PEDS: Ch 25 Alteration in Immunity/Immunologic Disorder

The nurse is monitoring the labs of a child admitted for an exacerbation of juvenile pauciarticular arthritis. Which lab result does the nurse expect to be elevated? erythrocyte sedimentation rate Immunoglobulin electrophoresis Lymphocyte immunophenotyping T-cell quantification radioallergosorbent test

Erythrocyte sedimentation rate (ESR) The erythrocyte sedimentation rate (ESR) is an indicator of inflammation; it would likely be elevated during an exacerbation of arthritis. Immunoglobulin electrophoresis determines the level of individual immunoglobulins; it would not be elevated in an autoimmune disease. Lymphocyte immunophenotyping T-cell quantification measures T-cells; this would be used to monitor immunosuppressive disorders. The radioallergosorbent test measures minute quantities of IgE in the blood; it is used for asthma and food allergy testing.

The nurse is caring for a child presenting with eye inflammation, knee pain, poor appetite and poor weight gain. The nurse is aware that this is which type of juvenile idiopathic arthritis? Pauciarticular (oligoarticular) Polyarticular Systemic Rheumatic arthritis

Pauciarticular (oligoarticular) Pauciarticular or (oligoarticular) arthritis symptoms include involvement of four or fewer joints; quite often the knee is involved, eye inflammation, malaise, poor appetite, poor weight gain. Polyarticular involves five or more joints; frequently involves small joints and often affects the body symmetrically. Systemic includes joint involvement, fever and rash may be present at diagnosis. Rheumatic arthritis typically involves small joints.

The nurse is caring for a child who is receiving naproxen for treatment of juvenile idiopathic arthritis. What interventions should the nurse include in this client's care plan? (SATA) Administer the medication with food Monitor lab results for an increase in liver enzymes Monitor renal labs for a decrease in renal function Crush the extended release medication Test muscle strength

Administer the medication with food Monitor lab results for an increase in liver enzymes Monitor renal labs for a decrease in renal function Naproxen is a nonsteroidal anti-inflammatory drugs (NSAID) that acts by inhibiting prostaglandin synthesis. Side effects include GI upset or bleeding (administering with food helps prevent GI side effects); decreased liver and renal function. Extended release preparations cannot be crushed as this disrupts the extended release action. Muscle strength is not typically affected by naproxen.

The nurse is caring for a child with juvenile idiopathic arthritis (JIA). There is involvement of five or more small joints and it is affecting the body symmetrically. This tells the nurse that the child: polyarticular JIA Pauciarticular JIA Systemic JIA a great risk for anaphylaxis

has polyarticular JIA. Polyarticular JIA is defined by the involvement of five or more joints, frequently the small joints, and affects the body symmetrically. Pauciarticular JIA is defined by the involvement of four or fewer joints. Systemic JIA presents with fever and rash in addition to join involvement at the time of diagnosis. The child with JIA is not at greater risk for anaphylaxis.

After teaching a class of nursing students about acquired immunodeficiency, the instructor determines that the teaching was effective when the students identify what as a contributing factor? Select all that apply.

Cancer Immunosuppressive drugs Malnutrition Factors contributing to secondary (acquired) immunodeficiency include severe systemic infection, cancer, renal disease, radiation therapy, severe stress, malnutrition, immunosuppressive therapy, and aging.

While obtaining a health history on a 3-year-old child, the nurse finds what information a concern? Select all that apply. Parents report the child as an infant had failure to thrive. Parents report the child has had recurrent bacterial infections. Parents report the child didn't start walking until 1 ½ years old. Parents report the child didn't sit up by herself until 9 months old.

Parents report the child as an infant had failure to thrive. Parents report the child has had recurrent bacterial infections. Parents report the child didn't start walking until 1 ½ years old. Parents report the child didn't sit up by herself until 9 months old. When collecting health history the nurse must be attuned to reports that may signal underlying conditions. A child who has experienced failure to thrive, repeated bacterial infections and developmental delays with regard to walking and sitting up presents the need for further investigation. These are consistent with an autoimmune disorder.