Week 2 Chapter 47 Flashcards by Steven Singh

Antibodies are received from an external source

Passive
ex: mother to baby IVIG

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Antibodies produced by native T Lymphocytes

Cellular

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Antibodies produced by native B cell lymphocytes

Humoral

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B Lymphocytes
Secrete antibodies to viruses and bacteria
Recognize antigens
Antibodies mark the antigen for destruction
NOT destroy foreign cell
Crosses the placenta in IgG

Humoral

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T cells
Does not recognize antigens
Direct and regulate immune response
Attack infected or foreign cells
NOT cross the placenta

Cellular Immunity

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GAE

Can’t bind to B lymphocytes

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Bind to b lymphocytes

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1st antibodies secreted by B lymphocytes after infection

IgM

Close to adult level by age 1

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IgD

Produced in small quantities

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IgG

Most abundant and effective in fighting infections

50% age 1
100% age 7

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Newborn exhibits

Decreased inflammatory response and phagocytic responses to invading organisms
Increased chance of infection
A functional spleen
Functional cellular immunity

Humoral develops over time
- Young children have large lymph nodes, tonsils, and thymus compared to adults

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Health Hx for Immunologic Disorders

Maternal HIV infections
Frequent, recurrent infections
Chronic cough
Recurrent low grade fever
Two or more serious infections in early childhood
Recurrent deep skin or organ abscesses
Persistent thrush in the mouth
Extensive eczema
Growth Failure

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Immunosuppressants
Cytotoxic Medications
Plasmapheresis
IV immunoglobulins IVIG
Antibiotics
DMARDs
Antiviral Meds
Immunizations
Bone Marrow and Stem Cell transplantation

Common Medications and Medical Treatments in Immune Disorders

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Peripheral stem cells are removed from the donor via apheresis or stem cells are retrieved from the umbilical cord and placenta. Stem cells are then transplanted as an infusion into the recipient

Stem Cell Transplant

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Transfer of healthy donor bone marrow cells into the veins of the recipient. Cells will ultimately migrate and grow in the bone marrow and recipient to restore immune functions

Bone Marrow Transplant

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Most are hereditary or congenital

Humoral deficiencies
Cellular immunity
Combination of humoral and cellular immunity deficiencies
Phagocytic system defects
Complement Deficiencies

Primary Immunodeficiencies

10 Warning Signs of Primary Immunodeficiency

4 or more new episodes of acute otitis media in 1 year
2 or more episodes of severe sinusitis
Tx c Abx for 2 months or longer with little effect
2 or more episodes of pneumonia in 1 year
Failure to thrive in infant
Recurrent deep skin organ abscess
Persistent oral thrush or skin candidiasis after 1 year of age
Two or more serious infections
Family Hx of primary immunodeficiency

Wiskott Aldrich Syndrome

X linked genetic disorder affects males only

Nursing Assessment
- Hx of petechiae
- Bloody diarrhea
- Hx of hematemesis or intracranial or conjunctival hemorrhages
- Eczema
- Low IgM, elevated IgA and IgE and normal IgG

Therapeutic Management
IVIG, steroids, splenectomy to correct thrombocytopenia, stem cell transplant

SCID

Rare X linked Autosomal Recessive Disorder
Absent T cell and B cell function

Nursing Assessment

Chronic Diarrhea
Failure to thrive
Hx of severe infections in infancy
Persistent Thrush
Adventitious Sounds

Therapeutic Management
-IVIG infusions to decrease infections until stem cell transplant

Causes of Secondary Immunodeficiency

Chronic illness
Malignancy and chemotherapy
Use of immunosuppressives
Malnutrition or protein losing state
Prematurity
HIV infection

S/S 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

Lab and Diagnostic Testing for HIV infection

PCR
- Tests HIV genetic material
+ in infected infants month or older

ELISA
Tests for antibodies to HIV
Less accurate than PCR

Platelet less than 30 requires Tx

CD4 and ANC
-Low in HIV infection

Goals of Nursing care of the child with HIV infection or other chronic immune disorder

Avoiding infection
Promoting compliance with medication regimen
Promoting nutrition
Providing pain management and comfort measures
Educating the child and caregivers
Providing ongoing psychosocial support

Stressors involved with Diagnosis of HIV infection in Children

Diagnosis of an incurable disease
Financial difficulties
Multiple family members with HIV
HIV associated stigmas
Desire to keep HIV infection confidential
Multiple medical appointments and hospitalizations

Family Education for the child with HIV

Medication Regimen Ongoing follow up When to call provider Stress reduction HIV education

Influencing Factors for Autoimmune Disease

Heredity Hormones Self Marker Molecules Environmental Influences - Viruses - Certain Drugs

SLE

Multisystem autoimmune disorder affects humoral and cellular immunity with periods of exacerbation and remissions - Rarely diagnosed before age 9 years Causes inflammatory response resulting in vasculitis

Complications of SLE

Ocular or visual changes CVA, transverse myelitis, pericarditis, CAD, valvular heart disease, seizures

Therapeutic Management of SLE

NSAIDs, corticosteroids, antimalarial agents, dialysis if ESRD occurs

Most common clinical manifestations of SLE

Alpocecia Anemia Arthritis Fatigue Lupus Nephritis Photosensitivity Pleurisy Raynaud Phenomena Seizures Skin rashes Thrombocytopenia

Common Lab and Diagnostic Tests for SLE

CBC Platelet Count WBC Complement Levels ANA titer

Pauciarticular

Involvement of 4 or fewer joints; quite often the knee is involved Non joint manifestations: Eye inflammation, malaise, poor appetite, poor weight gain Complications: Iritis, uneven leg bone growth

Polyarticular

Involvement 5 or more joints; frequently involves small joints and often affects the body symmetrically Non joint manifestations: Malaise, lymphadenopathy, organomegaly, poor growth Complications: Severe form of arthritis, rapid joint progression damage

Systemic

Addition to joint involvement, fever, and rash may be present at diagnosis Non joint manifestations: Enlarged spleen, liver, lymph nodes, myalgia, severe anemia Complications: Pericarditis, pericardial effusion, pulmonary fibrosis

Allergy

Immune mediated response resulting in an adverse physiologic event or reaction Affects up to 25% of population in developed countries Extent and response determined by the duration, rate, and amount of exposure to allergen Anaphylaxis - Food, drug, and insect stings most common

Antibody exposed to antigen (allergen) then?

Rapid cell activation (mediators and cytokines) then Changes in blood vessels, bronchi, and mucous secreting glands

Therapeutic Management of Anaphylaxis

Antihistamine Epinephrine Albuterol IV Fluids

Common Food Allergens to Avoid in Children Younger than 1 Year

Cow's Milk Eggs Peanuts Tree nuts Fish and Shellfish Wheat Soy