# A nurse is caring for a 38-year-old female client with acquired immunodeficiency syndrome (AIDS) who has developed Pneumocystis jirovecii pneumonia (PCP). The client's CD4+ T cell count is 85 cells/mm³. Which nursing intervention should be the priority?

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## 문제

A nurse is caring for a 38-year-old female client with acquired immunodeficiency syndrome (AIDS) who has developed Pneumocystis jirovecii pneumonia (PCP). The client's CD4+ T cell count is 85 cells/mm³. Which nursing intervention should be the priority?

## 보기

1. Encourage increased fluid intake to prevent dehydration
2. Administer prescribed antiretroviral therapy as scheduled
3. Implement strict isolation precautions to prevent secondary infections **✔ 정답**
4. Monitor oxygen saturation and respiratory status continuously

**정답: 3**

## 해설

With a CD4+ count of 85 cells/mm³ and active PCP, the client is at extreme risk for secondary infections, making strict isolation precautions the priority to prevent life-threatening complications. Other interventions are supportive but do not address the immediate need for infection control.

## 심화 해설

Understanding the Priority for a Client with AIDS and PCP

The correct answer is to implement strict isolation precautions to prevent secondary infections. For a client with acquired immunodeficiency syndrome (AIDS) and a profoundly low CD4+ T cell count of 85 cells/mm³, the immediate safety priority is protecting them from acquiring new, potentially life-threatening infections from the healthcare environment.

Why Infection Prevention is the Priority

The client’s CD4+ count of 85 cells/mm³ indicates severe immunosuppression. At this level, the body's ability to mount an immune response is critically impaired, making the client exceptionally vulnerable to both common and opportunistic pathogens. The presence of Pneumocystis jirovecii pneumonia (PCP) is itself a consequence of this immune failure. The foundational principle of care must be to prevent further harm, and the most immediate, modifiable threat is exposure to new infectious agents. The provided evidence underscores the critical link between immune status, measured by CD4+ count, and infection risk. A systematic review on fungal infections in people living with HIV establishes that clinical manifestations of infection are directly related to the degree of immunosuppression, with severe and atypical presentations occurring at low CD4+ counts [1]. This principle extends beyond fungal infections to all pathogens; a client with a CD4+ count of 85 cells/mm³ is a susceptible host in the chain of infection, and breaking this chain at the portal of entry through strict isolation is the most direct nursing action to prevent a catastrophic secondary infection.

Analysis of Other Options

- Option 1 (Encourage increased fluid intake): While maintaining hydration is a supportive measure for any client with a respiratory infection and fever, it does not address the most immediate threat to life. A secondary infection in a profoundly neutropenic and lymphopenic client can rapidly lead to sepsis and death, making prevention a higher priority than supportive care.

- Option 2 (Administer prescribed antiretroviral therapy): Administering antiretroviral therapy (ART) is essential for long-term immune reconstitution, but it does not provide immediate protection against environmental pathogens. The therapeutic effect of ART takes weeks to months to increase CD4+ counts, whereas a new infection can be acquired in moments. The immediate safety need is a physical barrier against pathogens.

- Option 4 (Monitor oxygen saturation and respiratory status): Continuous monitoring is a critical intervention for a client with active PCP. However, this is an assessment and supportive action for an existing condition. The nursing process dictates that preventing a new, predictable, and life-threatening complication (a secondary infection) takes precedence over monitoring an already-identified problem. The concept of multidisciplinary infection control measures as a transformative strategy to reduce infection rates, as highlighted in surgical settings, reinforces the high-impact value of proactive isolation protocols . This logic applies directly to a medical client whose intrinsic defenses are absent.

Clinical Application of Isolation Precautions

For this client, strict isolation precautions mean implementing a comprehensive protective environment. This goes beyond standard precautions and typically includes placing the client in a private room with positive-pressure airflow and HEPA filtration, requiring meticulous hand hygiene, and ensuring that all staff and visitors wear appropriate personal protective equipment (PPE) to prevent introducing pathogens. The goal is to create a physical shield, recognizing that the client’s own immune system cannot serve this function. This approach is analogous to the multidisciplinary disinfection and isolation protocols shown to significantly reduce postoperative infection rates by closing infection pathways . The principle of targeting infection prevention practices based on identified risk factors is also crucial; here, the CD4+ count of 85 cells/mm³ is the primary, non-modifiable risk factor that demands a compensatory, modifiable intervention: strict isolation .References (research sources)

- [1]Relationship Between Onychomycosis and HIV: A Systematic Review.Meta-analysis/systematic reviewCruz-López S, Albavera-Ramírez EA, Arenas R, Fuentes-Venado CE, Calzada-Mendoza CC, Farfán-García ED, Castillo-Cruz J, Chávez-Gutiérrez E, Martínez-Herrera E, Pinto-Almazán R. (2026) · DOI: 10.3390/jof12050360

## 임상 시나리오

Protective Isolation for Severe ImmunosuppressionCD4 count below 100 cells/mm³
For a client with a CD4+ T cell count of 85 cells/mm³, the immediate priority is strict protective isolation. The goal is to prevent the client from acquiring new bacterial, viral, or fungal infections from the environment, healthcare workers, or visitors.

Key interventions include placing the client in a private room with positive pressure airflow and HEPA filtration. All persons entering must perform strict hand hygiene and wear appropriate personal protective equipment. Live plants, fresh flowers, and raw foods are prohibited.

CautionDo not confuse protective isolation with standard or transmission-based precautions. This client is not a source of infection; the environment is the threat. Any break in protocol can lead to a life-threatening opportunistic infection.

## 핵심 개념

- **Pneumocystis jirovecii pneumonia (PCP)** — An opportunistic fungal infection of the lungs, a common AIDS-defining illness occurring when CD4 counts drop below 200 cells/mm³.
- **CD4+ T cell count** — A laboratory marker of immune function; a count below 200 cells/mm³ indicates severe immunosuppression and high risk for opportunistic infections.
- **Strict isolation precautions** — Protective environment interventions designed to minimize a severely immunocompromised patient's exposure to pathogens from the healthcare setting.

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