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NUR 211 Immune Disorders Summary

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This is a comprehensive and detailed summary on Chapter 36 Immune Disorders.

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  • Chapter 36
  • October 19, 2024
  • 11
  • 2021/2022
  • Summary
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Chapter 36 Management of Patients with Immune Deficiency Disorder

Vocabulary:
 Candidiasis: fungal infection of the skin and mucus membranes that causes Candida species
 Enzyme immunoassay (EIA): blood test that can determine presence of antibodies to HIV in blood or saliva, a variant of
this test is called enzyme-linked immunosorbent assay (ELISA)
 HIV-1: retrovirus isolated and recognized as the etiologic agent of HIV disease
 HIV encephalopathy: clinical syndrome characterized by a progressive decline in cognitive, behavioral, and motor function
 Immune reconstitution inflammatory syndrome (IRIS): syndrome that results from rapid restoration of pathogen-
specific immune response to opportunistic infections
 Kaposi sarcoma: malignancy that involved the epithelial layer of blood and lymphatic vessels
 Latent reservoir: the integrated HIV provirus within the CD4+ T cell during the resting memory state, does not express viral
proteins and is invisible to the immune system and antiviral medications
 Mycobacterium avium complex (MAC): infection caused by mycobacterial organisms that commonly causes respiratory
illness but can also infect other body systems
 Opportunistic infection: illness caused by various organisms some of which usually do not cause diseases in normal
immune system patients
 Peripheral neuropathy: disorder characterized by sensory loss, pain, muscle weakness and wasting of muscles in the hands
or legs and feet
 Pneumocystis pneumonia (PCP): common opportunistic lung infection; pathogen implication is most commonly fungus
 Polymerase chain reaction: sensitive lab technique that can detect and quantify HIV in person’s blood or lymph nodes
 Post-exposure prophylaxis (PEP): taking antiretroviral medications ASAP, but not more than 72 hours after possible
exposure to HIV; 2-3 drugs are usually prescribed which must be taken for 28 days
 Pre-exposure prophylaxis (PrEP): prevention method for HIV-negative people who are @ risk for contraction, taking
specific combination of HIV medicines daily; use with condoms and other preventive tools
 Progressive multifocal leukoencephalopathy: opportunistic infection that infects brain tissue and causes damage to the
brain and spinal cord
 Retrovirus: virus that carries genetic material in RNA instead on DNA and contains reverse transcriptase
 Reverse transcriptase: enzyme that transforms single-stranded RNA into double stranded DNA
 Viral load test: measures the quantity of HIV RNA or DNA in the blood
 Viral set point: amount of virus present in the blood after the initial burst of viremia and the immune response that follows
 Wasting syndrome: involuntary weight loss consisting of both lean and fat body mass

Reading Notes:
Introduction
 Immune system protects against foreign substances, proliferation of neoplastic cells, and key role in inflammation and
healing

Primary Immune Deficiencies

 Majority of PIDDs are diagnosed in infancy with male to female ratio of 5 to 1
 Early adulthood diagnosis are frequently confounded by frequent use of antibiotics that mask symptoms

Pathophysiology
 More than 270 different genes are associated with PIDDs
 Prevent the body from developing normal immune responses resulting in numerous disorders with differing clinical
symptoms

Clinical Manifestations
 Multiple infections despite aggressive treatment, infections with unusual or opportunistic organisms, failure to thrive and
poor growth, positive family history
 Look at chart 36-1 on pg. 1023



Assessment and Diagnostic Findings
 Onset in delay between onset of symptoms and time of Dx of PIDDs

, Chapter 36 Management of Patients with Immune Deficiency Disorder

 Family Hx should be carefully checked because of genetic origins of PIDDs
 Lab tests are used to identify antibody deficiencies, cellular T cell defects, neutrophil disorders and complement deficiencies
 CBC with diff should be analyzed first
 Lymphopenia may indicate an immunologic abnormality; serum Ig levels and antibody responses to vaccines should be
assessed to detect a humoral immune defect
o Use age-matched normal ranges -> levels change as person ages

Prevention
 Live vaccines are contradicted in patients with antibody deficiency disorders -> unable to generate antibodies and live
substance in vaccine can cause death
 Prenatal testing should be done

Medical Management
 Indication for PIDD include unusually frequent and severe infections -> referral to immunologist
 Neutroepnic patients are at increased risk for development of severe infections
 Infection control -> emergence of multi-drug-resistant organisms
 HSCT is curative -> stem cells may be from embryo or adults -> toxicity and reduced efficacy are limitations
 Another therapy uses cells as vehicles for delivery of genes or gene products -> gene therapy -> many AE such as toxicity

Pharmacologic Therapy
 Depends on type and severity of presenting infections in the PIDD Dx
 PPx drug treatment can prevent some bacterial and fungal infections -> emergence of resistant organisms
 Patients with antibody deficiencies receive regular Ig replacement therapy including immunoglobulin IV (IVIG) and subQ
immunoglobulin (SCIG) to provide functional antibodies

Nursing Management
 Many patients have comorbid autoimmune disorders such as thyroid disease, RA, and IBD
 Many require immunosuppressant therapy to ensure engraftment is successful -> nursing care must be meticulous
 Hand hygiene and infection prevention look at chart 71-2 for methods of prevention
 Identify S/S of infection early
 Education for how to administer therapy @ home chart 36-1 pg. 1023

Acquired Immune Deficiency

 Can be acquired from chemotherapy treatment or from infection such as with HIV
 Prevention, early detection, and ongoing treatment are important aspects of care for patient living with HIV/AIDS
o PLWHA

HIV Infection and AIDS
 1st decade since detection focused on recognition and treatment of opportunistic disease and introduction of PPx against
opportunistic infections
 2nd decade had progress in development of highly active antiretroviral drug therapy (HAART)
 3rd decade focused on issues of preventing new infections, adherence to antiretroviral therapy (ART), development of 2 nd
generation combination medications that affect different stages of viral lifestyle, and continued need for effective vaccine
 HIV antibody test: enzyme immunoassay (EIA) or variant ELISA -> 1984 allowing for early Dx before onset of symptoms
 HIV is managed more as a chronic disease in outpatient setting while AIDS may involve acute conditions that require
hospitalization


Epidemiology
 Lab evidence is preferred overall clinical S/S
 HIV can be classified between 0-unknown stages
o 0 indicates early infection inferred from lab tests
o Stages 1, 2, 3 are based on CD4+ T-lymphocyte count
o Cases with no info on CD4+ T-lymphocyte are classified as unknown

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