This document provides an overview of nursing care for children with immune system disorders. It discusses the normal anatomy and physiology of the immune system and how alterations can lead to disorders. Common disorders covered include primary immunodeficiency disorders like agammaglobulinemia and common variable immunodeficiency. Secondary immunodeficiency from conditions like HIV are also discussed. For each disorder, the document outlines assessment, diagnostics, treatment including nursing considerations, and management goals.
The term immunity refers to the body’s specific protective response to an invading foreign agent or organism.
The human body has the ability to resist almost all types of organisms or toxins that tend to damage the tissues and organs. The capability is called immunity.
This presentation is related with the contents regarding breast feeding. It includes complete information about breast feeding including different pictures and beautifully designed.
The term immunity refers to the body’s specific protective response to an invading foreign agent or organism.
The human body has the ability to resist almost all types of organisms or toxins that tend to damage the tissues and organs. The capability is called immunity.
This presentation is related with the contents regarding breast feeding. It includes complete information about breast feeding including different pictures and beautifully designed.
Anatomical & physiological changes in pregnancy & their clinical implications...alka mukherjee
• Women undergo several changes during pregnancy, including cardiovascular, hematologic, metabolic, renal, and respiratory changes that provide adequate nutrition and gas exchange for the developing fetus.
• Progesterone and estrogen levels rise continually through pregnancy, together with blood sugar, breathing rate, and cardiac output.
• The body’s posture changes during pregnancy to accommodate the growing fetus and the mother will experience weight gain.
• Breasts grow and change in preparation for lactation once the infant is born. Once lactation begins, the woman’s breasts swell significantly and can feel achy, lumpy, and
heavy (engorgement). This is relieved by nursing the infant.
• Plasma and blood volume increase over the course of the pregnancy and lead to changes in heart rate and blood pressure. Women may also have a higher risk of blood clots, especially in the weeks following labor.
• During pregnancy, both protein metabolism and carbohydrate metabolism are affected. One kilogram of extra protein is deposited, with half going to the fetus and placenta, and another half going to uterine contractile proteins, breast glandular tissue, plasma protein, and hemoglobin.
• Circulatory Changes
• Plasma and blood volume slowly increase by 40–50% over the course of the pregnancy (due to increased aldosterone) to accommodate the changes, resulting in an increase in heart rate (15 beats/min more than usual), stroke volume, and cardiac output. Cardiac output increases by about 50%, primarily during the first trimester.
• The systemic vascular resistance also drops due to the smooth muscle relaxation and overall vasodilation caused by elevated progesterone, leading to a fall in blood pressure. Diastolic blood pressure consequently decreases between 12–26 weeks, and increases again to pre-pregnancy levels by 36 weeks.
• Edema (swelling) of the feet is common during pregnancy, partly because the enlarging uterus compresses veins and lymphatic drainage from the legs.
• The platelet count tends to fall progressively during normal pregnancy, although it usually remains within normal limits. In a proportion of women (5–10%), the count will reach levels of 100–150 × 109 cells/l by term and this occurs in the absence of any pathological process. In practice, therefore, a woman is not considered to be thrombocytopenic in pregnancy until the platelet count is less than 100 × 109 cells/l.
• Pregnancy causes a two- to three-fold increase in the requirement for iron, not only for haemoglobin synthesis but also for for the foetus and the production of certain enzymes. There is a 10- to 20-fold increase in folate requirements and a two-fold increase in the requirement for vitamin B12.
Changes in the coagulation system during pregnancy produce a physiological hypercoagulable state (in preparation for haemostasis following delivery).
Natural and acquired immunity,several immune mechanisms are present in our bo...Anand P P
immune mechanisms and their categories.mainly two types of immune mechanisms are present natural and artificial mechanisms.several organs and specialized cells are serve for the part of immune mechanism of our body
Anatomical & physiological changes in pregnancy & their clinical implications...alka mukherjee
• Women undergo several changes during pregnancy, including cardiovascular, hematologic, metabolic, renal, and respiratory changes that provide adequate nutrition and gas exchange for the developing fetus.
• Progesterone and estrogen levels rise continually through pregnancy, together with blood sugar, breathing rate, and cardiac output.
• The body’s posture changes during pregnancy to accommodate the growing fetus and the mother will experience weight gain.
• Breasts grow and change in preparation for lactation once the infant is born. Once lactation begins, the woman’s breasts swell significantly and can feel achy, lumpy, and
heavy (engorgement). This is relieved by nursing the infant.
• Plasma and blood volume increase over the course of the pregnancy and lead to changes in heart rate and blood pressure. Women may also have a higher risk of blood clots, especially in the weeks following labor.
• During pregnancy, both protein metabolism and carbohydrate metabolism are affected. One kilogram of extra protein is deposited, with half going to the fetus and placenta, and another half going to uterine contractile proteins, breast glandular tissue, plasma protein, and hemoglobin.
• Circulatory Changes
• Plasma and blood volume slowly increase by 40–50% over the course of the pregnancy (due to increased aldosterone) to accommodate the changes, resulting in an increase in heart rate (15 beats/min more than usual), stroke volume, and cardiac output. Cardiac output increases by about 50%, primarily during the first trimester.
• The systemic vascular resistance also drops due to the smooth muscle relaxation and overall vasodilation caused by elevated progesterone, leading to a fall in blood pressure. Diastolic blood pressure consequently decreases between 12–26 weeks, and increases again to pre-pregnancy levels by 36 weeks.
• Edema (swelling) of the feet is common during pregnancy, partly because the enlarging uterus compresses veins and lymphatic drainage from the legs.
• The platelet count tends to fall progressively during normal pregnancy, although it usually remains within normal limits. In a proportion of women (5–10%), the count will reach levels of 100–150 × 109 cells/l by term and this occurs in the absence of any pathological process. In practice, therefore, a woman is not considered to be thrombocytopenic in pregnancy until the platelet count is less than 100 × 109 cells/l.
• Pregnancy causes a two- to three-fold increase in the requirement for iron, not only for haemoglobin synthesis but also for for the foetus and the production of certain enzymes. There is a 10- to 20-fold increase in folate requirements and a two-fold increase in the requirement for vitamin B12.
Changes in the coagulation system during pregnancy produce a physiological hypercoagulable state (in preparation for haemostasis following delivery).
Natural and acquired immunity,several immune mechanisms are present in our bo...Anand P P
immune mechanisms and their categories.mainly two types of immune mechanisms are present natural and artificial mechanisms.several organs and specialized cells are serve for the part of immune mechanism of our body
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Immunoglobulin Test: Impact of High Immunoglobulin Levels (IgA) | The Lifesci...The Lifesciences Magazine
An immunoglobulin test stands as a pivotal diagnostic procedure, delving into the intricate realms of the immune system by measuring the levels of immunoglobulins in the bloodstream.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
1. PRE-FINALS MODULE NO. 18
NURSING CARE OF A FAMILY WHEN A CHILD HAS AN
IMMUNE SYSTEM DISORDER
JASON ADOYOGAN, RN
NCM 109 LECTURER
2. MODULE OBJECTIVES
1.Discuss briefly the normal anatomy and
physiology associated with the Immune system.
2.Explain how alterations in the normal anatomy
and physiology of a child’s immune system leads
to the development of certain disorders.
3.Enumerate the most common and significant
disorders of the immune system
3. MODULE OBJECTIVES CONT..
4.Discuss how to assess the health of children
with immune system disorders.
5.Formulate nursing diagnoses for a child with a
disorder of the immune system.
6.Establish Nursing care outcomes and plan of
care for children with specific disorders of the
immune system.
4. LECTURE
CONTENTS
A. Brief review of the Immune system.
B. Common immune system disorders – Brief overview, assessment,
diagnostics, treatment (medical, nursing), nursing considerations
1) Immunodeficiency disorders
i. Primary immunodeficiency disorders
ii. Secondary (Acquired) immunodeficiency disorders
2) Allergy/ Hypersensitivity Disorders
i. 4 types of hypersensitivity reactions
ii. Anaphylactic shock
iii.Urticaria and Angioedema
iv.Atopic disorders
v. Drug and food allergies
vi.Stinging insect Hypersensitivity
vii.Contact Dermatitis
6. BREIF REVIEW OFTHE
IMMUNE SYSTEM
Immune System –
A system of tissues,
organs, and cells that
protects the body against
pathogenic organisms and
other foreign bodies.
8. The immune system protects the body initially by
creating local barriers and inflammation. The local
barriers provide chemical and mechanical defenses
through the skin, the mucous membranes, and the
conjunctiva. Inflammation draws polymorphonuclear
leukocytes and neutrophils to the site of injury, where
these phagocytes engulf the invading pathogens. If these
first-line defenses fail or are inadequate to protect the
body, the humoral immune response and the cell-
mediated immune response are activated.
9. DEFINITION OFTERMS
Antigen – foreign
substances. Antigens
include pathogens
(bacteria, fungi, or
viruses), food proteins,
and pollens.
10. DEFINITION OFTERMS
Antibody – An antibody,
also known as an
immunoglobulin, is a large, Y-
shaped protein used by the
immune system to identify
and neutralize foreign objects
such as pathogenic bacteria
and viruses.
11. DEFINITION OFTERMS
Immunity - the quality of being insusceptible to or
unaffected by a particular disease or condition.
(Mosby’s medical dictionary). It is the ability to
destroy antigens (Pilitteri, et al)
12. DEFINITION OFTERMS
Immunogen – It refers to an antigen capable of
stimulating the body to illicit immunity/immune response.
Allergen - If, during the immune response, mediating
substances are released that cause tissue injury and
allergic symptoms, the antigen is termed an allergen.
13. DEFINITION OFTERMS
B-Lymphocytes - B Cells originate in
the bone marrow where they develop
from plasma or memory cells. Primary
purpose is to produce immunoglobulins.
14. DEFINITION OFTERMS
T lymphocytes (also called T cells) are major
components of the adaptive immune system. Their
roles include directly killing infected host cells,
activating other immune cells, producing cytokines
and regulating the immune response.
Account for 70-80% of blood lymphocytes and are
responsible for cell mediated immunity.
15. T LYMPHOCYTE TYPES
1. Cytotoxic (killer) T-cells
- Have a specific ability to bind to the surface of antigens
and directly destroy the cell membrane and, therefore, the
cell.
2. Helper T (CD4) Cells
- Stimulates B lymphocytes to divide and mature into
plasma cells so the B cells can begin secreting
immunoglobulins.
3. Suppressor T-cells
- are specific cells that reduce the production of
immunoglobulins against a specific antigen and prevent
their overproduction.
19. DEFINITION OFTERMS
Autoimmunity - is the result of the immune
system being unable to distinguish self from
non-self, causing the immune system to trigger
immune responses against normal cells and
tissue rather than invading antigens.
21. HUMORAL IMMUNITY VS
CELL-MEDIATED IMMUNITY
Humoral immunity refers
to immunity created by
antibody production or B
lymphocyte involvement
whereas Cell-mediated
immunity is the type of
immune response caused
by T-lymphocyte activity
22. NATURAL IMMUNITY VS ARTIFICIAL IMMUNITY
Natural immunity occurs through contact
with a disease-causing agent, when the
contact was not deliberate, whereas
artificial immunity develops only through
deliberate actions of exposure.
23. ACTIVE VS PASSIVE IMMUNITY
Active immunity refers to a form of long-term, acquired
immunity. It is a result of antibodies that develop naturally
after an initial infection or artificially after a
vaccination whereas passive immunity is a form of
acquired immunity resulting from antibodies that are
transmitted naturally through the placenta to a fetus,
through the colostrum to an infant, or artificially by
injection of antiserum for treatment or prophylaxis.
Passive immunity is not permanent and does not last as
long as active immunity
25. IMMUNODEFICIENCY DISORDERS
When any portion of the immune system is missing
or not functioning properly, an immunodeficiency
can result. An immunodeficiency can be primary
(congenital) or acquired (secondary to a viral
infection, exposure to a toxic substance or some
drugs). If a child is suspected to have a humoral
immunodeficiency, live viral vaccines are
contraindicated, and all blood products should be
irradiated
26. PRIMARY IMMUNODEFICIENCY DISORDERS
Comprise over 150 inherited disorders.
They can present and be diagnosed at various
ages and affect all parts of the immune
system, including humoral defects, cell-
mediated defects, complement deficiencies,
and phagocyte disorders
27. Humoral Deficiency
Children with humoral defects are generally
well until 4 to 6 months of age because of the
presence of maternal antibody which crosses
the placenta. As this antibody wanes and the
child fails to produce his or her own antibody,
infections can begin to present.
28. X-LINKED AGAMMAGLOBULINEMIA &
COMMON VARIABLE IMMUNODEFICIENCY
• In X-linked agammaglobulinemia, male children
lack the enzyme necessary for B cells to mature;
• the B cells are incapable of maturing into antibody,
and patients are susceptible to infection from a
wide variety of pathogens.
• In patients with CVID, the levels of
immunoglobulins are low but usually not absent,
and antibody development is impaired.
29. X-LINKED AGAMMAGLOBULINEMIA &
COMMON VARIABLE IMMUNODEFICIENCY
• The cellular or T-lymphocyte response
remains adequate in CVID, protecting the
child from some pathogens.
• There is also an association with a higher
prevalence of autoimmune diseases and
lymphoreticular cancers in children with CVID.
30. DIAGNOSTICS
• Low immunoglobulin levels and absent B cells
• Genetic testing
Diagnosis of X-linked agammaglobulinemia is by
detecting low (at least 2 standard deviations below
the mean) levels of immunoglobulins (IgG, IgA, IgM)
and absent B cells (< 1% of all lymphocytes are
CD19+ cells, detected by flow cytometry). Transient
neutropenia may also be present.
31. MANAGEMENT
• Regular infusion of pooled human immunoglobulin.
• Immunoglobulin can be delivered intravenously
every 3 to 4 weeks or subcutaneously every 1 to 2
weeks.
• Health education - importance of early recognition
of signs and symptoms of infection.
• May need longer courses of antibiotic treatment
than immunocompetent children with the same
infection.
32.
33. B. SELECTIVE IGA DEFICIENCY
• The most common of the humoral
immunodeficiencies.
• May result from an increase in IgA suppressor
cells or defect in helper T-cells necessary for
IgA production.
• Also associated with atopic diseases
(allergies)
34. DIAGNOSTIC
• The clinical definition for this disorder is an
undetectable level of IgA, not merely a low level.
• The disorder can occur in as frequently as 1:500
people.
• Most people who lack IgA are completely
asymptomatic, and the deficiency is noted when the
person is being evaluated for another illness, such
as celiac disease.
35. MANAGEMENT
• There is no treatment specific for IgA
deficiency because there is no way to provide
IgA to the body.
• Protect the child from opportunistic infections.
• Health teaching on recognizing early signs of
infections.
36. C. T-LYMPHOCYTE DEFICIENCIES
• Involve inadequate numbers or inadequate
functioning of one or more types of T lymphocytes.
• Affects cell-mediated immunity and, because of
helper T-lymphocyte function, possibly humoral
immunity as well.
• An example is DiGeorge syndrome - a
chromosomal deletion syndrome with tremendous
phenotypic variability.
38. D. COMBINED T- AND
B-LYMPHOCYTE DEFICIENCY
• Severe combined immunodeficiencies (SCID) are
a group of inherited rare disorders associated with
large defects in T- and B-cell immunity.
• Children cannot respond directly to antigen
invasion, and no antibodies are produced.
SCID is 100% fatal if untreated, and early
recognition is key to early treatment and survival
40. TREATMENT
The definitive treatment for children with
SCID is correction of the immunologic
defect by hematopoietic stem cell
transplantation, possibly from cord
blood.
42. SECONDARY (ACQUIRED) IMMUNODEFICIENCY DISORDERS
Secondary immunodeficiency, or loss of immune system
response, can occur from factors such as:
• severe systemic infection
• cancer
• radiation therapy
• severe stress
• Malnutrition
• monoclonal antibody
therapy targeted at B cells
• other immunosuppressive
therapy and
• aging.
43. Anything that causes the body to lose
protein such as renal disease or protein-
losing enteropathies may also cause a
secondary immunodeficiency. There can
be complete or partial loss of both B- and
T-lymphocyte response.
44. 1. HIV INFECTION AND AIDS
HIV is a slowly replicating retrovirus and has at least two
main divisions, HIV-1 and HIV-2, followed by a variety of
further subtypes.
It is found in the blood, semen, vaginal secretions, and
breast milk. It has an incubation or latency period of
months to years. There are different strains of HIV.
Whereas HIV-2 is prevalent in Africa, HIV-1 is the dominant
strain in the United States and elsewhere.
45. TRANSMISSION
Horizontal transmission
• occurs through intimate sexual contact or parenteral exposure to
blood or body fluids containing visible blood. (M. Hockenberry, et
al., 2017)
Perinatal (vertical) transmission
• occurs when an HIV-infected pregnant woman passes the
infection to her infant. There is no evidence that casual contact
between infected and uninfected individuals can spread the virus.
(M. Hockenberry, et al., 2017)
46. PATHOPHYSIOLOGY
• The HIV virus primarily infects a specific subset of T
lymphocytes, the CD4+ T cells, but it can also
invade cells of the monocyte-macrophage lineage.
The virus takes over the machinery of the CD4+
lymphocyte, using it to replicate itself, rendering the
CD4+ cell dysfunctional. The CD4+ lymphocyte
count gradually decreases over time, at some point,
physical symptoms appear. (M. Hockenberry, et al.,
2017)
47. PATHOPHYSIOLOGY CONT.
• There is no effective way to destroy the HIV,
so it remains in the body for life and can
activate if the immune system becomes
depressed. When monocytes and
macrophages become affected, the person
with HIV infection cannot resist usual
infections such as the common cold.
48. PATHOPHYSIOLOGY CONT.
• When the CD4 count falls below 500 cells/mm3 or
the viral load rises above 5,000 copies/ml, it is
difficult for infected individuals to resist
opportunistic infections such as fungal infections.
The final result is that both the immune response
and the ability to screen and remove malignant
cells from the body are lost (Smith, 2011). (Silbert-
Flagg & Pillitteri, 2018)
49. SIGNS AND SYMPTOMS
Some people have flu-like symptoms within 2 to 4 weeks
after infection (called acute HIV infection). These symptoms
may last for a few days or several weeks. Possible
symptoms include
• Fever,
• Chills,
• Rash,
• Night sweats,
• Muscle aches,
• Sore throat,
• Fatigue,
• Swollen lymph nodes, and
• Mouth ulcers.
50.
51. CLINICAL MANIFESTATIONS
Common Clinical Manifestations of HIV Infection
in Children (M. Hockenberry, et al., 2017):
• Lymphadenopathy
• Hepatosplenomegaly
• Oral candidiasis
• Chronic or recurrent
diarrhea
• Failure to thrive
• Developmental delay
• Parotitis
52. Common Defining Conditions for Acquired Immune Deficiency
Syndrome in Children (M. Hockenberry, et al., 2017):
• Pneumocystis carinii pneumonia
(PCP)
• Lymphoid interstitial pneumonitis
(LIP)
• Recurrent bacterial infections
• Wasting syndrome
• Candidal esophagitis
• Human immunodeficiency virus
(HIV) encephalopathy
• Cytomegalovirus disease
• Mycobacterium avium-
intracellulare complex infection
• pulmonary candidiasis
• Herpes simplex disease
• Cryptosporidiosis
53. DIAGNOSTICS
Tests to detect the antigen are termed
polymerase chain reaction (PCR) tests.
Those for the antibody are termed
enzyme-linked immunosorbent assay
(ELISA) or Western blot confirmation.
57. MANAGEMENT (MAIN GOALS)
1.Prevention – For those people at risk for
developing/acquiring the disease.And also for infected
person from spreading it.
2.ReduceViral Load to an undetectable level.
3.Prevent opportunistic Infections.
4.Improvement of health/quality of life.
58. NURSING MANAGEMENT
• Health Education concerning transmission and
control of infectious diseases, including HIV
infection, is essential for children with HIV
infection and anyone involved in their care.
• Maintain strict personal hygiene practices.
• Cater to the child’s developmental needs.
59. NURSING MANAGEMENT CONT.
• Encourage adolescents at risk to undergo HIV
testing and counselling.
• The multiple complications associated with
HIV disease are potentially painful (Ezekowitz,
2009). Ongoing assessment of pain is crucial
and is most easily accomplished in older
children who are able to communicate.
61. PRECAUTIONS CONT.
• Disposable gloves must be worn when there is a
direct contact or possibility of contact with blood,
body fluids, mucous membrane and non-intact skin of
all patients. Gloves should preferably be changed after
patient contact and before administering care to
another patient. Gloves must be changed whenever
they are torn and when a needle-stick or other injury
occurs and when they are visibly dirty with blood
62. PRECAUTIONS CONT.
•Mask, eye protection or face shield,
and gown must be worn as
appropriate during procedures and
patient care activity that may result in
splashing of blood and body fluids.
63. PRECAUTIONS
•Proper handling of sharps.
Precautions should be taken to
prevent injuries caused by needles,
scalpels and other sharp instruments
64. MEDICAL MANAGEMENT
• Four classes of drugs are the mainstay of therapy:
1. nucleoside reverse transcriptase inhibitors
(NRTIs)
▪designed to block the production of viral DNA,
limiting the ability of the virus to infect cells.
▪Ex.: Zidovudine
65. MEDICAL MANAGEMENT
2.Non-nucleoside reverse transcriptase
inhibitors (NNRTIs)
▪inhibit the DNA synthesis of viruses but act
at different sites on the viral enzyme;
▪Ex.: nevirapine and efavirenz.
66. MEDICAL MANAGEMENT
3.Protease inhibitors (PIs),
▪Protease inhibitor drugs block the action of
protease enzymes. This prevents protease
enzymes from doing their part in allowing HIV
to multiply, interrupting the HIV life cycle as a
result. This can stop the virus from
multiplying.
▪Ex. ritonavir (Norvir), lopinavir/ritonavir
(Kaletra)
67. MEDICAL MANAGEMENT
4.integrase strand transfer inhibitors
(ISTIs).
The INSTI mechanism of action is to prevent HIV
integrase from incorporating proviral DNA into the
human host cell, thus inhibiting the HIV-catalyzed
strand transfer step.
Ex. raltegravir (Isentress), dolutegravir (Tivicay)
68. MEDICAL MANAGEMENT
• Children are prescribed a regimen involving
multiple drugs, such as one PI plus two NRTIs.
• In addition, many children are given prophylactic
therapy for PCP (such as trimethoprim-
sulfamethoxazole [TMP-SMZ]) beginning at 6
months of age.
69. MEDICAL MANAGEMENT
• If a child develops tuberculosis, a
combination of antituberculosis drugs, such
as isoniazid or rifampin, is used.
• In addition to routine Immunizations,
children with HIV should also receive
Pneumococcal and HPV vaccines.
Attenuated vaccines should be used with
caution.
70. ALLERGY/HYPERSENSITIVITY DISORDERS
Allergic diseases occur as a result of
abnormal antigen–antibody responses.
Symptoms can be chronic and minor, such as
those that occur with seasonal rhinitis, or
acute and severe, as in an anaphylactic
reaction.
71. 4 TYPES OF HYPERSNSITIVITY REACTIONS
Type I: Immediate
Involved Cell: IgE
Mechanism: IgE attached to surface of mast cell triggers release of
intracellular granules from mast cells on contact with antigens.
Effect: Allergies, asthma, atopic dermatitis, anaphylaxis
Type II: Cytotoxic
Involved Cell: IgG or IgM
Mechanism: Antigen–antibody reaction leading to antigen destruction;
complement is activated
Effect: Hemolytic anemia, transfusion reaction, erythroblastosis fetalis
72. 4 TYPES OF HYPERSNSITIVITY REACTIONS
Type III: Immune Complex Disease
Involved Cell: IgG or IgE
Mechanism: Antigen–antibody complexes precipitate; complement is
activated, leading to inflammatory response.
Effect: Rheumatoid arthritis, systemic lupus erythematosus
Type IV: Delayed
Involved Cell: T-lymphocyte
Mechanism: T cells combine with antigen to induce inflammatory
reactions by direct cell involvement or the release of lymphokines.
Effect: Contact dermatitis, transplant graft reaction
73. ASSESSMENT
• History taking. A family history is
important because there seem to be
familial tendencies with allergic
diseases.
• Common signs and symptoms;
o Rhinitis
o Urticaria (swelling and itching)
o Rash
o Dennie Line
o Allergic shiners
74. ANAPHYLACTIC SHOCK
• Anaphylactic shock is an immediate,
life-threatening, type I hypersensitivity
reaction that occurs after exposure to
an allergen in a previously sensitized
child.
76. SYMPTOMS
low blood pressure, shock, loss of consciousness
• Skin: hives, swelling, itch, warmth, redness, rash
• Stomach: nausea, pain/cramps, vomiting, diarrhea
• Other: anxiety, feeling of impending doom,
itchy/red/watery eyes, headache,
cramping of the uterus
77. MANAGEMENT
•Main goal is to reduce child’s
exposure to the allergen and
modify the child’s response to
the allergen.
78. MANAGEMENT
•Main goal is to reduce child’s
exposure to the allergen and
modify the child’s response to
the allergen.
79. NURSING MANAGEMENT
• Environmental control – involves limiting exposure to
allergens in a child’s environment.
- Avoid offending foods, medicines, insects etc.
• Health education to patient and family members on
prevention, the recognition of the signs and symptoms
as well as the steps to take when the said condition
occurs.
• If indicated, explain the importance of the need to carry
an epinephrine self-injector for children with history of
anaphylaxis.
80. MEDICAL MANAGEMENT
• Immunotherapy/Hypo sensitization – produce a state of
increased clinical tolerance or “sustained
unresponsiveness”
- is done when the child’s allergy symptoms cannot be
controlled by avoidance of an allergen or
conventional drug therapy.
Epinephrine, injected intramuscularly, is the standard of
care for the treatment of anaphylaxis regardless of the
cause (Muraro, Lemanske, Castells, et al., 2017).
81. URTICARIA AND ANGIOEDEMA
URTICARIA
- or hives, refers to macular wheals
surrounded by erythema arising from the
chorion layer of skin; they are intensely
pruritic (often described as having a burning
sensation).
82. URTICARIA AND ANGIOEDEMA
ANGIOEDEMA
- edema of the skin and subcutaneous tissue.
This occurs most frequently on the eyelids,
hands, feet, genitalia, and lips—areas where
skin is loosely bound by subcutaneous tissue.
83. TREATMENT
- Immediate:
•Administration of intramuscular epinephrine
•Oral anti-histamines
- Long-term:
•Corticosteroids
•Cyclosporine (an immunosuppressant)
•Omalizumab (Xolair) (monoclonal antibody) –
usually reserved for older adolescents or
adults.
84. ALLERGIC RHINITIS
- associated with an IgE-mediated
inflammatory response to allergen
exposure. It is a risk factor for the
development of asthma.
85. ASSESSMENT
- associated with an IgE-mediated
inflammatory response to allergen
exposure. It is a risk factor for the
development of asthma.
86. ASSESSMENT CONT.
• Common symptoms of allergic rhinitis
include;
oCongestion
oSneezing
oNasal engorgement
oprofuse watery nasal discharge
87. ASSESSMENT CONT.
• Common symptoms of
allergic rhinitis include;
oCongestion
oSneezing
oNasal engorgement
oprofuse watery nasal
discharge
88. TREATMENT/MANAGEMENT
• Avoidance of offending allergen
• Use of pharmacologic agents:
oAntihistamines
oLeukotriene inhibitors
oCorticosteroids
• Immunotherapy
89. PERENNIAL ALLERGIC RHINITIS
• Allergic rhinitis becomes perennial (year-round)
when the allergen is one that is present in the
environment year-round, such as house dust
mites or pet hair.
• In addition, serous otitis media can accompany
the disorder as a long-term consequence.
91. ATOPIC DERMATITIS
• Atopic dermatitis is a highly pruritic, chronic
inflammatory skin disease that is often the first
manifestation of allergic disease.
• Many children with this disease will often
develop allergic rhinitis and asthma.
• A complex inflammatory process that involves
an epidermal barrier defect.
92. TREATMENT
• Treatment is primarily aimed at reducing the
amount of allergen exposure, if such allergens can
be identified. Second major consideration in
treatment is aimed at reducing pruritus so children
do not irritate lesions and cause secondary
infections by scratching.
• Use of elimination diets to identify food allergens.
93. TREATMENT
• Regardless of the mode of hydration, the skin
should still be wet or moist when applying
lubricants.
• Antihistamines – to reduce itching.
• Use of steroids
oLow -potency steroids can be used for
maintenance.
oHigh-dose topical steroids can be used
intermittently for exacerbations.
94. TREATMENT
• Topical calcineurin inhibitors tacrolimus and
pimecrolimus are also useful in atopic
dermatitis management.
• Relapsing atopic dermatitis and severe refractory
cases of atopic dermatitis may require long-term,
anti-inflammatory therapy with intermittent use of
systemic anti-inflammatory or immunosuppressive
treatment.
95. DRUG ALLERGIES
• A drug allergy is the abnormal reaction of
your immune system to a medication. Any
medication — over-the-counter,
prescription or herbal — is capable of
inducing a drug allergy. However, a drug
allergy is more likely with certain
medications.
98. TREATMENT
• Discontinue using the drug and notify
prescriber.
• Administration of antihistamine, ex.
Diphenhydramine.
• In case of anaphylaxis, epinephrine
injection can be given.
99. FOOD ALLERGIES
• Are an abnormal immune response
caused by exposure to a particular food
protein. They can be IgE-mediated, cell-
mediated, or mixed reactions, although
IgE-mediated (type I hypersensitivity)
reactions account for most food reactions
(Robison & Pongracic, 2012).
101. TREATMENT
• Eliminate offending foods from the diet.
(Hypoallergenic diet)
• Health education: Urge parents to become
conscientious shoppers and read labels
carefully to be certain the foods they are
buying do not contain products to which their
child is sensitive.
102. STINGING INSECT HYPERSENSITIVITY
Children may have severe hypersensitivity
reactions to stings from bees, wasps, hornets,
or yellow jackets (Yavuz, Sahiner,
Buyuktiryaki, et al., 2013). Although a serum
sickness reaction may occur, the usual
reaction to these stings is an immediate type I
hypersensitivity reaction (anaphylaxis).
103. TREATMENT
• Hyposensitization by immunotherapy
• Acute anaphylaxis – administration of epinephrine
injection.
o Health education: importance of learning self-
administration of epinephrine.
• Avoid stinging insects;
o Not using scented preparations
o Not going barefoot
o Use of insect repellant
104. CONTACT DERMATITIS
• Contact dermatitis is an example of a
delayed or type IV hypersensitivity
response; it is a reaction to skin
contact with an allergen (a substance
irritating to the child only with prior
sensitization).
106. DIAGNOSTIC
oPatch testing – to identify allergens
causing contact dermatitis.
▪Corticosteroids should be temporarily
discontinued as it may alter result.
107. TREATMENT
• Removing identified allergen.
• Apply dressing moistened with water
saline or Burow’s solution.
• Application of hydrocortisone lotion
• Baths with baking soda mixture in water.