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patel immuology
Immune system dysfunction in children
| Question | Answer |
|---|---|
| Wiskott-Aldrich Syndrome | thrombocytopenia, eczema, hemorrhagic tendencies, reccurent infections, malignancy (in adolescents and early childhood.) |
| Wiskott-Aldrich Syndrom | children are prone to meningitis, herpes, and lymph malignancy |
| Wiskott-Aldrich Syndrom | supportive treatment with antibiotics , prophylaxis, platelet infusion, IG infusions, splenectomy, hemopeoetic stem cell transplantation, |
| Nursing management of Wiskott-Aldrich Syndrom | observe for excess bleeding from wounds or GI tract, refer parents to counseling, assess for splenomegaly, cervical lymphadenopathy and hepatomegaly |
| AIDS | transmission can occur during birth from blood, amniotic fluid and exposure to genital tract secretions, and through breast milk. |
| AIDS | transmission reduced due identification and administration of zidovudine during pregnancy. |
| HIV | targets and destroys Tcells decreasing and eventually eliminating cellular immunity. |
| Clinical sx of Aids. | asx at birht, HIV to AIDS time is shorter in children, lymphadenopathy, hepatosplenomegaly, nephropathy, oral candidiasis, failure to thrive, weight loss, diarrhea, chronic eczema, dermatitis, oppurtunistic infections, malignancies, |
| Children with AIDS frequently develop __________ | encephalopathy (resulting in developmental delay or deterioration in motor and intelectual fx) |
| preferred test in children for AIDS | PCR, repeated again at 15-18 months. |
| viral loads of les than 10,000 | low risk |
| viral loads of 10,000-100,000 | moderate risk |
| greater than 100,000 | high risk |
| tx of HIV/AIDS | prevention of transmission from mother to newborn, periodic lab testing, deliver C-sec, newbon should recieve 6 months of AZT after birth. |
| tx of HIV | infants started on prophylaxis for PCP by the age of 4-6 weeks and continue for a year or until 2 neg hiv test. |
| tx of HIV (DRUGS) | immune boosters, (HAART), aggresive antibiotics, ( children as young as 3 months) |
| NSG management of AIDS | facilitate numerous testing by infant and explain necessity to family |
| Physiologic management for AIDS | observation of potential sites of infection, assess breath sounds, resp status, abg's, LOC, MS, pneumonitis and neurological abnormalities should be reported. |
| Physiologic management for AIDS | ht. and wt, anemia, FTT, candida infections, encephalopathy (delays) severity in sx (report) |
| AAP reccomends telling __________ and _________ about AIDS diagnosis. | school age children and adolescents |
| when HIV progresses to AIDS the nursing care should focus on.... | preventing infection, managing pain, promoting respiratory and other organ function, nutrition, emotional support, growth and development |
| Preventing infections | frequent hand hygiene, keep produce, flowers out of room, do not give live vaccines (varicella, MMR) if there are no or mild sx at 12 months, annual TB testing, cough and DB, asepsis in dressing change, |
| side effects of HIV meds | Nausea and rashes |
| Vitamins that are known to effect immune fx | A, E, Zinc, Selenium |
| mucous membranes of AIDS patients | check for candida, hydrate, mouth washes with NS or lemon glycerine, guard against food-born illnesses |
| emotional care of adolescent | Teach about safe sex and link them to other infected peers. |
| discharge planning for AIDS | teach about transmission, home care, finances, nutrition, med compliance, support groups, home health, respite, psych consult, guilt from parent |
| Lupus that involves cardio, CNS, blood, kidneys. lungs. MS. | Systemic lupus |
| Lupus associated with antineoplastic drugs, INH, hydralzine, | drug induced lupus--sx go away after drugs are dc |
| Lupus is limited to skin | discoid lupus |
| SLE manifestations | onset of nephritis, arthritis, vaculitis, recurrent fever, chills, fatigue, malaise, weight loss. Most common sx are arthritis and rash, butterfly rash on face, hemolytic anemia, low WBC & plt, bleeding d/o, |
| Triggers of SLE | sun. cold, infections, stress, events, activites, situations |
| expect diet restriction if child has _____________ sx of lupus | excessive wieght gain, fluid retention from steroids, or renal damage |
| SLE is a chronic illness that affects primarily ________ . | adolescents; check psychosocial status r/t body image, depression, suicide, adaptation, infection, chronic pain, |
| ____________ are the leading cause of death for patients with SLE. | infections |
| Renal dysfuncton sx r/t SLE | edema, muscle cramps, diarrhea, tetany, convulsions (maintain fluid balance; check I's and O's |
| SLE kids are at risk for __________ r/t nutrition due to exacerbation with activity, steroids. | weight gain |
| adolescents should be warned that _________, _______, and _________ exacerbate sx. | alcohol, drugs and smoking |
| female adolescents should be warned about _____________ | birth control pills---because estrogen may exacerbate sx, discuss alternate birth control |
| chronic autoimmune inflammatory disease characteriszed by joint inflammation resulting in decreased mobility, swelling and pain. | Juvenile Rheumatoid arthritis |
| Affects the knees, ankles and elbows and occurs most frequently in females. | JRA |
| sx of JRA | fever, rash, lymphadenopathy, splenomegaly, hepatomegaly, limping, favoring of one extremity, uneven growth of extremities, pain stiffness loss of motion, swelling in large joints, |
| The goals of treatment of JRA are to _________ and _________. | relieve pain and prevent contractures |
| drugs for JRA | aspirin, (reye's), NSAIDS, Steroids, if they do not respond then methotrexate |
| uveitis---should be examined by eye doctor every 6 months. | complication of JRA |
| assesment for JRA | joint swelling, deformities, fever, nodules under skin, growth delays, enlarged lymph nodes |
| nursing care for JRA focuses on ____________ | promoting mobility, encouraging adequate nutrition, teaching parents and child about disease. |
| How do you promote impoved mobility in children with JRA | strengthen muscles, increase tone, maintan body alignment, prevent contractures. ROM, stretching, hydrotherapy, swimming. |
| hypersensetivity response | overreaction of the immune system, is responsible for allergic reactions. |
| Type 1 hypersensetivity | immediate reactions within seconds or minutes. |
| Type 2 | cytotoxic antibody reactions that occur when IgG or IgM antibodies recognize a drug or cell membrane and cause hypersensetivity reactions. |
| Type 3 | immune complex reactions when soluble complexes of drugs of thier metabolites cause a deposit with walls of blood vessels; |
| Type 4 | delayed responses that do not appear for several hours after exposure and requires 24-72 hours to develop fully. |
| Nursing care of allergic rx are _______ , __________ and Identifying ___________ | treating sx, alleviating anxiety and identifying sx. |
| what household items cause allergies in children | pets, dust, carpets, fabrics, feather pillows, bedding cigarette smoke. |
| 50% of children with ________ and 34% of children with 3 or more surgeries are sensetive to latex | spina bifida |
| children most at risk for latex allergy are those with __________ | myelodyplasia, congenital urinary tract anomalies, spina bifida |
| graft versus host disease can occur when organs are transplanted or when bone marrow or stem cells are transfused into recipient, typically as tx for leukemia or SCID. | Graft Versus Host disease |
| acute and chronic GVHD | before and after 100 days of transplant |
| acute manifestations of GVHD | pruritic, macular rash begins on extremities to trunk. N and V, anorexia, diarrhea, cramping, abdominal pain, jaundice, |
| chronic manifestations of GVHD | recurrent infections, skin rx, thrombocytopenia, eveidenced by mouth, throat, and esophageal ulcers, GI d/o, cholestasis, eye irritation |
| __________ is key to beginning therapy and stopping progression of life threatening GVHD. | Early identification |
Created by:
puja
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