Chapter 36: Management of Patients With Immune Deficiency Disorders
The nurse identifies a nursing diagnosis of ineffective airway clearance related to pneumocystis pneumonia and increased bronchial secretions for a client with AIDS. Which of the following would be appropriate for the nurse to include in the client's plan of care? Maintain the client in a supine or side-lying position. Encourage client to ambulate frequently in the halls. Assist with chest physiotherapy every 2 to 4 hours. Limit fluid intake to 1 1/2 to 2 liters per day.
Assist with chest physiotherapy every 2 to 4 hours The nurse should include interventions such as assisting with and/or performing chest physiotherapy every 2 to 4 hours to prevent stasis of secretions, assist the client to attain the semi- or high Fowler's position to facilitate breathing and airway clearance, allow for frequent rest periods to prevent excessive fatigue, and maintain a fluid intake of at least 3 liters per day unless contraindicated.
A client with cytomegalovirus (CMV) infection reports difficulty seeing. The physician determines that the client is developing CMV retinitis. What medication does the nurse anticipate the client will receive for this? zidovudine fluconazole azithromycin foscarnet
foscarnet The drug foscarnet is used to treat CMV retinitis and is given by controlled IV infusion. Alterations in renal function, fever, nausea, anemia, numbness in the extremities, and diarrhea are the most common adverse effects. Zidovudine is used in antiretroviral therapy to prevent the conversion of HIV to AIDS. Azithromycin is an antibiotic and not used to treat CMV retinitis.
A client has discussed therapy for his HIV-positive status. What does the nurse understand is the goal of antiretroviral therapy? Reverse the HIV+ status to a negative status. Treat mycobacterium avium complex. Eliminate the risk of AIDS. Bring the viral load to a virtually undetectable level
Bring the viral load to a virtually undetectable level
More than 50% of individuals with this disease develop pernicious anemia: Bruton disease Common variable immunodeficiency (CVID) DiGeorge syndrome Nezelof syndrome
Common variable immunodeficiency (CVID) More than 50% of clients with CVID develop pernicious anemia. Pernicious anemia is not associated with the other conditions.
During a third-trimester transabdominal ultrasound, cardiac anomaly and facial abnormalities are noted in the fetus. Further testing reveals that the thymus gland has failed to develop normally, and the fetus is diagnosed with thymic hypoplasia. Based on this diagnosis, the nurse anticipates careful monitoring for which common manifestation during the first 24 hours of life? Hypoglycemia Hypocalcemia Hyperkalemia Thrombocytopenia
Hypocalcemia The most frequent presenting sign in clients with thymic hypoplasia (DiGeorge syndrome) is hypocalcemia that is resistant to standard therapy. It usually occurs within the first 24 hours of life.
Reproductive health education for women who are HIV-positive includes recommending which of the following contraceptives? Oral estrogen contraceptives An intrauterine device (IUD) A diaphragm The female condom
The female condom The female condom, the first barrier method controlled by women, is the only proven, effective method to prevent the transmission of HIV and sexually transmitted infections (STI).
When the nurse administers intravenous gamma-globulin infusion, she recognizes that which symptom, if reported by the client, may indicate an adverse effect of the infusion? Tightness in the chest Nasal stuffiness Increased thirst Burning urination
Tightness in the chest Flank pain, tightness in the chest, or hypotension indicates adverse effects of gamma-globulin infusion. Nasal stuffiness and increased thirst are not recognized as adverse effects of gamma-globulin infusion. Burning urination is a sign of urinary tract infection, not an adverse effect of gamma-globulin infusion.
A client is prescribed didanosine as part of a highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client? "You should take the drug with an antacid." "It doesn't matter if you take this drug with or without food." "Be sure to take this drug about 1/2 hour before or 2 hours after you eat." "When you take this drug, eat a high-fat meal immediately afterwards."
"Be sure to take this drug about 1/2 hour before or 2 hours after you eat." Didanosine (Videx) should be taken 30 to 60 minutes before or 2 hours after meals. Other antiretroviral agents, such as abacavir, emtricitabine, or lamivudine can be taken without regard to meals. High-fat meals should be avoided when taking amprenavir. Atazanavir should be taken with food and not with antacids.
A nurse is providing discharge teaching to a client who is immunosuppressed. Which statement by the client indicates the need for additional teaching? "I won't go to see my sister while she has a cold." "I can eat whatever I want as long as it's low in fat." "I stopped smoking last year; this year I'll quit drinking alcohol." "I won't go to see my nephew right after he gets his vaccines."
"I can eat whatever I want as long as it's low in fat." The client requires additional teaching if he states that he can eat whatever he wants. Immunosuppressed clients should avoid raw fruit and vegetables because they may contain bacteria that could increase the risk of infection; foods must be thoroughly cooked. Avoiding people who are sick, products containing alcohol, and people who have just received vaccines are appropriate actions for an immunosuppressed client.
A client who has AIDS reports having diarrhea after every meal, and wants to know what can be done to stop this symptom. What should the nurse advise? Avoid fibrous foods, lactose, fat, and caffeine. Consume large, high-fat meals. Reduce food intake. Increase intake of iron and zinc.
Avoid fibrous foods, lactose, fat, and caffeine. Diarrhea may subside when the client avoids fibrous foods, lactose, fat, and caffeine. Although eating may seem to cause diarrhea, the client must understand that limiting the intake of food to control diarrhea only exacerbates wasting. The client will tolerate a low-fat, high-carbohydrate, and soft or liquid diet better than large, high-fat meals. The client should be advised to avoid large doses of iron and zinc because they can impair the functioning of the immune system.
A client with acquired immune deficiency syndrome (AIDS) informs the nurse of difficulty eating and swallowing, and shows the nurse white patches in the mouth. What problem related to AIDS does the nurse understand the client has developed? MAC Wasting syndrome Kaposi's sarcoma Candidiasis
Candidiasis Candidiasis, a fungal infection, occurs in almost all clients with AIDS and immune depression (Durham & Lashley, 2010). Oral candidiasis is characterized by creamy-white patches in the oral cavity and, if left untreated, can progress to involve the esophagus and stomach. Associated signs and symptoms include difficult and painful swallowing and retrosternal pain.
The nurse practitioner who is monitoring the patient's progression of HIV is aware that the most debilitating gastrointestinal condition found in up to 90% of all AIDS patients is: Anorexia. Chronic diarrhea. Nausea and vomiting. Oral candida.
Chronic diarrhea. Chronic diarrhea is believed related to the direct effect of HIV on cells lining the intestine. Although all gastrointestinal manifestations of AIDS can be debilitating, the most devastating is chronic diarrhea. It can cause profound weight loss and severe fluid and electrolyte imbalances.
A patient in the clinic states, "My boyfriend told me he went to the clinic and was treated for gonorrhea." While testing for the sexually transmitted infection (STI), what else should be done for this patient? Test for HIV without informing the patient. Test for HIV, requiring the patient to sign a permit. Inform the patient that it would be beneficial to test for HIV. Administer treatment for the STI and discharge the patient.
Inform the patient that it would be beneficial to test for HIV. HIV screening is recommended for all persons who seek evaluation and treatment for STIs. HIV testing must be voluntary and free of coercion. Patients must not be tested without their knowledge. HIV screening after notifying the patient that an HIV test will be performed (unless the patient declines) is recommended in all health care settings. Specific signed consent for HIV testing should not be required. In most settings, general informed consent for medical care is considered sufficient.
A secondary immunodeficiency is characterized by the following. Choose all that apply. It usually occurs as a result of underlying disease processes. It frequently is caused by certain autoimmune disorders. It may be caused by certain viruses. IgA deficiency is present in 40% of individuals. It is less common than primary immunodeficiency.
It usually occurs as a result of underlying disease processes. It frequently is caused by certain autoimmune disorders. It may be caused by certain viruses. Secondary immunodeficiencies are more common than primary immunodeficiencies and frequently result from underlying disease processes or their treatment. Common causes of secondary immunodeficiencies include chronic stress, burns, uremia, diabetes mellitus, certain autoimmune disorders, certain viruses, exposure to immunotoxin medications and chemicals, and self-administration of recreational drugs and alcohol.
A client with AIDS is admitted to the hospital with severe diarrhea and dehydration. The physician suspects an infection with Cryptosporidium. What type of specimen should be collected to confirm this diagnosis? Urine specimen for culture and sensitivity Blood specimen for electrolyte studies Stool specimen for ova and parasites Sputum specimen for acid fast bacillus
Stool specimen for ova and parasites A stool specimen for ova and parasites will give a definitive diagnosis. The organism is spread by the fecal-oral route from contaminated water, food, or human or animal waste. Those infected can lose from 10 to 20 L of fluid per day. Losing this magnitude of fluid quickly leads to dehydration and electrolyte imbalances.
A client receiving antiretroviral therapy reports "not urinating enough." What is the nurse's best action? Encourage the client to drink more fluids. Administer fluids 100 mL/hour IV. Assess blood urea nitrogen and creatinine. Assess liver function tests.
Assess blood urea nitrogen and creatinine. Adverse effects associated with antiretroviral therapy include potential nephrotoxicity. Assessing blood urea nitrogen and creatinine for clients who have decreased urination is appropriate. The other answers will not assist the nurse in determining the client's problem, which should be assessed before intervention are administered.
A client has discussed therapy for his HIV-positive status. What does the nurse understand is the goal of antiretroviral therapy? Reverse the HIV+ status to a negative status. Treat mycobacterium avium complex. Eliminate the risk of AIDS. Bring the viral load to a virtually undetectable level
Bring the viral load to a virtually undetectable level The goal of antiretroviral therapy is to bring the viral load to a virtually undetectable level. This level is no more than 500 or 50 copies, depending on the sensitivity of the selected viral load test. It is not possible to reverse the status to a negative, and it cannot eliminate the risk of AIDS but can help with prolonging the asymptomatic stage of HIV. Antiretroviral therapy does not treat mycobacterium avium complex.
A nurse is preparing to give a client an infusion of gamma globulin. The nurse knows to stop the infusion if the client experiences which symptoms? Select all that apply. Flank pain Shaking chills Tightness in the chest Hunger Fatigue
Flank pain Shaking chills Tightness in the chest Adverse reactions can include reports of flank and back pain, shaking chills, dyspnea, and tightness in the chest, as well as headache, fever, and local reaction at the infusion site.
A client with severe combined immunodeficiency is to receive a hematopoietic stem cell transplant. What would the nurse expect to be started? Antibiotic therapy Immunosuppressive agents Chest physiotherapy Anticoagulation
Immunosuppressive agents For a client undergoing a hematopoietic stem cell transplant, immunosuppression is started to ensure engraftment of depleted bone marrow. Antibiotic therapy may or may not be indicated. Chest physiotherapy would be appropriate for clients with ataxia-telangiectasis who have chronic lung disease. Anticoagulation would not be used.
A client with common variable immunodeficiency (CVID) comes to the ED reporting tingling and numbness in the hands and feet, muscle weakness, fatigue, and chronic diarrhea. An assessment reveals abdominal tenderness, weight loss, and loss of reflexes. A gastric biopsy shows lymphoid hyperplasia of the small intestine and spleen as well as gastric atrophy. Based on these findings, what common secondary problem has this client developed? Gastric ulcer Pernicious anemia Hyperthyroidism Sickle cell anemia
Pernicious anemia More than 50% of clients with CVID develop pernicious anemia. Lymphoid hyperplasia of the small intestine and spleen and gastric atrophy, which is detected by biopsy of the stomach, are common findings. Gastrointestinal malabsorption may occur.
A client is scheduled to receive an intravenous immunoglobulin (IVIG) infusion. The client asks the nurse about the infusion's administration and its adverse effects. Which condition should the nurse instruct this client to report immediately? Mouth sores Sneezing Constipation Tickle in the throat
Tickle in the throat Continually assess the client for adverse reactions; be especially aware of complaints of a tickle or lump in the throat, which could be the precursor to laryngospasm that precedes bronchoconstriction.
Telangiectasia is the term that refers to Vascular lesions caused by dilated blood vessels Inability to understand the spoken word Uncoordinated muscle movement Difficulty swallowing
Vascular lesions caused by dilated blood vessels Telangiectasia is the term that refers to vascular lesions caused by dilated blood vessels. Ataxia-telangiectasia is an autosomal-recessive disorder affecting both T-cell and B-cell immunity. Receptive aphasia is an inability to understand the spoken word. Dysphagia refers to difficulty swallowing.
The nurse is talking with a group of teens about transmission of human immunodeficiency virus (HIV). What body fluids does the nurse inform them will transmit the virus? Select all that apply. semen urine breast milk blood vaginal secretions
semen breast milk blood vaginal secretions There are only four known body fluids through which HIV is transmitted: blood, semen, vaginal secretions, and breast milk. HIV may be present in saliva, tears, and conjunctival secretions, but transmission of HIV through these fluids has not been implicated. HIV is not found in urine, stool, vomit, or sweat.
The lower the client's viral load, the shorter the time to AIDS diagnosis. the longer the survival time. the shorter the survival time. the longer the time immunity.
the longer the survival time. The lower the client's viral load, the longer the time to AIDS diagnosis and the longer the survival time. The key goal of antiretroviral therapy is to achieve and maintain durable viral suppression.
The nurse is caring for a young client who has agammaglobulinemia. The nurse is teaching the family how to avoid infection at home. Which statement by the family indicates that additional teaching is needed? "I will let my neighbor have my pet iguana." "I will apply lotion following every bath to prevent dry skin." "I can take my child to the beach, as long as we play in the sand rather than swim in the water." "I will avoid letting my child drink any juice that has been sitting out for more than an hour."
"I can take my child to the beach, as long as we play in the sand rather than swim in the water." Parents should verbalize ways to plan for regular exercise and activity that does not pose a risk of infections. Immunocompromised clients should avoid touching sand or soil because of the high level of bacteria and increased risk of diseases such as toxoplasmosis.
A child has just been diagnosed with a primary immune deficiency. The parents state, "Oh, no. Our child has AIDS." Which response by the nurse would be most appropriate? "Your child does not have AIDS but this condition puts your child at risk for it later in life." "Your child's condition is extremely serious. Like AIDS, it will most likely be fatal." "Although AIDS is an immune deficiency, your child's condition is different from AIDS." "We need to do some more testing before we will know if your child's condition is AIDS."
"Although AIDS is an immune deficiency, your child's condition is different from AIDS." Primary immune deficiencies should be not be confused with AIDS. They are not the same condition. In addition, a primary immune disorder does not increase the child's risk for developing AIDS later in life. Primary immune deficiency diseases are serious, but they are rarely fatal and can be controlled. Testing will reveal the evidence of a primary immune disease, not AIDS. AIDS is classified as a secondary immunodeficiency.
A client is considering beginning sexual relations and wants to know the best way to be protected from a sexually transmitted infection and HIV. What is the best response by the nurse? "Using a condom (latex) and spermicidal jelly is one of the most effective ways to decrease the risk of transmission of an STI and HIV." "Using a diaphragm with spermicidal jelly will also kill the bacteria and viruses that transmit STIs and HIV." "Using a lamb skin condom will be the most effective way to decrease transmission of STIs and HIV." "Douching immediately after intercourse will be the most effective way to kill bacteria and viruses."
"Using a condom (latex) and spermicidal jelly is one of the most effective ways to decrease the risk of transmission of an STI and HIV." Using a condom is one of the most effective ways to reduce the risk of HIV infection. Condoms are available for both men and women. A diaphragm would not be the most effective way because there is no protection for the penis or vagina. A lamb skin condom is not effective to prevent the transmission of HIV. Douching after intercourse is not an effective method to avoid transmission and does not offer protection from secretions that are already present.
There are major differences between primary and secondary immunodeficiencies. Select the most accurate statement the nurse would use to explain the cause of a secondary immunodeficiency. "Your diagnosis was inherited." "Your condition will predispose you to frequent and recurring infections." "Your immune system was most likely affected by an underlying disease process." "You will now be more likely to develop cancer in the future."
"Your immune system was most likely affected by an underlying disease process." A secondary immunodeficiency is the result of an underlying disease process or the treatment of a disorder. It is not genetically inherited. Some examples of a secondary immunodeficiency are chronic stress and diabetes mellitus.
What intervention is a priority when treating a client with HIV/AIDS? Assessing neurologic status Monitoring skin integrity Assessing fluid and electrolyte balance Monitoring psychological status
Assessing fluid and electrolyte balance Fluid and electrolyte deficits are a priority in monitoring clients with HIV/AIDS, and assessment of fluid loss and electrolyte imbalance is essential. Skin integrity should be monitored but is a lower priority. Neurologic and psychological status should also be monitored, but this is not as high a priority as fluid and electrolyte imbalance.
A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client? Sign a refusal of blood transfusion form so the client will not receive the transfusion. Bank autologous blood. Ask people to donate blood. Using volume expanders in case blood is needed.
Bank autologous blood. Signing the refusal form does not give the client any information about the options that are available and place the client at risk. Banking autologous blood that is self-donated is the safest option for the client. Directed donor blood may be no safer than blood collected from public donors. Those who support this belief say that directed donors may not reveal their high-risk behaviors that put the potential recipient at risk for blood-borne pathogens such as HIV.
A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of? Anorexia Chronic diarrhea Nausea and vomiting Oral candida
Chronic diarrhea Chronic diarrhea is believed related to the direct effect of HIV on cells lining the intestine. Although all gastrointestinal manifestations of acquired immune deficiency syndrome (AIDS) can be debilitating, the most devastating is chronic diarrhea. It can cause profound weight loss and severe fluid and electrolyte imbalances.
Which option should the nurse encourage to replace fluid and electrolyte losses in a client with AIDS? Liquids Gluten Sucrose Iron and zinc
Liquids The nurse should encourage clients with AIDS to consume liquids in order to help replace fluid and electrolyte losses. Gluten and sucrose may increase the complication of malabsorption. Large doses of iron and zinc should be avoided because they can impair immune function.
The nurse is aware that the most prevalent cause of immunodeficiency worldwide is Malnutrition Neutropenia Hypocalcemia Chronic diarrhea
Malnutrition The most prevalent cause of immunodeficiency worldwide is severe malnutrition.
A client with acquired immune deficiency syndrome (AIDS) is exhibiting shortness of breath, cough, and fever. What type of infection will the nurse most likely suspect? Mycobacterium avium complex Legionella Cytomegalovirus Pneumocystis jiroveci
Pneumocystis jiroveci Although mycobacterium, legionella, and cytomegalovirus may cause the signs and symptoms described, the most common infection in people with AIDS is pneumocystis pneumonia caused by pneumocystis jiroveci. It is the most common opportunistic infection associated with AIDS.
Which adverse effect(s) should the nurse closely monitor in a client who has secondary immunodeficiencies due to immunosuppressive therapy? Depression, memory impairment, and coma Respiratory or urinary system infections Rheumatoid arthritis Cardiac dysrhythmias and heart failure
Respiratory or urinary system infections Secondary immunodeficiencies occur as a result of underlying disease processes or the treatment of these disorders, including administration of immunosuppressive agents. Abnormalities of the immune system affect both natural and acquired immunity. Because immunodeficiencies result in a compromised immune system and pose a high risk for infection, careful assessment of the client's immune status is essential. The nurse assesses and monitors the client for signs and symptoms of infection.
A client has been diagnosed with HIV and has been placed on antiretroviral therapy. What does the nurse inform the client will be required for determining the progression of the disease as well as guiding drug therapy? The client will be required to stop the medication for 2 weeks and then have laboratory studies drawn to determine if the antiretroviral therapy has cured the disease. Viral load and T4-cell counts will be performed every 2 to 3 months. More antiretroviral medication will be added every 2 to 3 months. The Western blot test will be monitored every 6 months to see if the virus is still present.
Viral load and T4-cell counts will be performed every 2 to 3 months. Viral load testing is used to guide drug therapy and follow the progression of the disease. Viral load tests and T4-cell counts may be performed every 2 to 3 months once it is determined that a person is HIV positive. The medication should be adhered to and not discontinued. There is no cure for the disease at this time. Antiretroviral therapy is not generally changed or added to without reason or lack of response. The Western blot is used for confirmation of the presence of the HIV virus.
