Med-Surg: Chapter 19: Secondary Immune Dysfunction: Therapy-Induced Deficiencies

Question 1

What are secondary immune deficiencies caused by?

Answer 1

• medication-induced immunosuppression (most common); also corticosteroids
• radiation
• surgery

Question 2

Why Is Immunosuppressive Therapy prescribed?

Answer 2

prescribed to treat autoimmune disorders, as well as to prevent transplant rejection

Question 3

Chemotherapy

Answer 3

• immunosuppression is a side effect of chemotherapy in the treatment of cancer
• chemotherapy can lead to leukopenia; results in decreased cell-mediated and humoral responses

Question 4

Radiation Therapy

Answer 4

-can cause secondary immunodeficiency
-radiation destroys dividing and resting cells
-with increased radiation, there is increased pancytopenia (a decreased number of all types of blood cells—RBCs, WBCs, and Platelets)
>this causes further suppression of the immune system function

Question 5

Surgery

Answer 5

surgical removal of organs of the immune system, such as lymph nodes, thymus, or spleen, also suppress the immune response

Question 6

Pathophysiology: Chemotherapeutic Medications

Answer 6

> chemotherapeutic medications used to treat cancer are cytotoxic; they target rapidly dividing cancer cells

• cells of the immune system are also naturally rapidly dividing and so are inadvertent targets of chemotherapeutic therapy
• cells such as WBCs, including lymphocytes and phagocytes, are destroyed by these medications; this results in a decrease in the number of circulating lymphocytes and phagocytes
• the medications cause general immunosuppression b/c remaining lymphocytes are unable to release antibodies and lymphokines, which are substances that bind to receptors on target cells, facilitating a directed immune response

Question 7

Pathophysiology: Immunosuppressive Therapy

Answer 7

ex: corticosteroid
- is used to treat autoimmune disorders or prevent transplant rejection by specifically targeting the immune system
- the immunosuppressive medications interfere with cell-mediated immunity or the production of antibodies (humoral)
- in addition, corticosteroids have an anti-inflammatory effect (stabilizing blood vessel membranes, decreasing permeability, and blocking the movements of neutrophils and monocytes)
- immunosuppressive effects include decreased T cells b/c corticosteroids keep T cells in the bone marrow; results in the suppression of cell-mediated immunity and lymphopenia as well as a decrease in the inflammatory response
- also a decreased IgG production and decreased antibody-antigen binding

Question 8

Medical Management

Answer 8

management is primarily prevention

• good hand washing
• avoiding contact with people who have obvious infections, such as a cough or cold
• regular follow-up with a provider
• prompt action with any signs of infection, such as fever, chills, or cough
• any signs of UTI (difficulty upon urination, bloody urine, or lower back pain) should be reported

Question 9

Nursing Assessments

Answer 9

• Vital Signs

- Signs of Infection

Question 10

Nursing Assessments: Vital signs

Answer 10

• increased temperature, hypotension, and tachycardia = infection
• temperature increases in an attempt to kill organism
• hypotension results b/c increased permeability causing fluid shifts and dehydration
• tachycardia results in attempt to compensate for the hypotension

Question 11

Nursing Assessments: Signs of Infection

Answer 11

> Monitor WBC and differential
-increased WBCs and leukocytes are part of the body’s
natural response to infection

> Breath sounds
-decreased or adventitious breath sounds may be present with a respiratory infection

> Urine
-cloudy or foul-smelling urine may = UTI

> Skin
-skin rashes or lesions = skin infections, which may occur with immunodeficiency

Question 12

Nursing Actions

Answer 12

> Practice good hand washing
-first step in the prevention

> Treat infection with antibiotics or antivirals as ordered
-antibiotics or antivirals specifically targeting the organism help control the infection

> Anticipate changing or discontinuing the immunosuppressive medication if possible

• with a change in medication, the cause of secondary immune deficiency is removed
• this is considered only if the infection is deemed a greater risk than the primary problem being treated with the immunosuppressive medications

Question 13

Teachings

Answer 13

> Avoid crowds or large gatherings, and avoid exposure to anyone with a obvious illness

> Do not change cat litter boxes
-litter boxes expose the patient to toxoplasmosis

> Avoid Turtles and Reptiles as Pets
-they carry diseases and bacteria such as salmonella

> Eat a low-bacteria diet; avoid salads, raw fruits and vegetables, and undercooked meat, fish, and eggs
-these foods can carry bacteria that can cause infection

> Report Any of the Following:

• temperature greater than 100 Degrees F
• cough
• cloudy urine
• any drainage from a wound

Question 14

Evaluating Care Outcomes

Answer 14

well-managed patient has a good understanding of the immune disorder and accompanying risks

• patient takes all appropriate precautions, practices good hand washing, and knows when to contact the provider
• if an infection does occur, it is treated with the appropriate antibiotic or antiviral therapy