduce you to Herbert.

00:06 Herbert is with a nurse who is providing routine sexual health screening to clients in a community health clinic.

00:12 They are focused on providing care to gender diverse clients and to the LGBTQIA community.

00:20 Take a moment and look through these demographics.

00:33 Now let's get to the first question.

00:35 Which statement by the nurse are culturally sensitive, while obtaining important additional data regarding the client's health history? This is a select all that apply question.

00:47 Take a look at each individual answer and see what you think is the right answers.

00:58 Now let's look at each option individually. The first option.

01:02 Do you identify your sexual orientation as straight or gay? Using terminology and labels such as straight or gay, first of all, is not inclusive terminology.

01:13 The healthcare provider should avoid labels and use words that are open.

01:18 For example, a better question would be do you have sex with men, women, both, or neither? This helps to avoid assumptions, bias, and stigmas when completing any health assessment.

01:32 The next option? How are you protecting yourself from infections during sexual encounters? This again is an open ended question.

01:41 It allows clients to tell us what types of sexual activity they're engaging in avoiding assumptions.

01:48 The next option? Are you in any situation where you feel unsafe? There are many concerns around domestic violence and intimate partner violence.

01:57 So making sure that we ask this question every time on every visit helps to ensure that our clients and patients are safe.

02:06 Can you share with me what parts of your body you use for sex? Herbert is here for a sexual health history.

02:12 So knowing which parts of the body may be exposed are important for the health care provider to then know what types of assessments and testing that should be ordered. This is important.

02:22 And finally, have you or your partner been evaluated before for sexually transmitted infections? Herbert is only one part of the partnership.

02:31 So knowing Herbert's past history, and also his partner's past history is very important for conducting a comprehensive assessment.

02:39 So here are the correct answers.

02:44 Let's learn a little bit more about Herbert.

02:46 Herbert was assessed further regarding his sexual health history.

02:50 And he reports that he's always engaged in anal sex, and recently resumed his sexual activity with a brand new male partner in the last four months.

02:58 His last sexual encounter was about a week ago.

03:01 He states, "I use condoms sometimes during these encounters." Herbert reports that he's been tested for HIV and STIs previously, but he has no history.

03:11 The last time he was tested was "a while ago." Since he was "exclusive" with his previous partner.

03:17 His partner has since passed away.

03:20 The client states, "Do you think I should be tested again? What if I have HIV?" So that brings us to our question.

03:31 What are Herbert's risk factors based on his subjective data? Take a moment and review the subjective data and decide what those risk factors might be.

03:48 Now, let's go over the answers.

03:50 The first option, man who has sex with men.

03:53 The client is a male.

03:55 Who reports the gender of his partner who he's having sex with is also a male.

04:00 We know from the CDC reports that 68% of newly diagnosed HIV cases were amongst men who are gay or bisexual.

04:09 So this is definitely a risk factor. Sometimes uses condoms.

04:14 We know that condoms are very effective in reducing the risk of HIV, so only using them sometimes is not very protective.

04:24 Previously tested negative for STIs.

04:27 Having an STI increases your risk of acquiring another one.

04:31 Herbert denied any history.

04:33 Therefore, this is not a risk factor.

04:36 Recently reports resuming sexual activity.

04:39 This is not in and of itself a risk factor.

04:42 More information will need to be obtained, such as, are they practicing safe sex? or has the other partner been exposed to HIV or other STIs? And finally, engages in anal sex.

04:55 Anal sex is the highest risk behavior.

04:58 This is because body fluids that contain the HIV virus can come into contact with mucous membranes in the rectum.

05:05 So, the correct answers are - Man who has sex with men sometimes uses condoms and engages in anal sex.

05:16 Using the same information, let's try a different question.

05:20 So after reviewing the subject of data provided by Herbert, the nurse is most concerned about the clients reported. What? Now let's review the options.

05:33 Option number one, living situation.

05:36 The nurse is not currently concerned that Herbert is living alone.

05:40 He has not demonstrated any safety concerns or that he's unable to care for himself.

05:47 Engaging in sex.

05:49 Well, the nurse certainly understands that engaging in sexual activity can put a client at increased risk for HIV exposure.

05:56 However, unprotected sex is what places Herbert at the greatest risk of contracting HIV.

06:04 The correct answer, unprotected sex.

06:09 For the next question, let's look at which educational topics the nurse should anticipate discussing with Herbert.

06:17 Take a look at each intervention and decide whether it's indicated or not indicated.

06:30 Now, let's look at the answers.

06:31 Using condoms for each act of sexual intercourse.

06:35 Absolutely. The nurse should plan on discussing methods for preventing STIs and using a condom every time Herbert engages in sexual intercourse.

06:46 Taking HIV pre-exposure prophylaxis.

06:50 This is important because the option of PrEP is indicated for clients engaging in high risk behavior.

06:57 Herbert is identified as high risk because he's a man who has sex with men.

07:03 The next option initiating Anti Retroviral Therapy, also known as ART.

07:10 ART is indicated for clients who are diagnosed with HIV, or who have a known exposure within the last 72 hours.

07:18 This does not apply to Herbert.

07:20 And finally, testing for STIs.

07:23 Herbert should undergo STI testing, due to the fact that he has high risk factors.

07:29 It's important that he has a negative test prior to receiving any prep or other medications to avoid the possibility of drug resistance.

07:37 So, here are your final answers.

07:42 Next, the healthcare provider orders for Herbert laboratory results.

07:47 Feel free to pause the video and take a look at Herbert's results.

07:56 Now let's look at the next question.

07:59 Upon discharge, Herbert is prescribed oral emtricitabine tenofovir or PrEP, which two statements by the nurse will be provided with his new medication teaching.

08:12 Take just a second and review for the proper answer.

08:17 Now let's look at the options to determine which two statements are correct? The first statement, make sure to take it on an empty stomach.

08:26 This answer is correct.

08:28 Emtricitabine tenofovir should be taken on an empty stomach to enhance absorption.

08:34 The next option, you will be protected against STIs while on this medication.

08:39 Remember, PrEP is for the prevention of HIV infections.

08:44 So although other studies are promising, we don't have any studies that support that it protects against anything else.

08:53 The next option every three to six months, you will need kidney function testing.

08:58 HErbert's medical history indicates that he does have a history of hypertension and hypercholesterolemia.

09:05 These comorbidities increased the risk of kidney disease and PrEP can also cause damage to renal function.

09:12 Therefore, it's critical that we make sure that Herbert's BUN, creatinine, and creatinine clearance are normal prior to initiating therapy.

09:21 Did you check those labs? There was a contraindication in your bloodwork to receive this medication.

09:28 In addition to kidney function, we also tested Herbert for HIV.

09:33 A negative HIV test is necessary to avoid drug resistance.

09:38 And finally, as long as you take it every day, the time of day doesn't matter. This is also incorrect.

09:46 It's important to maintain therapeutic levels.

09:49 Therefore this medication must be taken at the same time.

09:54 Here are your correct answers.

09:58 Let's fast forward three months.

10:01 Take a moment and review Herbert's laboratory results.

10:10 Now we're ready for the final question.

10:13 Which two conclusions can the nurse make from Herbert's lab results? Take a look at the options and see what you think.

10:27 Now, let's review the options.

10:30 Option number one, Herbert demonstrates a proper understanding of HIV prevention.

10:36 We can't really determine this from the lab results.

10:39 So this is definitely not the best answer.

10:42 We could ask, are you using protection every time you have a sexual encounter? That might be a better choice.

10:50 The next option, medication adherence is evident regarding the prescribed HIV PrEP.

10:56 Herbert's HIV test is negative, which is good, but the nurse cannot conclude from this that he's been adhering to the medication regimen.

11:05 Again, asking Herbert the question, have you been taking your medication regularly would be more important.

11:12 The next option, kidney function results contraindicate the prescribed PrEP.

11:18 Herbert's kidney function tests are still within the normal range.

11:22 This indicates proper kidney function.

11:25 Therefore, he can continue PrEP.

11:28 The desired outcome for the client has been met.

11:31 The goal for Herbert was that he remained HIV and STI free.

11:36 The lab results confirm this.

11:38 Therefore, the nurse can draw the conclusion that the desired outcome for Herbert has in fact been met.

11:45 And finally, the client can continue taking the prescribed PrEP.

11:50 Herbert remains STI free, and the kidney function tests remains within the reference range.

11:56 There are no contraindications and Herbert can continue to take the prescribed medication.

12:04 Here are your answers.