NCLEX-PN Exam Prep: Care of the Client with Immunological Disorders
A number of body systems serve to protect the body against pathogens. These include the skin, mucous membrane, cilia in the lungs, saliva, hydrochloric acid in the stomach, flushing action of urinary flow in the renal system, and lower pH in the reproductive system. When there is a threat to the normal cellular function, the immune system responds. Those individuals with altered immune systems should be taught the benefits of adding foods such as fruits and vegetables, especially those that are high in antioxidants.
Hypersensitivity is an exaggerated immune response by an otherwise normal immune system that is caused by exposure to medications, pet dander, foods, or other allergens. When exposure occurs, the body responds with bronchial spasms, wheezing, rhinorrhea, and urticaria. Treatment of allergies includes the use of antihistamines such as diphenhydramine (Benadryl), cetirizine hcl (Zyrtec), Loratidine (Claritin), steroid preparations, and others. Immunoglobulin titers and skin testing can be done to determine the degree of response and the allergen responsible for the reaction.
There are other types of reactions. The Gell and Coombs Classification of Hypersensitivity Reactions is a method of classifying allergic response into four types of reactions:
- Type I: An allergic response, it can be immediate or a cumulative response. Examples of Type I are allergies to pet dander.
- Type II: Cytotoxic and cytolytic response, in which the production of autoantibodies results in the client’s cells and tissues being destroyed. Examples of this type of response include Goodpasture’s syndrome.
- Type III: Antigen-antibody complexes. Examples of this type of reaction include systemic lupus erythematosus and rheumatoid arthritis. See Chapter 14, “Care of the Client with Musculoskeletal and Connective Tissue Disorders,” for a discussion of lupus erythematosus and rheumatoid arthritis.
- Type IV: Delayed hypersensitivity reaction, which involves T-lymphocytes. Examples of this type are graft rejection, reaction to plant proteins such as poison ivy, and exposure to tubercle bacilli.
See other chapters that are specific to these disorders for treatment.
Immunodeficiency syndrome occurs when there is a failure of the body’s ability to fight infection. This syndrome can be a result of either a genetic disorder or infection with a retrovirus.
The client with immune disorders often presents to the doctor with signs of multisystem involvement. The cause is usually unknown and the infections are difficult to control. Iatrogenic causes of immunodeficiency might be secondary to other diseases, such as cancers, or could relate to treatments that suppress the normal function of the immune system, such as chemotherapy or radiation. Nurses dealing with clients who are immune suppressed must be aware of the dangers associated with disease transmission. Utilization of negative pressure rooms, isolation, handwashing, and sterile techniques help to prevent disease transmission. Room arrangement to avoid placing immune suppressed clients near clients with active infection, coughing, vomiting, or diarrhea are also necessary. When visiting several clients, the nurse should visit the immune suppressed client before visiting the client with infections.
Human Immunodeficiency Virus (HIV) leads to depletion of the CD4+ (T4) helper cells. This depletion causes an inability to fight off opportunistic infections. Infected CD4+ (T4) helper cells are targeted by Human Immunodeficiency Virus CD8+ killer cells. Acquired immune deficiency syndrome (AIDS) is caused by the HIV virus. AIDS was first identified in the 1980s and is believed to derive from infections found in the green monkey of Africa. It is thought that for some reason the virus mutated and became a virus that affects human beings. There are two types of HIV:
- Type 1 (HIV-1): Found in Western Europe and Asia
- Type 2 (HIV-2): Found in West Africa
HIV results in an abnormal cell that cannot fight infection. That abnormal cell duplicates, producing more of the virus. The result is a decrease in the helper cells and an increase in the suppressor cells.
Transmission occurs through sexual contact or parenteral or perinatal exposure to the retrovirus. Sexual contamination occurs when there is exposure of the mucous membranes to infected semen or vaginal secretions. Parenteral contamination occurs when needles or equipment is contaminated from infected blood or when the client receives contaminated blood products. Perinatal exposure occurs when the placenta is contaminated from contact with maternal blood and body fluids during birth or through breast milk from an infected mother.
Because the client is immune-suppressed, she is at risk for opportunistic infections. Some examples of opportunistic infections include the following:
- Candidiasis (If the client has persistent yeast infections, either vaginal or oral, that have been treated and are not responsive to treatment, the nurse should suspect that the client might be HIV positive.)
- Histoplasmosis (a fungal infection transmitted by bird feces)
- Pneumocystis carinii (caused by the protozoa jiroveci)
- Toxoplasmosis (transmitted by cat feces)
- Kaposi sarcoma
- Salmonella septicemia (transmitted through uncooked eggs or egg-laying animals)
- Herpes (transmitted by contact with lesions or blood)
- Mycobacterium (transmitted by droplets from the respiratory system)
- Wasting syndrome of HIV
- Cytomegalovirus (transmitted by blood and body fluids)
- Crytocococcoses (transmitted by inhaling the fungus into the lungs)
- Cryptosporidiosis (transmitted by contact with the parasite in the intestines)