520 Immunity and HIV

A client with acquired immunodeficiency syndrome is receiving zidovudine. Which laboratory value indicates an adverse reaction to zidovudine?

red blood cell (RBC) count of 1.8 million/μl (1.8 million x 10 to the 12th/L) Explanation: Because anemia (characterized by a decrease in RBCs below 4.0 million/μl) (4.0 million x 10 to the 12th/L) is a major adverse effect of zidovudine, the nurse should monitor the client's RBC count and assess for signs and symptoms of decreased cellular oxygenation. Zidovudine doesn't affect the blood glucose level, serum calcium level, or platelet count and the values listed are within normal limits.

When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following?

Antibodies to HIV are not present in his blood. Explanation: A negative test result indicates that antibodies to HIV are not present in the blood at the time the blood sample for the test is drawn. A negative test result should be interpreted as demonstrating that if infected, the body has not produced antibodies (which take from 3 weeks to 6 months or longer). Therefore, subsequent testing of an at-risk patient must be encouraged. The test result does not mean that the patient is immune to the virus, nor does it mean that the patient is not infected. It just means that the body may not have produced antibodies yet. When antibodies to HIV are detected in the blood, the test is interpreted as positive.

A client with human immunodeficiency virus (HIV) infection is taking zidovudine (AZT). What is the expected outcome of AZT for this client?

Enable slow replication of the virus. Explanation: Zidovudine (AZT) interferes with replication of HIV and thereby slows progression of HIV infection to acquired immunodeficiency syndrome (AIDS). There is no known cure for HIV infection. Today, clients are not treated with monotherapy but are usually on triple therapy due to a much-improved clinical response. Decreased viral loads with the drug combinations have improved the longevity and quality of life in clients with HIV/AIDS. AZT does not destroy the virus, enhance the body's antibody production, or neutralize toxins produced by the virus.

A client who is HIV positive is experiencing severe diarrhea. Which laboratory test result would the nurse expect to find?

Hypokalemia Explanation: Electrolyte imbalances such as decreased sodium, potassium, calcium, magnesium, and chloride typically result from profuse diarrhea. A urine specific gravity of 1.010 would indicate dilute urine. The client with severe diarrhea most likely would be dehydrated, leading to a high urine specific gravity. Proteinuria may suggest renal dysfunction and would not be associated with severe diarrhea unless the client was developing renal failure.

A client infected with human immunodeficiency virus (HIV) has a low CD4+ level. What intervention should the nurse implement?

Place the client in reverse isolation. Explanation: CD4+ levels in the blood of an individual with HIV infection determine the extent of damage to the individual's immune system. The test indicates the individual's risk of an opportunistic infection, but does not identify specific infections. Viral loads and resistance to specific antigens are determined using other diagnostic tests. Because of the client's risk, isolation is recommended.

The anatomy and physiology instructor is explaining a cell-mediated response to the pre-nursing students. What actions would the instructor explain occur in a cell-mediated response?

T-cell lymphocytes survey proteins in the body and attack the invading antigens. Explanation: During a cell-mediated response, T-cell lymphocytes survey proteins in the body, actively analyze the surface features, and respond to those that differ from the host by directly attacking the invading antigen. For example, a cell-mediated response occurs when an organ is transplanted. Immunoglobulins hinder the antigens physically by neutralizing their toxins through agglutination or by causing them to precipitate.

A nurse is caring for a client with human immunodeficiency virus (HIV). To determine the effectiveness of treatment the nurse expects the physician to order:

quantification of T-lymphocytes. Explanation: Quantification of T-lymphocytes is used to monitor the effectiveness of treatment for HIV. E-rosette immunofluorescence is used to detect viruses in general; it doesn't confirm HIV infection. The ELISA test detects HIV antibody particles but may yield inaccurate results; a positive ELISA result must be confirmed by the Western blot test. The Western blot test — electrophoresis of antibody proteins — detects HIV antibodies when used in conjunction with the ELISA. It isn't specific when used alone and doesn't monitor the effectiveness of treatment.

A nurse is assigned to a client with acquired immunodeficiency syndrome (AIDS). When handling the client's blood and body fluids, the nurse uses standard precautions, which include:

disposing of needles uncapped. Explanation: Disposing of needles uncapped is a standard precaution; most accidental needle sticks result from missed needle recapping. Standard precautions also include not cutting, breaking, or bending a needle after use because doing so may release aerosolized blood from the needle shaft; not leaving used needles lying around; and disposing of needles only in appropriately labeled, impermeable needle containers. Gloves aren't necessary when touching the client, and urine collection by catheterization doesn't require use of gloves, gown, and protective eyewear. It isn't necessary to wear gloves when instilling eyedrops.

The nurse is planning care for a client with human immunodeficiency virus (HIV). Which statement by the nurse indicates understanding of HIV transmission? Select all that apply.

"I will wear a mask, goggles, gown, and gloves when splashing bodily fluids is likely." "I will wash my hands after client care." Explanation: Standard precautions include wearing gloves for any known or anticipated contact with blood, body fluids, tissue, mucous membranes, and nonintact skin. If the task or procedure may result in splashing or splattering of blood or body fluids to the face, the nurse should wear a mask and goggles or face shield. If the task or procedure may result in splashing or splattering of blood or body fluids, the nurse should wear a fluid-resistant gown or apron. The nurse should wash hands before and after client care and after removing gloves. A gown, mask, and gloves are not necessary for all client care unless contact with bodily fluids, tissue, mucous membranes, and nonintact skin is expected. Nurses have an increased, not decreased, risk of occupational exposure to blood-borne pathogens. HIV is not transmitted in sputum unless blood is present.

A client with end-stage acquired immunodeficiency syndrome (AIDS) has profound manifestations of Cryptosporidium infection caused by the protozoa. In planning the client's care, the nurse should focus on their need for

fluid replacement. Explanation: The protozoal enteric infection caused by Cryptosporidium results in profuse watery diarrhea. Because diarrhea will lead to dehydration, the nurse should focus on fluid replacement. Pain management is also a concern in the care of a client with AIDS. However, with Cryptosporidium, the main concern is hydration. Antiretroviral therapy is most useful when a client with human immunodeficiency virus doesn't have opportunistic infections. With the wasting associated with AIDS, high-calorie nutrition is important, but with Cryptosporidium-related diarrhea, hydration takes precedence.