N512-19A Module Eight: Disorders of the Immune System Across the Life Span Discussion

N512-19A Module Eight: Disorders of the Immune System Across the Life Span Discussion N512-19A Module Eight: Disorders of the Immune System Across the Life Span Discussion Discussion 8 Derek Smith, a 31 y.o., Caucasian male injection drug user, who is homeless, presents to the ED with a chief complaint of shortness of breath. He describes a 1-month history of intermittent fevers and night sweats associated with a nonproductive cough. He has become progressively more short of breath, initially only with exertion, but now he feels dyspneic at rest. He appears to be in moderate respiratory distress. N512-19A Module Eight: Disorders of the Immune System Across the Life Span Discussion. His vital signs are abnormal, with fever to 39°C, heart rate of 112 bpm, respiratory rate of 20/min, and oxygen saturation of 88% on room air. Physical examination is otherwise unremarkable but notable for the absence of abnormal lung sounds. Chest x-ray film reveals a diffuse interstitial infiltrate characteristic of pneumocystis pneumonia, an opportunistic infection. In this discussion: Describe and discuss with your colleagues the underlying disease most likely responsible for this patient’s susceptibility to pneumocystis pneumonia. Describe and discuss the immunosuppression caused by this underlying disease. Describe and discuss the natural history of this disease and some of the common clinical manifestations seen during its progression. Describe your plan of care for this patient following his hospitalization (he will likely be admitted to the “medical respite floor,” of a local homeless shelter, which has the services of a Nurse Practitioner three times per week—with on-call weekend consultation, and a registered nurse, Monday through Friday). Include citations from the text or the external literature in your discussions. Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria. Permalink: https://nursingpaperessays.com/ n512-19a-module-…-span-discussion / ? Example Discussion 7 Approach and Responses – N512-19A Module Eight: Disorders of the Immune System Across the Life Span Discussion Pneumocystis pneumonia (PCP) is an infection caused by the fungus Pneumocystis jirovecii (Pneumocystis Pneumonia, n.d.) . People with a weakened immune system have more chances to get this infection. Disease like HIV/AIDS or medication such as corticosteroids that lower the body’s ability to fight against infection (Pneumocystis Pneumonia, n.d.) . PCP is a common life-threatening opportunistic infection in individuals with AIDS. When we consider Mr. Derek’s case, the patient is an IV drug user and homeless. HIV/AIDS could be the underline reason for PCP. Human immune deficiency (HIV) disease, characterized by progressive immune system impairment, destroys T cells and makes the patient more susceptible to infections and unusual cancers(Rebar et al., 2019). HIV is an RNA- based retrovirus that requires a human host to replicate. CD4 + cells (helper T cells) regulate cell-mediated immunity(Rebar et al., 2019). HIV destroys CD4+ T-cells. CD4+ antigen serves as a receptor for HIV and allows it to invade cells(Rebar et al., 2019). In untreated HIV infection/AIDS, a decrease in the number of CD4+ T cells occurs, and CD8+ T- cells increases.The virus replication within the CD4+ cells is causing cell death. HIV can affect almost any cell that has the CD4 antigen on its surface, including monocytes, macrophages, bone marrow progenitors, and glial, gut, and epithelial cells(Rebar et al., 2019). The human immune deficiency virus is responsible for HIV/AIDS. The course of the disease is varied. Many people with appropriate treatment live normal and longer. Others who do not seek medical attention die from opportunistic infections(Rebar et al., 2019). The average time frame between HIV infection and AIDS is ten years. Stage 1 is a primary infection; after initial exposure, a person can remain asymptomatic or may have flu-like symptoms(About HIV, n.d.). Flu-like symptoms include fever, chills, rash, night sweats, muscle ache, fatigue, swollen lymph nodes, and mouth ulcers(About HIV, n.d.). The stage is considered as chronic HIV infection, clinical latency, the patient may not have any symptoms or get sick during this phase. In untreated cases, the person moves to stage 3 AIDS, severe phase of infection, damaged immune systems, and develop opportunistic infections. The patient develops neurologic symptoms of HIV encephalopathy or symptoms of PCP, cytomegalovirus, and cancer. These symptoms include dyspnea, respiratory failure, hepatomegaly, splenomegaly, confusion, dementia, and seizure(About HIV, n.d.). The main diagnostic test has a window period. The nucleic acid test can detect HIV between 10- and 33-days post-exposure and the Antigen-antibody test can detect HIV between 18- and 45-days post-exposure(Rebar et al., 2019). A person should be tested after 90days of exposure to get a definitive diagnosis. The patient may also test for opportunistic infections. Opportunistic infections can cause reactivation of diseases such as syphilis, hepatitis B, tuberculosis, toxoplasmosis, and histoplasmosis(Rebar et al., 2019). The plan of care includes medical management and prevention of transmission. Prophylaxis treatment consists of Trimethoprim-sulfamethoxazole (TMP-SMX) for 21 days(Care of the AIDS Patient with Pneumocystis Pneumonia, n.d.). Corticosteroids also use in a patient with PCP have hypoxemia. The recommended dose is Prednisone 40 mg twice daily for five days, with a decreasing regimen followed for a total dose of 21 days(Care of the AIDS Patient with Pneumocystis Pneumonia, n.d.). Co-trimoxazole may be given PO or IV if the patient is hypersensitive to sulfa drugs(Rebar et al., 2019). Dapsone with Trimethoprim, clindamycin, atovaquone is also used. Prevention is a critical factor in controlling HIV/AIDS. Education and prevention materials are available to shelters through local agencies. These tools to educate how to prevent the transmission of HIV/AIDS(HIV/AIDS, n.d.). Mr. Derek is an IV drug user. Sharing needle is a standard mode of virus transmission. So, addiction treatment should be included in his care. Counseling helps to prevent further information on disease. Provide social support and educate the importance of taking medication for HIV/AIDS to prevent further progression of the disease(HIV/AIDS, n.d.). Antiretroviral therapy (ART) should be considered life long, and lifestyle changes are also significant(HIV/AIDS, n.d.). Any side effect or worsening of symptoms, a person should inform the physician. The physician should prescribe appropriate drugs for a homeless person. For example, avoid medicines that need refrigeration or require food for absorption(HIV/AIDS, n.d.). Instruct the patient do the proper follow-up care. References About HIV. (n.d.). Retrieved September 9, 2020, from https://www.cdc.gov/hiv/basics/whatishiv.html Care of the AIDS Patient With Pneumocystis Pneumonia. (n.d.). Retrieved September 9, 2020, from https://www.nursing.ceconnection.com/ovidfiles/00003465-200911000-00003.pdf HIV/AIDS. (n.d.). Retrieved September 9, 2020, from https://www.bhchp.org/sites/default/files/BHCHPManual/pdf_files/Part1_PDF/HIV_AIDS.pdf Pneumocystis pneumonia. (n.d.). Retrieved September 9, 2020, from https://www.cdc.gov/fungal/diseases/pneumocystis-pneumonia/index.html Rebar, C., Heimgartner, N., & Gersch, C. (2019). Pathophysiology made Incredibly Easy (6th ed.). Wolters Kluwer. 830 words Permalink In reply to Bincy Joseph Re: Discussion 8 by Lorri Rostetter – Wednesday, September 9, 2020, 10:03 PM Hi Bincy, Thanks for the great post! I learned more much more from your discussion post than I had obtained through my research for this discussion. I didn’t realize that opportunistic infections can cause reactivation of diseases such as syphilis, hepatitis B, tuberculosis, toxoplasmosis, and histoplasmosis, and that corticosteroids are used to treat hypoxemia. I thought your follow up care was very thorough. I would also add that in order to modify his behavior, D. S. should be given information regarding individual and small group therapy, along with community interventions. If ART is appropriate, a plan should be developed with the patient, ensuring close follow-up and communication after treatment is started, while monitoring patients who are currently abusing alcohol or drugs for missed appointments, poor adherence, or signs and symptoms of toxicity (Audain et al. 2013). He should also receive an influenza vaccine annually, along with hepatitis A and B vaccines, and should also be immunized against pneumococcus according to standard clinical guidelines. He will be offered tetanus, diphtheria, and pertussis (Tdap) vaccines, which is to be given to patients aged 19–64 if the last immunization was more than 10 years ago (Audain et al., 2013). Audain, G., Bookhardt-Murray, L.J., Fogg, C.J., Gregerson, P., Haley, C.A., Luther, P., Treherne, L., & Knopf-Amelung, S. (Ed). (2013). Adapting your practice: Treatment and recommendations for unstably housed patients with HIV/AIDS. Health Care for the Homeless Clinicians’ Network. https://nhchc.org/wp-content/uploads/2019/08/AIDS.pdf 247 words Permalink Show parent In reply to Bincy Joseph Re: Discussion 8 – N512-19A Module Eight: Disorders of the Immune System Across the Life Span Discussion by Lisa-Kay McColgan – Friday, September 11, 2020, 7:48 PM Dear Bincy, According to Spaan, van Leunen, Garnefski, & Kraaij, 2018, a person living with HIV is prone to mental health disorders. Approximately 34% of those living with HIV are depressed and about 28% suffer from anxiety (Spaan, van Leunen, Garnefski, & Kraaij, 2018). In addition, antiretroviral therapy non-adherence is also associated with mental health issues (Spaan, van Leunen, Garnefski, & Kraaij, 2018). I agree that Derek Smith would be an excellent candidate for psychosocial interventions at this time. In order to decrease the viral replication due to HIV, he will need to start antiretroviral therapy as soon as possible. Given his circumstances, it sounds as if he will need a great deal of assistance in order to accomplish so many obstacles. His chances of success will greatly improve with a good frame of mind. Lisa Reference Spaan, P., van Leunen, S., Garnefski, N., and Kraaij, V. (2018). Psychosocial interventions enhance HIV medication adherence: A systematic review and meta-analysis. Journal of Health Psychology, 25(10-11), 1326-1340. doi:10.1177/1359105318755545 164 words N512-19A Module Eight: Disorders of the Immune System Across the Life Span Discussion Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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