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Immunologic Alterations
By Nataliya Haliyash,
MD, BSN
Insitute of Nursing,
TSMU
Lecture objectives
Upon completion of this chapter you will be able to:
Describe the normal functions of the immune system.
Describe the etiology, clinical manifestations, and
medical treatment for the common immune system
alterations, juvenile idiopathic arthritis (JIA), systemic
lupus erythematosus (SLE), human
immunodeficiency virus (HIV), and allergic reaction to
drugs.
Identify nursing management of children with immune
system alterations, including developmental and
psychosocial needs.
Identify the education, resource, and support needs
of families who have children with immune system
alterations.
Immunity
nonspecific,
function against most threats to the body in a
broad sense.
Is represented by physical barriers such as:
the skin, mucous membranes,
cough reflex;
chemical barriers such as pH of the stomach, fatty acids and
proteolytic enzymes of the small intestine,
fever.
Acquired immunity
or integumentary
systemic lupus erythematosus.
Pathophysiology of JRA
Clinical manifestations
Systemic onset
Fever (usually high)
Rash (Salmon-pink, migratory, macular/papular, most
common late afternoon or early evening)
Arthralgia/myalgia
arthritis is defined as
Arthritis
joint swelling or effusion,
Fatigue/malaise
or two of the following:
warmth, pain on motion,
Lymphadenopathy
or limited range of
Hepatosplenomegaly
motion
Possible signs of carditis
(continues)
Polyarticular onset
Arthritis in many joints (five or more)
Low-grade fever
Pauciarticular onset
Arthritis in a few joints (less than 4)
Multidisciplinary approach
Medications
Physical and occupational therapy
Nutritional considerations
Family teaching
Pathophysiology:
Diagnosis of Lupus
Erythematosus
Diagnosis of Lupus
Erythematosus
Nonerosive arthritis:
Pleuritis or pericarditis
Renal disorder:
Persistent proteinuria OR cellular casts;
can progress to hypertension, nephrotic syndrome, renal
insufficiency, and end stage renal disease requiring
transplantation.
Neurological disorder:
Seizures OR psychosis without other cause.
Hematological disorder
Immunologic markers
ANA (antinuclear antibody) positive
Alopecia
4 of the 11 criteria must be present
Lupus Erythematosus
Treatment
Preventing exacerbations
Treating exacerbations when they occur
Minimizing organ damage and
complications
Medications
Nursing management
Clinical manifestations
CD4 counts normal: asymptomatic
Associated symptoms of opportunistic
infections
The younger the child at time of
acquisition, the more severe the
symptoms, faster progression, poorer
prognosis
Variations by age
Diagnosis of HIV
Treatment of HIV
Multidisciplinary approach
HAART (highly active antiretroviral
therapy)
Prevention of opportunistic infections
Nursing management and family teaching
Home
School
Community
(continues)
Clinical manifestation
Angioedema
Urticaria
Maculopapular rashes
Contact dermatitis
Anaphylaxis
Erythema multiforme
Stevens-Johnson syndrome
(continues)
Diagnosis
Treatment
Nursing management
Situation: Stevens-Johnson
syndrome
Endocrine Alterations
Anterior pituitary
Posterior pituitary
Thyroid
Parathyroids
Adrenal cortex
Adrenal medulla
Ovaries
Testes
Pancreas
Short stature
Deteriorating or absent rate of growth
Higher weight-for-height ratio
Delayed bone age
Diagnosis
Treatment
Nursing Management
Assessment
Nursing diagnoses
Delayed growth and development related
to inadequate growth hormone secretion
Disturbed body image related to short
stature
Deficient knowledge related to treatment
(continues)
Nursing Management
Outcome identification
Planning/implementation
Evaluation
Family teaching
(continues)
Clinical manifestations
Accelerated growth rate
Advanced bone age
Evidence of secondary sexual
characteristics
Acne
Adult body odor
Possible behavior changes
(continues)
Diagnosis
Complete history
Physical exam
Sexual maturation staging (Tanner staging)
Height, weight, span (fingertip to fingertip),
upper/lower body ratio
Radiological exams
Laboratory screening
(continues)
Treatment
Nursing management
(continues)
Diagnosis
First morning urine sample: osmolarity,
specific gravity, sodium
Serum osmolarity, sodium and creatinine
levels
Water deprivation test
(continues)
Treatment
Replacement of antidiuretic hormone or
vasopressin
Desmopressin acetate (DDAVP)
Nursing management
Other manifestations
(continues)
Diagnosis
Treatment
Nursing management
Family teaching
(continues)
Clinical manifestations
(continues)
Cold intolerance
Edema of face, eyes, hands
Delayed deep tendon reflexes
Delayed puberty
(continues)
Diagnosis
Treatment
Nursing management
Assessment
(continues)
(continues)
Clinical manifestations
Nursing management
Family teaching: home, school,
community
(continues)
Clinical manifestations
Male fetus: no physical changes
Female fetus: virilized external genitalia
Enlarged clitoris
Fusion of the labial folds
Rugate appearance to labia
Pseudohermaphroditism
Insulin management
Blood glucose management
Nutrition
Exercise
Assessment
Nursing diagnoses
Risk for injury related to insulin
insufficiency and deficiency
Risk for injury related to hypoglycemia or
hyperglycemia
Disturbed body image related to
developing a chronic disease
(continues)
Outcome identification
Planning/implementation
(continues)
Survival education
Insulin preparation and injection
Blood glucose and urine-ketone
monitoring
Hypoglycemia
Hypoparathyroidism
Addisons disease
Cushings syndrome