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Lymphatic, Infectious and Immune Diseases

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'Chicken pox' & 'Shingles' Chicken Pox is primary, Shingles is secondary infection ... 'Chicken pox' & 'Shingles' Sx = malaise, fever, pruritus, lymphadenopathy ... – PowerPoint PPT presentation

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Title: Lymphatic, Infectious and Immune Diseases


1
Unit 8
  • Lymphatic, Infectious and Immune Diseases

2
TONSILITISA recurrent infection
  • Tonsils are lymph tissue protecting pharyngeal
    cavity from invading organisms
  • Preop tonsillectomy
  • CBC
  • Check Bleeding tendencies(which labs?)
  • Contraindications acute infection, cleft palate,
    bleeding disorders

3
TONSILLITIS
  • Tonsillar Inflammation
  • Sore throat, swallowing difficulty
  • Snoring, sleep apnea, nasal voice
  • Fever, Otitis Media
  • Peritonsillar abscess pain when talking or
    drinking

4
TONSILITIS
  • Post op
  • Airway prone or side lying
  • Comfort ice collar, gargle
  • Hemorrhage frequent swallowing !
    Bleeding may occur 5 to 10 days post op
  • Analgesics, antipyretics, (acetaminophen ATC)
    clear liquids
  • Monitor for breathing difficulty

5
OTITIS MEDIA
  • Etiology supine position during feeding, short
    Eustachian tube
  • TX Antibiotics, ear drops (HOW)
  • Myringotomy no water in ears

6
Otitis Media
  • Most common reason children come to the
    pediatrician or emergency room
  • Fever or tugging at ear
  • Often increases at night when they are sleeping
  • History of cold or congestion

7
Otitis
  • ROM right otitis media
  • LOM left otitis media
  • BOM bilateral otitis media
  • OME Otitis media with effusion
  • (effusion means fluid collection)

8
Why a problem?
  • Infection can lead to rupture of ear drum
  • Chronic effusion can lead to hearing loss
  • OM is often a contributing factor in more serious
    infections mastoiditis, cellulites, meningitis,
    bacteremia
  • Chronic ear effusion in the early years may lead
    to decreased hearing and speech problems

9
Otitis Management
  • Oral antibiotics re-check in 10 days
  • Tylenol for comfort
  • Persistent effusion
  • PET pressure equalizing tubes
  • Outpatient procedure
  • Need to keep water out of ears
  • Hearing evaluation
  • Speech evaluation

10
Infectious Disorders
  • Communicable diseases
  • Incidence has declined with increase of
    immunizations
  • Further decreased with use of antibiotics and
    antitoxins
  • Antibiotics side effect is hearing loss, damage
    to VIII cranial nerve

11
Nursing Assessment in Identification of Infection
  • Recent exposure to infectious agents
  • Prodromal symptoms
  • Immunization history
  • History of having the disease

12
Prevent Spread of Disease
  • Primary prevention of the disease
  • Immunization
  • Control spread of disease to others
  • Reduce risk of cross-transmission of organisms
  • Infection control policies
  • Handwashing

13
Caution for Compromised Children
  • Children with immunodeficiency
  • Receiving steroid therapy
  • Other immunosuppressive therapies
  • Generalized malignancies
  • Immunologic disorder

14
Caution for Compromised Children (contd)
  • Risk for complications from communicable
    diseases, especially varicella (chickenpox) and
    erythema infectiosum (EI)
  • Risk for viremia from varicella zoster virus (VZV)

15
Fungal Skin Infections
  • Superficial infections that live on the skin or
    in mucosa
  • AKA dermatophytoses, tinea
  • Transmission from person to person or from
    infected animal to human
  • Examples tinea capitis, tinea corporis, tinea
    pedis, candidiasis

16
Oral Candidiasis Thrush Candida albicans
  • Yeast like fungal infection of oral cavity, white
    patches on tongue
  • Results from antibiotic therapy decreasing
    protective flora
  • Spread by poor handwashing
  • Tx oral nystatin

17
Selected Communicable Diseases airborne
  • Varicella 2-3 week incubation, skin care,
    Acyclovir
  • Measles Koplik spots, photophobia
  • Roseola high fever rash

18
Varicella Zoster Chicken pox Shingles
  • Chicken Pox is primary, Shingles is secondary
    infection of latent Varicella virus
  • Incubation is 10 21 days
  • Spread by droplet or direct contact
  • Rash of maculae, papules, vesicles, crusts
  • Communicable 1 day before eruption until crusts
    form

19
Varicella Zoster Chicken pox Shingles
  • Sx malaise, fever, pruritus, lymphadenopathy
  • Elevated immunologic markerslasting immunity
  • Strict isolation for immunosupressed children.
    Hospitalized children isolated for 8-21 days
    after exposure
  • Give acyclovir or VZIG up to 96 hrs after
    exposure to high risk children

20
Rubeola (Measles)
  • Agent Measles virus
  • Source secretions droplet transmission airborn
  • Incubation period 10-20 days communicability
    from 4 days before to 5 days after appearance of
    rash
  • Kopliks spots appear 2 days before rash on
    Buccal mucosa

21
Rubella (German Measles)
  • Agent rubella virus
  • Transmission direct contact or indirect contact
    with article freshly contaminated with
    nasopharyngeal secretions, blood, stool, or urine
  • Incubation period 14-21 days
  • Complications rare greatest danger is
    teratogenic effect on fetus

22
Mumps
  • Agent paramyxovirus
  • Transmitted via droplet or direct contact
  • Incubation period 14-21 days
  • Fever, headache, malaise, followed by parotitis
  • May cause epididymo-orchitis and
    meningoencephalitis

23
Pertussis (Whooping Cough)
  • Agent Bordetella pertussis
  • Spread by droplet or direct contact
  • Incubation period 6-20 days
  • Short rapid coughs followed by crowing or whoop
    sound
  • Complications pneumonia (usual cause of death)

24
Epstein-Barr Virus (Mononucleosis)
  • Oral-salivary transmission
  • Adolescents get sore throat, fever, fatigue,
    enlarged spleen, lymphadenopathy
  • Sx last 2-3 months
  • Complications if immunocompromised

25
Conjunctivitis
  • In newborns chlamydia, gonorrhea, or herpes
    simplex virus
  • In infants may be sign of tear duct obstruction
  • In children causes are bacterial (most common),
    viral, allergic, or foreign body- HIGHLY
    Contagious

26
RHEUMATIC FEVER
  • An autoimmune response to Group A Beta-hemolytic
    Strep
  • Inadequate TX of strep throat
  • ASO (antistreptolysin titer), ESR C-reactive
    protein
  • TX penicillin, erythromycin

27
Rheumatic FeverRheumatic Heart Disease
  • RF
  • - Infrequently seen in U.S. big problem in
    Third World
  • Self-limiting. Encourage parents to test and
    treat strep throat
  • Rheumatic heart disease
  • Most common complication of RF
  • Damage to heart valves result from RHD
  • Aschoff bodies Inflammatory hemorrhagic bullous
    lesions cause swelling in joints, skin, brain,
    serous surfaces, and nodules in heart valves.

28
Clinical Manifestations of Rheumatic Heart
Disease
  • Carditis involves endocardium, pericardium, and
    myocardium most commonly the mitral valve
  • Polyarthritis is reversible and migrates ,
    especially in large joints (knees, elbows, hips,
    shoulders, wrists
  • Erythema marginatum rash
  • Subcutaneous nodules rare, small, nontender
    nodules appear over bony prominences, hands,
    feet, elbows, scalp, scapulae, vertebrae)
    persist indefinitely

29
JONES CRITERIA for RHD 2 major or 1 major 2
minor
  • Polyarthritis migratory
  • Carditis mitral valve
  • Erythemia Marginatum rash
  • Chorea involuntary movements
  • Fever, joint pain
  • Subcutaneous nodules

30
Human Immunodeficiency Virus/Acquired
ImmunoDeficiency Syndrome
  • HIV spread by infected blood, semen and breast
    milk
  • AIDS is severe HIV infection
  • AIDS retrovirus attacks T-helper cells(CD4 T
    cells) which support immunity
  • AIDS opportunistic infection

31
HIV/AIDS
  • Perinatal transmission reduced by Moms voluntary
    test.
  • If HIV positive, Mom takes Zidovudine (AZT) and
    baby postnatally
  • HIV infants have sx by 9months
  • Big goal is to prevent HIV spread

32
HIV/AIDS
  • Pharmacology
  • 3TC, IV Immunoglobulin, DDI
  • Protease Inhibitors (ritonavir)
  • Bactrim, Septra for Pneumocystis Carinii
  • Polio vacc, antibiotics, antifungal,
    antidiarrheals
  • Epogen induces erythropoesis (RBC formation)

33
HIV/AIDS
  • Dx with ELISA and Western Blot
  • Mild pediatric HIV Lymphadenopathy, parotitis,
    hepatosplenomegaly
  • Moderate Lymphoid Interstitial pneumonitis
  • Severe (AIDS) Pneumocystis Carinii
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