Chapter 36: Management of Patients With Immune Deficiency Disorders
Congenital neutropenia syndromes
low levels of neutrophils from birth.
diagnostic test for primary immune deficiency diseases (PIDDs)
-Laboratory tests (used to identify antibody deficiencies, cellular (T-cell) defects, neutrophil disorders and complement deficiencies) -complete blood cell count - serum Ig levels (IgG, IgM, and IgA) and antibody responses to vaccines
a patient is infected with HIV after sharing needles with another IVdrug abuser. Upon infection with HIV, the immune system respondsby making antibodies against the virus, usually within how manyweeks after infection?
3 to 12 weeks
An adequate CD4+ response for most patients on ART is an increase in CD4+ count in the range of _______ to ______ mm3 per year, generally with an accelerated response in the first 3 months
50 to 150
normal CD4 count
500 to 1,500 cells
Medical Management for primary immune deficiency diseases (PIDDs)
-Hematopoietic stem cell transplantation (HSCT) - Gene therapy - Patients with antibody deficiencies receive regular Ig replacement therapy including both IV immunoglobulin (IVIG) and subcutaneous immunoglobulin (SCIG) to provide functional antibodies
The nurse receives a phone call at the clinic from the family memberof a patient with AIDS. The family member states that the patientstarted "acting funny" after reporting headache, tiredness, and a stiffneck. Checking the temperature resulted in a fever of 103.2°F. Whatshould the nurse tell the family member? a. "The patient probably has a case of the flu, and you should giveTylenol" b. "The patient may have cryptococcal meningitis and will need tobe evaluated by the physician" c. "This is one of the side effects from antiretroviral therapy and willrequire changing the medication" d. "The patient probably has Pneumocystis pneumonia and will needto be evaluated by the physician"
"The patient may have cryptococcal meningitis and will need tobe evaluated by the physician"
There are two major components of ART resistance:
(1) transmission of drug-resistant HIV at the time of initial infection (2) selective drug resistance in patients who are receiving non-suppressive regimens.
Prevention of HIV Infection
*Education - condoms (LATEX) - polyurethane female condom - pre-exposure prophylaxis (PrEP) -HIV status should be checked every 3 months to be sure that the person has not become infected - male circumcision,
Cryptococcus Neoformans
- A fungal infection - another common opportunistic infection among patients with AIDS - it causes neurologic disease.
Interpretation of negative HIV Test Results
- Antibodies to HIV are not present in the blood at this time, which can mean that the patient has not been infected with HIV or, if infected, the body has not yet produced antibodies (stage 0). - The patient should continue taking precautions. - The test result does not mean that the patient is immune to the virus, nor does it mean the patient is not infected; it just means that the body may not have produced antibodies yet. * If viral test used, a negative result is more consistent with the conclusion that the patient is uninfected.
Interpretation of Positive HIV Test Results
- Antibodies to HIV are present in the blood (the patient has been infected with the virus, and the body has produced antibodies). - HIV is active in the body, and the patient can transmit the virus to others. - Despite HIV infection, the patient does not necessarily have AIDS. - The patient is not immune to HIV (the antibodies do not indicate immunity).
how to distinguish candidiasis from oral hairy leukoplakia in patients with HIV
- Candidiasis Lesions can be easily scraped off with a tongue depressor or other instrument which is in contrast to lesions associated with oral hairy leukoplakia.
Common variable immunodeficiency (CVID)
- Caused by a variety of genetic abnormalities - resulting in defective ability of immune cells to produce normal amounts of antibodies, resulting in frequent bacterial or viral infections of the upper airway, sinuses, and lungs.
HIV Encephalopathy manifestations
- Early manifestations include memory deficits, headache, difficulty concentrating, progressive confusion, psychomotor slowing, apathy, and ataxia. -Later stages include global cognitive impairments, delay in verbal responses, a vacant stare, spastic paraparesis, hyperreflexia, psychosis, hallucinations, tremor, incontinence, seizures, mutism, and death.
Genotypic and phenotypic resistance assays are used to assess viral strains and inform selection of treatment strategies. Explain
- Genotypic assays detect drug-resistant mutations present in relevant viral genes - phenotypic assays measure the ability of a virus to grow in different concentrations of ART drugs.
preventions for patients with antibody deficiency disorders
- Live vaccines are contraindicated
pre-exposure prophylaxis (PrEP)
- a way for people who do not have HIV but who are at very high risk of getting HIV to prevent HIV infection by taking a pill every day. The pill (brand name Truvada) contains two medicines (tenofovir and emtricitabine) that are used in combination with other medicines to treat HIV.
Screening for symptoms of TB in HIV patient
- asking for cough of any duration - chest radiography is recommended to exclude TB disease in a patient with a positive skin test or interferon-gamma release assays
HIV Wasting Syndrome
- involuntary loss of more than 10% of one's body weight while having experienced diarrhea or weakness and fever for more than 30 days. - Wasting refers to the loss of muscle mass, although part of the weight loss may also be due to loss of fat.
Latent TB in a person with HIV infection is treated with ____________, supplemented with _____________ to prevent peripheral neuropathy, for 9 months since it has proven efficacy, good tolerability, and infrequent severe toxicity.
- isoniazid (INH) -pyridoxine (Aminoxin)
lipodystrophy syndrome
- loss or absence of fat, or the abnormal distribution of fat in the body, in HIV infection - lipoatrophy (localized subcutaneous fat loss in the face, arms, legs, and buttocks) - lipohypertrophy (central visceral fat [lipomata] accumulation in the abdomen - dorsocervical region [buffalo hump],
correct way to use a condom
- pinch - leave an inch - roll
primary immune deficiency diseases (PIDDs)
- pt is born with it - diagnosed in infancy
transcriptase-polymerase chain reaction (RT-PCR)
- used to track viral load and response to treatment of HIV infection - detect HIV in high-risk seronegative people before antibodies are measurable, to confirm a positive EIA result - creen neonate
_______ tests detect antibodies, not HIV itself, while antigen and RNA tests directly detect HIV. The updated CDC recommendations
-Antibody
Two surrogate markers are used routinely to assess immune function and level of HIV viremia:
-CD4+ T-cell count (CD4+ count) - plasma HIV RNA (viral load).
What should the nurse encourage people to do if they believe there has been an exposure to HIV?
-Pre-exposure prophylaxis (PrEP) might be appropriate. - PrEP involves taking one pill containing two HIV medications daily in order to avoid the risk of sexual HIV acquisition in adults and adolescents of age 12 and 754 older - HIV status should be checked every three months to be sure that the person has not become infected. The ultimate goal of PrEP is to reduce the acquisition of HIV infection with its resulting morbidity, mortality, and cost to individuals and society (US Public Health Service,
Cytomegalovirus Retinitis
-Retinitis caused by CMV is a leading cause of blindness in patients with AIDS.
intravenous immunoglobulin (IVIG) administration
-acute anaphylactic reaction is a potential side effect - hypotensionand signs of anaphyla - administered promptly after opening containerand infused within 4 hours.
Pneumocystis Pneumonia
-caused by P. jirovecii -a type of infection of the lungs (pneumonia) in people with a weak immune system. - People with a healthy immune system don't usually get infected with PCP.
Uses of Intravenous Immunoglobulin Replacement Therapy (IVIG)
-has been used in primary immunodeficiency diseases (PI), other immune deficiency disorders, and in a variety of inflammatory and autoimmune diseases. - Most immunologists strongly discourage the use of central catheters to administer IVIG due to the increased risk of serious blood infections.
woman-controlled methods to prevent HIV
-woman-controlled methods -microbicides
Those with HIV/AIDS are at greater risk of developing certain cancers. Which are:
1. Kaposi sarcoma 2. Lymphoma 3. Invasive cervical cancer
Gynecological Manifestations of AIDS (5)
1. Persistent candidiasis 2. vaginitis 3. cervical dysplasia: The development of abnormal cells in the narrow neck of a woman's uterus 4. neoplasia 5. Pelvic inflammatory disease (PID)
Immune system response to HIV infection in the CNS includes:
1. inflammation 2. atrophy 3. demyelination 4. degeneration 5. necrosis.
HIV Wasting Syndrome is defined as the involuntary loss of more than ____% of one's body weight while having experienced diarrhea or weakness and fever for more than ____days.
10 30
Achieving viral suppression requires the use of ART with at least two, and preferably three, active drugs from two or more drug classes and should occur within the first _____ TO ____ weeks of therapy especially if the patient is new to ART
12 to 24
The HIV antibody test, an enzyme immunoassay (EIA), became available in _________, allowing early diagnosis of the infection before the onset of symptoms.
1984
HIV status should be checked every ____ months to be sure that the person has not become infected
3
Primary or acute infection is characterized by high levels of viral replication, widespread dissemination of HIV throughout the body, and destruction of CD4+ T cells, which leads to dramatic drops in CD4+ T-cell counts (normally ______ to ____________)
500 to 1,500 cells/
Most people have about ____________ to ____________ CD4+ cells/mm3, but a level as low as 500 cells/mm3 can be considered within normal limits.
700 to 1,000
post-exposure prophylaxis (PEP) includes taking antiretroviral medicines as soon as possible, but no more than____ hours (3 days) after possible HIV exposure; two to three drugs are usually prescribed which must be taken for _____ days.
72 28
set point varies greatly from patient to patient and dictates the subsequent rate of disease progression; on average, ______ to _____ years can pass before a major HIV-related complication develops.
8 to 10
Patient teaching regarding infection prevention for the patient with an immunodeficiency includes which of the following guidelines? A) Cook all food thoroughly. B) Refrain from using creams or emollients on skin. C) Maintain contact only with individuals who have recently been vaccinated. D) Take OTC vitamin supplements consistently.
A (Feedback: All foods must be cooked to avoid food-borne illness. The patient should avoid contact with individuals who have recently been ill or vaccinated. The nurse should apply creams and emollients to any dry, chaffed, or cracked skin. Vitamin supplements may or may not be indicated.)
Family members of an immunocompromised patient have asked the nurse why antibiotics are not being given to the patient in order to prevent infection. How should the nurse best respond? A) "Using antibiotics to prevent infections can cause the growth of drug-resistant bacteria." B) "If an antibiotic is given to prevent a bacterial infection, the patient is at risk of a viral infection." C) "Antibiotics can never prevent an infection; they can only cure an infection that is fully developed." D) "Antibiotics cannot resolve infections in people who are immunocompromised."
A (Feedback: Although prophylactic drug treatment effectively prevents some bacterial and fungal infections, it must be used with caution because it has been implicated in the emergence of resistant organisms. Use of antibiotics does not directly increase the risk of viral infections.)
A nurse is preparing to administer a scheduled dose of IVIG to a patient who has a diagnosis of severe combined immunodeficiency disease (SCID). What medication should the nurse administer prior to initiating the infusion? A) Diphenhydramine B) Ibuprofen C) Hydromorphone D) Fentanyl
A (Feedback: Diphenhydramine and acetaminophen are administered 30 minutes prior to an IVIG infusion.)
A patient with Wiskott-Aldrich syndrome is admitted to the medical unit. The nurse caring for the patient should prioritize which of the following? A) Protective isolation B) Fresh-frozen plasma administration C) Chest physiotherapy D) Nutritional supplementation
A (Feedback: Patients with Wiskott-Aldrich syndrome (WAS) are at a grave risk for infection; infection prevention is a priority aspect of nursing care. Nutritional supplementation may be necessary, but infection prevention is paramount. Chest physiotherapy and FFP administration are not indicated.) Wiskott-Aldrich syndrome is characterized by abnormal immune system function (immune deficiency), eczema (an inflammatory skin disorder characterized by abnormal patches of red, irritated skin), and a reduced ability to form blood clots
The nurse is caring for a patient who has a diagnosis of paroxysmal nocturnal hemoglobinuria. When planning this patient's care, the nurse should recognize the patient's heightened risk of what complication? A) Venous thromboembolism B) Acute respiratory distress syndrome (ARDS) C) Myocardial infarction D) Hypertensive urgency
A (Feedback: Patients with paroxysmal nocturnal hemoglobinuriahave a high incidence of life-threatening venous thrombosis, which occurs most commonly in the abdominal and cerebral veins. This health problem is not linked to ARDS, MI, or hypertensive urgency.)
A home health nurse is caring for a patient who has an immunodeficiency. What is the nurse's priority action to help ensure successful outcomes and a favorable prognosis? A) Encourage the patient and family to be active partners in the management of the immunodeficiency. B) Encourage the patient and family to manage the patient's activity level and activities of daily living effectively. C) Make sure that the patient and family understand the importance of monitoring fluid balance. D) Make sure that the patient and family know how to adjust dosages of the medications used in treatment.
A Encouraging the patient and family to be active partners in the management of the immunodeficiency is the key to successful outcomes and a favorable prognosis. This transcends the patient's activity and functional status. Medications should not be adjusted without consultation from the primary care provider. Fluid balance is not normally a central concern.
An HIV-infected patient presents at the clinic for a scheduled CD4+ count. The results of the test are 45 cells/mL, and the nurse recognizes the patient's increased risk for Mycobacterium aviumcomplex (MAC disease). The nurse should anticipate the administration of what drug? A) Azithromycin B) Vancomycin C) Levofloxacin D) Fluconazole
A HIV-infected adults and adolescents should receive chemoprophylaxis against disseminatedMycobacterium avium complex (MAC disease) if they have a CD4+ count less than 50 cells/µL. Azithromycin (Zithromax) or clarithromycin (Biaxin) are the preferred prophylactic agents.
The nurse is caring for a patient with an immunodeficiency who has experienced sudden malaise. The nurse's colleague states, "I'm pretty sure that it's not an infection, because the most recent blood work looks fine." What principle should guide the nurse's response to the colleague? A) Immunodeficient patients will usually exhibit subtle and atypical signs of infection. B) Infections in immunodeficient patients have a slower onset but a more severe course. C) Laboratory blood work is often inaccurate in immunodeficient patients. D) Immunodeficient patients do not develop symptoms of infection.
A Immunodeficient patients often lack the typical objective and subjective signs and symptoms of infection. However, this does not mean that they wholly lack symptoms. Infections do not normally have a slower onset. Blood work may not be a reliable diagnostic tool, but that does not mean that the results are inaccurate.
A nurse is admitting a patient with an immunodeficiency to the medical unit. In planning the care of this patient, the nurse should assess for what common sign of immunodeficiency? A) Chronic diarrhea B) Hyperglycemia C) Rhinorrhea D) Contact dermatitis
A The cardinal symptoms of immunodeficiency include chronic or recurrent severe infections, infections caused by unusual organisms or organisms that are normal body flora, poor response to treatment of infections, and chronic diarrhea.
A nurse is assessing the skin integrity of a patient who has AIDS. When performing this inspection, the nurse should prioritize assessment of what skin surfaces? A) Perianal region and oral mucosa B) Sacral region and lower abdomen C) Scalp and skin over the scapulae D) Axillae and upper thorax
A The nurse should inspect all the patient's skin surfaces and mucous membranes, but the oral mucosa and perianal region are particularly vulnerable to skin breakdown and fungal infection.
A nurse is completing a nutritional status of a patient who has been admitted with AIDS-related complications. What components should the nurse include in this assessment? Select all that apply. A) Serum albumin level B) Weight history C) White blood cell count D) Body mass index E) Blood urea nitrogen (BUN) level
A, B, D, E Nutritional status is assessed by obtaining a dietary history and identifying factors that may interfere with oral intake, such as anorexia, nausea, vomiting, oral pain, or difficulty swallowing. In addition, the patient's ability to purchase and prepare food is assessed. Weight history (i.e., changes over time); anthropometric measurements; and blood urea nitrogen (BUN), serum protein, albumin, and transferrin levels provide objective measurements of nutritional status.
The nurse is applying standard precautions in the care of a patient who has an immunodeficiency. What are key elements of standard precautions? Select all that apply. A) Using appropriate personal protective equipment B) Placing patients in negative-pressure isolation rooms C) Placing patients in positive-pressure isolation rooms D) Using safe injection practices E) Performing hand hygiene
A,D,E (Feedback: Some of the key elements of standard precautions include performing hand hygiene; using appropriate personal protective equipment, depending on the expected type of exposure; and using safe injection practices. Isolation is an infection control strategy but is not a component of standard precautions.)
acquired immune deficiency syndrome
AIDS *a syndrome, or range of symptoms, that may develop in time in a person with HIV who does not receive treatment
A mutation of CCR5 that is common in Caucasians, but not other ethnic groups, has been identified. how does this affects these race in HIV?
About 1% of Caucasians lack functional CCR5 and are highly protected against HIV infection even if exposed (although protection is not absolute); about 18% are not markedly protected against infection but, if infected, demonstrate significantly slower rates of disease progression.
what happens after viral set point is reached?
After the viral set point is reached, a chronic stage persists in which the immune system cannot eliminate the virus despite its best efforts.
Hyper-immunoglobulin E syndrome (HIES)
Also called Job syndrome -Results from mutations in a gene that encodes a signaling module called STAT3 resulting in recurrent bacterial infections of skin and lungs.
Laboratory tests evaluate whether ART is effective for a specific patient. How?
An adequate CD4+ response for most patients on ART is an increase in CD4+ count in the range of 50 to 150 mm3 per year, generally with an accelerated response in the first 3 months
The nurse is caring for a patient who has been admitted for the treatment of AIDS. In the morning, the patient tells the nurse that he experienced night sweats and recently coughed up some blood. What is the nurse's most appropriate action? A) Assess the patient for additional signs and symptoms of Kaposi's sarcoma. B) Review the patient's most recent viral load and CD4+ count. C) Place the patient on respiratory isolation and inform the physician. D) Perform oral suctioning to reduce the patient's risk for aspiration.
Ans: C Feedback: These signs and symptoms are suggestive of tuberculosis, not Kaposi's sarcoma; prompt assessment and treatment is necessary. There is no indication of a need for oral suctioning and the patient's blood work will not reflect the onset of this opportunistic infection.
A hospital patient is immunocompromised because of stage 3 HIV infection and the physician has ordered a chest radiograph. How should the nurse most safely facilitate the test? A) Arrange for a portable x-ray machine to be used. B) Have the patient wear a mask to the x-ray department. C) Ensure that the radiology department has been disinfected prior to the test. D) Send the patient to the x-ray department, and have the staff in the department wear masks.
Ans: A Feedback: A patient who is immunocompromised is at an increased risk of contracting nosocomial infections due to suppressed immunity. The safest way the test can be facilitated is to have a portable x-ray machine in the patient's room. This confers more protection than disinfecting the radiology department or using masks.
A patient with HIV infection has begun experiencing severe diarrhea. What is the most appropriate nursing intervention to help alleviate the diarrhea? A) Administer antidiarrheal medications on a scheduled basis, as ordered. B) Encourage the patient to eat three balanced meals and a snack at bedtime. C) Increase the patient's oral fluid intake. D) Encourage the patient to increase his or her activity level.
Ans: A Feedback: Administering antidiarrheal agents on a regular schedule may be more beneficial than administering them on an as-needed basis, provided the patient's diarrhea is not caused by an infectious microorganism. Increased oral fluid may exacerbate diarrhea; IV fluid replacement is often indicated. Small, more frequent meals may be beneficial, and it is unrealistic to increase activity while the patient has frequent diarrhea.
A nurse is planning the care of a patient with AIDS who is admitted to the unit withPneumocystis pneumonia (PCP). Which nursing diagnosis has the highest priority for this patient? A) Ineffective Airway Clearance B) Impaired Oral Mucous Membranes C) Imbalanced Nutrition: Less than Body Requirements D) Activity Intolerance
Ans: A Feedback: Although all these nursing diagnoses are appropriate for a patient with AIDS, Ineffective Airway Clearance is the priority nursing diagnosis for the patient with Pneumocystis pneumonia (PCP). Airway and breathing take top priority over the other listed concerns.
A patient with HIV has a nursing diagnosis of Risk for Impaired Skin Integrity. What nursing intervention best addresses this risk? A) Utilize a pressure-reducing mattress. B) Limit the patient's physical activity. C) Apply antibiotic ointment to dependent skin surfaces. D) Avoid contact with synthetic fabrics.
Ans: A Feedback: Devices such as alternating-pressure mattresses and low-air-loss beds are used to prevent skin breakdown. Activity should be promoted, not limited, and contact with synthetic fabrics does not necessary threaten skin integrity. Antibiotic ointments are not normally used unless there is a break in the skin surface.
Since the emergence of HIV/AIDS, there have been significant changes in epidemiologic trends. Members of what group currently have the greatest risk of contracting HIV? A) Gay, bisexual, and other men who have sex with men B) Recreational drug users C) Blood transfusion recipients D) Health care providers
Ans: A Feedback: Gay, bisexual, and other men who have sex with men remain the population most affected by HIV and account for 2% of the population but 61% of the new infections. This exceeds the incidence among drug users, health care workers, and transfusion recipients.
A clinic nurse is caring for a patient admitted with AIDS. The nurse has assessed that the patient is experiencing a progressive decline in cognitive, behavioral, and motor functions. The nurse recognizes that these symptoms are most likely related to the onset of what complication? A) HIV encephalopathy B) B-cell lymphoma C) Kaposi's sarcoma D) Wasting syndrome
Ans: A Feedback: HIV encephalopathy is a clinical syndrome characterized by a progressive decline in cognitive, behavioral, and motor functions. The other listed complications do not normally have cognitive and behavioral manifestations.
A nurse is addressing the incidence and prevalence of HIV infection among older adults. What principle should guide the nurse's choice of educational interventions? A) Many older adults do not see themselves as being at risk for HIV infection. B) Many older adults are not aware of the difference between HIV and AIDS. C) Older adults tend to have more sex partners than younger adults. D) Older adults have the highest incidence of intravenous drug use.
Ans: A Feedback: It is known that many older adults do not see themselves as being at risk for HIV infection. Knowledge of the relationship between HIV infection and AIDS is not known to affect the incidence of new cases. The statements about sex partners and IV drug use are untrue.
A patient who has AIDS is being treated in the hospital and admits to having periods of extreme anxiety. What would be the most appropriate nursing intervention? A) Teach the patient guided imagery. B) Give the patient more control of her antiretroviral regimen. C) Increase the patient's activity level. D) Collaborate with the patient's physician to obtain an order for hydromorphone.
Ans: A Feedback: Measures such as relaxation and guided imagery may be beneficial because they decrease anxiety, which contributes to weakness and fatigue. Increased activity may be of benefit, but for other patients this may exacerbate feelings of anxiety or loss. Granting the patient control has the potential to reduce anxiety, but the patient is not normally given unilateral control of the ART regimen. Hydromorphone is not used to treat anxiety.
The nurse's plan of care for a patient with stage 3 HIV addresses the diagnosis of Risk for Impaired Skin Integrity Related to Candidiasis. What nursing intervention best addresses this risk? A) Providing thorough oral care before and after meals B) Administering prophylactic antibiotics C) Promoting nutrition and adequate fluid intake D) Applying skin emollients as needed
Ans: A Feedback: Thorough mouth care has the potential to prevent or limit the severity of this infection. Antibiotics are irrelevant because of the fungal etiology. The patient requires adequate food and fluids, but these do not necessarily prevent candidiasis. Skin emollients are not appropriate because candidiasis is usually oral.
A nurse is performing the admission assessment of a patient who has AIDS. What components should the nurse include in this comprehensive assessment? Select all that apply. A) Current medication regimen B) Identification of patient's support system C) Immune system function D) Genetic risk factors for HIV E) History of sexual practices
Ans: A, B, C, E Feedback: Nursing assessment includes numerous focuses, including identification of medication use, support system, immune function and sexual history. HIV does not have a genetic component.
A patient is beginning an antiretroviral drug regimen shortly after being diagnosed with HIV. What nursing action is most likely to increase the likelihood of successful therapy? A) Promoting appropriate use of complementary therapies B) Addressing possible barriers to adherence C) Educating the patient about the pathophysiology of HIV D) Teaching the patient about the need for follow-up blood work
Ans: B Feedback: ART is highly dependent on adherence to treatment, and the nurse should proactively address this. Blood work is necessary, but this will not have a direct bearing on the success or failure of treatment. Complementary therapies are appropriate, but are not the main factor in successful treatment. The patient may or may not benefit from teaching about HIV pathophysiology.
A nurse is performing an admission assessment on a patient with stage 3 HIV. After assessing the patient's gastrointestinal system and analyzing the data, what is most likely to be the priority nursing diagnosis? A) Acute Abdominal Pain B) Diarrhea C) Bowel Incontinence D) Constipation
Ans: B Feedback: Diarrhea is a problem in 50% to 60% of all AIDS patients. As such, this nursing diagnosis is more likely than abdominal pain, incontinence, or constipation, though none of these diagnoses is guaranteed not to apply.
A patient has come into contact with HIV. As a result, HIV glycoproteins have fused with the patient's CD4+ T-cell membranes. This process characterizes what phase in the HIV life cycle? A) Integration B) Attachment C) Cleavage D) Budding
Ans: B Feedback: During the process of attachment, glycoproteins of HIV bind with the host's uninfected CD4+ receptor and chemokine coreceptors, which results in fusion of HIV with the CD4+ T-cell membrane. Integration, cleavage, and budding are steps that are subsequent to this initial phase of the HIV life cycle.
A nurse is assessing a 28-year-old man with HIV who has been admitted with pneumonia. In assessing the patient, which of the following observations takes immediate priority? A) Oral temperature of 100°F B) Tachypnea and restlessness C) Frequent loose stools D) Weight loss of 1 pound since yesterday
Ans: B Feedback: In prioritizing care, the pneumonia would be assessed first by the nurse. Tachypnea and restlessness are symptoms of altered respiratory status and need immediate priority. Weight loss of 1 pound is probably fluid related; frequent loose stools would not take short-term precedence over a temperature or tachypnea and restlessness. An oral temperature of 100°F is not considered a fever and would not be the first issue addressed.
A patient with HIV will be receiving care in the home setting. What aspect of self-care should the nurse emphasize during discharge education? A) Appropriate use of prophylactic antibiotics B) Importance of personal hygiene C) Signs and symptoms of wasting syndrome D) Strategies for adjusting antiretroviral dosages
Ans: B Feedback: Infection control is of high importance in patients living with HIV, thus personal hygiene is paramount. This is a more important topic than signs and symptoms of one specific complication (wasting syndrome). Drug dosages should never be independently adjusted. Prophylactic antibiotics are not normally prescribed unless the patient's CD4 count is below 50.
A patient is in the primary infection stage of HIV. What is true of this patient's current health status? A) The patient's HIV antibodies are successfully, but temporarily, killing the virus. B) The patient is infected with HIV but lacks HIV-specific antibodies. C) The patient's risk for opportunistic infections is at its peak. D) The patient may or may not develop long-standing HIV infection.
Ans: B Feedback: The period from infection with HIV to the development of HIV-specific antibodies is known as primary infection. The virus is not being eradicated and infection is certain. Opportunistic infections emerge much later in the course of the disease.
Kaposi sarcoma trasmission
Can be transmitted via sexual contact and non-sexual routes (transfusion of contaminated blood & tissues transplants, or via saliva contact.)
A public health nurse is preparing an educational campaign to address a recent local increase in the incidence of HIV infection. The nurse should prioritize which of the following interventions? A) Lifestyle actions that improve immune function B) Educational programs that focus on control and prevention C) Appropriate use of standard precautions D) Screening programs for youth and young adults
Ans: B Feedback: Until an effective vaccine is developed, preventing HIV by eliminating and reducing risk behaviors is essential. Educational interventions are the primary means by which behaviors can be influenced. Screening is appropriate, but education is paramount. Enhancing immune function does not prevent HIV infection. Ineffective use of standard precautions apply to very few cases of HIV infection.
A nurse is working with a patient who was diagnosed with HIV several months earlier. The nurse should recognize that a patient with HIV is considered to have AIDS at the point when the CD4+ T-lymphocyte cell count drops below what threshold? A) 75 cells/mm3 of blood B) 200 cells/mm3 of blood C) 325 cells/mm3 of blood D) 450 cells/mm3 of blood
Ans: B Feedback: When CD4+ T-cell levels drop below 200 cells/mm3 of blood, the person is said to have AIDS.
A nurse is caring for a patient hospitalized with AIDS. A friend comes to visit the patient and privately asks the nurse about the risk of contracting HIV when visiting the patient. What is the nurse's best response? A) Do you think that you might already have HIV? B) Don't worry. Your immune system is likely very healthy. C) AIDS isn't transmitted by casual contact. D) You can't contract AIDS in a hospital setting.
Ans: C Feedback: AIDS is commonly transmitted by contact with blood and body fluids. Patients, family, and friends must be reassured that HIV is not spread through casual contact. A healthy immune system is not necessarily a protection against HIV. A hospital setting does not necessarily preclude HIV infection.
A nurse would identify that a colleague needs additional instruction on standard precautions when the colleague exhibits which of the following behaviors? A) The nurse wears face protection, gloves, and a gown when irrigating a wound. B) The nurse washes the hands with a waterless antiseptic agent after removing a pair of soiled gloves. C) The nurse puts on a second pair of gloves over soiled gloves while performing a bloody procedure. D) The nurse places a used needle and syringe in the puncture-resistant container without capping the needle.
Ans: C Feedback: Gloves must be changed after contact with materials that may contain high concentration of microorganisms, even when working with the same patient. Each of the other listed actions adheres to standard precautions.
A patient was tested for HIV using enzyme immunoassay (EIA) and results were positive. The nurse should expect the primary care provider to order what test to confirm the EIA test results? A) Another EIA test B) Viral load test C) Western blot test D) CD4/CD8 ratio
Ans: C Feedback: The Western blot test detects antibodies to HIV and is used to confirm the EIA test results. The viral load test measures HIV RNA in the plasma and is not used to confirm EIA test results, but instead to track the progression of the disease process. The CD4/CD8 ratio test evaluates the ratio of CD4 and CD8 cells but is not used to confirm results of EIA testing.
The mother of two young children has been diagnosed with HIV and expresses fear of dying. How should the nurse best respond to the patient? A) Would you like me to have the chaplain come speak with you? B) You'll learn much about the promise of a cure for HIV. C) Can you tell me what concerns you most about dying? D) You need to maintain hope because you may live for several years.
Ans: C Feedback: The nurse can help the patient verbalize feelings and identify resources for support. The nurse should respond with an open-ended question to help the patient to identify fears about being diagnosed with a life-threatening chronic illness. Immediate deferral to spiritual care is not a substitute for engaging with the patient. The nurse should attempt to foster hope, but not in a way that downplays the patient's expressed fears.
A patient with a recent diagnosis of HIV infection expresses an interest in exploring alternative and complementary therapies. How should the nurse best respond? A) Complementary therapies generally have not been approved, so patients are usually discouraged from using them. B) Researchers have not looked at the benefits of alternative therapy for patients with HIV, so we suggest that you stay away from these therapies until there is solid research data available. C) Many patients with HIV use some type of alternative therapy and, as with most health treatments, there are benefits and risks. D) You'll need to meet with your doctor to choose between an alternative approach to treatment and a medical approach.
Ans: C Feedback: The nurse should approach the topic of alternative or complementary therapies from an open-ended, supportive approach, emphasizing the need to communicate with care providers. Complementary therapies and medical treatment are not mutually exclusive, though some contraindications exist. Research supports the efficacy of some forms of complementary and alternative treatment.
A patient's primary infection with HIV has subsided and an equilibrium now exists between HIV levels and the patient's immune response. This physiologic state is known as which of the following? A) Static stage B) Latent stage C) Viral set point D) Window period
Ans: C Feedback: The remaining amount of virus in the body after primary infection is referred to as the viral set point, which results in a steady state of infection that lasts for years. This is not known as the static or latent stage. The window period is the time a person infected with HIV tests negative even though he or she is infected.
A patient has been diagnosed with AIDS complicated by chronic diarrhea. What nursing intervention would be appropriate for this patient? A) Position the patient in the high Fowler's position whenever possible. B) Temporarily eliminate animal protein from the patient's diet. C) Make sure the patient eats at least two servings of raw fruit each day. D) Obtain a stool culture to identify possible pathogens.
Ans: D Feedback: A stool culture should be obtained to determine the possible presence of microorganisms that cause diarrhea. Patients should generally avoid raw fruit when having diarrhea. There is no need to avoid animal protein or increase the height of the patient's bed.
A patient's current antiretroviral regimen includes nucleoside reverse transcriptase inhibitors (NRTIs). What dietary counseling will the nurse provide based on the patient's medication regimen? A) Avoid high-fat meals while taking this medication. B) Limit fluid intake to 2 liters a day. C) Limit sodium intake to 2 grams per day. D) Take this medication without regard to meals.
Ans: D Feedback: Many NRTIs exist, but all of them may be safely taken without regard to meals. Protein, fluid, and sodium restrictions play no role in relation to these drugs.
An 18-year-old pregnant female has tested positive for HIV and asks the nurse if her baby is going to be born with HIV. What is the nurse's best response? A) There is no way to know that for certain, but we do know that your baby has a one in four chance of being born with HIV. B) Your physician is likely the best one to ask that question. C) If the baby is HIV positive there is nothing that can be done until it is born, so try your best not to worry about it now. D) It's possible that your baby could contract HIV, either before, during, or after delivery.
Ans: D Feedback: Mother-to-child transmission of HIV-1 is possible and may occur in utero, at the time of delivery, or through breast-feeding. There is no evidence that the infant's risk is 25%. Deferral to the physician is not a substitute for responding appropriately to the patient's concern. Downplaying the patient's concerns is inappropriate.
A 16-year-old has come to the clinic and asks to talk to a nurse. The nurse asks the teen what she needs and the teen responds that she has become sexually active and is concerned about getting HIV. The teen asks the nurse what she can do keep from getting HIV. What would be the nurse's best response? A) There's no way to be sure you won't get HIV except to use condoms correctly. B) Only the correct use of a female condom protects against the transmission of HIV. C) There are new ways of protecting yourself from HIV that are being discovered every day. D) Other than abstinence, only the consistent and correct use of condoms is effective in preventing HIV.
Ans: D Feedback: Other than abstinence, consistent and correct use of condoms is the only effective method to decrease the risk of sexual transmission of HIV infection. Both female and male condoms confer significant protection. New prevention techniques are not commonly discovered, though advances in treatment are constant.
A patient has come into the free clinic asking to be tested for HIV infection. The patient asks the nurse how the test works. The nurse responds that if the testing shows that antibodies to the AIDS virus are present in the blood, this indicates what? A) The patient is immune to HIV. B) The patient's immune system is intact. C) The patient has AIDS-related complications. D) The patient has been infected with HIV.
Ans: D Feedback: Positive test results indicate that antibodies to the AIDS virus are present in the blood. The presence of antibodies does not imply an intact immune system or specific immunity to HIV. This finding does not indicate the presence of AIDS-related complications.
The nurse is addressing condom use in the context of a health promotion workshop. When discussing the correct use of condoms, what should the nurse tell the attendees? A Attach the condom prior to erection. B) A condom may be reused with the same partner if ejaculation has not occurred. C) Use skin lotion as a lubricant if alternatives are unavailable. D) Hold the condom by the cuff upon withdrawal.
Ans: D Feedback: The condom should be unrolled over the hard penis before any kind of sex. The condom should be held by the tip to squeeze out air. Skin lotions, baby oil, petroleum jelly, or cold cream should not be used with condoms because they cause latex deterioration/condom breakage. The condom should be held during withdrawal so it does not come off the penis. Condoms should never be reused.
During the admission assessment of an HIV-positive patient whose CD4+ count has recently fallen, the nurse carefully assesses for signs and symptoms related to opportunistic infections. What is the most common life-threatening infection? A) Salmonella infection B) Mycobacterium tuberculosis C) Clostridium difficile D) Pneumocystis pneumonia
Ans: D Feedback: There are a number of opportunistic infections that can infect individuals with AIDS. The most common life-threatening infection in those living with AIDS is Pneumocystis pneumonia (PCP), caused by P. jiroveci (formerly carinii). Other opportunistic infections may involve Salmonella,Mycobacterium tuberculosis, and Clostridium difficile.
Stage 1 of HIV infection
Apparent good health continues because CD4+ T-cell levels remain high enough to preserve immune defensive responses, but over time, the number of CD4+ T cells continues to decrease.
A patient diagnosed with common variable immune deficiency (CVID) has been admitted to the acute medicine unit. When reviewing this patient's laboratory findings, the nurse should prioritize what values? A) Creatinine and blood urea nitrogen (BUN) B) Hemoglobin and vitamin B12 C) Sodium, potassium and magnesium D) D-dimer and c-reactive protein
B (Feedback: A patient diagnosed with CVID often develops pernicious anemia; the patient's hemoglobin and vitamin B12 levels would be used to assess for this common complication of CVID. None of the other listed blood values directly relates to the signs and complications of CVID.)
The nurse is admitting a patient to the unit with a diagnosis of ataxia-telangiectasia. The nurse's assessment should reflect the patient's increased risk for what complication? A) Peripheral edema B) Cancer C) Anaphylaxis D) Gastrointestinal bleeds
B (Feedback: Frequent causes of death in patients with ataxia-telangiectasiaare chronic pulmonary disease and malignancy. Peripheral edema, anaphylaxis, and GI bleeding are not noted to be common among patients with ataxia-telangiectasia.)
A nurse is caring for a patient with a phagocytic cell disorder. The patient states, "My specialist says that I will likely be cured after I get my treatment tomorrow." To what treatment is the patient most likely referring? A) Treatment with granulocyte-macrophage colony-stimulating factor (GM-CSF) B) Hematopoietic stem cell transplantation C) Treatment with granulocyte colony-stimulating factor (G-CSF) D) Brachytherapy
B (Feedback: Hematopoietic stem cell transplantation (HSCT), another form of cell therapy, has proven to be a successful curative modality. Treatment with GM-CSF or G-CSF is not curative. Brachytherapy is not a treatment for immunodeficiency.)
A 20-year-old patient with an immunodeficiency is admitted to the unit with an acute episode of upper airway edema. This is the fifth time in the past 3 months that the patient has had such as episode. As the nurse caring for this patient, you know that the patient may have a deficiency of what? A) Interferons B) C1esterase inhibitor C) IgG D) IgA
B (Feedback: Hereditary angioneurotic edema results from the deficiency of C1esterase inhibitor, which opposes the release of inflammatory mediators. The clinical picture of this autosomal dominant disorder includes recurrent attacks of edema. A patient with this diagnosis does not lack interferons, IgG, or IgA.)
A nurse is preparing to discharge a patient with an immunodeficiency. When preparing the patient for self-infusion of IVIG in the home setting, what education should the nurse prioritize? A) Sterile technique for establishing a new IV site B) Signs and symptoms of adverse reactions C) Formulas for calculating daily doses D) Technique for adding medications to the IVIG
B (Feedback: The patient who is to receive IVIG at home will need information about adverse reactions and their management. A patient would not start a new IV site independently and the patient does not calculate changes in dose independently. Medications are not added to IVIG.)
A young couple visits the nurse practitioner stating that they want to start a family. The husband states that his brother died of a severe infection at age 6 months. He says he never knew what was wrong but his mother had him undergo "blood testing" as a child. Based on these statements, what health problem should the nurse practitioner suspect? A) Severe neutropenia B) X-linked agammaglobulinemia C) Drug-induced thrombocytopenia D) Aplastic anemia
B (Feedback: There is no evidence of drug-induced thrombocytopenia or aplastic anemia. The child would have only suffered from severe neutropenia if there was evidence of bacterial or fungal infections. The fact the mother of this individual had him tested for gamma-globulin as a child would indicate that his sibling had X-linked agammaglobulinemia. More than 10% of patients with X-linked agammaglobulinemia are hospitalized for infection at less than 6 months of age. Since the condition is X-linked it is important for the couple to undergo genetic testing.)
A hospital nurse has experienced percutaneous exposure to an HIV-positive patient's blood as a result of a needlestick injury. The nurse has informed the supervisor and identified the patient. What action should the nurse take next? A) Flush the wound site with chlorhexidine. B) Report to the emergency department or employee health department. C) Apply a hydrocolloid dressing to the wound site. D) Follow up with the nurse's primary care provider.
B After initiating the emergency reporting system, the nurse should report as quickly as possible to the employee health services, the emergency department, or other designated treatment facility.
A 6-month-old infant has been diagnosed with X-linked agammaglobulinemia and the parents do not understand why their baby did not develop an infection during the first months of life. The nurse should describe what phenomenon? A) Cell-mediated immunity in infants B) Passive acquired immunity C) Phagocytosis D) Opsonization
B Infants with X-linked agammaglobulinemia usually become symptomatic after the natural loss of maternally transmitted immunoglobulins (passive acquired immunity), which occurs at about 5 to 6 months of age. agammaglobulinemia: a group of inherited immune deficiencies characterized by a low concentration of antibodies in the blood due to the lack of particular lymphocytes in the blood and lymph.
A patient who has AIDS has been admitted for the treatment of Kaposi's sarcoma. What nursing diagnosis should the nurse associate with this complication of AIDS? A) Risk for Disuse Syndrome Related to Kaposi's Sarcoma B) Impaired Skin Integrity Related to Kaposi's Sarcoma C) Diarrhea Related to Kaposi's Sarcoma D) Impaired Swallowing Related to Kaposi's Sarcoma
B Kaposi's sarcoma (KS) is a disease that involves the endothelial layer of blood and lymphatic vessels. This malignancy does not directly affect swallowing or bowel motility and it does not constitute a risk for disuse syndrome.
A nurse is caring for a patient who has an immunodeficiency. What assessment finding should prompt the nurse to consider the possibility that the patient is developing an infection? A) Uncharacteristic aggression B) Persistent diarrhea C) Pruritis (itching) D) Constipation
B Persistent diarrhea is among the varied signs and symptoms that may suggest infection in an immunocompromised patient. Aggression, pruritis, and constipation are less suggestive of an infectious etiology.
A nurse has created a plan of care for an immunodeficient patient, specifying that care providers take the patient's pulse and respiratory rate for a full minute. What is the rationale for this aspect of care? A) Respirations affect heart rate in immunodeficient patients. B) These patients' blunted inflammatory responses can cause subtle changes in status. C) Hemodynamic instability is one of the main complications of immunodeficiency. D) Immunodeficient patients are prone to ventricular tachycardia and atrial fibrillation.
B Pulse rate and respiratory rate should be counted for a full minute, because subtle changes can signal deterioration in the patient's clinical status. The rationale for this action is not because of the relationship between heart rate and respirations. These patients do not have a greatly increased risk of hemodynamic instability or dysrhythmias.
A nurse has admitted a patient diagnosed with severe combined immunodeficiency disease (SCID) to the unit. The patient's orders include IVIG. How will the patient's dose of IVIG be determined? A) The patient will receive 25 to 50 mg/kg of body weight. B) The dose will be determined by the patient's response. C) The dose will be determined by body surface area. D) The patient will receive a one-time bolus followed by 100- to 150-mg doses.
B The optimal dosage of IVIG is determined by the patient's response. In most instances, an IV dose of 200 to 800 mg/kg of body weight is administered.
A patient with HIV is admitted to the hospital because of chronic severe diarrhea. The nurse caring for this patient should expect the physician to order what drug for the management of the patient's diarrhea? A) Zithromax B) Sandostatin C) Levaquin D) Biaxin
B Therapy with octreotide acetate (Sandostatin), a synthetic analogue of somatostatin, has been shown to be effective in managing chronic severe diarrhea. *Somatostatin inhibits many physiologic functions, including gastrointestinal motility and intestinal secretion of water and electrolytes.
A patient has been admitted with a phagocytic cell disorder and the nurse is reviewing the most common health problems that accompany these disorders. The nurse should identify which of the following? Select all that apply. A) Inflammatory bowel disease B) Chronic otitis media C) Cutaneous abscesses D) Pneumonia E) Cognitive deficits
B,C,D (Feedback: Patients with phagocytic cell disorders experience recurrent cutaneous abscesses, chronic eczema, bronchitis, pneumonia, chronic otitis media, and sinusitis. Irritable bowel syndrome and cognitive deficits are atypical.)
How is HIV transmitted?
Bodily fluids -Blood -Semen -Vaginal fluid -Breast milk
A nurse caring for a patient who has an immunosuppressive disorder knows that continual monitoring of the patient is critical. What is the primary rationale behind the need for continual monitoring? A) So that the patient's functional needs can be met immediately B) So that medications can be given as ordered and signs of adverse reactions noted C) So that early signs of impending infection can be detected and treated D) So that the nurse's documentation can be thorough and accurate
C (Feedback: Continual monitoring of the patient's condition is critical, so that early signs of impending infection may be detected and treated before they seriously compromise the patient's status. Continual monitoring is not primarily motivated by the patient's functional needs or medication schedule. The nurse's documentation is important, but less than infection control.)
A patient's primary immunodeficiency disease is characterized by the inability of white blood cells to initiate an inflammatory response to infectious organisms. What is this patient's most likely diagnosis? A) Chronic granulomatous disease B) Wiskott-Aldrich syndrome C) Hyperimmunoglobulinemia E syndrome D) Common variable immunodeficiency
C (Feedback: In one rare type of phagocytic disorder, hyperimmunoglobulinemia E syndrome (formerly known as Job syndrome), white blood cells cannot initiate an inflammatory response to infectious organisms. The other listed health problems do not have this pathology.)
A teenager is diagnosed with cellulitis of the right knee and fails to respond to oral antibiotics. He then develops osteomyelitis of the right knee, prompting a detailed diagnostic workup that reveals a phagocytic disorder. This patient faces an increased risk of what complication? A) Thrombocytopenia B) HIV/AIDS C) Neutropenia D) Hemophilia
C (Feedback: Patients with phagocytic cell disorders may develop severe neutropenia. None of the other listed health problems is a common complication of phagocytic disorders.)
The nurse educator is differentiating primary immunodeficiency diseases from secondary immunodeficiencies. What is the defining characteristic of primary immunodeficiency diseases? A) They require IVIG as treatment. B) They are the result of intrauterine infection. C) They have a genetic origin. D) They are communicable.
C (Feedback: Primary immunodeficiency diseases are genetic in origin and result from intrinsic defects in the cells of the immune system. Primary immunodeficiency diseases do not always need IVIG as treatment, and they are not communicable. Primary immunodeficiencies do not result from intrauterine infection.)
A home health nurse will soon begin administering IVIG to a new patient on a regular basis. What teaching should the nurse provide to the patient? A) The need for a sterile home environment B) Complementary alternatives to IVIG C) Expected benefits and outcomes of the treatment D) Technique for managing and monitoring daily fluid intake
C (Feedback: The patient who is to receive IVIG at home will need information about the expected benefits and outcomes of the treatment as well as expected adverse reactions and their management. The home environment cannot be sterile and complementary alternatives to IVIG have not been identified. Fluid management is not a central concern.)
The nurse is working with the interdisciplinary team to care for a patient who has recently been diagnosed with severe combined immunodeficiency disease (SCID). What treatment is likely of most benefit to this patient? A) Combined radiotherapy and chemotherapy B) Antibiotic therapy C) Hematopoietic stem cell transplantation (HSCT) D) Treatment with colony-stimulating factors (CSFs)
C (Feedback: Treatment options for SCID include stem cell and bone marrow transplantation, but HSCT is the definitive therapy for the disease and supersedes the importance of antibiotics. CSFs, radiation therapy, and chemotherapy are not indicated.)
A patient with AIDS is admitted to the hospital with AIDS-related wasting syndrome and AIDS-related anorexia. What drug has been found to promote significant weight gain in AIDS patients by increasing body fat stores? A) Advera B) Momordicacharantia C) Megestrol D) Ranitidine
C -Megestrol acetate (Megace), a synthetic oral progesterone preparation, promotes significant weight gain. In patients with HIV infection, it increases body weight primarily by increasing body fat stores.
In women with early-stage HIV infection, ____________________ usually presents the same as in women without HIV infection, with white adherent vaginal discharge associated with mucosal burning and itching of mild-to-moderate severity and sporadic recurrences
Candida vulvovaginitis
characterized by painless, creamy white, plaque-like lesions that can occur on the buccal surface, hard or soft palate, oropharyngeal mucosa, or tongue surface.
Candidiasis
A nurse is admitting an adolescent patient with a diagnosis of ataxia-telangiectasis. Which of the following nursing diagnoses should the nurse include in the patient's plan of care? A) Fatigue Related to Pernicious Anemia B) Risk for Constipation Related to Decreased Gastric Motility C) Risk for Falls Due to Loss of Muscle Coordination D) Disturbed Kinesthetic Sensory Perception Related to Vascular Changes
C Ataxia-telangiectasia is an autosomal recessive neurodegenerative disorder characterized by cerebellar ataxia (loss of muscle coordination), telangiectasia (vascular lesions caused by dilated blood vessels), and immune deficiency. Decreased coordination is likely to constitute a risk for falls. The patient does not characteristically lose tactile sensation or experience pernicious anemia or constipation.
A patient with a diagnosis of primary immunodeficiency informs the nurse that he has been experiencing a new onset of a dry cough and occasional shortness of breath. After determining that the patient's vital signs are within reference ranges, what action should the nurse take? A) Administer a nebulized bronchodilator. B) Perform oral suctioning. C) Assess the patient for signs and symptoms of infection. D) Teach the patient deep breathing and coughing exercises.
C Dyspnea and cough are among the many signs and symptoms that may suggest infection in an immunocompromised patient. There is no indication for suctioning or the use of nebulizers. Deep breathing and coughing exercises do not address the patient's complaints or the likely etiology.
A patient with a diagnosis of common variable immunodeficiency begins to develop thick, sticky, tenacious sputum. The patient has a history of episodes of pneumonia at least one time per year for the last 10 years. What does the nurse suspect the patient is developing? A) Pulmonary edema B) A pulmonary neoplasm C) Bronchiectasis D) Emphysema
C Frequent respiratory tract infections in patients with CVID typically lead to chronic progressive bronchiectasis and pulmonary failure. Pulmonary edema is often a result of vascular insufficiency. A patient suffering from CVID is likely to develop gastric cancer, not lung cancer. The patient is not at risk for emphysema.
The nurse care plan for a patient with AIDS includes the diagnosis of Risk for Impaired Skin Integrity. What nursing intervention should be included in the plan of care? A) Maximize the patient's fluid intake. B) Provide total parenteral nutrition (TPN). C) Keep the patient's bed linens free of wrinkles. D) Provide the patient with snug clothing at all times.
C Skin surfaces are protected from friction and rubbing by keeping bed linens free of wrinkles and avoiding tight or restrictive clothing. Fluid intake should be adequate, and must be monitored, but maximizing fluid intake is not a goal. TPN is a nutritional intervention of last resort.
An immunocompromised patient is being treated in the hospital. The nurse's assessment reveals that the patient's submandibular lymph nodes are swollen, a finding that represents a change from the previous day. What is the nurse's most appropriate action? A) Administer a PRN dose of acetaminophen as ordered. B) Monitor the patient's vital signs q2h for the next 24 hours. C) Inform the patient's primary care provider of this finding. D) Implement standard precautions in the patient's care.
C Swollen lymph nodes are suggestive of infection and warrant prompt medical assessment and treatment.
During stage 0, which is also known as acute/recent infection, most varieties of HIV-1 use the chemokine cell receptor molecule for entry to T cells in addition to the CD4+ receptor, which suggests that the R5 variant is preferred to a different variant (CXCR4) but the preferred coreceptor can shift over the course of infection.
CCR5 (R5 virus)
All viruses target specific cells. HIV targets cells with _________ receptors, which are expressed on the surface of T lymphocytes, monocytes, dendritic cells, and brain microglia.
CD4+
Testing for latent TB at the time of HIV diagnosis should be routine, regardless of an individual's risk of TB exposure. Individuals with negative diagnostic tests for latent TB who have stage 3 HIV infection should be retested once their _____ count increases due to ART.
CD4+
The __________ count serves as the major laboratory indicator of immune function and prophylaxis for opportunistic infections, and is the strongest predictor of subsequent disease progression and survival
CD4+
The ________ serves as the major laboratory indicator of immunefunction and prophylaxis for opportunistic infections, and is the strongest predictor of subsequent disease progression and survival
CD4+ count
Mature T cells (T lymphocytes) are composed of two major subpopulations that are defined by cell surface receptors of ________ or __________
CD4+ or CD8+.
Autoimmune polyglandular syndrome type 1
Causes a diverse range of symptoms, including autoimmunity against different types of organs and candidiasis, a fungal infection caused by Candida yeast.
What laboratory test should the nurse review first to identify antibodydeficiencies?
Complete blood count with manual differential should always be analyzed first
first manifestation of kaposi sarcoma?
Cutaneous signs may be the first manifestation of HIV; they can appear anywhere on the body and are usually brownish pink to deep purple.
A nurse educator is explaining that patients with primary immunodeficiencies are living longer than in past decades because of advances in medical treatment. This increased longevity is associated with an increased risk of what? A) Chronic obstructive pulmonary disease B) Dementia C) Pulmonary fibrosis D) Cancer
D (Feedback: Advances in medical treatment have meant that patients with primary immunodeficiencies live longer, thus increasing their overall risk of developing cancer. It does not mean that they are at increased risk of COPD, dementia, or pulmonary fibrosis.)
A patient who has received a heart transplant is taking cyclosporine, an immunosuppressant. What should the nurse emphasize during health education about infection prevention? A) Eat a high-calorie, high-protein diet. B) Limit physical activity in order to conserve energy. C) Take prophylactic antibiotics as ordered. D) Perform frequent handwashing.
D (Feedback: Hand hygiene is imperative in infection control. A well-balanced diet is important, but for most patients this is secondary to hygiene as an infection-control measure. Prophylactic antibiotics are not normally used. Limiting physical activity will not protect the patient from infection.)
A nurse is planning the care of a patient who requires immunosuppression to ensure engraftment of depleted bone marrow during a transplantation procedure. What is the most important component of infection control in the care of this patient? A) Administration of IVIG B) Antibiotic administration C) Appropriate use of gloves and goggles D) Thorough and consistent hand hygiene
D (Feedback: Hand hygiene is usually considered the most important aspect of infection control. IVIG and antibiotics are not considered infection control measures, though they enhance resistance to infection and treat infection. Gloves and goggles are sometimes indicated but are less effective than hand hygiene.)
The nurse is preparing to administer IVIG to a patient who has an immunodeficiency. What nursing guideline should the nurse apply? A) Do not exceed an infusion rate of 300 mL/hr. B) Slow the infusion rate if the patient exhibits signs of a transfusion reaction. C) Weigh the patient immediately after the infusion is complete. D) Administer pretreatment medications as ordered 30 minutes prior to infusion.
D (Feedback: The nurse should administer pretreatment acetaminophen and diphenhydramine as prescribed 30 minutes before the start of the infusion. The patient should be weighed prior to the treatment and the IV infusion rate should not exceed 200 mL/hour. The nurse should stop the transfusion in the event of any signs of a reaction.)
A home health nurse is reinforcing health education with a patient who is immunosuppressed and his family. What statement best suggests that the patient has understood the nurse's teaching? A) "My family needs to understand when I can go get the seasonal flu shot." B) "I need to know how to treat my infections in a home setting." C) "I need to understand how to give my platelet transfusions." D) "My family needs to understand that I'll probably need lifelong treatment."
D (Feedback: The patient must be made aware that all health-related instructions are lifelong. Immunizations may be contraindicated and infection usually requires inpatient treatment. Platelet transfusions are not indicated for most patients who have immunodeficiencies.)
The home health nurse is assessing a patient who is immunosuppressed following a liver transplant. What is the most essential teaching for this patient and the family? A) How to promote immune function through nutrition B) The importance of maintaining the patient's vaccination status C) How to choose antibiotics based on the patient's symptoms D) The need to report any slight changes in the patient's health status
D (Feedback: They must be informed of the need for continuous monitoring for subtle changes in the patient's physical health status and of the importance of seeking immediate health care if changes are detected. Nutrition is important, but infection control is the priority. Patients and families do not choose antibiotics independently. Vaccinations are often contraindicated in immunocompromised patients.)
The parents of a 1-month-old infant bring their child to the pediatrician with symptoms of congestive heart failure. The infant is ultimately diagnosed with DiGeorge syndrome. What will prolong this infant's survival? A) Stem cell transplantation B) Long-term antibiotics C) Chemotherapy D) Thymus gland transplantation
D (Feedback: Transplantation of fetal thymus, postnatal thymus, or human leukocyte antigen (HLA)-matched bone marrow has been used for permanent reconstitution of T-cell immunity in infants with DiGeorge syndrome. Antibiotics and chemotherapy do not address the etiology of the infant's disease. Stem cell transplantation is not a common treatment modality.)
IVIG has been ordered for the treatment of a patient with an immunodeficiency. Which of the following actions should the nurse perform before administering this blood product? A) Ensure that the patient has a patent central line. B) Ensure that the IVIG is appropriately mixed with normal saline. C) Administer furosemide before IVIG to prevent hypervolemia. D) Weigh the patient before administration to verify the correct dose.
D The nurse should obtain height and weight before treatment to verify accurate dosing. IVIG can be administered through a peripheral line. Diuretics are not normally given prior to administration, and IVIG is not mixed with normal saline.
A nurse is providing health education regarding self-care to a patient with an immunodeficiency. What teaching point should the nurse emphasize? A) The importance of aggressive treatment of acne B) The importance of avoiding alcohol-based cleansers C) The need to keep fingernails and toenails closely trimmed D) The need for thorough oral hygiene
D Many patients develop oral manifestations and need education about promoting good dental hygiene to diminish the oral discomfort and complications that frequently result in inadequate nutritional intake. Alcohol cleansers do not necessarily need to be avoided and nail care is not a central concern.
Glycosylation disorders with immune deficiency
Defects in glycosylation, which refers to the attachment of sugars to proteins; can disrupt the immune system resulting in immune deficiency.
Cryptococcus Neoformans Diagnosis
Diagnosis is confirmed by CSF analysis
HIV-1 differentiation assay
Differentiates HIV-1 from HIV-2
_________ is the ability of pathogens to withstand the effects of medications that should be toxic to them.
Drug resistance
______ is a test that detects and measures antibodies in your blood. This test can be used to determine if you have antibodies related to certain infectious conditions.
EIA -also called ELISA
TB in individuals with advanced immune deficiency can be rapidly progressive and fatal if treatment is delayed and such patients often have smear-negative sputum specimens. Therefore, after collection of available specimens for culture and molecular diagnostic tests what is done?
Empiric treatment (therapy based on the educational guess) for TB is warranted in patients with clinical and radiographic presentation suggestive of HIV-related TB.
HIV disease progression is classified from less to more severe;once a case is classified into a surveillance severity stage, it can be reclassified into a less severe stage if the CD4+ T-lymphocytes increase. true/false
FALSE! once a case is classified into a surveillance severity stage, it cannot be reclassified into a less severe stage even if the CD4+ T-lymphocytes increase, which often occurs when a person receives ART.
nonlatex condoms will protect an patient that is allergic to latex agains HIV.
FALSE!! Nonlatex condoms made of natural materials such as lambskin are available for people with latex allergy but will not protect against HIV infection.
TWO people with HIV can have sex without worrying of trasmission because they are already infected.
FALSE!!! Avoid having unprotected sex with another HIV-seropositive person. Cross-infection with that person's HIV can increase the severity of infection. *Take ART regularly to achieve viral suppression.
human immune deficiency virus
HIV - HIV is a virus that attacks a type of white blood cell called a CD4 cell in the body's immune system. It reduces the body's ability to fight infection and illness. The body can fight off many viruses, but some of them can never be completely removed once they are present. HIV is one of these. * treatment with antiretroviral therapy can minimize the effect of the virus by slowing or halting its progression.
_______ infection has been best managed as a chronic disease, most appropriately in an outpatient care setting, whereas _______ may involve acute conditions that require hospitalization
HIV AIDS
two forms of HIV
HIV-1 and HIV-2
AIDS-Related Lymphomas
Hodgkin lymphoma and non-Hodgkin lymphoma
_________ causes venereal warts and is a risk factor for cervical intraepithelial neoplasia, a cellular change that is frequently a precursor to cervical cancer.
Human papillomavirus (HPV)
The nurse should be alert to the possibility of __________, especially in the 3-month period after treatment with ART is initiated, because this syndrome is associated with significant morbidity and patients often require hospital admission.
Immune Reconstitution Inflammatory Syndrome (IRIS)
ACQUIRED IMMUNE DEFICIENCY
Immune deficiency can be acquired due to: - medical treatment such as chemotherapy - infection from agents such as human immune deficiency virus (HIV).
________ results from rapid restoration of organism-specific immuneresponses to infections that cause either the deterioration of a treatedinfection or new presentation of a subclinical infection.
Immune reconstitution inflammatory syndrome (IRIS)
Hyper-immunoglobulin M (hyper-IgM) syndromes
Immune system fails to produce normal IgA, IgG, and IgE antibodies but can produce normal or elevated IgM. Infants usually develop severe respiratory infections.
Progressive Multifocal Leukoencephalopathy
Infection of immunosuppressed patients (AIDS, transplants, leukemics) caused by reactivation of JC (Johnson Cuningham) virus. Progressive course to death within months. - demyelinating CNS disorder that affects the oligodendroglia. -Infection of brain
cancerous condition starting as purple or brown papules on the lower extremities that spreads through the skin to the lymph nodes and internal organs; frequently seen with AIDS
Kaposi sarcoma
fat redistribution syndrome
Lipodystrophy is a problem with the way your body makes, uses, and stores fat. It's also called fat redistribution.
The gastrointestinal manifestations of HIV infection and AIDS include:
Loss of appetite Nausea Vomiting Oral and esophageal candidiasis Chronic diarrhea
warts, hypogammaglobulinemia, infections, and myelokathexis syndrome (WHIMS)
Low levels of white blood cells, especially neutrophils, which predispose to frequent infections and persistent warts.
NF-kB Essential modifier (NEMO) mutations
Mutations in the NEMO gene cannot "turn on" other genes especially those involved in inflammation and the immune response and are, therefore, highly susceptible to infections with mycobacteria.
___________ has the oldest and largest HIV epidemic in the Western world and could serve as a future model for other locales.
New York City
a patient with AIDS is having a recurrence of 10 to 12 loose stools a day, what medication may help this patient with controlling the chronic diarrhea? a. Octreotide b. rifaximin (xifaxan) c. bismuth subsalicylate (pepto bismol) d. atropine diphenoxylate (lomotil)
Octreotide
Progressive Multifocal Leukoencephalopathy Clinical manifestations
Often begin with mental confusion and rapidly progress to include blindness, aphasia(unable to speak or understand), muscle weakness, paresis (partial or complete paralysis), and death
______________ is a serious complication that arises during successful ART in patients with HIV-TB co-infection who are receiving TB treatment.
Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS)
Chronic granulomatous disease (CGD)
Phagocytes are unable to kill certain bacteria and fungi resulting in increased susceptibility to infections.
Leukocyte adhesion deficiency (LAD)
Phagocytes are unable to move to the site of an infection resulting in an inability to fight pathogens resulting in recurrent, life-threatening infections and poor wound healing.
A patient with HIV develops a nonproductive cough, shortness ofbreath, a fever of 101°F, and an O2 saturation of 92%. What infectioncaused by Pneumocystis jiroveci does the nurse know could occurwith this patient? a. Mycobacterium avium complex (MAC) b. Pneumocystis pneumonia c. Tuberculosis d. Community-acquired pneumonia
Pneumocystis pneumonia
Nurses must recognize the differences among common laboratory tests used to diagnose and assess HIV infection and guide therapy. For example, the EIA is a diagnostic screening test that determines the presence of antibodies to HIV. The _______ test, which measures viral load, is used along with the ______ count, which indicates the level of immune dysfunction, to assess the stage and severity of HIV infection. It is important to assess the extent of damage to the immune system before initiation of ART and/or prophylactic treatment for opportunistic infections.
RT-PCR CD4+
when is recommendable to do resistance testing in patients in HIV care?
Resistance testing in persons who are chronically infected is recommended at the time of entry into HIV care.
CARD9 Deficiency
Results in susceptibility to fungal infections such as candidiasis; fungi are usually present on the skin; does not cause severe problems in healthy people.
Facial lipoatrophy
SIDE EFFECT OF ART
safety precaution HIV patients
STANDARD PRECAUTIONS - Use new gloves for every patient. - Wear protective eye wear, masks or face shields (with safety glasses or goggles) during procedures likely to generate droplets of blood or body fluids. * In general, protective eye wear, masks and clothing are not needed for routine care of AIDS virus-infected persons.
HIV in older adults
Signs of HIV/AIDS can be mistaken for the aches and pains of normal aging. Older adults might be coping with other diseases common to aging that can mask the signs of HIV/AIDS.
It is generally recommended that herbal products not be used with antiretroviral medications. ______________ may decrease blood levels of some anti-HIV medications and make them less effective; echinacea should be avoided because it may stimulate viral replication.
St. John's wort
when stage 2 occurs in HIV?
Stage 2 occurs when CD4+ T-lymphocyte cells are between 200 and 499
The key goal of ART
Standard antiretroviral therapy (ART) * to achieve and maintain durable viral suppression.
HIV-1 nucleic acid amplification test
Tests directly for virus
HIV-1/HIV-2 immunoassay
Tests for both HIV-1 and antibodies
HIV/1-HIV-2 antigen/antibody combination immunoassay
Tests for both antibody and virus for both HIV-1 and HIV-2
how to manage chronic diarrhea?
Therapy with octreotide acetate (Sandostatin), a synthetic analog of somatostatin, has been shown to effectively manage chronic severe diarrhea.
Wiskott-Aldrich syndrome (WAS)
Thrombocytopenia, infection, and malignancies-Problems with B and T cells and platelets resulting in prolonged episodes of bleeding, recurrent bacterial and fungal infections and increased risk of cancers and autoimmune diseases.
Autoimmune lymphoproliferative syndrome (ALPS)
Unusually high numbers of lymphocytes accumulate in the lymph nodes, liver, and spleen leading to enlargement of those organs. * Causes numerous autoimmune problems including low levels of red blood cells, platelets, and neutrophils.
Ataxia Telangiectasia
Vascular lesions rare childhood disease. It affects the brain and other parts of the body. - Ataxia refers to uncoordinated movements, such as walking. - Telangiectasias are enlarged blood vessels (capillaries) just below the surface of the skin.
___________ is a better predictor of the risk of HIV disease progression than the CD4+ count. The lower the __________, the longer the time to AIDS diagnosis and the longer the survival time.
Viral load viral load
what is the most important indicator of response to ART?
Viral load should be measured at baseline and on a regular basis thereafter because viral load is the most important indicator of response to ART.
The CDC estimates that only 36% of the people living with HIV in the United States are prescribed ART and that among these individuals, only 76% have suppressed viral loads
Viral loads are often not suppressed because the patient is not adhering to the treatment plan.
enzyme immunoassay (EIA)
a blood test that can determine the presence of antibodies to HIV in the blood or saliva; a variant of this test is called enzyme-linked immunosorbent assay (ELISA)
Antiretroviral therapy (ART)
a combination of several medications prescribed for people who are HIV-positive to delay the onset of AIDS
HIV becomes AIDS when
a person's white blood cell count is so low 200 or below, it leaves their immune system defenseless
Amphoteric
a substance that can act as both an acid and a base
immune reconstitution inflammatory syndrome (IRIS):
a syndrome that results from rapid restoration of pathogen-specific immune responses to opportunistic infections
EIA test
a test that screens for the presence of HIV antibodies in the blood
Optimal viral suppression is defined generally as
a viral load persistently below the level of detection (HIV RNA less than 20 to 75 copies/mL, depending on the assay used).
The nurse is monitoring the patient's CD4 and cell count for increase or decrease in viral load. An increase in the CD4 count indicates a ________ in viral load and the ability to fight viral infections. I
decrease
A patient is admitted for the treatment of a primary immunodeficiency and intravenous immunoglobulin (IVIG) is ordered. What should the nurse monitor for as a potential adverse effect of IVIG administration? A) Anaphylaxis B) Hypertension C) Hypothermia D) Joint pain
a. Potential adverse effects of an IVIG infusion include hypotension, flank pain, chills, and tightness in chest, terminating with a slightly elevated body temperature and anaphylactic reaction. Hypertension, hypothermia, and joint pain are not usual adverse effects of IVIG.
A patient is diagnosed with pneumocystis pneumonia (PCP). What medication does the nurse anticipate educating the patient about for treatment? a. TMP-SMZ (Bactrim) b. Cephalexin (Keflex) c. Azithromycin (Zithromax) d. Garamycin (Gentamicin)
a. TMP-SMZ (Bactrim)
Cryptococcal Meningitis
among patients with HIV infection most commonly occurs as a subacute meningitis or meningoencephalitis with fever, malaise, and headache.
viral set point
amount of virus present in the blood after the initial burst of viremia and the immune response that follows
polyurethane female condom
an effective contraceptive, provides a physical barrier that prevents exposure to genital secretions containing HIV, such as semen and vaginal fluid, and is inserted by the woman
serologic testing algorithm for recent HIV seroconversion (STARHS)
analyzes HIV-positive blood samples to determine whether an HIV infection is recent or has been ongoing.
Immune Reconstitution Inflammatory Syndrome (IRIS) treatment
anti-inflammatory medications such as cortisone.
There are three types of HIV diagnostic tests:
antibody tests antigen/antibody tests nucleic acid (RNA) tests.
____________, which refers to reduced, self-initiated, cognitive, emotional, and behavioral activity, is also commonly reported among those living with a diagnosis of HIV with rates as high as 65%
apathy
Microbicides
are gels, films, or suppositories that can kill or neutralize viruses and bacteria; vaginal and rectal microbicides are being researched to see if they can prevent sexual transmission of HIV.
assessment of body change distress (ABCD) questionnaire
assesses subjective report of bodily changes and body dissatisfaction and the impact of bodily changes on psychosocial variables, quality of life, and HIV self-care behaviors
A patient with HIV has been on antiretroviral therapy (ART) for 6months. The patient comes to the clinic with home medications, andthe nurse observes that there are too many pills in the container.Which factors are associated with nonadherence to ART? (Select allthat apply.) a. Lives alone b. Active substance abuse c. Taking other medication d. Depression e. Lack of social support
b, d, e
The updated CDC recommendations (2014b) tests for HIV antigens and HIV nucleic acid. Why?
because studies from populations at high risk for HIV demonstrated that antibody testing alone might miss a considerable percentage of HIV infections detectable by virologic tests, especially during stage 0.
Blood tests can detect HIV infection sooner after exposure than oral fluid tests. Why?
because the level of antibody in blood is higher than it is in oral fluid.
Why are live vaccines contradicted in patients with antibody deficiency disorders?
because the patient is incapable of generating antibodies and the live substance in the vaccine can cause disease
Why are live vaccines contraindicated in patients with antibodydeficiency disorders?
because the patient is incapable of generating antibodies, and the live substance in the vaccine can cause disease
Initially, there is a period during which those who are HIV positive test negative on the HIV antibody blood test, although they are infected and highly infectious. Why?
because their viral loads are very high
HIV Encephalopathy
brain disease and dementia occurring with AIDS
viral set point how long can it last?
can last for years and is inversely correlated with disease prognosis. The higher the viral set point, the poorer the prognosis.
Persistent, recurrent vaginal _________may be the first sign of HIV infection in women.
candidiasis
Facial wasting
characterized as a sinking of the cheeks, eyes, and temples caused by the loss of fat tissue under the skin * SIDE EFFECT OF ART
HIV encephalopathy
clinical syndrome characterized by a progressive decline in cognitive, behavioral, and motor functions
Mycobacterium avium Complex
common opportunistic infection that typically occurs in patients with CD4+ T-lymphocyte (CD4+) cell counts less than 50 cells/ mm3.
Pneumocystis pneumonia (PCP):
common opportunistic lung infection; pathogen implicated is most commonly a fungus
DiGeorge syndrome
congenital absence of the thymus gland
A patient is on ART for the treatment of HIV. What does the nursedetermine would be an adequate CD4+ count to determine theeffectiveness of treatment for a patient per year? a. 1 mm3 to 10 mm3 b. 10 mm3 to 20 mm3 c. 20 mm3 to 45 mm3 d. 50 mm3 to 150 mm3
d. 50 mm3 to 150 mm3
ELISA test
detects anti-HIV antibodies; Western blot given as follow-up
Patients who have neutropenia are at risk for what problem?
developing sever infections
peripheral neuropathy
disorder characterized by sensory loss, pain, muscle weakness, and wasting of muscles in the hands or legs and feet
peripheral neuropathy:
disorder characterized by sensory loss, pain, muscle weakness, and wasting of muscles in the hands or legs and feet
antibody differentiation tests
distinguishes HIV-1 from antibodies
HIV can be transmitted by casual contact
false
Cryptococcal meningitis is characterized by symptoms:
fever, headache, malaise, stiff neck, nausea, vomiting, mental status changes, and seizures.
Immune Reconstitution Inflammatory Syndrome (IRIS) is characterized by:
fever, respiratory and/or abdominal symptoms, and worsening of the clinical manifestations of an opportunistic infection or the appearance of new manifestations.
During the ____ stage of HIV infection, the patient may be asymptomatic or may exhibit various signs and symptoms such as fatigue or skin rash.
first
During the ________ decade, progress was associated with the recognition and treatment of opportunistic diseases and introduction of prophylaxis against opportunistic infection
first
Immune Reconstitution Inflammatory Syndrome
from rapid restoration of organism-specific immune responses to infections that cause either the deterioration of a treated infection or new presentation of a subclinical infection. *occurs during the initial months after beginning ART
Many of the antiretroviral agents may cause fat redistribution syndrome and metabolic alterations such as dyslipidemia and insulin resistance, which put the patient at risk for early-onset _______ disease and ______.
heart diabetes.
Adverse effects associated with all HIV treatment regimens include:
hepatotoxicity, nephrotoxicity, and osteopenia, along with increased risk of cardiovascular disease and myocardial infarction
Five disorders of common, primary immunodeficiencies are
humoral immunity, T-cell defects, combined B- and T-cell defects, phagocytic disorders, complement production
Potential adverse effects of an IVIG infusion include
hypotension, flank pain, chills, and tightness in chest, terminating with a slightly elevated body temperature and anaphylactic reaction.
opportunistic infection
illness caused by various organisms, some of which usually do not cause disease in people with normal immune systems
Lymphopenia indicates
immunologic abnormality
Seborrheic dermatitis
indurated, diffuse, scaly rash involving the scalp and face. *HIV
Redness, swelling, tenderness, purulent drainage, fever and chills, and an elevated white blood cell count are classic signs of __________
infection.
wasting syndrome
involuntary weight loss consisting of both lean and fat body mass
Treatment of suspected TB in individuals with HIV infection is the same as for those who are HIV uninfected and should include an initial four-drug combination of:
isoniazid, rifampin (Rifadin), pyrazinamide, and ethambutol (Etibi)
HIV-1 nucleic acid tests
looks for the virus RNA directly
Kaposi sarcoma
malignancy that involves the epithelial layer of blood and lymphatic vessels
viral load test
measures the quantity of HIV RNA or DNA in the blood
primary immune deficiency diseases (PIDDs) Major signs and symptoms
multiple infections despite aggressive treatment, infections with unusual or opportunistic organisms, failure to thrive or poor growth, and a positive family history
Mycobacterium avium complex (MAC)
opportunistic infection caused by mycobacterial organisms that commonly causes a respiratory illness but can also infect other body systems
progressive multifocal leukoencephalopathy:
opportunistic infection that infects brain tissue and causes damage to the brain and spinal cord
the most common neurologic symptom at any stage of HIV infection.
peripheral neuropathy
Somatostatin inhibits
physiologic functions, including gastrointestinal motility and intestinal secretion of water and electrolytes.
a sensitive laboratory technique that can detect and quantify HIV in a person's blood or lymph nodes
polymerase chain reaction
pre-exposure prophylaxis (PrEP):
prevention method for HIV-negative people who are at high risk of HIV infection; involves taking a specific combination of HIV medicines daily; use with condoms and other prevention tools.
The period from infection with HIV to the development of HIV-specific antibodies is known as ______________ OR ______________ (previously known as the window period) and is part of stage 0
primary infection or acute HIV infection
severe combined immune deficiency (SCID)
rare, life-threatening disorders caused by mutations in different genes involved in development and function of T and B cells; infants appear healthy at birth but are highly susceptible to severe infections.
a virus that carries genetic material in ribonucleic acid (RNA) instead of DNA and contains reverse transcriptase
retrovirus
The _______ decade witnessed progress in the development of highly active antiretroviral drug therapies (HAART) as well as continuing progress in the treatment of opportunistic infections.
second
Primary immunodeficiencies predispose people to three conditions:
severe infections, autoimmunity, cancer
Discuss the assessment findings for a patient who has developedPneumocystis pneumonia (PCP).
subacute onset of progressive dyspnea, fever, nonproductive cough, and chest discomfort that worsens within days to weeks. In mild cases, pulmonary examination usually is normal at rest. With exertion, tachypnea, tachycardia, and diffuse dry (cellophane) rales may be auscultated. Oral thrush is a common coinfection. Fever is apparent in most cases and may be the predominant symptom. Hypoxemia is the most characteristic laboratory abnormality, along with elevated lactate dehydrogenase levels
Post-Exposure Prophylaxis for Health Care Providers
taking antiretroviral medicines as soon as possible, but no more than 72 hours (3 days) after possible HIV exposure; two to three drugs are usually prescribed which must be taken for 28 days.
post-exposure prophylaxis (PEP):
taking antiretroviral medicines as soon as possible, but no more than 72 hours (3 days) after possible HIV exposure; two to three drugs are usually prescribed which must be taken for 28 days.
Gastrointestinal symptoms may be related to __________
the direct inflammatory effect of HIV on the cells lining the intestines.
Keep condoms cool and dry. Never use skin lotions, baby oil, petroleum jelly, or cold cream as lubricants. Why?
the oil in these products will cause the latex condom to break. Products made with water (such as K-Y jelly or glycerin) are safer to use.
The _____ decade has focused on issues of preventing new infections, adherence to antiretroviral therapy (ART), development of second- generation combination medications that affect different stages of the viral life cycle, and continued need for an effective vaccine.
third
what is the ultimate goal of PrEP?
to reduce the acquisition of HIV infection with its resulting morbidity, mortality, and cost to individuals and society
Whats the overall goal of ART?
to suppress HIV replication to a level below which drug-resistant mutations do not emerge
What are the two major components of antiretroviral therapy (ART)resistance?
transmission of drug resistant HIV at the time of initial infection and selective drug resistance in patients who are receiving nonsuppressive regimens.
Patients with HIV-TB co-infection with low CD4+ counts who start ART are at high risk of developing TB-IRIS.
true
Patients with neutropenia are at increased risk for developing severe infections despite substantial advances in supportive care.
true
Simplifying treatment regimens and decreasing the number of medications that must be taken each day increase patients' adherence to therapy.
true
TB disease can develop in the lungs as well as in extrapulmonary sites such as the central nervous system (CNS), bone, pericardium, stomach, peritoneum, and scrotum and initial diagnostic testing is directed at the anatomic site of symptoms or signs, such as the lungs, lymph nodes, and cerebrospinal fluid.
true
The reduction in T cells increases the risk for opportunistic infections
true
When latex male condoms are used consistently and correctly during vaginal or anal intercourse, they are highly effective in preventing the sexual transmission of HIV.
true
herpes zoster
viral disease affecting the peripheral nerves, characterized by painful blisters that spread over the skin following the affected nerves, usually unilateral; also known as shingles *HIV
Molluscum contagiosum
viral infection characterized by deforming plaque formation. HIV
__________ test use target amplification methods to quantify HIV RNA or DNA levels in the plasma
viral load test
The amount of virus in the body after the initial immune response subsides is referred to as the _____________, which results in an equilibrium between HIV levels and the immune response that may be elicited.
viral set point
AIDS-Related Lymphomas symptoms:
weight loss, night sweats, and fever.
Stage 3 of HIV
when the count drops below 200 cells/mm3 of blood and at this point, the person is considered to have AIDS for surveillance purposes.
Immunodeficiency disorders may be caused by a defect in, or a deficiency of:
•Immunodeficiency disorders may be caused by a defect in, or a deficiency of: - phagocytic cells, -B lymphocytes, -T lymphocytes, -complement system.
What type of precautions should be used when providing care to a patient who requires immunosuppression to prevent infection?
•Universal or standard precautions
