EXAM 1 - autoimmune problems and Infectious diseases PDF

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autoimmune and infectious diseases in children. nursing care, pathophysiology, treatment, s/sx, medications, side effects, general knowledge of care....

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STUDENT Handout – Immunologic Disorders/Infectious NURB3220

Susan Snell RN, MSN, FNP

Immunologic Disorders (pages 1846-1873) Variations in pediatric anatomy and physiology: immature immune system at birth, decreased inflammatory response to invading organisms (lymph system differences, phagocytosis and cellular and humoral immunity). Common medical treatments Immunizations: Nursing implications? 1. 2. Bone Marrow or stem cell transplantation Common drugs for immunologic disorders are listed in table 47.1 p. 1849-50 Nursing process: Assessment Nursing diagnoses, goals, intervention and evaluation.

Primary Immunodeficiencies HYPOGAMMAGLOBULINEMIA refers to a variety of conditions in which child does not form antibodies appropriately. Therapeutic management is periodic administration IVIG. WISKOTT-ALDRICH SYNDROME is a rare X-linked (who is affected?) genetic disorder that results in immunodeficiency, eczema, and thrombocytopenia

SEVERE COMBINED IMMUNE DEFICIENCY is a rare X-linked or autosomal recessive disorder. SCID is characterized by absent T-cell and B-cell function.

Secondary Immunodeficiencies HIV INFECTIONS Pathophysiology: HIV affects immune function mainly in T-cell function, but it also affects B-cells (natural killer cells), and monocyte/macrophage function. Bottom line the infant’s or child’s immune system can’t fight infections it ordinarily could. No cure HIV infection but survival has improved due to highly active antiretroviral therapy (HAART). HAART has also improved growth, neurodevelopment, and immune function. TRANSMISSION: Infants primarily contract HIV from their mothers. (How?) _____________________, ___________________________, ___________________.

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STUDENT Handout – Immunologic Disorders/Infectious NURB3220

Susan Snell RN, MSN, FNP

In the US perinatal transmission has decreased due to improved maternal detection and treatment as well as newborn treatment. Child: ______________________ Adolescent: primarily sexual activity or IV drug use (tattoos). Blood transfusions – rare. MANAGEMENT MEDICATIONS – prescribed based on _____________________________. NURSING ASSESSMENT  Health history Common signs and symptoms reported might include: FTT Recurrent bacterial infections Opportunistic infections Chronic or recurrent diarrhea Recurrent or persistent fever Developmental delay Prolonged candidiasis 

Physical exam Inspection and Observation – _____________________________________________________________________ ______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ ________________________________________________________________________

Auscultation and Palpation – _________________________________________ ________________________________________________________________ Lab and diagnostics – Reverse transcriptase-polymerase chain reaction (PCR) test – detects presence of infection in infants older than 1 month and to exclude infection as early as possible Enzyme-linked immunosorbent assay (ELISA) test- + in infants of HIV-infected mothers (transplacentally acquired antibodies) less accurate at detecting HIV infection in infants and toddlers CD4 counts low in HIV infection

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STUDENT Handout – Immunologic Disorders/Infectious NURB3220

Susan Snell RN, MSN, FNP

NURSING MANAGEMENT

Avoid Infection: Medication compliance: _________________________________________________ _____________________________________________________________________ Promote nutrition – infant _______________________, Child_________________________________________. Document growth Pain management/promote comfort – _______________________________________. Educate family and client – medications! Provide Support – stress from _____________________________________________ _____________________________________________________________________ PREVENTION All pregnant women - Routine HIV counseling and testing, HIV + treat with an antiretroviral, Management HIV exposed infant - 6 week course of ZDV Breast feeding - ? Adolescents: ___________________________, ______________________________, ___________________________, _________________________________________, ___________________________________________, ________________________________________.

AUTOIMMUNE DISORDERS SYSTEMIC LUPUS ERYTHEMATOSUS Chronic, multi-system, autoimmune disease characterized by inflammation of the connective tissue. Can affect any system. Characterized by exacerbations and remissions. Therapeutic Management focuses on treating inflammatory response: mild to moderate SLE - _______________________, _________________________, ______________. Severe SLE or frequent exacerbations (flares): _______________________________, _____________________. ESR disease (glomerulonephritis): dialysis Common Manifestations: arthralgia, alopecia, anemia, arthritis, fatigue, photosensitivity, skin rashes (discoid or malar butterfly rash), oral ulcers, seizures, renal disorder

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STUDENT Handout – Immunologic Disorders/Infectious NURB3220

Susan Snell RN, MSN, FNP

LAB: decreased H&H, decreased platelets, low WBC. C3 and C4 also decreased. + ANA usually found in children with SLE Provide support/Teach:

JUVENILE IDIOPATHIC ARTHRITIS Autoimmune inflammatory disorder that mainly affects the joints Characterized by joint swelling, pain, redness, warmth stiffness. Therapeutic Management: NSAIDS, Corticosteroids, and anti-rheumatic drugs such as methotrexate and etanercept (necessary to prevent disease progression). Nursing Management is supportive and directed toward: Pain Management/ Maintaining mobility (How?):

Promoting normal life

ALLERGY AND ANAPHYLAXIS FOOD ALLERGY – immunologic reaction resulting from the ingestion of a food or food additive. During first few years of life the most common food allergens are milk, eggs, peanuts, tree nuts, fish and shellfish (these typically persist adulthood), wheat and soy. Determine between allergy and intolerance. Reactions vary. Management: Verify allergy, avoid allergen, and treat reaction with medications. Which meds?

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STUDENT Handout – Immunologic Disorders/Infectious NURB3220

Susan Snell RN, MSN, FNP

ANAPHYLAXIS Severe, immediate hypersensitivity reaction Leading causes of anaphylaxis are peanuts/nuts, eggs, fish-shellfish, bee or wasp stings, drugs (PCN, NSAIDS), radiopaque dyes and latex. Management- support airway, breathing and circulation, administer O2, administer epinephrine, administer IV fluids to provide volume expansion.

Infectious/communicable Disorders (pages 1334-1376) Review basic information on pages 1334-1338 (transmission, fever, etc.) Variations in pediatric anatomy and physiology: immature responses of immune system make infants and children more susceptible to infection. Young children increased risk because protection from immunizations is not complete.

BACTERIAL INFECTIONS MRSA Transmission: Direct Contact, respiratory droplets, blood, or sharing personal items (towels/sports equipment), or contact with contaminated surfaces or items. CAMRSA – skin and soft tissue infections are common in the child Diagnosis determined through culture Nursing Management Antibiotics, wound care, and reassessment, Teaching is essential (what would you teach?)

SCARLET FEVER Infection from Grp A strep (usually from strep throat). Usually seen in children 5-12 years-old. Transmission droplets facilitated by close contact (schools, day care). Food borne (how?)- human contamination of food. No longer contagious after been on antibiotics x 24 hours.

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STUDENT Handout – Immunologic Disorders/Infectious NURB3220

Susan Snell RN, MSN, FNP

Treated at home typically: PCN antibiotic of choice. Allergic use erythromycin. Encourage ? _____________________. Diet: soft foods, warm or cold liquids soothing.

PERTUSSIS Acute respiratory disorder characterized by paroxysmal cough and copious secretions. Characterized by: • Stage 1- begins with 7-10 days of S&S URI • Stage 2 – paroxysmal cough lasts 1-4 wks - increased severity of cough, cyanosis, salivation, neck vein distention • Stage 3 – convalescent – several weeks to months – coughing episodes, whooping and vomiting that decrease in severity and frequency. Transmission: Direct contact or droplets from coughing. Vaccination: DTaP: When? ________________________________________. Increased incidence of cases in adolescents and adults required to get 1 booster of TdaP instead of Td Isolation precautions: ? Most Common complication: Pneumonia Medication: Macrolide antibiotics (?)- ___________________, _______________________, _________________________________. Antibiotics also recommended for close contacts Nursing Management: 1. Physical Assessment:

2. 3. 4. 5. 6.

Provide high humidity environment, frequent suctioning. (?) ____________________ Observe for signs of airway obstruction. Encourage fluids. (?) ____________________ Promote rest by _______________________________. Provide emotional support and reassurance!

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STUDENT Handout – Immunologic Disorders/Infectious NURB3220

Susan Snell RN, MSN, FNP

VIRAL EXANTHEMS VIRAL COMMONALITIES Many have a rash (exanthem) Most are accompanied by a fever Most are accompanied by cold or flulike symptoms Most are transmitted by direct contact with droplets or airborne particles Most can be prevented by immunization All require that the child be isolated from others to prevent spread Treatment is mostly symptomatic Encephalitis is rare but can occur as a complication of most childhood viral infections General Nursing Management: PREVENTION! How do we prevent? _____________________________ Limit exposure Teach! 1. ____________________________ 2. ________________________________ Skin care: 1. Lukewarm baths with oatmeal or baking soda. 2. Keep fingernails short 3. Soothing lotions, sensitive skin soaps. Common Medications: No Aspirin! Antipyretics — Acetaminophen or Ibuprofen: Make sure parents give right type right way. Know how to measure, Store out of reach of children Rubeola (Measles) Clinical presentation: Present with a red maculopapular rash that gradually turns brownish. Begins behind ears and spreads downward. Develop Koplick’s spots on buccal mucosa. Transmission: Direct contact with droplets (primarily) or airborne particles. Vaccinations: _________________________________ Isolation precautions: ________________________________ Rubella (3 day Measles): Clinical presentation: Present with a pinkish maculopapular rash. Begins on face, neck and scalp and spreads downward to feet over a 3 day period. As rash develops on a new area it fades 7 of 10

STUDENT Handout – Immunologic Disorders/Infectious NURB3220

Susan Snell RN, MSN, FNP

over previous area. Develop pinpoint reddish spots on soft palate. This is Forscheimers sign. Transmission: Direct contact with droplets or airborne particles. More importantly transplacental transmission. Vaccinations: ____________________________________ Isolation precautions: _________________________ Erythema Infectiosum (Fifth Disease) Clinical presentation: Present with a maculopapular lacy rash on trunk and extremities. Fiery red edematous rash on cheeks known as slapped cheek sign. Transmission: Direct contact with droplets, airborne particles, or blood/blood products. More importantly transplacental transmission. Isolation precautions: _________________________ Varicella (Chicken Pox) Clinical presentation: Initially present with macular lesions that progress to papules, then vesicles to pustules. Lesions appear in crops. Transmission: Direct contact, droplet, or airborne particles. Vaccination: ____________________________ Isolation precautions: _______________________________ Most Common complication: Typically secondary bacterial skin infections ____________________ Varicella can be fatal in the immunocompromised child!!!!!!!!!!! Reye syndrome has been known to occur after varicella infections. Hand, Foot and Mouth Clinical presentation: Present with high fever, vesicles on tongue and oral mucosa which erode to shallow ulcers, vesicles on hands and feet. Transmission: Direct contact with fecal, oral secretions, spread mostly through saliva. Mumps Clinical presentation: CLASSIC clinical sign parotid swelling. Complication: 8 of 10

STUDENT Handout – Immunologic Disorders/Infectious NURB3220

Susan Snell RN, MSN, FNP

Aseptic meningitis. Orchitis most concerning for parents of adolescent boys. Sterility rare!!! Transmission: Droplets. Vaccinations: __________________________ Isolation precautions: __________________________________________ ZOONOTIC INFECTIONS and VECTOR BORNE Diseases caused by infectious agents transmitted directly or indirectly from animals or vectors (mosquitos, ticks, or other insect vectors). Cat-Scratch disease (cats carry bacteria in saliva). Treatment supportive and aimed at managing symptoms. Rabies Transmission: contaminated animal bites Disease is typically fatal once virus has established itself If determination is made to treat, vaccines are as follows:  Human rabies immune globulin (HRIG): half of the dose is infiltrated locally around the wound, the rest is administered intramuscularly  Human diploid cell vaccine (HDCV): best if administered 48 hours after bite, then on days 3, 7, 14, and 28 Lyme Disease Transmission: infected deer tick bite Symptoms ring-like rash (bullseye) Therapeutic management: antibiotics doxycycline for children older than 8 years (Why?)-_____________________________; amoxicillin for children younger than 8 years for 14-28 days. Rocky Mountain Spotted Fever Transmission: wood tick or dog tick bite Delays in diagnosis and therapy are significant factors associated with severity of disease and death. Therapeutic management: Doxycycline is the drug of choice regardless of age PARASITIC AND HELMINTHIC INFECTIONS Parasites seen frequently in children are head lice and scabies. Helminthic infections include pinworms, roundworms, and hookworms. These can be a source of embarrassment for families.

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STUDENT Handout – Immunologic Disorders/Infectious NURB3220

Susan Snell RN, MSN, FNP

Pediculosis Capitis Transmitted by direct contact with infected persons or contact with contaminated or infected objects. Clinical manifestations: Nits are visible and attached firmly to hair shaft, commonly found behind ears and at nape of the neck, cause intense pruritus. Scabies: Transmitted by close personal contact with infected persons. Clinical manifestations: Intense pruritus, especially at night and nap times, infants and young children may be irritable and restless and sleep fitfully, burrows, papules, vesicles, and nodules are common. In infants and young children: lesions often found on the head, palms, soles, and axillae. In older children: lesions often found in the webs of the fingers, elbows, axillae, and groin and on the buttocks. Therapeutic Management: *Scabicidal medications include permethrin 5% cream (Elimite), lidane (Kwell, Scavene), and crotamiton (Eurax) *Oral antihistamines for itching *Antibiotics only if secondary infection develops *Soothing creams or lotions may also be used to reduce pruritus

Nursing implications - Give child a warm soap-and-water bath - Apply scabicidal lotion to body and head, avoiding eyes and mouth - Leave lotion on for 8 to 14 hours before washing off - Treat all family members and close contacts - Change clothing, bedding, and towels daily; wash in hot water and dry in hot dryer HELMINTHS Worms that live as parasites. Children more commonly affected due to increased hand to mouth activity and likelihood of fecal contamination. Treatment consists of administration of oral medications effective against a specific helminth. Treat entire family. Anticipatory guidance to prevent re-infestation and educate about spread of disease, personal hygiene and sanitary practices

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