Immune Dysfunction And Hypersensitivity Reactions Discussion

Discuss characteristic findings of immune dysfunction for either hypersensitivity reactions or AIDS. Explain what symptomology the patient would exhibit and how these symptoms may complicate daily living and relationships.

CLASS COURSE BOOK

Cellular and Immunological Complexities

By Jeannie Randall

Essential Questions

What are the normal functions of the immune system?

What are characteristic findings of immune dysfunction, including hypersensitivity reactions, cancer, and AIDS?

What are supportive nursing interventions for patients suffering from immune dysfunction?

What resources should patients be linked to as they transition to

recovery?

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Introduction

The immune system is the body’s safeguard against pathogenic microorganisms. A healthy immune system allows the body to fight off invading microorganisms and prevent infection. Immune pathology occurs when the immune system stops functioning properly. Pathologies of the immune system may be caused by internal hypersensitivity reactions, microbial invasion of the immune system, or cellular mutations caused by cancerous cells. Nursing response to immune system disorders involves physical, spiritual, and psychosocial support to improve patient outcomes. This chapter will discuss normal and abnormal immune functions, nursing interventions, and patient education. Patient resources and linkage to care to promote restoration of health will also be explored.

Pathophysiology

Normal Function

Innate defenses of the immune system may be physical barriers, such as the skin and mucus membranes. Innate chemical barriers of the immune system include lysozymes found in bodily secretions and hydrochloric acid found in the stomach. Other innate defenses are antimicrobial cells, including phagocytes, lymphocytes, and the complement complex.

The complement system (see Figure 4.1) enhances the activity of antibodies and phagocytes. The complement system is comprised of small, inactive proteins that circulate in the blood. When stimulated by infection, enzymatic action cleaves these proteins, which causes a release of cytokine and starts a cascade of immunologic events. The result is the stimulation of phagocytes that engulf the invading microbes, an inflammatory response that attracts more phagocytes to the affected area, and the activation of the membrane attack complex (MAC), which ultimately kills the infected cell (Janeway, Travers, Walport, & Shlomchik, 2001).

Figure 4.1

Complement Complex

 Note. Adapted from Immunobiology: The Immune System in Health and Disease (5th ed.), by C. A. Janeway, Jr., P. Travers, M. Walport, & M. J. Shlomchik. New York, NY: Garland Science, 2001.

The inflammatory response is triggered upon invasion of pathogenic microorganisms. Inflammation occurs locally upon injury to tissue and includes activity of leukocytes, platelets, monocytes, basophils, and macrophages. This response is part of the immune system and may be innate or acquired. Acquired immune response involves humoral response of the B lymphocytes or cell mediated response of T lymphocytes (U.S. National Library of Medicine, 2018b) (see Figure 4.2).

Figure 4.2

Cell Mediated Response

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Abnormal Findings

When the immune systems do not function correctly, disease ensues. Different abnormal responses include hypersensitive response of the immune system and autoimmune responses (Merck, 2018). Nurses must be prepared to manage patient care holistically in response to disease and immune dysfunction. Immune dysfunction may present as hypersensitivity, anaphylactic shock, or some cancers.

Hypersensitivity

An exaggerated immune response that occurs on second and following exposures to an antigen is known as hypersensitivity. Hypersensitivity leads to inflammation and eradication of healthy tissue. This is also known as an allergic reaction. Allergic reactions can be immediate or delayed.

Hypersensitivity reactions are the result of complex immune responses involving degranulation of mast cells, which activates the release of histamine. Most hypersensitivity reactions are mild. Mild allergic reactions may present with itching, hives, watery eyes, rash, scratchy throat, and rhinitis (U.S. National Library of Medicine, 2018a).

Nurses must be aware of the signs and symptoms of anaphylactic shock, a life-threatening allergic reaction requiring immediate response. Common antigens that are associated with anaphylactic shock include certain foods, such as peanuts, tree nuts, dairy, eggs, and shellfish; environmental allergens, including mold, pollen, venom from insect stings; and certain medications.

Symptoms may include flushing, nausea, vomiting, fever, rash, hives, angioedema, feelings of impending doom, bronchospasm, back pain, and circulatory collapse (U.S. National Library of Medicine, 2018a).

Nursing Considerations

In the clinical setting, nurses must be aware of signs, symptoms, and appropriate response should a patient exhibit anaphylactic shock. If a nurse suspects an anaphylactic reaction, immediate steps must be taken. First, stop administration of any medications and alert the primary physician. Assess the patient’s vital signs, oximetry, and breath sounds. Prepare for emergency response, including administration of oxygen, IV fluids, and resuscitative medications: epinephrine IM or SQ, albuterol inhalant, corticosteroids, and antihistamines. It is common for facilities to have specific protocols in place with standing orders for intervention in the event of anaphylaxis. Nurses should familiarize themselves with their organization’s protocols. Patients with known allergies producing anaphylactic response are advised to carry an epi-pen. Nurses may be involved in patient education involving the use and storage of the epi-pen.

Cancer

Cancer arises when an unhealthy cell that should normally die and be replaced by new, healthy cells undergoes genetic changes causing the unhealthy cell to divide and multiply. As the unhealthy cells divide and multiply, they start to form masses of tissue known as tumors. Malignant tumors can spread to other parts of the body, including the blood and lymphatic systems, causing new cancers throughout the body. Nursing support of cancer patients is multifaceted and involves medical, psychosocial, and spiritual management.

Surgery is often categorical treatment for cancers that are contained within a specific body compartment. Surgery may also be performed for relief of symptoms when a tumor is causing pressure or pain (National Cancer Institute, n.d.) Surgery may be performed prophylactically for certain high- risk diseases, such as some breast cancers. Surgery may also be used to grade tumors. Tumors are graded as a 1-2-3-4, based on their rate of growth and level of abnormality.

The higher the grade, the more abnormal and rapidly growing the tumor is (National Cancer Institute, 2013). A small, incisional biopsy to collect tissue for microscopic examination can yield information as to the level of aggressiveness, or grade of a tumor. An excisional biopsy may be used to remove the entire tumor if the tumor is small or discovered to be benign.

It is not possible to accurately determine whether one will develop cancer. There are certain risk factors that increase the likelihood of the development of cancer. Genetic predisposition and age are risk factors that cannot be controlled. Other risk factors include alcohol and tobacco use, sun exposure, chemical exposure to known carcinogens, infection, obesity, diet, hormone use, and immunosuppression (National Cancer Institute, 2015).

Nursing Management

There are potential complications nurses will observe for with any postsurgical patient. Nausea and vomiting are common post surgically, with about half of postsurgical patients experiencing nausea, and 30% experiencing vomiting (Koutoukidis, Stainton, & Hughson, 2017). The postoperative nurse must be prepared to monitor for and control any nausea and vomiting, as it could delay discharge.

Patients should be monitored for urinary retention post surgically as anesthesia, anxiety, and pain can lead to retention (Baldini, Bagry, Aprikian, & Carli, 2009).

Patients should be encouraged to ambulate as soon as able to improve bladder function. Encouraging fluid intake, positioning patients in normal voiding position, and running water may help encourage micturition (Pavlin, Pavlin, Fitzgibbon, Koerschgen, & Pitt, 1999). Catheterization may be necessary as a last resort if the patient is unable to void.

Pain is often associated with recovery from surgery. Nurses must be ready to assess and manage for pain with their postsurgical patients. Often patients will be on an IV pain pump immediately following surgery. Oral and intramuscular pain meds may also be ordered upon discontinuation of the pain drip.

Nonpharmaceutical pain management, such as guided relaxation, soothing music, therapeutic touch, and TENS units, may be employed by nurses to help patients manage pain (Demir, 2012).

Nurses should assess postsurgical patients for any body image disturbances. Surgical treatment of certain cancers may involve removal of body tissue, such as in breast cancer. The alteration may cause anxiety, stress, and negative body image.

A negative self-image may have a negative impact on recovery from disease and surgery (Bolton, Lobben, & Stern, 2010).

Nurses can monitor a patient’s behavior and affect and communicate with patients for an overall sense of their well-being. If there is concern regarding negative body image, nurses can collaborate with the primary physician, surgeon, behavioral specialists, and other support to foster healthy response to bodily changes.

Pharmacological interventions, behavior modifications, or surgical corrections may be employed to restore or improve body image following surgical alterations.

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Negative Body Image

A female patient has just undergone a bilateral mastectomy with reconstructive breast surgery after a breast cancer diagnosis. In recovery, the nurse notes she is sobbing and emotional. The nurse offers comfort and encourages the woman to talk about her feelings. The woman has bandages and drains in place and expresses she feels disfigured and less of a woman.

The patient expresses she has more pain than she anticipated. The nurse educates her on the recovery process. The nurse explains that recovery will take several months, but the drains and bandages will be removed, and the soreness will resolve.

The nurse provides information on comfortable clothing, expectations of recovery, and pain management. Prior to discharge, the nurse equips the patient with resources to breast cancer support groups through the hospital and in the local community.

Deep vein thrombosis (DVT) is a potential complication of surgery for which patients must be monitored. Prolonged bed rest can cause pooling of the blood in the lower extremities that can lead to clots and DVT. Early, frequent ambulation as tolerated is recommended for the prevention of this. Nurses should routinely assess for pain, swelling, and positive Homan’s sign postsurgically.

Patients must be equipped to manage their recovery upon discharge. Nurses have an important role in this preparation. Home management may involve wound care, pain management, return to activity, monitoring for complications, and specialized care depending on type of surgery.

For example, patients recovering from certain colorectal cancer surgeries may return home with a colostomy. Nurses must educate patients on the proper care and treatment of this. Follow up is common in the home setting. The home health nurse can provide ongoing support, including ostomy care.

The home health nurse will be involved in routine assessment of the ostomy site to ensure proper healing. Ongoing education in the home setting can help the patient to become independent in ostomy self-care.

Nurses should be involved in educating the patient on pain management after hospitalization. Patients often will go home with prescription pain medications, and it is imperative they understand proper use of these medications to avoid overmedication and potential dependency. The patient should be educated on alternative pain management techniques, such as the use of TENS units, massage therapy, physical therapy, and relaxation techniques.

Biologic and Targeted Therapy

Chemotherapeutic agents target vulnerabilities in cancer cells and prevent growth and reproduction of such cells. Different chemotherapeutic agents affect different stages of cell reproduction and typically a combination of agents will be used in cancer treatment. Chemotherapy is often used as an adjunct to surgery or radiation (American Cancer Society, 2018).

Nurses administering chemotherapeutic agents via IV must be aware of the chemical properties and risks associated with the medications. Many chemotherapeutic agents have a toxic effect on tissue and great care must be made to identify and prevent extravasation of the IV.

Constant patient supervision is warranted during administration of IV chemotherapy to monitor for this. If extravasation is suspected, nurses must immediately stop the infusion. Elevation of the affected area is important if extravasation occurs. Signs and symptoms of extravasation include swelling and redness at IV site, absence of blood return from catheter, or resistance to flow.

Nausea and vomiting are common side effects of chemotherapy. Supporting medications, such as serotonin blockers, sedatives, and antihistamines, may be ordered to help prevent and alleviate symptoms of nausea and vomiting.

Patients should be made aware of the potential for this side effect and monitored and supported. Nurses should be assessing patients for episodes and timing of retching after chemotherapy. Intake and output should be monitored. The nurse should monitor the patient’s ability to eat.

Antiemetic medications may be prescribed prior to and directly after chemotherapy as prophylactic prevention of nausea. The nurse can employ nonpharmacologic interventions, such as guided imagery, relaxation techniques, and soothing music, to support patient comfort.

Patients should be educated about the potential for postchemotherapy nausea and vomiting, medications, and relaxation strategies prior to administration.

Personal safety of the nurse when handling chemotherapeutic agents is important. Gloves should be worn always while handling these medications. Care must be taken when handling all excrement from patients receiving chemotherapy. Equipment needs to be disposed of properly.

Chemotherapeutic agents can have a caustic effect on healthy tissue. Only registered nurses with specific, documented training in management of chemotherapeutic agents should administer chemotherapy.

Patient teaching is an important role for the nurse regarding chemotherapy. Patients need to be provided with realistic expectations. Patients should be informed on administration and potential side effects of the medications, expected course of treatment, and realistic expectation of outcomes.

Everyone will experience side effects of chemotherapy differently. As chemotherapy lowers the number of white blood cells, patients are at increased risk of infection. Patients should be educated on immediately reporting fever above 101 following chemotherapy. Patients should avoid anyone exhibiting signs or symptoms of common illnesses, such as cold or flu.

Some patients will experience flu-like symptoms, such as body aches and pains, up to 3 days following chemotherapy. Patients should be educated on the use of over-the-counter medications, such as ibuprofen or Advil, to manage this. Often, chemotherapy will result in fatigue.

Patients need to be encouraged to plan for this and balance activity and rest. Hair loss is an expected side effect of chemotherapy. Some patients may lose a small amount of hair, whereas others may lose all their hair. Linking patients to local resources for cranial prosthesis (wig) may alleviate stress involved with hair loss (University of California San Francisco, 2018).

Radiation Therapy

The use of ionizing radiation is introduced to impart energy into the cancer cell that causes molecular damage to cell DNA. Radiation is best suited to treat localized cancers, especially if the cancer is in a location difficult to reach by surgery, such as the brain. Radiation does cause irreversible changes not only in cancer cells, but also in healthy tissue.

Each individual has a maximum lifetime exposure to radiation that can be tolerated (American Cancer Society, 2010). Health care providers must be mindful as to any radiation exposures and take appropriate precautions to prevent exposure.

In areas where radiation will be used, personnel will wear protective gowns and equipment. Radiation therapy may be applied externally or internally using a radiation implant.

Nursing Considerations

With external radiation it is important to monitor the skin for any adverse reactions, such as blanching, erythema, or ulcerations. Any significant changes should be reported to the physician immediately. Patients should be taught to use only water when washing the affected area. Soaps, lotions, perfumes, and deodorants can be very irritating and damaging post radiation.

When internal radiation is used, it is imperative the patient be given a private room. Visitation needs to be limited to prevent exposure of others to radiation. Visitors should be instructed to sit at least 6 feet away from the patient. Patients will be instructed to remain on bedrest to prevent dislodging the implant.

Targeted Disruption

Genetic analysis has allowed classification of many cancers based on the range of mutations present in the cancer phenotype (Hoadley et al., 2014). This has allowed the manufacture of specific, targeted medications that impact specific markers in cancer cells.

These drugs are typically used in conjunction with conventional chemotherapy. Highly individual targeting of these drugs against specific cancer cells can decrease negative toxic effects associated with conventional cancer treatments, such as chemotherapy.

The nurse should be award that there are some side effects associated with targeted disruption (National Cancer Institute, 2018). These include diarrhea, elevated liver enzymes, interruption of blood clotting and wound healing, and hypertension.

Psychosocial and Spiritual Management of Cancer

Nurses are in a unique position to provide psychosocial and spiritual care for patients and families dealing with cancer. Nurses are at patients’ sides throughout their cancer journeys, from diagnoses, through treatment and outcome. The use of therapeutic communication to encourage dialogue with cancer patients cannot be overemphasized, but it is often unexplored.

Nurses can build trusting relationships with their patients to encourage verbalization of feelings and needs. Good psychosocial care has been shown to have a positive effect on physical symptoms, quality of life, and reduction of psychosocial distress (Ellis, Woodcock, Rawlings, & Bywater, 2006). Psychosocial care is delivered through building a trusting relationship with patients through supportive, caring, and nonjudgmental verbal and nonverbal communication.

The nurse’s relationships with patients will vary and should be individualized based on the patient’s needs. Nurses need to be aware of potential psychosocial effects of cancer, including alterations in body image, sense of desexualization, loss of control, potential fear of outcomes such as death, depression, and loss of self-esteem. Providing a platform for patients to verbalize fears, hopes, understandings, and lack of understanding allows the nurse to explore patient needs and link patients to appropriate care and resources.

Spiritual well-being is important for all patients and can present in many forms. Nonjudgmental exploration of a patient’s self of spiritual well-being is an important focus for the cancer nurse. Allowing patients to express their spiritual needs and beliefs can provide for exploration of feelings. Patients who are experiencing spiritual distress should be supported and linked to appropriate resources based on their specific beliefs and needs.

Figure 4.3

Holistic Approach of Nursing

Holistic Nursing Care

The nurse enters the room of a patient who has just been diagnosed with colon cancer. The cancer has not spread and can be treated by surgical intervention. The nurse notes the patient is shaking and teary. The patient’s husband is also visibly upset. The nurse takes a chair next to the patient and holds her hand.

After a few moments, the nurse asks the patient if she would like to discuss the diagnoses. The patient cries out: “Does this mean I’m going to die?” The nurse continues holding the patient’s hand and discusses how she understands this is frightening and overwhelming. The nurse shares with the patient some facts about her cancer and about the expected treatment.

Throughout the patient’s stay, the nursing staff can coordinate consultations with the surgeon, the gastroenterologist, and the entero-stomal nurse specialist to provide patient education and reasonable expectations. The patient and family are linked to a colorectal cancer support group.

HIV and AIDS

Acquired immunodeficiency syndrome (AIDS) is an immune deficiency caused by viral infection of human immunodeficiency virus (HIV). The HIV virus infects CD4+ lymphocytes, which are integral in the development of cytotoxic T-cells and plasma cells. HIV is a retrovirus, using RNA to carry its genetic code. HIV targets CD4 lymphocytes, inserting its genetic code into the infected cell, causing the infected lymphocyte to reproduce more HIV virus (U.S. Department of Health and Human Services, 2018a).

Figure 4.4

HIV Life Cycle

 The result is suppression of the immune response and a secondary immune deficiency that leads to the development of AIDS. As CD4 cells are depleted by the virus, immune response is dangerously weakened. This leaves the infected individual prone to many secondary infections and cancer, as the body can no longer fight opportunistic infections.

HIV can lay dormant in the system for months or years, meaning many infected individuals will have no signs or symptoms of disease for a long time. This is extremely dangerous, as an infected person with no knowledge of disease existence can transmit the virus to others through exchange of bodily fluids.

The Centers for Disease Control and Prevention (CDC) estimates by the end of 2015, 1,122,900 Americans were living with HIV, with 37,600 new infections in 2014 (CDC, 2017).

Stage 1 of HIV progression presents as nonspecific, flu-like symptoms. Typically, these symptoms will disappear within 1-6 weeks, and infected individuals may have no further symptoms for months to years. Not every infected individual will experience this.

Regardless of the lack of symptoms, the HIV virus continues proliferating within the immune cells. Stage 2 may last from months up to 10 years, with infected individuals displaying few to no symptoms. Stage 3 defines an immune system that is so badly damaged it can no longer fight off infection (AVERT, 2017). At this stage, individuals

will fall victim to many illnesses and disease. A Stage 3 diagnoses is made once the CD4 count falls below 200 cells/mm3 (U. S. Department of Health and Human Services, 2018e). Once it has progressed to Stage 3, the disease is very difficult to treat.

HIV is present in body fluids, including blood, semen, vaginal fluid, rectal fluid, and breast milk. Transmission can occur through unprotected sex, sharing needles, contaminated blood transfusions, breastfeeding, and from mother to baby during pregnancy. The CDC recommends all adults between the ages of 13 and 64 get tested at least once in their lifetime, and routinely if risk behavior exists (U.S. Department of Health and Human Services, 2018f).

Prevention of HIV involves avoiding contact with infected bodily fluids. Individuals should avoid unprotected sex with partners of unknown HIV status and be encouraged to use condoms. Expectant mothers who are HIV positive should be monitored closely throughout the pregnancy. While in utero, the unborn fetus is protected from HIV infection by the placenta.

Cesarean section is necessary to prevent transmission of the virus in the birth canal. The Department of Health and Human Services (2017) recommends all newborns of HIV positive mothers to be administered antiretroviral medications postpartum to prevent acquisition of HIV in the perinatal period. HIV positive mothers are to avoid breastfeeding as the virus can be transmitted through breast milk.

IV drug users must avoid sharing needles, as transmission of virus from infected blood through needle sharing is a possibility. Postexposure prophylaxis (PEP) is the administration of HIV medicines immediately after viral exposure to reduce risk of infection.

PEP is intended as emergency treatment and should not be used on a routine basis. PEP involves administration of at least three HIV medicines given for 28 days. PEP must be started within 3 days of exposure for maximum effectiveness (U.S. Department of Health and Human Services, 2018c).

Pre- exposure prophylaxis (PrEP) involves daily administration of specific HIV medications for individuals who are not HIV positive but are at high risk of exposure. PrEP has shown 90% effectiveness for the prevention of HIV contraction through sexual activity and 70% effectiveness for prevention of contraction through injection drug use (U.S. Department of Health and Human Services, 2018d).

There is currently no cure for HIV. Upon a positive diagnosis, infected individuals should be linked to care and treatment. HIV treatment involves the daily administration of a combination of antiretroviral medications and is known as antiretroviral therapy (ART). ART is important for preventing the spread of HIV, and all infected individuals should be on an ART regimen.

ART does not cure HIV, but it can delay and prevent the onset of AIDS. ART can keep viral levels low and help prevent the spread of HIV to others. ART consists of a combination of medications that prevent the HIV virus from replication. The HIV epidemic has resulted in much research and development of antiretroviral medications over the past few decades.

There are currently seven different classes of HIV medications that affect different stages of viral replication, and ART will typically involve administration of medications from at least two separate classes of drugs. Side effects and potential drug interactions depend on which medications a person is using.

Drug resistance can occur when the HIV virus mutates after exposure to HIV medication, rendering the medication no longer effective. It is imperative for infected individuals to be consistent with their regimen, as mutation and drug resistance is more likely with poor adherence.

Short-term side effects may include fatigue, nausea, vomiting, diarrhea, headache, fever, insomnia, dizziness, and muscle pain. If an individual experiences symptoms of anaphylaxis, such as swelling of the face, lips, or throat, immediate medical attention must be received.

Potential long-term side effects can appear months or years after undergoing ART. Examples of long-term side effects include kidney failure, liver damage, heart disease, hyperlipidemia, lipodystrophy, osteoporosis, and psychiatric effects (U.S. Department of Health and Human Services, 2018b).

Nursing Considerations

HIV prevention is an important focus for public health nursing. Education on transmission and prevention should be provided and ongoing in the community. There are government programs and funding available for free HIV testing.

For those known to be HIV positive, nursing case management should be employed to link individuals to appropriate care and treatment and support adherence to ART for the prevention of advancement to AIDS and lessened risk of further spread of disease.

The inpatient care of a patient with an AIDS diagnoses requires intensive nursing management. Hospitalization for management of AIDS typically marks a major psychosocial transition. The hospitalized patient may be confronted with life threatening realities, questions about their health care, increased dependence on care providers, loss of autonomy, and feelings of loneliness and helplessness (Agrawal, Jain, Agrawal, Singh, & Yadav, 2015).

If a patient has a CD4 count less than 200, the patient is at great risk of developing infection from opportunistic organisms (U.S. Department of Health and Human Services, 2018e). With a weakened immune system, infection control for the AIDS patient is of utmost importance. Nursing care includes meticulous adherence to infection control measures, administration of prophylactic medications, and patient and family education on hygiene and infection control.

Universal precautions should be employed by the nurse with all patients. Gloves, gowns, and masks should be worn according to hospital protocol for personal protection when encountering any bodily fluids. If a needle stick were to occur, the health care personnel should immediately report the exposure and undergo protocols which may include HIV testing and pre- exposure prophylaxis (PrEP).

Psychosocial and spiritual support of the patient should be individualized and supportive. Nurses may play a big role in providing nonjudgmental support and care. Interdisciplinary collaboration with social workers, spiritual counselors, and clergy should be encouraged and tailored to the individual.

As there is currently no cure for HIV, an HIV diagnoses may be daunting for

the individual. Strong psychosocial reactions, including fear, stress, and depression, are common among newly diagnosed patients (University of California San Francisco, 2017). It is imperative for patients to be supported psychologically during this time. Nurses can provide nonjudgmental support and therapeutic communication to allow exploration of feelings. Proper education on disease progression and management is imperative.

The Affordable Care Act includes provisions requiring job-based and private insurance companies to offer new benefits and protections for those living with HIV. Many insurance plans will cover ART, with corresponding deductibles and out-of-pocket expenses, as indicated by the individual plan.

There are also several government resources available to help patients cover the expenses of ART and ongoing medical care. Medicaid, which provides coverage for older adults, lower income individuals, and those with disabilities, does cover the expenses for many Americans living with HIV. The Ryan White program is available to those that do not otherwise have the resources to cover health care expenses of HIV treatment (U.S. Department of Health and Human Services, 2017b).

Caring for HIV Patient

A newly diagnosed HIV patient is admitted to the medical surgical unit to begin ART. The patient has a CD4 count below 200 but is not yet experiencing any signs of other infection. The patient is agitated and demanding answers. He asks the nurse if this means he can never engage in sexual activity again.

The patient is a 34-year-old, single, heterosexual male. He is unsure from whom he contracted the virus. He reports many different sex partners over the past years.

The nurse can gather informative pamphlets and media education from the hospital resources. The nurse spends time listening to the patient’s concerns and questions and equips the patient with supportive literature and reviews the literature with the patient.

The patient is also linked to a hospital nurse case manager who educates the patient on the disease, treatment options, medication side effects, importance of adherence to ART, sexual education on the prevention of spreading the disease, lifestyle modifications to include smoking cessation, safe sex practices, healthy diet, and exercise.

The patient is discharged once CD4 counts start to rebound. Upon discharge, the patient is involved in a community HIV support group. The patient is assigned a social worker and a nurse case manager to help monitor CD4 counts, adherence to medical management, and psychosocial support.

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Reflective Summary

A healthy immune system provides the human body a response mechanism with which to fight off pathogenic organisms. The immune system uses physical, chemical, and antimicrobial cells to fight off opportunistic microorganisms that can cause illness.

An abnormal or dysfunctional response of the immune system leads to disease. Nurses must be aware of normal and abnormal responses of the immune system and need to be equipped to handle a patient whose immune response is dysfunctional.

Nurses must be prepared to respond to physical, psychosocial, and spiritual needs of the patient experiencing disease because of an abnormal immune response to support the patient during illness, promote restoration of health, and cope with potential life-threatening complications.

Key Terms

Acquired Immunodeficiency Syndrome (AIDS): Advanced stage of HIV when HIV has been left untreated, immune system is damaged, and body is left open to opportunistic infections that may lead to death.

Anaphylactic Shock: A life threatening reaction to an invading antigen, resulting in extreme hypersensitivity response.

Cancer: Disease caused by uncontrolled division of abnormal body cells, causing growth of malignant tumors.

Complement System: A system of plasma proteins activated by pathogens, resulting in eradication of damaged cells and pathogens.

Cranial Prosthesis: Medically prescribed wig for hair loss of cancer patients.

Deep Vein Thrombosis: Clot formation in vein.

Human Immunodeficiency Virus (HIV): Sexually transmitted virus that can lead to acquired immunodeficiency syndrome (AIDS) if left untreated; characterized by the reduction in T cells within the immune system, leading to a severely compromised immune system.

Hypersensitivity: An exaggerated allergic reaction to allergens.

Immune System: The body system responsible for protecting the body from foreign substance invasion.

Membrane Attack Complex: Immune structure formed on the pathogen surface that allows immune protein entrance and exit to and from the pathogen, resulting in pathogen destruction.

Phagocytes: A cell of the human immune system capable of engulfing bacteria and other small pathogens.

References

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