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AH 2 Final > Immunodeficiency Disorder: Secondary > Flashcards

Immunodeficiency Disorder: Secondary Flashcards

1
Q

Immunodeficiency Disorder - Secondary: Acquired Immune Deficiency

etiology
6 causes

A
  • Etiology
    > result of underlying disease processes or treatment
    > neutropenia = high risk for sepsis, WBC <1000/mm3 (5k-10k)
  • Causes
    > autoimmune disorders
    > immunotoxic meds: corticosteroids, NSAID, chemo
    > alcoholism, drug abuse
    > spleen removal
    > malnutrition/stress
    > HIV
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2
Q

Immunodeficiency Disorder - Secondary: Aquired Immune Deficiency

diagnostic

A
  • WBC/diff: severe neutropenia
  • Bone marrow biopsy
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3
Q

Immunodeficiency Disorder - Secondary: Aquired Immune Deficiency

treatment

A
  • Infections
  • Intravenous immunoglobulin (IVIG)
    > provide lacking immunoglobulin
  • Hematopoietic stem cell transplant
  • Monoclonal antibody therapy
    > target antibodies to specific antigens
  • Growth factors (neupogen)
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4
Q

Immunodeficiency Disorder - Secondary: Aquired Immune Deficiency

nurse assessment/data collection

A
  • Hx
    > past infections, treatment response
  • Nutritional status, hygiene, use of alcohol/drugs/tobacco
  • Px
    > manifs of infection
    > pts do not have typical manifs of infection
  • Monitor: Manifs of Infection
    > VS, labs, C&S reports from wounds, lesions, sputum, urine, blood
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5
Q

Immunodeficiency Disorder - Secondary: Aquired Immune Deficiency

nursing diagnosis

A
  • Ineffective protection
  • Risk for infection
  • Risk for impaired skin integrity
  • Ineffective hlth maintenance
  • Imbalanced nutrition
    > less
  • Social isolation
  • Fear r/t threat to well-being
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6
Q

Immunodeficiency Disorder - Secondary: Aquired Immune Deficiency

hlth promo/pt teaching

A
  • Prevention of infections
    > hand washing & hygiene: bathing, foot care, dental hygiene, scrub fruits & veggies, food storage & prep, clean kitchen & bathroom
    > avoid crowds/infections
  • Lifestyle mod to reduce risk
  • Nutrition & diet
  • Neutropenic precautions
  • Manifs of infection
  • Med teaching
    > prophylactic med regimen
  • F/U care
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7
Q

Immunodeficiency Disorder - Secondary: HIV/AIDS

patho

A
  • Retrovirus: intracellular parasite
  • HIV targets cells w/ CD4 receptors (special T cells)
  • Complex life cycle tht turns host cells into “factories” for HIV
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8
Q

Immunodeficiency Disorder - Secondary: HIV/AIDS

staging

A
  • Stage 1: Catgeory A
    > primary infection: rapid viral replication (1-3wks)
    > asymptomatic
  • Stage 2: Category B
    > HIV symptomatic: CD4 < 200
    > AIDS begins
  • Stage 3: Category C
    > severe AIDS: CD4 < 100
    > opportunistic diseases
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9
Q

Immunodeficiency Disorder - Secondary: HIV/AIDS

risk factors

A
  • Sharing infected injection drug use equip
  • Having sexual relations w/ infected individuals
  • Infants born to mothers w/ infection and/or who are breastfed by infected mothers
  • People who received organ transplants, HIV-infected blood, or blood products
    > btwn 1978-1985
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10
Q

Immunodeficiency Disorder - Secondary: HIV/AIDS

labs & diagnostics

A
  • EIA
    > antibodies are detected, resulting in positive results & marking the end of the window period
  • Western Blot
    > also detects antibodies to HIV; used to confirm EIA
  • Viral Load
    > measures HIV RNA in plasma
  • CD4/CD8
    > these are markers found on lymphocytes, HIV kills CD4 cells, which results in a significantly impaired immune system
  • OraQuick
    > in home HIV test
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11
Q

Nurse Role: HIV Screen Process

A
  • Pre & Post test counseling
  • Sequence due to “Window Period”
    > retesting essential at 3 wks, 6 wks, & 3 mnths
    > 3wks-3mnths btwn infection w/ HIV and seroconversion (production of antibodies against virus)
    > HIV screening may be negative if done early
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12
Q

Immunodeficiency Disorder - Secondary: HIV/AIDS

nurse counseling

A
  • Focus on pt’s own unique circumstances/risks
  • Acknowledge/support for positive steps already made
  • Enhance self-perception of risk
  • Use explicit language
  • Help pt set goal to reduce chance of acquiring/transmitting HIV
  • Avoid porividing unnecessary info
  • Use condoms, protection during oral sex, don’t share toys
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13
Q

Immunodeficiency Disorder - Secondary: HIV/AIDS

gero considerations

A
  • 1/4 of ppl living w/ HIV age > 50
  • Reasons
    > unprotected intercourse
    > do not consider themselves at risk
    > social bias towards homosexuality
    > current or past use IV drugs (share needles)
    > received HIV-infected blood before 1985
    > reduction in immune system function
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14
Q

Immunodeficiency Disorder - Secondary: HIV/AIDS

medical care goals

A
  • Goals
    > Antiretroviral therapy (ART) to suppress virus
    > prevent/dcr complications
    > monitor disease progression & immune func
    > manage symptoms
    > prevent development of opportunistic disease: detect & treat
    > prevent transmission of HIV
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15
Q

Immunodeficiency Disorder - Secondary: HIV/AIDS

goals of ART

A
  • Suppress HIV replication/prevent drug resistance
  • Reduce morbidity & prolong duration/quality of survival
  • Restore & preserve immunologic func
  • Suppress plasma HIV viral load
  • Prevent HIV transmission
  • In US, ART is now recommended for all HIV-infected pts regardless of their viral load or CD4 count
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16
Q

PrEP Medication

A
  • Truvada (emtrictiabine & tenofovir)
    > Pre-Exposure Prophylaxis
    > reduces risk of transmission from known HIV + ppl to HIV -
    > need to use condoms
    > need HIV testing & other labs q3mnths
    > does not protect from STD
    > daily dose: do not miss any!
17
Q

PrEP Medication - Adverse Effects

A
  • Risk of damage to kidney/liver
  • Lactic acidosis
  • Osteopenia
    > bone softening
  • Headache
  • Abd pain
  • Wt loss
18
Q

PrEP Medication - AEs

cns
gi/bili
renal
cv

A
  • CNS
    > depression, neuropathies, fatigue
  • GI/Bili
    > N/V/D, pancreatitis, hepatotoxicity
  • Renal
    > stones, nephrotoxicity, renal failure
  • CV
    > HTN, MI, stroke, dysrhythmias
19
Q

PrEP Medication - AEs

pulm
ms/skin
hematologic
endocrine

A
  • Pulmonary
    > bronchitis, dyspnea
  • MS/Skin
    > osteopenia; fat redistribution syndrome (lipodystrophy)
  • Hematologic
    > anemia, neutropenia, thrombocytopenia
  • Endocrine
    > insuln resistance/diabetes
20
Q

HIV/AIDS Medical Treatment: Problems w/ Compliance

A
  • CDC estimates 36% of HIV pts use ART; only 76% have suppressed viral loads
  • Barriers to adherence to treatment plan
    > side effects of meds
    > psychological/mental illness/neurocognitive impairment
    > low health literacy
    > low social support
    > high alcohol consumptions/active substance abuse
    > homelessness/poverty
    > nondisclosure of HIV serostatus, denial stigma
    > inconsistent access to med
  • Positive relationship btwn pt & hlth care provider is associated w/ better adherence
21
Q

HIV/AIDS Collaborative Care

A
  • Opportunistic infections
  • Resp failure
  • Cachexia & wasting
  • Med side effects
    > education & support
  • Educate abt self-care
  • Community support systems
  • Emotional & ethical concerns
22
Q

AIDS: Opportunistic Diseases Ex

A
  • Psoriasis
  • Kaposi’s sarcoma
  • Oral lesions from genital warts
  • Cytomegalovirus (CMV)
    > leading cause of blidness in AIDS
23
Q

AIDS: Nursing Process - Assessment

A
  • Assess physical & psychosocial status
  • Identify risk factors
    > IV drug use, sexual practices
  • Immune system func
  • Nutritional status
  • Skin integrity
  • Resp status & neurologic status
  • Fluid & electrolyte balance
  • Knowledge lvl
24
Q

AIDS: Nursing Process - Diagnosis

A
  • Impaired skin integrity
  • Diarrhea
  • Risk for infection
  • Activity intolerance
  • Disturbed thought processes
  • Ineffective airway clearance
  • Pain
  • Imbalanced nutrition
  • Social isolation
  • Anticipatory grieving
  • Deficient knowledge
25
AIDS: Nursing Process - Planning/Goals
- **Absence of infection** - **Expression of grief** - **Improved nutritional status** - **Incrd socialization** - **Incrd knowledge regarding disease prevention & self-care** - **Incrd comfort** - **Improved airway clearance** - **Improved activity tolerance** - **Maintenance of skin integrity** - **Resumption of usual bowel pattern** - **Improved thought process**
26
AIDS Nursing Interventions ## Footnote neuro activity skin
- **Neuro Status** > assess mental/neurologic status > ensure pt safety, protect - **Activity** > balance btwn activity & rest - **Skin** > assess/reposition q2 > pressure reduction devices > skin care
27
AIDS Nursing Interventions ## Footnote bowels nutrition isolation
- **Bowels** > eliminate food irritants > meds as prescribed - **Nutrition** > control N/V/oral discomfort > daily weight > high calories/protein food > fluid 2-4L/day - **Isolation** > acceptance & understanding
28
AIDS Nursing: Health Maintenance
- **Encourage exercise** - **Don't stop meds!** - **Stress reduction** - **Maintain vaccinations** - **Monitor labs** - **Assess for infections** - **When to call HCP** - **Discuss risk behaviors**

AH 2 Final (24 decks)

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