CASE PRESENTATION

INTRODUCTION- My client was admitted in antenatal ward through OPD

with the complaint of 9 month amenorrhoea and pain in the lower abdomen,
and also on ART since 1 year.
BASELINE DATA OF THE PATIENTName-

Mrs shakuntala

Age-

27 years

Sex-

female

Address-

Santoshi nagar, chowrasiya colony, Raipur.

Registration no-

I/73

DOA-

04/01/14

Unit-

antenatal unit

Ward no-

03

Bed no-

16

Religion-

Hindu

Marital status-

Married

Educational status- 9th

Occupation-

Housewife

Diagnosis-

Pregnancy with HIV

Dr.consultant-

Dr.Abha Singh

CLIENT COMPLAINTS-(document in patients own word)

Pain in lower abdomen- YES
Dizziness-

NO

Other complains-

NO

Weakness-

HISTORY OF THE CLIENT

YES

FAMILY HISTORYType of familyNuclear

yes

Joint

no

No. of family members- 02 members

Any disease- no any significant family history.
s.n
o

Name of the
persons

1.

Mr. Tikeshwar 30 yrs

sahu
Mrs.shakuntala 27 yrs

2.

Age/sex Relationship
with client

Health
status

Specify
disease(if
any)
HIV +ve

Husband

Stable

Patient

Not good HIV+ve

FAMILY TREE-(symbolic representation)

Male

female

SOCIO ECONOMIC HISTORYFamily income-

4000/month

No of earning member-

01

Education-

9th pass

Social support-

poor

Relationship with neighbours- poor

SANITARY HISTORYGoodAverage-

female client

PoorOral hygiene:

GoodPoor Bathing habit:Daily-

Alternate -

Grooming :Maintained-

Not maintainedENVIRONMENTAL HISTORYType of house:Pucca:-

Kuccha:Ventilation:Adequate-

InadequateElectricity:Available-

Not availableWater supply:Tap waterWellHand pumpTube well-

Drainage system:OpenClosed-

PERSONAL HEALTH HISTORYHealth facility nearby home:Present-

AbsentSleep pattern:Regular-

IrregularBladder and bowel habits:Regular-

IrregularAllergies :-

nil

Health habits:Smoking
Tobacco

None of these

Alcohol
Drugs
Religious history:Religion-

Hindu

Exercise :remark- no particular exercises,perform regular motor activities.

NUTRITIONAL HISTORY

VegetarianNon vegetarian-

MENSTRUAL HISTORYCycle-

30 days

Duration-

4 days

Amount of blood loss-

40ml/cycle

No of pads used-

3 pads/day

MEDICAL HISTORY OF THE CLIENT

PAST MEDICAL HISTORYChildhood illness-

no

(if yes then list down)

Adult illness-

no

(if yes then list down)

Hospitalization-

No

Accident-

no

Hyperlipidema

no

Hypertension-

Diabetes mellitus-

no

Chronic obstructive pulmonary disease-

Other chronic illness-

no

(if yes then list down)

Trauma to chest-

no

Throat and dental extraction-

no

Rheumatic fever-

no

Thrombo embolism-

no

no
no

PRESENT MEDICAL HISTORY- my client was admitted in ward through

OPD with the complaint of lower abdominal pain and 9 month amenorrhoea.
SURGICAL HISTORY OF THE CLIENT
PAST SURGICAL HISTORYSurgery-

no

PRESENT SURGICAL HISTORY- no any significant present surgical

history.
OBSTETRICAL HISTORYNo of living children-

00

Last menstrual period-

04/04/13

Expected date of delivery-

11/01/14

Gravid-

01st gravida

Abortion-

nil

Stillbirth-

nil

PAST OBSTETRICAL HISTORYMy patient is not having any significant past obstetrical history, she has
conceived for the first time.
INVESTIGATIONPRESENT INVESTIGATION
Date
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.

Investigation
S.creatinine
Total Bilirubin
Direct Bilirubin
SGOT
SGPT
Alkaline phosphate
S.sodium
Haemoglobin
W.B.C
Lymphocytes
Monocytes
Eosinophils
Basilophils

MEDICATION-

In client
0.5mg/ml
0.2mg/dl
0.2mg/dl
28U/L
9U/L
92U/L
137m/Mole
9.8gm%
10000
15.4
9.6
3.9
0.9

Normal
0.7-1.5mg/dl
0.2-1.2mg/dl
0.1-0.4mg/dl
5-45U/L
5-45U/L
33-98U/L
135150m/mole
11.5-16.5
4000-11000
20-45%
0-8%
0-7%
0-1%

Remark
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Low
Normal
Normal
Increased
Increased
Normal

My patient is taking antiretroviral therapy since an year,other than ART

following are the medications prescribed

Inj ceftriaxone
Inj gentamycin
Inj metrogyl
Inj MVI
Tab aciloc
Tab calcium

PHYSICAL EXAMINATION OF CLIENT

GENERAL APPEARANCEBody positions:Normal-

Abnormal-

Nourishment:Well nourished-

Under nourishment-

Health:Healthy-

Unhealthy

Activity :Active-

Dull-

General built:Thin-

Emaciated-

Semiconscious-

Anxious-

MENTAL STATUSConsciousnessConsciousLook:NormalWorried-

Depressed-

SKIN CONDITIONColorPallor-

Cyanosis-

Flushing-

Normal-

Texture
Dryness-

Wrinkling-

FlakingExcessive moisture-

Skin turgorPresent-

Absent-

TemperatureWarm

Cold-

Clammy-

Normal-

ScarsPresent

Absent-

Absent-

Abnormal-

Brown-

EdemaPresentHair distributionNormalHair colorBlackHEAD AND FACEScalpCleanliness-

Dandruff-

Pediculi-

Infection-

FaceSymmetrical-

Asymmetrical-

Pale-

Flushed-

Puffiness-

Fear-

Normal-

EYESEye brow:Normal-

Absent-

Eye lashes:Equal distribution-

Infection-

Unequal distributionSty-

Sclera:White-

Dry-

YellowMoist-

Cornea and iris:Regular-

Irregular-

Abrasions-

Pupils:DilatedReacted to light-

Constricted

Vision:NormalEARS:External ear:-

Abnormal-

Discharges

none of these

Obstructions
Hearing:Normal-

Abnormal-

Discharge-

NOSE:External nose:Crust
Nostril:Inflammation

none of these

septal deviations
MOUTH AND PHARYNXLips:Redness-

Pale-

PinkCyanosis-

Mouth:Nil

Foul smellTeeth :Discoloration

none of these

Dental carries
Tongue:-

normal

Gums:-

normal

Bleeding
Gingival infection
Uvula:-

none of these

Symmetrical-

Asymmetrical-

Enlarged-

Hoarseness-

Tonsils:NormalVoice:NormalNECKLymph nodes:

Enlarged-

Palpable-

MassesPresent-

Absent

Swelling:Present-

Absent-

Neck range of motion:Flexion

Normal

Extension
Rotation
BREASTNormal-

Symmetrical-

AbnormalAsymmetrical-

Nipple:Protruded-

Inverted-

Pigmented-

Discharge-

Cracked-

Glands

THORAX AND LUNGS

Shape:Normal-

Abnormal-

Inadequate-

Expansion:AdequateTenderness:Breath sounds:HEARTRate-

nil
normal
78/m
n

Rhythm:Regular-

Irregular-

Abnormal-

Inappropriate-

Not palpable-

Size:NormalLocation:AppropriateApical pulse:PalpableHeart sound:Murmer-

S1 and s2-

High pitch-

Low pitch-

ABDOMENShape:-

Normal

Abnormal-

Girth-

Scar-

Ascitis-

Distension-

Skin rashes-

Bowel sound:
Present-

Absent-

Liver:Palpable-

Not palpable-

Spleen:Palpable-

Not palpable-

Tenderness:Present-

Absent-

EXTREMITIESUpper limb:Normal-

Abnormal-

Abnormal-

Absent-

Lower limb:NormalMovement:PresentTremors:Present-

Absent-

Edema :Present-

Absent-

Varicose vein:Present-

Absent-

Reflexes:PresentGENITALIA(FEMALE)

Absent-

Hair distribution-

Bleeding-

DischargeUrethal meatus-

Vaginal opening-

normal

Clitoris-

normal

Foul smell-

YES

Mass-

absent

RECTUM-

no any abnormality

InflammationYES

Normal-

Scars-

Lesions-

Ulceration-

Rashes-

Pain-

Bleeding-

Sphincter control-

VITAL SIGNS98.6F

Temperature:FebrileAfebrile-

Route for monitoring temperature:Oral

AxillaryRectalPulse:-

78/min

Monitoring site-

radial

RateRegular-

Irregular-

Palpable-

Not palpable-

Strong beats-

Weak beats-

Bounding pulse-

Thready pulse-

Pulse deficit-

Water hammer pulse-

Remarks-.........................................................................................................
Respiration :Rate-

20/min

Remarks-

regular

Blood pressure:Lying down position-

120/70 mmhg

Pulse alternances:Loud sound-

Soft sound-

HEIGHT-

156 cm

WEIGHT-

42kg

UnderweightNormalOverweightObesityExtreme obesityOBSTETRICAL EXAMINATIONPer abdomenInspectionShape of the abdomen-

normal

Skin condition-

normal

Striae gravidarum-

present

Scar-

nil

PalpationFundal palpationDIAGNOSIS:

36 cm height
HIV WITH PREGNANCY

DEFINITION:
HIV(HUMAN IMMUNODEFICIENCY VIRUS)
The human immunodeficiency virus (HIV) is a lentivirus (slowly replicating
retrovirus) that causes the acquired immunodeficiency syndrome (AIDS), a
condition in humans in which progressive failure of the immune system allows
life-threatening opportunistic infections and cancers to thrive.
PREGNANCY
Pregnancy is the fertilization and development of one or more offspring,
known as an embryo or fetus, in a woman's uterus.
HIV WITH PREGNANCY
When a women is infected with HIV during pregnancy.
Incidence:
The world estimates of HIV infections have been reviewed recently. In 2007,
UNAIDS estimated that 33.2 million people were living with
HIV/AIDS worldwide; of these 15.4 million were women. In many
regions of the world more women than men are at risk of HIV infection, with
50% of all new daily infections in Sub-Saharan Africa being in women.
Children account for more than 12% of all new infections, and globally 2.5
million children less than 15 years of age were living with HIV in 2007. About
1,200 children under the age of 15 years become infected with HIV daily
(UNAIDS/WHO, 2007). Without appropriate care and treatment, more than
50% of newly infected children will die before their second birthday.
Perinatal transmission of HIV
Vertical transmission to the neonates is about 14-25%.transplacental
transmission occurs20%before 36 weeks,50%before delivery and 30% during
labour.vertical transmission is more in cases with preterm birth and prolonged

rupture of membrane.maternal anti retroviral therapy reduces the risk of vertical

transmission by 70%.Breast feeding increases transmission by 30-40%.
Incubation period
The incubation period is about 1-3 weeks.
Immunopathogenesis
Due to profound cell mediated immunodefieciency,as the HIV leads to slow but
progressive destruction of T cells.after a peak viral load there is gradual fall
until a steady state of viral concentration is reached.this is known as set point
which is a state of balance between the viruss ability to replicate and the host
ability to protect itself by neutralisation and removal of virus.when the set point
viral load is high causes more destruction of host CD4+ cells leading to
progressive immunocompression giving rise to opportunistic infections and
cancers.
Causes
To become infected with HIV, infected blood, semen or vaginal secretions must
enter your body. You can't become infected through ordinary contact
hugging, kissing, dancing or shaking hands with someone who has HIV or
AIDS. HIV can't be transmitted through the air, water or via insect bites.
HIV can be infected in several ways, including:
By having sex. You may become infected if you have vaginal, anal or
oral sex with an infected partner whose blood, semen or vaginal
secretions enter your body. The virus can enter your body through mouth
sores or small tears that sometimes develop in the rectum or vagina
during sexual activity.
From blood transfusions. In some cases, the virus may be transmitted
through blood transfusions. American hospitals and blood banks now
screen the blood supply for HIV antibodies, so this risk is very small.
By sharing needles. HIV can be transmitted through needles and
syringes contaminated with infected blood. Sharing intravenous drug
paraphernalia puts you at high risk of HIV and other infectious diseases,
such as hepatitis.

 During pregnancy or delivery or through breast-feeding. Infected

mothers can infect their babies. But receiving treatment for HIV infection
during pregnancy, mothers significantly lower the risk to their babies
Risk factors
When HIV/AIDS first surfaced in the United States, it mainly affected men who
had sex with men. However, now it's clear that HIV is also spread through
heterosexual sex.
Anyone of any age, race, sex or sexual orientation can be infected, but you're at
greatest risk of HIV/AIDS if you:
Have unprotected sex. Unprotected sex means having sex without using
a new latex or polyurethane condom every time. Anal sex is more risky
than is vaginal sex. The risk increases if you have multiple sexual
partners.
Have another STI. Many sexually transmitted infections (STIs) produce
open sores on your genitals. These sores act as doorways for HIV to enter
your body.
Use intravenous drugs. People who use intravenous drugs often share
needles and syringes. This exposes them to droplets of other people's
blood.
Are an uncircumcised man. Studies indicate that lack of circumcision
increases the risk of heterosexual transmission of HIV.
Effects
pregnancy has no effect in the progression of disease in HIV positive mother.
increased incidence of abortion ,prematurity, IUGR and perinatal mortality in
HIV seropositive mothers still remains in conclusive. maternal morbidity and
mortality is not increased by pregnancy.
Clinical presentation
Initial presentation of an infected patient may be fever , malaise,
headache, sore throat, lymphadenopathy and maculopapular rash.
primary illness may be followed by an asymptomatic period.
disease progression may lead to multiple opportunistic infection with
candida , tuberculosis, pneumocystitis and others.

 patient may present with neoplasms such as cervical carcinoma,

lymphomas and kaposis sarcoma.
there may be associated constitutional symptoms like weight loss,
lymphadenopathy or protracted diarrhoea.
CD4+count <200 cells /mm3 is diagnostic of AIDS.
the median time from infection to AIDS is about 10 years.
Diagnosis
The enzyme immunoassay(EIA) is used widely as a screening test for HIV
antibodies.it is extremely sensitive ,in expensive but less specific.EIA kits are
commercially available.this is then confirmed by western blot test or
immunofluorescence assay(IFA).the western blot detects specific viral antigens
P24(capsid),GP41(envelope) and GP 120/160(envelope).false positive rate of
western blots is less than 1 in 10000.
Complication
HIV infection weakens immune system, making you highly susceptible to
numerous infections and certain types of cancers.
Infections common to HIV/AIDS
Tuberculosis (TB). In resource-poor nations, TB is the most common
opportunistic infection associated with HIV and a leading cause of death
among people with AIDS. Millions of people are currently infected with
both HIV and tuberculosis, and many experts consider the two diseases to
be twin epidemics.
Salmonellosis. You contract this bacterial infection from contaminated
food or water. Signs and symptoms include severe diarrhea, fever, chills,
abdominal pain and, occasionally, vomiting. Although anyone exposed to
salmonella bacteria can become sick, salmonellosis is far more common
in HIV-positive people.
Cytomegalovirus. This common herpes virus is transmitted in body
fluids such as saliva, blood, urine, semen and breast milk. A healthy
immune system inactivates the virus, and it remains dormant in your
body. If your immune system weakens, the virus resurfaces causing
damage to your eyes, digestive tract, lungs or other organs.

 Candidiasis. Candidiasis is a common HIV-related infection. It causes

inflammation and a thick, white coating on the mucous membranes of
your mouth, tongue, esophagus or vagina. Children may have especially
severe symptoms in the mouth or esophagus, which can make eating
painful.
Cryptococcal meningitis. Meningitis is an inflammation of the
membranes and fluid surrounding your brain and spinal cord (meninges).
Cryptococcal meningitis is a common central nervous system infection
associated with HIV, caused by a fungus found in soil. The disease may
also be associated with bird or bat droppings.
Toxoplasmosis. This potentially deadly infection is caused by
Toxoplasma gondii, a parasite spread primarily by cats. Infected cats pass
the parasites in their stools, and the parasites may then spread to other
animals and humans.
Cryptosporidiosis. This infection is caused by an intestinal parasite that's
commonly found in animals. You contract cryptosporidiosis when you
ingest contaminated food or water. The parasite grows in your intestines
and bile ducts, leading to severe, chronic diarrhea in people with AIDS.
Cancers common to HIV/AIDS
Kaposi's sarcoma. A tumor of the blood vessel walls, this cancer is rare
in people not infected with HIV, but common in HIV-positive people.
Kaposi's sarcoma usually appears as pink, red or purple lesions on the
skin and mouth. In people with darker skin, the lesions may look dark
brown or black. Kaposi's sarcoma can also affect the internal organs,
including the digestive tract and lungs.
Lymphomas. This type of cancer originates in your white blood cells and
usually first appears in your lymph nodes. The most common early sign is
painless swelling of the lymph nodes in your neck, armpit or groin.
Other complications
Wasting syndrome. Aggressive treatment regimens have reduced the
number of cases of wasting syndrome, but it still affects many people
with AIDS. It's defined as a loss of at least 10 percent of body weight,
often accompanied by diarrhea, chronic weakness and fever.

 Neurological complications. Although AIDS doesn't appear to infect the

nerve cells, it can cause neurological symptoms such as confusion,
forgetfulness, depression, anxiety and difficulty walking. One of the most
common neurological complications is AIDS dementia complex, which
leads to behavioral changes and diminished mental functioning.
Kidney disease. HIV-associated nephropathy (HIVAN) is an
inflammation of the tiny filters in your kidneys that remove excess fluid
and wastes from your bloodstream and pass them to your urine. Because
of a genetic predisposition, the risk of developing HIVAN is much higher
in blacks.
Regardless of CD4 count, antiretroviral therapy should be started in those
diagnosed with HIVAN.

Management:
Prenatal care:
Voluntary serological testing for HIV infection to all pregnant women in
the prenatal clinic should be offered.
In seropositive cases the following additional tests should be done like
test for other STDs such as hepatitis B virus, syphilis, Chlamydia, herpes
and rubella then serological testing for cytomegalovirus and
toxoplasmosis,test for tuberculosis and husbands should also be offered
serological test for HIV.
Counselling about the risk of HIV transmission to the fetus and neonates
should be made and termination offered.women with AIDS are
discouraged to become pregnant.
Progression of the disease is assessed is assessed by
CD4+ T lymphocytes counts
HIV/RNA(viral load)
The patient should have T lymphocyte count in each trimester.if the count
falls to less than 200cells/mm3 ,the patient should receive prophylaxis
against pneumocystitis carinii and other opportunistic infections.
Highly active antiretroviral therapy (HAART) to HIV positive women is
effective in reducing the viral (HIVRNA) load.triple chemotherapy is
preferred as a first line defence and to be started any time between 14 and

28 weeks and then continued throughout pregnancy,labour and

postpartum period.
Medical mgmt
i. Zidovudine (AZT) 300 mg twice daily.(Monitor haemoglobin levels)
ii. Lamivudine (3TC) 150 mg twice daily
iii. Nevirapine (NVP) 200 mg daily x 14 days, then 200mg twice daily.

Zidovudine
Zidovudine or azidothymidine (AZT) (also called ZDV) is a nucleoside analog
reverse-transcriptase inhibitor (NRTI), a type of antiretroviral drug used for the
treatment of HIV/AIDS infection. AZT inhibits the enzyme (reverse
transcriptase) that HIV uses to synthesize DNA, thus preventing viral DNA
from forming. it can also be used to prevent HIV transmission, such as from
mother to child during the period of birth or after a needle stick injury. Used by
itself in HIV-infected patients, AZT slows HIV replication in patients, but does
not stop it entirely.Current treatment regimens involve relatively lower dosages
(e.g., 300 mg) of AZT taken just twice a day, almost always as part of highly
active antiretroviral therapy (HAART), in which AZT is combined with other
drugs (known affectionately as "the triple cocktail") in order to prevent the
selection of HIV into an AZT-resistant form.
Lamivudine
Lamivudine is an analogue of cytidine. It can inhibit HIV reverse transcriptase
and also the reverse transcriptase of hepatitis B. It is phosphorylated to active
metabolites that compete for incorporation into viral DNA. They inhibit the
HIV reverse transcriptase enzyme competitively and act as a chain terminator of
DNA synthesis.Lamivudine is administered orally, and it is rapidly absorbed

with a bio-availability of over 80%.Lamivudine is often given in combination

with zidovudine, with which it is highly synergistic. Lamivudine treatment has
been shown to restore zidovudine sensitivity of previously resistant HIV.
Nevirapine
Nevirapine (NVP is a non-nucleoside reverse transcriptase inhibitor (NNRTI)
used to treat HIV infection and AIDS.As with other antiretroviral drugs, HIV
rapidly develops resistance if nevirapine is used alone, so recommended therapy
consists of combinations of three or more antiretrovirals.Nevirapine in triple
combination therapy has been shown to suppress viral load effectively when
used as initial antiretroviral therapy (i.e., in antiretroviral-naive patients).
Although concerns have been raised about nevirapine-based regimens in those
starting therapy with high viral load or low CD4 count, some analyses suggest
that nevirapine may be effective in these patients. A single dose of nevirapine
given to both mother and child reduced the rate of HIV transmission by almost
50% compared with a very short course of zidovudine (AZT).prophylaxis with
single-dose nevirapine in addition to zidovudine is more effective than
zidovudine alone.

Medication(in patient)
S. Name of
No drug

Dose

Route Time

1gm

I/V

Inj
Ceftriaxo
ne

Q 12
hrly

Action

Bind to
bacterial cell
wall
membrane,
causing cell
death.
Therapeutic
effects:
bactericidal
action
against
susceptible

Side effect

CNSseizure
GIdiarrhea,
nausea,
vomiting,
cramp
GU:
interstitial
nephritis
Derm.rashes,

Nursing
responsibility

- Assess
patient for
infection at
beginning
and during
therapy.
- Obtain
specimens for
culture and
sensitivity
before

2.

3.

Inj
Gentamy
cin

Tab
Aciloc

80m
g

150
mg

I/V

PO

Q 12
Hrly

Q12
hrly

bacteria.

urticaria
Hemat:
blood
dyscrasias,
hemolytic
anemia
Misc:
allergic
reactions
including
anaphalaxi
s.

initiating
therapy. First
dose may be
given before
receiving
results.

Inhibits
protein
synthesis in
bacteria at
level of 30s
ribosomes

Ototoxicity
Nephrotoxi
city
Muscle
paralysis

Assess the
patient for
infection

Inhibit the
action of
histamine at
the H2
receptor site
located
primarily in
gastric
parietal
cells,
resulting in
inhibition of
gastric acid
secretion.
Therapeutic

-monitor
input and
output
-daily weight
-Assess the
patient with
epigastric or
abdominal
pain and
frank or
occult blood
in the stool,
emesis, or
gastric
aspirate.

CNS:
confusion,
dizziness,
drowsiness
,
hallucinati
on,
headache.
CV:
arrhythmia
s
GI: altered
taste, black -Assess
tongue,
geriatric and
constipatio debilitated

4.

Tab
Metrogyl

400
mg

PO

BD

effect:
healing and
prevention
of ulcers.
Decreased
symptoms of
gastroesopha
geal reflux.
Decreased
secretion of
gastric acid.

n, dark
patients
stools,
routinely for
diarrhea,
confusion.
drug
induced
hepatitis,na
usea,
GU:
decrease
sperm
count,
impotence.
Endo.:
gynecomas
tia
Hemat:
anemia,
neutropeni
a
thrombocyt
openia.

Disrupts
DNA and
protein
synthesis in
susceptible
organisms.
Therapeutic
effect:
bactericidal,
trichomonaci
dal, or
amebicidal
action.

CNS:
seizures,
dizziness,
headache
EENT:
tearing.
GI:
abdominal
pain,
anorexia,
nausea,
diarrhea,
dry mouth,
furry
tongue,

-Assess
patient for
infection at
beginning of
and
throughout
therapy.
-Obtain
specimens for
culture and
sensitivity
before
initiating
therapy. First
dose may be

glossitis,
unpleasant
taste,
vomiting.
Derm:
rashes,
urticaria,
burning,
mild
dryness,
skin
irritation
Hemat. :
leucopenia.

6.

Tab.
Calcium

PO

OD

Calcium
supplement

7.

Tab. MVI

PO

OD

Vitamin
supplement

given before
receiving
results.
-Monitor
neurologic
status during
and after IV
infusion.

-Monitor
intake and
out put and
daily weight
specially for
patient on
sodium
restrictions.
Check the
medication
rights.
hypervitam Monitor vital
inosis
signs.

Health education
Continue medicines as prescribed by the physician.
Avoid breast feeding.

Provide newborn formula milk as per advise of physician.

Use contraceptive methods.
Use family planning methods.
HIV testing of baby recommended after 14-21 days of birth.
Prevent further pregnancies.
Maintain personal hygiene.
Eat nutritious balanced diet.
Follow-up should be done.

Bibliography1. Dutta, d.c. (2009),Textbook of obstetrics. 6th edition,new central book

agency (p) ltd.pg-300-302

2. Ghai o. P. (2007) essential peadiatrics ,5th edition , mehta publisher pg-224245

3. Jecob, annamma. (2008)A comprehensive textbook of midwifery 2nd
eition,jaypee brothers medical publisher (p) ltd,pg-98-99
4. Lippincott (2006) manual of nursing practice,8th edition, elsvier publication,
pg-160-164
5. Marlow (2001) peadiatric nursing,7th edition,jaypee medical publisher (p)
ltd, pg-114-118
6. Sharma, piyush (2009). Midwifery and obstetrical nursing,1st edition New
gen next publication, pg-65
7. http://www.westerncape.gov.za/eng/directories/services/11500/6389
8. http://aidsaction.net/hsm/section2.html
9. http://www.babycentre.co.uk/pregnancy/antenatalhealth/physicalhealth/hiv&
aids/
10.http://www.thebody.com/content/art13590.html
11.http://aids.gov/hiv-aids-basics/prevention/reduce-your-risk/pregnancy-andchildbirth/
12.http://www.aidsmap.com/Mother-to-baby-transmission/page/1044918/
13. http://www.americanpregnancy.org/pregnancycomplications/hivaids.html