The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 3: Assessment of Physical SymptomsAs an another example, a patient may report a “flushing,” “sweats,” a “feeling of being hot,” or a“feeling of being chilled.” In this context, each of these is a symptom. A sign (which may or maynot be present) might in this instance be a fever, and the diagnosis may be an infection oranother26problempicas(see Table 3-2).IIITable 3-2: Differential Diagnosis and Management of Fever in HIV-Related IllnessCausesInterventions that may have arole as treatment strategies• Infections• Malignancies• Autoimmune disorders• Granulomatous disorders• Drug-related fevers• Thrombosis• Transfusion-relatedTreatment of underlying causeAntipyretics including acetaminophen,salycilates, NSAIDsPhysical treatments includingcooling, sponging, etc.• Factitious• Unknown/otherIt is important to be aware that the clinical signs cannot give an indicator of the degree to whicha patient is distressed or bothered by a symptom – that must be defined by the patient’s selfreport.Pain is another subjective sensation (symptom) that may, or may not, be associated withsigns. Although sometimes distress can be seen – as, for example, an anguished appearance,crying, writhing, tachycardia, or other physical manifestations – none of these signs can trulygive the clinician a full indicator of the degree to which a patient is distressed or bothered by thepain. That must be defined by the patient’s self-report.In the case of chronic pain, it is not uncommon for a patient to demonstrate little in the way ofphysical manifestations of distress even when he or she reports that the pain is severe. A patientmay have no visible signs of distress but may report that the pain is 10/10 (on a scale of zeroto 10). Even in the absence of signs of distress, the pain must be assessed, the etiology of thepain considered, and the associated distress concurrently treated. (See Chapter 4: Pain.)By keeping these distinctions in mind, health professionals can more easily keep a focus on thetwo broad goals of symptom assessment: the goal that is related to the treatment of pathophysiology,and the goal that is related to the treatment of distress.U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 41