A client with chronic cirrhosis has esophageal varices.
It is most important for the nurse to monitor the client for the onset of which problem?

Choice A rationale:

Incorrect. Suppressor T-cells (also known as regulatory T-cells) play a role in regulating the immune response, but their proliferation is not the primary mechanism by which HIV suppresses the immune system. In fact, HIV can disrupt the function of suppressor T-cells, leading to an impaired ability to control immune responses.

Choice B rationale:

Incorrect. Cytotoxic T-cells (also known as CD8+ T-cells) are important for killing infected cells, but their deficiency is not the direct cause of immune suppression in HIV. However, HIV can indirectly lead to a deficiency of cytotoxic T-cells by disrupting their production and function.

Choice C rationale:

Incorrect. B-lymphocytes produce antibodies, and IgM is an early antibody produced in response to infection. However, an increase in B-lymphocytes and IgM is not characteristic of HIV infection. In fact, HIV can impair B-cell function, leading to decreased antibody production.

Choice D rationale:

Correct. HIV primarily targets and destroys helper T-cells (also known as CD4+ T-cells). These cells play a crucial role in coordinating the immune response by activating other immune cells, such as cytotoxic T-cells and B-cells. The depletion of helper T-cells leads to a progressive weakening of the immune system, rendering the body vulnerable to opportunistic infections and cancers.

Specific mechanisms of CD4+ T-cell destruction by HIV:

Direct infection and lysis: HIV can directly infect CD4+ T-cells and replicate within them, eventually leading to the death of the infected cells.

CD4+ T-cell apoptosis: HIV can induce programmed cell death (apoptosis) in CD4+ T-cells through various mechanisms, including the activation of pro-apoptotic pathways and the disruption of anti-apoptotic signals.

Immune dysregulation: HIV infection can also dysregulate the immune system, leading to chronic inflammation and immune activation. This can further contribute to CD4+ T-cell depletion and dysfunction.

Choice A rationale:

While teaching the client about infection prevention measures is important, it is not the most immediate priority in this situation. The client is already potentially contagious, and these measures may not be sufficient to prevent transmission if the client is not properly isolated.

It's crucial to remember that the client may be experiencing cognitive impairment due to illness, making it harder to fully comprehend and adhere to instructions.

Additionally, some clients may not have access to or be able to afford masks and hand sanitizer, potentially hindering compliance with these measures.

Choice B rationale:

Isolating the client is the most critical action to prevent the spread of COVID-19 to others. This includes separating the client from other patients, family members, and healthcare workers who are not wearing proper PPE.

PPE, such as gloves, gowns, masks, and eye protection, creates a barrier between the healthcare worker and the client, minimizing the risk of transmission via direct contact or droplets.

Proper isolation techniques include placing the client in a designated negative-pressure isolation room, if available, or designating a separate area within a multi-bed room.

It's essential to restrict the client's movement within the healthcare facility and limit visitors to essential personnel only.

Choice C rationale:

Reporting the COVID-19 result to the local health department is important for tracking and managing the spread of the virus; however, it is not the most immediate priority in this situation.

The priority is to prevent further transmission by isolating the client.

Choice D rationale:

Counseling family members to monitor for symptoms is important, but it is not the most immediate priority in this situation. The priority is to prevent transmission by isolating the client.