Live With HIV

2006-07-22T05:55:00.000-07:00

Assessment

A. Observe for possible sites of infection.
1. IV sites
2. Catheter sides
3. Pressure points.
4. All body crevices.

B. Observe for sign of inflammation or systemic infection.
1. Changes in temperature-fever may be only sign since signs of inflammation may not appear due to diminished neutrophils.
2. Changes in whitw blood cell count and differential count.
3. Signs of inflammation: pain,redness, swelling and heat.

C. Assess lungs for adventitious sounds.

D. Assess nutritional status.
1. Calorie and protein intake to build immune system.
2. Adequate vitamins and minerals (iron and zinc) as well as vitamin C and vitamin A.

2006-07-21T06:27:00.000-07:00

Nursing Care for the Immunosuppressed Client

Etiology of imunosuppression
A. Tteatment drug protocols.
1. Cancer chemotherapeutic agents.
2.Antibiotic such as tetracycline,chloramphenicol, streptomycin, gentamycin inhibit cellular immunity.
3. Mafenide and silver sulfadiazine inhibit neutrophil movement to the area of infammation.
4. Steroids cause temporary lymphocytopenia, increase in neutrophils, decrease in monocyte and eusinophils.
a. Chronic use leads to nonresponsive immune system.
b. Anergy may lead to susceptibility to opportunistic infections.

B. Age- the older a client's chronologic age, the more susceptible to infections.

C. Acute and chronic diseases: AIDS, Cancer, Inflammantory boel disease, Diabetes.

D. Poor nutritional status.
1. Protein and calorie depletion lead to lympocyte suppression.
2. Iron deficiency causes atrophy of the liver, spleen and bone marrow, and lymphoid tissue.
3. Zinc deficiency affects thymus gland.

E. Surgery and anesthesia.

F. Stress, both specific and generalized.
1. Environtmental stress such as pollution, high intensity sound or noise may create stress that result in immunosuppression.
2. Sressful live events, such as loss of job, marriage or death, decrease immune function.

G. Psychiatric illness, especially major illness such as schizoprenia, depression or manic episode.

H. Lesions of the central nervous system, especially the hypothalamus, produce changes in the immune response.

2006-07-20T00:21:00.000-07:00

Cellular Immune Response

A. T cell are more complex and do not recognize free antigen as it circulates in the body.
1. T cells respond to an antigen only when they recognize the antigen, and, at the same time, recognize the host cell protein called MCH that has made its way to the surface of the cell.
2. When a T cell recognizes an antigen, it responds in several ways.

B. The T cells are composed of two major categories and four types of cells.
1. T4 is first category (30 percent of all T cells) and inludes killer or cytotoxic and suppressor cells.
a. The killer t cell destroys viruses, bacteria, and cancer cells trough contracting the cells, distrupting the cell membrane and finally destroying the entire cell.
b. suppressor T cells turn off the immune response by suppressing both the B and T cells several weeks after the infection has activated them. Without these cells, the immune response would always be mobilized.
2. T8, the second category (about 60-80 percent of T cells), includes helper and inducer T cells.
a. Helper T cells assist both other T cells and B cells. Helper cells recognize a specific antigen and allow killer cells to destroy cells bearing the antigen.
They assist b cells to secrete antibodies.
b. Inducer T cells trigger T lymphocytes to mature.
3. T cells all have specific function and each type carries "marker" protein on its surface.

C. Normal vs AIDS immune response.
1. In the normal immune system, proportion of killer/suppressor and helper/inducer T cells are evenly distributed.
2. AIDS patients show an acquired defect of immunity.
a. Helper T cells are depleted which causes a reversal of normal ratio of helper to killer suppressor T cells.
b. Patient cannot activate effective immune response either to foreign invaders or to cancer cells.
c. This deficiency leads to the majority of signs and symptoms observed in AIDS patients.

2006-07-20T00:05:00.000-07:00

Hummoral Immune Response

A. B cells function to produce antibodies called immunoglobulins (Ig). These proteins bind to antigen and aid in their destruction.
B. The primary immune response is when the B cell recognizes antigen in the blood or lymph, or on the surface off an infested cell.
1. With recognition, it becomes activated and there is a latent period before the appearence of the antibody.
2. The B cell divides into memory cells.
3. All subsequent cells have the antibody molecules on their membranes which make them capable of responding to the antigen in the future.
a. Membranes act as receptors for the antigen.
b. Large quantities of antibodies can be secreted into the blood stream when the antigen is next encountered.
c. These remain in a person's system for years and will respond if the antigen challenges the body in the future (secondary immune response).

2006-07-19T23:04:00.000-07:00

IMMUNE SYSTEM PHYSIOLOGY

A. A complex system of organs and cells that work to distinguish foreign invaders from natural component in the body.
1. Invaders or antigens can be organisms such as viruses, bacteria, fungi, parasites, tissue cells from smembranes provide the firs line of defense againts invading organism.
3. When a foreign organism enters the body, it may be destroyed by circulating white blood cells, macrophages and neutrophils-the second line of defense.
a. The macrophage white blood cells destroy any antigen or organism recognized as foreign.
b. The neutrophiles are mobilized when an antigen causes an inflammantory response.
c. This combination of white blood cells does not identify specific antigen, only specific foreign organism.

B. Immune response is triggered when an antigen has not been stopped or destroyed by the body's first and second defense system.
1. Lymphocytes then mobilize to defense the body againts invaders or antigen.
a. B cells (30 percent of blood lymphocytes) develop in the bone marrow.
b. T cells (70 percent of blood lymphocytes) originate in the bone marrow but complete development in the hymus gland.

C. The immune response has two major components: humoral (antibody) and cellular (cell mediated or delayed immunity).
1. The immune process takes places in the blood and fluid outside the cells (humoral) and inside or on the surface of the cell.
2. Humoral immune process involve interactions between antigens and antibodies.
3. Cellular or cell-mediated immune process involve interactions betweens antigen and certain specialized lymphocytes.
4. When antigens or foreign molecules enter the body and are not destroyed by the first or second line of defense, the immune system mounts a response specific to each antigen.

2006-07-19T13:09:00.000-07:00

AIDS: Theory and Nursing Care

This chapter provides you with background on one of the most critical health care problem facing our country today. The first section review immune system physiology to establish the foundation for understanding the HIV-1 infection.