Pediatric Immunity & Infection Prevention (NURS 445) PDF

Managing the care of pediatric patients with alterations in Immunity, Inflammation, and Infection prevention C HI LD H E A LT H N U R S I N G N U R S 4 45  1.Describe the concept of immunity. (CO7) 2.Recall the concept of inflammation and its role in the immune system, i...

Managing the care of pediatric patients with alterations in Immunity, Inflammation, and Infection prevention C HI LD H E A LT H N U R S I N G N U R S 4 45  1.Describe the concept of immunity. (CO7) 2.Recall the concept of inflammation and its role in the immune system, including common clinical manifestations and basic nursing interventions associated with inflammation. (CO7) Module 5 3.Outline how immunity develops and changes within the first year of life. (CO7) objectives 4.Describe the immune system changes throughout pediatric development. (CO1, CO4, CO7) 5.Recall the difference between innate immunity and adaptive immunity. (CO7) 6.Appraise the spectrum of immunity from impaired immunity to hyper responsive immunity and autoimmune response. (CO1, CO4, CO7) 7.Discuss the role of the four sub-sects of adaptive immunity: natural, acquired, active and passive. (CO1, CO7) 8.Discuss the use of routine immunizations to prevent childhood illness. Categorize live and inactivated vaccines. (CO1, CO4, CO5) 9.Describe when a live vaccine can be given to the patient. (CO1, CO4, CO5) 10.Discuss the laws regarding childhood vaccinations. (CO3, CO4, CO5) 11.Discuss the role of routine vaccinations for disease prevention. (CO1, CO4, CO5)  12.Describe the rationale for the recommended vaccine schedule during the first 5 years of life. (CO4, CO5) 13.Describe how human immunodeficiency virus and acquired immune deficiency syndrome affect the immune system in infants who acquire the virus through birth or through breastmilk. (CO4, CO7) Module 5 14.Develop a plan of care for a pediatric patient with human immunodeficiency virus or objectives acquired immune deficiency syndrome. (CO4, CO5) 15.Describe the clinical manifestations, etiology, diagnosis strategies, treatment options, and nursing interventions associated with human immunodeficiency virus or acquired immune deficiency syndrome. (CO4, CO7) 16.Describe the clinical manifestations, etiology, diagnosis strategies, treatment options, and nursing interventions associated with hypersensitivities and allergic responses. (CO7) 17.Describe the clinical manifestations, etiology, diagnosis strategies, treatment options, and nursing interventions associated with juvenile idiopathic arthritis. (CO7) 18.Identify the appropriate personal protective equipment for common childhood illnesses. (CO1, CO7) 19.Assess likelihood of childhood illness based on age and setting, including pertussis, measles, varicella, and rotavirus. (CO1, CO4, CO5, CO7) 20.Identify developmentally appropriate caregiver or patient education regarding infection prevention. (CO1, CO5, CO7) Concept of Immunity (Linnard-Palmer pg. 438) Immune system’s job is to eliminate foreign substances to prevent infection There are two types of immunity: innate and adaptive. Innate immunity: cells and proteins, such as macrophages, neutrophils, and killer cells created to identify and react to foreign organisms Adaptive immunity: Lymph system components that identify self vs. non-self. This part of the immune system changes and remembers previous exposure to microorganisms. Types of Adaptive Immunity Adaptive immunity breaks down further into natural and artificial immunity Natural immunity: ◦ Passive-Maternal antibodies ◦ Active-Exposure to infection Artificial immunity: ◦ Passive-IVIG (artificial antibodies) ◦ Active-immunizations Pediatric Physiology and Due to the immature responses of the immune system, infants and young children are more Immune susceptible to infection. System The newborn displays a decreased inflammatory response to invading organisms, contributing to an increased risk for infection. Cellular immunity is generally functional at birth, and humoral immunity occurs when the body encounters and then develops immunity to new diseases. Since the infant has had limited exposure to disease and is losing the passive immunity acquired from maternal antibodies, the risk of infection is higher. Concept of inflammation The Centers for Disease Control and Prevention (CDC) has defined inflammation as “the body's reaction to injury, irritation, or infection characterized by redness, swelling, warmth, and/or pain; caused by accumulation of immune cells and substances around the injury or infection.” Fever Infection stimulates the release of endogenous pyrogens Pyrogens act on the hypothalamus and trigger prostaglandin production which increases the body’s set temperature This triggers the cold response (shivering, This decreases heat loss and resets body temperature. vasoconstriction, decrease in peripheral perfusion) Fever occurs as a result Why does the body do this?  At least every 4 to 6 hours Managing Fever Assess temperature 30 to 60 minutes after antipyretic With any change in condition in a Child With Use same site and device for temperature an Infectious measurement- Age and unit specific Disease Administer antipyretics when appropriate Notify physician of temperature per institution or specific order guidelines Encourage oral intake or administer intravenous fluids PRN Keep linens and clothing clean & dry Changes to the immune system throughout pediatric development  Prenatal/in utero Infancy Transmission through breast milk, in utero infections transmitted- HIV, Hep B,C Developmental considerations Toddlers and Poor hand hygiene Fecal-oral route transmission preschoolers Pet encounters As children go through developmental stages, they are susceptible to certain organisms Lax hygiene due to their psychosocial and School aged Mutual sharing physiological changes that occur during that time. Adolescents (period of wellness) Assessment Inspection and observation ◦ Skin, mouth, throat, and hair for lesions or wounds ◦ Hydration status and vital signs Palpation ◦ Palpate skin: temperature, texture, turgor, moisture ◦ Palpate rash ◦ Palpate lymph nodes Personal Protective Equipment and Precautions ◦ Airborne-N95-negative pressure room ◦ Droplet-Mask and eye protection PRN ◦ Contact-gown and gloves ◦ Enteric precautions-same as contact + must wash hands with soap and water ◦ Standard- gloves What infections go with each category? Immunizations Pediatric considerations Vaccine schedule Do NOT have to memorize schedule Vaccines Best prevention for childhood illnesses and the Are they required by law? Live vaccines cannot be potential complications Know state law where you Live vaccines given to pregnant women. they can bring practice Don’t forget teens. SC law allows for medical, MMR religious, and special Varicella excemptions Rotavirus Intranasal influenza Who should not receive live vaccines? 1. Immunocompromised patients ◦ HIV, cancer, transplant recipients 2. Pregnant women Children less than a year old should not receive MMR or Varicella (both live vaccines) Still have mother’s passive immunity Children less than 2 years of age should not receive the Live flu vaccine (Flu Mist)  Vaccine administration Nursing role in vaccinations: Educate patient/caregiver about vaccination Must provide Vaccine Information Sheet (VIS) by law before vaccine administration Obtain consent Prepare vaccine Select appropriate injection site (if an injectable vaccine) IM-preferred site-depends on age Provide pain relieve and/or distraction PRN Immunizations Immunization barriers: Contraindications- vaccine specific Long wait times History of severe anaphylactic reaction Expense Encephalopathy within days of administration Language barriers of DTaP Lack of knowledge of immunizations History of Guillain-Barré syndrome (GBS) Misinformation Illness-moderate to severe acute illness with or without fever Scope of Immunity Concept Suppressed immune response due to illness such as Human Immunodeficiency (HIV) Hypersensitive response such as food and environmental allergies Autoimmune response such as Juvenile Idiopathic Arthritis (JIA) Perinatally Acquired Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) (Linnard-Palmer, pg. 444) HIV virus leads to AIDS. HIV causes reverse transcription which results in gradual suppression of cell-mediated immunity. This leads to a weakened immunity and ability to fight off infection. HIV is transmitted by direct contact with an infected person’s body fluids, secretions, or blood. HIV and AIDS may be transmitted to children via the following routes: Infants: Transmission from an infected mother, either in utero, during delivery, or via breastfeeding Adolescents: Unprotected sex with an infected sexual partner or injection drug use Any age: Transfusion of HIV-infected blood products when product screening is inadequate HIV/AIDS Flu-like symptoms, swollen lymph nodes, pneumonia Etiology Manifestations Very low total CD4 cell count Etiology Highly active antiretroviral therapy (HAART) Diagnosis Treatment Nutritional support, rest, medication adherence, emotional support, education Nursing Interventions prevention of transmission of the virus, identification of disease progression and when to seek treatment,  Babies born exposed to HIV will test positive at birth Perinatal and begin antiretroviral medications to prevent transmission. HIV testing will repeat several times transmission depending on risk of transmission. Most babies will test negative by 6 months of age. Once the infant has two and nursing care negative HIV tests, he/she can stop medications. What would the nurse be responsible for? Hyper-reactive immune response An overreaction of the immune system to an antigen. Could be an environmental trigger, food, medication Ranges from mild (sneezing) to severe (anaphylaxis). Rising number of children with severe allergies. An Epi pen (or two) should be available at all settings for children with known anaphylaxis history or risk factors. Anaphylactic shock (Linnard-Palmer, pg. 440) assessment diagnosis Implementation/ planning interventions evaluation Autoimmune response (Linnard-Palmer, pg. 443) The immune system fails to recognize “self” from foreign invader and attacks Juvenile Idiopathic Arthritis (JIA) is an autoimmune response that leads to chronic inflammation of the joints with varying degrees of severity and number of joints affected. Diagnostic criteria require report of morning stiffness, joint pain, and limping; x-rays of joints (late- stage disease); blood labs including erythrocyte sedimentation rate (ESR), rheumatoid factor; presence of rheumatoid nodules; swelling or fluid around three or more joints at the same time; and symmetry.  Medications include nonsteroidal anti- inflammatory drugs (NSAIDs), steroids JIA treatment (sparingly), antirheumatic medications also called disease-modifying antirheumatic drugs and nursing (DMARDs) (risk of immune suppression) care Non-pharm treatment-physical and occupational therapy, surgery, regular exercise, assistive Swollen knees devices Nursing care includes education, family support, medication adherence, follow up appointments, and home care. Childhood illness Pertussis Measles Varicella Rotavirus Infection prevention frequently cleansed food preparation and frequent hand Providing clean water washing eating surfaces control of fecal control over bodily contamination for secretions (mucus daycare programs and respiratory with diapered secretions) children