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  2. 2. <ul><ul><li>Commensalism: Host provides shelter & food for organism; organism retains ability to exist independently </li></ul></ul><ul><ul><li>Mutualism: Host provides shelter & food for organism; both benefit </li></ul></ul><ul><ul><li>Parasitism: Host provides shelter & food; parasite benefits, but host may be harmed. </li></ul></ul>MICROORGANISMS & HOST RELATIONSHIPS:
  3. 3. IMMUNITY
  4. 5. What we will cover today… <ul><li>Overview: A & P of Immune System </li></ul><ul><li>Diagnostic Tests and Assessment </li></ul><ul><li>Nursing Techniques & Procedures </li></ul><ul><li>Congenital Immunology Health Problems </li></ul><ul><li>Acquired Immunologic Health Problems </li></ul><ul><li>Infectious Immunologic Health Problems </li></ul>
  5. 6. Overview … <ul><li>Nonspecific immunity (resistance of body to a harmful organism) </li></ul><ul><li>Functional at birth </li></ul><ul><li>First line of defense </li></ul><ul><li>Reacts similarly to all invaders </li></ul><ul><li>Includes phagocytosis of foreign material by white blood cells </li></ul>
  6. 7. Nonspecific immunity ( resistance of body to a harmful organism) <ul><li>Includes phagocytosis of foreign material by white blood cells </li></ul><ul><li>PMNs or granulocytes , which include basophils, eosinophils, & neutrophils, are most common type of white blood cells & are involved in acute inflammatory process (1 st line of defense) </li></ul><ul><li>Monocytes migrate to tissues where y become macrophages & have great phagocytic ability, functioning to eliminate foreign invaders & or material </li></ul><ul><li>Lymphocytes include B lymphocytes (B cells) & T lymphocytes (T cells), are responsible for specific immune response as well as NK cells (Natural Killer cells) concerned w/ viral control as well as autoimmune responses </li></ul>
  7. 8. Inflammatory response <ul><li>A NONSPECIFIC RESPONSE to any tissue injury aimed at maintaining body's homeostasis; </li></ul><ul><li>chemicals are released from injured cells, </li></ul><ul><li>which cause blood vessels to dilate, </li></ul><ul><li>bringing large numbers of neutrophils & macrophages to area </li></ul><ul><li>for phagocytosis of injured cells & foreign material, </li></ul><ul><li>allowing healing to occur </li></ul>
  8. 9. Specific immune response <ul><li>Second line of defense </li></ul><ul><li>Not functional at birth, must be learned by body </li></ul><ul><li>Not fully functional until a child is 6 years old </li></ul>
  9. 10. Specific Immune Response <ul><li>Humoral immunity depends upon antibody-producing abilities of B-cells </li></ul><ul><li>In response to antigens (foreign substances that trigger an immune response), B-cells convert into plasma cells & secrete specific antibodies (immune system proteins) to assist body in eliminating foreign proteins </li></ul>
  10. 11. Specific Immune Response <ul><li>Five classes of antibodies w/ different functions </li></ul><ul><li>IgG is antibacterial & antiviral antibody found in large quantities in all body fluids; this antibody can cross placenta; maternal IgG provides passive immunity for first 6 months of infant's life </li></ul><ul><li>IgA is found in saliva, tears, bronchial secretions, mucous secretions of small intestine, vagina & in breast milk; IgA is not present at birth & reaches normal levels at 6 to 7 years of age </li></ul><ul><li>IgM is body's primary antibody response to an antigen; IgM levels are low at birth & reach adult levels by 1 year of age </li></ul><ul><li>IgD's role in unknown but seems to be related to B-cell differentiation </li></ul><ul><li>IgE is normally found in very small amounts; IgE is associated w/ allergic reactions; elevated levels of IgE are associated w/ allergic individuals & clients infected w/ intestinal parasites; IgE is not present at birth </li></ul>
  11. 12. Cellular response <ul><li>T cells are produced in thymus & function to protect individual from intracellular organisms, viruses, & slow growing bacteria </li></ul><ul><li>Responsible for rejection of foreign grafts </li></ul><ul><li>Specialized types of T cells include killer T cells, suppressor T cells, & helper T cells </li></ul><ul><li>Killer T cells kill virus infected cells & depend upon IgG being bound to cell </li></ul><ul><li>Suppressor T cells inhibit activities of other T & B cells </li></ul><ul><li>Helper T cells help regulate actions of B cells </li></ul>
  12. 13. Complement <ul><li>Enzyme that responds to antigen-antibody reactions causing inflammation & destruction of foreign cells </li></ul><ul><li>Plays a role in autoimmune diseases (body attacks itself) </li></ul><ul><li>Levels of proteins lower in newborns than older children & adults </li></ul>
  13. 14. Diagnostic Tests & Assessments of Immune System <ul><li>Bone marrow aspiration : fluid-containing bone marrow cells are aspirated from iliac crest to provide information about hematologic & immunologic disorders </li></ul><ul><ul><li>Usually performed under local anesthesia </li></ul></ul><ul><ul><li>Post-procedure complications include bleeding & infection </li></ul></ul>
  14. 15. Diagnostic Tests & Assessments of Immune System <ul><li>White cell differentials (differential blood count ): compare % of types of white cells against whole; by evaluating ∆ in types of WBCs, information can be obtained related to type of infection </li></ul><ul><ul><li>Neutrophils  in response to acute infections </li></ul></ul><ul><ul><li> eosinophil counts are associated w/ allergies & parasitic infections as well as skin diseases such as eczema & psoriasis </li></ul></ul><ul><ul><li>Basophil counts may  in response to chronic infection & stress; white blood cells contribute to inflammatory process & allergic reactions because they release histamine </li></ul></ul>
  15. 16. Allergy testing <ul><li>Determines reactions to specific antigens </li></ul><ul><li>Four types of allergy tests available </li></ul><ul><ul><li>Scratch tests can test many antigens at once; although less sensitive than or allergy tests, results can be obtained in about 30 minutes </li></ul></ul><ul><ul><li>Prick test is similar to scratch test in that antigens are placed on skin; tends to be slightly more sensitive than scratch test </li></ul></ul>
  16. 17. Allergy testing <ul><li>More types of allergy tests available… </li></ul><ul><ul><li>Intradermal testing injects antigen into dermis; reactions are noted by redness & swelling </li></ul></ul><ul><ul><li>Radioallergosorbent testing (RAST) looks for allergen-specific IgE antibodies in a blood sample; it is no more sensitive than other methods but does not involve risk of anaphylaxis or allergic reactions </li></ul></ul>
  17. 18. Common Nursing Techniques & Procedures for Immune System <ul><li>Immunity from disease can be acquired either from exposure to disease or by immunization (introducing an antigen into body) </li></ul><ul><ul><li>Active immunity involves body's formation of antibodies in response to exposure to an antigen </li></ul></ul><ul><ul><li>Passive immunity is temporary immunity achieved by administration of antibodies produced by another individual; when antibodies pass from mother to fetus, passive immunity is acquired </li></ul></ul>
  18. 19. Vaccines <ul><li>Contain antigens to specific diseases; they cause body to respond w/ development of antibodies & active immunity </li></ul><ul><li>Vaccines may contain killed virus, live virus, or toxoids; </li></ul><ul><ul><li>live vaccines have weakened virus but still carry risk of infection; </li></ul></ul><ul><ul><li>killed virus & toxoid vaccines do not carry this risk; </li></ul></ul><ul><ul><li>live vaccines should be avoided in immunocompromised or pregnant client </li></ul></ul>
  19. 20. Vaccines <ul><li>Childhood vaccinations are currently recommended for hepatitis B, diphtheria, tetanus, pertussis, hemophilus influenzae B, polio, measles, mumps, rubella, & varicella; vaccinations for hepatitis A are also recommended in certain areas </li></ul><ul><li>Vaccination schedules allow initial vaccination to occur after passive immunity from mother has disappeared; some vaccinations do not provide lifelong immunity & should be repeated </li></ul>
  20. 21. Vaccines <ul><li>American Academy of Pediatrics provides current recommendations on vaccination schedule </li></ul><ul><li>Prior to administering vaccinations, absence of allergic reaction history should be verified </li></ul><ul><li>Instruct parents to maintain vaccination schedule; if vaccinations are delayed, follow AAP recommendations for completing vaccination program </li></ul>
  21. 22. Congenital Immunologic Health Problems <ul><li>Severe combined immunodeficiency disease </li></ul><ul><ul><li>Description </li></ul></ul><ul><ul><ul><li>Severe combined immunodeficiency disease (SCID) is most severe of several different congenital disorders of immune system yielding susceptibility to infections </li></ul></ul></ul><ul><ul><ul><li>Other forms of immunodeficiency include B cell & T cell deficiencies </li></ul></ul></ul>
  22. 23. Congenital Immunologic Health Problems <ul><ul><li>Etiology & pathophysiology </li></ul></ul><ul><ul><ul><li>SCID occurs as a result of x-linked recessive or autosomal recessive inheritance, as well as because of a spontaneous mutation </li></ul></ul></ul><ul><ul><ul><ul><li>Characterized by absence of both humoral & cellular immunity </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Maternal antibodies may protect infant for a short period of time, but chronic infections become apparent around 3 months of age </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Death usually occurs w/in first 2 years of life </li></ul></ul></ul></ul>
  23. 24. Congenital Immunologic Health Problems <ul><ul><li>Assessment </li></ul></ul><ul><ul><ul><li>Initial infection often persistent thrush (oral candidiasis) </li></ul></ul></ul><ul><ul><ul><li>Followed by chronic infections </li></ul></ul></ul><ul><ul><ul><li>Organisms causing infection may include cytomegalovirus & Pneumocystis carinii </li></ul></ul></ul><ul><ul><ul><li>Failure to thrive also accompanies diagnosis </li></ul></ul></ul><ul><ul><ul><li>Leukocyte counts are usually reduced </li></ul></ul></ul>
  24. 25. Congenital Immunologic Health Problems <ul><ul><li>Priority nursing diagnoses </li></ul></ul><ul><ul><ul><li>Risk for infection related to immunodeficiency </li></ul></ul></ul><ul><ul><ul><li>Altered growth & development </li></ul></ul></ul><ul><ul><ul><li>Altered nutrition: less than body requirements </li></ul></ul></ul><ul><ul><ul><li>Risk for ineffective coping </li></ul></ul></ul>
  25. 26. Congenital Immunologic Health Problems <ul><ul><li>Planning & implementation </li></ul></ul><ul><ul><ul><li>Protecting child from infection is of primary importance; careful hand-washing is essential, as well as preventing contact w/ infected individuals </li></ul></ul></ul><ul><ul><ul><li>Live plants & fresh flowers should be avoided as they harbor mold & bacteria </li></ul></ul></ul><ul><ul><ul><li>While hospitalized, care should be taken in planning room assignment to reduce exposure to infection </li></ul></ul></ul><ul><ul><ul><li>Bone marrow transplant offers best hope for survival </li></ul></ul></ul>
  26. 27. Medication Therapy <ul><li>Intravenous immune globulin (IVIG) (see Box 11-1) </li></ul><ul><li>Immunizations should be administered 14 days prior to or 3 months after IVIG administration </li></ul><ul><li>Antibiotic therapy when indicated; monitor for overgrowth of non-susceptible organisms </li></ul><ul><li>Maintain intact skin & mucous membranes </li></ul>
  27. 28. Client education <ul><li>Teach family ways to protect child from infection </li></ul><ul><li>Provide emotional support & support group referrals </li></ul><ul><li>Genetic counseling provides family w/ information about transmission </li></ul>
  28. 29. Evaluation: <ul><li>Client remains free of infection; family demonstrates appropriate coping methods related to diagnosis & prognosis </li></ul>
  29. 30. Acquired Immunologic Health Problems <ul><li>Allergies </li></ul><ul><ul><li>Description </li></ul></ul><ul><ul><ul><li>Hypersensitivity to a foreign protein </li></ul></ul></ul><ul><ul><ul><li>Antigen-antibody reaction causes release of histamine & or chemicals into body; chemicals are responsible for allergic symptoms </li></ul></ul></ul><ul><ul><ul><li>Broad group of disorders; symptoms vary dependent on body cell that has been sensitized </li></ul></ul></ul>
  30. 31. Acquired Immunologic Health Problems <ul><li>Allergies </li></ul><ul><ul><li>Etiology & pathophysiology </li></ul></ul><ul><ul><ul><li>First exposure to antigen causes production of antibodies (usually IgE) </li></ul></ul></ul><ul><ul><ul><li>Subsequent exposure to same antigen causes an antigen-antibody reaction w/ cell damage causing release of histamine & or chemicals </li></ul></ul></ul><ul><ul><ul><li>Chemicals travel through bloodstream causing allergic symptoms </li></ul></ul></ul>
  31. 32. Acquired Immunologic Health Problems <ul><li>Allergies </li></ul><ul><ul><li>Etiology & pathophysiology </li></ul></ul><ul><ul><ul><li>Most allergens are large molecular weight proteins </li></ul></ul></ul><ul><ul><ul><ul><li>Common inhalant allergens include mold, pollen & house dust, pet dander </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Common food allergens include cow's milk, eggs, wheat, chocolate, citrus fruits </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Drugs including oral & injectables </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Animal serum/venom & insect stings </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Contact allergens include plants, dyes, & chemicals </li></ul></ul></ul></ul>
  32. 33. Assessment <ul><li>Family history of allergies </li></ul><ul><li>History of reactions: allergy symptoms can be numerous </li></ul><ul><ul><li>Respiratory system: allergic rhinitis, asthma, serous otitis media, allergic croup </li></ul></ul><ul><ul><li>Skin: eczema, atopic dermatitis, angioedema, urticaria </li></ul></ul><ul><ul><li>Gastrointestinal system: diarrhea, constipation, colic </li></ul></ul>
  33. 34. Assessment <ul><li>History of reactions: allergy symptoms can be numerous </li></ul><ul><ul><li>Neurologic system: headache, tension-fatigue, convulsions </li></ul></ul><ul><ul><li>Genitourinary system: dysuria, enuresis </li></ul></ul><ul><ul><li>Miscellaneous: serum sickness & anaphylaxis </li></ul></ul><ul><li>Elevated eosinophil counts </li></ul>
  34. 35. Assessment <ul><li>Allergy testing: Skin or RAST test </li></ul><ul><ul><li>Skin testing can involve a scratch or intradermal injection of small amounts of suspected allergens; scratch test is often an initial diagnostic tool as it allows for testing a large number of allergens quickly w/ results in about 30 minutes; if child is allergic to allergen, a reddened wheal will form in 15 to 30 minutes; anaphylaxis during testing; it is more expensive & felt to be less sensitive. </li></ul></ul>
  35. 36. Assessment <ul><li>Allergy testing: Skin or RAST test </li></ul><ul><ul><li>RAST test is a blood test looking for specific IgE antibodies; used in individuals who have a history of a strong reaction, as this test allows no opportunity for anaphylaxis during testing; it is more expensive & felt to be less sensitive </li></ul></ul>
  36. 37. Priority nursing diagnoses <ul><li>Risk for injury </li></ul><ul><li>Altered tissue perfusion: cardiopulmonary </li></ul><ul><li>Impaired skin integrity </li></ul><ul><li>Diarrhea </li></ul><ul><li>Knowledge deficit </li></ul>
  37. 38. Planning & implementation <ul><li>Interventions are aimed at reducing exposure to allergen </li></ul><ul><ul><li>Food. once food allergens are identified, all labels of prepared food should be carefully read to avoid allergens </li></ul></ul><ul><ul><li>Environment: create surface that's easily cleaned; focus in particular on child s bedroom; no carpet, bedroom curtains & bedding should be washable; avoid dust-collecting items in bedroom; avoid live plants & flowers; keep animals out of bedroom; no stuffed toys in bedroom </li></ul></ul><ul><ul><li>Inhalant: avoid cigarette smoking in child's presence & environment </li></ul></ul>
  38. 39. Planning & implementation <ul><li>Interventions are aimed at reducing exposure to allergen </li></ul><ul><li>Immunotherapy aims at increasing child's tolerance of allergen; also called hyposensitization or allergy shots, this rapy provides for introduction of allergen in small but increasing amounts by subcutaneous injections </li></ul>
  39. 40. Planning & implementation <ul><ul><li>Injections are given in controlled environment because of risk of systemic reaction or anaphylaxis </li></ul></ul><ul><ul><li>Child remains in controlled environment for 15 minutes post-injection to allow for monitoring of side effects </li></ul></ul><ul><ul><li>Emergency treatment must be readily available in case anaphylaxis occurs </li></ul></ul>
  40. 41. Medication Therapy <ul><li>Antihistamines are given prior to or early in reactive phase; antihistamines compete w/ histamine on receptor sites, refore if given late in reaction, will be ineffective </li></ul><ul><li>Bronchodilators may be given for lower-respiratory symptoms </li></ul>
  41. 42. Medication Therapy <ul><li>Corticosteroids may be administered systemically or topically, depending upon symptoms </li></ul><ul><li>Cromolyn sodium is a preventive medication for asthma; it is not useful during an acute attack </li></ul><ul><li>Epinephrine is administered for anaphylaxis </li></ul>
  42. 43. Client education <ul><li>Parents & child should be taught to manage symptoms, control environmental exposure, & recognize medical emergencies </li></ul><ul><li>Obtain medic alert bracelets, especially for drug allergies </li></ul><ul><li>Safe administration of medications </li></ul>
  43. 44. Evaluation: <ul><li>Child & Parents verbalize medication understanding, demonstrate their use correctly, & verbalize environmental control of allergens </li></ul>
  44. 45. Infectious Immunologic Health Problems <ul><li>TORCH is an acronym for a group of infections, which when acquired in utero, cause teratogenesis </li></ul><ul><ul><li>T is for toxoplasmosis: toxoplasmosis is an infectious disease by organism Toxoplasma gondii & is usually contracted from cat feces & undercooked meats </li></ul></ul><ul><ul><li>0 is for other, which includes syphilis & hepatitis; congenital syphilis is caused by spirochete Treponema pallidum </li></ul></ul>
  45. 46. Infectious Immunologic Health Problems <ul><li>TORCH is an acronym for a group of infections, which when acquired in utero, cause teratogenesis </li></ul><ul><ul><li>R stands for rubella; also called German measles </li></ul></ul><ul><ul><li>C refers to cytomegalovirus or CMV a member of herpes family </li></ul></ul><ul><ul><li>H is for herpes simplex virus </li></ul></ul>
  46. 47. Etiology & Pathophysiology <ul><li>Maternal exposure to organism allows fetal exposure through placenta </li></ul><ul><li>The earlier in gestation that infection occurs, greater damage that may occur </li></ul><ul><li>Mother may be asymptomatic during pregnancy & syndrome may not be recognized until after baby is born </li></ul>
  47. 48. Assessment <ul><li>Assessment of newborn is comprehensive, reviewing all systems </li></ul><ul><li>Maternal history during pregnancy </li></ul><ul><li>Intrauterine growth retardation may be apparent at birth </li></ul>
  48. 49. Assessment <ul><li>Symptoms including hydrocephalus, blindness, microcephaly, mental retardation, as well as FTT, suggest TORCH infection; depending upon organism involved, infant may also display jaundice, rash, deafness, cardiac defects </li></ul><ul><li>Serologic blood sampling for toxoplasmosis, rubella, CMV; & herpes; VDRL for syphllis & a hepatitis profile </li></ul>
  49. 50. Priority nursing diagnoses <ul><li>Altered nutrition: less than body requirements </li></ul><ul><li>Risk for altered parent attachment </li></ul><ul><li>Altered growth & development </li></ul>
  50. 51. Planning & implementation <ul><li>The child should be isolated as virus may be shed for up to a year after birth; pregnant women are at increased risk </li></ul><ul><li>Parents may grieve at loss of normal newborn; emotional support must be available </li></ul>
  51. 52. Planning & implementation <ul><li>Physical care supporting infant's needs will be individualized </li></ul><ul><li>Nutritional support will be needed to support intake of food; child may require a nasogastric or gastric tube or utilize a &quot;premie&quot; nipple to make sucking easier </li></ul>
  52. 53. Medication Therapy <ul><li>Depends upon infectious organism </li></ul><ul><li>For toxoplasmosis, an extended course of pyrimethamine (Daraprim) & sulfadiazine (generic) may be given; leucovorin may be added to reduce bone marrow suppression </li></ul>
  53. 54. Medication Therapy <ul><li>Treatment for congenital syphllis is usually a 10 to 14 day course of penicillin </li></ul><ul><li>Acyclovir (Zovirax) is used to treat infants w/ congenital herpes infection </li></ul>
  54. 55. Client education <ul><li>Parents are educated to meet physical needs of their handicapped infant; nutrition support is of primary importance </li></ul><ul><li>Infant stimulation to promote physical development of child; special instructions need to be given to assist parents working w/ blind or deaf child </li></ul><ul><li>Instructions must be given about potential viral shedding; parents are instructed to avoid contact w/ pregnant women </li></ul>
  55. 56. Evaluation: <ul><li>Parents verbalize & demonstrate appropriate child care measures including nutritional support; </li></ul><ul><li>Parents express confidence in their ability to care for their child; </li></ul><ul><li>Parents demonstrate safe medication administration </li></ul>
  56. 57. Sepsis <ul><li>Description: sepsis is systemic bacterial infection spread through bloodstream </li></ul><ul><li>Etiology & pathophysiology </li></ul><ul><ul><li>Neonates are at high risk because of inability to localize an infectious organism; low birth weight is a risk factor for sepsis </li></ul></ul>
  57. 58. Sepsis <ul><li>Etiology & pathophysiology </li></ul><ul><ul><li>Immunocompromised children at high risk </li></ul></ul><ul><ul><li>Children w/ skin defects/injuries or w/ invasive devices at high risk </li></ul></ul><ul><ul><li>Organisms involved include Escherichia coli, pseudomonas, enterococcus, staphylococcus </li></ul></ul>
  58. 59. Assessment <ul><li>Monitor clients for risk factors for sepsis </li></ul><ul><li>Hypothermia or hyperthermia </li></ul><ul><li>Lethargy, poor feeding </li></ul><ul><li>Jaundice or hepatosplenomegaly </li></ul><ul><li>Respiratory distress </li></ul><ul><li>Vomiting </li></ul>
  59. 60. Priority nursing diagnoses <ul><li>Hypothermia </li></ul><ul><li>Hyperthermia </li></ul><ul><li>Ineffective infant feeding pattern </li></ul>
  60. 61. Planning & implementation <ul><li>Maintain temperature w/in normal range w/ antipyretics as ordered, tepid sponge bath, appropriate clothing </li></ul><ul><li>Monitor blood glucose; support nutrition; lethargy, hypoglycemia, & hyperthermia can all contribute to poor feeding </li></ul><ul><li>Maintain antibiotic therapy on schedule, monitor for side effects </li></ul>
  61. 62. Medication therapy <ul><li>Antibiotic therapy based on culture and sensitivity </li></ul><ul><li>Antipyretics such as acetaminophen (Tylenol) for elevated temperature </li></ul>
  62. 63. Client education <ul><li>Teach the parents how to monitor temperature and means of maintaining a neutral body temperature </li></ul><ul><li>Instruct parents on the purpose of the antibiotics and potential side effects </li></ul>
  63. 64. Evaluation <ul><li>Harmful sequelae of sepsis will be prevented </li></ul><ul><li>Parents are able to describe the purpose of the antibiotics and can list side effects for which the child is being monitored </li></ul>
  64. 65. Acquired immunodeficiency syndrome (AIDS) <ul><li>Description: infection with retrovirus human immunodeficiency virus (HIV) </li></ul><ul><li>Etiology and pathophysiology </li></ul><ul><ul><li>Virus transmitted through blood and body fluids of infected person </li></ul></ul><ul><ul><li>Most common source of infection in children is perinatally, from an infected mother to her infant </li></ul></ul><ul><ul><ul><li>Across the placenta </li></ul></ul></ul><ul><ul><ul><li>At the time of birth </li></ul></ul></ul><ul><ul><ul><li>Possibly through breast milk </li></ul></ul></ul>
  65. 66. Acquired immunodeficiency syndrome (AIDS) <ul><li>Etiology and pathophysiology </li></ul><ul><ul><li>Also could be contracted from transfusions with infected blood or blood products </li></ul></ul><ul><ul><li>Once in the body, the HIV enters the T lymphocytes, particularly the CD4 cell </li></ul></ul><ul><ul><li>The CD4 cell begins synthesis of the HIV DNA </li></ul></ul><ul><ul><li>Leads to death of CD4 cell </li></ul></ul><ul><ul><li>Infected child is susceptible to infection caused by deficiency in cell-mediated and humoral immunity </li></ul></ul>
  66. 67. Assessment <ul><li>Diagnostic tests for HIV start at birth; the child of the HIV-positive mother is followed up to 18 months before infection can be determined; tests are divided into early (birth, 3, and 6 months) and later (12, 15, and 18 months) </li></ul><ul><li>Early tests to detect the HIV antigen (p24 antigen), HIV (HIV culture and polymerase chain reaction [PCR]) </li></ul><ul><li>After maternal antibodies have disappeared, ELISA test (enzyme-linked immunosorbent assay) </li></ul>
  67. 68. Assessment <ul><li>CBC and CD4 levels </li></ul><ul><li>Presenting symptoms include chronic diarrhea, failure to thrive, delayed development </li></ul><ul><li>Frequent infections including candidiasis, Streptococcus pneumoniae, Hemophilus influenzae , Staphylococcus aureus , and herpes simplex </li></ul><ul><li>Opportunistic infections including pneumocystis carinii </li></ul>
  68. 69. Priority nursing diagnoses <ul><li>Risk for infection related to immunosuppression secondary to HIV infection </li></ul><ul><li>Altered nutrition: less than body requirements </li></ul><ul><li>Ineffective family coping </li></ul>
  69. 70. Planning and implementation <ul><li>Focus on preventing infection </li></ul><ul><ul><li>Normal health precautions including handwashing, avoiding contact with infected persons, maintaining nutritional status, good skin care, promoting a hygienic environment. </li></ul></ul><ul><ul><li>Immunizations on schedule; the child and all household contacts should avoid immunization with live virus vaccines </li></ul></ul><ul><ul><li>Following medical orders on prophylactic drugs </li></ul></ul>
  70. 71. Management of symptoms <ul><ul><li>Diarrhea management, monitoring hydration and nutrition status, maintaining skin integrity </li></ul></ul><ul><ul><li>Monitoring for infection including pneumonia, meningitis, otitis media and others </li></ul></ul><ul><ul><li>Support of family coping </li></ul></ul><ul><ul><ul><li>Encourage participation in parent support groups </li></ul></ul></ul><ul><ul><ul><li>Demonstrate acceptance of child during everyday contact </li></ul></ul></ul><ul><ul><ul><li>Utilize communication skills to allow parents to verbalize feelings </li></ul></ul></ul>
  71. 72. Medication therapy <ul><li>Prophylaxis treatment </li></ul><ul><ul><li>Against HIV: zidovudine (AZT) </li></ul></ul><ul><ul><li>Against pneumocystis cari nii: trimethoprim-sulfamethoxazole (Bactrim or Septra) </li></ul></ul><ul><ul><li>Against bacterial infections: intravenous immune globulin (IVIG) </li></ul></ul><ul><ul><ul><li>Infections: appropriate antimicrobial therapy; for antibiotic therapy, see Table 11-1 </li></ul></ul></ul>
  72. 73. Client education <ul><li>Information is presented on preventing the spread of HIV to other members of the household and those having contact with the child </li></ul><ul><li>Parents are taught to maintain a clean home environment and ways to reduce bacterial exposure </li></ul><ul><li>Information about nutritional support, diarrhea, and skin management as well as medication regimen is given </li></ul><ul><li>Developmental stimulation information is shared with the parents </li></ul><ul><li>Infection monitoring information is given to the parents </li></ul>
  73. 74. Evaluation: <ul><li>Parents : </li></ul><ul><li>Verbalize medication regimen, describe safety measures to prevent infection, </li></ul><ul><li>Identify symptoms of infection to be reported to physician, </li></ul><ul><li>Discuss their concerns about caring for this child, and join a support group </li></ul>
  74. 75. Childhood communicable diseases <ul><li>Description: a group of diseases common during childhood </li></ul><ul><li>Etiology and pathophysiology </li></ul><ul><ul><li>Variety of diseases spread from person to person </li></ul></ul><ul><ul><li>Infectious organism often viral </li></ul></ul><ul><li>Mode of transmission describes how the organism moves from one individual to another </li></ul><ul><li>Incubation period describes the time between exposure to the disease and disease outbreak; during this time, the child may be contagious </li></ul><ul><li>Period of communicability is the time period when the organism can move from the host to another individual </li></ul>
  75. 76. Assessment <ul><li>in contact with children should be constantly alert to the appearance of symptoms associated with the childhood diseases and take measures to prevent the spread the infection to other children </li></ul><ul><li>Client history will include record of vaccinations as well as history of exposure to children with communicable diseases </li></ul><ul><li>Regardless of the reason the child is seeking treatment, all children should be assessed for symptoms of communicable diseases including rashes, temperature, and swollen glands </li></ul><ul><li>The period of time between the initial symptoms and the presence of the full-blown disease is called the prodromal period </li></ul>
  76. 77. Priority nursing diagnoses <ul><li>Hyperthermia </li></ul><ul><li>Risk for injury secondary to complications of childhood diseases </li></ul><ul><li>Body image disturbance </li></ul><ul><li>Risk for impaired skin integrity related to scratching secondary to itch </li></ul><ul><li>Social isolation </li></ul>
  77. 78. Planning and Implementation <ul><li>Immediate steps are taken to reduce exposure of other children to the possibly infected child </li></ul><ul><li>Monitor temperature and use temperature control measures to reduce hypertbermia </li></ul><ul><ul><li>Tepid baths </li></ul></ul><ul><ul><li>Limit clothing and bed coverings </li></ul></ul><ul><ul><li>Give NSAIDs as ordered; avoid aspirin as aspirin intake with a viral infection may contribute to the development of Reye syndrome </li></ul></ul><ul><ul><li>Increase liquid intake </li></ul></ul>
  78. 79. Medication therapy <ul><li>Antibiotic therapy usually not recommended unless secondary bacterial infection occurs </li></ul><ul><li>Antipyretics, analgesics, and anti-inflammatory drugs may be ordered; aspirin is usually contraindicated in acute viral infections </li></ul>
  79. 80. Client education <ul><li>Instructions should be given regarding available vaccines to prevent the development of childhood contagious disease </li></ul><ul><li>Information should be given regarding isolation precautions for the illness </li></ul><ul><li>Parents should be aware of symptoms that indicate the development of complications of the specific illness </li></ul>
  80. 81. Evaluation: <ul><li>Client receives vaccinations on schedule; </li></ul><ul><li>Client develops no complications of childhood communicable disease; </li></ul><ul><li>Parents describe isolation precautions for their child with a communicable disease </li></ul>
  81. 85. Lymph System