Used in pts with stubborn arthritis, not responded to NSAIDS■SE: potential for inc infection, malignancy risks, liver/lung toxicity, & birth defects○Cyclophosphamide■Potent immunosuppressive chemotherapy agent, used in combo with corticosteroids■Need education session about benefits and risks- infertility and future malignancy ○Mycophenolate mofetil■Purine inhibitor-For active lupus & lupus nephritis■SE: Inc infection risk, liver toxicity, & birth defects--> sexually active females need to be on effective birth control■Nursing care management**●Minimize exacerbations○Avoid sun: sunscreen (SPF >30), hats, & protective clothing○“Slip, slop, slap” rule= slip on a shirt, slop on sunscreen, & slap on a hat●Promote normal growth and development○Diet, exercise, and rest■Balanced diet that does not exceed calorie expenditure■Low salt diet: If pt= nephrotic or hypertensive
■Low fat diet: If pt=dyslipidemia■Diet rich in calcium & vitamin D=prevent osteoporosis●Therapy compliance●Patient social and family support○Discuss importance of infection control, diet, adolescent image (wt gain), SE of meds-nutritional counseling ●(2) Key points for a child with an allergic reaction-anaphylaxis.○Anaphylaxis:Acute clinical syndrome resulting from interaction of an allergen in a hypersensitive patient○Pathophysiology■Result of an interaction between an allergen and a preexisting specific IgE=histamine release causes vasodilation and increased capillary permeability allowing fluid to leak into the interstitial space, vasospasm, bronchoconstriction. Get increase venous pooling, reduced arterial pressure and rapid fluid loss in interstitial spaces causing decrease venous return○Clinical manifestations■Occurs seconds to minutes after exposure, feelings of uneasiness, impending doom; flushing, feeling warm, urticaria and angioedema. Sometimes loss of consciousness○Therapeutic management■Ventilation (HOB elevated)■Restoring adequate circulation ■Preventing further exposure-remove antigen, fluids, oxygen, beta-agonists, antihistamines and corticosteroids. Mild with antihistamines (Benadryl or cetirizine)○Nursing care management■Recognize and intervene; IVF’s, I&O, vital signs■IM epinephrine= 1st line of therapy■Prevention is primary goal○Quality patient outcomes: Early recognition, airway patency maintained, adequate circulation restored and maintained, further exposure to allergen preventedPractice Questions1.An 11-month-old male child has been admitted to the cardiac section of a pediatric hospital after having a high fever, peeling of his hands and feet, and a bright red “strawberry tongue” for the past 3 days. Kawasaki disease (KD) is suspected. Initial treatment with intravenous antibiotics has not decreased the fever. What therapy would the nurse expect to administer?
You've reached the end of your free preview.
Want to read all 18 pages?