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Peds > The Child with Hematologic or Immunologic Disorders > Flashcards

The Child with Hematologic or Immunologic Disorders Flashcards

Exam 3

1
Q

Functions of the Hematologic System

Erythrocytes or red blood cells (RBCs): What do they do?

A

Transport nutrients and oxygen to the body tissues

Transport waste products from the tissues

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2
Q

Functions of the Hematologic System

Thrombocytes or platelets: What do they do?

A

Clotting

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3
Q

Functions of the Hematologic System

Leukocytes or white blood cells (WBCs): What do they do?

A

Fight infection

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4
Q

Types of Anemia: What are they?

A

Nutritional deficiency

Toxin exposure

Aplastic anemia

Hemolytic anemia

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5
Q

Types of Anemia:

What are the types of Nutritional deficiency anemias?

A

Iron deficiency,

folic acid deficiency,

pernicious anemia

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6
Q

Types of Anemia:

What are the types of Toxin exposure
anemias?

A

Lead poisoning

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7
Q

Types of Anemia:

What is Aplastic Anemia? How is it acquired?

A

Acquired as an adverse reaction to medication

Rare congenital bone marrow failure (Fanconi anemia)

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8
Q

Types of Anemia

Hemolytic anemia include?

A

Sickle cell anemia,

Thalassemias

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9
Q

Components of the Complete Blood Count (CBC) include?

A

RBC count

Hemoglobin (Hgb)

Hematocrit (Hct)

RBC indices

WBC count

Platelet count

Mean platelet volume (MPV)

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10
Q

Components of the Complete Blood Count (CBC): RBC count

A

Actual number of counted RBCs

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11
Q

Components of the Complete Blood Count (CBC): Hemoglobin (Hgb)

A

Measure of the protein made up of heme and globin

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12
Q

Components of the Complete Blood Count (CBC): Hematocrit (Hct)

A

Indirect measure of red blood cells

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13
Q

Components of the Complete Blood Count (CBC):
RBC indices

A

Cell diameter,

Hgb/RBC

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14
Q

Components of the Complete Blood Count (CBC)

WBC count

A

Actual count of the number of WBCs in a volume of blood

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15
Q

Components of the Complete Blood Count (CBC)

Platelet count

A

Number of platelets per blood volume

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16
Q

Components of the Complete Blood Count (CBC)

Mean platelet volume (MPV)

A

Measurement of the size of the platelets

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17
Q

What is the most common hematological disorder of childhood?

A

RED BLOOD CELL DISORDERSAnemia

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18
Q

RED BLOOD CELL DISORDERS/ Anemia:

What is it?

A

Decrease in number of RBCs and/or hemoglobin concentration below normal

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19
Q

RED BLOOD CELL DISORDERSsAnemia

What is a defining trait of it?

A

Decreased oxygen-carrying capacity of blood

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20
Q

RED BLOOD CELL DISORDERSsAnemia

Classification of Anemias-how?

A

Etiology and physiology

Morphology

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21
Q

RED BLOOD CELL DISORDERSsAnemia

Classification of Anemias: Etiology and physiology

A

RBC and/or Hgb depletion

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22
Q

RED BLOOD CELL DISORDERSsAnemia

Classification of Anemias: Morphology

A

Characteristic changes in RBC size, shape, and/or color

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23
Q

Effects of Anemia on Circulatory System include:

A

Hemodilution

Decreased peripheral resistance

Increased cardiac circulation and turbulence

Growth issues

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24
Q

Effects of Anemia on Circulatory System include:

Increased cardiac circulation and turbulence can lead to what?

Also, what can it lead to?

A

May have murmur
May lead to cardiac failure

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25
Q

Diagnostic Evaluation

A

Screening CBC for pediatric patients across childhood (U.S. recommendations)

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26
Q

Diagnostic Evaluation

Screening CBC for pediatric patients across childhood (U.S. recommendations)

What should be put into practice?

A

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

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27
Q

Diagnostic Evaluation

Screening CBC for pediatric patients across childhood (U.S. recommendations)

When should hemoglobin concentration or hematocrit be measured?

A

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).

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28
Q

Therapeutic Management

A

Treat underlying cause

Nutritional intervention for deficiency anemias

Supportive care

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29
Q

Therapeutic Management:

Treat underlying cause: What is needed ?

A

Transfusion after hemorrhage if needed

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30
Q

Therapeutic Management:

Transfusion after hemorrhage if needed

Treat underlying cause:

The indication for RBC transfusion is risk of:

A

The indication for RBC transfusion is risk of cardiac decompensation

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31
Q

Therapeutic Management:

Treat underlying cause:
Transfusion after hemorrhage if needed

What happens when the number of circulating RBCs is increased?

A

When the number of circulating RBCs is increased, tissue hypoxia decreases, cardiac function is improved, and the child will have more energy

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32
Q

Therapeutic Management

Supportive care: What is needed?

A

IV fluids to replace intravascular volume

Oxygen

Bed rest

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33
Q

ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:Iron Deficiency Anemia- What is it caused by?

A

Caused by inadequate supply of dietary iron

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34
Q

ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:Iron Deficiency Anemia- How is it viewed?

A

Generally is preventable

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35
Q

ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:Iron Deficiency Anemia- How can iron be ingested for infants?

A

Iron-fortified cereals and formulas for infants

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36
Q

ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:Iron Deficiency Anemia-

Special needs of premature infants

A

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.

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37
Q

ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:Iron Deficiency Anemia-Why are adolescents at risk?

A

Adolescents at risk due to rapid growth and poor eating habits

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38
Q

What is the most prevalent nutritional disorder in the United States and the most common mineral disturbance?

A

Iron Deficiency Anemia

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39
Q

ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia- What does this anemia affect?

A

Iron deficiency anemia affects red cell size and depth of color but does not involve abnormal hemoglobin.

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40
Q

ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia- What can cause it (what factors)

A

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.

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41
Q

ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia- Why are children ages 12-36 months of age at risk?

A

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.

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42
Q

ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia-How is iron during fetal development? What does it depend on?

A

Iron is stored during fetal development, but the amount stored depends on maternal iron stores.

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43
Q

ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia-When are fetal iron stores depleted?

A

Fetal iron stores are usually depleted by ages 5 to 6 months.

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44
Q

ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia-How can dietary iron be introduced?

A

Dietary iron can be introduced by breast-feeding, iron-fortified formula, and cereals during the first 12 months of life.

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45
Q

ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia-What is the nurse’s main goal?

A

The main nursing goal in prevention of nutritional anemia is parent education regarding correct feeding practices.

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46
Q

ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia-What should the nurse prepare parents about when giving iron?

A

If administering iron- The nurse should prepare the mother for the anticipated change in the child’s stools.

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47
Q

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?

A

If the iron dose is adequate, the stools will become a tarry green color.

A lack of color change may indicate insufficient iron.

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48
Q

ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia-How should iron be administered?

How is iron best absorbed?

A

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.

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49
Q

ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia-What may occur with iron administration?

A

Vomiting and diarrhea may occur with iron administration.

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50
Q

ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia- If Vomiting and diarrhea occur with iron administration, what should be done?

A

If these occur, the iron should be given with meals, and the dosage reduced and gradually increased as the child develops tolerance.

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51
Q

ANEMIA CAUSED BY NUTRITIONAL DEFICIENCIES:
Iron Deficiency Anemia- What do liquid preparations of iron do? So what should be done?

A

Liquid preparations of iron stain the teeth; they should be administered through a straw and the mouth rinsed after administration.

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52
Q

Foods Rich in Iron

A

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

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53
Q

Lead Poisoning :Sources of Lead

A

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

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54
Q

Complications of Lead Poisoning:
Lower levels (high but on the lower level)

A

Behavioral problems

Learning difficulties

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55
Q

Complications of Lead Poisoning:

Higher levels (requires chelation treatment)

A

Seizures
Brain damage

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56
Q

Types of Hemoglobinopathies

A

Sickle cell anemia

Hemoglobin SC disease

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57
Q

Types of Hemoglobinopathies:

Hemoglobin SC disease: What are they?

A

α-Thalassemia
β-Thalassemia

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58
Q

Sickle Cell Anemia: What is it?

A

A hereditary hemoglobinopathy

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59
Q

Sickle Cell Anemia: Ethnicity- Who does it occur in primarily?

A

Occurs primarily in African-Americans

Occasionally also in people of Mediterranean descent

Also seen in South American, Arabian, and East Indian descent

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60
Q

Sickle Cell Anemia: What kind of disorder is it considered?

A

Autosomal recessive disorder

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61
Q

Sickle Cell Anemia: Autosomal recessive disorder

How many people are carriers

A

1 in 12 African-Americans are carriers (have sickle cell trait)

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62
Q

Sickle Cell Anemia: Autosomal recessive disorder

If both parents have trait, what does that mean?

A

If both parents have trait, each offspring will have 1 in 4 likelihood of having disease

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63
Q

Sickle Cell Anemia: Where would individuals with sickle cell trait have a survival advantage?

A

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.

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64
Q

Sickle Cell Anemia:

A hereditary hemoglobinopathy- What does this mean?

A

hemoglobinopathies, in which normal adult hemoglobin is replaced by abnormal hemoglobin.

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65
Q

Sickle Cell Anemia Pathophysiology- What occurs?

A

Large tissue infarctions occur

Damaged tissues in organs lead to impaired function

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66
Q

Sickle Cell Anemia Pathophysiology-

Damaged tissues in organs lead to impaired function

A

Splenic sequestration

67
Q

Sickle Cell Anemia Pathophysiology-

Damaged tissues in organs lead to impaired function –>Splenic sequestration

What would this require? What may Splenic sequestration result in?

A

May require splenectomy at early age

Results in decreased immunity

68
Q

Sickle Cell Anemia Pathophysiology-

When do the most acute symptoms of the disease occur?

A

The most acute symptoms of the disease occur during periods of exacerbation called crises

69
Q

Sickle Cell Anemia Pathophysiology-

There are several types of episodic crises including:

A

There are several types of episodic crises, including

vasoocclusive,

acute splenic sequestration, cerebrovascular accident and infection.

70
Q

Sickle Cell Anemia Pathophysiology-

The clinical manifestations of sickle cell anemia (SCA) are primarily the result of

A

The clinical manifestations of sickle cell anemia (SCA) are primarily the result of increased red blood cell (RBC) destruction

71
Q

Sickle Cell Crisis

Acute exacerbations that vary in severity and frequency include:

A

Vaso-occlusive crisis (VOC)

Splenic sequestration

Aplastic crises

Acute Chest Syndrome- medical emergency!

72
Q

Sickle Cell Crisis

Vaso-occlusive crisis (VOC): how it is? how common is it?

A

AKA painful event/ painful episode

Most common type of crisis

73
Q

Sickle Cell Crisis

Vaso-occlusive crisis (VOC): What occurs during it?

A

Stasis of blood with clumping of cells in microcirculation → ischemia → infarction

74
Q

Sickle Cell Crisis

Vaso-occlusive crisis (VOC): What are signs that this is occurring?

A

Signs—fever, pain, tissue engorgement

75
Q

Sickle Cell Crisis

Splenic sequestration: how dangerous?

A

Life-threatening—death can occur within hours

76
Q

Sickle Cell Crisis

Splenic sequestration: What occurs during this?

A

Blood pools in the spleen

77
Q

Sickle Cell Crisis

Splenic sequestration: What are signs this is occurring?

A

Signs

Profound anemia
Hypovolemia
Shock

78
Q

Sickle Cell Crisis

Aplastic crises: What happens during this?

A

Diminished production and increased destruction of RBCs

79
Q

Sickle Cell Crisis

Aplastic crises: What is it triggered by?

A

Triggered by viral infection or depletion of folic acid

80
Q

Sickle Cell Crisis

Aplastic crises: What are signs this is occurring?

A

Signs include profound anemia, pallor

81
Q

Sickle Cell Crisis

Acute Chest Syndrome- how is it viewed?

A

Acute Chest Syndrome- medical emergency!

82
Q

Sickle Cell Crisis

Acute Chest Syndrome- medical emergency!

What is it similar to?

A

Similar to pneumonia

83
Q

Sickle Cell Crisis

Acute Chest Syndrome- medical emergency!

What are symptoms?

A

Severe chest and back pain, fever, cough, tachypnea, wheezing, and hypoxia

84
Q

Sickle Cell Crisis

Acute Chest Syndrome- medical emergency!

What would result in sickling in the lungs?

A

VOC or infection results in sickling in the lungs

85
Q

Sickle Cell Crisis

Acute Chest Syndrome- medical emergency!

Repeated episodes lead to what?

A

Repeated episodes may lead to pulmonary hypertension

86
Q

Sickle Cell Crisis:

Precipitating factors include:

A

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

87
Q

Sickle Cell Crisis:

Precipitating factors include: Hypoxia?

A

From high altitude, poorly pressurized airplanes, hypoventilation, vasoconstriction due to hypothermia

88
Q

Sickle Cell Crisis:

The management of crises includes:

A

The management of crises includes adequate hydration, pain management, minimization of energy expenditures, electrolyte replacement, and blood component therapy if indicated.

89
Q

Diagnosis of Sickle Cell: How?

A

Cord blood in newborns

Newborn screening done in 43 states

Genetic testing to identify carriers and children who have disease

90
Q

Medical Management

What kind of treatment for infection?

A

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

91
Q

Medical Management

Treatment for infection: What should be monitored?

A

Monitor reticulocyte count regularly to evaluate bone marrow function

92
Q

Medical Management

Treatment for infection: What can be given early in crisis? What does it do?

A

Blood transfusion, if given early in crisis, may reduce ischemia

93
Q

Nursing Management:

What should be assessed in sickle cell disease?

A

Multisystem assessment

Assess pain

94
Q

Nursing Management:

What should be monitored in sickle cell?

A

Monitor child’s growth—watch for failure to thrive

Carefully monitor for signs of dehydration and shock

95
Q

Nursing Management:

What should be observed in sickle cell?

A

Observe for presence of inflammation or possible infection

96
Q

Nursing Management:

What should be maintained in sickle cell?

A

Maintain HYDRATION (oral or other as needed)

97
Q

Nursing Management:

What should you be teaching parents about sickle cell?

A

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.

98
Q

Nursing Management:

Why is adequate hydration important in sickle cell anemia patients?

A

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.

99
Q

Nursing Management:

Having to do with hydration, what are parents with sickle cell children taught? What should parents be checking?

A

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

100
Q

Nursing Management:

What is impaired in children with SCA? What does this mean?

A

Children with SCA have impaired kidney function and cannot concentrate urine.

101
Q

Nursing Management:

Telling parent to ‘push fluids’ or encouraging drinking is not specific enough for parents- Why?

A

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.

102
Q

Nursing Management: SCA

Without the ability to concentrate urine, the child needs what?

A

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.

103
Q

Nursing Management: SCA

What are not valid signs of hydration status in children with SCA?

A

Dilute urine and specific gravity are not valid signs of hydration status in children with SCA.

104
Q

Thalassemia: What is it?

A

Inherited blood disorders of hemoglobin synthesis

105
Q

Thalassemia: How is it classified?

A

Classified by Hgb chain affected and by amount of effect

106
Q

Thalassemia: how is it classified (dom, recessive?)

A

Autosomal recessive with varying expressivity

107
Q

Thalassemia: In order for offspring to have the disease, who must be carriers?

A

Both parents must be carriers to have offspring with disease

108
Q

Thalassemia:

What are the two types?

A

a-Thalassemia

b-Thalassemia

109
Q

Thalassemia:

a-Thalassemia: What is affected?

A

α chains affected

110
Q

Thalassemia:

a-Thalassemia: Who does it occur in?

A

Occurs in Chinese, Thai, African, and Mediterranean people

111
Q

Thalassemia:

b-Thalassemia: Who does it occur in?

A

Occurs in Greeks, Italians, and Syrians

112
Q

Thalassemia:

b-Thalassemia: How common is it? How many forms does it have?

A

B is most common and has four forms

113
Q

Thalassemia major

A

refers to a variety of inherited disorders characterized by deficiencies in production of certain globulin chains.

114
Q

B-Thalassemia: How many types and what are they?

A

Four types:

Thalassemia minor

Thalassemia trait

Thalassemia intermediate

Thalassemia major “Cooley anemia”—

115
Q

B-Thalassemia:

Thalassemia minor: What is it?

A

Thalassemia minor—asymptomatic silent carrier

116
Q

B-Thalassemia:

Thalassemia trait: What is it?

A

Thalassemia trait—mild microcytic anemia

117
Q

B-Thalassemia:

Thalassemia intermediate—moderate: What is it?

A

Thalassemia intermediate—moderate to severe anemia + splenomegaly

118
Q

B-Thalassemia:

Thalassemia major “Cooley anemia”—: What is it?

A

severe anemia requiring frequent blood transfusions to survive

119
Q

Thalassemia Pathophysiology

A

Anemia results from defective synthesis of Hgb, structurally impaired RBCs, and shortened life of RBCs

120
Q

Thalassemia Pathophysiology:

What occurs in this?

A

Chronic hypoxia

121
Q

Thalassemia Pathophysiology:

What occurs in this: Chronic hypoxia- What are symptoms?

A

Headache, irritability, precordial and bone pain, exercise intolerance, anorexia, epistaxis

122
Q

Thalassemia Pathophysiology:

When is it detected?

A

Detected in infancy or toddlerhood

123
Q

Thalassemia Pathophysiology:

Detected: What are signs?

A

Pallor,

FTT,

hepatosplenomegaly,

severe anemia (Hgb <6)

124
Q

Thalassemia Pathophysiology:

Diagnosis- how?

A

By hemoglobin electrophoresis

RBC changes often seen by 6 weeks of age

Child presents with severe anemia, FTT

125
Q

Medical Management of Thalassemias

A

Blood transfusion to maintain normal Hgb levels

126
Q

Medical Management of Thalassemias

What occurs secondary to blood transfusions?

A

Side effect—hemosiderosis

127
Q

Medical Management of Thalassemias

What does deferoxamine do?

A

Binds excess iron for excretion by kidney

128
Q

Medical Management of Thalassemias

How to treat hemosiderosis?

A

Treat with iron-chelating drugs such as deferoxamine

129
Q

Medical Management of Thalassemias

Deferoxamine- how is it administered?

A

IV or SQ over 8-10 hours multiple times/wk

May be given at home with IV pump per parents

130
Q

Medical Management of Thalassemias

What is the objective of supportive therapy?

A

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.

131
Q

Nursing Management of Thalassemias

A

Observe for complications of transfusion

Emotional support to family

Encourage genetic counseling

Parent and patient teaching for self-care

132
Q

Nursing Management of Thalassemias:

What is prognosis?

A

Retarded growth

Delayed or absent secondary sex characteristics

Expect to live well into adulthood with proper clinical management

Bone marrow transplant is potential cure

133
Q

Nursing Management of Thalassemias:

The objectives of nursing care are to

A

(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.

134
Q

Diagnostic Tests

A

Complete blood count
Bone marrow aspiration/biopsy
Lumbar puncture
Radiographic examination
MRI
CT
Ultrasound
Biopsy of tumor

135
Q

Nursing Management for Thalassemias:

(other stuff)

A

Nutrition

Pain

Bone marrow suppression

Education of family and child

136
Q

Slide 32

A
137
Q

Nursing Management for Thalassemias:

Bone marrow suppression: What should be done about this?

A

Isolation and transmission precautions

138
Q

Nursing Management for Thalassemias:

Education of family and child: What should be done about this?

A

Careful handwashing

Prevention of spread of infection

Oral care

139
Q

Neutropenia: What is rarely required?

A

Therapy to increase the ANC is rarely required

140
Q

Neutropenia: What is it?

A

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

141
Q

Neutropenia: Children who have recurrent or severe infections can benefit from?

A

Children who have recurrent or severe infections, however, may benefit from the administration of granulocyte colony-stimulating factor.

142
Q

Neutropenia: What is rarely required?

A

Therapy to increase the ANC is rarely required

143
Q

Variations in Pediatric Anatomy and Physiology

How do newborns receive passive immunity?

A

The newborn receives passive immunity from maternal antibodies via the placenta and breastfeeding

144
Q

Variations in Pediatric Anatomy and Physiology

The newborn exhibits

A

Decreased inflammatory and phagocytic responses to invading organisms

Increased susceptibility to infection

A functional spleen

Generally functional cellular immunity

145
Q

Variations in Pediatric Anatomy and Physiology

What kind of immunity develops over time?

A

Humoral immunity develops over time

146
Q

Variations in Pediatric Anatomy and Physiology

How do children lymph nodes compare to adults?

A

Young children have larger lymph nodes, tonsils, and thymus compared to adults

147
Q

Ten Warning Signs of Primary Immunodeficiency

A

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

148
Q

Nursing Assessment of Severe Combined Immune Deficiency (SCID)

A

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

149
Q

Causes of Secondary Immunodeficiency

A

Chronic illness
Malignancy and chemotherapy
Use of immunosuppressive medication (lowers the immune response)
Malnutrition or protein-losing state
Prematurity
HIV infection

150
Q

Types of Juvenile Idiopathic Arthritis

A
  1. Pauciarticular
  2. Polyarticular
  3. Systemic
151
Q

Types of Juvenile Idiopathic Arthritis- What is the most common type?

A

Pauciarticular

152
Q

Types of Juvenile Idiopathic Arthritis

Pauciarticular

A

Involvement of four or fewer joints

153
Q

Types of Juvenile Idiopathic Arthritis

Pauciarticular- What joints usually?

A

The knee

154
Q

Types of Juvenile Idiopathic Arthritis

Pauciarticular- nonjoint manifestations?

A

Eye inflammation

malaise

poor appetite

poor weight gain

155
Q

Types of Juvenile Idiopathic Arthritis

Pauciarticular- complications

A

Iritis and uveitis

uneven leg bone growth

156
Q

Types of Juvenile Idiopathic Arthritis

Polyarticular-

A

Involvement of five or more joints

157
Q

Types of Juvenile Idiopathic Arthritis

Polyarticular-what kind of joints and how does it affect the body?

A

Frequently involves small joints and often affects the body symmetrically

158
Q

Types of Juvenile Idiopathic Arthritis

Polyarticular-nonjoints manifestations

A

Malaise

Lymphadenopathy

organomegaly

poor growth

159
Q

Types of Juvenile Idiopathic Arthritis

Polyarticular-complications?

A

Often a severe form of arthritis

Rapidly progressing joint damage

rhematoid nodules

160
Q

Types of Juvenile Idiopathic Arthritis

Systemic-what is it?

A

In addition to joint involvement,

fever

and rash may be present

161
Q

Types of Juvenile Idiopathic Arthritis

Systemic-nonjoint manifestations

A

Enlarged spleen, liver, lymph nodes, myalgia, severe anemia

162
Q

Types of Juvenile Idiopathic Arthritis

Systemic-complications

A

Pericarditis

Pericardial effusion

pleuritis

Pulmonary fibrosis

163
Q

Signs and Symptoms of HIV Infection in Children

A

Failure to thrive
Recurrent bacterial infections
Opportunistic infections
Chronic or recurrent diarrhea
Recurrent or persistent fever
Developmental delay
Prolonged candidiasis

164
Q

Goals of Nursing Care of the Child With HIV Infection or Other Chronic Immune Disorder

A

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

Peds (15 decks)

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