Immune Function, Deficiency, and HIV/AIDS

• Immunocompetence, immune deficiency, and autoimmune disorders are all components of immune function and dysfunction.

Immune Deficiency Conditions

• Primary immune deficiency is an inherited genetic mutation.
• Acquired immune deficiency includes HIV and AIDS.

Therapeutic Immunosuppression

• Drug-induced immunosuppression needs a delicate balance between controlling the body's immune response and managing side effects.
• Therapeutic immunosuppression is used for organ transplant recipients, autoimmune disorder management, non-Hodgkin lymphoma, rheumatoid arthritis, and neoplastic growths.

Diagnostic Tests and Treatment of Immune Deficiencies

• Diagnostic tests - health history, current complaints or symptoms, and physical examination findings.
• Treatment - immune globulin (Ig), bone marrow transplant, Granulocyte colony stimulating factor (filgrastim [Neupogen]), and antimicrobial agents.

HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immunodeficiency Syndrome)

• HIV-1 and HIV-2 are types of retroviruses that use reverse transcriptase in their pathophysiology.

HIV Transmission

• The three highest risks for contracting HIV are unprotected sex with an HIV-positive person, sharing needles/syringes with an infected person, and maternal-fetal exposure.

HIV Exposure Prophylaxis

• Pre-exposure prophylaxis (PrEP) involves Truvada combined with safer sexual practices.
• Post-exposure prophylaxis (PEP) should be started less than 72 hours after exposure, it is more effective for single-episode exposures with an HIV-positive partner.

HIV Prevention

• Safe sexual practices include barrier protection and touch/intimacy.
• The risk of contracting HIV from blood transfusions, products, or donated organs/tissue is about 1 in 2 million.
• Clinical trials show promise for an HIV vaccine.
• Education can help achieve prevention.

HIV Signs and Symptoms

• Individuals may experience no symptoms or flu-like symptoms.
• Sentinel infections include oral thrush, recurrent infections, skin disorders, night sweats, swollen lymph glands, and significant unintended weight loss.

HIV Diagnosis

• Diagnostic tests include HIV-1 Test System, OraQuick In-Home HIV, enzyme-linked immunosorbent assay (ELISA), and the HIV-1 nucleic acid (NAT) test.

Management of HIV Infection

• For CD4 lymphocyte counts of less than 350 cell/mm³, antiretroviral therapy (ART) should be initiated.
• The World Health Organization (WHO) staging and antiretroviral drugs are key components.

HIV Stages

• First stage (Acute HIV infection) develops within 2-4 weeks with flu-like symptoms, high HIV levels, and negative antibody testing for about 1. 5 months.
• Second stage (Chronic HIV infection) is asymptomatic but can still be transmitted to others, often advancing to AIDS without treatment.
• Third stage (AIDS: Terminal stage) severely damages the immune system, leading to opportunistic infections and cancer; without treatment, life expectancy is about 3 years.

Opportunistic Infections

• Viral infections: herpes simplex virus type 1 and 2, varicella-zoster virus, cytomegalovirus, hepatitis.
• Bacterial infections: Mycobacterium tuberculosis and Mycobacterium avium complex.
• Fungal infections: Cryptococcosis, histoplasmosis, coccidiomycosis, candidiasis, and Pneumocystis jiroveci.
• Parasitic infections: Toxoplasmosis and cryptosporidiosis.

HIV: Other Complications

• Wasting syndrome.
• Neoplasms: Kaposi sarcoma and lymphomas.
• Neurologic complications.

Autoimmune and Autoinflammatory Disorders

• The immune system attacks the body's own cells in autoimmune and autoinflammatory disorders.
• These disorders can be local, systemic, or mixed.
• Autoimmune and autoinflammatory disorders include general signs and symptoms such as fever, fatigue, abdominal pain or digestive issues, swollen glands, joint pain, and swelling.
• Diagnosis includes health history, complete physical examination and blood tests.
• Treatment includes replacing or supporting lost body function and therapies to halt the destructive process.

Systemic Lupus Erythematosus (SLE)

• The body produces abnormal antibodies that attack the target tissues instead of foreign agents in SLE.
• Discoid, systemic, and drug-induced forms exist.
• SLE: etiology and pathophysiology - Abnormal reaction against proteins found in the nucleus of body cells, prolonged exposure to sunlight, and exacerbation by drugs.
• Signs and Symptoms Painful or swollen joints and muscle pain, extreme fatigue, unexplained fever, red rash usually on the face (malar rash or butterfly rash), Loss of hair, sensitivity to the sun, weakness and profound fatigue, mouth ulcers, poor appetite, weight loss, abnormal menses and edema and swollen glands.
• A diagnosis of SLE is confirmed when at least 4 of the 11 presented clinical presentations or laboratory test results are evident.
• There is no cure for SLE.
• Treatment is geared towards controlling symptoms or managing them to prevent exacerbations.
• Nursing considerations include caring for a patient with a low immune response, assessing the ability to participate in ADLs, pain management, assisting with mobility, providing education about the disease, and reviewing appropriate skin care.

Hodgkin Lymphoma

• Hodgkin Lymphoma etiology includes genetic, environmental, or genetic and environmental factors combined.
• The pathophysiology of Hodgkin Lymphoma includes Reed-Sternberg cells.
• Symptoms include lymphadenopathy, abdominal fullness, fatigue, night sweats, weight loss, and pruritus.
• Lymphoma is definitively determined by determining the presence of R-S cells.
• Treatment is dependent on the stage of the disease and may include chemotherapy and radiation. Nursing care focuses on the patient's symptoms and dealing with the side effects of the therapies.

Non-Hodgkin's Lymphoma (NHL)

• Non-Hodgkin's Lymphoma (NHL) is the seventh most common cancer in men and women.
• Incidence is higher in men than women.
• It is less predictable and tends to spread to other body sites more rapidly than HL.
• Symptoms of NHL include Unilateral, painless enlargement of a lymph node that may progress to generalized, painless lymphadenopathy, high fevers, chills, night sweats, weight loss, cough, dyspnea, chest pain, nausea, vomiting, a sense of fullness in the abdomen, and constipation, and hepatomegaly or splenomegaly.
• Aid in staging, CT, magnetic resonance imaging (MRI), PET, or ultrasound can be used.

Primary Lymphedema

• Primary lymphedema is an inherited form caused by a congenital condition in which there is deficient growth of the lymphatic system, especially in a lower extremity.
• Primary lymphedema chiefly affects females and most often becomes apparent during the middle teens to early 20s.

Secondary Lymphedema

• Secondary lymphedema is an acquired form caused by an obstruction caused by trauma to the lymph vessels and nodes.
• Can be caused by a Mastectomy with lymph nodes removed or an Extensive soft-tissue injury and scar formation Parasites that enter lymph channels and block them

Symptoms of Lymphedema

• Patients may present with a variety of symptoms, including a restricted range of motion; heavy feeling; aching discomfort; recurrent infections; and thick, hard skin.
• Treatment goals are to minimize the impact of the disease process on the individual.

Fibromyalgia

• Fibromyalgia is a chronic systemic pain and multiple symptoms that are not caused by another source or disease.
• Affects women 10 times more than men and seen in women ranging from 25 to 60 years of age.
• Stressors such as infection, trauma, drugs, hormonal influences, and psychological distress can trigger fibromyalgia and its related symptoms.

Symptoms of Fibromyalgia

• The most common feature of the disorder is musculoskeletal pain.
• Hyperalgesia - heightened response to painful stimuli
• Allodynia-pain response to nonpainful stimuli

Allergy

• Allergy is an abnormal response to certain substances and is considered a systemic immune disorder rather than a localized one.
• Hypersensitivity reaction - Body’s excessive response to a normally harmless substance.
• Allergens can enter the body in several ways and can have either a local or a systemic effect.

Symptoms of Allergy and Hypersensitivity

• Itchy, red, watery eyes, Soft palate pruritus, clear rhinorrhea, sneezing, erythema, edema and dyspnea and wheezing

Allergy & Hypersensitivity Diagnosis

• Diagnosis includes the patient history of reactions, Radioallergosorbent test (RAST), skin scratch test, and patch test.

Anaphylactic shock

• IgE-mediated immune responses include allergic conjunctivitis or allergy-induced asthma.
• Non-IgE allergen Responses include: Lodine-based dyes for select radiologic studies & select narcotics such as morphine and vancomycin, especially if administered too rapidly.

Symptoms of Anaphylactic Shock

• Include Urticaria (hives), angioedema, Wheals, tachycardia, decreased pulses, and a rapid drop in blood pressure.

Treatment of Anaphylaxis

• Establish a patent airway, administer intravenous epinephrine, provide psychological support.