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 and 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??