Immune Test 7
The nurse is instructing a group of women of childbearing age about human immunodeficiency virus (HIV) during pregnancy. What would be a priority recommendation in this setting?
Screening for HIV
Rheumatoid Arthritis (RA)
Autoimmune disease in which immune system attacks its own cartilage and connective tissues. Results in crippling deformities. Most commonly found in women between ages 23 and 35 but can affect people of any age. Muscles, bones, and skin adjacent to affected joint atrophy.
The nurse is caring for a school-age child recently diagnosed with an allergy to peanuts. Which nursing action is a priority?
Include the child when discussing foods that contain peanuts.
The nurse is caring for a 6-month-old infant with Wiskott-Aldrich syndrome. Which teaching does the nurse provide the parent?
"Do not insert anything in the rectum."
To avoid anaphylactic reactions in children, which question would be most important to ask a parent before administering penicillin to her infant?
"Has she ever had penicillin before?"
The nursing instructor has completed a presentation on normal immune function. Which statement by a student would suggest a need for further education?
"Humoral immunity is generally functional at birth." Normal immune function is a complex process involving phagocytosis (process by which phagocytes swallow up and break down microorganisms), humoral immunity (immunity mediated by antibodies secreted by B cells), cellular immunity (cell-mediated immunity controlled by T cells), and activation of the complement system. Cellular immunity is generally functional at birth, and as the infant is exposed to various substances over time, humoral immunity develops.
The nurse provides client teaching to parents of a newborn who have questions about immunizations. Which comment(s) by the parents demonstrate knowledge of immunizations? Select all that apply.
"Immunizations may be killed or modified organisms." "Immunizations prevent some types of bacterial infections." "Many vaccines are given in the form of an injection."
Gout s/s
1. Exquisite pain and tenderness over joint 2. Swelling 3. Redness 4. Tophi (nodules) 5. Light touch will cause crazy ass pain
The nurse is working with a pregnant client who is HIV positive and has been prescribed oral zidovudine. Which statement by the nurse explains the primary rationale for taking this medication?
"It is to help prevent transmission of the disease to your infant."
The nurse is speaking with a teenager who has requested HIV testing. Which is the best statement by the nurse regarding HIV testing?
"The ELISA method detects antibodies so a person may have a false negative test for up to six months after exposure.
The nurse is administering nevirapine to an adolescent client diagnosed with HIV. The client asks the nurse how this medication helps fight HIV. How should the nurse respond?
"The medication disrupts the virus life cycle of HIV. This prevents the disease from progressing."
Teaching for people with HIV
- Universal precautions -Hand washing** -Take meds on time and do not stop taking -Small nutrient dense frequent meals -Avoid risky behavior that could increase chance of getting/spreading HIV -Infection control precautions at home: No sick people, blood spills clean with bleach, avoid raw and uncooked eggs, meat and fish -S/S to report to DR
Primary immunodeficiency
- congenital - usually genetic errors - lack of B cell and or T cell activity
The nurse is monitoring the CD4 count of an infant who has contracted HIV from the mother in utero. The nurse is concerned that treatment with antiretroviral therapy is not effective when noting which CD4 level?
1300/mm3 The number of CD4 T lymphocytes in the blood helps to determine the effectiveness of antiretroviral therapy. Normal is 1500/mm3 in the infant, so anything below that number may indicate that the therapy is not effective.
Labs for hypersensitive reactions
-A skin prick test, also called a puncture or scratch test, checks for immediate allergic reactions -Serum tests can also be performed in order to detect a tendency to develop immediate hyperreactivity reactions in general. -Serum beta-tryptase (tryptase) is an indicator of mast cell activity and can readily be measured in hospital routine laboratories.
Warnings signs of primary immunodeficiency
-Four + episodes of acute otitis media in 1 year -2 + episodes of severe sinusitis in 1 year -Treatment with ABT for 2 months or longer will little effect -2 + episodes of pneumonia in 1 year -Failure to thrive in the infant -Recurrent deep skin or organ abscesses -Persistent oral thrush or skin candidiasis after 1 year of age -HX of infection needing IV ABT to clear -Two + serious infections EX: Sepsis -Family history of primary immunodeficiency
Lupus DX in kids
-Low hemo and hemat -Decrease platelets -low WBC -Complete C3 and C4 will be low -Antinuclear antibody test +
Wiskott-Aldrich syndrome s/s
-Petechiae -Blood diarrhea -Bleeding episode before 6 months old -Hematemesis, intercrail or conjunctival hemorrhage -Eczema -Elevated IgA and IgE -Low IgM -Normal IgG
Which client will the nurse assess first after receiving shift report?
A client with human immunodeficiency virus (HIV) whose temperature is 102.2°F (39°C)
Which nursing intervention is priority when caring for a child with HIV?
Administer prescribed medications.
Juvenile arthritis medical management
Any form of arthritis that occurs in individuals under the age of 16 -Manage pain -Help them to live a normal life -Maintain mobility -Give meds: NSAIDs, corticosteroids, antuthematics -ROM, exercise, swimming -Teach about splints -Assess for skin breakdown -Encourage sleep: Warm bath, warm compress -Two sets of books -Leave class early -Encourage them to be social -Summer camps -Support groups
A school-aged child, who is allergic to bee stings, states, "I think I was stung by a bee outside." Which intervention by the school nurse is most appropriate?
Assess the client for signs of anaphylactic shock
Intercritical gout
Asymptomatic period between acute gout attacks
rheumatoid arthritis DX in kids
Complete blood count (white cells, red cells, and platelets) Lab tests on blood or urine. X-rays (to rule out breaks or damage to bones) Imaging tests, such as magnetic resonance imaging (MRI) scans.
SLE Necrosis
Connective tissue and fibrin deposits collect in blood vessels on collagen fibers and on organs. The deposits lead to necrosis and inflammation in blood vessels, lymph nodes, gastrointestinal tract, and pleura.
Side effects and complications of opportunities infections related to HIV- Things to watch for & report
New onset or worsening of any of the following: -Fever -Cough -Weakness -N/V/D -Dysphagia/ trouble swallowing -Forgetfullness -Skin leasions -SOB, dyspnea -HA -Vision changes -Pain -Night sweats -Lymphasenopathy
Type 2 hypersensitivity reaction
Cytotoxic reaction- meaning that healthy cells die as they respond to the antigens. This can cause long-term damage to cells and tissues, resulting in conditions such as: -IgG, IgM -Transfusions reactions, HDFN, good pasture syndrome, autoimmune thrombocytopenic purpura, myasthenia gravis Common causes of type 2 hypersensitivity reactions include drugs such as: penicillin thiazides cephalosporins methyldopa
Interventions for HIV
Drug therapy Respiratory support Comfort Rest and Activity Pain management Nutrition therapy (diet high in calories and protein, stay hydrated, avoid fatty foods) Mouth care (Soft toothbrush, avoid ETOH-based mouth wash) Complimentary therapy Complications with taking meds Dietitian involved- giving them what they like to eat
SLE Dysphagia
Dysphagia is the most frequent gastrointestinal complaint in patients with systemic lupus erythematosus (SLE) and may occur in association with retrosternal chest pain, heartburn, regurgitation, or odynophagia.
Wiskott-Aldrich syndrome
Eczema, recurrent respiratory infections, thrombocytopenia, all caused by X-linked B and T lymphocyte deficiency, Caucasian
A nurse is preparing a presentation for a group of new parents and is planning to discuss nutrition during the first year. As part of the presentation, the nurse is planning to address foods that should be avoided to reduce the risk of possible food allergies. Which foods would the nurse most likely include? Select all that apply.
Eggs Shrimp Peanuts
Interventions of SLE
Non-Pharm: Avoid prolonged sun exposure, wear sunscreen daily (SPF 50+), well a balanced diet, rest periods, get enough sleep, regular exercise, ROM, healthy weight Pharm: (Treat symptoms) Meds often used are hydroxychloroquine (Plaquenil), NSAIDs (Ibuprofen), Immunosuppresntats, steroids, glucocorticoids
When providing discharge instructions to a child who was admitted to the hospital following stridor, wheezing, and urticaria after taking penicillin, which nursing action is priority?
Encourage the child to wear a medical alert bracelet for penicillin.
S/S of HIV
Extreme fatigue, loss of appetite, unexplained weight loss of more than 10 pounds in 2 months, swollen glands, leg weakness or pain, unexplained fever for more than a week, night sweats, unexplained diarrhea, dry cough, white spots in mouth and throat, painful blisters, painless purple-blue lesions on the skin, confusion, disorientation, recurrent vaginal infections that are resistant to treatment
Assessment for hypersensitive reactions Type 3:
Fever, arthralgia, swollen lymph nodes, malaise, arthritis in multiple joints, nephritis, Urticaria (hives), rash, angioedema** Damage is usually only temporary and will resolve in a few days; Prolonged exposure though can lead to irreversible damage or serum sickness and can be fatal
Interventions of SLE
Give medications: Analgesics, anti-inflammatory, and meds to treat specific clinical manifestations Teach: Disease process, sunscreen daily, energy conservation, get immunizations, avoid oral contraceptives, referral to the pulmonologist, nephrologist, neurologist, cardiologist, and dermatologist as needed.
diagnosis of gout
History, physical assessment, aspiration of joint fluid, radiology (XR to see crystals)
teaching for people with gout
If left untreated flare-ups may become worse with shorter remission periods Avoid alcoholic drinks, especially beer Take uric acid lowering agents as directed Report flare-ups Proper nutrition: No high purine foods EX: Red meat, organ meat, fish Maintain a healthy weight Splinting of joint may help with pain Take NSAIDs to control pain
The nurse is preparing educational materials for a group of new parents about allergic reactions. Which specific immunoglobulin should the nurse emphasize as being responsible for these types of reactions?
IgE IgE is involved in immediate hypersensitivity reactions and is associated with allergy and parasitic infections. IgA is found in saliva, sweat, and tears and provides defense against pathogens on exposed surfaces. IgG is the most frequently occurring antibody in plasma and neutralizes bacterial toxins. IgM lyses cell walls and is early to arrive in the presence of an infection in the bloodstream.
A nurse is providing care to a child who is HIV positive and prescribed IV zidovudine. Which nursing actions would be appropriate when administering the drug? Select all that apply.
Infuse the drug over 60 minutes. Monitor the child for paresthesias. Give the drug in the morning and after lunch. Reinforce use of meticulous handwashing.
Rheumatoid Arthritis (RA) signs and symptoms
Joint pain, joint swelling, erythema, morning stiffness and fatigue. Onset is usually insidious with vague complaints of joint and muscle pain that evolves into joint pain with synovitis (inflammation of the synovial membrane) This can lead to joint dysfunction and deformity
NI for Rheumatoid Arthritis (RA)
Nonpharm: ROM, aerobic exercise, PT/OT, proper nutrition, healthy weight, rest Pharm: Goal of meds is to decrease and control the inflammation that leads to destruction, pain and stiffness. Treatment is based on the severity of the disease. Common Types Meds: NSAIDs, Glucocorticoids, analgesics, DMARDs Examples: Methotrexate, sulfasalazine, hydroxychloroquine, leflunomide, tofacitinib
Which nursing action is most appropriate when caring for a child with positive serum IgE antibodies, a white blood cell count of 6,000/mm3, and 10% eosinophils?
Obtain a careful health history. The child with positive serum IgE antibodies, a white blood cell count of 6,000/mm3, and 10% eosinophils indicates allergies. Thus, taking a careful history to assess for symptoms and familial tendency is the most appropriate action. Reviewing CD4 counts and percussing for hepatomegaly would be more appropriate if HIV was suspected. Preparing for a stem cell transplant would be more appropriate if severe combined immunodeficiency (SCID) was suspected.
Hypogammaglobulinemia medical management
Periodic administration of IVIG Assess baseline BUN and creatinine Make sure they are well hydrated Premedicate with Benadryl and Tylenol
Complications related to HIV
Pneumocystis pneumonia (PCP). Candidiasis (thrush). Tuberculosis (TB). Cytomegalovirus. Cryptococcal meningitis. Toxoplasmosis.
The nurse is providing education regarding 2030 Health Goals to reduce the incidence of acquired immunodeficiency syndrome (AIDS) within the community. Which goal will the nurse choose as a primary prevention strategy?
Provide education to sexually active females about proper condom usage. Primary prevention strategies focus on preventing a disease before it occurs, which includes condom usage to prevent being exposed to AIDS. Screening for the presence of AIDS is a secondary prevention strategy because it does not prevent an individual from contracting AIDS, but would allow for early identification. Improving air quality and reducing allergens are goals to prevent allergies.
Complications of Systemic lupus erythematosus (SLE)
Renal failure, premature heart disease, interstitial lung disease, hypercoagulation, stroke, avascular necrosis of joints, and increased risk for infection. Can also have complications from the toxic effects of medications
Assessment for hypersensitive reactions Type 5
Similar to complications seen with hyperthyroidism or graves disease Anxiety and irritability. A fine tremor of the hands or fingers. Heat sensitivity and an increase in perspiration or warm, moist skin. Weight loss, despite normal eating habits. Enlargement of the thyroid gland (goiter) Change in menstrual cycles.
Assessment for hypersensitive reactions Type 2:
Similar to type 1: include a sudden onset of breathlessness, fever, a rapid heartbeat, cough (especially in the morning), copious production of phlegm
S/S of SLE
Skin rashes (butterfly), oral or nasal ulcers, thinning hair, joint tenderness, pleural or pericardial effusions, renal (urine protein) and neurological (seizures/confusion) disorders, hematological disorders such as thrombocytopenia, leukopenia, or anemia. Immunological criteria (+ for antinuclear antibodies, low complement, + anti-Sm, antiphospholipid antibodies, +anti-double-strand DNA (Needs to have 4:17 to be DX)
What is SLE
Systemic lupus erythematosus (SLE) is a chronic inflammatory disease termed the great imitator because it can affect almost any organ system.
The registered nurse (RN) and unlicensed assistive personnel (UAP) are caring for a pediatric client with an immune disorder receiving a stem cell transplant. Which action by the UAP will cause the RN to intervene?
The UAP takes a rectal temperature on the client.
Assessment for hypersensitive reactions Type 4:
VS: May be similar to anaphylaxis: Resp distress, decreased o2, hypotension and tachycardia Skin: Mild reactions may include rash, especially on hands were latex gloves would be HX of latex allergy: Reaction may be more severe if previously had a reaction Allergy to: Avocado, chestnut, peaches, bannan, kiwi, mango, papaya, passion fruit, tomamoto, raw potato
Difference of types of hypersensitivity reactions
Type 1, 2, 3, 4, 5
A child comes to the emergency department with difficulty breathing from severe bronchoconstriction. The parent informs the nurse that the child ate a peanut, to which the child is allergic. Which type of reaction is this client having?
Type I: anaphylaxis
Type 5 hypersensitivity reaction
The reaction of auto-antibodies with normal cell surface receptors, stimulates continual overreaction of the target cell autoimmune, receptor mediated IgM or IgG Grave's disease (TSH receptor) Myasthenia gravis (Ach receptor) B-Cell gammopathies (increased levels of gamma globulin)
Risk factors for getting HIV
Unprotected sexual contact with an individual who: Is known to be infected Injects or has injected drugs Shared needles with an infected individual Had sex with multiple partners
Labs for HIV/AIDS
Western Blot test. CD4 count. Viral loads. How much virus they have and what impact it has on their immune system. Determines what medication they get put on.
Type 1 hypersensitivity reaction
causes an immediate response and occurs after a person has exposure to an antigen. -IgE mediated -Ex: Asthma, allergic rhinitis, atopic dermatitis, anaphylactic shock, urticaria, angioedema -Can be triggered by: food products, such as nuts, shellfish, and soy animal sources, such as cats, rats, or bee stings environmental sources, such as mold, latex, and dust allergic conditions, such as allergic rhinitis, allergic asthma, and conjunctivitis
Type 1 hypersensitivity sensitization stage
the person encounters the antigen but does not experience any symptoms.
A nurse is providing care to a child with HIV who is prescribed therapy with a nucleoside reverse transcriptase inhibitor. What would the nurse expect to administer?
Zidovudine
Hypogammaglobulinemia
a below normal concentration of gamma globulin in the blood associated with a decreased resistance to infection
The nurse is educating a child with a peanut allergy about the signs and symptoms of an anaphylactic reaction. The nurse realizes additional teaching is needed when the child identifies which sign/symptom?
constipation
Type 3 hypersensitivity reaction
antigens and antibodies form complexes in the skin, blood vessels, joints, and kidney tissues. These complexes cause a series of reactions that lead to tissue damage. Causes of a type 3 hypersensitivity reaction can include: drugs that contain proteins from different organisms, such as antivenins the drug infliximab, which people use to manage autoimmune conditions animal sources, such as insect stings or tick bites Type 3 hypersensitivity reactions can lead to: serum sickness lupus rheumatoid arthritis small-vessel vasculitis Henoch-Schönlein purpura -IgG, IgM -Extracellular fungal, viral, or bacterial
Severe combined immune deficiency treatment
bone marrow transplantation Stem Cell IVIG/ ABT
The nurse is monitoring the labs of a child admitted for an exacerbation of juvenile pauciarticular arthritis. Which lab result does the nurse expect to be elevated?
erythrocyte sedimentation rate (ESR)
Gout
hereditary metabolic disease that is a form of acute arthritis, characterized by excessive uric acid in the blood and around the joints
CD4 + cell count
measures the number of CD4+ T cells (helper T cells) in the bloodstream of patients with HIV CD4+ >500 = No s/s (women may have yeast infections related to medications) CD4+ 500-300 = Increased risk fo resp infections, dermatological manifestations (herpes) CD4+ 350-200 = Increased infections mediated by the adaptive immune system and may develop s/s such as fever, fatigue, severe bacterial infections CD4+ <200 = Now considered to have AIDS and likely to develop specific infections related to OIs
s/s of fibromyalgia
pain in the muscles, bones, and joints. poor sleep, headaches, altered thought process, stiffness and muscle aches especially in the morning, paraesthesia, and sensation of hand edema with no visual swelling. Fatigue due to non-restorative sleeping. Arthralgic: Pain in one or more joints. Myalgia: Soreness and achiness in the muscles that can range from mild to severe.
The nurse is preparing to administer intravenous immunoglobulin (IVIG) for a child who has not had an IVIG infusion in over 10 weeks. The nurse knows to first:
premedicate with acetaminophen or diphenhydramine. Premedication with diphenhydramine or acetaminophen may be indicted in children who have never received intravenous immunoglobulin (IVIG), have not had an infusion in over 8 weeks, have had a recent bacterial infection, or have history of serious infusion-related adverse reactions. The nurse should first premedicate, and then obtain a baseline physical assessment. Once the infusion begins, the nurse should continually assess for adverse reaction.
S/S of type 1 hypersensitivity reactions
rash flushing hives itching edema wheezing rhinitis stomach cramps Responses can also cause: nausea and vomiting shortness of breath cardiac symptoms loss of consciousness
Type 4 hypersensitivity reaction
reactions are cell-mediated. This type also differs from the other three in that it causes a delayed reaction. Cytoxocins, T-cell dependent, monocytes, macrophages, lysomal enzymes TB test, Latex allergy, Poison ivy
two stages to type 1 hypersensitivity
sensitization stage and the effect stage.
pediatric client is admitted to the hospital. The primary health care provider suspects a problem with the child's immune system. The nurse anticipates preparing this client for which test initially
serum blood testing
Type 1 hypersensitivity effect stage.
the person has exposure to the antigen again. As the body now recognizes the antigen, it is able to produce a response that results in the symptoms that people typically experience with an allergic reaction.
What you should do if you have a needle stick/ exposed to HIV
-Report right away -Run under water (Do NOT squeeze) -Get permission to screen patients blood -If HIV test is + for patient then referral care if given to person who was exposed -If - then antiretroviral medications are prescribed- Meds will depend on the risk of HIV exposure- Generally 2 or more meds are given to be taken for 28 days -HIV testing is done at 6 weeks, 12, weeks, and again 4-6 months after exposure. -Nursing mothers are encouraged to stop breastfeeding
Severe combined immune deficiency education
-prevent infection -Child should not be around people other than the ones who live in the home -No sick people -Handwashing -Prophylactic ABT -No live vaccines -Proper nutrition- May need supplemental feedings -Give IVIG infusions -A bone marrow transplant- From a sibling is preferred -Posttransplant care -May have severe cutaneous human papillomavirus infection reaction after stem cell transplant -Genetic counseling -Ongoing support
Severe combined immune deficiency
Newborn without proper B or T-cells. Problem with bone marrow. In adults, m/c due to aplastic anemia. possibly from benzene poisoning
Assessment for hypersensitive reactions Type 1:
Resp rate, depth, lung sounds, Spo2, ABGs: Resp rate increased, dyspnea, tight chest, throat tightness, decreased spo2, ABGs = Hypoxemia Bp/HR: Hypotension and tachycardia General: Watery eyes, runny nose, sneezing, **Angioedema**, felling faint, diaphoretic, N/V/D, abd pain
The nurse is administering the drug cyclophosphamide to a child who has severe systemic lupus erythematosus (SLE). What body system is the nurse most concerned about regarding adverse effects of this drug immediately after administration?
renal Cyclophosphamide is a cytotoxic drug that interferes with normal function of DNA by alkylation, and is given for treatment of severe SLE. The medication is very nephrotoxic; therefore, the nurse must provide adequate hydration and have child void frequently during and after infusion to decrease risk for hemorrhagic cystitis.
The nurse is explaining patterns of incidence and transmission of HIV to a group of adolescent girls. She explains that the risks for this population are much higher because of the possibility of both vertical and horizontal transmission. Horizontal transmission refers to transmission of the disease during:
sexual contact. Horizontal transmission refers to person-to-person transfer of the virus. Transmission by feeding with breast milk, birthing, and pregnancy are all examples of vertical transmission.
Acute gout
sudden onset of redness, swelling, heat, extreme tenderness (disturbed purine imbalance, associated with elevated serum levels of uric acid), primarily occurs in men older than 40 yrs AKA: Colchicine
Serum sickness
systemic injury initiated by antigen-antibody complexes that circulate in the blood caused by nonhuman proteins in certain medications and treatments that your body mistakes as being harmful, causing an immune reaction. One of the most common types of medication that causes serum sickness is antivenom. This is given to people who've been bitten by a venomous snake.
