Question

Case Study #6 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 0.66 mL/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.a.'s return visit for an injection, he complains of a stuffy nose. 10. What is your immediate concern?

Answer 1

1.Mr.T.Q can be honoured for his injection because he has a prescription from his physician. The thing at this stage to be done is to verify with his primary physician for the genuineness of the prescription and his actual condition.So a nurse has to inform this to the duty doctor who is responsible for verifying it.

W.Some of the essential components which has to be needed in the assessment are

• His past medical and surgical history
• Any allergy (medication and food)
• What repeated form of infection he gets and how he manages it
• His nutritional status
• His infection control practices

3.The patient who are having PIDD are highly prone for infection so a live attenuated vaccine like MMR should not be administered to trigger infection caused by the microorganisms present innthe vaccine. The other reason being he is in immunoglobulin therapy where it can fight infection and makes a MMR not necessary

4.Primary immunodeficiency are referred to genetic or congenital occurring from birth whereas secondary immunodeficiency refers to PIDD caused due to a environment,medications or any other disease