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Question
Lifelong Learning Is Opportunity At Its Best
PNR 201 MEDICAL SURGICAL NURSING I (January 08 - February 18, 2018)
Week 3 : The Immune and Lymphatic System
Case Study
Instructions
Case Study #1
Scenario
You are a nurse at a university health clinic. Twenty-year-old T.Q. comes in and informs you he is a new student
and he has an immunodeficiency problem. He gives you a letter from his attending physician, hands
you a vial of gamma globulin, and asks you to give him his "shot." The letter from T.Q.'s physician states
T.Q. was diagnosed with primary immunodeficiency disease (PIDD) at age 2. He has an adequate number
of B cells, but they fail to mature properly and become plasma cells or immunoglobulin. T.Q. states he has
a history of chronic respiratory and gastrointestinal infections. He is maintained on 0.66mL/kg of gamma
globulin (GamaSTAN) given intramuscularly every 3 weeks and has tolerated this well. He has no known
drug allergies (NKDA). His vital signs are stable.
1. Can you honor T.Q.'s prescription? Why or why not? How could you provide him with his injection?
2. While the provider is verifying the information, you place T.Q. in a treatment room and
obtain his permission to perform a history and physical assessment so the clinic has baseline
information. What essential components do you need to include and why?
3. You note on T.Q.'s health record that he has not received an MMR (measles, mumps, rubella)
vaccine. Why?
4. The provider receives confirmation from T.Q.'s physician that T.Q. has a PIDD and
orders the gamma globulin (GamaSTAN). Differentiate between primary and secondary
immunodeficiency.
5. . Explain why T.Q. is at greater risk for developing infections than his classmates.
6. What role does gamma globulin play in managing PIDD?
7. What questions would you ask T.Q. that would assure you the medication itself is safe to
administer?
8. Your assessment of T.Q. is unremarkable. After you administer the gamma globulin, you
assess T.Q.'s knowledge and give specific precaution instructions. What will you assess and
what precautions will you review?
9. Write a sample SOAP note documenting T.Q.'s visit to the clinic.
CASE STUDY PROGRESS
Several weeks later, on T.Q.'s return visit for an injection, he complains of a stuffy nose.
10. What is your immediate concern?
11. What assessment do you need to perform to evaluate his stuffy nose?
12. If T.Q. were developing a sinus infection, what manifestations would you likely see when
examining him?
13. 3. T.Q. denies any cough, headache, sore throat, fatigue, or muscle ache. T.Q.'s nares do not
appear swollen or red, although he does have some clear mucous drainage. External auditory
canals and tympanic membranes clear. There is no adenopathy or sinus tenderness, and
his lung sounds are clear to auscultation. Oral cavity and pharynx normal; there is no
inflammation, swelling, exudate, or lesions. Vital signs are 110/60, 76, 18, 98.4 ° F (36.9 °
C). Should you give the medication or ask him to return when he is no longer having nasal
stuffiness? Why or why not?
14. What do you need to teach T.Q. before he leaves the clinic?
15. Write a sample SOAP note documenting T.Q.'s visit to the clinic
Case Study #2
Scenario
You are working in a community health clinic and you have just taken C.Q., a 38-year-old woman, into
the consultation room. C.Q. has been divorced for 5 years, has two daughters (ages 14 and 16), and works
full time as a legal secretary. She is here for her yearly routine physical examination C.Q. states she is in a
serious relationship, is contemplating marriage, and just wants to make certain she is "okay." No abnormalities
were noted during C.Q.'s physical examination. Blood was drawn for routine blood chemistries
and hematology studies; since she has never been tested, C.Q. agrees to a human immunodeficiency
virus (HIV) test. The physician requests you perform a rapid HIV test, which is an antibody test. Within 20
minutes, the results are available and are positive.
1. Does a positive rapid HIV test mean that C.Q. definitely has HIV? If it is negative, does it mean she definitely does not have HIV?
2. . What counseling do you need to provide to C.Q.?
CASE STUDY PROGRESS
C.Q. returns to the clinic two days later. The physician informs you that C.Q.'s Western blot test results
confirm that she is HIV positive; he requests that you be present when he talks to her. Before leaving C.Q.'s
room, the physician requests that you give C.Q. verbal and written information about local HIV support
groups and help C.Q. call a friend to accompany her home this evening. She looks at you through her tears
and states, "I can't believe it. J. is the only man I've had sex with since my divorce. He told me I had nothing
to worry about. I can't believe he would do this to me."
Explanation / Answer
1. Yes , if we are instructed to administer as per the protocol of the clinic.In addition, his physician needs to be contacted regarding details of his previous shots, due dose or any other specific details. The on call doctor can be called in for any further clarification.
2.collect details regarding previous illnesses, health issues, and along with an assessment.
3.The vaccinations were probably not given as they can cause disease rather preventing them, moreover live vaccines can be a problem. Live vaccines also do not work with globulins.
4. Primary immunodeficiency is inherited genetically or is immune related whereas secondary is due to external conditions like HIV , burns and malnutrition.
5.TQ has compromised immunity placing him at an increased risk than his friends.
6. It helps in producing antibodies to fight against infection.
7. Assess the vial for any impurities or discoloration and ask him about how he stored the vial.
Scenario 2
1. Positive rapid test means HIV antibodies are present in the blood but needs to be confirmed with other supporting tests like Elisa or western blot. But for negative results it is necessary to repeat blood test as it may take from months to years for HIV antibodies to be present in the blood.
2. Counselling should be done on drug therapy, side effects of ART, prevention of transmission , safe sexual practices, encouraging to seek support from family and friends.
3.
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