Altered Immune Response: Immunodeficiency

The nurse is teaching an older adult about strategies to maintain a healthy immune system and prevent infection. The nurse knows that the client needs additional teaching if the client makes which​ statement?

"I will call the health care provider if I feel like I am getting​ sick." ​"I take the type of vitamins recommended for​ seniors." ​"I don​'t want to get a flu shot because I will get the flu from​ it." This is the correct answer. ​"I plan on taking a yoga class for​ seniors." The influenza vaccine should be administered annually to prevent infection with the flu virus. The nurse should educate the client that the influenza vaccine does not cause the flu.Yoga can be used as a stress management strategy as well as a source for regular​ exercise, both of which assist the client in maintaining a healthy immune system.Nutritional and vitamin supplementation is important for maintenance of a healthy immune system in older adults.Older clients should be encouraged to seek medical attention for​ fatigue, change in​ appetite, skin​ rashes, and symptoms of systemic infection.

A nurse is caring for four clients on a postoperative surgical floor. The nurse recognizes that which client is most at risk for infection because of​ immunosuppression?

A client who had a femoral bypass A client who had a total colectomy A client who had an​ above-the-knee amputation A client who had a splenectomy correct Removal of immune organs such as the lymph​ nodes, spleen, or thymus gland reduces the amount of specific tissue available to maintain an adequate immune response. Clients who have had a splenectomy are at higher risk for infection.The client who had an​ above-the-knee amputation, the client who had a total​ colectomy, and the client who had a femoral bypass are not at risk for infection because of immunosuppression.

Aging of the Immune System: Normal Influences of Aging

Aging is associated with physiological changes that cause decreased levels of functioning in many body systems. Aging encompasses a lifetime of the cumulative effects of exposure to the environment, illness, and stress. These factors contribute to age-related decreased immune functioning, or immunosenescence. The ways aging influences the immune system are as follows: Influence Characteristics Overall decrease in function Reduced speed and strength of the immune response Reduced neuroendocrine regulation of immune activities Decrease in humoral immunity Decreased B-cell response to antigenic stimulation Decreased number of B cells in the circulation Decreased production of IgE antibodies Increased antibody production against self Decreased humoral immunity until the age of 60 years; then increased afterwards Decrease in cellular immunity Decreased proliferative responses by T lymphocytes Decreased interleukin-2 Decreased ratio of helper T cells and cytotoxic T cells to other T cells

The nurse is caring for a​ 76-year-old client admitted with a diagnosis of sepsis. The nurse understands the manifestations of bacteremia in the older adult and expects which assessment ​findings?

Agitation This is the correct answer. Decreased level of consciousness This is the correct answer. High fever Confusion This is the correct answer. Nausea and vomiting ​Confusion, agitation, and a decreased level of consciousness are manifestations of bacteremia in the older adult. Older adults usually are hypothermic or run a​ low-grade fever with bacteremia. Nausea and vomiting are not expected manifestations of bacteremia in the older adult.

Aging of the Immune System: Nutrients and Herbal Remedies

An adequate intake of vitamins and trace elements is needed for the immune system to function effectively. Deficiencies of vitamins and trace elements are seen in nearly one third of all older clients, which causes low immune responses and increasing susceptibility to infections. The effectiveness of herbal supplements in boosting the immune system is also being investigated. Additional information about vitamins, trace elements, and herbal supplements is as follows: Supplement Impact on Immune System Vitamins A and D Improve delayed-type hypersensitivity Assist in preventing infection Zinc Improve immune cellular function Reduce respiratory infections Ginseng Believed to improve overall health and boost the immune system Yogurt Low in calories and high in calcium and vitamins, which aids overall health and boosts immunity

Immunodeficiency in the Older Client: Introduction

An immune deficiency occurs when the immune system has a malfunction in its ability to respond and protect the body from an antigenic attack. Immunodeficiencies are categorized as being primary or secondary. Primary immunodeficiencies are the result of genetic abnormalities in the embryonic development of the immune system. Secondary immunodeficiencies occur when the immune system is damaged from aging or infections.

Mr. Zheng is a​ 78-year-old man who is undergoing chemotherapy for colon cancer. He is visiting the clinic because of increased​ fatigue, decreased​ appetite, and​ low-grade fever. Based on these​ symptoms, what is your major​ concern?

An opportunistic infection This is the correct answer. Lymph tissue is enlarged Increased lymphocyte count Chemotherapy is not working The symptoms of​ fatigue, decreased​ appetite, and a​ low-grade fever are all indicative of an infection in an older adult. Because chemotherapy drugs depress the immune​ system, Mr. Zheng is at higher risk for an opportunistic infection. Rather than an increased lymphocyte​ count, he would have a decreased lymphocyte​ count, further suppressing his immune system. Because chemotherapy is acting to suppress the immune system and Mr. Zheng has evidence of an opportunistic​ infection, there is no reason to believe the chemotherapy is not working. Lymph tissue can enlarge in response to an​ infection; therefore, this would be an expected finding.

A nurse identifies that prevention of infection is a high priority for a​ 90-year-old client. The nurse implements which intervention as an infection prevention​ measure?

Assess the client for a high elevation in temperature. Maintain clean technique with all urinary catheter insertions. Restrict the client​'s protein intake. Monitor the client​'s mental status and orientation. correct Often, confusion or mental status change is the only symptom an older adult will have of an infection. It is very important for the nurse to monitor for changes in mental status and orientation and report them to the health care provider. In the older​ adult, the client is more likely to experience hypothermia or a​ low-grade fever with infection. High fevers are uncommon in an older client with an infection. Strict aseptic technique should always be used with all urinary catheter insertions. Clean technique is not appropriate for this client. Low protein intake decreases lymphatic​ tissue, causes atrophy of the thymus​ gland, and alters the​ cell-mediated immune response. The client should have an​ adequate, not​ restricted, intake of protein.

The nurse is reviewing the medications of an​ 89-year-old client who is diagnosed with breast cancer. The nurse knows that which medications will cause suppression of the client​'s immune ​system?

Atenolol​ (Tenormin) Cisplatin​ (Platinol) This is the correct answer. Promethazine hydrochloride​ (Phenergan) Prednisone​ (Deltasone) This is the correct answer. Alendronate​ (Fosamax) Prednisone is a corticosteroid that causes suppression of the immune system.Cisplatin is a chemotherapeutic agent that causes suppression of the immune system.Atenolol is a​ beta-adrenergic blocking agent that does not cause suppression of the immune system.Alendronate is a biphosphonate that inhibits the breakdown of bone in clients with osteoporosis. It has no effects on the immune system.Promethazine hydrochloride is an antihistamine used as an antiemetic for clients with nausea and vomiting. It has no effect on the immune system.

Aging of the Immune System: Chronic Illness

Being diagnosed with a chronic illness has a detrimental affect on the immune system, primarily through the central nervous system. With a chronic illness, the individual's mood is affected. Lymphocytes have receptors on their surfaces for many neuroendocrine hormones that affect the lymphocytes. Consequently, mood can become altered, causing an increase in the number of autoantibodies and decreasing immune responses to antigens. Feedback systems exist between the central nervous system and immune system that try to control the effects of chronic illness. Depending on the extent of the illness, immune system function can deteriorate.

Which of the following is a common symptom of urinary tract infections in the older​ adult?

Decreased sensation of needing to void Decreased urine stream Pain on urination Falls correct Falls are a symptom of urinary tract infections​ (UTIs) in the older​ adult, associated with the client experiencing urgency and urinary frequency and then falling in an attempt to reach the toilet. Older adults experience a sense of urgency with a​ UTI, not a decreased sense of needing to void. UTI pain in the older client is typically experienced as constant suprapubic or flank​ pain, not pain on urination. Decreased urine stream is associated with prostatic disease in the male​ client, which may cause a UTI but is not a symptom.

The nurse is planning interventions to reduce the incidence of skin breakdown in the older adult. The nurse understands that which factors predispose an older adult client to alterations in skin ​integrity?

Dehydration This is the correct answer. Increase in subcutaneous fat tissue Increased elasticity of skin Malnutrition This is the correct answer. Reduced physical activity correct Water content decreases in the skin of the older​ adult, which increases the skin​'s susceptibility to skin injury. Dehydration further decreases the water content of the​ skin, increasing risk for alteration of skin integrity.The result of reduced physical activity on skin integrity is pressure on the tissue between the exterior of the body and bony​ prominences, which interferes with normal blood flow to the area.Nutritional deficits increase the risk of pressure ulcer development.Skin elasticity actually​ decreases, not​ increases, in the older adult. The decreased elasticity contributes to a greater risk for pressure ulcer development.Subcutaneous tissue actually becomes thinner in the older​ adult, increasing the risk for skin tears.

Which of the following interventions would be helpful in ensuring adequate nutritional intake in an older​ adult?

Ensuring a quiet environment at mealtime Limiting snacking to encourage full meals Conducting a calorie count This is the correct answer. Encouraging fluids during meals A calorie count is an excellent way to assess for adequate caloric and nutritional intake in an older adult. Limiting rather than encouraging fluids during meals reduces the feeling of fullness and encourages the older client to eat more. Providing a pleasant social environment will stimulate​ appetite; a quiet environment often inhibits appetite. Offering frequent smaller meals as opposed to three meals a day can increase nutritional​ intake, so​ nutrient-dense snacks should be encouraged.

Aging of the Immune System: Exercise

Exercise may prevent or slow the age-related decline in the immune response. Long-term moderate physical activity is associated with several benefits, including: Reduction in infectious disease risk Increased rates of vaccine efficacy Reduction of inappropriate inflammation Increased wound healing Improved physical and psychosocial aspects of daily living Moderate physical activity performed on a regular basis decreases immunosenescence and improves health for the older client. Tai chi has an impact on circulating levels of IgG and IgM in addition to helping cardiovascular function, mental control, flexibility, balance, and muscle strength.

The nurse is reviewing the nutritional supplements and herbal preparations that a client takes on a daily basis. The nurse knows that which supplements and herbal preparations have a positive effect on a client​'s immune ​function?

Ginseng This is the correct answer. Zinc This is the correct answer. Vitamin A This is the correct answer. Calcium Gingko Vitamins A and D are known to improve​ delayed-type hypersensitivity and assist in preventing infection. Ginseng is an herbal preparation that is believed to improve overall health and boost the immune system. Zinc is a mineral that improves immune cellular function and reduces respiratory infections. Calcium is not known to have a direct effect on immunity. Gingko is an herbal supplement sometimes used for memory. It is not known to have an effect on immunity.

What theory states that immunodeficiency results in progressive destruction of body​ cells?

Immune dysregulation This is the correct answer. Immune deficiency Autoimmune ​Drug-induced Immune dysregulation centers on the concept that multiple changes in the immune system disrupt the regulation among the multiple components of the immune process and results in progressive destruction of body cells. The immune deficiency theory focuses on the breakdown of the body​'s immune system as a result of age. The autoimmune theory states​ that, with​ age, the body has less ability to distinguish normal tissue from​ invaders, such as bacteria.​ Drug-induced immunodeficiency is a precipitating factor in the development of immune​ deficiencies, not a theoretical framework.

The nurse identifies the client problem of an alteration in nutritional intake in a​ 96-year-old client with dementia. The nurse implements which intervention to ensure the client maintains adequate nutritional ​intake?

Implement calorie counts for the client​'s entire intake. This is the correct answer. Plan for the client to eat three meals per day. Force fluids during each meal. Administer the prescribed multivitamin. This is the correct answer. Ask the nursing assistant to set up the client​'s tray and assist the client with the meal. correct Calorie counts allow the nurse to evaluate if the client is consuming enough calories and allow the nurse to make dietary changes if needed. A client with dementia may need assistance with eating. Providing assistance with the meal ensures that the client will consume adequate calories. Nutritional and vitamin supplementation is an important aspect of maintaining adequate nutritional intake in the older adult. Older adults are more likely to have vitamin and protein deficiencies in their diets. Intake of fluids should be limited during the meal because liquids provide a false feeling of fullness and subsequently decrease the client​'s nutrient intake. The older client should actually be offered several small meals per day instead of three meals in 1 day.

Signs and symptoms of pneumonia in the older adult are atypical. Which of the following are manifestations of pneumonia in the older ​adult?

Increased appetite Bradycardia Lethargy Your answer is correct. Disorientation This is the correct answer. Falls correct

Older adults have increased incidence of tuberculosis. Which of the following is a common cause for tuberculosis in this age​ group?

Influenza Contact with children Reactivation of a dormant infection This is the correct answer. Acute pneumonia Reactivation of a dormant infection that has not been effectively treated in the past is a common cause of tuberculosis in the older adult. Tuberculosis in children is not common and is not a source of tubercular infection in elderly people. Both influenza and acute pneumonia are considered acute disease processes and are not associated with tuberculosis. Debilitation as a result of chronic​ disease, however, is associated with development of tuberculosis in the older adult.

Which of the following vaccinations are encouraged with the older adult with ​immunodeficiency?

Influenza This is the correct answer. Measles Pneumococcal This is the correct answer. Mantoux Herpes zoster correct

Place each characteristic in the correct column for each type of factor affecting a​ person's immune system.

Internal Factors Age Modifiable Factors Underlying disease processes Internal Factors Gender External Factors Environmental pollutants Internal Factors Inherited genetic sequence External Factors Ultraviolet light External Factors Radiation Modifiable Factors Nutritional status External Factors Drugs

Which of the following precipitating factors is characterized by an alteration in the​ cell-mediated immune​ response?

Major injury Age Major surgery Malnutrition correct Low protein intake because of malnutrition decreases lymphatic tissue and causes atrophy of the thymus​ gland, altering the​ cell-mediated immune response. Major​ surgery, specifically removal of organs associated with the immune​ system, such as the spleen or thymus​ gland, reduces the overall immune response. Age causes a decrease in the size of the thymus gland and​ T-cell function. Major injury results in destruction of immune system​ tissues, leading to​ shock, which damages cell function.

A nurse is addressing the problem if ineffective protection among a group of residents in a​ long-term-care facility. Which interventions should the nurse implement to address this ​problem?

Monitor the clients​' charts to see if chest​ x-rays have been completed to screen for tuberculosis. Administer a pneumococcal vaccine to all residents. This is the correct answer. Ensure that all residents have blood cultures drawn to screen for infection. Ensure that all clients have been given a​ two-step Mantoux test. This is the correct answer. Check to see if the residents have received a vaccine for herpes zoster. correct The older client is immunosuppressed and is at high risk for contracting pneumonia. All clients should receive the pneumococcal vaccine.The older adult population is much more likely to have a​ false-negative result on a​ one-step Mantoux test. All older adult clients should receive a​ two-step Mantoux test.A herpes zoster vaccine is recommended in the older adult population because they are more susceptible to contracting herpes zoster.A chest​ x-ray should only be administered to screen for tuberculosis infection if a client has a positive​ two-step Mantoux test result.Blood cultures are not routinely drawn unless an infection is suspected because their purpose is to identify an infecting organism. Older clients should not have blood drawn unless necessary.

Immunodeficiency in the Older Client: Causes

Multiple factors affect a person's immune system and ultimately cause an immunodeficiency. These factors include: Cause Characteristics Internal factors Age and gender Inherited genetic sequence Modifiable factors Nutritional status Underlying disease processes External factors Environmental pollutants Radiation Ultraviolet light Drugs

Mr.​ Hernandez, a​ 77-year-old retired prison​ guard, is at the clinic to have his second Mantoux test read. You measure an induration of 5 mm with a reddened area extending 20 mm. What is your interpretation of this​ finding?

Negative Mantoux test result This is the correct answer. Mr. Hernandez has tuberculosis Positive Mantoux test result Mr. Hernandez does not have tuberculosis Older people such as Mr. Hernandez are given a​ two-step Mantoux test because their first test often reads as negative because of immunosuppression even if the client has been exposed to tuberculosis. A second test is given to confirm a negative test result. A negative Mantoux test result is defined as an induration 10 mm or less in diameter. Mr. Hernandez has an induration of 5​ mm, so the test result is negative. The area of redness is not considered in the measurement. A positive test result only shows that an individual has been exposed to​ tuberculosis, not whether he or she has or does not have tuberculosis. You would need to follow this up with a chest​ x-ray to determine if disease is present.

Place each characteristic in the correct column for each influence of aging on the immune system.

Overall Decrease In Function Reduced strength of immune response Overall Decrease In Function Reduced speed of immune response Decrease In Cellular Immunity Decreased ratio of helper T cells to other T cells Overall Decrease In Function Reduced neuroendocrine regulation Decrease In Humoral Immunity Decreased production of IgE Decrease In Humoral Immunity Decreased​ B-cell response Decrease In Cellular Immunity Decreased​ interleukin-2 Decrease In Humoral Immunity Increased antibody production against self Decrease In Humoral Immunity Decreased number of B cells Decrease In Cellular Immunity Decrease in responses by T lymphocytes

Infections Associated with an Aging Immune System: Pneumonia

Pneumonia is a leading cause of death in people older than the age of 65 years. Clearance of foreign invaders by the action of mucus production and cilia is less effective in the older client. As a part of the aging process, there is a loss of both alveolar ducts and surrounding elastic tissue. The signs and symptoms of pneumonia in the older client are atypical, often causing the diagnosis to be missed. Manifestations of pneumonia in the older client include: General deterioration Lethargy Falls Change in mental status and orientation Anorexia Gastrointestinal dysfunction Tachycardia To prevent pneumonia, all people 65 years of age and older should receive the pneumococcal vaccine. The antibody response is lower in older persons and may decline after 5 to 10 years. Revaccination is occasionally recommended after 5 years, especially in those who received the first dose of the vaccine before the age of 60 years.2

In teaching an older adult client about stress and its​ effects, which of the following would be the most important to​ include?

Reviewing how stress blocks the immune response Teaching coping strategies This is the correct answer. Avoidance of all stressful situations Telling client stress increases with age Teaching effective coping strategies is an effective way to decrease stress and its effects on the immune system. Stressors are a part of​ life, and although it would be prudent to minimize stressful​ situations, it is impossible to avoid all stressful situations. Stress does not block the immune​ response, but it does diminish the immune​ response, and the effect is cumulative over time. Stress does not necessarily increase with​ age, but because its effects are​ cumulative, the effects of stress on an already compromised immune system are significant.

Mrs. Giotti is a​ 79-year-old woman admitted to the hospital for treatment of a urinary tract infection. Her temperature is​ 98.9°F (37.2°C), blood pressure is​ 132/88 mmHg, respirations are 18​ breaths/min, and pulse is 88​ beats/min. She is experiencing suprapubic pain. She seems to take a long time to answer questions and asks you to repeat questions frequently. The health care​ provider's orders include​ "up as​ tolerated" and a regular diet. In developing a care​ plan, what is your primary​ concern?

Risk for constipation Risk for stasis ulcers Risk for infection Risk for falls correct Mrs. Giotti is at high risk for falls. Falls are a symptom of a urinary tract infection​ (UTI), but they are also a risk related to​ fatigue, urinary frequency and urgency associated with a​ UTI, and mental status​ changes, all of which Mrs. Giotti is exhibiting. There is no risk for infection because she already has​ one; however, you should monitor for signs of​ septicemia, which can be caused by an untreated UTI. She is at risk for constipation and stasis ulcers related to immobility if she is not out of​ bed, but she can be up as tolerated. Risk for constipation and stasis ulcers is not the priority concern.

Aging of the Immune System: Stress

Stress has a negative effect on the immune system and causes the initiation of the fight-or-flight response to normal everyday worry about bills, work, or relationships or to traumatic experiences. The cumulative effect of stress over time contributes to the physical aging of the immune system. An increase in the amount of stress perceived by a person is associated with poorer cellular immunity. However, the use of active coping to eliminate or circumvent the stress has a positive effect on immune function, particularly at high stress levels.

A nurse is conducting a community health presentation at a senior center about exercise in the older adult. In reviewing the activities offered by the senior​ center, the nurse encourages which class to best promote health and immune​ function?

Tai chi class This is the correct answer. Ice skating trip Painting class Bus trip to the local shopping mall Tai chi has an impact upon circulating levels of IgG and IgM in addition to helping cardiovascular​ function, mental​ control, flexibility,​ balance, and muscle strength. It is the best choice to promote​ well-being and increased immunity.Ice skating poses a greater risk of injury in the older adult and is not the best choice to promote health and immune function in the older adult.A bus trip to the mall may involve​ walking, which is a form of exercise.​ However, it is a​ short-term activity, and the greatest benefit occurs with regular exercise.Painting is a sedentary activity and it is not the best choice for the client wishing to promote health and immune function.

A nurse is evaluating a group of clients in an extended care facility for tuberculosis infection. The nurse knows that a negative Mantoux result will require which​ intervention?

The client will need a second Mantoux test in 1 week. This is the correct answer. The client should be started on isoniazid​ (INH). The client will need a chest​ x-ray. The client does not have tuberculosis infection. No intervention is needed. Older clients who reside in an extended care facility are at a higher risk for developing tuberculosis because of a less effective immune response and weakened immune system. A​ two-step Mantoux test is used to screen residents for exposure to tuberculosis.A chest​ x-ray is performed to diagnose and evaluate tuberculosis infection in the presence of a positive Mantoux test result. The client will need a repeat Mantoux test before a chest​ x-ray would be​ ordered.False-negative responses to Mantoux testing are common in clients who have a suppressed immune system. To verify that the client has a true negative Mantoux​ result, the test must be repeated in 1 week.INH is used to treat a tuberculosis​ infection, which cannot be determined until a second Mantoux test is performed.

Infections Associated with an Aging Immune System: Skin Infections

The older client is more susceptible to injury and skin breakdown because of thinner, less elastic skin. The older client is also prone to developing peripheral neuropathy. This disorder causes a decrease in sensation leading to: Abrasions Burns Stasis ulcers Additional predisposing factors for skin infections in the older client include: Reduced physical activity Malnutrition Dehydration The older client is prone to developing superficial cellulitis of the skin and reactivation of the herpes zoster virus. Because of the overuse of antibiotics and frailty in older clients, hospital-acquired infections are increasing, specifically vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, and Clostridium difficile.

Immunodeficiency in the Older Client: Pathophysiology

The pathophysiology of immune deficiencies depends on the precipitating factor or cause and is categorized as follows: Precipitating Factor Characteristics Drug-induced immunodeficiency This occurs with the use of chemotherapy drugs, drugs to prevent organ rejection, and corticosteroids. These drugs cause suppression of the immune system, leading to opportunistic infections. Age Aging causes a decrease in thymus gland and T-cell function. Malnutrition Low protein intake decreases lymphatic tissue, causes atrophy of the thymus gland, and alters the cell-mediated immune response. Major injuries Immune tissues are destroyed and lead to shock states that damage cell function. Major surgery Removal of immune organs such as the lymph nodes, spleen, or thymus gland reduces the amount of specific tissue available to maintain an adequate immune response. Radiation Exposure to radiation suppresses immune function by destroying the lymph tissue or by causing atrophy of bone marrow function and depression of stem cell production of lymphocytes.

Immunodeficiency in the Older Client: Theories

Three major theories help to explain immunodeficiencies. These theories are the autoimmune theory, the immune deficiency theory, and the immune dysregulation theory. More information about these theories is as follows:1 Theory Criteria Autoimmune As a person ages, the ability of the immune system to differentiate between invaders and normal tissues diminishes. Immune cells begin to attack normal body tissues, causing conditions associated with aging, such as arthritis. Immune deficiency With increasing age, the immune system is no longer able to defend the body from foreign invaders, leading to a breakdown in the body's defenses and to the onset of disease. Immune dysregulation Multiple changes in the immune system disrupt the regulation among the multiple components of the immune process. This results in progressive destruction of the body cells.

Infections Associated with an Aging Immune System: Tuberculosis

Tuberculosis incidence is the highest in people older than the age of 65 years and occurs through the reactivation of a dormant infection that has not been effectively treated in the past. Older clients are also at increased risk of initial infection because of chronic debilitating illnesses or residing in nursing homes.3 Typical symptoms of tuberculosis are less common in the older client. Pleural effusion may be the only manifestation. Other symptoms of the disorder in the older client include confusion and altered mental status. Because the older client has a blunted immune system and delayed reactivity, a two-step Mantoux method of administering the tuberculin test is used. The presence of an infection needs to be differentiated from active disease. Older clients with an infection may be treated with daily isoniazid (INH) for 6 to 12 months. Active disease is treated more aggressively with a combination of drugs over a longer period of time.

Infections Associated with an Aging Immune System: Urinary Tract Infection

Urinary tract infection is one of the most common problems in the older client. The prevalence increases with age and affects both men and women. Causes of infection include fecal contamination with Escherichia coli, bladder dysfunction, prostatic disease in the male client, and the presence of indwelling urinary catheters. In the older client, symptoms of a urinary tract infection may include: Urinary frequency Urgency Suprapubic or flank pain Fever may or may not occur Mental status changes Falls Decline in activities of daily living Hospitalization may be required because a urinary tract infection can lead to septicemia, hypotension, and dehydration in the older client.

An​ 89-year-old client presents to the emergency department with mental status​ changes, flank​ pain, and increased falls. The nurse expects the health care provider to order which diagnostic ​tests?

Urine culture and sensitivity This is the correct answer. Complete blood count This is the correct answer. Blood urea nitrogen level​ (BUN) Urinalysis This is the correct answer. ​X-ray of​ kidneys, ureters and bladder Mental status​ changes, flank​ pain, and an increase in falls are common signs of a urinary tract infection in the older adult. A urine culture and sensitivity will identify the pathogen and which antibiotic will be effective for treatment. An​ x-ray of the​ kidneys, ureters, and bladder is a diagnostic test used to identify calcifications in the kidneys. It is not an indicated diagnostic test to treat a urinary tract infection. A urinalysis will assess for​ pyuria, bacteria, and blood in the urine. A bacteria count of greater than​ 100,000/mL is indicative of infection. The BUN level indicates the kidney​'s clearance of nitrogenous waste products into the urine. An abnormal BUN level is not indicative of urinary tract infection. A complete blood count will show leukocytosis and an increased number of neutrophils in a client with a urinary tract infection.

Adequate levels of which nutritional supplement is associated with a reduction in respiratory infections​ specifically?

Vitamin D Zinc This is the correct answer. Ginseng Vitamin A Zinc improves immune cellular function and is specifically related to a reduction in respiratory infections. It is often prescribed for prevention of the common cold. Vitamins A and D improve​ delayed-type hypersensitivity reactions and assist in preventing​ infections, but they do not specifically prevent respiratory infections. Ginseng is an herbal remedy thought to boost the immune​ system, but there is no evidence it is specifically effective in targeting respiratory infections.

Nursing Care for Immunodeficiency in the Older Client: Assessment

When assessing the older client for an immunodeficiency, you will focus on specific areas, including: Age Nutritional status Recent infections Immunization status Allergies Diagnosis of autoimmune diseases, cancer, and chronic illnesses Recent surgical procedures Pain Current medications Recent blood transfusions Current lifestyle and mobility Presence of stress

The nurse is teaching an elderly client about the effects of nutrition on the immune system. The nurse knows the client understands when the client makes which​ statement?

​"A low-fat diet will keep me from getting​ infections." ​"I need to watch how much bread I​ eat." ​"If I do not eat enough​ meat, I might be more likely to get​ sick." This is the correct answer. ​"I will be sure to eat only salad in the​ future." Low protein intake decreases lymphatic​ tissue, causes atrophy of the thymus​ gland, and alters the​ cell-mediated immune response. Carbohydrate intake is important in maintaining a balanced diet. There is no relationship between decreased carbohydrate intake and immune deficiency. An elderly client​'s diet should not be limited to only one food group because it will lead to nutrient deficiencies and subsequently malnutrition. The client should have an adequate intake of protein to maintain immune function. There is no relationship between a​ low-fat diet and decreased immune response.

The nurse is discussing the effects of aging on immune disorders with a nursing student. The nurse knows that the student understands the principles of autoimmunity when the student makes which​ statement?

​"Autoimmunity occurs when the body overreacts to an​ infection." ​"With an autoimmune​ disorder, the immune system gradually loses the ability to​ function." ​"Autoimmune disorders happen when the body develops antibodies to​ itself." This is the correct answer. ​"A client with an autoimmune disorder will develop​ allergies." Allergies develop because of hyperreactivity of the immune​ system, but they do not have the same pathophysiology of autoimmunity. With increasing​ age, the immune system is no longer able to defend the body from foreign​ invaders, leading to a breakdown in the body​'s defenses and to the onset of disease. This is called immune​ deficiency, but it is not related to the principle of autoimmunity. Autoimmunity occurs when immune defenses are directed against host​ tissue, not infectious organisms. The ability of the immune system to differentiate between invaders and normal tissues diminishes in an autoimmune disorder. Immune cells begin to attack normal body​ tissues, causing conditions associated with​ aging, such as arthritis.

The nurse is discussing the benefits of regular exercise with a client diagnosed with venous insufficiency. The nurse recognizes that the client understands the effects of exercise on immune processes when the client makes which ​statement?

​"Exercising will only make me feel tired and take up too much of my​ time." ​"The sore on my leg may heal more quickly if I​ exercise." This is the correct answer. ​"My flu shot will work better if I walk every​ day." This is the correct answer. ​"Exercising will only make the swelling I have​ worse." ​"I won​'t get sick as​ much." correct Regular exercise has been associated with a reduction in the risk for infectious disease. The efficacy of vaccines is improved with regular exercise. Regular exercise increases the rate of wound healing. Exercise is shown to increase physical and psychosocial​ well-being. Exercise can actually promote a reduction in inappropriate inflammation.

Mrs. Fisk is a​ 70-year-old African American woman who is being seen for her annual physical examination. When you ask how much she​ exercises, she​ responds, "I've never exercised a day in my​ life, and now​ I'm too tired all the​ time." You follow up that response by asking if she does housework. She​ responds, "No. I just sit in my chair and watch my stories on the​ TV." What is your best​ response?

​"If you​ exercise, you​ won't need to get any​ vaccinations." ​"Exercise can reverse​ immunosuppression." ​"You can jog for just 15 minutes a​ day, and it will boost your immune​ system." ​"Moderate physical activity can reduce your risk for infectious​ disease." correct Exercise can prevent or slow​ age-related decline in the immune​ response, and lack of exercise can exacerbate​ immunosuppression, thereby placing Mrs. Fisk at higher risk for an infection. Although exercise increases a​ vaccine's efficacy, it does not eliminate the need for vaccinations. Exercise can prevent or slow immunosenescence​ (decreased immune function related to​ age), but it cannot reverse it. Moderate exercise in the older adult must be modified to accommodate arthritic changes. Mrs. Fisk is sedentary. Jogging is high impact and may initiate an inflammatory response in Mrs.​ Fisk's joints. A​ low-impact exercise, such as tai​ chi, would be more appropriate.

A client tells the​ nurse, "I have had diabetes for 10​ years, and it seems like I am getting colds all of the time. Why is this​ happening?" What is the nurse​'s best​ explanation?

​"There is no relationship between your diabetes and getting colds. Have you been with large crowds​ recently?" ​"Having a chronic illness such as diabetes changes how your white blood cells respond to​ infections, which means you get sick more​ often." This is the correct answer. ​"You are getting a lot of colds because you are not eating​ properly." ​"Your central nervous system is suppressing your immune system because you are​ depressed." With a chronic​ illness, the individual​'s mood is affected. Lymphocytes have receptors on their surfaces for many neuroendocrine hormones that affect the lymphocytes.​ Consequently, mood can become​ altered, causing an increase in the number of autoantibodies and decreasing immune responses to antigens. The nurse should respond with the most specific answer to the client​'s question.There is a definite causal relationship between the existence of chronic illness and decreased immunity and increased risk of infection. The nurse should address the causal relationship rather than placing the blame on other factors.The question does not mention that the client is depressed. Although clients with chronic disease have a tendency toward depressive​ mood, it is not correct to assume that the client is depressed.The question makes no mention of the client​'s nutritional​ status, so it would be inappropriate for the nurse to assume the client has a poor diet just because of a diabetes history.