N512 Disorders of the Immune System Final Project

Final Project

This assignment entails the development of a Power Point Presentation (PPP) on your choice of an immunodeficiency disease incorporating evidence-based practice literature and reliable electronic sources. The presentation shall include at least 10 slides, excluding the title and reference slides. N512 Disorders of the Immune System Final Project

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Submission Parameters:

Please use the following criteria to develop your PPP:

Introductory slide with at least 3 presentation objectives
Description of an immunodeficiency disease
A description of the disorder’s pathophysiology and clinical presentation.
A description of the associated laboratory, radiological, or other referral diagnostic tests required with supporting references.
Presentation of a comprehensive, holistic plan of care.
Conclusion
- Provide brief concluding statements
- List of References in APA format (6 references minimum)
- You are encouraged to use the Notes section associated with each slide to provide more extensive discussion/narratives of the slide content.

In regards to APA format, please use the following as a guide:

Use references throughout the Power Point Presentation
Apply appropriate spelling, grammar, and organization throughout the Presentation
Include a reference list at the end of the Presentation
Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. ANA)

Final Project Rubric – N512 Disorders of the Immune System Final Project

Criteria	60 Points	50 Points	40 Points	30 Points
Content – Accuracy	Provides an accurate and complete explanation of the diagnosis/disorder; its patho-physiology; clinical presentation, assessment processes, and plan of care, drawing exclusively upon relevant literature. N512 Disorders of the Immune System Final Project	For the most part, explanations of the diagnosis/disorder; its patho-physiology; clinical presentation, examination, assessment processes, and plan of care, accurate and complete, drawing mostly on the relevant literature.	–Explanations of the diagnosis/ disorder; its pathophysiology; clinical presentation, assessment processes, and plan of care, are too brief, making it challenging for the reader to comprehend the breadth and depth of the material presented.	Explanations of the diagnosis/ disorder; its pathophysiology; clinical presentation, examination, assessment processes, and plan of care, contain inaccuracies or are incomplete little to no reference is made to the relevant literature.
Criteria	20 Points	16 Points	12 Points	8 Points
Research Effort	Went above and beyond to research information; included six or more unique citations from evidence-based literature	Did a very good job of researching; utilized materials provided to their full potential. Provided four to five unique citations from the evidence-based literature.	Used the material provided in an acceptable manner, providing at least three unique citations from the evidence-based literature.	Did not utilize resources effectively; did little research, providing one to two unique citations from the evidence-based literature.
Criteria	5 Points	4 Points	3 Points	2 Points
Sequencing of Information	Information is organized in a clear, logical way. It is easy to anticipate the next slide.	Most information is organized in a clear, logical way. One slide or piece of information seems out of place.	Some information is logically sequenced. An occasional slide or piece of information seems out of place.	There is no clear plan for the organization of information.
Effectiveness	Project includes all material needed to give a good understanding of the topic. The project is consistent its purpose.	Project is lacking one or two key elements. Project is consistent with its purpose most of the time.	Project is missing more than two key elements. It is rarely consistent with its purpose.	Project is lacking several key elements and has inaccuracies. Project is completely inconsistent with its purpose.
Criteria	10 Points	7 Points	5 Points	3 Points
Style	Grammar, punctuation, mechanics, & usage correct & idiomatic, consistent with Standard American English; demonstrates competent use of mechanics and APA. References are relevant, authoritative and contemporary.	Grammar, punctuation, mechanics, & usage good mostly consistent with Standard American English, errors do not interfere with meaning or understanding; minimal APA errors. Adequate references.	Grammar, punctuation, mechanics and usage distracting & could interfere with meaning or understanding; poor use of APA. Minimal use of appropriate references.	Grammar, punctuation, mechanics, & usage interfere with understanding; no APA use. Poor use and/or selection of references. N512 Disorders of the Immune System Final Project

Discussion 8

Derek Smith, a 31 y.o., Caucasian male injection drug user, who is homeless, presents to the ED with a chief complaint of shortness of breath. He describes a 1-month history of intermittent fevers and night sweats associated with a nonproductive cough. He has become progressively more short of breath, initially only with exertion, but now he feels dyspneic at rest. He appears to be in moderate respiratory distress. His vital signs are abnormal, with fever to 39°C, heart rate of 112 bpm, respiratory rate of 20/min, and oxygen saturation of 88% on room air. Physical examination is otherwise unremarkable but notable for the absence of abnormal lung sounds. Chest x-ray film reveals a diffuse interstitial infiltrate characteristic of pneumocystis pneumonia, an opportunistic infection.

In this discussion:

Describe and discuss with your colleagues the underlying disease most likely responsible for this patient’s susceptibility to pneumocystis pneumonia.
Describe and discuss the immunosuppression caused by this underlying disease.
Describe and discuss the natural history of this disease and some of the common clinical manifestations seen during its progression.
Describe your plan of care for this patient following his hospitalization (he will likely be admitted to the “medical respite floor,” of a local homeless shelter, which has the services of a Nurse Practitioner three times per week—with on-call weekend consultation, and a registered nurse, Monday through Friday).

Include citations from the text or the external literature in your discussions.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria. N512 Disorders of the Immune System Final Project

Example Discussion Approach

The underlying disease responsible for pneumocystis pneumonia would be Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS). Following the infection of the CD4 T lymphocytes, the genetic RNA code is released into the cell and is converted by the HIV produced reverse transcriptase enzyme into DNA (Cachay, 2019). The reverse transcriptase is error prone and easily mutates during the conversion of RNA to DNA (Cachay, 2019), allowing for HIV heterogeneity to develop rapidly (Hammer & McPhee, 2019). Following the viral DNA entry into the cell’s nucleus and with help from the HIV integrase enzyme the viral DNA becomes integrated in the host chromosome (Hammer & McPhee, 2019). According to Hammer & McPhee, the integrated HIV DNA is referred to as “provirus” and dependent upon on the activation state of the host cell, the “provirus” could remain latent or become transcriptionally active (Hammer & McPhee, 219). When cellular activation occurs, it “triggers NF-kß which is a cytoplasmic transcription factor that migrates to the nucleus and initiates viral gene expression (Hammer & McPhee, 2019). The HIV protein Nef is “abundantly expressed during infection and reroutes a variety of cell surface proteins to disrupt host immunity and promote the viral replication cycle” (Buffalo et al, 2019). Budding occurs when the “viral proteins and RNA are packaged at the infected cell’s exterior membrane” (Hammer & McPhee, 2019) and the budded virus is considered to be mature when “HIV protease cuts structural proteins in the virus and causes them to rearrange” (Cachay, 2019). There are 7 steps in the HIV life cycle 1) binding, 2) fusion, 3) reverse transcription, 4) integration, 5) replication, 6) assembly, and 7) budding (U.S. Department of Health and Human Services, 2020).

There are two main stages of HIV infection 1) Acute HIV infection and 2) Chronic HIV infection (Sax & Hirsch, 2019). The chronic HIV infection can be subdivided into three stages 1) Chronic infection without AIDS, 2) AIDS which is characterized by a CD4 cell count <200 cells/microL or the presence of any AIDS defining condition, and 3) AIDS and Advanced HIV infection which is characterized by a CD4 cell count <50 cells/microL (Sax & Hirsch, 2019). There is a rapid viral replication and infection of CD4 cells and the HIV RNA levels are very high in early HIV infection (Sax & Hirsch, 2019). During the acute infection 60% of individuals with early HIV infection will be asymptomatic and symptomatic individuals may experience fever, lymphadenopathy, sore throat, rash, myalgia/arthralgia, diarrhea and headache (Sax & Hirsch, 2019). Dependent upon the sensitivity of serologic tests, seroconversion can be detected within the first several weeks following HIV infection (Sax & Hirsch, 2019). Seroconversion is the development of detectable antibodies against HIV antigens (Sax & Hirsch, 2019) and about 6 months of infection, the plasma viremia has reached a steady level known as the viral set point (Sax & Hirsch, 2019). The chronic HIV infection without AIDS stage maintains a stable viral level with a progression in the decline of CD4 cells and the individual will present with no symptoms or generalized symptoms of fatigue, sweats, weight loss, and lymphadenopathy (Sax & Hirsch, 2019). As the CD4 cell counts decrease, individuals may present with oropharyngeal or vulvovaginal candidiasis, oral hairy leukoplakia, seborrheic dermatitis, bacterial folliculitis, methicillin-resistant staphylococcus aureus (MRSA), herpes simplex virus, varicella-zoster virus, human papillomavirus (HPV), and streptococcus pneumoniae (Sax & Hirsch, 2019). When individuals present with some of these infections or a CD4 cell count <200 cells/microL they are considered to have AIDS (Sax & Hirsch, 2019). As the CD4 cell count declines to <50 cells/microL, immunosuppression allows for opportunistic illnesses, such as pneumocystis jirovecii pneumonia, esophageal candidiasis, Kaposi sarcoma, wasting syndrome, disseminated Mycobacterium avium, cytomegalovirus disease, cryptococcal meningitis, and encephalopathy, to occur more frequently (Sax & Hirsch, 2019). N512 Disorders of the Immune System Final Project

The plan of care for D.S. following discharge from the hospital to the medical respite care floor at the homeless shelter would include continuation of antibiotic treatment, ART medications, and steroids. D.S would be monitored for fever, rash, difficulty sleeping, difficulty breathing, chest pain, coughing up blood, lip and/or nailbeds turning blue, drink plenty of fluids, and rest (Alberta Health Services, 2020). While D.S is on the medical respite floor, his healthcare needs will be monitored and he would compliant with his medications, treatments, and therapy. Maintaining compliancy once he is discharged from the medical respite floor will be challenging due to D.S. being homeless and not properly following up with his care and not attending to his healthcare needs properly.

Sources:

Alberta Health Services. (2020a). Pneumocystis Pneumonia and AIDS: Care Instructions. Myhealth.Alberta.Ca. https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ut2641

Buffalo, C. Z., Iwamoto, Y., Hurley, J. H., & Ren, X. (2019). How HIV Nef Proteins Hijack Membrane Traffic To Promote Infection. Journal of Virology, 93(24). https://doi.org/10.1128/jvi.01322-19

Cachay, E. R. (2019, August). Human Immunodeficiency Virus (HIV) Infection. Merck Manuals Consumer Version; Merck Manuals. https://www.merckmanuals.com/home/infections/human-immunodeficiency-virus-hiv-infection/human-immunodeficiency-virus-hiv-infection

Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease : an introduction to clinical medicine (8th ed.). Mcgraw-Hill Education Medical.

Sax, P. E., & Hirsch, M. S. (2019, November 21). UpToDate. Uptodate.Com. https://www.uptodate.com/contents/the-natural-history-and-clinical-features-of-hiv-infection-in-adults-and-adolescents

U.S Department of Health and Human Services. (2020b, July 31). Budding Definition. AIDSinfo. https://aidsinfo.nih.gov/understanding-hiv-aids/glossary/814/budding. N512 Disorders of the Immune System Final Project

N512 Disorders of the Immune System Final Project