Week 2 Chapter 47 Flashcards
Antibodies are received from an external source
Passive
ex: mother to baby IVIG
Antibodies produced by native T Lymphocytes
Cellular
Antibodies produced by native B cell lymphocytes
Humoral
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
T cells
Does not recognize antigens
Direct and regulate immune response
Attack infected or foreign cells
NOT cross the placenta
Cellular Immunity
GAE
Can’t bind to B lymphocytes
MD
Bind to b lymphocytes
1st antibodies secreted by B lymphocytes after infection
IgM
Close to adult level by age 1
IgD
Produced in small quantities
IgG
Most abundant and effective in fighting infections
50% age 1
100% age 7
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
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
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
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
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
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
