immunodeficiency problem

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immunodeficiency problem

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?  immunodeficiency problem
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?  immunodeficiency problem
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?  immunodeficiency problem

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  immunodeficiency problem
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  immunodeficiency problem