Immune+Cell+Changes

Immunology and Cellular changes

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The Immune System...

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Leukemia

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Leukemia’s: Malignant diseases of the bone marrow and lymphatic system

Pathophysiology: Over production of immature WBCs in the blood producing tissues of the body WBCs are low - leuk’emia’ Compete with normal red blood cell production So… Anemia - decreased RBCs Infection - neutropenia Bleeding - decreased platelet production Weakened bone…fractures Bone pain from invasion and pressure Spleen, liver and lymph infiltrated

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">More common in Caucasian males between 2 and 5 <span style="color: #bd1f1f; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Acute lymphoid leukemia (ALL) cure rate ~ 80% <span style="color: #bd1f1f; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Acute Nonlymphoid leukemia (acute myelogenous leukemia) AML cure rate ~50%

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<span style="color: #bd1f1f; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Survival rates are influenced by: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Initial WBC count <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Age at diagnosis <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Type of cell involved <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Sex <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Karotype analysis

<span style="color: #bd1f1f; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Management: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Induction therapy <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Elimination of leukemic cells in bone marrow <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">CNS prophylactic therapy - prevents CNS invasion <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Intensification therapy – eliminates residual cells <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Maintenance therapy – maintain remission <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Hematopoietic stem cell transplant

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Possible second malignancy

<span style="color: #bd1f1f; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Nursing Care: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">*Education due to all procedures – lumbar punctures, bone marrow aspiration and biopsy, finger sticks and blood draws <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Pain relief <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Prevent infection, hand washing, and restrict sick visitors, private rooms <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Bleeding, administer platelets, aseptic technique with sticks, activities restriction <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Observe for 20 minutes after chemo administration <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Safeguard nurses <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Venous access device

<span style="color: #bd1f1f; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Complications from drug toxicity: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Anaphylaxis <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Nausea and vomiting – zofran, dexamethasone, before the chemo <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Anorexia <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Mucosal ulceration – bland, soft diet, saline washes, soft tooth sponges, local anesthetics <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Rectal ulceration sitz baths, stool softners, no rectal temps <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Neuropathy <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Hemorrhagic cystitis (chemical irritation) increase fluid, frequent voiding, meds <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Alopecia maybe, hair regrows in 3-6 months, thicker, curlier, darker <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Moon face from steroids (increase appetite, mood) <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Mood changes (steroids)

<span style="color: #7700ff; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Lymphomas <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Hodgkin and Non-Hodgkins

<span style="color: #7700ff; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Hodgkins Lymphoma

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<span style="color: #7700ff; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Hodgkins lymphoma ‘hogs’ the lymph nodes <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Age 15-19 <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Originates in the lymph nodes <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Metastasizes to spleen, liver, bone marrow, lungs <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">A – asymptomatic <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">B – symptomatic – fever, night sweats, weight loss, abdominal pain, nausea, cough, pruritis

<span style="color: #7700ff; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Tests: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">CBC <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Erythrocyte sedimentation rate <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Serum copper <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Ferritin <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Fibrinogen <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Immunoglobulins <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">T-cell function <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Uric acid <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Liver function tests <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Urinalysis <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Lymph node biopsy – Reed Sternberg cells <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Bone marrow aspiration

<span style="color: #7700ff; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Primary treatment: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Radiation and chemotherapy <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Early diagnosis 90% survival, advanced 65-75% survival

<span style="color: #7700ff; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Nursing: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Preparation, explanation, support <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Fatigue <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Infertility – sperm bank

<span style="color: #7700ff; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Non-Hodgkins lymphoma ‘not a hog, shares and spreads’ <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Younger than 14 <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Diffuse and disseminated <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Lymphoblastic <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Burkitt or Non-Burkitt <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Large cell

<span style="color: #7700ff; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Clinical manifestations depend on site and extent <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Organ symptoms from enlarged lymph nodes <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Leukemia like symptoms <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Hodgkins like symptoms

<span style="color: #7700ff; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Tests: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Lymph node biopsy <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Bone marrow examination <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Radiographic studies esp. of GI and lungs <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Lumbar puncture

<span style="color: #7700ff; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Management: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Aggressive irradiation and chemotherapy <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Prognosis excellent with localized disease <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Relapse after 2 years is rare, survival after 24 months is considered a cure <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Nursing care is directed at chemo administration, managing side effects and support

Wiki Notes Immunology/Cellular changes

HIV <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Retrovirus transmitted by lymphocytes and monocytes <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Found in blood, semen, vaginal secretions and breast milk <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Incubation of months to years <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Horizontal/Vertical transmission

<span style="color: #008000; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">HIV virus infects T lymphocytes…the virus takes over the cell machinery=dysfunctional <span style="color: #008000; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Lymphocytes decrease leading to immunodeficiency, opportunistic illnesses, death

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">1980s - At first in pediatrics acquired from mother, rarely blood or abuse <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Teens drug use, sexual activity <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Decline since due to testing <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Perinatal - Highly Active Antiretroviral Therapy (HAART) <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">HAART combination of 6 drug classes including 25 medicines <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">HAART must be taken everyday, as prescribed, not a cure but controls the virus <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Medications prevent viral replication so there is less virus in the system <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">This leaves your immune system a chance to recover and to fight off disease <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Left untreated HIV attacks the immune system and becomes AIDS

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<span style="color: #008000; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Diagnosis: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">>18 months enzyme-linked immunosorbent assay (ELISA), western blot immunoassay <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Will be positive till 18 months due to maternal antibodies

<span style="color: #008000; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Mild symptoms <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Lymphadenopathy <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Parotitis <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Hepatosplenomegaly <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Recurrent sinusitis or otitis media <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Oral candidiasis <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Failure to thrive <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Developmental delay <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Recurrent diarrhea

<span style="color: #008000; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Moderate <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Lymphoid interstitial pneumonitis (LIP), organ specific dysfunctions or infections

<span style="color: #008000; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Severe <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">AIDs defining illnesses <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Wasting syndrome <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Cytomegalovirus disease <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">*Pneumocystis carinii pneumonia (PCP), most common opportunistic <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Candidal esophagitis <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Pulmonary candidiasis <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Herpes Simplex

<span style="color: #008000; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Therapeutic Management: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Goal to slow the growth of the virus <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Antiretroviral drugs suppress replication <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Therapy lifelong

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X linked recessive disorders:

<span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">X linked agammaglobulinemia:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Diagnosis: delayed due to immune development and maternal transfer of IgG <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Eventual bone marrow transplant, hematopoietic stem cell transplant (HSCT)

<span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Nursing Care: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Prevent infection <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Support <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Genetic counseling

<span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Wiskott-Aldrich Syndrome (WAS)

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Triad: eczema, thrombocytopenia, immunodeficiency

<span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Management: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Platelets for bleeding <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">IV gamma globulin <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Prophylactic antibiotics <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Bone marrow transplant (HSCT)

<span style="color: #cb0000; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Blood Transfusion Therapy: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Order <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Consent <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Baseline vital signs, then q15 for 1 hour <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Check ID with another nurse <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Administer first 50 ml and stay with child <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Use appropriate tubing and filter (not microdrops, regular 10-15 drops/ml) <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Gently shake <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Use within 30 minutes or send back <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Infuse within 4 hours <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Rx: STOP transfusion, leave line open with normal saline and new tubing <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Contact physician

<span style="color: #cb0000; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Complications: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Hemolytic rx <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Fever (acetaminophen) <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Allergic rx (antihistamines) <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Circulatory overload (transfuse slowly) <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Air emboli <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Hypothermia (allow blood to warm) <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Alloimmunization (sensitization)

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<span style="color: #cb0000; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Hematopoietic Stem Cell Transplant (HSCT)

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<span style="color: #cb0000; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Hematopoietic Stem Cell Transplant (HSCT)

<span style="color: #cb0000; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Steps: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Immune system is suppressed/destoyed by chemo and radiation <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Stem cells are transfused and begin to repopulate the bone marrow <span style="color: #cb0000; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">*Once this begins no turning back, no rescue <span style="color: #cb0000; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">*Problem: GVHD (graft versus host disease) <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Ex. Kidney transplant/dialysis = rescue

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Allogeneic - matching bone marrow <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Umbilical stem cell, cord blood <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Autologous - patient’s own marrow

<span style="color: #cb0000; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Management: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">3-6 week hospitalization <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Fear complications

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<span style="color: #cb0000; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Apheresis: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Removal of blood <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Separation into blood components <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Reinfusion


 * <span style="color: #e02929; font-family: 'Times New Roman',Times,serif; font-size: 27.2px;">Self versus Nonself: **


 * <span style="color: #e02929; font-family: 'Times New Roman',Times,serif; font-size: 27.2px;">Juvenile Idiopathic Arthritis, JIA, (Juvenile Rheumatoid Arthritis, JRA) **

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Chronic autoimmune disease causing chronic inflammation of joints and tissues <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Before age 16 with peak between ages 1 and 3 <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Twice as many girls afflicted <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Joint inflammation > effusion > erosion > fibrosis <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Can be systemic with other organs affected such as skin, heart and eyes <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Frequent eye exams to watch for chronic or acute uveitis (infammation of the iris and cillary body)
 * <span style="color: #e02929; font-family: 'Times New Roman',Times,serif; font-size: 27.2px;">Juvenile idiopathic arthritis: **

<span style="color: #e02929; font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Goal is to decrease pain, inflammation and disfigurement. Promote growth and development.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">No definitive tests

<span style="color: #e02929; font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Treatment/Nursing interventions: <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Medication administration
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Nonsteroidal antiinflammatory drugs (NSAIDs)
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Methotrexate
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Corticosteroids
 * <span style="color: #e02929; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Entanercept (Enbrel) * a newer successful medication
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Slow acting antirheumatic drugs (SAARDs) sulfasalazine, hydroxychloroquine, gold, and D-penicillamine

<span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Physical and occupational therapy <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Ophthalmologic exams <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Splints - usually at night <span style="color: #e02929; font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Comfort measures - warm baths, hand soaks, swimming <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Dietary support - calibrated to activity level so child doesn't struggle with obesity which can put more work on joints <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">School and psychosocial support - may need to come in later after joints warm up in am <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Low impact sports

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Chronic multisystem auto immune disease of connective tissue and blood <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Can affect any system <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Symptoms can be mild or life threatening <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Cause is unknown but has a hereditary component and triggers (ultraviolet light, pregnancy, hormones, infections) <span style="color: #e02929; font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">*The Antinuclear Antibody Test (ANA) is often used for diagnosing SLE media type="youtube" key="H_QKeq70sbI" width="504" height="377"
 * <span style="color: #e02929; font-family: 'Times New Roman',Times,serif; font-size: 27.2px;">Systemic Lupus Erythematosus (SLE) **

<span style="color: #e02929; font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Manifestations: <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Fever, fatigue, weight loss, anorexia <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Butterfly rash over nose, alopecia <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Arthritis, myositis <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Headache, behavioral changes <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Pericarditis, myocarditis, endocarditis <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Abdominal pain, nausea, vomiting, colitis <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Hepatomegaly, splenomegaly, lymphadenopathy <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Anemia, cytopenia <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Retinopathy <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Raynaud syndrome

<span style="color: #e02929; font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Nursing interventions/treatments <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Medication administration - corticosteroids, NSAIDs, antimalarial drugs, antihypertensives, aspirin, antibiotics or immunosuppressants <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Supportive care

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<span style="color: #c42121; font-family: 'Times New Roman',Times,serif; font-size: 17px;">References:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Axton, S. E., & Fugate, T. (2003). Chapter 8: Care of Children with musculoskeletal dysfunction. In M. Connor & Y. Kopperman (Eds.), Pediatric nursing care plans (2nd ed., pp. 187-216). Upper Saddle River, New Jersey: Prentice Hall Pearson Education, Inc..

<span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Axton, S. E., & Fugate, T. (2003). Chapter 9: Care of children with neurological/neuromuscular dysfunction. In M. Connor & Y. Kopperman (Eds.), Pediatric nursing care plans (2nd ed., pp. 217-252). Upper Saddle River, New Jersey: Prentice Hall Pearson Education, Inc..

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Wilson, D. (2005). The child with musculoskeletal or articular dysfunction. In M Hockenberry, D. Wilson & M. Winkelstein (Eds.), Wong's essentials of pediatric nursing (7th ed., pp. 1147-1186). St. Louis, Missouri: Elsevier Mosby.

<span style="color: #c42121; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Videos:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">JIA 1 located at <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">[]

<span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">JIA 2 video located at []

<span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">SLE located at []

<span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Lupus <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">[]

<span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">Lupus on Good Morning America <span style="font-family: 'Times New Roman',Times,serif; font-size: 20.8px;">[] <span style="color: #bd1f1f; font-family: 'Times New Roman',Times,serif; font-size: 130%;">References:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 12pt;">Bryant, R. (2009). Chapter 26: The child with hematologic or immunologic dysfunction. In M. J. Hockenberry & D. Wilson (Eds.), Wong's essentials of pediatric nursing (8th ed., pp. 911-948). St. Louis, MO: Mosby Elsevier.

<span style="color: #b71a1a; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Videos:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">The Immune Center <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">http://youtu.be/IWMJIMzsEMg

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">The Immune System <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">http://youtu.be/q5o-APJcCA8

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Leukemia <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">http://youtu.be/CFx6hz-2ots

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Leukemia http://youtu.be/cFlk2bmsJv4

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">ALL and AML <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">http://youtu.be/NE5BtHcZZXo

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Hodgkins Lymphoma <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">http://youtu.be/tvIw9BIX0cs

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Lymphomas <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">http://youtu.be/dVFUIhqj1xE

<span style="color: #cb0000; font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Videos:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 15.600000381469727px;">HIV and Pregnancy http://youtu.be/y_0qya2oCNs

<span style="font-family: 'Times New Roman',Times,serif; font-size: 15.600000381469727px;">HIV <span style="font-family: 'Times New Roman',Times,serif; font-size: 15.600000381469727px;">http://youtu.be/54T0KMmwoTs

<span style="font-family: 'Times New Roman',Times,serif; font-size: 15.600000381469727px;">Blood administration: <span style="font-family: 'Times New Roman',Times,serif; font-size: 15.600000381469727px;">http://youtu.be/WJuqiTEc2tk

<span style="font-family: 'Times New Roman',Times,serif; font-size: 15.600000381469727px;">Blood types <span style="font-family: 'Times New Roman',Times,serif; font-size: 15.600000381469727px;">http://youtu.be/oz4Ctau8mC8

<span style="font-family: 'Times New Roman',Times,serif; font-size: 15.600000381469727px;">HSCT <span style="font-family: 'Times New Roman',Times,serif; font-size: 15.600000381469727px;">http://youtu.be/b5UnL9JocLg

<span style="font-family: 'Times New Roman',Times,serif; font-size: 15.600000381469727px;">Caiden's Story located at <span style="font-family: 'Times New Roman',Times,serif; font-size: 15.600000381469727px;">http://youtu.be/o8mj_G3JfsI