A 52-year-old male was admitted to the hospital 4 days ago with a 1-week history of sharp abdominal pain, fever, nausea, and vomiting. Computed tomography (CT) scan revealed acute pancreatitis. He was placed on intravenous (IV) antibiotics, opiate analgesics, and total parenteral nutrition (TPN). He has been NPO since admission. His relevant medical history includes acquired immune deficiency syndrome (AIDS) diagnosed 13 years ago and associated wasting syndrome and peripheral neuropathy. His CD4 count is 54 and viral load is undetectable. Current medications include fentanyl, imipenem/cilastatin, testosterone transdermal, atazanavir, abacavir, and lamivudine. The patient works as a lawyer and lives with his partner of 11 years. The physical therapist is asked to see the patient today for strengthening, endurance, and gait activities. He is expected to be hospitalized for another 3 to 4 days, and then will be discharged home.
What functional limitations may you expect based on his health history?
What are the examination priorities?
What are the most appropriate physical therapy interventions?
What precautions should be taken during physical therapy interventions?
What potential complications may limit the effectiveness of your interventions?
- CD4 COUNT: Number of T cells expressing CD4 that are circulating in the blood, described as number of cells/μL blood; CD4 cells are sometimes called T-helper cells and are critical in initiating the coordinated immune response to foreign organisms; normal value is ~500 to 1500 cells/μL
- NPO: Abbreviation for Latin phrase nil per os, meaning “nothing through the mouth”; individuals with instructions to be NPO are not allowed to eat or drink for various medical reasons
- TOTAL PARENTERAL NUTRITION (TPN): Supplying all of a person's nutritional needs intravenously, thereby bypassing the gastrointestinal tract; nutritional source when individuals cannot eat or drink
- VIRAL LOAD: Amount of human immunodeficiency virus (HIV) circulating in the blood, described by number of copies of HIV/mL blood; values range from undetectable (meaning none was found) to > 50,000/mL
- WASTING SYNDROME: Unintentional loss of lean body mass, often associated with AIDS
Understand the implications of the CD4 count and viral load in the health of a person infected with HIV.
Describe the signs and symptoms of HIV-related peripheral neuropathy.
Identify the causes and sequelae of wasting syndrome.
Discuss the benefits of aerobic and resistance exercise in the management of HIV-related wasting, weakness, and deconditioning.
PT considerations during management of the individual with HIV/AIDS with HIV wasting syndrome and peripheral neuropathy:
- General physical therapy plan of care/goals: Maximize function by increasing general strength; increase endurance to allow independent performance of activities of daily living (ADLs); decrease pain and dysesthesia associated with peripheral neuropathy; independent ambulation with or without assistive device
- Physical therapy interventions: Patient education regarding loss of strength and endurance with bedrest; general strengthening ...