Immunocompromise (HIV and AIDS, Oncology and Chemotherapy, Transplant Patient) for Certified Emergency Nursing (CEN)

Immunocompromise (HIV and AIDS, Oncology and Chemotherapy, Transplant Patient)

Definition/Etiology:

Immunocompromise – failure of absence of elements in the immune system. 

Can occur as primary or secondary (we usually see secondary in the ER). 

Primary – Born with it such as DiGeroge Syndrome

Secondary – Acquired such as HIV/AIDs, organ transplant, oncology with chemo. 

Neutropenic – WBCs <1,000

Pathophysiology:

• HIV/AIDs – disease process is to kill CD4 cells (which help with our immunity). HIV becomes AIDs when CD4 count falls below 200.
• Oncology/Chemo – chemo works to kill off fastest growing cells in the body (both good and bad) so also kills off any developing WBCs making the person immunocompromised
• Organ transplant – on immunosuppressant drugs to prevent organ rejection

Clinical Presentation:

• Usually present with secondary infections.
• Fever (maybe)
• Pain
• Low WBCs (less than 1,000)
• If organ transplant, pain at the transplant site.

Collaborative Management:

• Treatment based upon complaint
• Labs
• Neutropenic precautions
• Appropriate hand hygiene shown to be the most effective measure
• Limit the number of people in the room if possible.

Evaluation | Patient Monitoring | Education:

• Monitoring/Educate primary complaint
• In addition, maintain and educate on neutropenic precautions
• No fresh fruits or flowers

Linchpins: (Key Points)

• Immunocompromised with a fever = bad news
• Isolate
• Neutropenic precautions
• “No fresh fruits or flowers”