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This chapter is from the book

This chapter is from the book

Key Concepts

This chapter discussed immunologic disorders. The nursing student should use these key concepts to answer questions as they relate to the care of this client. Remembering the pathophysiology of the disease process, the treatment, and the laboratory values will help you to be able to answer questions in the physiologic integrity portion of the NCLEX exam.

Key Terms

  • AIDS
  • Clinical categories
  • ELISA
  • HAART (Highly Active Antiretroviral Therapy)
  • Helper T4 lymphocyte
  • Kaposi’s sarcoma
  • Nucleoside analog reverse transcriptase inhibitors
  • Opportunistic infection
  • Pneumocystis carinii pneumonia (PCP)
  • Polymerase chain (PCR)
  • Protease inhibitor
  • Retrovirus
  • Ribonucleotide reductase inhibitors
  • Standard precautions
  • Viral culture
  • Viral load
  • Wasting syndrome
  • Western Blot assay

Diagnostic Tests

The exam reviewer should be knowledgeable of the preparation and care of clients receiving exams to diagnose immunologic disorders. While reviewing these diagnostic exams, the exam reviewer should be alert for information that would be an important part of nursing care for these clients. The pertinent labs and exams are as follows:

  • Human Leukocyte Antigen (HLA)
  • Anti-DNA antibody testing
  • Erythrocyte Sedimentation Rate (ESR)
  • Serum complement levels
  • ELISA
  • Western Blot assay
  • Oral mucosal transudate test
  • Urine HIV antibody test
  • Rapid HIV antibody test
  • Home testing kits
  • Viral Load
  • Viral culture
  • CD4/CD8 counts + T cell count
  • Lymphocyte counts (WBC)
  • P24 antigen assay
  • Quantitative RNA assay: polymerase chain reaction
  • Biopsies for cancers
  • Pap smears for cervical cancer
  • Urinalysis
  • Chest x-rays
  • Sputum of lung secretions
  • Cultures and cell smears for other opportunistic diseases

Pharmacological Agents Used in the Care of the Client with Immunologic Disorders

An integral part of care to clients with immunologic disorders is pharmacological intervention. These medications provide an improvement of the clients’ endocrine problems. The nursing exam reviewer needs to focus on the drugs in Table 12.2. Included in this table are the most common drugs used to treat immunologic disorders. These medications are not inclusive of all the agents used to treat HIV and immune disorders; therefore, you will want to keep a current pharmacology text handy for reference.

TABLE 12.2 Pharmacological Agents Used in the Treatment of Clients with Immunologic Disorders

Drug Name

Action

Side Effects

Nursing Care

Nucleoside Analog Reverse Transcriptase Inhibitors

These drugs are used to treat viral infections such as cytomegalovirus, herpes simplex virus (HSV), and varicella-zoster. They inhibit reverse transcriptase.

Zidovudine (Retrovir, AZT) *Combivir is a combination drug containing AZT and 3TC

Drug crosses the blood-brain barrier, causing dizziness.

Assess for dizziness; check CBC, liver, and renal function; can cause bone marrow suppression.

Didanosine (ddI, Videx)

Could lead to peripheral neuropathies; food decreases absorption of the drug. Might suppress bone marrow.

Administer on an empty stomach; monitor hearing and vision as well as neuro-logical function. Can increase effects of allopurinol (Zyloprim), magnesium sulfate, aluminum antacids. Can cause GI symptoms, pancreatitis, stomatitis. Rash, myalgia, hypertension, palpitations, ear pain and photophobia.

Zalcitabine (ddC, HIVID)

Same as above plus avoid alcohol.

Same as above, plus assess liver function.

Lamivudine (Epivir, 3TC)

Same as above; plus can lead to pancreatitis.

Same as above, plus avoid fatty foods.

Stavudine (d4T, Zerit)

Same as above.

Same as above.

Abavir (Ziagen)

Flu-like symptoms might indicate hypersensitivity to the drug. Stop drug and inform doctor immediately.

Same as above, plus assess for flu-like symptoms.

Non-Nucleoside Analog Reverse Transcriptase Inhibitors

These drugs inhibit synthesis of the enzyme reverse transcriptase.

Nevirapine (Viramune)

May cause headaches and arthralgia.

Do not give with antacids because they decrease the effectiveness of the drug.

Efavirenz (Sustiva)

Drug crosses blood-brain barrier.

Drug can lead to head-aches and vivid dreams.

Same as above.

Delavirdine (Rescriptor)

Could cause headaches and hives.

Keep in cool location because heat deteriorates medication.

Protease Inhibitors

These drugs work to block the HIV protease enzyme and to prevent viral replication and release of viral particles.

Saquinavir (Invirase)

Take with a high-fat, high-calorie meal for maximum effect.

Teach the client to avoid the sun because the medication could cause sun sensitivity.

Indinavir (Crixivan)

Administer on an empty stomach. Teach the client that taking on an empty stomach increases absorption. Could cause hepatotoxi-city.

Ritonavir (Norvir)

Drug could cause diarrhea and increased blood glucose levels.

Administer with food. Monitor blood glucose levels.

Nelfinavir (Viracept)

Same as above.

Same as above.

Amprenavir (Agenerase)

Same as above.

Same as above.

Lopinavir (Kaletra, ABT-378/r)

Same as above.

Same as above; do not give to clients with allergies to sulfonamides.

Ribonucleotide Reductase Inhibitors

These drugs interfere with DNA synthesis and help to stop viral replication.

Hydroxyurea (Hydrea)

Monitor CBC because drug could suppress bone marrow function.

Teach the client to report extreme fatigue.

Entry Inhibitors

Prevents the virus from fusing with the inside of a cell.

Enfuvirtide (Fuzeon, T-20)

Local reactions at the injection site. GI upset and diarrhea.

Monitor the injection site for nodules, errythema, and purities at the injection site.

Drugs Used to Treat Pneumocystis Carinii Pneumonia (PCP)

Trimethoprim/ sulfamethoxazole (Apo-Sulfatrim, Bactrim, Cotrim, Septra), metronidazole (Flagyl)

Could lead to nausea, vomiting, hyponatremia, rashes, fever, leucopenia, thrombocytopenia, and liver problems. Taking Flagyl with alcohol causes extreme nausea.

Should be given either prophylactically to prevent PCP or to treat. Do not take Flagyl with alcohol.

Pentamidine isethionate (Pentacarinate, Pentam)

This drug is given prophylactically for clients with a CD4+ count less than 200 and those with PCP.

Usually given IV, IM, or may be given in an aerosol prepa-ration. Should be given with a bronchodilator to prevent bronchospasms.

Narcotics/Analgesics Examples: morphine sulfate, meperidine (Demerol), hydrocodone (Lortab)

These drugs are used to treat myalgia and pain associated with AIDS.

Monitor for respiratory depression and oversedation.

Anticonvulsants Examples: phenytoin (Dilantin), fosphenytoin (Cerebyx), phenobarbital

These drugs are used to treat seizure disorders related to neurological effects of AIDS.

Monitor CBC; monitor for respiratory depression; oversedation. Dilantin could lead to gingival hypertrophy. (See Chapter 11, “Care of the Client with Disorders of the Neurological System.”)

Drugs Used to Treat Fungal Infections Fluconazole (Diflucan) for cryptococcosis Ketoconazole (Nizoral) for histoplasmosis Nystatin (Monistat) for vaginal yeast infections * Unresolved vaginal yeast infections may indicate infections with HIV.

These drugs can cause nausea and vomiting.

Monitor CBC.

Drugs Used to Treat Tuberculosis Pyrazinamide (Tebrazid), isoniazid (Laniazid)

See Chapter 5, “Care of the Client with Respiratory Disorders.”

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