HIV and SLE: Nursing Care and Management

Hypersensitivity Reactions

• Type I: Immediate hypersensitivity (anaphylactic), causes allergic rhinitis, acute anaphylaxis, hives, eczema, and asthma
• Type II: Cytotoxic hypersensitivity, causes transfusion reaction after receiving incompatible blood
• Type III: Arthus hypersensitivity (immune complex), causes serum sickness, glomerulonephritis
• Type IV: Delayed cell-mediated hypersensitivity, causes contact dermatitis (poison ivy)

Common Food Allergens

• Peanuts
• Tree nuts
• Seafood
• Milk
• Eggs
• Seeds

Allergy Prevention Measures

• Breastfeeding for all babies until at least 4 months of age and ideally for 6 months
• Hydrolyzed formula for high-risk babies who are unable to breastfeed
• Introduce high-allergy foods at home
• No whole milk until after 1 year of age
• Introduce infants to peanuts by 4-6 months of age

Anaphylaxis

• Symptoms: Sneezing, laryngeal edema, tightness, tingling of mouth or face, subsequent swelling of lips and tongue, severe flushing, urticaria, and itching
• Management: Ensure adequate airway, administer epinephrine, oxygen, corticosteroids, and antihistamines, keep the child warm and lying flat or with feet slightly elevated, start an IV

Priority Action

• Ensure an adequate airway

Immune System

• Major components: chemical barriers, interferon, inflammation
• Pediatric differences: organs mature during infancy and childhood, immaturity of the immunologic system places the infant and young child at greater risk for infection, disorders manifest differently in children than adults
• Nonspecific immune functions: chemical barriers, interferon, inflammation
• Specific immune functions: humoral response (B-cells and helper T-cells), cell-mediated response (T-cells and helper T-cells)

Immune System Dysfunction

• Under function: increased susceptibility to infection
• Over function: produces antibodies against cells of the body, allergies, and autoimmune disease

Nursing Care for Immunodeficiency

• Prevent contact with organisms
• Create barriers if contact is unavoidable
• Kill organisms if contact is made

HIV Indicators

• Failure to thrive
• Recurrent bacterial infections
• Opportunistic infections
• Chronic or recurrent diarrhea
• Recurrent or persistent fever
• Developmental delay
• Prolonged candidiasis

HIV Transmission and Treatment

• Transmission: not specified
• Gold standard of pharmacologic treatment: not specified
• PCP and other infections: addressed with therapy
• Nursing challenges: respiratory management, promoting normal growth and development, preventing infection, providing comfort, supporting families, infection transmission, medication adherence

AAP Statement on HIV Disclosure

• Not specified

Systemic Lupus Erythematosus (SLE)

• Manifestations: malar butterfly rash, red, round raised patches, oral and nasal ulcers, arthritis, pleuritis, pericarditis, peritonitis, renal disorder, neurologic disorder, hematologic disorders, immunologic disorder, positive ANA assay
• Treatment: avoid exposure to sun, prevent infections, wear sunscreen, steroids, NSAIDS, anticonvulsants, antihypertensives, hydroxychloroquine, killed virus vaccines rather than live virus vaccines

Nursing Considerations for Immunizations

• Do not administer live vaccines to immunosuppressed persons
• Refer to individual vaccine for method of administration and contraindications
• Report adverse reactions via the vaccine adverse reaction (VAR) reporting system