Chapter 36

A client is diagnosed with severe combined immunodficiency (SCID). What would the nurse expect to integrate into the client's plan of care?

preparation for bone marrow transplant

Which term defines the balance between the amount of HIV in the body and the immune response?

viral set point

A patient in the clinic states, "My boyfriend told me he went to the clinic and was treated for gonorrhea." While testing for the sexually transmitted infection (STI), what else should be done for this patient?

inform the patient that it would be beneficial to test for HIV

A nurse is assessing a client with a primary immunodeficiency. Afterward the nurse documents that the client displayed ataxia. The nurse makes this documentation because the client has

uncoordinated muscle movements

panhypoglobulinemia

general lack of immunoglobulins in the blood

Which term means a lack of one or more of the five immunoglobulins

hypogammaglobulinemia

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. What would the nurse describe as the first step?

Attachment --> once HIV enters the host cell, attachment occurs in which teh glycoproteins of HIV bind with the host's unaffected CD4+ receptor and chemokine coreceptors 2. uncoating. 3. Cleavage 4. Budding.

Primary immunodeficiencies are commonly seen in

infants and young children --> rare disorders with genetic origins --> without treatment, infants and children with these disorders seldom survive to adulthood

A client with severe combined immunodeficiency is to receive a hematopoietic stem cell transplant. What would the nurse expect to be started?

immunosuppresive agents --> to ensure engraftment of depleted bone marrow

The nurse completes a history and physical assessment on a client with acquired immune deficiency syndrome (AIDS) who was admitted to the hospital with respiratory complications. The nurse knows to assess for what common infection (80% occurence) in persons with AIDS?

pneumocystis pneumonia --> one of the first and most common opportunitic infections associated with AIDS --> can be present despite the absence of crackles --> untreated--> pulmonary impairment and respiratory failure

Which of the following tests determines initiation of antiretroviral treatment?

CD4/CD8 ration --> determines initiation of antiretroviral treatment and use of prophylactic medications

Which of the following indicates that a client with HIV has developed AIDS?

Herpes simplex ulcer persisting for 2 months --> diagnosis of AIDS cannot be made until the person with HIV meets case criteria established by the CDC. ----> immune system becomes compromised ----> CD4 T cell count drops below 200cells and develops one of the opportunistic diseases: pneumocystis carinii pneumonia, candidiasis, cytomegalovirus, or herpes simplex

A client with ataxia-telangiectasia is admitted to the unit. The nurse caring for the client would expect to see what included in the treatment regimen?

IV gamma globulin administration --> also antimicrobial therapy and bone marrow transplant.

A nurse educator is preparing to discuss immunodeficiency disorders with a group of fellow nurses. What would the nurse identify as the most common secondary immunodeficiency disorder?

AIDS

Lipoatrophy

results in a localized loss of subcutaneoua fat in the face (sinking cheeks, eyes and temples), arms, legs and buttocks

A client with chronic mucocutaneous candidiasis, an autosomal recessive disorder, asks the nurse, "Will my children have this disease?" Which response by the nurse is appropriate?

All of your children will be carries of the recessive gene, but may not develop the disease

A child has just been diagnosed with a primary immune deficiency. The parents state, "Oh, no. Our child has AIDS." Which response by the nurse would be most appropriate?

Although AIDS is an immunodeficiency, your child's condition is different from AIDS --> primary immunodeficiencies do not increase the child's risk for developing AIDS later in life. --> serious but rarely fatal and can be controlled. --> AIDS is a secondary immunodeficiency disorder

The nurse is caring for a client whose most recent laboratory values reveal a neutrophil level of 21,000 mm3. When preparing to assess the client, the nurse should prioritize what assessment?

Assessing the client for signs and symptoms of infection --> Neutrophil: 3,000-7,000 mm^3 --> rise in neutrophil levels is a response to infection.

Trimethoprim/Sulfamethoxazole

Bactrim, Septra prevents pneumocystis pneumonia

A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of?

Chronic diarrhea

reverse transcriptase

Enzyme that transforms single-stranded RNA into double stranded DNA --> not a blood test

A client suspected of having human immunodeficiency virus (HIV) has blood drawn for a screening test. What is the first test generally run to see if a client is, indeed, HIV positive?

Enzyme-linked immunosorbent assay (ELISA) ELISA--> initial HIV screening test

Hyperreflexia

Exaggerated reflex response

When administering intravenous gamma globulin infusion, the nurse recognizes that which report by the client may indicate an adverse effect of the infusion?

Flank Pain--> chest tightness

A healthcare worker has been exposed to the blood of an HIV-positive client and is awaiting the results of an HIV test. In the meantime, what precautions must the healthcare worker take to prevent the spread of infection?

Follow the same sexual precautions as someone who has been diagnosed with AIDS

The nurse is preparing a teaching plan for a client with an immunodeficiency. What aspect would the nurse emphasize as most important?

Frequent and thorough hand washing the most impt. aspect is frequent and thorough hand washing to prevent infection. If infection is prevented, signs and symptoms will not develop and medication would not necessarily be needed.

Which option should the nurse encourage to replace fluid and electrolyte losses in a client with AIDS

Liquids

A nurse is preparing an in-service presentation about primary immunodeficiencies. When describing these conditions, what would the nurse need to integrate into the presentation?

Most cases are typically diagnosed in infancy, with a male to female ratio of 5-1 --> large fraction are not diagnosed until adolescence of early adulthood when the gender distribution equalizes -->primary immunodeficiencies are less common the secondary immunodeficiencies

A majority of clients with CVID develop which type of anemia

Pernicious

A nursing student is preparing a teaching plan for a client with an immunodeficiency disorder. The student is going to include the cardinal symptoms in teaching. Which of the following would the student include? Choose all that apply.

-chronic diarrhea -poor response to treatment of infections -chronic or recurrent severe infections

The nurse receives a phone call at the clinic from the family of a client with AIDS. They state that the client started "acting funny" and reported headache, tiredness, and a stiff neck. Checking the temperature resulted in a fever of 103.2°F. What should the nurse inform the family member?

The client may have cryptococcal meningitis and will need to be evaluated by the provider --> common infection for people with AIDS --> causes neurologic disease --> symptoms: fever, headache, malaise, stiff neck, nausea, vomiting, mental status changes, seizures

A nurse is preparing to give a client an infusion of gamma globulin. The nurse knows to stop the infusion if the client experiences which symptoms?

-tightness in the chest -flank pain -shaking chills -dysonea -headache -fver -local reaction at the infusion site

Steps of HIV infection

1. Attachment 2. uncoating 3. cleavage 4. budding

What treatment option does the nurse anticipate for the patient with severe combined immunodeficiency disease (SCID)?

Bone marrow transplant Stem Cell Transplant

A client who is HIV positive is receiving highly active antiretroviral therapy (HAART) that includes a protease inhibitor (PI). The client comes to the clinic for a follow-up visit. Assessment reveals lipoatrophy of the face and arms. The client states, "I'm thinking the side effects of the drug are worse than the disease. Look what's happening to me." The nurse would most likely identify which nursing diagnosis as the priority?

Disturbed body image related to loss of fat in the face and arms --> concerned about how he looks to others.

A client is administered foscarnet to treat a case of cytomegalovirus (CMV) retinitis. Which adverse effect should the nurse closely monitor in this client?

Electrolyte imbalances Foscarnet adverse effects: alterations in renal function, fever, nausea, electrolyte imbalances, and diarrhea.

Which of the following is the most common HIV-related malignancy

Kaposi's Sarcoma

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?

Ribonucleic Acid (RNA) --> HIV is a retrovirus that carries its genetic material in the form of RNA rather than DNA.

A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority?

Risk for injury --> this type of dementia impairs cognition and judgement, placing client at risk for injury

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?

Stool specimen for ova and parasites --> organism is spread by the fecal-oral route from contaminated water, food or human or animal waste. --> can lose 10 to 20L of fluid per day, leading to dehydration and electrolyte imbalances.

The nurse is gathering data from laboratory studies for a client who has HIV. The clients T4-cell count is 200/mm3, and the client has been diagnosed with Pneumocystis pneumonia. What does this indicate to the nurse?

The client has converted from HIV infections to AIDS

HAART

highly active antiretroviral therapy- use of combinations of drugs that are effective against AIDS

vacant stare

blank with no expression

p24 antigen test

blood test that measures viral core protein

Which microorganism is known to cause retinitis in people with HIV/AIDS?

cytomegalovirus

There are many ethical issues in the care of clients with HIV or HIV/AIDS. What is an ethical issue healthcare providers deal with when caring for clients with HIV/AIDS?

disclosure of the client's condition

What does the nurse understand will result if the patient has a deficiency in the normal level of complement

increased susceptibility to infection --> Complement system is an integral part of the immune system.

Primary infection stage

period from infection with HIV to the development of antibodies to HIV

A nurse knows more than 50% of clients with CVID develop the following disorder

pernicious anemia

A client with human immunodeficiency virus (HIV) develops a nonproductive cough, shortness of breath, a fever of 101°F and an O2 saturation of 92%. What infection caused by Pneumocystis jiroveci does the nurse know could occur with this client?

pneumocystis pneumonia

A client is scheduled to receive an intravenous immunoglobulin (IVIG) infusion. The client asks the nurse about the infusion's administration and its adverse effects. Which condition should the nurse instruct this client to report immediately?

tickle in the throat

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?

trimethoprim-sulfamethoxazole

complement system

proteins in the blood that help antibodies and T cells kill their target

A client taking abacavir has developed fever and rash. What is the priority nursing action?

report to the health care provider --> fever and rash could be indicative of a hypersensitivity reaction. ----> anaphylactic reaction/allergy --> notify the provider and medication should be stopped immediately. --> be sure that the client's air way is in not compromosed.

secondary immunodeficiency

result of an underlying disease process or the treatment of a disorder --> not genetically inherited --> acquired later in life --> ex: chronic stress and diabetes mellitus

Telangiectasia

skin lesion due to permanently enlarged and dilated blood vessels that are visible "spider veins"

Rate of viral clearance

the amount of virus in circulation and the number of infected cells.

When assisting the client to interpret a negative HIV test result, what does the nurse tell the client that this result means?

the body has not produced antibodies to the AIDS virus

Which assessment finding would the nurse expect to document for a client with ataxia-telangiectasis?

vascular lesions

Which adverse effect(s) should the nurse closely monitor in a client who has secondary immunodeficiencies due to immunosuppressive therapy?

Respiratory or urinary system infections --> secondary immunodeficiencies occur as a result of underlying disease processes or the treatment of these disorders, including administration of immunosuppressive agents. --> abnormalities of the immune system affect both natural and acquired immunity. --> immunodeficiencies result in a compromised immune system and pose a high risk for infection --> therefore must be careful assessment of the client's immune status is essential.

A nurse is reviewing treatment options with parents of an infant born with severe combined immunodeficiency disease (SCID). The nurse recognizes that the parents understand the teaching based on which statement?

We could have our 10 year old daughter tested, as the ideal stem cell donor is a human leukocyte antigen-identical sibling

A client with suspected human immunodeficiency virus (HIV) has had two positive enzyme-linked immunosorbent assay (ELISA) tests. What diagnostic test would be run next?

Western blot

There are major differences between primary and secondary immunodeficiencies. Select the most accurate statement the nurse would use to explain the cause of a secondary immunodeficiency.

Your immune system was most likely affected by an underlying disease process

A client is beginning highly active antiretroviral therapy (HAART). The client demonstrates an understanding of the need for follow up when scheduling a return visit for viral load testing at which time?

6 weeks

apathy

a lack of feeling, emotion, or interest

A client receiving antiretroviral therapy reports "not urinating enough." What is the nurse's best action?

assess blood urea nitrogen and creatinine --> adverse effects associated with antiretroviral therapy include potential nephrotoxicity

What intervention is a priority when treating a client with HIV/AIDS?

assessing fluid and electrolyte balance

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?

assist with chest physiotherapy every 2 to 4 hours --> prevents stasis of secretions

Which nursing action is essential before an EIA test is performed?

Obtaining a general consent for medical care from the client

A client with HIV will be started on a medication regimen of three medications. What drug will the nurse instruct the client about?

Reverse transcriptase inhibitors --> drugs that interfere with the virus' ability to make a genetic blueprint.

A client is diagnosed with pneumocystis pneumonia (PCP). What medication does the nurse anticipate educating the client about for treatment?

TMP-SMZ

The nurse is admitting a client to the unit with a diagnosis of ataxia-telangiectasia. The nurse would recognize that the client is exhibiting telangiectasia when assessing the presence of what?

Vascular lesions caused by dilated blood vessels

A client with acquired immune deficiency syndrome (AIDS) reports diarrhea after every meal. What is the nurse's best response?

avoid fibrous foods, residue, lactose, fat and caffeine

A client is taking a corticosteroid for the treatment of systemic lupus erythematosus. When the nurse is providing instructions about the medication to the client, what priority information should be included?

be alert for signs and symptoms of infection and report them immediately to the physician --> earlier treatment promotes a shorter duration of illness and reduced complication. --> avoid crowds during period of immunosuppresion --> do not omit a dose, even if nausea occurs, meds can be taken with food

A client is prescribed didanosine as part of a highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client?

be sure to take the drug about 1/2 hour before or 2 hours after you eat

When describing the effects of treatment for phagocytic cell disorders, which of the following would the nurse include as being the most successful?

hematopoietic stem cell transplantation

pernicious anemia

lack of mature erythrocytes caused by inability to absorb vitamin B12 into the bloodstream

Ataxia

lack of muscle coordination

HIV is harbored within which type of cell?

lymphocyte

Kaposi's sarcoma

malignant tumor of the blood vessels associated with AIDS --> diagnosed through biopsy --> prognosis depends on the extent of the tumor, the presence of other symptoms of HIV infection and the CD4+ count

Based on the nurse's base knowledge of primary immunodeficiencies, how would the nurse complete this statement? Primary immunodeficiencies

develop early in life after protection from maternal antibodies decreases. --> disorders involve one or more components of the immune system. --> primary immunodeficiencies are seen primarily in infants and children.

agammaglobulinemia

disorder marked by an almost complete lack of immunoglobulins or antibodies

Which condition is an early manifestation of HIV encephalopathy

headache Early manifestations: headache, memory deficits, difficulty concentrating, progressive confusion, psychomotor slowing, apathy, and ataxia Later stages--> hyperreflexia, a vacant stare, and hallucinations

HIV

human immunodeficiency virus --> causes AIDS --> retrovirus that carries its genetic material in the form of RNA rather than DNA --> consists of a viral core containing the viral RNA, surrounded by an envelope consisting of protruding glycoproteins.

ESR

indicator of the presence of inflammation in the body

enzyme-linked immunosorbent assay (ELISA)

initial HIV screening test --> positive when there are sufficient HIV antibodies --> positive when there are antibodies from other infectious diseases. --> if positive twice then Western Blot test is run.

A nurse is implementing appropriate infection control precautions for a client who is positive for human immunodeficiency virus (HIV). The nurse knows which body fluid is not a means of transmission?

urine --> can be transmitted through: blood, breast milk and semen

the term used to define the amount of virus in the body after the initial immune response subsides is

viral set point --> results in equilibrium between HIV levels and the immune response that may be elicited.

The mahority of patient with primary immunodeficiency are in which age group?

younger than 20

The nurse is caring for a young client who has agammaglobulinemia. The nurse is teaching the family how to avoid infection at home. Which statement by the family indicates that additional teaching is needed?

"I can take my child to the beach, as long as we play in the sand rather than swim in the water" -> avoid touching sand or soil because of the high level of bacteria and increased risk of diseases such as toxoplasmosis

Which blood test confirms the presence of antibodies to HIV?

Enzyme immunoassay (EIA) --> EIA and western blotting identify and confirm the presence of antibodies to HIV

What test will the nurse assess to determine the client's response to antiretroviral therapy?

viral load --> 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.