NUR 203 Child Health Week 3 Part III

Week 3 Part III: Child Health - NUR 203

Learning Objectives

• Nursing Process Framework

  • Compose patient-centered care plans using evidence-based practice for children with infectious/communicable illnesses.

• Fever Management

  • Discuss strategies for effectively reducing fever in pediatric patients with the support of evidence-based practices.

• Collaborative Care

  • Develop evidence-based plans for pediatric patients with sepsis/scarlet fever, incorporating family and interdisciplinary health team collaboration.

• Viral Infections Care

  • Provide care for children with viral infections using knowledge of pathophysiology and pharmacotherapy, respecting family values and preferences.

• Conjunctivitis Recognition

  • Recognize various types of conjunctivitis prevalent in the pediatric population.

• Refractive Errors

  • Discuss common refractive errors diagnosed in children.

• Cultural Integration in Care

  • Integrate patient/family culture in the care and education planning for pediatric acute otitis media.

• Communication and Supportive Technology

  • Design care plans prioritizing communication strategies and technology that align with family preferences for teaching and learning.

• Health Promotion in Diabetes

  • Examine current health trends and protocols for promoting health in pediatric patients with diabetes mellitus.

• Nutrition Education for Parents

  • Prepare educational plans focusing on essential nutrition components to achieve therapeutic outcomes.

Chapter 47: Nursing Care of Children with Immunologic Disorders

Immunodeficiency

• Definition: Inability to mount appropriate immune responses.

• Includes:

  • Autoimmune disorders.

  • Allergic disorders.

• Typically chronic in nature.

Variations in Pediatric Anatomy and Physiology

• Newborns derive passive immunity from maternal antibodies via placenta and breastfeeding.

• Characteristics of newborn immune function:

  • Decreased inflammatory and phagocytic responses.

  • Increased infection susceptibility.

  • Functional spleen and generally functional cellular immunity.

  • Humoral immunity develops over time.

  • Larger lymphatic structures compared to adults (lymph nodes, tonsils, thymus).

Types of Immunity

• Passive Immunity: Antibodies from external sources (e.g., mother to baby, IVIG).

• Cellular Immunity: Antibodies produced by T-cell lymphocytes.

• Humoral Immunity: Antibodies produced by B-cell lymphocytes.

Common Medications for Immune Disorders

• Immunosuppressants.

• Cytotoxic medications.

• Plasmapheresis.

• IV immunoglobulins.

• Antibiotics.

• Disease-modifying antirheumatic drugs (DMARDs).

• Antiviral medications and immunizations.

• Bone marrow or stem cell transplantation.

Health History Considerations

• Relevant maternal history (e.g., HIV infection).

• Indicators of recurrent disease:

  • Frequent infections, chronic cough, low-grade fever.

  • Serious infections in early childhood.

  • Skin/organ abscesses and persistent thrush.

  • Eczema and growth failure.

Primary Immunodeficiencies

• Mostly hereditary or congenital:

  • Types:

    • Humoral deficiencies.

    • Cellular immunity deficiencies.

    • Combination deficiencies.

    • Phagocytic system defects.

    • Complement deficiencies.

Ten Warning Signs of Primary Immunodeficiency

1. Four or more episodes of acute otitis media in one year.

2. Two severe sinusitis episodes.

3. Antibiotic treatment for more than two months with little effect.

4. Two or more pneumonia episodes in one year.

5. Failure to thrive in infants.

6. Recurrent deep skin or organ abscesses.

7. Persistent oral thrush or skin candidiasis post-1 year.

8. Infections needing IV antibiotics.

9. Two or more severe infections (e.g., sepsis).

10. Family history of primary immunodeficiency.

Assessments for Specific Syndromes

• Wiskott-Aldrich Syndrome:

  • History of petechiae, bloody diarrhea, or early bleeding episodes.

  • Eczema and abnormal lab results (low IgM, elevated IgA/IgE).

• Severe Combined Immune Deficiency (SCID):

  • Chronic diarrhea, failure to thrive, history of severe infections, and lab findings (low immunoglobulins).

Causes of Secondary Immunodeficiency

• Factors include:

  • Chronic illness, malignancy, chemotherapy, malnutrition.

  • Prematurity and HIV infection.

Signs and Symptoms of HIV Infection in Children

• Indicators include:

  • Failure to thrive, recurrent bacterial infections, opportunistic infections.

  • Chronic diarrhea, persistent fever, and developmental delays.

Laboratory Testing for HIV

• PCR Tests: Detects HIV genetic material, positive after one month of age in infants.

• ELISA Tests: Tests for HIV antibodies, less reliable in young children.

• Platelet Count: Low levels (<30,000) may require treatment.

• CD4 Counts: Often low in children with HIV.

Goals of Nursing Care for HIV Infection

• Prioritize:

  • Avoiding infection, promoting medication compliance, enhancing nutrition.

  • Providing pain management, education for children/caregivers, and psychosocial support.

Family Education for HIV-infected Children

• Important components include:

  • Medication adherence, follow-up care, and recognition of when to seek further medical advice.

  • Stress reduction techniques and comprehensive HIV education.

Stressors with HIV Diagnosis

• Include:

  • Financial challenges, stigma, confidentiality concerns, and extensive medical appointments.

Systemic Lupus Erythematosus (SLE) Manifestations

• Common clinical signs:

  • Alopecia, anemia, arthralgia, arthritis, fatigue, organ-specific issues (e.g., lupus nephritis).

  • Photosensitivity, seizures, and rashes.

Laboratory Tests for SLE

• SLE Definition: Chronic autoimmune disorder with exacerbation/remission phases.

• Testing includes:

  • CBC showing decreased hemoglobin/hematocrit, lower platelet and WBC counts.

  • Complement levels (C3, C4) usually decreased, positive ANA titer.

Types of Juvenile Idiopathic Arthritis

• Pauciarticular (Oligoarticular):

  • Involves four or fewer joints (commonly the knee).

• Polyarticular:

  • Involves five or more joints, often affecting small joints symmetrically.

• Systemic:

  • Joint involvement with fever/rash.

• Nonjoint manifestations and complications vary with types.

Common Food Allergens in Young Children

• To Avoid:

  • Cow's milk, eggs, peanuts, tree nuts, fish/shellfish, wheat, and soy.

Anaphylaxis Overview

• Definition: Acute IgE-mediated severe response to allergens occurring within minutes.

• Symptoms: Cutaneous, cardiopulmonary, gastrointestinal, and neurologic manifestations.

• Treatment: Focus on airway, breathing, circulatory assessment with immediate epinephrine administration and secondary diphenhydramine use. Corticosteroids prevent late-onset reactions.