Download Alterations in RENAL/GU

Alterations in
Immunological Status:
Allergies, JRA
Allergies
Reactions involving
immunologic mechanism,
usually IgE responses
Allergens
Foods (Box 13-2, p. 528 Hockenberry 9th ed.)
Lactose Intolerance
Avoid foods HIGH in lactose
Infancy-- Soy formula
In older children NO MILK Lactaid, etc
Atopic Dermatitis (eczema)
 Treat
(Box 13-5.p 541)
pruritis and inflammation,
hydrate skin, prevent 2ndary infections
 Topical corticosteroids—1st-line tx
Symptoms of Milk Allergy
p. 530 Box 13-3 (Hockenberry, 9th ed.)
GI
Respiratory
Others
PREVENT FOOD ALLERGIES
No solids for 4-6 months of age
Until 12 months of age = no cow’s milk, eggs,
fish, corn, citrus, peanuts, chocolate
Introduce foods 1 every 5-7 days
Drug Allergies
Usually skin response
Or
ANAPHYLAXSIS !!
Environmental
Airborne
House dust mites
Cigarette smoke
Cat/Dog Dander
HX & Physical
Diagnosis
Skin Testing
Specific IgE Immunoassays—
No patient risk other than blood draw
Not influenced by medications
May be used for patient’s with rashes
Lower sensitivity than skin testing (~70%)
Only a potential of allergy
Not as cost effective as skin testing for
screening.
RAST test(Radio/allergo/Sorbent Test)—
Skin Testing
Prick
Safe for any age
Rapid
Multiple tests
Minimal discomfort
Results in 15 minutes
Over 80% accuracy for
inhalants
Over 90% accurate for
foods
Intradermal
Not tolerated by young
patients
More sensitive (1000X)
Results in 15 minutes
If negative, results are
near 100% predictive
Not used for foods
Meds—
Treatment
Topical corticosteroids, Oral Antihistamines, Nasal steroid
sprays, Leukotriene antagonists, Nasal antihistamines, oral
decongestants
Desensitization shots
Takes months to show effect, over 80% efficacy
Environmental Changes
Mattress & pillow covers; wash bed linens weekly
Ø carpet especially shag; reduce humidity level
Ø blinds; should be replaced with curtains
Ø pets; no stuffed animals unless washable
Frequent filter changes on furnace
Treatment for Food Allergies
#1—Avoidance!!
Research studies are being performed at Duke and
Mt. Sinai specifically focusing on food
desensitizations
10 years from now, there may be other treatments
At this time, only research protocols exist
Management of Food Allergies
Have an individual management plan—know food triggers
Have a Food Allergy Action Plan
Educate yourself and others—know school interventions
Seek help from food allergy resources:
www.foodallergy.org
Join a food allergy support group
Epipen and Epipen Jr.
Epipen: patients over 66 lbs (33kg)
Epipen Jr: patient 33 lbs –66 lbs (15-30kg)
Patients who require the use of an Epipen should
go to the Evergency Room for further evaluation
TO MAKE SURE THE EMERGENCY IS OVER
TO PREVENT RECURRENCE OF ANAPHYLAXIS (MAY
HURS AFTER INITIAL SYMPTOMS)
OCCUR
6-8
Juvenile Rheumatoid Arthritis
(JRA)
Inflammatory Disease with an
unknown etiology
Pathophysiology
http://www.arthritis9.com/what-are-juvenile-rheumatoidarthritis-symptoms.html
Chronic inflammation of synovial lining of
the joint with fluid buildup (effusion)
into joint space
 joint erosion, and adhesion formation
Incidence
Also called juvenile
chronic arthritis or
idiopathic arthritis of
childhood
Peak ages: 1to 3 years
and 8 to 10 years
Girls > boys
Often undiagnosed
Prognosis
Actually a heterogenous group of
diseases
Pauciarticular onset (involves ≤4 joints)
Polyarticular onset (involves ≥5 joints)
Systemic onset (high fever, rash,
hepatosplenomegaly, pericarditis,
pleuritis, lymphadenopathy)
Poorest prognosis w/systemic onset; > 4
joints
Common symptoms
Stiffness
Pain & Swelling
Loss of mobility in affected joints
Warm to touch, usually without
erythema
Tender to touch in some cases
Symptoms increase with stressors
Growth retardation
Affiliated symptoms
Iridocyclitis/uveitis
Inflammation of iris and ciliary body
Unique to JRA
Requires treatment by ophthalmologist
90% children have negative rheumatic
factor
Symptoms may “burn out” and become
inactive
Chronic inflammation of synovium
with joint effusion, destruction of
cartilage, and adhesion formation as
disease progresses
Diagnostic Evaluation
No definitive diagnostic tests
Elevated sedimentation rate in some cases
X-ray 1st: widening of joint space,
2nd: fusion and articular erosion
Antinuclear antibodies (ANA) common, but
not specific for JRA
Leukocytosis during exacerbations
Diagnosis based on criteria of American
College of Rheumatology
American College of Rheumatology
Diagnostic Criteria
Age of onset younger than 16 years
One or more affected joints
Duration of arthritis more than 6
weeks
Exclusion of other forms of arthritis
Management Goals
Preserve Joint Function
Prevent Physical Deformity
Relieve Symptoms w/o further
complications
Treatment
Exercise/PT
Medications
NSAIDS
Ibuprofen, Tolmetin, Naprosyn
SAARD’s
D-Penicillamine, Gold, Quinine
Others
Cytoxic drugs (Methotrexate) & Corticosteroids
TNF Blockers—new kid on the block
Etanercept (Enbrel) IM 2X/wk self administered
Infliximab (Remicade) IV q 2mos
Nursing Measures
Careful Assessment
Administer medications
and teach family about
management
Moist heat
Referrals
American Juvenile
Arthritis Organization
http://www.arthritis.org