Immunity
RA caused by
Caused by leukotrienes and prostaglandins produce enzymes such as collagenase that break down collagen. These enzymes in the joint cause edema, proliferation of synovial membrane and pannus formation, destruction of cartilage and erosion of bone.
A client has been diagnosed with HIV and has been placed on antiretroviral therapy. What does the nurse inform the client will be required for determining the progression of the disease as well as guiding drug therapy? a) The Western blot test will be monitored every 6 months to see if the virus is still present. b) Viral load and T4-cell counts will be performed every 2 to 3 months. c) More antiretroviral medication will be added every 2 to 3 months. d) The client will be required to stop the medication for 2 weeks and then have laboratory studies drawn to determine if the antiretroviral therapy has cured the disease.
b
A client has undergone diagnostic testing for human immunodeficiency virus (HIV) using the enzyme immunoassay (EIA) test. The results are positive and the nurse prepares the client for additional testing to confirm seropositivity. The nurse would prepare the client for which test? a) p24 antigen capture assay b) Western blot assay c) OraSure test d) Nucleic acid sequence-based amplification
b
A client that is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication does the nurse expect that the client will take for the treatment of this infection? a) Amphotericin B (Fungizone) b) Trimethoprim-sulfamethoxazole (Bactrim, Septra) c) Nystatin (Mycostatin) d) Fluconazole (Diflucan)
b
A nurse is taking the health history of a newly admitted client. Which of the following conditions would NOT place the client at risk for impaired immune function? a) Surgical history of a splenectomy b) Surgical removal of the appendix c) Previous organ transplantation d) History of radiation therapy
b
Which of the following microorganisms is known to cause retinitis in people with HIV/AIDS? a) Cryptococcus neoformans b) Pneumocystis carinii c) Cytomegalovirus d) Mycobacterium avium
c
You are the clinic nurse caring for a client with a suspected diagnosis of HIV. You are preparing to draw blood for a confirmatory diagnostic test on this client. What is the most important action that the nurse should perform before testing a client for HIV? a) Advise the client to take off any ornaments and metallic objects. b) Advise the client to avoid excess fluid intake. c) Obtain a written consent from the client. d) Advise the client to abstain from having intercourse.
c
Measures to protect against latex allergy
8-12 % OF healthcare workers are latex sensitive Decrease exposure by using alternative products Use powder free gloves Avoid oil based hand creams and lotion before putting on gloves Contact employee health department if sensitivity to latex occurs If allergic, avoid contact and wear braclet
Pregnancy
CDC, 2006- All pregnant people should be routinely screened unless they decline, in areas of high infection rates, repeat screening in third trimester
Decades ago, a typical childhood surgery, after repeated bouts with tonsillitis, was to have a tonsillectomy and adenoidectomy. That was before the role of the tonsils and adenoids were better understood. As it is understood today, what are the roles of the tonsils and adenoids? a) They are lymphoid tissues that eliminate cancer cells. b) They are lymphoid tissues that filter bacteria from tissue fluid. c) They are lymphoid tissues that program T lymphocytes. d) They are lymphoid tissues that increase the efficacy of antibiotics.
b
The nurse is caring for an elderly client with a respiratory infection. While reviewing age-related changes in the immune system, the nurse identifies which of the following as having contributed to this client's infection? a) Failure of the immune system to differentiate "self" from "non-self" b) Impaired ciliary action as a result of exposure to environmental toxins c) Decreased sensation and slowing of reflexes d) Decreased phagocytosis by Kupffer cells
b
A 20-year-old male patient cut his hand while replacing a window. While reviewing the complete blood count (CBC) with differential, the nurse would expect which of the following cell types to be elevated first in order to prevent an infection in the patient's hand? a) Monocytes b) Eosinophils c) Neutrophils d) B cells
c
A client has dilated cardiomyopathy and has just found out he will be receiving a heart. What medication does the client understand that he will have to take for the duration of his life to help suppress the immune system to prevent rejection of the new heart? a) Adalimumab (Humira) b) Infliximab (Remicade) c) Cyclosporine (Sandimmune) d) Etanercept (Enbrel)
c
A client is informed that his white blood cell count is low and that he is at risk for the development of infections. The client asks, "Where do I make new white blood cells?" What is the best response by the nurse? a) "White blood cells are produced in the thymus gland." b) "White blood cells are produced in the lymphatic tissue." c) "White blood cells are produced in the bone marrow." d) "White blood cells are produced in the plasma."
c
A client on antiretroviral drug therapy is discussing with the nurse that sometimes he "forgets to take his meds for a few days." What should the nurse inform the client can occur when the medications are not taken as prescribed? a) The client will have to take the drugs intravenously to ensure compliance. b) The client will have to take higher doses of the antiviral medications. c) The client is risking the development of drug resistance and drug failure. d) The funding for the medications will cease if the client is not taking the meds correctly.
c
A client who is HIV positive is experiencing severe diarrhea. Which laboratory test result would the nurse expect to find? a) Hypernatremia b) Proteinuria c) Hypokalemia d) Urine specific gravity of 1.010
c
A client who is HIV positive is taking zidovudine. Which adverse effects should the nurse closely monitor for in this client? a) Pancreatitis b) Alterations in the renal function c) Anemia and granulocytopenia d) Numbness in the extremities
c
A client will be taking the tumor necrosis factor inhibitor, infliximab (Remicade), for the treatment of rheumatoid arthritis. Prior to beginning this therapeutic regimen, what screening should the client have? a) Screening for rubella b) Screening for peptic ulcer disease c) Screening for tuberculosis d) Screening for syphilis
c
A client with AIDS has been tested for cytomegalovirus (CMV) with positive titers. What severe complication should the nurse be alert for with cytomegalovirus? a) Diarrhea b) Hearing impairment c) Blindness d) Fatigue
c
A nurse is preparing an in-service presentation about human immunodeficiency virus (HIV) for a group of new graduate nurses. As part of the presentation, the nurse is planning to describe the events that occur once HIV enters the host cell. Which of the following would the nurse describe as the first step? a) Uncoating b) Budding c) Attachment d) Cleavage
c
A patient being treated for HIV/AIDS has a decreased appetite, almost to the point of anorexia. What is the nurse's best action? a) Ask his family to bring in food that he enjoys. b) Ask the dietician to prepare his favorite meals. c) Administer megestrol acetate (Megace). d) Talk to the patient about his unwillingness to eat.
c
HIV is harbored within which type of cell? a) Nerve b) Platelet c) Lymphocyte d) Erythrocyte
c
The immune system is a complicated and intricate system that contains specialized cells and tissues that protect us from external invaders and our own altered cells. Which of the following is the term used to define any substance capable of inducing a specific immune response and of reacting with the products of that response? a) Antibodies b) Lymphocytes c) Antigens d) Lymphokines
c
The nurse is administering a skin test for detection of exposure to tuberculosis. How would the nurse determine if the client was exposed to tuberculosis? a) The injection area will break out in a fine macular rash. b) The client will have a productive cough. c) The injection area swells if the client has developed antibodies against the antigen. d) The injection area will become painful with in duration if the client has antibodies against the antigen.
c
What type of immunoglobulin does the nurse recognize that promotes the release of vasoa ctive chemicals such as histamine when a client is having an allergic reaction? a) IgM b) IgG c) IgE d) IgA
c
Which blood test confirms the presence of antibodies to HIV? a) p24 antigen b) Erythrocyte sedimentation rate (ESR) c) Enzyme-linked immunoabsorbent assay (ELISA) d) Reverse transcriptase
c
Which of the following immunity types becomes active as a result of infection by a specific microorganism? a) Artificially acquired passive immunity b) Naturally acquired passive immunity c) Naturally acquired active immunity d) Artificially acquired active immunity
c
Which of the following immunoglobulins assumes a major role in blood-borne and tissue infections? a) IgA b) IgM c) IgG d) IgD
c
Which of the following is an early manifestation of HIV encephalopathy? a) Hallucinations b) Vacant stare c) Headache d) Hyperreflexia
c
Which of the following medication classifications are known to inhibit prostaglandin synthesis or release? a) Antibiotics (in large doses) b) Adrenal corticosteroids c) Nonsteroidal antiinflammatory drugs (NSAIDs) in large doses d) Antineoplastic agents
c
Which type of cells is capable of recognizing and killing infected or stressed cells and producing cytokines? a) Null lymphocytes b) Memory cells c) Natural killer cells d) Cytotoxic T cells
c
he lower the patient's viral load, a) the longer the time immunity. b) the shorter the time to AIDS diagnosis. c) the longer the survival time. d) the shorter the survival time.
c
A 25-year-old man receives a knife wound to the leg in a hunting accident. Which of the following types of immunity was compromised? a) Adaptive immunity b) Specific immunity c) Passive immunity d) Natural immunity
d
A client has discussed therapy for his HIV-positive status. What does the nurse understand is the goal of antiretroviral therapy? a) Treat mycobacterium avium complex. b) Eliminate the risk of AIDS. c) Reverse the HIV+ status to a negative status. d) Keep the CD4 cell count above 350/mm3 and viral load undetectable.
d
A nursing instructor is giving a lecture on the immune system. Which of the following cells will the instructor include in her discussion on phagocytosis? a) Plasma cells and memory cells b) Lymphokines and Suppressor T cells c) Regulator T cells and Helper T cells d) Neutrophils and monocytes
d
The body has several mechanisms to fight disease, one of which is sending chemical messengers. Specifically, the messengers released by lymphocytes, monocytes, and macrophages have differing roles in the immune response. Which messenger promotes inflammation, fever, and angiogenesis? a) Tumor necrosis factor b) Interferons c) Colony-stimulating factors d) Interleukins
d
The nurse caring for a client with renal failure is most concerned about a compromised immune system in the client for which of the following reasons? a) A deficiency of circulating antibodies b) An excess of circulating hemoglobin c) An excess of circulating lymphocytes d) A deficiency of circulating lymphocytes
d
Which of the following is a process in which the antigen-antibody molecule is coated with a sticky substance that facilitates phagocytosis? a) Apoptosis b) Agglutination c) Immunoregulation d) Opsonization
d
Which of the following statements accurately reflects current stem cell research? a) Clinical trials are underway in patients with acquired immune deficiencies only. b) Stem cell transplantation cannot restore immune system functioning. c) Stem cell transplantation has been performed in the laboratory only. d) The stem cell is known as a precursor cell that continually replenishes the body's entire supply of both red and white cells.
d
Which of the following is accurate regarding acquired immunity? Select all that apply. a) Usually develops as a result of exposure to an antigen through immunization b) A nonspecific immunity present at birth c) Can develop by contracting a disease d) An immunologic response acquired during life but not present at birth e) Also know as innate immunity
• Usually develops as a result of exposure to an antigen through immunization • An immunologic response acquired during life but not present at birth • Can develop by contracting a disease
Rapid Diagnostic Tests
OraSure (saliva) OraQuick (blood)
Allergic Reaction
Allergen triggers the B cell to make IgE antibody, which attaches to the mast cell. When that allergen reappears, it binds to the IgE and triggers the mast cell to release its chemicals
A client is given a nursing diagnosis of social isolation related to withdrawal of support systems and stigma associated with AIDS. Which outcomes would indicate that the nurse's plan of care was effective? Select all that apply. a) Client verbalizes feelings related to the changes imposed by the disease. b) Client demonstrates knowledge of safer sexual practices. c) Client identifies appropriate sources of assistance and support. d) Client demonstrates beginning participation in events and activities. e) Client demonstrates practices to reduce the risk transmission to others.
Client demonstrates beginning participation in events and activities. • Client identifies appropriate sources of assistance and support. • Client verbalizes feelings related to the changes imposed by the disease.
Nursing Diagnosis for RA
Comfort Acute/Chronic Pain Fatigue Self Care Deficits Self Disturbed Body Image Ineffective Coping/Role Performance Mobility Impaired Mobility Teaching and Learning Knowledge Deficit
Treatment Failure
Common with antiretroviral therapy Client nontolerance of adverse effects Client nonadherence to complex regimen Emergence of resistant strains Genetic variability Therapy always changing—stay current with latest treatments
Type 4
Contact dermatitis Latex allergies
Type 3
Glomerulonephritis SLE Rheumatoid Arthritis
Nursing Diagnosis
Impaired Skin Integrity Diarrhea Risk for Infection Activity Intolerance Disturbed Thought Processes Ineffective Airway Clearance Pain r/t impaired skin integrity(diarrhea), skin lesions, peripheral neuropathy Imbalanced nutrition Social Isolation Anticipatory Grieving Deficient Knowledge
Phases of HIV therapy
Latent phase—virus lies dormant People often unaware they have HIV Once diagnosis confirmed, decision made about starting or delaying treatent Current protocols: defer treatment in asymptomatic adults who have CD4 counts above 350 cells/mcL Therapy is initiated when CD4 is under 200 cells/mcL or symptoms appear
HIV Viral Load Test-
Measure amt of actively replicating HIV >5,000 to 10,000 copies/ml indicate need for treatment
Which of the following are modes of transmission for HIV? Select all that apply. a) Seminal fluid b) Casual contact c) Vaginal secretions d) Blood e) Amniotic fluid
Seminal fluid • Blood • Vaginal secretions • Amniotic fluid
Type 2
Transfusion reactions ABO incompatibility Hemolytic Disease of newborn Myasthenia Gravis
A client is beginning highly active antiretroviral therapy (HAART). The client demonstrates an understanding of the need for follow up when he schedules a return visit for viral load testing at which time? a) 6 weeks b) 18 weeks c) 12 weeks d) 24 weeks
a
A female client comes to the clinic and tells the nurse, "I think I have another vaginal infection and I also have some wartlike lesions on my vagina. This is happening quite often."What should the nurse consult with the physician regarding? a) Testing the client for the presence of HIV b) Having the client abstain from sexual activity for 6 weeks while the medication is working c) Using a medicated douche in order to keep the vaginal pH normal d) Instructing the client to wear cotton underwear
a
A woman infected with HIV comes into the clinic. What symptoms may be the focus of a medical complaint in women infected with HIV? a) Gynecologic problems b) Muscle and joint pain c) Rashes on the face, trunk, palms, and soles d) Weight loss
a
At 39 weeks' gestation, a pregnant female, visits her physician for a scheduled prenatal checkup. The physician determines that the fetus has developed an infection in utero and sends the patient for an emergency C section. The patient is very concerned about the health of her unborn child. Based on the knowledge of the immune system, the delivery room nurse explains about which of the following immunoglobulins that will be increased in the fetus at the time of birth and actively fighting the infection? a) IgG b) IgD c) IgM d) IgA
a
During which stage of the immune response does the circulating lymphocyte containing the antigenic message return to the nearest lymph node? a) Proliferation b) Response c) Effector d) Recognition
a
The nurse identifies a nursing diagnosis of ineffective airway clearance related to pneumocystis pneumonia and increased bronchial secretions for a client with AIDS. Which of the following would be appropriate for the nurse to include in the client's plan of care? a) Assist with chest physiotherapy every 2 to 4 hours. b) Limit fluid intake to 1 1/2 to 2 liters per day. c) Maintain the client in a supine or side-lying position. d) Encourage client to ambulate frequently in the halls.
a
The nursing students are learning about the immune system in their anatomy and physiology class. What would these students learn is a component of the immune system? a) Lymphoid tissues b) Cytokines c) Red blood cells d) Stem cells
a
Which of the following adverse effects should the nurse closely monitor in a patient who takes immunosuppressive drugs? a) Respiratory or urinary system infections b) Rheumatoid arthritis c) Depression, memory impairment, and coma d) Heart failure, infusion reactions, and life-threatening infections
a
Which of the following assessment should be completed if suspecting immune dysfunction in the neurosensory system? a) Ataxia b) Urinary frequency c) Burning on urination d) Hematuria
a
Which of the following is usually the most important consideration in decisions to initiate antiretroviral therapy? a) CD4 counts b) HIV RNA c) ELISA d) Western blot assay
a
Which of the following options should the nurse encourage to replace fluid and electrolyte losses in a patient with AIDS? a) Liquids b) Gluten c) Sucrose d) Iron and zinc
a
Which of the following responses identifies a role of T lymphocytes? a) Transplant rejection b) Allergic hay fever and asthma c) Bacterial phagocytosis and lysis d) Anaphylaxis
a
Which type of immunity becomes active as a result of the infection of a specific microorganism? a) Naturally acquired active immunity b) Artificially acquired passive immunity c) Naturally acquired passive immunity d) Artificially acquired active immunity
a
A 64-year-old male client, who leads a sedentary lifestyle, and a 31-year-old female client, who has a very stressful and active lifestyle, require a vaccine against a particular viral disorder. As the nurse, you would know that in one of these clients, the vaccine will be less effective. In which client is the vaccine more likely to be less effective and why? a) The female client because of her lifestyle b) The male client because of his age c) The female client because of her age d) The male client because of his lifestyle
b
A client has been diagnosed with AIDS. Which of the following statements correctly describes a secondary immune deficiency? a) The normal protective immune response attacks the body, leading to tissue damage. b) An interference develops in an already developed immune system. c) The body produces inappropriate or exaggerated responses to specific antigens. d) Immune cells or tissues experience an improper development.
b
A client has had mumps when he was 9 years old. He had a titer prior to entering nursing school and shows immunity. What type of immunity does this reflect? a) Natural passive immunity b) Naturally acquired active immunity c) Passive immunity d) Artificially acquired active immunity
b
A client taking abacavir (ABC) has developed fever and rash. What is the priority nursing action? a) Administer acetaminophen (Tylenol). b) Call the health care provider to report. c) Administer Lidocaine cream for the rash. d) Document the information.
b
A client will be taking the tumor necrosis factor inhibitor, infliximab (Remicade), for the treatment of rheumatoid arthritis. Prior to beginning this therapeutic regimen, what screening should the client have? a) Screening for syphilis b) Screening for tuberculosis c) Screening for rubella d) Screening for peptic ulcer disease
b
Nursing students are reviewing the pathophysiology of human immunodeficiency virus (HIV). They demonstrate understanding of the information when they state which of the following as containing the genetic viral material? a) Glycoprotein envelope b) Ribonucleic acid (RNA) c) Viral core d) Deoxyribonucleic acid (DNA)
b
The nurse is caring for an elderly client with a respiratory infection. While reviewing age-related changes in the immune system, the nurse identifies which of the following as having contributed to this client's infection? a) Decreased sensation and slowing of reflexes b) Impaired ciliary action as a result of exposure to environmental toxins c) Failure of the immune system to differentiate "self" from "non-self" d) Decreased phagocytosis by Kupffer cells
b
The nurse understands that which cells circulate throughout the body looking for virus-infected cells and cancer cells? a) Cytokines b) Natural killer cells c) Interleukins d) Interferons
b
Which stage of the immune response occurs when the differentiated lymphocytes function in either a humoral or a cellular capacity? a) Effector stage b) Response stage c) Recognition stage d) Proliferation stage
b
While visiting the pediatric clinic with her 2 year old, a mother picks up a brochure about immunizations and asks about active and passive acquired immunity to childhood diseases. The nurse explains that immunizations are which of the following and why? a) Active acquired immunity, because the person develops defenses in response to a disease b) Active acquired immunity, because the person's own body develops defenses c) Passive acquired immunity, because the defenses are given to the person in the form of an immunization d) Passive acquired immunity, because the defenses are developed from a substance given to the person
b
A client with AIDS has been tested for cytomegalovirus (CMV) with positive titers. What severe complication should the nurse be alert for with cytomegalovirus? a) Hearing impairment b) Diarrhea c) Blindness d) Fatigue
c
A nurse is explaining treatment options to a patient diagnosed with an immune dysfunction. Which of the following statements made by the patient accurately reflects the teaching about current stem cell research? a) "Currently stem cell transplantation has only been performed in the laboratory, but future research with embryonic stem cell transplants for humans with immune dysfunction has been promising." b) "Stem cell clinical trials have only been attempted in patients with acquired immune deficiencies but plans are underway to begin human cloning using embryonic stem cells." c) "Stem cell transplantation has been carried out in humans with certain types of immune dysfunction and clinical trials using stem cells are underway in patients with a variety of disorders having an autoimmune component." d) "Stem cell transplantation has been discontinued based on concerns about safety, efficacy, resource allocation, and human cloning."
c
A client who is being treated for complications related to acquired immunodeficiency disorder syndrome (AIDS) is receiving interferon parenterally as adjunctive therapy. Why does the nurse understand this route is being used? a) The medication, given orally, will cause diarrhea. b) The medication will work more rapidly parenterally. c) The taste of the medication is not palatable. d) Digestive enzymes destroy its protein structure.
d
A nurse is teaching a community group about healthy lifestyles. A participant asks about how to maintain a healthy immune system. The nurse informs the group that which of the following factors will positively affect the immune system? a) Residential exposure to radiation b) Poor nutritional status c) Rigorous, competitive exercise d) Strong family and community connections
d
A nurse is working in a pediatric clinic. After giving a hepatitis B immunization to an infant, the mother asks what kind of protection this provides for her child. The correct response is which of the following? a) Active acquired immunity, which is temporary b) Passive acquired immunity, which is temporary c) Passive acquired immunity, which lasts many years or a lifetime d) Active acquired immunity, which lasts many years or a lifetime
d
A patient comes into the emergency department with complaints of difficulty walking and loss of muscle control in the arms. As the nurse begins the physical examination, which of the following assessment should be completed if an immune dysfunction in the neurosensory system is suspected? a) Review the urinalysis report for hematuria b) Assess for hepatosplenomegaly by measuring abdominal girth c) Assess joint mobility using passive range of motion. d) Assess for ataxia using the finger-to-nose test and heel-to-shin test
d
A patient undergoing a skin test has been intradermally injected with a disease-specific antigen on the inner forearm. The patient becomes anxious because the area begins to swell. Which of the following may be used to decrease anxiety in this patient? a) Apply ice packs to reduce the swelling b) Advise the patient to use prescribed analgesics c) Gently rub the swollen area to accelerate the blood flow d) Assure the patient that this is a normal reaction
d
Geoffrey, an 8-year-old boy, attends the grammar school where you practice nursing. Geoffrey has a known allergy to peanuts. If Geoffrey has any contact with peanuts, he will develop a severe allergic reaction. The school nurse meets with all of Geoffrey's teachers to explain the process involved. In her discussion, the nurse explains that Geoffrey's immune system has identified peanuts as a foreign invader and has produced specific cells to attack if Geoffrey should come in contact with peanuts again. The formation of these specific cells is known as which of the following? a) Inflammatory response b) Cell-mediated response c) Memory response d) Humoral response
d
When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by ____. a) The fact that it is a mutated virus originally thought to be bovine in nature b) Means of transmission c) Cure rate of the virus d) HIV-1 is more prevalent than HIV-2 subtypes
d
Which of the following cell types are involved in humoral immunity? a) Memory T lymphocyte b) Helper T lymphocyte c) Suppressor T lymphocyte d) B lymphocytes
d
Which of the following cells destroy antigens already coated with antibody? a) Suppressor T cells b) Memory cells c) Natural killer (NK) cells d) Null lymphocytes
d
The nurse is teaching a client with HIV how to use a male condom. The client demonstrates understanding of the information when he states which of the following? Select all that apply. a) "I can reuse a condom two or three times when I'm having sexual intercourse." b) "I can keep several condoms in my wallet in my back trouser pocket so they are readily available." c) "I need to hold the condom by the tip to squeeze out the air before putting it on." d) "I should avoid using baby oil or petroleum jelly with a condom." e) "I should unroll the condom all the way over my erect penis."
e, d, c
NRTI
efavirenz (Sustiva) Adverse effects: rash, fever, N/D, headache, stomatitis, parasthesia, hepatotoxicity, steven-johnson syndrome
PI
lopinavir/ritonavir (Kaletra) Adverse effects: N/V/D, abdominal pain, headache, anemia, leukopenia, DVT, pancreatitis, lymphadenopathy, hemorrhagic collitis,
NNRTI
zidovudine (AZT, Retrovir) Adverse effects: fatigue, generalized weakness, myalgia, nausea, headache, abdominal pain, vomiting, anorexia, rash, bone marrow suppression, neutropenia, anemia, granulocytopenia, lactic acidosis with steatorrhea, neurotoxicity
During an annual examination, an older patient tells the nurse, "I don't understand why I need to have so many cancer screening tests now. I feel just fine!" Based on the knowledge of neoplastic disease and the aging immune system, what teaching should the nurse include in the patient's plan of care? Select all that apply. a) Nutritional intake to support a competent immune response plays an important role in reducing the incidence of cancer. A healthy diet including protein, vitamins, minerals, and some fats can alter the risk of cancer development. b) The immune system is integrated with other psychophysiologic processes and is regulated by the brain. Aging of the brain can have immunologic consequences and can affect neural and endocrine function increasing the risk of cancer development. c) Education about the importance of adhering to a recommended vaccine schedule should be initiated to boost the immune system function. d) The increase in occurrence of autoimmune diseases due to aging strongly suggests a predisposition to various types of cancer due to the body's inability to differentiate between self and nonself. Routine screening increases the chance of finding and treating cancer early. e) Tumor cells may possess special blocking factors that coat tumor cells and prevent their destruction by killer T lymphocytes; therefore, the body may not recognize the tumor as foreign and fail to destroy the malignant cells. Routine screening increases the chance of finding and treating cancer early.
• Tumor cells may possess special blocking factors that coat tumor cells and prevent their destruction by killer T lymphocytes; therefore, the body may not recognize the tumor as foreign and fail to destroy the malignant cells. Routine screening increases the chance of finding and treating cancer early. • The increase in occurrence of autoimmune diseases due to aging strongly suggests a predisposition to various types of cancer due to the body's inability to differentiate between self and nonself. Routine screening increases the chance of finding and treating cancer early. • Nutritional intake to support a competent immune response plays an important role in reducing the incidence of cancer. A healthy diet including protein, vitamins, minerals, and some fats can alter the risk of cancer development.
CD4 Cell Count
<200/mm3 or <14% usually recommend treatment. Testing specific for opportunistic diseases
Teaching about AIDS
AIDS education- kindergarten-12th grade Roles defined for nurse in school setting: 1. Participate in education programs for teachers 2. Assist schools and other organizations to develop educational materials 3. Review, adapt, and develop educational materials 4. Participate in public discussions about HIV/AIDS 5. Take part in meetings with school administrators, staff, and parents 6. Facilitate networking among parents and AIDS community groups
Nursing Care for SLE
Altered Skin Integrity r/t rash or discoid lesions Protect against infection Prevent sun exposure Limit use of cosmetics Good hygiene Avoid exposure to fluorescent lights Prevent exposure to infections Prophylactic antibiotics for dental work and surgery Adhere to immunizations Adolescents to avoid tattoos and body piercings Maintain fluid balance/adequate hydration Promote rest Manage side effects of drugs Provide emotion support Avoid triggers of disease Sun exposure Stressors Alcohol, smoking, drugs Use of birth control pills
Systemic Lupus Erythematosus (SLE)
An autoimmune disorders that results from deposits of antigen/antibody complexes in the connective tissues of the body. Disease process can be mild to rapidly fatal Has periods of exacerbations and remissions
Hypersensitivity Reactions
Anaphylactic: type I Cytotoxic: type II Immune complex: type III Delayed-type: type IV
Treatment Goals
Control inflammation Reduce pain Minimize physical disability
Western Blot Assay
Detects antibodies >99.9% reliability
If HIV positive
Do not engage in unprotected sexual activity Inform all current and former sexual partners Inform all health care personnel Do not donate blood, plasma, blood products, sperm, organs, or tissue If female- do not become pregnant
S/S
Early symptoms mimic rheumatoid arthritis Fever, weight loss, loss of appetite, malaise, arthralgias, symmetric polyarthritis (major symptom) Arthritis is not usually deforming Skin Manifestations Butterfly rash Multisystem Effects
EIA (ELISA)
Enzyme-linked immunosorbant assay Tests for HIV antibodies not virus itself May be negative early in infection ( <13 wks) May need repeated tests
Diagnostic tests
Erythrocyte Sedimentation Rate - ESR Indicative of Inflammation in body C- Reactive Protein- Indicative of inflammation in body Rheumatoid Factor- antibodies that are present in 70% to 90% of people with rheumatoid arthritis (RA). Anti-CCP (citrulline modified proteins is more specific and tends to be only elevated in patients with rheumatoid arthritis or in patients about to develop rheumatoid arthritis.
SLE triggers
External Triggers Colds Fatigue Stress Sunlight Medications Hormone Replacement Therapy Oral Contraceptives
Highly Active Antiretroviral Therapy (HAART)
Five drug classes used in various combinations Nucleoside reverse transcriptase inhibitor (NRTI) Nonnucleoside reverse transcriptase inhibitor (NNRTI) Protease inhibitor (PI) Nucleotide reverse transcriptase inhibitor (NtRTI) Fusion (entry) inhibitor
Medications
Gold Compounds Aurofin - Side effects Bone marrow suppression, renal toxicity, dermatitis, N&V, stomatitis Corticosteroids Prednisone, prednisolone, hydrocortisone Topical Analgesic Capsaicin
Assessment/Diagnosis
Health history: include onset of and evolution of symptoms, family history, past health history, and contributing factors Functional assessment Arthrocentesis Radiography, bone scans, CT, and MRI Tissue biopsy Blood studies
People at risk for HIV/AIDS
Hemophilia/Blood Transfusions Health Care Workers Pregnancy and Breast Feeding Older Adults
Primary Mediators
Histamine - vasodilation, smooth muscle contraction, increased vascular permeability, increased mucus secretions Platelet-activating Factor - bronchoconstriction, increased vascular permeability Prostaglandins - Smooth muscle contraction, vasodilation, increased capillary permeability, fever & pain
Assessment
History and manifestations; comprehensive allergy history Diagnostic tests CBC: eosinophil count Eosinophils - Abnormal is >4% of cell count RAST- Radioallergosorbent test Measure of IgE Skin tests note precautions! Screening procedures
Nursing Care
Ineffective Airway Clearance- Maintain patent airway Position fowlers to high fowlers Respiratory assessment O2 via NC Elevate HOB Nasal/oral airway SQ Epinephrine Reassure Decreased Cardiac Output- Monitor VS Assess peripheral perfusion Monitor LOC Start IV Administer NS or RL Monitor I&O (foley)
EpiPen
Inform pt kits w/ syringes of remeasured epi are available by RX Ensure pt, family, and care givers know how to use Wear a med alert bracket Instruct on proper storage and avoid exposure to high temp or sun Frequently check expiration date Emphasize that the kit should be readily available in all settings where pt studies, works, or plays. In addition to the pt, someone else should be instructed on use
Nursing Care cont
Knowledge Deficit- Use of EPI Pen (After removing the EpiPen autoinjector from its carrying tube, grasp the unit with the orange tip (injecting end) pointing downward. Form a fist around the unit with the orange tip down; with your other hand, remove the blue safety release cap. Hold the black tip near outer thigh. Swing and jab firmly into the outer thigh until a click is heard with the device perpendicular (90-degree angle) to the thigh. Do NOT inject into buttocks.Hold firmly against the thigh for approximately 10 seconds. Remove the unit from the thigh, and massage the injection area for 10 seconds. Call 911 and seek immediate medical attention. Carefully place the used EpiPen, needle-end first, into the device storage tube without bending the needle. Screw on the storage tube completely, and take it with you to the hospital emergency room. Medic Alert Bracelet Avoid known allergens Prevent allergens in home Pg. 1045
Secondary Mediators
Leukotrienes- S&S of inflammation, smooth muscle contraction in airways, wheal-flare contraction of skin, 100-10,000 more potent when causing bronchostriction Bradykinin - increased vascular permeability, vasodilation, hypotension, bronchial constriction Serotonin- potent vasoconstrictor, bronchial constriction.
Goals of care
Major goals may include Relief of pain and discomfort Relief of fatigue Promotion of restorative sleep Increased mobility Maintenance of self-care Improved body image Effective coping Absence of complications
Criteria for classifying SLE
Malar rash Discoid rash Photosensitivity Oral ulcers Arthritis Serositis Kidney Disease Neurologic Disorders Hematologic Disorders Immunological Disorders Positive Antinuclear Antibody
CBC
Measure anemia, leukopenia and thrombocytopenia *Lymphopenia
Safe Sex
Monogomy, or limit # of partners No unprotected sex New relationship- both get tested, if both negative practice safer sex for 6 months, followed by retesting, if negative-safe Use latex condoms for oral, vaginal, and anal sex, avoid natural or animal skin condoms For vaginal/anal sex, lube condom with spermicidal agent nonoxynol-9 for additional protection Do not use oil-based lube (petroleum jelly) Women carry and use female condom Other means of birth control do not provide protection Engage in safer sexual practices that are less damaging to sensitive tissues Do not use drugs or alcohol Do not share needles, razors, toothbrushes, sexual toys, or other items contaminated with blood
SLE treatment
NSAIDs Steroids Topical Oral IV Antimalarial Plaquenil (hydoxychloroquine) Immunosuppressive Agents Cyclophosphamide (Cytoxan) Belimumbab (Benlysta) Side effects - nausea, diarrhea, fever, inflammation of the nose and throat, bronchitis, insomnia, pain in extremity, depression, and migraine.
HIV Pharmacology
No cure yet, but many new drugs developed Some therapeutic successes People live symptom-free longer Rates of transmission from mother to newborn reduced 70% decline in death rate in US Incidence of infections still very high in African nations
Manifestations
Onset insidious, may be abrupt Progressive, characterized by remissions and exacerbations Pain predominant on arising, lasting more than an hour, also occurs after prolonged activity Affexted joints appear hot, red and swollen "boggy" and tender to palpation, decreased ROM and weakness Multiple joints affected in symmetric pattern, proximal interphalangeal, metacarpophalangeal, wrists, knees ankles, and toes involved Systemic- fatigue, weakness, anorexia, weight loss, fever, rheumatoid nodules, anemia
Latex Allergies
Persons at risk: Health care workers, Hx of many surgeries, Children with Spinabifida, History of 3 or more surgeries, Hx of allergies to Kiwi fruit, Bananas,, Pineapples, Mangoes,, Passion fruit,, Avocados,, Chestnuts
Therapeutic Goals
Reduce HIV RNA load in the blood To undetectable level or less than 50 copies/mL Increased lifespan Higher quality of life Decreased risk of transmission from mother to child
People at risk for RA
Rheumatoid Arthritis Women 3 times > men Ages 40-60 years Genetic predisposition Heavy Smokers Hx of Periodontal Disease Juvenile Rheumatoid Arthritis Occurs 6mo to 16 years Girls>boys
Prevention and treatment of anaphylaxis
Screen and prevent! Treat respiratory problems, oxygen, intubation, and cardiopulmonary resuscitation as needed Epinephrine 1:1,000 subcutaneously Auto injection system: EpiPen May follow with IV epinephrine IV fluids Monitor for "rebound" or delayed reaction 4-10 hrs after initial allergic reaction (12-14 hrs for severe reaction)
HIV/AIDS Clinical Category A
Stage I- Primary HIV Infection Acute Illness
hiv/aids clinical category B
Stage II Clinically Asymptomatic Generalized Lymphadenopathy Other Acute Disease Symptoms
HIV/AIDS Clinical category C
Stage III Opportunistic Infections
Type 1 Body response
Systemic Response - wide spread body response to histamine Swelling, edema of skin Laryngeal Stridor Localized response Chemical mediators (histamine) are released locally Hives Examples of Reactions Extrinsic Asthma Allergic Rhinitis Anaphylaxis Reactions to insect stings
Who's at risk for Lupus
Women > men 9:1 ratio Women of childbearing age Greater incidence African americans Hispanics Asians
The nurse is talking with a group of teens about transmission of human immunodeficiency virus (HIV). What body fluids does the nurse inform them will transmit the virus? Select all that apply. a) Breast milk b) Blood c) Urine d) Semen e) Vaginal secretions
a, b, d, e
A 38-year-old female patient has begun to suffer from rheumatoid arthritis. She is also being assessed for disorders of the immune system. She works as an aide at a facility that cares for children infected with AIDS. Which of the following is the most important factor related to the patient's assessment? a) Her home environment b) Her use of other drugs c) Her diet d) Her age
b
Which of the following indicates that a client with HIV has developed AIDS? a) Weight loss of 10 lb over 3 months b) Herpes simplex ulcer persisting for 2 months c) Severe fatigue at night d) Pain on standing and walking
b
Chronic illnesses may contribute to immune system impairment in various ways. Renal failure is associated with which of the following? a) Decreased bone marrow function b) Altered production of white blood cells c) Deficiency in circulating lymphocytes d) Increased incidence of infection
c
Which of the following has not been implicated as a factor for noncompliance with antiretroviral treatment? a) Active substance abuse b) Lack of social support c) Past substance abuse d) Depression
c
When do most perinatal HIV infections occur? a) Through breast feeding b) In utero c) Through casual contact d) After exposure during delivery
d
Hypersensitivity
An excessive or altered immune response to an antigen(a foreign substance) that enters the body AKA Allergens Foods, Drugs, Pollen, Weeds, Blood
A client with AIDS is admitted to the hospital with severe diarrhea and dehydration. The physician suspects an infection with Cryptosporidium. What type of specimen should be collected to confirm this diagnosis? a) Stool specimen for ova and parasites b) Blood specimen for electrolyte studies c) Urine specimen for culture and sensitivity d) Sputum specimen for acid fast bacillus
a
A client with HIV will be started on a medication regimen of three medications. Which medication will be given that will interfere with the virus's ability to make a genetic blueprint. What drug will the nurse instruct the client about? a) Reverse transcriptase inhibitors b) Protease inhibitor c) Integrase inhibitors d) Hydroxyurea (Hydrea)
a
A nurse is taking health history from a new client, which includes asking about a history of blood transfusions. This is important for which of the following reasons? a) Exposure to foreign antigens may cause altered immune function. b) Blood products cause a high risk for exposure to HIV. c) Blood products cause a high risk for hepatitis B. d) Blood products cause lower antibody titers.
a
All the following items are related to cancer. Which does not affect the immune system? a) Diagnostic tests for cancer b) Radiation treatment c) Chemotherapy d) Altered production of lymphocytes
a
A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client? a) Ask people to donate blood. b) Bank autologous blood. c) Sign a refusal of blood transfusion form so the client will not receive the transfusion. d) Using volume expanders in case blood is needed.
b
A client will be receiving a hepatitis B vaccination series prior to employment in a dialysis center. What type of immunity will this provide? a) Forced immunity b) Naturally acquired active immunity c) Passive immunity d) Artificially acquired active immunity
d
Diagnostic tests for SLE
Anti-DNA antibody testing Specific for SLE ESR > 100mm/hr Kidney Function UA BUN/Creatinine Kidney Biopsy Serum Complement Test C3 and C4 Values decreased Total blood complement level: 41 to 90 hemolytic units C3 levels: Males: 88 to 252 mg/dL Females: 88 to 206 mg/dL C4 levels: Males: 12 to 72 mg/dL Females: 13 to 75 mg/dL
Diagnostic notes
Antibody response to HIV is detected at approximately 3-6 weeks after infection, depending on the generation of the EIA being used.[18] The detection of the p24 antigen by the fourth-generation assays shortens the window by 4.4-4.8 days compared to third-generation assays.[19] Individuals who test negative on the initial evaluation should undergo repeat antibody testing in 3 months in case they had not seroconverted at the initial evaluation. According to the Association of Public Health Laboratories[20] (APHL), a positive HIV-1 EIA test should be repeated in a duplicate form, and, if either test result is positive, a confirmatory test such as Western blot, indirect immunofluorescence assay (IFA), or a nucleic acid amplification technique (NAAT) should be performed. If the NAAT result is negative, Western blot should be performed to confirm the absence of antibodies. If the result is positive, the diagnosis of established HIV-1 infection is made. The same algorithm is followed when using a HIV-1/HIV-2 immunoassay, but the interpretation of the Western blot differs slightly (discussed below).
Treatment
Antihistamines: Block H1-Histamine receptors First Generation (Diphenhydramine (Benadryl), Chlorpheniramine (Chlor-Trimeton), Hydroxyzine (Atarax)) cause drowsiness) Second Generation (Cetirizine (Zyrtec), Desloratadine (Clarinex)Loratadine (Alavert, Claritin), Fexofenadine (Allegra), Levocetirizine (Xyzal)) non- sedating Side effects Headache, nervousness, dizziness, depression, edema, increased appetite, Mast Cell Stabilizers: Stabilize mast cells prevent release of chemical mediators Cromolyn Sodium Intal, NasalCrom Corticosteroids: Anti-inflammatory effects Leukotriene Modifiers: Zafirlukast (Accolate) Montelukast (Singulair), Zileuton (Zyflo CR) Primarily treat asthma Immunotherapy Allergy shots Epinephrine Tx of anaphylaxis or milder allergic reactions SQ - 1:1000 dilution EPI Pens
Criteria to diagnosis
Morning stiffness in and around the joints for at least one hour. Swelling or fluid around three or more joints simultaneously. At least one swollen area in the wrist, hand, or finger joints. Arthritis involving the same joint on both sides of the body (symmetric arthritis). Rheumatoid nodules, which are firm lumps in the skin of people with rheumatoid arthritis. These nodules are usually in pressure points of the body, most commonly the elbows Abnormal amounts of rheumatoid factor in the blood. X-ray changes in the hands and wrists typical of rheumatoid arthritis, with destruction of bone around the involved joints. Rheumatoid arthritis is officially diagnosed if four or more of these seven factors are present. The first four factors must have been present for at least six weeks.
The term used to define the balance between the amount of HIV in the body and the immune response is which of the following? a) Viral set point b) Viral clearance rate c) Primary infection stage d) Window period
a
Which of the following is an action of cytotoxic T cells? a) Lyse cells infected with virus b) Attack of foreign invaders (antigens) directly c) Decrease B cell activity to a level at which the immune system is compatible with life d) Production of circulating antibodies
a
Which of the following is a center for immune cell proliferation? a) Spleen b) Lymph node c) Pancreas d) Liver
b
A public health nurse is giving an informational presentation on HIV/AIDS at a nearby college. How would the nurse best define AIDS? a) Acquired immunodeficiency syndrome is a sexually transmitted disease. b) Acquired immunodeficiency syndrome is an infectious disease transmitted in blood and body fluids. c) Acquired immunodeficiency syndrome is an infection by the human immunodeficiency virus. d) Acquired immunodeficiency syndrome is a fatal infection that profoundly weakens the immune system.
d
During the immune response, cytotoxic cells bind to invading cells, destroy the targeted invader, and release lymphokines to remove the debris. Which type of T-cell lymphocyte is cytotoxic? a) Regulator T cells b) Helper T cells c) Suppressor T cells d) Effector T cells
d
What test will the nurse assess to determine the patient's response to antiretroviral therapy? a) EIA enzyme immunoassay b) Western blot c) CBC d) Viral load
d
Rheumatoid Arthritis
Chronic systemic autoimmune disorder caused by abnormal, overactive functioning of the immune system that produces a response against the body's own cells and tissues - Primarily affects connective tissue of the joint
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? a) T-cell lymphocytes survey proteins in the body and attack the invading antigens. b) The invading antigens precipitate. c) The invading antigens link together (agglutination). d) Toxins of invading antigens are neutralized.
a
The body has several mechanisms to fight disease, one of which is sending chemical messengers. Specifically, the messengers released by lymphocytes, monocytes, and macrophages have differing roles in the immune response. Which messenger enables cells to resist viral replication and slow viral replication? a) Interferons b) Interleukins c) Colony-stimulating factor d) Tumor necrosis factor
a
Which of the following statements reflects the treatment of HIV infection? a) Treatment of HIV infection for an individual patient is based on the clinical condition of the patient, CD4 T cell count level, and HIV RNA (viral load). b) Treatment should be offered to individuals with plasma HIV RNA levels less than 55,000 copies/mL (RT-PCR assay). c) Treatment should be offered to all patients once they reach CDC category B: HIV symptomatic. d) Treatment should be offered to only select patients once they reach CDC category B: HIV symptomatic.
a
A client with AIDS develops pneumocystis pneumonia. The nurse would most likely expect to include administration of which agent in the client's plan of care? a) Azithromycin b) Aerosolized pentamidine c) Clindamycin d) TMP-SMZ
d
A nurse is implementing appropriate infection control precautions for a client who is positive for human immunodeficiency virus (HIV). The nurse demonstrates a need for a review of transmission routes by identifying which body fluid as a means of transmission? a) Blood b) Breast milk c) Semen d) Urine
d
Matt Carson, a 20-year-old college student, was riding his motorcycle home from class when he lost control of the bike and sustained serious internal injuries, including a ruptured spleen. Matt has been taken to the OR to remove his spleen and the ED nurse is meeting with Matt's parents to answer some of their additional questions. Which of the following will be included in the nurse's discussion regarding special considerations following the removal of Matt's spleen? a) Matt will be susceptible to bleeding because the spleen synthesizes vitamin K. b) Matt will be susceptible to acidosis because the spleen maintains acid-base balance. c) Matt will be susceptible to anemia because the spleen produces red blood cells. d) Matt will be susceptible to infection because the spleen removes bacteria from the blood.
d
Which type of cells is capable of recognizing and killing infected or stressed cells and producing cytokines? a) Null lymphocytes b) Memory cells c) Cytotoxic T cells d) Natural killer cells
d
