Health Promotion and Maintenance Q 123
During a home visit, a client with AIDS tells the nurse that he has been exposed to measles. Which action by the nurse is most appropriate?
A. Administer an antibiotic
B. Contact the physician for an order for immune globulin
C. Administer an antiviral
D. Tell the client that he should remain in isolation for 2 weeks
Correct Answer: B. Contact the physician for an order for immune globulin
The client who is immunosuppressed and is exposed to measles should be treated with medications to boost his immunity to the virus. If the patient knows that he has been exposed to measles and his CD4 count is less than 200, he should talk to his doctor about whether post-exposure prophylaxis (PEP) with immunoglobulin may be an option. PEP may provide some protection or lessen the severity of infection if it occurs. If the CD4 count is 200 or greater, PEP can also include getting the MMR vaccine. Ideally, PEP should be administered within 72 hours of exposure to measles.
Option A: Antibiotics may not be an effective treatment. One important characteristic of measles infection is that it produces more serious illness and increased mortality among immunocompromised individuals, primarily those with defects in T-cell immunity. Because >90% of the human immunodeficiency virus (HIV)–infected children live in regions where measles is still endemic, achieving high rates of measles vaccine coverage is especially important among these populations to suppress excess measles-associated morbidity and mortality.
Option C: Antivirals would not be as effective as immunoglobulins for the client with AIDS. Early identification and antiretroviral treatment of HIV-infected infants and children are critical to maximizing measles vaccine immunogenicity and providing protection against other HIV-related complications.
Option D: The patient should remain in isolation, but the administration of immunoglobulin is a priority. The impact of HIV-related immunocompromise and subsequent effects of antiretroviral therapy (ART) on immune reconstitution and, ultimately, on vaccine immunogenicity is unclear.