Transcript Immunologic Alterations - NURSING FDTC Batch Spring 2011

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:
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CBC
UA
BUN/Creatinine
ANA
SLE: Treatment
• Targeted at the organs affected
• Overall immunosuppression is usually necessary
• Medications:
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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??