NURSING IT ALONG

Sue Cirelli, MSN ARNP ACRN

Primary care providers have often observed that their HIV patients are reluctant to report certain events. Some adverse events that need to be discussed with the primary care provider include but are not limited to: any unusual sensation, fatigue, headache, taste perversion, pains, changes in mood or behavior, diarrhea, vomiting, or nausea. Why would patients not report such symptoms? Many are fearful of more medical interventions and the vicious cycle of doctoring the ailment. When caring for HIV infected persons, it may be beneficial to nurse some adverse events rather than doctor the same events.

Back in the dark ages, say 15 to 20 years ago, we provided prophylactic treatments that were at least as efficient as some of the present medical modalities and that were, to my sensibilities, a lot kinder and gentler. With the rush to our arsenal of scientific curatives, we have perhaps forgotten the art of healing. Anecdotally, (because no group will ever put money here) many of us have used nursing/common-sense remedies for ourselves as well as for clients with good results. Although I know it may seem radical, and I will certainly write any appropriate prescription, perhaps we should get in touch with what the client actually needs before we get in touch with the prescription pad.

The three GIs, the soldiers of misfortunediarrhea, nausea, and vomitinghave long been in the Nightingale camp. Chamomile tea, the B.R.A.T.T. diet (bananas, rice, applesauce, tea, and toast), sips of fluids along with saltines, clear juices, caffeine-free flat sodas, clear soups, andif antibiotic-induced diarrhea is the problemactive culture yogurt are just some interventions that still work. Nausea is remarkably controlled by natural ginger, whether in the form of real ginger ale, tea, or cookies. Dry breads and crackers as well as a natural lemons juice also work wonders. Vomiting can be also be controlled in a gentler manner using many of the above-mentioned remedies. Moreover, all three GIs respond to stress reduction, rest, slower gross muscular movements, and attending to the bodys need for sleep. Nutritional interventions by a registered dietitian (RD) can also have longer lasting results and can be far easier to tolerate than many medical interventions.

What can be done for the after-effects of diarrhea, nausea, and vomiting? Does the patient have fatigue? First of all, check their nutritional input: no fuel = no work capability. Monitor and change the patients daily activities to match their energy cycle. Counsel them to use rest and timeouts, and to gradually develop a low-impact exercise regimen. Concentrate on honest, good, healthful, pleasant things and give them permission to heal by talking with them, not at them or down to them. Dealing with appetite loss? Teach grazing habits and the use of new seasonings, recipes, and sauces. Assess patients for loneliness. Many are not interested in cooking for one or eating alone. Are gas pains or bloating the problem? Warm, moist heat provided by rice in a damp sock (heated by oven or microwave) and applied to the abdomen is very effective, as is rolling (arms straight over head) from side to side on a soft flat surface like the floor. Is the patients buttocks sore, red, or inflamed? Try a sugar-Popsicle. The sugar seals any slightly bleeding areas, the ice cools, and the stick (give safety admonishments to those who need them), while not introduced into the rectum, does provide leverage for the cooling application. If the GIs have caused hemorrhoids, get some tar-rope (in some places called plumbers wool) and tuck it right next to the hemorrhoids; they will usually be gone within 24 hours. Make sure to have the tar rope changed after each bowel movement to maintain hygiene. Skin macerated? Try good old udder balm (bag balm) or bees wax.

Encourage yourself and your clients to refuse martyrdom. Primary healthcare providers need to be aware of anything unusual; it is probably a side effect of either HIV or medical regimens. While healthcare providers may be ready and able to change doses, add treatments, switch regimens, and be involved and informed, lets not lose the mosaic healing arts amid our more prosaic medical algorithms.

Sue Cirelli is a nurse practitioner who has been active in ANAC (Association of Nurses in AIDS Care) for ten years. She co-authored the abstract for the C.H.E.E.R.S. adherence program that was presented at the recent Durban conference and has been active as the Consortia Chair in District 7 ECFAN . She has also been seated on the Title I Planning Council, has been a member of the Community Planning Partnership in District 7, and received the Public Health Hero award from the State of Florida Department of Health in Orange County, Florida.

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Sue Cirelli, MSN ARNP ACRN, at or via e-mail at