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Download Immunologic Alterations - NURSING FDTC Batch Spring 2011
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Immunologic Alterations NUR 264 Pediatrics Angela Jackson, RN, MSN Developmental Differences • The immune system of neonates and young children is immature • Infants and young children are susceptible to infectious organisms that can cause illness and its associated morbidity • Immunizations help prevent many viral and bacterial infections • The immune system matures by three to six years of age • Lymphoid tissue reaches adult size by six weeks of age, becomes larger during the prepubertal period, then goes back to normal by puberty Systemic Lupus Erythematosus (SLE) • Peak age of childhood onset is 11 to 15 years • Occurs in female 8 to 10 times more often than males • Occurs more often in African-Americans than in Caucasians SLE: Clinical Manifestations • Dependant upon which organs are targeted by the immune complexes, are chronic, and characterized by remissions and exacerbations • See box 31-11 and 31-12 on page 1185 for clinical manifestation and classification criteria SLE: Diagnosis • Diagnosis is based on history, physical exam and laboratory testing • Must have four of the eleven criteria • If ANA is negative, lupus is an unlikely diagnosis • Lab testing including: – – – – CBC UA BUN/Creatinine ANA SLE: Treatment • Targeted at the organs affected • Overall immunosuppression is usually necessary • Medications: – – – – – – Corticosteroids Salicylates NSAIDs Anti-hypertensive medications Anticonvulsant medications Anti-malarial medications (useful for rash and arthritis) SLE: Nursing Management • Teach the client and family about the disease process and projected course • Teach importance of recognizing signs of infection • Teach importance of adequate nutrition and fluid intake • Teach medication administration and potential side effects • Provide support Allergic Reaction to Medications • Adverse reaction to drugs or their metabolites caused by immunologic responses • Reactions demonstrate either systemic hypersensitivity or organ-specific patterns and usually recur on re-exposure to the same drug, but may also occur with prolonged administration Allergic Reaction to Medications • Clinical Manifestations – Cutaneous • Urticaria – wheal-like lesions appear after beginning the drug, resolve rapidly after stopping the drug • Angioedema • Maculopapular rash – most common form or cutaneous reaction • Contact dermatitis – usually pruritic, erythematous, vesicular or maculopapular. May take 5-7 days to develop Allergic Reaction to Medications – Multiple organ system involvement • Anaphylaxis • Nonspecific histamine release – same systemic manifestations as anaphylaxis • Erythema multiforme/Stevens-Johnson syndrome – erythematous, maculopapular, vesicular, urticarial rash. Mucosal and conjunctival lesions and epidermal loss of 10% or less with Stevens-Johnson syndrome • Toxic epidermal necrolysis (TEN) – fever epidermal loss of more than 30% of body surface are and visceral involvement with an associated 30 –40% mortality rate • Hypersensitivity syndromes • Drug fever Stevens-Johnson Syndrome Toxic epidermal necrolysis Urticaria, Maculopapular Rash and Angioedema The End! • Questions??
