NCMA 219 JIA

• Alterations with Infectious, Inflammatory and Immunologic Responses


  • Juvenile Rheumatoid Arthritis
  • Allergic Rhinitis
  • Eczema
  • Asthma

  
• Cellular Aberrations


  • Basic Concepts on Oncology
  • Leukemia
  • Lymphomas
  • Wilms' tumor
  • Brain tumors
• Juvenile idiopathic arthritis (JIA)


  The name replacing juvenile rheumatoid arthritis (JRA) in the research literature and now in clinical practice
• Only a small percentage of children have a positive rheumatoid factor, yet the name JRA burdens the family with images of adult disfiguring rheumatoid arthritis, a distinctly different disease
• JIA


  A chronic autoimmune inflammatory disease causing inflammation of joints and other tissue with an unknown cause
• JIA starts before age 16 years with a peak onset between 1 and 3 years of age. Twice as many girls as boys are affected
• The reported incidence of chronic childhood arthritis varies from 1 to 20 cases per 100,000 children with a prevalence of 10 to 400 per 100,000
• Pathophysiology of JIA


  The disease process is characterized by chronic inflammation of the synovium with joint effusion and eventual erosion, destruction, and fibrosis of the articular cartilage. Adhesions between joint surfaces and ankylosis of joints occur if the inflammatory process persists
• Clinical manifestations of JIA


  • The outcome is variable and unpredictable. The disease, even in severe forms, is rarely life threatening but can cause significant disability. The arthritis tends to wax and wane; however, patterns of clinical remission indicate approximately 25% will obtain clinical remission off medication for a follow-up duration of at least 4 years. Children with arthritis in four or fewer joints had the greatest likelihood for a sustained remission. Children with extensive arthritis and a positive rheumatoid factor were less likely to have a sustained remission
• Classification of Juvenile Idiopathic Arthritis


  • Systemic arthritis
  • Oligoarthritis
  • Polyarthritis rheumatoid factor negative
  • Polyarthritis rheumatoid factor positive
  • Psoriatic arthritis
  • Enthesitis-related arthritis
  • Undifferentiated arthritis
• Diagnostic evaluation of JIA


  A diagnosis of exclusion; there are no definitive tests. Classifications are based on the clinical criteria of age of onset before age 16 years, arthritis in one or more joints for 6 weeks or longer, and exclusion of other causes. Laboratory tests may provide supporting evidence of disease
• Therapeutic management of JIA


  There is no cure. The major goals are to control pain, preserve joint range of motion and function, minimize effects of inflammation such as joint deformity, and promote normal growth and development. Treatment includes medications, physical and occupational therapy, ophthalmologic slit lamp examinations, splints, comfort measures, dietary management, school modifications, and psychosocial support
• Medications used for JIA


  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Methotrexate
  • Corticosteroids
  • Biologic agents
• Nursing care for JIA


  Relieve pain, promote general health, encourage heat and exercise
• Allergic rhinitis


  Inflammation of the inside of the nose caused by an allergen, such as pollen, dust, mold or flakes of skin from certain animals
• Symptoms of allergic rhinitis


  Cold-like symptoms, such as sneezing, itchiness and a blocked or runny nose. These symptoms usually start soon after being exposed to an allergen
• Treatment/Management of allergic rhinitis


  Reduce exposure to allergens, take over-the-counter medications like non-sedating antihistamines, regularly rinse the nasal passages with a salt water solution, use stronger medications like nasal sprays containing corticosteroids
• Atopic dermatitis (eczema)


  A type of pruritic eczema that usually begins during infancy and is associated with an allergic contact dermatitis with a hereditary tendency (atopy)
• It's unlikely that the condition will disappear completely
• Treatment / Management


  1. Reduce exposure to allergens

  2. Take over-the-counter medications

  3. Regularly rinse nasal passages with salt water

  4. Prescribe stronger medication like nasal spray with corticosteroids
• Forms of atopic dermatitis based on age and distribution of lesions


  • Infantile (infantile eczema)
  • Childhood
  • Preadolescent and adolescent
• Infantile form of atopic dermatitis


  • Generalized, especially cheeks, scalp, trunk, and extensor surfaces of extremities
  • Erythema
  • Vesicles
  • Papules
  • Weeping
  • Oozing
  • Crusting
  • Scaling
  • Often symmetric
• Childhood form of atopic dermatitis


  • Symmetric involvement
  • Clusters of small erythematous or flesh-colored papules or minimally scaling patches
  • Dry and may be hyperpigmented
  • Lichenification (thickened skin with accentuation of creases)
  • Keratosis pilaris (follicular hyperkeratosis) common
• Adolescent or adult form of atopic dermatitis


  • Same as childhood manifestations
  • Dry, thick lesions (lichenified plaques) common
  • Confluent papules
• Other physical manifestations of atopic dermatitis


  • Intense itching
  • Unaffected skin dry and rough
  • African-American children likely to exhibit more papular or follicular lesions than are white children
  • Lymphadenopathy, especially near affected sites
  • Increased palmar creases (many cases)
  • Atopic pleats (extra line or groove of lower eyelid)
  • Prone to cold hands
  • Pityriasis alba (small, poorly defined areas of hypopigmentation)
  • Facial pallor (especially around nose, mouth, and ears)
  • Bluish discoloration beneath eyes ("allergic shiners")
  • Increased susceptibility to unusual cutaneous infections (especially viral)
• Therapeutic management of atopic dermatitis


  1. Hydrate the skin

  2. Relieve pruritus

  3. Reduce flare-ups or inflammation

  4. Prevent and control secondary infection
• Nursing care for atopic dermatitis


  1. Assess family history and environmental/dietary factors

  2. Examine skin lesions

  3. Control intense pruritus

  4. Cut and file nails short

  5. Use gloves, cotton stockings, and one-piece outfits to decrease skin contact
• Asthma is a chronic inflammatory disorder of the airways characterized by recurring symptoms, airway obstruction, and bronchial hyperresponsiveness
• Classic manifestations of asthma


  • Dyspnea
  • Wheezing
  • Coughing
• Triggers tending to precipitate or aggravate asthma exacerbations


  • Allergens (outdoor and indoor)
  • Irritants
  • Exercise
  • Cold air
  • Changes in weather or temperature
  • Environmental change
  • Colds and infections
  • Animals
  • Medications
  • Strong emotions
  • Conditions
  • Food additives
  • Foods
  • Endocrine factors
• Therapeutic management of asthma


  1. Maintain normal activity levels

  2. Maintain normal pulmonary function

  3. Prevent chronic symptoms and recurrent exacerbations

  4. Provide optimum drug therapy with minimum or no adverse effects

  5. Assist the child in living as normal and happy a life as possible

  
• Asthma medication classes

  • Long-term control medications (preventive medications)
  • Quick-relief medications (rescue medications)
• Corticosteroids

  Anti-inflammatory drugs used to treat reversible airflow obstruction, control symptoms, and reduce bronchial hyperresponsiveness in chronic asthma
• β-Adrenergic agonists (short acting)


  Used for treatment of acute exacerbations and for the prevention of exercise-induced bronchospasm
• Salmeterol (Serevent)


  A long-acting β2-agonist (bronchodilator) used twice a day for long-term prevention of symptoms, especially nighttime symptoms, and exercise induced bronchospasm
• Theophylline


  A methylxanthine drug used primarily in the ED when the child is not responding to maximal therapy
• Cromolyn sodium


  A medication used in maintenance therapy for asthma, stabilizes mast cell membranes, inhibits activation and release of mediators from eosinophil and epithelial cells, and inhibits the acute airway narrowing after exposure to exercise, cold dry air, and sulfur dioxide
• Anticholinergics

  May also be used for relief of acute bronchospasm, but have adverse side effects that include drying of respiratory secretions, blurred vision, and cardiac and CNS stimulation
• Cancer is a complex of diseases which occurs when normal cells mutate into abnormal cells that take over normal tissue, eventually harming and destroying the host
• Characteristics of cancer


  • Uncontrolled growth and spread of abnormal cells
  • Proliferation (rapid reproduction by cell division)
  • Metastasis (spread or transfer of cancer cells from one organ or part to another not directly connected)