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23 Cards in this Set
- Front
- Back
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Chances of AIDS in children:
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8% chance of newborn getting HIV after 1st trimester if mom starts meds in 2nd trimester.
25% chance of HIV if mom is untreated |
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HIV CLASSIFICATION
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CATEGORY N: NOT SYMPTOMATIC
Children who have no signs or symptoms considered to be the result of HIV infection or who have only one of the conditions listed in Category A. Women CD4 < 200 HSV (herpes simplex) CMV |
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HIV Disease Classifications
CATEGORY A: MILDLY SYMPTOMATIC |
Children with two or more of the conditions listed below but none of the conditions listed in Categories B and C.
lymphadenopathy, hepatomegaly, splenomegaly, dermatitis, parotitis, recurrent or persistent upper respiratory infections (URI), sinusitis, or otitis media |
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HIV Disease Classifications
CATEGORY B: MODERATELY SYMPTOMATIC |
Children who have symptomatic conditions other than those listed for Category A or C that are attributed to HIV infection.
anemia, neutropenia, thrombocytopenia, bacterial meningitis, pneumonia, sepsis, candidiasis, cardiomyopathy, CMV, diarrhea, hepatitis, HSV, stomatitis, bronchitis, pneumonitis, or esophagitis, herpes zoster, lymphoid interstitial pneumonia (LIP), nephropathy, persistent fever (lasting >1 month), toxoplasmosis, varicella, disseminated (complicated chickenpox). |
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HIV Disease Classifications
CATEGORY C: SEVERELY SYMPTOMATIC |
Children who have any condition listed in 1987 surveillance case definition for acquired immunodeficiency syndrome, with the exception of LIP
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Diagnostic Evaluation HIV:
Enzyme-linked immunosorbent assay (ELISA) and Western Blot immunoassay – Performed ========= |
Performed to determine HIV status if born to HIV Neg or Unknown HIV status for children 18 months or older
If mother HIV Positive Assays will be positive because of maternal antibodies Indicating HIV even if infant is Negative Maternal antibodies can be present for up to 18 months Additional test needed to determine true status |
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2 Positive ELISAs + 1 Positive Western Blot =
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HIV
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seropositivity=
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Changing from negative to positive
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HIV polymerase chain reaction (PCR
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Can be performed with 48 hours old
DX by 1 to 4 months of age More accurate than ELISA or Western Blot for children of HIV positive mothers |
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Diagnosis of AIDS
See Box 26-10, p. 940 |
Pneumocystic carinii pneumonia (PCP)
LOP Recurrent bacterial infections Wasting syndrome Candidal esophagitis HIV encephalopathy Cytomegalovirus (CMV) Heraptic Simplex virus (HSV) Window 6 weeks to build antibodies. IF tested inside window can be false positive or negative. Tested at 7 weeks -2 ELISAs and 1 Western Blott (adult) CD4 < 200 =AIDS diagnosis 1 episode of PCP 1 episode Candidal Esophygitis (women) |
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HIV Therapeutic Management:
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Nucleoside reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors Nucleotide reverse transcriptase inhibitors Protease inhibitors Know each classification intersects mapping of DNA process at a different place. |
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NIH Recommendation for Management
For children: |
Zidovudine (ZDU or AZT), every 6 hours for 6 weeks after birth
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NIH Recommendation for Management
All infected mothers should |
receive oral zidovudine (ZDU or AZT) after the first trimester, IV ZDU during L&D, and oral ADU at birth
The WHO recommend taking AZT and lamivudine (3TC) as well as a single-does of nevirapine during childbirth/delivery |
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NIH Recommendation for Management
Immunizations for children What vaccines can HIV positive children receive? |
Start at 2 months
4 years of age for MMRs |
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NANDA DX
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Diarrhea related to GI infection, malignancy, or drug reactions.
Impaired Gas Exchange related to pulmonary disease Altered Growth and Development related to chronic infection and poor nutrition. Risk for Ineffective Family Coping related to life-threatening illness. |
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Goals
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preventing infection,
managing pain, promoting respiratory and other organ function, promoting adequate nutritional intake, and providing emotional support to the parents and child while promoting the child’s development |
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Goals
PCP – |
control pain promote respiratory function (deep breath, hydration)
Cell mediated immmunity-T cell B cell mediated humoral immunity- |
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Severe Combined Immunodeficiency Disease
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Defect characterized by absence of humoral and cell-mediated immunity
Early susceptibility to infection Chronic infections Failure to thrive Diagnosis Therapeutic Management Nursing Prognosis poor if bone marrow donor unavailable Failure to thrive- Organic-physical reason for falling to lowest point on weight chart. Inorganic-psychological reason for FTT. (parent too young) Educate Gammuglobulin-jumpstart immune system, IV IGG Nephrotic syndrome from IV IGG Wasting syndrome is FTT situation. |
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Wiskott-Aldrich Syndrome:
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X-linked recessive disorder
Defective gene identified Abnormality triad Symptoms Treatment Counteracting bleeding tendencies IV gamma globulin Prophylactic antibiotics Curative therapy??? Poor prognosis Nursing care Low platelet Poor humoral immunity Lots of exzema before age 1 year old Highly succeptiable to cancers Death usually occurs bleeding event or cancer before age of 15. Spleenectomy sometimes |
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Classifications of Allergic Reactions
Type I: |
IgE-Mediated Hypersensitivity: Immediate/Anaphylaxis
Immediate or anaplylaxis Symptoms include: sudden, occurring within seconds of exposure, sneezing, tightness or tingling of the mouth of face, severe flushing, generalized urticaria, itching and edema, erythema, and wheezing and dyspnea. Priority Nursing DX: Ineffective breathing pattern Anaphylaxis Management DX: RAST Known triggers Box 13-1, Lemone Burke, p. 333 Eggs, seafood, wasps, bees, PCN, lidocaine Treatment Epinephrine Epipen Respiratory support (Epi nebulizer) Less severe Type 1 Antihistamine (diphenhydramine) and decongestant (pseudoephedrine) |
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Classifications of Allergic Reactions
Type:2 |
Cytotoxic hypersensitivity
Ii-tissue destroyer when IgM and IgG activate complement, which leads to tissue damage. Symptoms: dyspnea and fever Transfusion reactions Drug Reactions: PCN & cephalosporins After reaction is over spleen cleans up. Works Hard. Symptomtology will tell you if 1 0r 2 . Blood work |
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Classifications of Allergic Reactions
Type III: |
Immune complex (Arthus) hypersensitivity
ALS, sclera derma where immune complexes are deposited in tissues, where they activate complement, which results in a generalized inflammatory reaction. Symptoms: urticaria, fever and joint pain. |
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Classifications of Allergic Reactions
Type IV: |
Delayed (cell-mediated) hypersensitivity
Iv-(ppd skin test) (delayed) Hypersensitivity: where antigens stimulate T cells that release lymphokines, and cause inflammation and tissue damage (no immunoglobulins are involved) include fever, intense erythema and itching, and thickening of affected skin. Causes: contact dermatitis, poison ivy, latex, positive PPD CBC to look at eosinophil counts A radioallergosorbent test (RAST) |
