1. Describe nursing interventions for a child with Kawasaki disease 2. List nursing interventions for oral care for a child with Stevens-Johnson syndrome 3. Devise a nursing care plan for a 12-year-old with juvenile idiopathic arthritis, including teaching about home management 4. Identify characteristics for mononucleosis 5. Differentiate between insulin-dependent and non–insulin-dependent diabetes mellitus 6. Outline the educational needs of the child with diabetes and of the parents in the following areas: nutrition and meal planning, glucose monitoring, insulin administration, and exercise Disorders of the immune system are a result of several different causes. Deficiencies of the immune cells resulting in the inability of the body to resist an infection are considered immunodeficiency. This group of disorders includes HIV/AIDS. They are discussed in Chapter 15. Other disorders are caused by an abnormal and excessive immune response to a foreign antigen. These disorders are hypersensitivity disorders such as allergies and atopic dermatitis (see Chapter 16 for further discussion on these disorders). Table 19-1 Major Types of Juvenile Idiopathic Arthritis Table 19-2 Classification of Types of Diabetes Mellitus
Immune Disorders
Immune System
evolve.elsevier.com/Price/pediatric/
Juvenile Idiopathic Arthritis
Signs and Symptoms
TYPE
INCIDENCE RATE
GENDER AFFECTED
AGE
JOINTS AFFECTED
OTHER MANIFESTATIONS
PROGNOSIS
Systemic
10%-20%
Both equally
Any
Few to multiple
High fever (especially in the evening), chills, rash on trunk and extremities, enlarged liver and lymph nodes, pericarditis/pleuritis, leukocytosis, abdominal pain, anemia, arthralgias before arthritis begins
Approximately 50% develop chronic joint disease; prognosis depends on number of joints involved
Polyarticular, RF-positive
5%; may be familial
90% girls
>8 yr
Any or multiple large and small joints, upper and lower extremities, symmetrical pattern
Rapid, severe course; rheumatoid nodules (palpable near elbows); low fever; slight anemia
Early joint erosion, with many having permanent disability
Polyarticular, RF-negative
20%-30%
70%-75% girls
Early childhood, school age
Multiple large and small joints
Arthritis persists, loss of bone mass, small percentage with iridocyclitis, growth disturbances, low fever, malaise, anorexia, anemia
Small percentage have joint damage
Oligoarticular
40%-55%; may be familial
Girls: 20%-35% develop a polyarticular course after approximately 3 yr
Early childhood
Knees, ankles, elbows (<4 joints); asymmetric pattern
Chronic iridocyclitis with occasional loss of vision, malaise, low fever, slight anemia; slightly enlarged liver, spleen, and lymph nodes during active disease
More favorable prognosis regarding long-term joint function
Boys: Many develop spondyloarthropathies
Late childhood
Large joints of lower extremities, hips, spine
Small percentage have acute iridocyclitis
Diabetes Mellitus
TYPE
ONSET
CLINICAL FEATURES
OTHER COMMENTS
Type 1 DM
Primarily in childhood but can occur at any age
Polydipsia, polyuria, polyphagia, weight loss occurring for usually less than 1 mo
Child requires insulin to maintain life
Type 1 can be diagnosed in children before symptoms appear and in family members at risk
Type 1 appears to have both genetic and environmental components
Hyperglycemia: random plasma glucose above 200 mg/dL with symptoms or fasting blood glucose above 126 mg/dL and 2-hr postprandial blood glucose above 200 mg/dL with no symptoms
Glycosuria, ketonuria
Vaginal monilial infections in adolescent girls
Elevation of antiislet or antiinsulin antibodies and presence of other indicators of immune connection
Type 2 DM
Usually after age 40 yr but can occur at any age
Hyperglycemia: fasting blood glucose above 126 mg/dL and 2-hr glucose tolerance test result above 200 mg/dL on more than one occasion without precipitating factors
Condition has some genetic basis
Some affected children need insulin on occasion (e.g., during severe stress or illness)
Child is usually obese
Serum insulin level can be normal or less than normalYou may also need
Immune Disorders
WordPress theme by UFO themes