Chapter 27

Nursing Care of the Child with an Immunologic Disorder

Grows as the infant is exposed to the environment Phagocytosis Body attacks what does not belong there Builds more antibodies as the infant is exposed (when see things again then sends out antibodies and dont get illness or not as severe) Cellular Immunity Does not involve antibodies but uses macrophages Humeral Immunity Antibodies attack foreign substances Infant born with moms immunity but disappears by 2-3 month Infants more sick because exposed to new viruses and bacteria that werent exposed to before Know there are 2 diff types of immunity to fight things and it gets more specific as a child gets older

Variations in Pediatric Anatomy and Lymph System Physiology

Medical Treatments
Immunizations Most important thing to do To prevent disease Stem Cell transplant Or bone marrow transplant Replace with healthy cells and build up immunity Stem cells come from umbilical cords and are very immature and Bone marrow transplant (match with same bone marrow type) and given to child who doesnt have proper bone marrow and helps to fight off infection Bone marrow transplant very risky and will be on immunosuppressive drugs

 Medications IVIG give child immune antibodies to fight infection, given q 6 weeks to get IV infusion, when child goes in we need to pretreat with tylenol and benadryl bc can have rxn from the IV med, replacing immunoglobulins by IV route NSAIDS bring down inflammation Corticosteroids suppresses immune system, bad thing with long term corticosteroids it may stunt childs growth (try to limit), these drugs can mask signs of infection

 Immunoglobulin electrophoresis Determining diff levels of immune antibodies in body Delayed hyper-sensitivity skin test Administered to skin and record at 48-72 hrs and poke skin and see how the skin reacts ESR Use to see if have inflammation somewhere in the body (erythrocyte sedimentation rate) Will be elevated with inflammation Check rheumatoid factor with determining have rheumatoid arthritis Antinuclear antibody Check what antibodies are attacking the self (auto antibodies)

Labs

Primary Immunodeficiency's Hypogammaglobulinemia

Dont have the antibodies that you need (IgG, IgM) born without the ability to make these Just got over infection and then get another how you tell if they have this Water bottle of sterile saline and powder that is given IV, and give q 6 weeks bc missing those antibodies Meds are very expensive (dont mix together until see the whites in the childs eyes) Give pre medication of tylenol and benadryl If they react give the meds slower Wiskott-aldrich Syndrome Genetic disorder linked to males only (carried on the y) See a child with immunodeficiency Most children have echsema, thrombocytopenia, and immunodeficiency Only cure is a stem cell or bone marrow transplant Bloody diarrhea, petechia, bleeding/bruising, peticki = signs Get IVIG, good skin care, prevent infection, and stem cell/bone marrow transplant

 Severe Combined Immune Deficiency In both boys and girls, genetic disorder Missing the t cells and b cells (we need to fight infection) Once moms immunity wears off at 3 months the child will have infections, chronic diarrhea, failure to thrive (lose weight, not eating well) These infections they have are severe iinfections and will be in the hospital bc have no immune system May notice thrush on mouth, constant and cant get out of their system Check blood for if they have the immunoglobulins that they should Treatment is stem cell and bone marrow transplant, IVIG until get stem cell or bone marrow transplant Prophylactic long term antibiotics, education on how to prevent infection

Child with rash From Wiskott-Aldrich Syndrome Peticki rash

 HIV infection Attacking T and B cells and cant fight off infection

Secondary Immunodeficiencies

Assessment- failure to thrive, recurrent infections, recurrent thrush Diagnose with PCR after 1 month of age-more sensitive test (during pregnancy or during birthing process) Polymerase chain reaction test (PCR) The eliza test is done later (treat until do this test and know they dont have the infection) Treatment: antiretroviral to prevent encephalopathy. C-sections, no breastfeeding End result of HIV infection is it goes to the brain (dont want encephalopathy) Prevent spread of HIV no breastfeeding, would do c section bc trauma can occur during birth and can transfer to child Mom continues to take antiretroviral drugs during the pregnancy Ryan White foundation can apply for financial money to help pay for the meds for mom

Autoimmune Disorders
Systemic Lupus Erythematosus (SLS) Can start as young as 15 (usually teenagers and older being diagnosed with this) Body attacking itself Get butterfly rash around cheeks, muscuoloskeltal changes, blood changes, skin changes, very tired, fevers, pain and sweeling in joints and could be any joint, tend to have numbness/tingling/cooling in toes and fingers Will have disease for life but want to keep this in steady state and have minimal or no joint pain Give corticosteroids, NSAIDS, anti-milaral drugs Make sure wearing mittens, socks, wear sunscreen (cover extremities bc of numbing/coolness)

 Juvenile Idiopathic Arthritis Affects fingers and knees Bodys antibodies are attacking the joints, typically the knees Have disease for life so want to prevent complications esp swollen joints Give corticosteroids to bring swelling down Knees will be enlarged, red, and have lots of pain, very stiff in the morning and hard to get out of bed If young child they will be fussy and irritable, they will favor a joint by limping, dont play with peers like they should ESR will be elevated bc indicates inflammation Wont see rheumatoid factor elevated bc its the body attacking itself Warm bath helps loosen joints, therapy to help ROM, wearing splints depending on where it hurts

Anaphylaxis
Food Allergies Common foods-milk, peanuts, eggs, tree nuts, fish/shellfish, wheat, soy Many times out grow the milk allergy but not peanuts Most common are peanuts, eggs, and fish/shellfish IgE is coming out and saying they dont like this and see a rxn like hives, itching, swelling around mouth Peanuts can go as far as anaphylaxis (just the dust of peanuts can trigger a rxn in some) Itching, vomiting, hives 2 min hours later when rxn will occur Wheezing moving in the wrong direction Can do skin testing (scratch test then orally eat food for rxn) Teach parents about epi-pen (they should have one in home, car, and in classroom at school) need pen near them Big thing is assess ABCs

 Anaphylaxis Immediate assessment of ABCs. Epinephrine treatment, benadryl, corticosteroids As soon as know they are breathing then give them epi pen Want to reduce the swelling with meds Have such a severe rxn that the throat is swelling Call rescue squad and get immediate assistance Be aware if are allergic to bees (the second rxn is more sever than first) Latex Allergy Prevent contact with and with cross-over foods Kiwi, bananas, peaches, pears, avocado, ect. (can cause same type of rxn as if come in contact with latex) Will see hives (big botchy hives) need to wear a bracelet with food allergy on it

Nursing Process
Assessment Diagnosis Planning Implementation Evaluation

Nursing Diagnoses
Ineffective protection Imbalanced nutrition: Less than body requirements Pain Impaired skin integrity Delayed Growth and Development

 End of Presentation