Lymphatic, Infectious and Immune Diseases

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Unit 8

• Lymphatic, Infectious and Immune Diseases

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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

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TONSILLITIS

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

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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

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OTITIS MEDIA

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

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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

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Otitis

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

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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

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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

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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

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Nursing Assessment in Identification of Infection

• Recent exposure to infectious agents
• Prodromal symptoms
• Immunization history
• History of having the disease

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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

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Caution for Compromised Children

• Children with immunodeficiency
• Receiving steroid therapy
• Other immunosuppressive therapies
• Generalized malignancies
• Immunologic disorder

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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)

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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

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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

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Selected Communicable Diseases airborne

• Varicella 2-3 week incubation, skin care,
  Acyclovir
• Measles Koplik spots, photophobia
• Roseola high fever rash

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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

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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

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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

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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

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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

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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)

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Epstein-Barr Virus (Mononucleosis)

• Oral-salivary transmission
• Adolescents get sore throat, fever, fatigue,
  enlarged spleen, lymphadenopathy
• Sx last 2-3 months
• Complications if immunocompromised

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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

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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

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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.

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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

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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

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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

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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

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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)

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HIV/AIDS

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