Unit 8 Carrying for Patients with an Immune Disorder

The nurse teaches the client that reducing the viral load will have what effect?

Longer Survival

Allergic Disorders A/F

Manifestations• Shock, laryngeal edema, wheezing, stridor, tachycardia, generalized itching, hypotension, bronchospasm, and angioneurotic edema

proteins produced by B-lymphocyte plasma cells referred to as immunoglobulins (Igs)

Antibodies

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?

"It's possible that your baby could contract HIV, either before, during, or after delivery.

An adult patient's primary care provider prescribed fluticasone (Flonase) by metered-dose inhaler, which the patient states that she administers whenever she senses the onset of her allergy symptoms. How should the nurse respond to this patient's statement?

"This drug has a long-term effect and won't provide immediate relief of your symptoms."

The nurse is preparing to infuse gamma-globulin intravenously (IV). When administering this drug, the nurse knows the speed of the infusion should not exceed what rate?

3 mL/min

Only use the nasal spray for 3 to 4 days once every 12 hours.

A client has had a "stuffy nose" and obtained an oxymetazoline nasal spray. What education should the nurse provide to the client in order to prevent "rebound congestion"?

Addressing possible barriers to adherence

A client 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?

The daughter is 15 years of age.

A client will be having a hysterectomy and wants her daughter to provide directed donor blood. What factor would eliminate her daughter from donating the blood?

AIDS Prevention Strategies

Abstain from sexual intercourse. Avoid casual sex with multiple partners. Use a condom or spermicide; nonoxynol-9. Abstain from using IV drugs that contribute to disinhibition and hypersexuality. Bank autologous blood (self-donated) or directed donor blood.

Traditionally, HIV infection has been a danger for specific population groups who engaged in risky behaviors. Recently, incidence has spread to groups who are not typically thought to be in danger of contracting HIV. Which population group in the United States has HIV infection rates eight times higher than whites?

African Americans

AIDS

An infectious and fatal disorder that weakens the immune system HIV: pathogen that causes AIDS HIV/AIDS is pandemic—34 million infected per World Health Organization Occurrence: homosexual men, IV drug users, heterosexual women, healthcare workers Mortality—declining; 1.8 million people

A junior nursing student is having an observation day in the operating room. Early in the day, the student reports eye swelling and dyspnea to the OR nurse. What should the nurse suspect?

Anaphylaxis due to a latex allergy

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 the blood

Allergic Disorders Delayed Hypersensitivity Response: Type IV

Antigens are initially phagocytized by macrophages; sensitized T cells then produce cytokines that cause an inflammatory reaction.May develop over several hours or days

A client with a diagnosis of primary immunodeficiency disease informs the nurse that he has been experiencing a new onset of a dry cough and occasional shortness of breath. After determining that the client's vital signs are within reference ranges, what action should the nurse take?

Assess the client for signs and symptoms of infection.

Chronic Fatigue Syndrome A/F

Flulike symptoms or an upper resp. infection, muscle pain, headache Severe ongoing fatigue. Worsens after physical activity, fatigue interferes with work in or outside home

Autoimmune Disorders Autoantibodies

Autoimmune disorders: : antibodies against self-antigens are immunoglobulins; target histocompatible cells, cells whose antigens match the individual's own genetic code Diseases are considered autoimmune when they are characterized by unrelenting, progressive tissue damage without any verifiable etiology.

A client who has AIDS reports having diarrhea after every meal, and wants to know what can be done to stop this symptom. What should the nurse advise?

Avoid fibrous foods, lactose, fat, and caffeine.

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?

Banking autologous blood that is self-donated is the safest option for the client

AIDS Transmission

Body fluids: blood, semen, vaginal secretions, breast milk High risk factors Unprotected sexual intercourse Multiple sex partners Sharing IV needles Nonautologous transfusion Infected mother to infant transmission

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

Bone Marrow Transplant

Which is usually the most important consideration in the decision to initiate antiretroviral therapy?

CD4+ counts

AIDS—end stage of HIV infection Classifications

Category 1, 2 or 3 and Category A, B, or C

Types of WBC

Cells that perform phagocytosis (process of engulfing and digesting bacteria and foreign material) Netrophils are also called microphones because they are small, present in blood, and migrate to tissue.

The client diagnosed with chronic fatigue syndrome (CFS) is at risk for injury related to neurally mediated hypotension. To maintain the safety of the client, the nurse should do all of the following, except:

Encourage the client to relax in a tub of tepid water for 15 minutes.

Which blood test confirms the presence of antibodies to HIV?

Enzyme immunoassay (EIA)

Autoimmune Disorders D/F

Erythrocyte sedimentation rate (ESR), antistreptolysin O titer, antinuclear antibody titer, rheumatoid factor Drug Therapy Immunosuppressive agents: cyclosporine (Sandimmune), tacrolimus (Prograf) Cytotoxic agents: azathioprine (Imuran) Corticosteroids: prednisone (Meticorten)

AIDS—end stage of HIV infection

Fever, swollen and tender lymph nodes, pharyngitis, rash, muscle and joint pain, Kaposi's sarcoma, Pneumocystis pneumonia, abnormal Pap tests, PID

aids ethical issues

Financial and insurance implications: fear of disclosure of HIV status will affect employment, health insurance coverage, housing

Allergic Disorders P/E

First exposure to an allergen does not produce symptoms. Sensitization: process by which cellular and chemical events occur after a second or subsequent exposure to an allergen Once sensitization occurs, one of four types of hypersensitivity responses can occur; may be immediate or delayed Types: types I, II,III, and IV

AIDS Structural • characteristics

Genetically incomplete—capsid; double layer of lipid material surrounds the virus (gp120 and gp41) Capsid enzymes—reverse transcriptase, integrase, protease T-cell lymphocyte fusion—connects HIV to T cell's co- receptors Entry inhibitors—development of new category of antiretroviral drugs

A client 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?

Guided Imagery

A male 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 antibodies to the AIDS virus are present in the blood, this indicates what?

HIV

A clinic nurse is caring for a client admitted with AIDS. The nurse has assessed that the client 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?

HIV encephalopathy

When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by which characteristic?

HIV-1 is more prevalent than HIV-2 subtypes

AIDS Subtypes

HIV-1—mutates easily and frequently More prevalent in the United States HIV-2—less transmittable; longer interval between virus and AIDS Western Africa is the primary site of infection.

Types of Immunoglobulins

IgA, IgD, IgE, IgG, and IgM

A client with a family history of allergies has suffered an allergic response based on a genetic predisposition. This atopic response is usually mediated by what immunoglobulin?

Immunoglobulin E

Nonantibody Proteins

Interleukins• Interferons• Tumor necrosis factor (TNF)

The nurse working in an allergy clinic is preparing to administer skin testing to a client. Which route is the safest for the nurse to use to administer the solution?

Intradermal

Allergic Disorders Suppression of the allergic response

Mechanisms Eosinophil chemotactic factor (ECF): chemical mediator, from mast cells Chemotaxis: process of attracting migratory cells to a particular area of the body Epinephrine: interferes with the release of vasoactive chemicals from mast cells Corticosteroids (anti-inflammatory hormones) block the synthesis of prostaglandins and leukotrienes.

Chronic Fatigue Syndrome D/F

Medical History and Physical exam are unremarkable, patient may have other physical or psych conditions. but are unrelated to presenting symptoms. Blood tests related to CFS: alkaline phosphatase, BUN, Serum Calcium, Glucose, Thyroid stimulating hormone levels. Medical workup

Immunity to a disease after recovery is possible because the first exposure to the pathogen has stimulated the formation of which of the following?

Memory cells

Autoimmune Disorders N/M

Obtain a family history. Vital signs Examine the client for signs of localized inflammation and compromised body functions. Assess level of energy. Review laboratory test findings—report patterns to identify exacerbations.

To prevent the risk of HIV transmission, standard precautions should be used. Cleaning the client's anal area without wearing gloves indicates that the nurse needs to reinstruct the caregiver in measures related to standard precautions. Handwashing before and after client care, disposing of sharps in a puncture-resistant container, and cleaning up spills with a dilute bleach solution are appropriate measures.

Patient Care with HIV at Home

Lymphoid Tissues

Play a role in immune response

Which intervention is the single most important aspect for the client at risk for anaphylaxis?

Prevention

Opsonization:

Proteins cooperate with

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?

RNA

Allergic Disorders D/F

Radioallergosorbent blood test (RAST) Scratch or prick test, patch test, intradermal injection test; skin testing with extracts of various substances (antigens) Elimination diets: try to establish cause- and-effect relationships

Natural Killer (NK) Cells

Release potent chemicals that lethally alter the target cell's membrane.

AIDS Replication Enzymes

Reverse Transcriptase- copies viral RNA to viral DNA Integrase—incorporates viral DNA into host cell's DNA • Protease—freeing the replicated viral particles into the cytoplasm of the cell

Aids leading to dementia nursing dx

Risk for Injury

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?

Signs and Symptoms of an Adverse Reaction

What is designed to reduce the risk of transmission of bloodborne pathogens) and Body Substance Isolation (designed to reduce the risk of transmission of pathogens from moist body substances); they are applied to all patients in health care facilities regardless of their diagnosis or presumed infectious status.

Standard Precautions

A client is in the primary infection stage of HIV. What is true of this client's current health status?

The client is infected with HIV but lacks HIV-specific antibodies.

Pneumocystis pneumonia

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% occurrence) in persons with AIDS?

edema redness

The nurse is conducting an assessment on a client that has acute irritant contact dermatitis. What signs and symptoms would the nurse expect to see upon assessment?

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?

The patient will remain in the clinic to be monitored for 30 minutes following the injection.

Primary infection

The period from infection with HIV to the development of antibodies to HIV is known as which of the following?

Types of Lymphoid tissues

Thymus, Tonsils, Adenoids, Spleen, Lymph Nodes

Autoimmune Disorders P/E

Tissue injury theory: infection, trauma, or introduction of a drug that integrates itself into the membranes of the host's cells Example: streptococcal infections and rheumatic heart disease Genetic instruction theory: genetically predisposed to autoimmune disorders Other: sequestered antigen theory

Allergic Disorders M/M

Treatment used to relieve allergic symptoms depends on type of allergy Methods Drug therapy: diphenhydramine (Benadryl), pseudoephedrine hydrochloride (Sudafed) Desensitization: form of immunotherapy in which a person receives weekly or twice weekly injections of dilute but increasingly higher concentration of an allergen without interruption Sublingual-swallow immunotherapy (SLIT

A client has sought care, stating that she developed hives overnight. The nurse's inspection confirms the presence of urticaria. What type of allergic hypersensitivity reaction has the client developed?

Type I

A patient is being tested for HIV using enzyme immunoassay (EIA). The EIA shows antibodies. The nurse expects the health care provider to order what test to confirm the EIA test results?

Western Blot Test

Antibodies to HIV are not present in his blood.

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

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?

X-linked agammaglobulinemia

Immune response

a target-specific system of defense, primarily involves the lymphocytes and lymphoid tissue

Chronic Fatigue Syndrome P/E

profound fatigue with no identifiable cause; fatigue worsens with physical activity and does not improve with rest Cause: no cause has yet been established Deficiency in adenosine triphosphate (ATP) Viral assaults

A client is prescribed an oral corticosteroid for 2 weeks to relieve asthma symptoms. The nurse educates the client about side effects, which include

adrenal suppression

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?

anaphylaxis

EIA and Western blotting identify and confirm the presence of

antibodies to HIV

• Nonantibody proteins

provide additional methods for disabling antigens and further protecting the body.

A client with acquired immune deficiency syndrome (AIDS) informs the nurse of difficulty eating and swallowing, and shows the nurse white patches in the mouth. What problem related to AIDS does the nurse understand the client has developed?

candidiasis

Allergic disorder

characterized by a hyperimmune response to weak antigens that usually are harmless

90% aids

chronic diarrhea

Allergic Disorders Immediate Hypersensitivity Response

due to antibodies interacting with allergens and occurs rapidly Type I, atopic or anaphylactic: mediated by immunoglobulinE (IgE) antibodies (most severe) Type II, cytotoxic: mediated by immunoglobulin M or G (IgM or IgG) antibodies Type III, immune complex: mediated by IgG antibodies

Cancer cells

escape NK cell surveillance—causes cancer cells to spread beyond primary site

Allergic disorder characterized by

he manner in which the allergen gains entry to the body and the intensity of the response • Allergens • Types

AIDS—end stage of HIV infection Drug Regimen

highly active antiretroviral therapy (HAART) Reverse transcriptase inhibitor—zidovudine (AZT), nevirapine (Viramune) Protease inhibitor—indinavir (Crixivan), saquinavir (Invirase) Entry inhibitor—enfuvirtide (Fuzeon) Integrase inhibitor—raltegravir (Isentress) Combinations: Atripla, Stribild, Truvada (PrEP)

AIDS end stage of HIV infection P/E

impairs the ability of infected T4 cells to recognize foreign antigens and stimulate B-cell lymphocytes Rate of progression: weak strain of HIV, amount of virus, atypical CCR5 or CXCR4 co-receptors hinder conversion of HIV to AIDS; effective drug treatment

Autoimmune Disorders

killer T cells and autoantibodies attack or destroy natural cells

HIV is harbored within which type of cell

lymphocyte

Lymphoid tissues

play a role in immune response and prevention of infection

AIDS—end stage of HIV infection- Criteria

Markedly decrease T4-cell countDevelopment of certain cancers; opportunistic infections

The blood is screened very carefully; the risk is 1 in 2,000,000.

A client requires a blood transfusion for anemia and is concerned about the risk of contracting acquired immune deficiency syndrome (AIDS). What is the best response by the nurse?

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 client 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 latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse.

A female client with human immunodeficiency virus (HIV) receives family-planning counseling. Which statement about safer sex practices for persons with HIV is accurate?

The nurse puts on a second pair of gloves over soiled gloves while performing a bloody procedure.

A nurse would identify that a colleague needs additional instruction on standard precautions when the colleague exhibits what behavior?

Allergic Disorders Complications

Clients with inhalant allergies or allergic rhinitis may develop nasal polyps from the chronic inflammation; prone to sinus infections, secondary pulmonary infections, asthma

Types of non antibody proteins:

Complement system Cytokines

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?

Diphenhydramine

Allergic Disorders Anaphylaxis: rapid and profoundtype I hypersensitivity response

Massive release of histamine causes vasodilation; increased capillary permeability Signs: angioneurotic edema is the acute swelling of the face, neck, lips, larynx, hands, feet, genitals, internal organs; hypotension; bronchoconstriction

Monocytes— macrophages

Perform phagocytosis: process of engulfing and digesting bacteria and foreign materialbecause they are large, present in tissues such as lungs, liver, lymph nodes, spleen, and peritoneum; migrate after a cell-mediated response

A nurse is assessing the skin integrity of a client who has AIDS. When performing this inspection, the nurse should prioritize assessment of what skin surfaces?

Perianal region and oral mucosa

Which of the following is the function of macrophages and neutrophils?

Phagocytosis

Autoimmune Disorders A/F

Symptoms depend on the tissues and organs affected; symptoms are characteristic of an acute inflammatory response. Inflammatory symptoms: develop as antibodies attack normal tissue mistakenly identified as nonself Exacerbations alternate with periods of remission; duration of these periods is completely unpredictable.

Family members of an immunocompromised client have asked the nurse why antibiotics are not being given to the client in order to prevent infection. How should the nurse best respond?

Using antibiotics to prevent infections can cause the growth of drug-resistant bacteria.

OTC antihistmines

sedation

The lower the client's viral load,

the longer the survival time

The nurse educator is differentiating primary immunodeficiency diseases from secondary immunodeficiencies. What is the defining characteristic of primary immunodeficiency diseases?

they have a genetic origin

antiretroviral therapy

to keep the CD4 cell count above 350/mm3 and bring the viral load to a virtually undetectable level. This level is no more than 500 or 50 copies, depending on the sensitivity of the selected viral load test.

A client who is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication will the client take for the treatment of this infection?

trimethoprim-sulfamethoxazole