Immunologic Alterations

1
Immunologic Alterations

• NUR 264
• Pediatrics
• Angela Jackson, RN, MSN

2
Developmental Differences

• The immune system of neonates and young children
  is immature
• Infants and young children are susceptible to
  infectious organisms that can cause illness and
  its associated morbidity
• Immunizations help prevent many viral and
  bacterial infections
• The immune system matures by three to six years
  of age
• Lymphoid tissue reaches adult size by six weeks
  of age, becomes larger during the prepubertal
  period, then goes back to normal by puberty

3
Systemic Lupus Erythematosus (SLE)

• Peak age of childhood onset is 11 to 15 years
• Occurs in female 8 to 10 times more often than
  males
• Occurs more often in African-Americans than in
  Caucasians

4
SLE Clinical Manifestations

• Dependant upon which organs are targeted by the
  immune complexes, are chronic, and characterized
  by remissions and exacerbations
• See box 31-11 and 31-12 on page 1185 for clinical
  manifestation and classification criteria

5
SLE Diagnosis

• Diagnosis is based on history, physical exam and
  laboratory testing
• Must have four of the eleven criteria
• If ANA is negative, lupus is an unlikely
  diagnosis
• Lab testing including
• CBC
• UA
• BUN/Creatinine
• ANA

6
SLE Treatment

• Targeted at the organs affected
• Overall immunosuppression is usually necessary
• Medications
• Corticosteroids
• Salicylates
• NSAIDs
• Anti-hypertensive medications
• Anticonvulsant medications
• Anti-malarial medications (useful for rash and
  arthritis)

7
SLE Nursing Management

• Teach the client and family about the disease
  process and projected course
• Teach importance of recognizing signs of
  infection
• Teach importance of adequate nutrition and fluid
  intake
• Teach medication administration and potential
  side effects
• Provide support

8
Allergic Reaction to Medications

• Adverse reaction to drugs or their metabolites
  caused by immunologic responses
• Reactions demonstrate either systemic
  hypersensitivity or organ-specific patterns and
  usually recur on re-exposure to the same drug,
  but may also occur with prolonged administration

9
Allergic Reaction to Medications

• Clinical Manifestations
• Cutaneous
• Urticaria wheal-like lesions appear after
  beginning the drug, resolve rapidly after
  stopping the drug
• Angioedema
• Maculopapular rash most common form or
  cutaneous reaction
• Contact dermatitis usually pruritic,
  erythematous, vesicular or maculopapular. May
  take 5-7 days to develop

10
Allergic Reaction to Medications

• Multiple organ system involvement
• Anaphylaxis
• Nonspecific histamine release same systemic
  manifestations as anaphylaxis
• Erythema multiforme/Stevens-Johnson syndrome
  erythematous, maculopapular, vesicular,
  urticarial rash. Mucosal and conjunctival lesions
  and epidermal loss of 10 or less with
  Stevens-Johnson syndrome
• Toxic epidermal necrolysis (TEN) fever
  epidermal loss of more than 30 of body surface
  are and visceral involvement with an associated
  30 40 mortality rate
• Hypersensitivity syndromes
• Drug fever

11
Stevens-Johnson Syndrome
12
Toxic epidermal necrolysis
13
Urticaria, Maculopapular Rash and Angioedema
14
The End!

• Questions??