Week 9/10 Asynchronous Work: Immune, Integumentary, & Musculoskeletal

HIV

A virus that attacks and destroys the human immune system

-causes immune dysfunction, cant fight pathogens

Juvenile Idiopathic Arthritis (JIA):

-autoimmune disease which effects the synovial joints and erodes bone and cartilage

-unknown etiology

Congenital Hypothyroidism

thyroid hormone deficiency present at birth

Anaphylaxis

-hyper reaction

-A severe and life-threatening allergic reaction that causes extreme inflammation

Non-specific immune response:

-none specific, innate

-inflammation (cytokines, sound alarm)

-faster (24 hrs)

-physical barriers

-chemical barriers

-Phagocytosis, macrophages

Specific immune response:

-Active immunity, memory

-B and T cells

-antibodies mount the immune response against pathogens

-takes longer

What is IgA?

-local immunity passed from breast milk to infant

What is IgG?

-responsible for Rh reactions

What is IgE?

-responsible for allergic response and parasites

How long do antibodies take to react to specific antigens?

3 days

Risk factors for HIV:

-perinatal exposure (delivery and breastmilk)

-blood product exposure

-assault survivor

-STI w/o knowing

Nursing considerations for HIV:

-treat to reduce viral load

-monitor CDC, WBC, liver function test

-optimize nutrition

-prevent infection

Systemic Lupus Erythematosus (SLE):

-auto immune, inflammation

-rash and arthritis

-pain, altered image

Nursing considerations for SLE:

-comfort patients

-administer medication

-emotional support

-avoid sun/UV light

S/s of JIA:

-swelling in at least 1 joint for longer than 6 weeks AND

-2 of the following: decreased ROM, pain, warmth over joints

Medications to treat JIA:

NSAID and methotrexate

What is methotrexate:

stops the inflammatory process that causes damage in the joints and body tissues

Nursing considerations for JIA:

-educate on continuing to be mobile

-medications are immune suppressants, educate on side effects of this

-manage pain

S/s of Anaphylaxis

-rash

-hives, swelling

-redness, flushing

-itching

-wheal and flare (IgE mediated reaction)

-bronchospasm

-severe: narrowing airways, stridor

Atopic triangle:

-food allergies

-asthma

-eczema

Nursing considerations for anaphlaxis:

-administer epinephrine

-educate on epipen

-educate on hydration importance for eczema

S/s of Congenital Hypothyroidism

-poor or slow growth

-weak or floppy muscle tone

-swelling around the eyes

-difficulty feeding

Club foot

A birth defect in which the foot is twisted out of shape or position

-3 categories

-needs to be corrected before child starts to walk

Fracture

break or disruption in the bones

-excessive or traumatic force exceeds strength of the bone

Osteogenesis imperfecta

brittle bone disease

-faulty bone mineralization resulting in frequent fractures and bone deformities

Osteomyelitis

bacterial infection of the bone that causes abscesses on bone

-can occur due to open fracture

-can occur due to blood source

Immobilization effect on muscular system:

-decreased muscle strength and endurance

-atrophy

-contractures and loss of joint mobility

Immobilization effect on skeletal system:

bone demineralization

Immobilization effect on cardiovascular syetem:

-altered distribution of blood volume

-increased risk of DVT due to increased clotting

-dependent edema

Immobilization effect on respiratory system:

-decreased need for oxygen

-loss of respiratory muscle strength

Immobilization effect on gastrointestinal system:

-distention caused by poor abdominal muscle tone

-difficulty feeding in prone position

-peristalsis slowed, constipation/anorexia

Immobilization effect on metabolism:

-decreased metabolic rate

-negative nitrogen balance

-hypercalcemia (due to demineralization)

Immobilization effect on integumentary system:

-decreased circulation and pressure leading to decreased healing capacity

Immobilization effect on urinary system:

-difficulty voiding in supine position

-urinary retention

Immobilization effect on psychologic:

-altered perception of self and environment

-dependence on others creates frustration, helplessness, anxiety

-social isolation creates anger, regression

Nursing considerations for immobility:

-assess skin color, capillary refill time, temp, sensation, movement of digits, pulse

-ensure padding

-assess for skin redness or breakdown

What is talipes equinovarus?

toes faing inward and lower than heel

-MOST COMMON

-treated: weekly foot stretching prior to new cast

S/s of osteogenesis imperfecta:

-multiple bone fractures

-blue sclera

-early heading loss

-bowed legs and arms

-kyphosis/scoliosis

Nursing considerations for osteogenesis imperfecta:

-supportive care and rehabilitation to prevent further contractures or deformities

-medications to increase bone density

What is achondroplasia?

Dwarfism

-obesity, hydrocephalus, skeletal issues, bowed legs

Nursing considerations for soft tissue injuries:

RICE

-rest, ice (30 mins max), compression, elevate

ICES

-immobilize, compression, elevation, support

How common are fractures in infants? Children?

common in children

-rare in infants (under 1), warrants investigation

Complete fracture

bone fragments are seperated

Incomplete fracture

bone fragments are still attached

Closed or simple fracture

fracture occurs without a break in the skin

Open or compound fracture

fractured bone protrudes through the skin

S/s of fractures:

-generalized swelling

-pain or tenderness

-deformity

-diminished functional use

-may have bruising or muscular rigidity

-edema

-warmth or redness

6 P's assessment of fracture:

-pain and point of tenderness

-pallor

-pulselessness (diminished, late sign)

-Paresthesia (numbness, late sign)

-Paralysis

-pressure

Compartment syndrome:

medical emergency

-first 48 hrs of fracture

-bleeding and swelling into tissues, arm expands, tissue cant keep up

S/s of compartment syndrome:

-pain, pallor

-poikilothermia (coolness)

-paresthesia (numb)

-pulselessness

-paralysis (late finding)

-cast comes off/fasiotomy

What is traction for fracture?

Pulling force to part of body to position and hold bone fragments in correct alignment

-immobilizes fracture site, reduces muscle spasms

What is distraction of fracture:

-process of separating opposing bone to encourage regeneration of new bone in created space

-used when limbs are unequal in length and new bone is needed to elongate shorter limb

S/s of osteomyelitis:

-2 to 7 days of pain

-warmth, fever

-tenderness

-decreased ROM in affected limb

-marked (increased) WBC

-irritability, lethargy

Nursing considerations for Osetomyletis:

-administer IV antibiotics

-place PICC line (due to length of treatment)

-teach family about PICC line care

-promote bed rest and immobility of limb (watch for DCT)

Name two goals for fracture management or JIA?

preserve function

preventing deformity

relieve symptoms