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Chapter 26

Chapter 26. Caring for the Child with an Immunologic or Infectious Condition. The Immune System. Protection offered by the immune system is called immunity Innate (natural) Adaptive (active) Passive (acquired). The Body’s Defense. Skin (most important physical barrier)

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Chapter 26

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  1. Chapter 26 Caring for the Child with an Immunologic or Infectious Condition

  2. The Immune System • Protection offered by the immune system is called immunity • Innate (natural) • Adaptive (active) • Passive (acquired)

  3. The Body’s Defense • Skin (most important physical barrier) • Protects the deeper tissues from injury • Protects the body from foreign matter invasion • Regulates temperature • Aids in water retention • Aids in synthesis of vitamin D • Initiates the sensations of touch, pain, heat, and cold • The mucous membranes provide a protective barrier against the entry of pathogens

  4. Barriers • Mechanical barriers: the mechanical action of fluids (tears, urine, vaginal secretions, and semen) that flow out from the body and carry unwanted intruders • Chemical barriers (acidic secretions of stomach and digestive enzymes) neutralize organisms taken into the body through the mouth

  5. Congenital Immunodeficiency Disorders • B-cell disorders • T-cell disorders • B-lymphocyte disorders • Combined immunodeficiency disorders • Wiskott-Aldrich syndrome

  6. Immunodeficiency Disorders  

  7. Human Immunodeficiency Virus • Signs and symptoms • Lymphadenopathy, hepatosplenomegaly, chronic diarrhea, FTT, oral thrush, skin infections, fevers, recurrent respiratory infections & neurological involvement • Diagnostic testing (ELISA & PCR) • Nursing care • Provide psychological and physiological care • Give antiviral therapy • Provide symptomatic care and be supportive • Pain management • Treating malnutrition • Use the team approach

  8. Transplantation(Medically Induced Posttransplant) • Nursing care • Give corticosteroids • Induction (suppress immune system) • Maintenance (correct amount of immunosupression) • Rejection (increased immunosupression) • Prevent infection • Promote good nutrition and general health • Maintain barriers • Identify early identification and give aggressive treatment

  9. Autoimmune Disorders

  10. Systemic Lupus Erythematosus • Signs and symptoms • Variable, fever, malaise, chills, fatigue, weight loss, butterfly rash, arthritis • Nursing care • Manage pain and inflammation • Treat symptoms • Prevent complications • Give antimalarial medications • Give corticosteriods • Give immunosuppressive agents • Give palliative care & psychosocial support

  11. Juvenile Rheumatoid Arthritis • Signs and symptoms • Involves few or multiple joints, limping, favoring a particular joint, pain, uneven growth, swelling, loss of motion, and stiffness • Nursing care • Relieve pain and prevent contractures • Encourage medical appointments • Discuss drug and physical therapy (surgery if necessary) • Provide parental support • Discuss ADLS, warm compresses, good nutrition, and summer camp

  12. Allergic Reaction(Anaphylaxis) • Signs and symptoms • Wheezing, tachycardia, hypotension, cyanosis, altered LOC (see Nursing Insight: Signs and Symptoms of Anaphylaxis) • Nursing care • Perform CPR • Activate the emergency system • Ensure adequate airway • Administer epinephrine (adrenaline) • Place a tourniquet proximal to the site • Keep the child lying flat, keep the child warm, and keep child’s feet elevated • Administer corticosteroids and antihistamines • Determine the cause of the attack

  13. Infectious Diseases of Childhood

  14. Chain of infection model Pathogenic microorganism Reservoir Means of escape Mode of transmission Means of entry Host susceptibility Infection • Epidemiological triangle • Host • Environment • Agent

  15. Infection (Table 26-1) • Chicken pox (viral) • Diphtheria (bacterial) • Infectious mononucleosis (viral) • Fifth disease (viral) • Haemophilus influenzae Type B (bacterial) • Mumps (viral) • Pertussis (bacterial) • Pneumococcal disease (bacterial) • Poliomyelitis (viral) • Roseola (viral) • Rubeola (viral) • Scarlet fever (bacterial) • Tetanus (bacterial)

  16. Infection • Signs and symptoms • Each infectious condition has unique signs and symptoms • Common signs and symptoms • Fever, malaise, anorexia, and pruritus • Nursing care • Provide good skin care and nutrition • Maintain barriers and immune response • Educate families about promoting stress reduction • Perform accurate assessment • Prevent disease transmission • Treat signs and symptoms • Teach families about universal precautions • Prevent complications

  17. Common Viral Infections

  18. Reye Syndrome Clinical Alert! Reye Syndrome Risk with Use of Aspirin Prolonged fever, mild hepatitis, and fatigue Educate parents about Reye Syndrome and use of aspirin-free medications for control of fever

  19. Cytomegalovirus Infections • Signs and symptoms • Prolonged fever, mild hepatitis, and fatigue • Nursing care • Give ganciclovir (antiviral agent) • Teach parents about average recovery time • Teach parents that children can resume activity as tolerated

  20. Herpes Zoster • Signs and symptoms • Cutaneous vesicular lesions • Nursing care • Decrease itching (calamine lotion) • Decrease pain (Acetaminophen) • Give acyclovir (antiviral medication) • Apply cool water compresses and give baths

  21. Small Pox • Signs and symptoms • Lesions produce pus • Chills, fever, headache, and vomiting • Nursing care • Implement isolation • Give antibiotic to prevent secondary infection • Give vaccinia Immune Globulin (VIG)

  22. Infectious Mononucleosis • Signs and symptoms • Cervical lymph nodes become swollen, firm, and tender • Chills, fever, headache, anorexia, and malaise • Nursing care • Maintain bedrest • Maintain hydration • Decrease fever • Implement isolation

  23. Common Fungal Infections

  24. Candida Albicans(Oral Thrush) • Signs and symptoms • White plaques on the surface of tongue and buccal membranes • Nursing care • Maintain nutrition • Give nystantin (administer with gloved finger using a swab; administer after feedings) • Educate parents about prevention

  25. Fungal Infections(Table 26-2) • Tinea capitis (Ringworm) • Tinea pedis (Athlete’s foot) • Tinea cruris (Jock itch) • Tinea corporis (epidermal layer of the skin)

  26. Immunizations • Inactivated vaccines (microbe is killed but still capable of producing antibodies) • Live attenuated vaccines (microbe not killed; decreases virulence) • Toxoids (geared toward a toxin-producing organism)

  27. Immunizations • Nursing roles • Maintain current knowledge • Assess current immunization • Be skilled in vaccine administration • Discuss immunization clinics • Ensure long-term tracking • Keep documentation • Discuss follow-up care • Contact centers for Disease Control • Educate parents about local and systemic; allergic reactions • Address unique concerns of each family

  28. Animal-Borne Infectious Diseases

  29. Rabies • Signs and symptoms • Generalized flu symptoms (malaise, fever, sore throat) • Alternations in mental status • Seizures • Hyperexcitability • Respiratory arrest • Nursing care • Clean wound • Administer Rabies Immune Globulin (HRIG) • Administer Rabies vaccine series (HDCV)

  30. West Nile Virus • Signs and symptoms • Headache, malaise, anorexia, nausea, vomiting, myalgia, eye pain, lymphadenopathy, and maculopapular rash • Nursing care • Educate parents about the disease • Give symptomatic care • Respond to parental concerns • Teach about insect repellents

  31. Avian Influenza • Signs and symptoms • Typical flu symptoms (cough, sore throat, fever, and myalgia) • Severe pneumonia and acute respiratory distress • Nursing care • Give supportive and symptomatic care • Give aggressive treatment of complications (pneumonia) • Give antiviral medications • Teach family about preparing for a pandemic

  32. An Emerging Issue in Infectious Disease: Resistant Organisms • Bacterial resistance due to misuse, overuse, and noncompliance • Nurses can provide • Implement isolation measures • Ensure education for health care professionals • Increase public awareness • Provide strategies to decrease transmission • Provide family education • Give information about current practices in infection control

  33. Antibiotic Alternatives • Monoclonal (based on passive immunity) • Probiotics (colonized in the intestine to improve immune function)

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