Alterations In Immunity For The Pediatric Patient Flashcards by Jade Ring

Type of immunity recieved from the placenta & breast milk in the new born…

Passive - recieves Antibodies directly

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The two types of immunity are:

______ (Non-Specific Immunity)

______ (Specific Immunity

Innate Immunity

Adaptive Immunity

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This type of Immunity…

First line of defense, present from birth.

Non-specific: Responds to a broad range of pathogens.

Rapid response (minutes to hours).

Key Components:
Physical barriers (skin, mucous membranes).

Chemical barriers (stomach acid, enzymes, antimicrobial peptides).

Cellular defenses: Macrophages, neutrophils, natural killer (NK) cells.

Inflammatory response and fever.

Innate Immunity

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Example: Skin preventing bacterial entry, macrophages engulfing bacteria.

This type of immunity…

Innate Immunity

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This type of immunity…

Second line of defense, developed after pathogen exposure.

Highly specific: Targets particular antigens.

Slower initial response but provides long-term immunity.

Key Components:

Humoral immunity (B cells and antibodies).

Cell-mediated immunity (T cells: CD4+ helper T cells and CD8+ cytotoxic T cells).

Memory cells for quicker responses upon re-exposure.

Adaptive Immunity

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Example: Vaccination leading to the production of memory B and T cells for future protection.

This type of immunity…

Adaptive

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Type of immunity…

Mediated by B cells and antibodies (immunoglobulins, Ig).

Targets extracellular pathogens (bacteria, toxins, viruses in body fluids).

Key mechanisms:

B cells recognize antigens and differentiate into plasma cells to produce antibodies.

Antibodies neutralize pathogens, promote phagocytosis (opsonization), and activate the complement system.

Memory B cells provide long-term immunity.

Humoral- Antibody mediated immunity

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Example: Antibodies fighting off Streptococcus pneumoniae infection.

Type of immunity…

Humoral

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Type of immunity…

Mediated by T cells (Cytotoxic CD8+ T cells and Helper CD4+ T cells).

Targets intracellular pathogens (viruses, some bacteria, and cancer cells).

Key mechanisms:

Cytotoxic T cells (CD8+) destroy infected or abnormal cells.

Helper T cells (CD4+) activate B cells, macrophages, and other immune cells.

Cytokines regulate immune responses.

Cellular mediated immunity

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Example: Cytotoxic T cells killing virus-infected cells in COVID-19.

This type of immunity…

Cell mediated immunity

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Newborns inflammation response compared to adults…

Decreased

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Adaptive Immunity

_____ Immunity is generally functional at birth, while _____ Immunity occurs when the body encounter new diseases….

Cellular Immunity @ birth

Humoral immunity Development over time

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_______ are specialized immune cells that capture, process, and present antigens to T cells, activating the adaptive immune response.

Antigen-Presenting Cells (APCs)

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Key Types of APCs

_____ The most potent APCs, primarily responsible for initiating T cell responses.

Macrophages – Engulf pathogens and present antigens, also involved in inflammation.

______ Present antigens to helper T cells (CD4+), assisting in antibody production.

Dendritic Cells (DCs)

B Cells

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Dendritic cells present antigens to T cells, which release….

Cytokines

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_____ are small signaling proteins released by immune cells that regulate inflammation, immune responses, and cell communication.

They act as messengers to coordinate the body’s defense against infections, diseases, and injuries.

Cytokines

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Antibodies received from external source

IVIGS IV immunoglobin adminstion

Mother to baby - Placenta/ breast milk

This type of immunity…

Passive

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B-cell lymphocytes
Secretes antibodies that recognize antigens
No destruction to foreign cell
Can cross the placenta as IGG

This type of immunity…

Humoral immunity

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T cell lymphocytes
Attack infected or foreign cells
Doesn’t recognize antigens
Maternal T cells don’t cross the placenta

This type of immunity…

Cellular immunity

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Origin & Maturation: Develop and mature in the bone marrow.

Function: Responsible for humoral immunity (antibody-mediated).

Activation: Activated by antigens binding to their B cell receptors (BCRs) or by helper T cells.

Response: Differentiate into plasma cells, which produce antibodies, or memory B cells for long-term immunity.

Pathogen Targeting: Effective against extracellular pathogens like bacteria and viruses in body fluids.

Type of cell…

Cells (B Lymphocytes)

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Origin & Maturation: Develop in the bone marrow but mature in the thymus.

Function: Responsible for cell-mediated immunity (directly attacking infected cells).

Types:

Helper T cells (CD4⁺): Activate B cells and other immune cells.

Cytotoxic T cells (CD8⁺): Destroy infected or cancerous cells.

Regulatory T cells (Tregs): Suppress immune responses to prevent autoimmunity.

Activation: Require antigen presentation via MHC molecules on other cells.

Type of cell…

Pathogen Targeting: Effective against intracellular pathogens like viruses and some bacteria.

T Cells (T Lymphocytes)

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Antibody function

Most abundant, has highest opsonization & neutralization, most effective bacterial phagocytosis….

IgG

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Deficiency in this antibody leads to autoimmune Deficiency.

Secreted from plasma into internal or external secretions

IgA

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This antibody

Involved in allergic reactions & parasitic infections…

IgE

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Function of this Antibody is "Unknown"

IgD

Antibody function Neutralize pathogens & starts inflammatory response...

IgM

Which antibody... Function: Provides long-term immunity and is the main antibody in secondary immune responses. Features: Crosses the placenta to protect newborns. Activates complement (immune response amplification). Enhances phagocytosis (helps immune cells engulf pathogens).

IgG (Most Abundant)

Which antibody... Function: Protects mucosal surfaces (respiratory, gastrointestinal, and urogenital tracts) by neutralizing pathogens before they enter the bloodstream. Features: Found in secretions (saliva, tears, breast milk). Prevents pathogen adherence to mucosal surfaces.

IgA (Mucosal Immunity)

Which antibody... Function: First antibody produced during an infection, crucial for early immune response. Features: Largest antibody (pentamer structure). Strongly activates complement for pathogen destruction. Primarily found in blood and lymphatic fluid.

IgM (First Responder)

This antibody... Function: Triggers allergic reactions and helps defend against parasitic infections (e.g., helminths). Features: Binds to mast cells and basophils, causing histamine release during allergic responses. Involved in anaphylaxis and asthma reactions.

IgE (Allergic Reactions & Parasite Defense)

AUTOSOMAL RECESSIVE disorder that causes babies to be born with out B cells (humoral) & T cells (cells mediated) Name problem....

Severe combined immunodeficiency disease

Primary immunodeficiency Severe combined immunodeficiency disease Born without B & T cells Assessment Findings Family history Failure to thrive Sever infections Infancy Persistent Thrush Chronic Diarrhea Lab results: Low on all immunoglobulin levels Treatment: Allergenic hematopoietic cell transplant (Bone Marrow): .....(Result of bone marrow transplant)..... Infusion of.... Subq adenosine deaminase enzyme replacement (certain types only) Long term antibiotics therapy Gene therapy development

Bone marrow transplant is Curative Infusion of IVIG

Primary immunodeficiency disease Type of vaccinea that are contraindicated....

Live vaccines Viral Vaccines: Measles, Mumps, and Rubella (MMR) Varicella (Chickenpox) Zoster (Shingles, Zostavax) Yellow Fever Rotavirus Oral Polio Vaccine (OPV) (not used in the U.S.) Influenza (LAIV, nasal spray) Smallpox (Vaccinia virus) Bacterial Vaccines: Bacillus Calmette-Guérin (BCG) (Tuberculosis) Typhoid (Ty21a, oral form)

live vaccines are contraindicated in immunocompromised & preggers. List live vaccines

Viral Vaccines: Measles, Mumps, and Rubella (MMR) Varicella (Chickenpox) Zoster (Shingles, Zostavax) Rotavirus Influenza (LAIV, nasal spray) Oral Polio Vaccine (OPV) (not used in the U.S.) Yellow Fever Smallpox (Vaccinia virus) Bacterial Vaccines: Bacillus Calmette-Guérin (BCG) (Tuberculosis) Typhoid (Ty21a, oral form)

HIV virus can be spread vertical or horizontal and affects function of immune system. What does vertical/ horizontal spread mean..

Vertical = mother to offspring Horizontal = Person - Person

HIV stages... Very contagious, large viral load in blood. Flu like symptoms

Stage 1 Acute stage

HIV stages Very Contagious, large viral load in their blood. Flu like symptoms

HIV stages Asymptomatic or latent HIV still active & reproducing in blood May progress fast or last decades

Stage 2 Chronic infection

____ is the 3rd stage of HIV

AIDS

HIV testing Everyone ages 13 - 64..... High risk... Preggers....

Everyone atleast 1 time High risk Yearly Preggers Before birth

Test for HIV Antibody test - HIV Antibodies-Enzyme-Linked-Immunosorbent- Assay. Aka.... Not for use...

ELISA < 18 months

Antibody / Antigen HIV test Not for use...

<18 months

HIV test NAT Nucleic Acid Test looks for virus in the blood and....

Measures amount of vitus

CD4 count _____ Normal immune function, early HIV stage. _____ Weakened immunity, risk of opportunistic infections increases. ____ AIDS diagnosis (severe immunosuppression, high risk of life-threatening infections).

500 Normal immune function, early HIV stage. 200–499 Weakened immunity, risk of opportunistic infections increases. <200 AIDS diagnosis (severe immunosuppression, high risk of life-threatening infections).

ANC (cells/µL) Clinical Significance _____ Normal ______ Mild neutropenia, low risk of infection. _____ Moderate neutropenia, increased infection risk. _____Severe neutropenia, high risk of bacterial/fungal infections.

ANC (cells/µL) Clinical Significance ≥1500 Normal 1000–1500 Mild neutropenia, low risk of infection. 500–999 Moderate neutropenia, increased infection risk. <500 Severe neutropenia, high risk of bacterial/fungal infections.

PREP & PEP in HIV Exposure...

PREP Pre-exposure prophylaxis: Used before exposure to Prevent getting HIV PEP Post-exposure Prophylaxis Most be started within 72 hrs of exposure

PREP in HIV contraction Reduces risk of contraction from sex by.... Dirty needles...

99% sex 74% dirty needles

Antiretroviral therapy for HIV Includes ___ medications from atleast 2 drug classes. Goal:......

3 meds Goal: reduce viral load so low that it is undetectable Prevents AIDS Won't transmit to sex partner

Most serious SE of Antiretroviral medication...

Liver damage

Typical survival time frame for AIDS without treatment...

3 years

Infection caused by a normally nonpathogenic organism in a host whose resistance has been decreased by a disorder....

Opportunistic infections

Opportunistic cancers associated with HIV.

Karposi sarcoma

Skin Lesions: Red, purple, or brown patches/plaques on the skin or mucous membranes. Commonly on the face, legs, feet, mouth, or genitals. Visceral Involvement (in severe cases): Lungs → Shortness of breath, cough, hemoptysis. Gastrointestinal tract → Bleeding, diarrhea, abdominal pain. Lymph nodes → Swelling, systemic symptoms. Describes....

Karposi sarcoma

Hypersensitivity reactions include...

Food allergies Anaphylaxis

Difference between Food Intolerance & Food Allergy...

Food allergy involves a IgE mediated response. Manifestions Anaphylaxis, growth failure Diarrhea, vomiting, ab pain/cramps Cough, wheeze, rhinitis, infiltrates Urticaria (Hives), rash, atopic dermatitis

Testing for food allergies... Testing for IgE mediated allergy.

Skin prick test Radioallergosorbent (RAST) blood test

Medications for food allergies (2) based on severity and duration of symptoms) (1) for anaphylaxis

Antihistamines & Corticosteroids Epinephrine

Food allergy prevention Exclusively breastfeed how long...

First 6 months

Preventing Peanut Allergy 1. Infants with egg allergy / severe eczema or both need to introduce Peanut containing foods when.... 2. Infant with moderate eczema introduce age appropriate Peanut foods by this age... 3. Infant No Allergy or Eczema introduce

1. 4 - 6 months 2. By 6 months

An acute IgE mediated response that involves many organ systems and maybe life threatening. Exposure to Peanut, tree nut, shellfish, eggs Bee or wasp sting Penicillin, NSAIDS, contrast dyes Latex Problem....

Anaphylaxis

Anaphylaxis 1. Support breathing 2. Adminster epinephrine 3. IV fluids Observe the child for ____ to ID and treat recurrent May administer diphenhydramine, corticosteroids, albuterol

4 - 10 hrs

Michigan Care Improvement Registry Database of vaccination Immunization must be documented on website how quickly....

72 hrs

COVID - 19 infection rates & death compared to adults

Both lowered

Hospital management for COVID 19 1. <12 yrs.... 2. 12 - 17 administer Remdesivir, What is Remdesivir? How it work? Requires monitoring of... 3. Oxygen as needed, if oxygen is given, give this medication too... Mechanical Ventilation OR ECMO for sever cases. Additional meds given include antirheumatic/ immunosuppressant

1. Prophylactic anticoagulants 2. Remdesivir is an IV antiviral drug used for moderate to severe COVID-19. Works by blocking viral RNA replication. Requires monitoring for liver and kidney toxicity. 3. Dexamethasone

COVID 19 Children >6 months are recommended to take the bivalent vaccine. What does bivalent mean...

bivalent is a vaccine that contains antigens from two different strains of a virus or bacterium, providing immunity against both.

Delayed immune response to SARS COV-2 That causes inflammation in many body systems. Vaccine against COVID 19 can help reduce risk SS Redeye Swollen hands / Feet / mucous membranes Peeling / cracking of lips Give upset Dizzy Hypotension Cool calmy skin SOB Neurological complications / seizures This disease....

Multitsystem inflammatory syndrome in Children MIS-C

MIS-C Multisystem inflammatory syndrome in Children Is a delayed immune response to SARS COV-2 that causes inflammation in whole body. Treatment...

IVIG 3 - 5 days Corticosteroids (Lower inflammation) ECG monitor for Cardiac complications

Vaccine Administration Infants <12 mnths Needle length... Needle gauge... Vastus Laterales... (Amount) Deltoid NOT RECOMMENDED Ventrogluteal (>7mnths) - (Amount)

Length 5/8 - 1 inch Gauze 22 - 25 Vaccine Administration Infants <12 mnths Needle length... Needle gauge... Vastus Laterales... 0.5mL Deltoid NOT RECOMMENDED Ventrogluteal (>7mnths) - 0.5mL

Vaccine administration Toddler 1 - 2 yrs Needle length.... Needle gauge.... Vastus Laterales....(Amount) Deltoid..... Ventrogluteal.....

Needle length 5/8 - 1" Needle gauge 22 - 25 Vastus Laterales... 0.5 - 1mL Deltoid 0.5 mL Ventrogluteal 1 mL

Vaccine Administration Preschoolers 3 -5 yrs Needle length.... Needle gauge.... Vastus Laterales.....(Max Amount) Deltoid...... Ventrogluteal......

Needle length 5/8 - 1" Needle gauge 22 - 25 gauge Vastus Laterales 1 mL Deltoid 0.5 mL Ventrogluteal 1.5mL

Vaccine Administration School aged 6-10 Needle length.... Needle gauge... Vastus Laterales....(Max amount) Deltoid.... Ventrogluteal.....

Needle length 5/8 - 1.5" Needle gauge 22 - 25 Vastus Laterales 1.5 - 2 mL Deltoid 0.5 - 1 mL Ventrogluteal 1.5 - 2 mL

Nasal drop vaccine Administration. Place supine with head Hyperextension. Place dropper at or near the tip of their nose. How long to maintain this posistion...

1 min minimal

Nasal spray administration. Child upright, head slightly tilted back. Hold 1 nostril closed, take deep breath and squeeze bottle simultaneously. T or F

How should fever initially be managed...

Increased fluids & decreased activity

Is aspirin a NSAID.... Give examples of meds like aspirin...(2)

Yes Ibuprofen & Naproxen

Antipyretics are used when a child demonstrates discomfort with a temperature over....

38.5 C / 101.3F

Never give aspirin or aspirin containing products to <19 yrs when they have a fever due to risk of ....

Reye syndrome

Can you give ibuprofen to a child with a fever...

Yes, but acetaminophen is better Ibuprofen is an NSAID like aspirin but doesn't cause reye syndrome with use in children with fever

Children under < ___ yrs should not take ibuprofen....

6 months

Parents should call provider if.... 1. Child <_____ has a rectal temp of... 2. Child is lethargic or listless.... 3. Fever lasting.... 4. Axillary temp of... Fever in immunocompromised Child 5. Persistent low temp of....

1. >38 or 100.4 2. T 3. 3 - 5 days 4. >40.6 / 105 5. <36.5

PEWS / PAWS Score Behavior 0. Playing/appropriate 1. Sleeping 2. Irritated 3. __________ Cardiovascular 0 Pink or cap refill 1 - 2 sec 1. Pale dusty or cap refill 3 sec 2. Gray / Cyanosis or cap refill 4 sec or tachycardia >20 normal rate 3._______ Respiratory 0. WDL 1. <10 Above norm or Use accessory muscle or 30% FIO or 3 L/min 2. >20 above normal RR or Retraction or 40% FIO or 6L / min 3._______

3. Lethargic and confused/ reduced response to pain 3. Gray / Cyanosis/ mottled or Cap refill 5 or longer or Tachycardia >30 normal or bradycardia 3. >5 below normal parameters with Grunting or Retractions Or 50% FIO or 8L/min

Systemic overresponse to bacterial infection (Most common), fungi, viral, parasites Define... Why are neonates at greater risk....

Sepsis Lack of IgM

This condition of systemic overresponse to pathogens will result in a systemic inflammatory response syndrome....

Sepsis

Signs of Sepsis in Neonatal Vs Children

Neonatal: Lethargy & feeding intolerance Hypothermia, apnea, bradycardia Hypotension- septic shock Children: Fever, tachycardia, Tachypnea Hypotension- septic shock

Why NPO in neonates with sepsis....

Prevent Necrotizing Enterocolitis

Labs for sepsis White Blood Cell (WBC) Count: Leukocytosis (↑ WBC) ..... Leukopenia (↓ WBC) may indicate...... Neutrophil Count: Neutrophilia with left shift (↑ immature bands) suggests bacterial infection. Neutropenia may indicate ....... Hemoglobin & Hematocrit (H&H): Assess for......

White Blood Cell (WBC) Count: Leukocytosis (↑ WBC) suggests infection. Leukopenia (↓ WBC) may indicate severe sepsis. Neutrophil Count: Neutrophilia with left shift (↑ immature bands) suggests bacterial infection. Neutropenia may indicate overwhelming sepsis. Hemoglobin & Hematocrit (H&H): Assess for anemia.

Platelet Count in sepsis screen What does it suggest....

Thrombocytopenia (↓ platelets): Suggests disseminated intravascular coagulation (DIC), common in severe sepsis.

Aminoglycosides ✔ Gentamicin ✔ Tobramycin ✔ Amikacin & Ampicillin Are used to treat sepsis in neonates. Which has precautions for sever adverse effects....

Aminoglycosides Peak & though Hearing test

Aminoglycosides A mean old mycin Used to treat sepsis in neonates Require peak & trough levels & hearing test When to assess these levels...

Peak Level: 30 minutes after end of IV infusion (or 1 hour after IM injection). Trough Level: Right before the next dose. Hearing Test: Before, during, and after prolonged therapy (especially in preterm neonates).

Older infants and children will receive these antibiotics for sepsis.... This antibiotic for CNS or central line infection....

Older infants & children recieve 3rd generation cephalosporin * allergy to penicillin may have allergy to cephalosporin CNS or Central Line infection = Cephalosporin & Vancomycin Redman syndrome

RBC graveyard...

Spleen

Babies born during this season are more likely to be sick...

Winter

How long until passive immunity fades in infants...

6 - 12 months

IgA production is associated with this organ according to teacher...

Appendix

Passive immunity Which type of cells can cross the placenta, which can't...

Humoral: B cells can cross the placenta Cellular Immunity: T cells can't cross the placenta

Which type of cells release cytokines (B or T)...

Both

Severe combined immunodeficiency disease. How does this happen...

Autosomal Recessive Babies born without B & T cells

Failure to thrive What is the #1 cause... #2.....

1: anatomical defects 2: feeding issues

Allogenic hematopoietic cell transplant from a sibling is used for this disease.... Outcome....

Severe combined immunodeficiency disease Curative. Bone Marrow transplant allows growth of immune & other blood cells

HIV in peds. This problem will happen before immune deficiency....

Seizure/ neurological

Which is the only approved Home Test for HIV...

ELISA

Herpes simplex virus 1 HSV1 Salmonella infection (GI) Candidiasis (fungal) Toxoplasmosis (parasitic) Pneumocystis (fungal) pneumonia Tuberculosis (bacteria) Cancer: Karposi sarcoma, cervical, non-Hodgkin lymphoma Are examples of...

Opportunistic infections

List opportunistic infections associated with AIDS...(7)

Antihistamine & corticosteroids are given for allergic reactions. Which is first line medication of Antihistamine...

Claritin/ Zyrtek. Not benadryl

Exclusively breastfeed for first 6 months of life to prevent food allergies. Then introduce which types of foods first...

Low allergy causing foods first Soon after, high allergy causing foods (Eggs, milk, peanut, tree nut, fish, shell fish, wheat / soy

Never give this food <1yrs old...

Honey

Which food allergy would you talk to hcp before baby receiving Influenza vaccine...

Egg

With anaphylaxis which route is first line treatment.... 2nd...

IM first (Epipen) IV 2nd

Epipen should be held with this end up.... How long to hold it in thigh for after injection...

Blue up / orange down 5 secs Call 911 after

Which spot of forbidden for IM Injections...

Dorsogluteal

Location: Located on the lateral (outer) side of the thigh, between the greater trochanter of the femur and the knee. Landmarking: Divide the thigh into thirds from the hip to the knee. The injection is given in the middle third, on the lateral side. Usage: Preferred site for IM injections in infants (under 1 year) due to its large muscle mass.

Vastus Lateralis (Thigh Muscle)

Location: Found on the upper arm, covering the shoulder. Landmarking: Locate the acromion process (bony top of the shoulder). Measure 2–3 finger widths below it, in the thickest part of the deltoid. The injection is given in the center of the triangle-shaped muscle. Usage: Common for small-volume IM injections (≤1 mL), including vaccines in adults.

Deltoid (Upper Arm Muscle)

Location: Found on the lateral side of the hip, in the gluteal region. Landmarking: Place the heel of your hand on the greater trochanter (hip bone). Use the index finger to point toward the anterior superior iliac spine (front hip bone). Spread the middle finger back toward the iliac crest (top of the hip bone). The injection is given in the center of the "V" formed by the index and middle fingers. Usage: Preferred site for IM injections in adults due to its deep muscle mass and lower risk of nerve injury.

Ventrogluteal (Hip Muscle)

Degree of injection for IM...

90°

Emla cream is applied how long proir to an injection to create a numbing effect...

1 hr

The PEWS score (behavior, cardiovascular, respiratory) is done how often.... When might extra points be added.....

Every VS Extra points if: Nebulized treatment Vomiting after surgery Parent / Nurse concern

When is lethargy a concern in peds. Is difficult to arouse Has poor or absent eye contact Shows minimal response to stimulation (e.g., voice, touch) Appears floppy, weak, or excessively sleepy Does not engage normally with caregivers or the environment

Always contact HCP