Pediatric Nursing Exam 3 Review - PDF

N452 Exam #3 Review You know the drill by now…Medication calculations, IV fluid calculations, growth and development, pediatric assessment, medications we have covered in class-like Toradol (Ketorolac), Factor, Chemotherapy drugs…all are fair game Immune How does HIV progress in infants vs. childr...

N452 Exam #3 Review You know the drill by now…Medication calculations, IV fluid calculations, growth and development, pediatric assessment, medications we have covered in class-like Toradol (Ketorolac), Factor, Chemotherapy drugs…all are fair game Immune How does HIV progress in infants vs. children, spread of HIV in adolescents · HIV infects the CD4 T-cells (Helper cells) and uses them to replicate the HIV virus. The CD4 cells are then dysfunctional and the person’s immune system is suppressed · B cells get suppressed as well, so a person with HIV has a suppressed immune system and a suppressed bone marrow that cannot produce enough new cells to fight infections · HIV is the virus that causes AIDS (acquired immunodeficiency syndrome) · Perinatal transmission: o From infected mom to baby, can occur in utero, during birth or via breastfeeding o We treat known HIV infected moms with antiretroviral drug therapy like Zidovudine, perform elective C-sections, and educate them on avoiding breastfeeding o HIV testing is currently voluntary for pregnant women · HIV in children: o Transmission of HIV in children via sexual contact is very rare, and sexual abuse should be ruled out in these cases o Transmission of HIV in adolescents via sexual contact is the major mode of transmission · Infection in children: o Either rapid progression due to immature immune system and death by age 4 o Slower progression with manifestation of AIDS occurring in school of adolescence o What we will see: § HSM, lymphadenopathy, FTT, developmental delay, oral thrush, diarrhea, and parotitis § Children have recurrent infections that do not respond to treatment especially opportunistic infection · How to diagnose HIV: o Western Blot test and ELISA test § In infants, these tests may be falsely positive due to the antibodies of the mom § These antibodies persist for about 18 months § Only do these tests on children over 18 months!!!! o In infants, we use Polymerase chain reactions (PCR) and p24 antigen detection tests § These will diagnose an infant in as little as 4 weeks old · An infant born to an HIV + mother is presumed positive until proven otherwise · Treating HIV: o Goals of treatment: § Slow the growth of the virus § Promote normal growth and development § Prevent complications § Improve quality of life § Prolong survival  o EARLY RECOGNITION IS KEY!!!! · HIV pharm: o Combinations of antiretroviral drugs are the most effective treatment o Antiretroviral drugs are not a cure, but can slow viral progression o Adherence to med schedules is critical, but some taste awful and the timing can be inconvenient a lot of issues with compliance · Nursing care: o Infection prevention o Nutritional support o Pain control (why so much pain?) o Providing psychological family centered care o Assessing for signs of disease progression o Providing ethically safe care o If parents are infected, making custody arrangements for the child o Encouraging day care and school participation · Education= key to prevention!!!! Immunizations in kids with HIV · Immunizations are given only when CD4 counts indicate no severe suppression is present · Immediate prophylaxis after exposure to diseases is recommended due to poor immune response to immunizations Tcell counts and what do they mean for patients (memorize the chart in notes) Infant 12 mos. 1-5 yr 6-12 yr No suppression >1500 >1000 >500 Moderate Suppression 750-1499 500-999 200-499 Severe Suppression