Immunology & Infection

Define Immunodeficiency, Allergy/Hypersensitive, & Autoimmune?

• Immunodeficiency- underactive or nonfunctional system

• Allergy/Hypersensitive-overactive or poorly regulated system

• Autoimmune-abnormal or excessive response against one’s own cells

What is AIDS?

• Acquired immunodeficiency; HIV infections and AIDS

  • Pneumocystis pneumonia(PCP)

  • Fungal infections

• Spread by blood and body secretions, sexual contact, IV drug use

• 8,500 mothers with HIV give birth every year

• Rate of perinatal transmission to infant is <1%

What is the nursing management for patients with HIV?

• HIV status of mother unknown- expedited HIV test

• Mother HIV +: treat infant with antiretroviral prophylaxis within 6-12 hours of birth

• Maternal Zidovudine: halts maternal-fetal transmission

What are the 4 types of allergic responses? (don’t need to focus on types)

• ***Abnormal antigen-antibody responses

• Hypersensitivity: When it happens immediately

• Type I Immediate: Anaphylactic IgE antibodies (hives, flushing, itching, swelling, nausea, vomiting, wheezing, SOB, LOC

• Type II Cytotoxic Response: IgE and IgM

  • Rh negative mom with Rh+ fetus

• Type III Immune Complex: Complexes in skin, joints, kidney

  • Autoimmune issues

• Type IV Cell: Mediated Hypersensitivity: Contact dermatitis rash

• IgM= Made; IgG= Get

How is allergy assessed with Hx., lab?

• History: Symptoms and what triggers them

• Laboratory testing: CBC w/diff, eosinophil count; goes up with allergen exposure

• Skin testing

How are allergans theraputically managed?

• Environmental Control

  • Limit exposure to allergen→ educate family on removing allergen

• Pharmacologic Therapy

  • Intranasal steroids (Flonase) and antihistamines/decongestants

• Immunotherapy (hypo sensitization)

  • Increases IgG antibodies, shots and sublingual

What are the symptoms of anaphylactic shock?

• *Immediate life-threatening hypersensitivity reaction that occurs after exposure to an allergen in a previously sensitized child

• Breathing: wheezing, SOB, throat tightness, trouble swallowing

• Circulation: pale/blue color, low HR, dizzy, LOC

• Skin: hives, swelling, itchy, warm and red

• Stomach: nausea, cramping, vomiting, diarrhea

• Other: anxiety, feeling of impending doom, itchy eyes, headache

How is anaphylaxis managed?

• Identify foods, insects, medications and latex

• Epinephrine IM (Epipen)

• Antihistamines, steroids, albuterol

• Activate EMS/ 911

• Rebound reaction common

• Observe for 4hours post Epipen

• Hives and swelling common

What is atopic disorders?

• ***Patients with atopic disorders are much more likely to have increased allergic responses

• Much higher production of IgE antibodies → something is triggering it

• Allergic rhinitis

• Eczema

• Asthma

What is allergic rhinitis (risk factor for?)

• *Risk factor for development of asthma

• Assessment

  • Congestion, sneezing, watery eyes, nasal discharge

  • Dennie line/allergic salute

  • Allergic shiners

  • Causes: pollen, mold or irritants

  • Otitis Media

Waht is atopic dermatitis?

• Affects 15-20% of children

• May develop asthma and allergic rhinitis

• Most likely triggered by food allergy

• Assessment

  • Ruptured vesicles that exude yellow, sticky crusty lesions

• Treatment

  • Thick lubricant creams, steroids

What are some food and other allergies?

• *an abnormal immune response caused by exposure to a particular food protein

• Most common foods: peanuts, egg whites, milk, wheat, soy, seafood, and tree nuts

• Assessment

  • Food proteins cross through placenta and through BM

  • Most times it is exposure to a food the SECOND time

• Treatment

  • Eliminate offending foods from child diet

  • Educate regarding EpiPen

• Vaccines: egg allergy should not get flu vaccine

• Milk Intolerance: FTT, vomiting diarrhea, colic→ in babies would have symptoms of bloody stool & distention of stomach

• Peanut Hypersensitivity: *85% cause of fatalities related to food

• Immunotherapy via ingestion and shots

• Stinging Insect: bees, wasps, hornets, yellow jackets

• * All Risk for anaphylaxis

What are the stages of the infectious process?

How is the spread of infection preventing?

• Nosocomial: aka Healthcare-associated infections (HAI’s): infections contracted while in a hospital or healthcare setting

  • *****Antibiotic-resistant organisms (MRSA, VRE, ESBL (extended spectrum beta-lactamases)

• Precautions

  • *Standard

  • *Contact (touch)- isolation room, gown, gloves

  • *Airborne (small particles in the air)-

    • NEGATIVE pressure, use N95, HEPA filter

  • *Droplet (large particles in air thru coughing, sneezing, talking, suctioning)

What are the viral infections?

• Roseola: fever 101-105 for 1-3 days, fever gone, RASH

• Rubella (german measles): MMR vaccine prevents, congenital Rubella

• Rubeola (measles): MMR vaccine prevents, “Koplik spots”

• Varicella (chickenpox): VZIG vaccine, shingles

• Herpes: Acyclovir or Valacyclovir, neuralgia

• Variola (smallpox): eradicated

• Fifth Disease (Slapped Cheek) caused by Parvovirus

• *Treatment for these viruses are supportive and preventive

What is enterovirus (coxsackie virus) & rhinovirus

• Resp: pharyngitis, pneumonia, bronchitis

• Skin: Coxsackie virus “hand, foot, and mouth”

• GI: gastroenteritis

• Eye infection: conjunctivitis

• Neurologic disease: meningitis, encephalitis

• Heart: myocarditis

What is HSV?

• Herpesvirus HSV

  • HSV-1: ORAL region

  • HSV-2: GENITAL region

• Treatment: Acyclovir cream→ best treatment for HSV; may also use Abreva or gentramycin

  • Baby gets treated with ancycloveir if Mom is postive as preventive measure

• HSV-1 = usually oral, HSV-2 = usually genital — but either virus can infect either site depending on exposure route abuse?

• HPV (common warts, flat warts, plantar warts)

• Certain strains can cause vaginal, vulvar and cervical cancer in females and penile cancer in males

• Vaccine available at 9yrs old

What are the common community viral outbreaks?

• Mumps: contagious for 5 days from onset of swollen parotid gland

  • MMR vaccine available but caused by unvaccinated humans

• Epstein-Barr (Mono): “kissing disease” 15-24yr olds

  • Symptoms: fever, cervical adenopathy, pharyngitis

  • Enlarged spleen is common

• Covid-19

  • Multisystem inflammatory syndrome

What are the two main bacterial infections?

• Streptococcal disease; *Organism found in respiratory/female genital tract

  • Strep throat

  • *Scarlet Fever

  • Impetigo

  • Tonsillitis

  • Toxic Shock

  • GBS- babies can contract from Mom → give abx during delivery

• Staphylococcal infections; *Organism found in skin/soft tissue

  • Folliculitis

  • Cellulitis

  • MRSA

  • Scalded skin

What to keep in mind with tonsillectomy

• Frequent throat infections

• Tonsillar hypertrophy- OSA (obstructive sleep apnea); bc not able to breathe so grwth would be stunted bc blood flow not getting to brain once removed would be able to grow properly

• Laser or ligation of tonsils- no sutures

  • *Increased risk for bleeding

• Adenoids removed

• Possible earache after surgery

• Liquids and cold/ice cream; Nothing Red

• 24-48hrs can take soft food; No Crusts etc

What are the other bacterial infections?

• Diphtheria: DTaP vaccine, erythromycin or penicillin-almost extinct

• Pertussis (whooping cough):DTaP vaccine, infants get prior to vaccination

• Tetanus (lockjaw):DTaP vaccine, acute, spastic paralytic illness caused by neurotoxin

• Lyme Disease: Deer tick, amoxicillin, doxycycline

What are the types of fungal infections?

• Jock itch

• Athletes foot

• Ringworm

• Candidiasis

What is the teaching and prevention to be done with immune& infection?

• Immunizations

• Early treatment

• Good handwashing

• Bug/Tick spray

• What to look for….