Management of Immunocompromised Patients in Beginning I Essay

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  • Subject: Disease
  • Type: Essay
  • Paper: #85496540

Excerpt from Essay :

Management of Immunocompromised Patients

In beginning I writer specific nursing assignment. The Question: 2000 Words While clinical placement asked prepare a single room an admission. The patient requiring admission isolation room immunocompromised.

Immunocompromised patients usually require isolation in order to prevent them from becoming infected with infections from other patients which is known as protective isolation. For the immunocompromised patients, their immune system is unable to fight the infectious diseases. There are many diseases or conditions that lead to immunodeficiency in patients.

One is AIDS (acquired immunodeficiency syndrome). The pathophysiology of AIDS starts when the person's CD4+ T cell count begins to decrease as the disease kills these cells. This is HIV-induced cell lysis where the virus enters the CD4+ cells where it inserts its genetic information to the cell nucleus thus taking over the cell and replicating itself. The virus then mutates extremely rapidly thus making it more and more difficult for the body's immune system to respond against it. The period when the virus enters the body is the acute phase and it is characterized by rapid replication of the virus leading to an abundance of the virus in the patient's blood. Though the disease does not cause immunodeficiency during the acute phase, as the CD4+ count decreases, it leads to a gradual loss of the immune system's ability to generate new T cells which leads to a further decrease of the T cell numbers. The virus also destroys the CCR5 core-receptor which is expressed by the CD4+ cells leading to a loss of the CD4+ cells in the intestinal mucosa. However, the CD4+ cells in the mucosal tissues are only partially affected.

The second disease is Hepatitis C The Hepatitis C virus can be found in multiple sites in the human body including the liver, dendritic cells, epithelium and the CNS. The virus replicates quite fast in the hepatocytes through an RNA polymerase process that is RNA-dependent. Lymphocytes try to recognize the infected cells and to use an immune response to control the spread of the virus. However, the virus replicates faster than the immune system is able to response making the immune system unable to contain the viruses. This leads to the development of a chronic infection resulting from a hepatocellular carcinoma and liver cirrhosis. This may lead to liver failure.

Organ transplantation also leads to the patient being immunocompromised as a result of t-cell deficiency. Organ transplantation is a secondary or acquired cause of immunodeficiency which causes the number of T cells available for immune response to be low.

Processes in room preparation

In preparing a room for the patient, there are various general principles that should be taken into consideration. First is that the door to the patient's room should be kept closed at all times while preparing the room. This can be done by using a key to lock the room or using an automatic door that opens when the sensors detect a person approaching the door and closes after the person leaves the sensor region. The room may also be fitted with an extraction fan to ensure circulation of clean air. Unnecessary furniture should be removed from the room before the patient is admitted and it is important to ensure that the necessary items are available such as pedal bins and plastic bags for removal of waste. The room needs to be cleaned thoroughly using an antiseptic cleaning agent which kills pathogens in the room. All surfaces in the room need to be thoroughly cleaned including walls, windows, door, bed, bed rail, bedside equipment, surfaces, etc.

Since the patient is immunocompromised, it is important to use disposable aprons which will prevent transmission of infection. If these are not available, plastic aprons which are non-disposable may be used and these should be disinfected by use of heat or disinfectant. Gloves should be provided. Long sleeved disposable aprons are best since they provide maximum protection. Conventional non-sterile plastic gloves which are disposable may also be used if the long-sleeved type is not available. It is also important to ensure that there are sufficient masks for the health service delivery personnel Glauser & Pizzo, 2009()

The health service delivery personnel should be provided with signs to act as reminders for them to use protective equipment such as aprons, gloves and masks. They should also be reminded to wash their hands before and after contact with the patient in order to avoid any risk of infection. A non-medicated detergent or soap with antiseptic characteristics should be provided to help kill pathogens.

It is important to have proper waste disposal containers. For clinical waste, color-coded bags should be provided. Hardened containers that are sealed should be provided for needles and sharps. All reusable equipment should be disinfected before reuse. If possible, autoclaving should be used. The health delivery professionals should be provided with containers to place the used equipment before they are disinfected Bodey, 2010()

The linen should also be changed daily and dirty linen should be placed in a linen bag that is color-coded. Patient charts should be kept outside of the room to prevent contamination. Other supplies brought in for the patient such as food should be brought in sterile conditions Marrie, 2009()

Strategies to prevent transmission of infection

In order to prevent transmission of infection to the immunocompromised patients, it will be necessary for the nurses and other health care providers to assess the risk factors and conduct physical and diagnostic evaluations to identify the potential sources of infection. There is need to pay special attention to the conditions that are associated with increased risk of infection. The sources of infection will then be disinfected or eliminated completely Rutala & Weber, 2008()

The immunocompromised patients should also be given the 23-valent pneumococcal polysaccharide vaccine. This is for those above the age of 5. For those under the age of 5 years, they receive the 7-valent pneumococcal polysaccharide protein-conjugate vaccine. Other medication that should be given is trimethoprim-sulfamethoxazole so as to prevent Pneumocystis carinii pneumonia and broad spectrum antifungal drugs to protect against fungal infections such as oral candidiasis. Penicillin prophylaxis may also be given to the patient to prevent infection of pneumonia. This is particularly essential in those patients who are from a splenectomy or those who may be functionally asplenic Yokoe & Classen, 2008()

Other measures include restriction of visitors to the patient to only those who do not show any visible signs of any respiratory infection and other environmental interventions which include keeping windows and door closed, use of negative-pressure rooms and the use of HEPA (high-efficiency particular air) filters. Another important environmental intervention is avoiding flowers and plants in the patient's room as a result of the risk of Aspergillus infection. The patient may also be placed on oxygen and respiratory care through oxygen humidifiers or a mist tent.

Health education is also important in making sure that the patient takes the necessary steps in their own care. The patient should be educated to understand their condition and the importance of personal hygiene such as washing hands regularly and how they can monitor their vital signs and symptoms on their own. The patient should also be taught to avoid areas that are dirty, dusty and crowded. If possible, they should also avoid coming into contact with other sick people in order to reduce their chances of contracting these infections. The health care providers should also be educated on how to manage immunocompromised patients Streifel, 2007()

Equipment used in patient-care should also be handled with care. Equipment that is solved with blood, body secretions, excretions, and body fluids should be handled and disposed of with care in order to prevent contamination of the skin or mucous membranes, clothing, surfaces in the patient's room or to the environment in general. Reusable equipment should not be used to care for another patient unless it is properly disinfected Saiman & Siegel, 2008()

The health care professionals should exercise great care to prevent injuries when using sharp instruments such as scalpels and needles. They should also take care never to reuse sharps that have been used. One of the common causes of reuse of sharps is recapping of used needles and other sharps Rubin & Young, 2002()

Patient movement should be restricted only to times when it is absolutely necessary. This is in order to prevent the patient from coming into contact with sources of infection Agusti & Torres, 2009()

Care plan and important measures during assessment and management

Care of immunocompromised patients is delicate in the sense that they are susceptible to viral, fungal and bacterial infections. It is important that the patient's vital signs should be monitored regularly to make sure that any major changes in their condition are noted early in advance. This is important because the normal immune responses of the patients do not normally occur as a result of their immune system being compromised. Also, regular monitoring is important since the patients do not exhibit certain symptoms of common diseases. Fever…

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