Case Study, Chapter 36, Management of Patients With Immune Deficiency Disorders

Case Study 1: 

1. The nurse educator for an oncology unit is preparing an in-service presentation for new
nurses about the care of patients with immunodeficiencies. Patients with cancer who are
receiving chemotherapy, as well as those with bone marrow transplants, are
immunocompromised and require special attention to assess for signs of infection. The
nurse educator focuses on special care needs of this patient population. (Learning
Objective 4)

 1. What is the rationale for assessing the pulse and respiratory rates for 1 full minute in a
patient with immunodeficiency?

Continuous and carefully monitoring are vital in the care for immunocompromised patients, for
even the slightest change could be an early sign of infection—such as rapid pulse (tachycardia)
and rapid breathing (tachypnea). Assessing for the full minute assures the most accurate
measurement. Early detection is vital to the preservation on patients life.

 2. What special precautions about dietary restrictions and food preparation should be
included in the teaching for a patient with immunodeficiency?

-Maintaining nutrition is vital in caring for a patient with immunodeficiency. Mouth care before
and after meals. Small frequent feedings necessary

---soft foods, careful chewing to avoid altered mucosal lining. Moderate temperature to avoid
burning or freezing the mucosal lining.

--avoid uncooked fruits & vegetables, and those without peelable skin,

3. What nursing actions should be implemented to decrease the risk of infection in the
patient with immunodeficiency?

-Hand washing and infection prevention are vital.

-Meticulous care necessary: oral care especially. Assist patient in performing hygiene care, use
an electric razor and soft toothbrush.

-replace water bottle and equipment containers daily.

-Cleanses skin with Iodine before any venipuncture procedures. Change CVAD dressing (using
sterile technique) every 72-96 hours.
-Placing patient in private room.

-Ongoing patient education

Case Study 2:  

Josh Parsons, a 36-year-old patient diagnosed with leukemia, is immunocompromised. The

patient’s absolute neutrophil count is 750. The patient has a moderate risk for infection.
The nurse provides patient and family education on ways to decrease the risk for infection.
(Learning Objective 5)

1. What should the nurse include in the teaching session with the patient and family?

-Avoid visitors who have recently had an infection or vaccination.

-Educate importance of safe food handling and to avoid raw/fresh fruit and vegetables.

-Educate importance of meticulous hygiene practice and hand washing.

-Avoid crowds and large groups of people.

-Avoid potential trauma to skin and mucous membranes (creating a portal of entry) by using
electric razors, soft tooth brushes and using stool softeners to avoid straining and constipation.

2. The nurse is planning to provide education on HIV infection transmission and

prevention strategies at a local senior center. (Learning Objectives 3 and 4). What
should the nurse include in the session considering the needs of the older population?
a. There tends to be a stigma about older adults and that they are not still sexually
active, when truly many are. Not only are they still active, many are widowed
and divorced, leading them to explore and take on new partners.
b. Provide HIV prevention and education
c. Encourage and promote HIV testing
d. Provide resources for linkage to treatment and care for HIV infected older adults
e. Encourage practice of safer methods to prevent HIV/AIDS----condom education,
multiple partner risks.