Nursing 4 Lecture 3 Autoimmunity MCKINNEY

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Nursing 4 Lecture 3 Autoimmunity MCKINNEY
2012-01-25 19:23:35

Nursing 4 Lecture 3 Autoimmunity MCKINNEY
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  1. Pediatric Differences in the Immune System
    -Lymphode tissue increases in mass during infancy and early childhood and reaches adult size by six weeks of age

    -The thymus reaches its peek mass before puberty and then involutes(shrinks) meaning that no more B-Cells will be made

    -The spleen reaches its full size during adulthood

    -Peyer's Patches increase until adolescence

    -Immaturity of the Immunologic System places the infant and younger and child at greater risk for infection

    -The infant has limited capacity to mount and antibody response, the ablility to respond to infections requires gradually as the infant acquires immunity actively and passively

    -Full term newborn receives an adult level of IgG as a result of transplacental transfer from the mother; this disappears during the first 6 to 8 months causing a physiologic drop in the IgG

    -Absolute lymphocyte counts reach a peak during the first year; helper T Cells reach adult levels by 6 years of age

    -Immunodeficiencies typically manifest in the first 6 months of life

    -HIV infection is typically passed from the mother to be baby- it is not sexual
  2. Corticosteroid Therapy in Children
    -Gastrointestinal irritation, edema, susceptible to infection, growth limitation, hypertension, loss of muscle mass, joint pain, osteoporosis may lead to bone fractures
  3. Predisolone
    Classification: Corticosteroid

    Action: Decreases inflammation; suppresses the immune response; affects bone marrow and the metabolism of proteins, carbohydrates, and fats

    Absorption: Rapid absorption from the gastrointestinal tract

    Excretion: Metabolized in the liver and excreted in the urine

    Contraindications: Do not give if the child has a systemic fungal infection or is sensitive to any of the ingredients

    Precautions: More prone to infection, avoid exposure to measles or chickenpox, immunize the child with live-virus vaccines before beginning corticosteroid treatment, avoid giving nonsteroidal antinflammatory drugs or aspirin because it may increase the risk of gastrointestinal bleeding

    Adverse Reactions: Gastrointestinal distress, cushingoid state (moon face, buffallo hump), delayed wound healing, skin eruption, carbohydrate intolerance, fluid retention, growth delay in children. Acute adrenal insufficiency can occur when the child is under stress or if the medication is withdrawn abruptly. DO NOT discontinue this medication without tapering the dose

    Nursing Considerations: Teach the parent to have the child take the medication with food or milk, store the medication in a cool, dry location. Notify the physician for any of the following- fever, other signs of infection, fatigue, muscle weakness, sudden weight gain, sever gastric irritation, slow wound healing, or growth delay, or if the child is experiencing increased stress.
  4. Topical Steroids
    -Used for treatment of ophthalmic reactions and skin conditions such as eczema

    -Apply directly to the skin or mucuos membranes to reduce edema or redness and counteract itching

    Example: hydrocortisone cream
  5. Inhaled Corticosteroids
    -Produce a very strong local action and can control symptoms in children with asthma and allergic rhinitis

    Example: beclomethasone
  6. Therapeutic Management of Corticosteroid Therapy
    -Because of immunosuppression, killed-virus vaccines are substituted for live-virus vaccines for children receiving high-dose or long-term steroids

    -Short-term high-dose therapy (for 1 week for less) is preferred over long-term therapy if there is a strong indication for the use of steroids
  7. Nursing Care for the Child Receiving Corticosteroids
    -Measure the height, weight, and blood pressure every visit to the Doctors

    -Observe for the usual side effects

    -Teach the patient to report any illness, bruising, or delayed wound healing
  8. Systemic Lupus Erythematosus in Children
    -Exposure to the sun, ultraviolet light, stress, fatigue, viruses, bacteria, certain medications, and some food additives

    -African American, Hispanics, and Asian children that are female between 9 and 15 years old

    -Manifestation: Malaise, arthralgia (joint pain), and recurrent fever of unknown etiology frequently are among the early manifestations; butterfly rash, discoid rash: red, round, raised patches that spread, photosensitivity, arthritis, pleuritis, renal disorder, neurologic disorders, hematologic disorders, immunologic disorders, posigive ANA assay; MAY HAVE WEIGHT LOSS AND GROWTH IMPAIRMENT, headache, and memory problems, Raynauds phenomenon often goes with it; Most serious complications= Renal disease and neurologic problems.