Med-Surg · chapter 29 · Immunological Function
Immunodeficiency
The 13 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 3 practice questions with the reasoning.
Key points
Immune defense impairment
As such, immunodeficiency disorders impair the immune system’s ability to defend the body against foreign invaders. They may lead to infections that develop and recur often and that are typically more severe and longer lasting than usual.
Primary onset and rarity
These disorders typically become evident during infancy or childhood, but some may not be recognized until adulthood. There are more than 100 primary immunodeficiency disorders, and all are quite rare.
B-cell deficiency infections
If there is a problem with B cells, a person has a high susceptibility to pneumonia, otitis, and other infections caused by extracellular bacteria.
Primary clinical manifestations
Clinical manifestations of primary immunodeficiencies include infections with opportunistic or unusual organisms, persistent infections despite aggressive treatment, failure to thrive, and a positive family history.
Humoral diagnostic tests
A complete blood cell count with manual differential can reveal abnormal levels of serum IgG, IgM, and IgA. Antibody responses to vaccines should also be evaluated to detect a humoral immunodeficiency.
Live vaccine contraindication
Live vaccines are contraindicated in patients with antibody deficiencies because their bodies may not be able to defend against the weakened form of the virus in the vaccine.
Preventing infections
To prevent infections in those with immunodeficiencies, the nurse should educate the patient to perform good oral hygiene, avoid eating undercooked food or drinking contaminated water, receive immune globulin treatments if ordered by the physician, and avoid individuals with infections (Fernandez, 2023).
HIV transmission routes
Human immunodeficiency virus is a blood-borne virus that may be spread by sexual contact, sharing needles, or accidentally sticking oneself with a needle previously used by an infected individual.
HIV immune destruction
This causes progressive destruction of the cell-mediated immune system and eliminates CD4 + T-helper lymphocytes. Eventually, HIV progresses into AIDS, especially if untreated.
AIDS infection risk
Characterized by extremely low levels of helper T cells, AIDS leaves the affected individual at risk for a range of life-threatening infections.
Pre-exposure prophylaxis
The use of pre-exposure prophylaxis, such as tenofovir disoproxil fumarate and emtricitabine, may be necessary for high-risk patients, for example, to reduce their chances of acquiring HIV if they are exposed.
Standard precautions
To reduce the risk of transmission of blood-borne infection, take standard precautions with any patient, regardless of their HIV status.
ART treatment goals
Antiretroviral therapy (ART) is a treatment designed to suppress HIV replication to reduce HIV-associated morbidity, restore and preserve immunological function, suppress plasma HIV viral load, and prevent HIV transmission.
Terms to know
- immunodeficiency
- The result of the malfunctioning of an underactive or weakened immune system is termed immunodeficiency.
- primary immunodeficiencies
- The primary immunodeficiencies generally are present at birth; they are genetic and usually hereditary.
- secondary immunodeficiencies
- Secondary immunodeficiencies generally develop later in life and are caused by another disorder or the use of certain medications, such as chemotherapy or corticosteroids.
- acquired immunodeficiency syndrome (AIDS)
- A well-known example is acquired immunodeficiency syndrome (AIDS), which is caused by the human immunodeficiency virus (HIV) (see 22.2 Viral and Fungal Infections).
- Human immunodeficiency virus
- Human immunodeficiency virus is a blood-borne virus that may be spread by sexual contact, sharing needles, or accidentally sticking oneself with a needle previously used by an infected individual.
- Antiretroviral therapy (ART)
- Antiretroviral therapy (ART) is a treatment designed to suppress HIV replication to reduce HIV-associated morbidity, restore and preserve immunological function, suppress plasma HIV viral load, and prevent HIV transmission.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
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Every question here, with the answer
At a 10:00 follow-up visit, a nurse reviews a patient’s established stage 3 HIV diagnosis. The patient’s CD4 count has increased to 500 cells/µL with therapy. Which entry best reflects the section’s guidance on staging?
- Stage 3 (AIDS); CD4 count has increased to 500 cells/µL with therapy.
- HIV stage undetermined; repeat CD4 testing needed before retaining the previous stage.
- Stage 1 (acute HIV); reclassified because the current CD4 count is 500 cells/µL.
- Stage 2 (chronic HIV); reclassified because immune function has improved with treatment.
Answer: Stage 3 (AIDS); CD4 count has increased to 500 cells/µL with therapy.
The section states that an increased CD4 count with therapy does not move a patient back to an earlier stage. Reclassification as stage 1 or 2 incorrectly reverses staging, while documenting an undetermined stage disregards the established stage 3 diagnosis.
During a 09:00 care conference, a patient with HIV reports difficulty paying for care and uncertainty about housing. The nurse is organizing the interdisciplinary plan by team member. Which assessment items belong in the social-work portion of the documented plan? Select all that apply.
- Potential interactions among the patient’s medications.
- Availability of support from family or other people.
- Stability of the patient’s housing.
- Financial resources available to support care.
- Dietary intake and nutritional status.
Answer: Availability of support from family or other people., Stability of the patient’s housing., Financial resources available to support care.
The section assigns assessment of financial resources, housing stability, and social support to social workers. Dietary intake and nutritional status belong to the nutritionist’s assessment, while medication-interaction monitoring is assigned to pharmacists and the medical team.
At 14:20, a nurse sustains a needlestick from a needle previously used on a patient and washes their hands. Which next action should the nurse take and then document?
- Arrange blood testing for the source patient and report the incident when the results are available.
- Take the first dose of antiretroviral postexposure prophylaxis and then report the incident.
- Review the source patient’s HIV status and report the incident if HIV infection is confirmed.
- Immediately report the incident to the facility’s infectious disease representative or as facility policy directs.
Answer: Immediately report the incident to the facility’s infectious disease representative or as facility policy directs.
The section directs immediate reporting after handwashing. Waiting for test results or confirmed HIV infection delays that response, while taking prophylaxis before reporting reverses the stated sequence. Source-patient testing when possible and prompt postexposure prophylaxis are additional measures, not replacements for immediate reporting.
Where every quote comes from
Section 29.3 Immunodeficiency of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.