The Child with Hematologic or Immunologic Disorders Flashcards
Exam 3
Functions of the Hematologic System
Erythrocytes or red blood cells (RBCs): What do they do?
Transport nutrients and oxygen to the body tissues
Transport waste products from the tissues
Functions of the Hematologic System
Thrombocytes or platelets: What do they do?
Clotting
Functions of the Hematologic System
Leukocytes or white blood cells (WBCs): What do they do?
Fight infection
Types of Anemia: What are they?
Nutritional deficiency
Toxin exposure
Aplastic anemia
Hemolytic anemia
Types of Anemia:
What are the types of Nutritional deficiency anemias?
Iron deficiency,
folic acid deficiency,
pernicious anemia
Types of Anemia:
What are the types of Toxin exposure
anemias?
Lead poisoning
Types of Anemia:
What is Aplastic Anemia? How is it acquired?
Acquired as an adverse reaction to medication
Rare congenital bone marrow failure (Fanconi anemia)
Types of Anemia
Hemolytic anemia include?
Sickle cell anemia,
Thalassemias
Components of the Complete Blood Count (CBC) include?
RBC count
Hemoglobin (Hgb)
Hematocrit (Hct)
RBC indices
WBC count
Platelet count
Mean platelet volume (MPV)
Components of the Complete Blood Count (CBC): RBC count
Actual number of counted RBCs
Components of the Complete Blood Count (CBC): Hemoglobin (Hgb)
Measure of the protein made up of heme and globin
Components of the Complete Blood Count (CBC): Hematocrit (Hct)
Indirect measure of red blood cells
Components of the Complete Blood Count (CBC):
RBC indices
Cell diameter,
Hgb/RBC
Components of the Complete Blood Count (CBC)
WBC count
Actual count of the number of WBCs in a volume of blood
Components of the Complete Blood Count (CBC)
Platelet count
Number of platelets per blood volume
Components of the Complete Blood Count (CBC)
Mean platelet volume (MPV)
Measurement of the size of the platelets
What is the most common hematological disorder of childhood?
RED BLOOD CELL DISORDERSAnemia
RED BLOOD CELL DISORDERS/ Anemia:
What is it?
Decrease in number of RBCs and/or hemoglobin concentration below normal
RED BLOOD CELL DISORDERSsAnemia
What is a defining trait of it?
Decreased oxygen-carrying capacity of blood
RED BLOOD CELL DISORDERSsAnemia
Classification of Anemias-how?
Etiology and physiology
Morphology
RED BLOOD CELL DISORDERSsAnemia
Classification of Anemias: Etiology and physiology
RBC and/or Hgb depletion
RED BLOOD CELL DISORDERSsAnemia
Classification of Anemias: Morphology
Characteristic changes in RBC size, shape, and/or color
Effects of Anemia on Circulatory System include:
Hemodilution
Decreased peripheral resistance
Increased cardiac circulation and turbulence
Growth issues
Effects of Anemia on Circulatory System include:
Increased cardiac circulation and turbulence can lead to what?
Also, what can it lead to?
May have murmur
May lead to cardiac failure
Diagnostic Evaluation
Screening CBC for pediatric patients across childhood (U.S. recommendations)
Diagnostic Evaluation
Screening CBC for pediatric patients across childhood (U.S. recommendations)
What should be put into practice?
Put Prevention into Practice program for the U.S. Public Health Service
American Academy of Family Physicians and U.S. Preventive Services Task Force
American Academy of Pediatrics
Diagnostic Evaluation
Screening CBC for pediatric patients across childhood (U.S. recommendations)
When should hemoglobin concentration or hematocrit be measured?
AAP- Hemoglobin concentration or hematocrit should be measured once during infancy (between 9-12 months), early childhood (1-5 years), late childhood (5-12 years), and adolescence (14-20 years).
Therapeutic Management
Treat underlying cause
Nutritional intervention for deficiency anemias
Supportive care
Therapeutic Management:
Treat underlying cause: What is needed ?
Transfusion after hemorrhage if needed
Therapeutic Management:
Transfusion after hemorrhage if needed
Treat underlying cause:
The indication for RBC transfusion is risk of:
The indication for RBC transfusion is risk of cardiac decompensation
Therapeutic Management:
Treat underlying cause:
Transfusion after hemorrhage if needed
What happens when the number of circulating RBCs is increased?
When the number of circulating RBCs is increased, tissue hypoxia decreases, cardiac function is improved, and the child will have more energy
Therapeutic Management
Supportive care: What is needed?
IV fluids to replace intravascular volume
Oxygen
Bed rest
ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:Iron Deficiency Anemia- What is it caused by?
Caused by inadequate supply of dietary iron
ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:Iron Deficiency Anemia- How is it viewed?
Generally is preventable
ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:Iron Deficiency Anemia- How can iron be ingested for infants?
Iron-fortified cereals and formulas for infants
ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:Iron Deficiency Anemia-
Special needs of premature infants
Use only breast milk or iron-fortified formula (containing 7 to 12 mg/L for full-term infants and 15 mg/L for preterm infants of iron) for the first 12 months.
ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:Iron Deficiency Anemia-Why are adolescents at risk?
Adolescents at risk due to rapid growth and poor eating habits
What is the most prevalent nutritional disorder in the United States and the most common mineral disturbance?
Iron Deficiency Anemia
ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia- What does this anemia affect?
Iron deficiency anemia affects red cell size and depth of color but does not involve abnormal hemoglobin.
ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia- What can cause it (what factors)
Iron deficiency anemia can be caused by any number of factors that decrease the supply of iron, impair its absorption, increase the body’s need for iron, or affect the synthesis of hemoglobin.
ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia- Why are children ages 12-36 months of age at risk?
Children 12 to 36 months of age are at risk for anemia because cow’s milk is a staple of their diet and it is a poor source of iron.
ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia-How is iron during fetal development? What does it depend on?
Iron is stored during fetal development, but the amount stored depends on maternal iron stores.
ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia-When are fetal iron stores depleted?
Fetal iron stores are usually depleted by ages 5 to 6 months.
ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia-How can dietary iron be introduced?
Dietary iron can be introduced by breast-feeding, iron-fortified formula, and cereals during the first 12 months of life.
ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia-What is the nurse’s main goal?
The main nursing goal in prevention of nutritional anemia is parent education regarding correct feeding practices.
ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia-What should the nurse prepare parents about when giving iron?
If administering iron- The nurse should prepare the mother for the anticipated change in the child’s stools.
ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia-If iron dose given is adequate, how should stool appear?
What may a lack of color change indicate?
If the iron dose is adequate, the stools will become a tarry green color.
A lack of color change may indicate insufficient iron.
ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia-How should iron be administered?
How is iron best absorbed?
The iron should be given in two divided doses between meals when the presence of free hydrochloric acid is greatest.
Iron is absorbed best in an acidic environment.
ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia-What may occur with iron administration?
Vomiting and diarrhea may occur with iron administration.
ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia- If Vomiting and diarrhea occur with iron administration, what should be done?
If these occur, the iron should be given with meals, and the dosage reduced and gradually increased as the child develops tolerance.
ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia- What do liquid preparations of iron do? So what should be done?
Liquid preparations of iron stain the teeth; they should be administered through a straw and the mouth rinsed after administration.
Foods Rich in Iron
Red meats (easiest for the body to absorb)
Tuna and salmon
Eggs
Tofu
Enriched grains
Dried beans, peas, and fruits
Leafy green vegetables
Iron-fortified breakfast cereals
Lead Poisoning :Sources of Lead
Paint in homes built before 1978
Dust from windowsills, walls, and plaster in older homes
Soil from sites where cars that used leaded gas had been parked
Glazed pottery and stained glass products
Lead pipes supplying water to the home
On the clothing of parents who work in certain manufacturing jobs.
Certain folk remedies, such as greta or arzacon
Old painted toys or furniture
Complications of Lead Poisoning:
Lower levels (high but on the lower level)
Behavioral problems
Learning difficulties
Complications of Lead Poisoning:
Higher levels (requires chelation treatment)
Seizures
Brain damage
Types of Hemoglobinopathies
Sickle cell anemia
Hemoglobin SC disease
Types of Hemoglobinopathies:
Hemoglobin SC disease: What are they?
α-Thalassemia
β-Thalassemia
Sickle Cell Anemia: What is it?
A hereditary hemoglobinopathy
Sickle Cell Anemia: Ethnicity- Who does it occur in primarily?
Occurs primarily in African-Americans
Occasionally also in people of Mediterranean descent
Also seen in South American, Arabian, and East Indian descent
Sickle Cell Anemia: What kind of disorder is it considered?
Autosomal recessive disorder
Sickle Cell Anemia: Autosomal recessive disorder
How many people are carriers
1 in 12 African-Americans are carriers (have sickle cell trait)
Sickle Cell Anemia: Autosomal recessive disorder
If both parents have trait, what does that mean?
If both parents have trait, each offspring will have 1 in 4 likelihood of having disease
Sickle Cell Anemia: Where would individuals with sickle cell trait have a survival advantage?
In areas of the world where malaria is common, individuals with sickle cell trait tend to have a survival advantage over those without the trait.
Sickle Cell Anemia:
A hereditary hemoglobinopathy- What does this mean?
hemoglobinopathies, in which normal adult hemoglobin is replaced by abnormal hemoglobin.
Sickle Cell Anemia Pathophysiology- What occurs?
Large tissue infarctions occur
Damaged tissues in organs lead to impaired function
Sickle Cell Anemia Pathophysiology-
Damaged tissues in organs lead to impaired function
Splenic sequestration
Sickle Cell Anemia Pathophysiology-
Damaged tissues in organs lead to impaired function –>Splenic sequestration
What would this require? What may Splenic sequestration result in?
May require splenectomy at early age
Results in decreased immunity
Sickle Cell Anemia Pathophysiology-
When do the most acute symptoms of the disease occur?
The most acute symptoms of the disease occur during periods of exacerbation called crises
Sickle Cell Anemia Pathophysiology-
There are several types of episodic crises including:
There are several types of episodic crises, including
vasoocclusive,
acute splenic sequestration, cerebrovascular accident and infection.
Sickle Cell Anemia Pathophysiology-
The clinical manifestations of sickle cell anemia (SCA) are primarily the result of
The clinical manifestations of sickle cell anemia (SCA) are primarily the result of increased red blood cell (RBC) destruction
Sickle Cell Crisis
Acute exacerbations that vary in severity and frequency include:
Vaso-occlusive crisis (VOC)
Splenic sequestration
Aplastic crises
Acute Chest Syndrome- medical emergency!
Sickle Cell Crisis
Vaso-occlusive crisis (VOC): how it is? how common is it?
AKA painful event/ painful episode
Most common type of crisis
Sickle Cell Crisis
Vaso-occlusive crisis (VOC): What occurs during it?
Stasis of blood with clumping of cells in microcirculation → ischemia → infarction
Sickle Cell Crisis
Vaso-occlusive crisis (VOC): What are signs that this is occurring?
Signs—fever, pain, tissue engorgement
Sickle Cell Crisis
Splenic sequestration: how dangerous?
Life-threatening—death can occur within hours
Sickle Cell Crisis
Splenic sequestration: What occurs during this?
Blood pools in the spleen
Sickle Cell Crisis
Splenic sequestration: What are signs this is occurring?
Signs
Profound anemia
Hypovolemia
Shock
Sickle Cell Crisis
Aplastic crises: What happens during this?
Diminished production and increased destruction of RBCs
Sickle Cell Crisis
Aplastic crises: What is it triggered by?
Triggered by viral infection or depletion of folic acid
Sickle Cell Crisis
Aplastic crises: What are signs this is occurring?
Signs include profound anemia, pallor
Sickle Cell Crisis
Acute Chest Syndrome- how is it viewed?
Acute Chest Syndrome- medical emergency!
Sickle Cell Crisis
Acute Chest Syndrome- medical emergency!
What is it similar to?
Similar to pneumonia
Sickle Cell Crisis
Acute Chest Syndrome- medical emergency!
What are symptoms?
Severe chest and back pain, fever, cough, tachypnea, wheezing, and hypoxia
Sickle Cell Crisis
Acute Chest Syndrome- medical emergency!
What would result in sickling in the lungs?
VOC or infection results in sickling in the lungs
Sickle Cell Crisis
Acute Chest Syndrome- medical emergency!
Repeated episodes lead to what?
Repeated episodes may lead to pulmonary hypertension
Sickle Cell Crisis:
Precipitating factors include:
Anything that increases the body’s need for oxygen or alters transport of oxygen
Trauma, infection, fever
Physical and emotional stress
Increased blood viscosity due to dehydration
Hypoxia
Sickle Cell Crisis:
Precipitating factors include: Hypoxia?
From high altitude, poorly pressurized airplanes, hypoventilation, vasoconstriction due to hypothermia
Sickle Cell Crisis:
The management of crises includes:
The management of crises includes adequate hydration, pain management, minimization of energy expenditures, electrolyte replacement, and blood component therapy if indicated.
Diagnosis of Sickle Cell: How?
Cord blood in newborns
Newborn screening done in 43 states
Genetic testing to identify carriers and children who have disease
Medical Management
What kind of treatment for infection?
Aggressive treatment of infection
Possibly prophylactic with oral penicillin from age 2 months to 5 years
Blood transfusion, if given early in crisis, may reduce ischemia
Exchange transfusion may be appropriate in some situations
Hydroxyurea
Medical Management
Treatment for infection: What should be monitored?
Monitor reticulocyte count regularly to evaluate bone marrow function
Medical Management
Treatment for infection: What can be given early in crisis? What does it do?
Blood transfusion, if given early in crisis, may reduce ischemia
Nursing Management:
What should be assessed in sickle cell disease?
Multisystem assessment
Assess pain
Nursing Management:
What should be monitored in sickle cell?
Monitor child’s growth—watch for failure to thrive
Carefully monitor for signs of dehydration and shock
Nursing Management:
What should be observed in sickle cell?
Observe for presence of inflammation or possible infection
Nursing Management:
What should be maintained in sickle cell?
Maintain HYDRATION (oral or other as needed)
Nursing Management:
What should you be teaching parents about sickle cell?
Nursing care of the child with SCA focuses on teaching the family how to prevent and recognize sickle cell problems, managing pain during crises, and helping the child and parents adjust to a lifelong, chronic disease.
Nursing Management:
Why is adequate hydration important in sickle cell anemia patients?
In a child with sickle cell anemia it is essential that adequate hydration is maintained to minimize sickling and delay the vasooclusion and hypoxia-ischemia cycle.
Nursing Management:
Having to do with hydration, what are parents with sickle cell children taught? What should parents be checking?
Parents are taught signs of dehydration and ways to minimize loss of fluid to the environment.
The nurse should teach the parents to check for moist mucous membranes as an indicator of hydration status
Nursing Management:
What is impaired in children with SCA? What does this mean?
Children with SCA have impaired kidney function and cannot concentrate urine.
Nursing Management:
Telling parent to ‘push fluids’ or encouraging drinking is not specific enough for parents- Why?
Telling parent to ‘push fluids’ or encouraging drinking is not specific enough for parents.
The nurse should give the parents and child a target fluid amount for each 24-hour period because accurate monitoring of output may not reflect the child’s fluid needs.
Nursing Management: SCA
Without the ability to concentrate urine, the child needs what?
Without the ability to concentrate urine, the child needs additional intake to compensate.
Dilute urine and specific gravity are not valid signs of hydration status in children with SCA.
Nursing Management: SCA
What are not valid signs of hydration status in children with SCA?
Dilute urine and specific gravity are not valid signs of hydration status in children with SCA.
Thalassemia: What is it?
Inherited blood disorders of hemoglobin synthesis
Thalassemia: How is it classified?
Classified by Hgb chain affected and by amount of effect
Thalassemia: how is it classified (dom, recessive?)
Autosomal recessive with varying expressivity
Thalassemia: In order for offspring to have the disease, who must be carriers?
Both parents must be carriers to have offspring with disease
Thalassemia:
What are the two types?
a-Thalassemia
b-Thalassemia
Thalassemia:
a-Thalassemia: What is affected?
α chains affected
Thalassemia:
a-Thalassemia: Who does it occur in?
Occurs in Chinese, Thai, African, and Mediterranean people
Thalassemia:
b-Thalassemia: Who does it occur in?
Occurs in Greeks, Italians, and Syrians
Thalassemia:
b-Thalassemia: How common is it? How many forms does it have?
B is most common and has four forms
Thalassemia major
refers to a variety of inherited disorders characterized by deficiencies in production of certain globulin chains.
B-Thalassemia: How many types and what are they?
Four types:
Thalassemia minor
Thalassemia trait
Thalassemia intermediate
Thalassemia major “Cooley anemia”—
B-Thalassemia:
Thalassemia minor: What is it?
Thalassemia minor—asymptomatic silent carrier
B-Thalassemia:
Thalassemia trait: What is it?
Thalassemia trait—mild microcytic anemia
B-Thalassemia:
Thalassemia intermediate—moderate: What is it?
Thalassemia intermediate—moderate to severe anemia + splenomegaly
B-Thalassemia:
Thalassemia major “Cooley anemia”—: What is it?
severe anemia requiring frequent blood transfusions to survive
Thalassemia Pathophysiology
Anemia results from defective synthesis of Hgb, structurally impaired RBCs, and shortened life of RBCs
Thalassemia Pathophysiology:
What occurs in this?
Chronic hypoxia
Thalassemia Pathophysiology:
What occurs in this: Chronic hypoxia- What are symptoms?
Headache, irritability, precordial and bone pain, exercise intolerance, anorexia, epistaxis
Thalassemia Pathophysiology:
When is it detected?
Detected in infancy or toddlerhood
Thalassemia Pathophysiology:
Detected: What are signs?
Pallor,
FTT,
hepatosplenomegaly,
severe anemia (Hgb <6)
Thalassemia Pathophysiology:
Diagnosis- how?
By hemoglobin electrophoresis
RBC changes often seen by 6 weeks of age
Child presents with severe anemia, FTT
Medical Management of Thalassemias
Blood transfusion to maintain normal Hgb levels
Medical Management of Thalassemias
What occurs secondary to blood transfusions?
Side effect—hemosiderosis
Medical Management of Thalassemias
What does deferoxamine do?
Binds excess iron for excretion by kidney
Medical Management of Thalassemias
How to treat hemosiderosis?
Treat with iron-chelating drugs such as deferoxamine
Medical Management of Thalassemias
Deferoxamine- how is it administered?
IV or SQ over 8-10 hours multiple times/wk
May be given at home with IV pump per parents
Medical Management of Thalassemias
What is the objective of supportive therapy?
The objective of supportive therapy is to maintain sufficient hemoglobin levels to prevent bone marrow expansion and bony deformities and to provide sufficient RBCs to support growth and normal physical activity.
Nursing Management of Thalassemias
Observe for complications of transfusion
Emotional support to family
Encourage genetic counseling
Parent and patient teaching for self-care
Nursing Management of Thalassemias:
What is prognosis?
Retarded growth
Delayed or absent secondary sex characteristics
Expect to live well into adulthood with proper clinical management
Bone marrow transplant is potential cure
Nursing Management of Thalassemias:
The objectives of nursing care are to
(1) promote compliance with transfusion and chelation therapy,
(2) assist the child in coping with the anxiety-provoking treatments and the effects of the illness,
(3) foster the child’s and family’s adjustment to a chronic illness, and
(4) observe for complications of multiple blood transfusions.
Diagnostic Tests
Complete blood count
Bone marrow aspiration/biopsy
Lumbar puncture
Radiographic examination
MRI
CT
Ultrasound
Biopsy of tumor
Nursing Management for Thalassemias:
(other stuff)
Nutrition
Pain
Bone marrow suppression
Education of family and child
Slide 32
Nursing Management for Thalassemias:
Bone marrow suppression: What should be done about this?
Isolation and transmission precautions
Nursing Management for Thalassemias:
Education of family and child: What should be done about this?
Careful handwashing
Prevention of spread of infection
Oral care
Neutropenia: What is rarely required?
Therapy to increase the ANC is rarely required
Neutropenia: What is it?
Neutropenia is a reduction in the number of circulating neutrophils and is usually defined as an absolute neutrophil count (ANC) of less than 1000/mm3 in infants 2 weeks to 1 year of age or less than 1500/mm3 in children older than 1 year of age
Neutropenia: Children who have recurrent or severe infections can benefit from?
Children who have recurrent or severe infections, however, may benefit from the administration of granulocyte colony-stimulating factor.
Neutropenia: What is rarely required?
Therapy to increase the ANC is rarely required
Variations in Pediatric Anatomy and Physiology
How do newborns receive passive immunity?
The newborn receives passive immunity from maternal antibodies via the placenta and breastfeeding
Variations in Pediatric Anatomy and Physiology
The newborn exhibits
Decreased inflammatory and phagocytic responses to invading organisms
Increased susceptibility to infection
A functional spleen
Generally functional cellular immunity
Variations in Pediatric Anatomy and Physiology
What kind of immunity develops over time?
Humoral immunity develops over time
Variations in Pediatric Anatomy and Physiology
How do children lymph nodes compare to adults?
Young children have larger lymph nodes, tonsils, and thymus compared to adults
Ten Warning Signs of Primary Immunodeficiency
Four or more new episodes of acute otitis media in 1 year
Two or more episodes of severe sinusitis
Treatment with antibiotics for 2 months or longer with little effect
Two or more episodes of pneumonia in 1 year
Failure to thrive in the infant
Recurrent deep skin or organ abscesses
Persistent oral thrush or skin candidiasis after 1 year of age
History of infections requiring IV antibiotics to clear
Two or more serious infections such as sepsis
Family history of primary immunodeficiency
Nursing Assessment of Severe Combined Immune Deficiency (SCID)
Chronic diarrhea
Failure to thrive
History of severe infections early in infancy
Persistent thrush
Adventitious sounds related to pneumonia
Lab findings of very low levels of immunoglobulins
Causes of Secondary Immunodeficiency
Chronic illness
Malignancy and chemotherapy
Use of immunosuppressive medication (lowers the immune response)
Malnutrition or protein-losing state
Prematurity
HIV infection
Types of Juvenile Idiopathic Arthritis
- Pauciarticular
- Polyarticular
- Systemic
Types of Juvenile Idiopathic Arthritis- What is the most common type?
Pauciarticular
Types of Juvenile Idiopathic Arthritis
Pauciarticular
Involvement of four or fewer joints
Types of Juvenile Idiopathic Arthritis
Pauciarticular- What joints usually?
The knee
Types of Juvenile Idiopathic Arthritis
Pauciarticular- nonjoint manifestations?
Eye inflammation
malaise
poor appetite
poor weight gain
Types of Juvenile Idiopathic Arthritis
Pauciarticular- complications
Iritis and uveitis
uneven leg bone growth
Types of Juvenile Idiopathic Arthritis
Polyarticular-
Involvement of five or more joints
Types of Juvenile Idiopathic Arthritis
Polyarticular-what kind of joints and how does it affect the body?
Frequently involves small joints and often affects the body symmetrically
Types of Juvenile Idiopathic Arthritis
Polyarticular-nonjoints manifestations
Malaise
Lymphadenopathy
organomegaly
poor growth
Types of Juvenile Idiopathic Arthritis
Polyarticular-complications?
Often a severe form of arthritis
Rapidly progressing joint damage
rhematoid nodules
Types of Juvenile Idiopathic Arthritis
Systemic-what is it?
In addition to joint involvement,
fever
and rash may be present
Types of Juvenile Idiopathic Arthritis
Systemic-nonjoint manifestations
Enlarged spleen, liver, lymph nodes, myalgia, severe anemia
Types of Juvenile Idiopathic Arthritis
Systemic-complications
Pericarditis
Pericardial effusion
pleuritis
Pulmonary fibrosis
Signs and Symptoms of HIV Infection in Children
Failure to thrive
Recurrent bacterial infections
Opportunistic infections
Chronic or recurrent diarrhea
Recurrent or persistent fever
Developmental delay
Prolonged candidiasis
Goals of Nursing Care of the Child With HIV Infection or Other Chronic Immune Disorder
Avoiding infection
Promoting compliance with the medication regimen
Promoting nutrition
Providing pain management and comfort measures
Educating the child and caregivers
Providing ongoing psychosocial support
