Class notes
Adult health 2 final
- Course
- Adult Health 2
- Institution
- Rockhurst University
Lecture notes of 15 pages for the course Adult Health 2 at Rockhurst University (Final study guide)
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Adult Health 2 Final
Immunodeficiency Disorders: Primary
Rare; genetic cause (male to female 5-1)
Usually diagnosed in infants/toddlers – some adolescence/young adults
Often accompany autoimmune disorders
Common Types
-
Antibody deficiency, Phagocytic dysfunction, B or T cells defects (or both), Complement system deficiency
Clinical Manifestations
-
Severe/recurrent infections, failure to thrive or positive family history
Medical Treatment
- Antibiotics (infection/prophylactic), IVIG or SQ, Hematopoietic stem cell transplant (curative), no live
vaccines, genetic counseling
Immunodeficiency Disorders: Secondary – Acquired Immune Deficiency not born
with !
Etiology
- Result of underlying disease processes or treatment, neutropenia = high risk for sepsis
o WBC < 1000/mm3 (5000-10000mm3) = NEUTROPENIC
Causes
- Autoimmune disorders, immunotoxic medications (corticosteroids, NSAID, chemo), alcoholism, drug abuse,
spleen removal, malnutrition/stress, HIV
Diagnostics – WBC/diff: severe neutropenia, bone marrow biopsy
segstbands
Treatment bandemia - > 10 %
- Infections, intravenous immunoglobulin (IVIG), hematopoietic stem cell transplant, monoclonal antibody
not curative
therapy (target antibodies to specific antigens), growth factors (neupogen) -
increase
of WBC
production
Assessment/Data Collection
- History – past infections, treatment response; nutritional status, hygiene, use of alcohol/drugs/tobacco
- Physical: manifestation of infection – patients do not have typical manifestations of infection
- Monitor: manifestations of infection – VS, lab values, C&S reports from wound, sputum, urine, blood
Diagnosis
- Ineffective protection, risk for infection, risk for impaired skin integrity, ineffective health maintenance,
imbalanced nutrition, social isolation, fear related to threat to well-being
Patient Teaching
- Prevention of infection – handwashing, avoid crowds/infections, hygiene and cleaning home wash raw fruits a veggies
- Lifestyle modification to reduce risk
- Nutrition and diet
Nursing
- Neutropenic precautions, manifestations of infection, medication teaching (prophylactic med regimen),
follow-up care
Immunodeficiency Disorders: Secondary – HIV
Pathophysiology
- Retrovirus: intracellular parasite
, - HIV targets cells with CD4 receptors (special T cells)
- Complex life cycle that turns the host cells into “factories” for HIV
↑ Staging CD4 -500 - 1000
normal
- Stage 1: Category A
o Primary infection: rapid viral replication (1-3 weeks) – asymptomatic coldfin like symptoms
fine for years
then feel
- Stage 2: Category B
o HIV symptomatic: CD4 <200 – AIDS begins
- Stage 3: Category C
o Severe AIDS-CD4 <100 – opportunistic diseases
Risk Factors
- Sharing infected injection drug use equipment, sexual relations with infected individuals, infants born to
mothers with HIV infection or breastfed, HIV infected organs or blood
Lab Tests for Diagnosing and Tracking
Nurses Role: HIV Screening Process
- Pre and posttest counseling, sequence due to “Window Period”
o Retesting essential at 3 weeks, 6 weeks, and 3 months
o 3 weeks-3 months between infection with HIV and seroconversion (production of antibodies
against the virus)
o
HIV screening may be negative if done early
Nursing: Counseling
- Focus on client’s unique circumstances/risks, acknowledge and support for positive steps already made,
enhance of self-perception of risk, use explicit language, help client set goal to reduce chance of
acquiring/transmitting HIV, avoid providing unnecessary information, safe sex practices
Gerontology Considerations
- Reasons: unprotected sex, don’t consider themselves at risk, social bias towards homosexuality, current or
past IV drugs (share needles), received HIV-infected blood before 1985, reduction in immune system
Medical Care
- Goals
o Antiretroviral therapy (ART) – to suppress virus, prevent or decrease complications, monitor
disease progression and immune function, manage symptoms, prevent dev. of opportunistic
disease (detect and treat), prevent transmission of HIV
- Goals of ART
o Suppress HIV replication/prevent drug resistance, reduce morbidity and prolong duration/quality
of survival, restore and preserve immunologic function, suppress plasma HIV viral load, prevent
HIV transmission (ART is now recommended for all HIV-infected patients regardless of CD4
count)
PrEP Medication
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