Nursing Clinical Rounds

 

The immune system is a complex network that protects the body from infection and abnormal cells. When functioning optimally, it identifies foreign invaders and mounts a targeted response. However, in clients with immune disorders—ranging from autoimmune conditions to HIV/AIDS—this protective system becomes compromised or overactive. Nurses must be equipped to identify risks, collect relevant clinical data, and implement interventions that promote immune health, prevent complications, and support recovery. This discussion explores the immunity processes and evidence-based strategies for managing patients with altered immune responses.

Mr. Devon Lee, a 58-year-old male with a history of hypertension and type 2 diabetes, is admitted to the hospital with persistent fatigue, weight loss, and low-grade fever. His recent labs reveal leukopenia, a low CD4+ T-cell count, and positive ELISA and Western Blot tests, confirming HIV infection. He is started on combination antiretroviral therapy (cART). During his hospital stay, he develops oral candidiasis and a productive cough. The nurse assesses for signs of opportunistic infections and notes decreased appetite and mild confusion. In addition to managing Devon’s current symptoms, the care team must educate him on immune health promotion, monitor for complications, and initiate safety protocols to prevent infection transmission.

Choose ONE of the following topic areas and respond thoroughly:

1. The Immune Response in HIV and Other Conditions

Describe the process of immunity, including the roles of T cells, B cells, and antibodies.
How is the immune response altered in HIV, autoimmune conditions, or allergic reactions?
What are the clinical implications of these changes in nursing care?
2. Identifying and Assessing Immune Disorders

What clients are at higher risk for immune dysfunction, and why?
What assessment data (labs, history, symptoms) should the nurse prioritize for early detection?
How can nurses distinguish immune-related concerns from other health problems?
3. Promoting Immune Health and Preventing Infection

 

flares or severe systemic infection.Useful for tracking the severity of his current infection (e.g., pneumonia). 
Antibody Titers (ANA, RF, Anti-dsDNA)Used to diagnose and track autoimmune conditions. Antinuclear Antibodies (ANA) are common screening tests.Not relevant to his HIV diagnosis, but essential for suspected autoimmune disorders.

 

🗣️ Prioritized History and Symptom Assessment

 

Assessment CategoryKey Focus Areas (Red Flags)
Infection HistoryRecurrence and Severity: History of frequent, prolonged, or unusually severe infections. Opportunistic Infections (OIs): Presence of infections that a healthy immune system normally fights off (e.g., Pneumocystis pneumonia, oral candidiasis [thrush], unusual fungal or viral infections).
Systemic SymptomsConstitutional Symptoms: Unexplained, persistent low-grade fever, chronic fatigue lasting more than 6 weeks, and unintended weight loss (Mr. Lee's presenting symptoms). These often signal systemic inflammation or advanced HIV.
Autoimmune/Allergic SymptomsJoint and Skin: New onset of bilateral joint pain, redness, stiffness (autoimmunity). Respiratory/GI: Wheezing, shortness of breath, or new food intolerances (hypersensitivity/allergy).
Medication/Social HistoryImmunosuppressants: Current use of steroids, biologics, or chemotherapy. Risk Behaviors: Sexual, injection drug use (for HIV risk). Exposure: Travel history, occupational exposure.

Sample Answer

 

 

 

 

 

 

 

 

Identifying and Assessing Immune Disorders 🛡️

 

 

What clients are at higher risk for immune dysfunction, and why?

 

Clients with certain characteristics, comorbidities, and lifestyle factors are at a significantly higher risk for immune dysfunction. This dysfunction can manifest as immunodeficiency (e.g., HIV), autoimmunity (e.g., Lupus), or hypersensitivity (e.g., severe allergies).

High-Risk Client GroupReason for Increased RiskExample Condition
Elderly ClientsImmunosenescence: The thymus atrophies, leading to decreased T-cell production; T-cell activity is less vigorous; and the immune response is generally slower and less effective, increasing susceptibility to infections and cancer.Increased risk of pneumonia, influenza, shingles.
Clients with Chronic DiseasesChronic inflammation and metabolic stress (like in diabetes and obesity) impair T-cell function and leukocyte migration. Poorly controlled diabetes impairs neutrophil function and blood flow, hindering immune cell delivery.Mr. Lee (Diabetes, HIV): Impaired immunity due to both conditions.
Clients on Immunosuppressive TherapyMedications intentionally suppress the immune system to prevent organ rejection or treat autoimmune conditions, making the client highly vulnerable to infection. 

Aced Essays

Free Resources