Human Immunodeficiency Virus
UNFOLDING Reasoning
Michelle Johnson, 36-years old
Primary Concept
Immunity
Interrelated Concepts (In order of emphasis)
• Gas Exchange
•Infection
• Stress
• Coping
• Clinical Judgment
• Patient Education
• Communication
• Collaboration
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
• Management of Care 17-23% ✓
• Safety and Infection Control 9-15% ✓
Health Promotion and Maintenance 6-12% ✓
Psychosocial Integrity 6-12% ✓
Physiological Integrity
• Basic Care and Comfort 6-12% ✓
• Pharmacological and Parenteral Therapies 12-18% ✓
, lOMoAR cPSD| 56342273
• Reduction of Risk Potential 9-15% ✓
• Physiological Adaptation 11-17% ✓
UNFOLDING Clinical Reasoning Case Study:
History of Present Problem:
Michelle Johnson is a 36-year-old African American female with no prior medical history who presents to the emergency
department complaining of extreme fatigue for the past several months and experiencing occasional night sweats. During
the past week, she has developed a sore throat, dry, nonproductive cough, fever at night with increasing shortness of
breath. Michelle embarrassingly admits that she has had a vaginal yeast infection that she has tried to treat with over the
counter medications with no success. Michelle states to the triage nurse, “I came in today because I am worried
something is wrong with me, I hope it’s nothing serious!”
Personal/Social History:
Michelle has been divorced for five years and has two daughters (ages 14 and 16) who works full time as a legal
secretary. She has recently been working longer hours, skipping meals, and stressed over the possibility of not being able
to provide for her two daughters. She has been involved in only one relationship since her divorce. She is engaged to
Ken, who has hemophilia and plan to get married next year.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
-Extreme fatigue for the past several months There are many different reasons she could be experiencing these
and experiencing occasional night sweats. symptoms, a viral or bacterial infection going on in her body. However,
the fact that it has been going on for several months is very alarming.
May need to do some more testing to see if it is serious. HIV symptoms
are very similar so this should be one of her tests the Dr’s perform.
-In the past week she has developed a sore Possible respiratory infection starting, whether it is bacterial or viral
throat, dry, nonproductive cough, fever at we will need to find out.
night with increasing shortness of breath.
A yeast infection that will not go away is a very big red flag for HIV. She
-Vaginal yeast infection that she has tried to
treat with over the counter medications with should have seen her Dr as soon as this started to happen. HIV most
no success. often has gynecological problems associated with it.
RELEVANT Data from Social History: Clinical Significance:
- working longer hours, skipping meals, and Patient has a lot on her plate and is in a very stressful situation. She
stressed over the possibility of not being able works long hours, is a single mom and has a fiancée that is sick. She
to provide for her two daughters. does not have time to take care of herself.
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment:
T: 99.6 F/37.6 C Provoking/Palliative: Denies
(oral)
P: 108 (regular) Quality:
R: 24 (regular) Region/Radiation:
BP: 110/75 Severity:
O2 sat: 91% RA Timing:
UNFOLDING Reasoning
Michelle Johnson, 36-years old
Primary Concept
Immunity
Interrelated Concepts (In order of emphasis)
• Gas Exchange
•Infection
• Stress
• Coping
• Clinical Judgment
• Patient Education
• Communication
• Collaboration
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
• Management of Care 17-23% ✓
• Safety and Infection Control 9-15% ✓
Health Promotion and Maintenance 6-12% ✓
Psychosocial Integrity 6-12% ✓
Physiological Integrity
• Basic Care and Comfort 6-12% ✓
• Pharmacological and Parenteral Therapies 12-18% ✓
, lOMoAR cPSD| 56342273
• Reduction of Risk Potential 9-15% ✓
• Physiological Adaptation 11-17% ✓
UNFOLDING Clinical Reasoning Case Study:
History of Present Problem:
Michelle Johnson is a 36-year-old African American female with no prior medical history who presents to the emergency
department complaining of extreme fatigue for the past several months and experiencing occasional night sweats. During
the past week, she has developed a sore throat, dry, nonproductive cough, fever at night with increasing shortness of
breath. Michelle embarrassingly admits that she has had a vaginal yeast infection that she has tried to treat with over the
counter medications with no success. Michelle states to the triage nurse, “I came in today because I am worried
something is wrong with me, I hope it’s nothing serious!”
Personal/Social History:
Michelle has been divorced for five years and has two daughters (ages 14 and 16) who works full time as a legal
secretary. She has recently been working longer hours, skipping meals, and stressed over the possibility of not being able
to provide for her two daughters. She has been involved in only one relationship since her divorce. She is engaged to
Ken, who has hemophilia and plan to get married next year.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
-Extreme fatigue for the past several months There are many different reasons she could be experiencing these
and experiencing occasional night sweats. symptoms, a viral or bacterial infection going on in her body. However,
the fact that it has been going on for several months is very alarming.
May need to do some more testing to see if it is serious. HIV symptoms
are very similar so this should be one of her tests the Dr’s perform.
-In the past week she has developed a sore Possible respiratory infection starting, whether it is bacterial or viral
throat, dry, nonproductive cough, fever at we will need to find out.
night with increasing shortness of breath.
A yeast infection that will not go away is a very big red flag for HIV. She
-Vaginal yeast infection that she has tried to
treat with over the counter medications with should have seen her Dr as soon as this started to happen. HIV most
no success. often has gynecological problems associated with it.
RELEVANT Data from Social History: Clinical Significance:
- working longer hours, skipping meals, and Patient has a lot on her plate and is in a very stressful situation. She
stressed over the possibility of not being able works long hours, is a single mom and has a fiancée that is sick. She
to provide for her two daughters. does not have time to take care of herself.
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment:
T: 99.6 F/37.6 C Provoking/Palliative: Denies
(oral)
P: 108 (regular) Quality:
R: 24 (regular) Region/Radiation:
BP: 110/75 Severity:
O2 sat: 91% RA Timing:
