TX: surgery, chemo, radiation, 60+% expected to survive if not metastasized Retinoblastoma : sporadic, genetic intraocular tumor, congenital, uni or bilateral, leukokoria or cats eye, strabismus (lazy eye- 2 nd most common sign) TX: enucleation of eye, radiation, cryotherapy, chemo Nursing: involve parents, prepare, prosthetic eye, 90% survival
Immunology : IgG crosses placenta, IgA & IgE absent at birth, cell mediated immunity strong at birth- thymus, spleen, tonsils, use irradiated blood for infants (decrease severe rxn), maternal antibodies passed to fetus late in pregnancy, higher risk for those born pre term, breastfeeding passess antibodies HIV : 200 infants, 90% acquire perinatal, minorities more affected, majority <7 mo, adolescents 15-24 are fastest growing group Transmission: sex, parental exposure, in utero, intrapartum, breastfeeding Patho: infects CD4 T cells, makes cells dysfunctional increased risk of opportunistic infections, more rapid progression in neonate r/t immaturity of immune system S&S: infants clinically normal at birth, lymphadenopathy, hepatosplenomegaly, oral candidiasis, chronic or recurrent diarrhea, developmental delay, opportunistic infections TX: antiretroviral drugs, adherence, safety, prevention Juvenile Idiopathic Arthritis : chronic childhood arthritis, autoimmune, inflamm of synovium, joints, & surrounding tissues, starts before 16, peaks 1-3 & 8-10, females > males, no cure, supportive care TX: minimize inflamm, control pain, glucocorticoids, disease modifying antirheumatic (methotrexate), limit alcohol & NSAIDs Systemic Lupus Erythematosus: autoimmune disease of blood vessels & ct, 10-15% pediatric, dx at 10-19 yrs, more severe at onset, more aggressive in childhood Patho: abnormal antibodies, immune complexes, deposits in tissues, inflammation, lupus nephritis, any tissue can be damanged S&S: fever, fatigue, wt loss, arthralgia, butterfly rash, Raynaud phenomenon, kidney function DX: CBC with differential, CMP, UA (protein & cast cells), immunoglobulin levels, lupus anticoagulant, antinuclear antibodies, C3 & C4 Manage: no cure, coritcosteroids, Nsaids, diet, rest, exercise Muskuloskeletal Bones : primary ossification- complete at birth except for fontanels Anterior: closes at 18 mo Posterior: closes at 2-3 mo Secondary ossification: occurs as long bones grow, helps strengthen bones, fractures at the growth plate are a concern, kids bones are porous & less dense than adult bones (give Vit D) Osteogenesis Imperfecta: brittle bones disease, autosomal dominant or recessive, connective tissue disorder, types I-IV, mistaken for child abuse, type 2 most fatal- die within first yr of life, decrease in severity at puberty, S&S: blue sclera, thin, soft skin, large anterior fontanel, short stature, increased joint flexibility, weak muscles, conductive hearing loss, multiple fractures DX : detected prior to delivery or after first fracture/ with delay in walking, x ray (zebra stripes- biphosphonate), DXA scan (bone density scan) TX : supportive measures, nutrition, hematologic stem cell transplant, no BP- can break bones, precautions, surgery with rods to strengthen bones Marfan Syndrome
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- Spring '17
- The Maids, Cortisol, Bone marrow, dx, wt loss