Peds 47 Nursing Child Immunity

💥treatment of anaphylaxis

assessment and support of the airway, breathing, and circulation. Epinephrine is usually required, and intramuscular or intravenous diphenhydramine is used secondarily. Late-onset reactions can be prevented with corticosteroids

💥anaphylaxis

Anaphylaxis is an acute IgE-mediated response to an allergen that involves many organ systems and may be life-threatening.

💥Cellular immunity

Antibodies produced by native T-cell lymphocytes

15. A school-aged child, who is allergic to bee stings, states, "I think I was stung by a bee outside." Which intervention by the school nurse is most appropriate? Determine if the client was stung Apply an ice compress to the site Assess the client for signs of anaphylactic shock Administer epinephrine

Assess the client for signs of anaphylactic shock

9. The parents of a 3-month-old infant report concerns the infant is irritable, feeds poorly, and has a rash. The nurse notes weeping, crusty lesions on the infant's cheeks and neck. Which action by the nurse is most appropriate? Advise the parents to change the infant's formula. Instruct the parents to soak the lesions in mineral oil. Contact the health care provider to request treatment. Encourage parents to avoid feeding the infant peanuts.

Contact the health care provider to request treatment

💥common cause of anaphylaxis

In addition to nuts, shellfish, eggs, and bee or wasp stings, drugs such as penicillin and NSAIDs, radiopaque dyes, and latex are the leading causes of anaphylaxis

17. The nurse is caring for a school-age child recently diagnosed with an allergy to peanuts. Which nursing action is a priority? Advise parents the child may benefit from skin testing. Remind parents to report the allergy to the child's school teacher. Include the child when discussing foods that contain peanuts. Offer the parents information about a community support group.

Include the child discussing foods that contain peanuts

4. The parents of an adolescent tell the nurse, "Our child seems to have allergy symptoms every time we visit our favorite cafe. I don't understand since the only allergy indicated in the testing was to eggs?" How should the nurse respond? "Does your child get a whipped cream or foam topping on their favorite drink?" "Maybe the allergy testing didn't evaluate everything your child is allergic to." "That doesn't really make any sense if your child is only allergic to eggs." "Maybe coffee drinks just don't agree with your child's system."

Does your child get whipped cream or foam topping on their favorite drink

💥common food allergens in first years & older children and adults

During the first few years of life, the most common food allergens are milk, eggs, peanuts, tree nuts, fish and shellfish, wheat, and soy. Older children and adults most often demonstrate allergy to peanuts, tree nuts, fish, and shellfish

💥treatment of Severe Combined Immune Disease SCID

IVIG infusions to decrease infections until stem cell transplant

💥treatment of wiskott-aldrich syndrome

IVIG, high-dose steroids, splenectomy to correct thrombocytopenia, stem cell transplant (only cure)

💥food allergy onset & symptoms

Most reactions occur within minutes of exposure, but they may occur up to 2 hours after ingestion. Signs and symptoms of a food allergy reaction include hives, flushing, facial swelling, mouth and throat itching, and runny nose. Many children also have a gastrointestinal reaction, including vomiting, abdominal pain, and diarrhea. In extreme cases, swelling of the tongue, uvula, pharynx, or upper airway may occur. Wheezing can be an ominous sign that the airway is edematous. Rarely, cardiovascular collapse occurs.

20. A pediatric client is newly diagnosed with a stinging-insect allergy. Which advice is mostappropriate for the nurse to provide this client's parent? "I recommend you consult a genetic counselor to reveal other susceptible family members." "Your child should join a peer support group to help relieve anxiety about this problem." "Obtain your child a medical alert ID bracelet so the presence of the allergy can be identified easily." "Arrange for your child to receive allergy testing for foods with ingredients similar to those in insect venom."

Obtain your child a medical alert ID bracelet so the presence of the allergy can be identified easily

2. A nurse is providing education to pregnant women diagnosed with HIV. Which statement indicates the need for further teaching? Pregnancy will accelerate the progression of the disease. My health care provider may want me to have a cesarean birth. Antiretroviral treatment is effective in reducing maternal-fetal transmission. It is not safe to breastfeed my baby, so I will use formula.

Pregnancy will accelerate the progression of the disease FALSE

5. The nurse is explaining patterns of incidence and transmission of HIV to a group of adolescent girls. She explains that the risks for this population are much higher because of the possibility of both vertical and horizontal transmission. Horizontal transmission refers to transmission of the disease during: feeding with breast milk. sexual contact. the birthing process. pregnancy.

Sexual contact

16. The nurse is preparing a care plan for a 4-year-old client newly diagnosed with severe combined immune deficiency. What is the priority goal for this client? The client will return to normal activities after discharge. The client will demonstrate basic knowledge of the disorder. The client will perform hygiene care with assistance. The client will remain free from infection.

The client will remain free from infection

💥body reaction with anaphylaxis

The reaction is severe and usually starts within 5 to 10 minutes of exposure, though delayed reactions are possible. Histamines and secondary mediators are released from the mast cells and eosinophils in response to contact with an allergen. Cutaneous, cardiopulmonary, gastrointestinal, and neurologic symptoms occur. Vasodilation results in a rapid decrease in plasma volume, leading to the risk of circulatory collapse.

💥IgD bind to b-lymphocytes? function

binds b-lymphocytes, produces in smallest quantities, unknown function

💥IgM bind to b-lymphocytes? function

binds to b-lymphocytes, first antibodies secreted by b-lymphocytes after infection

💥symptoms of Severe Combined Immune Disease SCID

chronic diarrhea, failure to thrive, history severe infections, persistent thrush, adventitious sounds related to pneumonia, low immunoglobulins

💥cellular immunity t-cell lymphocyte actions

do not recognize antigens, direct & regulate immune response (helper t-cells), attack infected & foreign cells (killer t-cells & natural killer cells), do not cross placenta

💥anaphylaxis

food, drug, insect sting

💥allergies

immune-mediated responses resulting in adverse physiologic event or reaction, affects 25% population,

💥symptoms of wiskott-aldrich syndrome

petechiae, bloody diarrhea (or bleeding 1st 6 months of life), hematemesis/intracranial/conjunctival hemorrhages, eczema, low IgM, high IgA & IgE, normal IgG

💥Severe Combined Immune Disease SCID

rare, x-linked autosomal recessive disorder, absent t-cell & b-cell function, 5 types, potentially fatal requiring emergency intervention

14. The nurse is instructing a group of women of childbearing age about human immunodeficiency virus (HIV) during pregnancy. What would be a priority recommendation in this setting? Proper nutrition Screening for sexually transmitted infections (STIs) Screening for HIV Prophylactic treatment for HIV

screening for HIV

💥humoral immunity b-cell lymphocyte actions

secrete antibodies to viruses and bacteria, recognize antigens, antibodies mark the antigen, do not destroy foreign cell, cross placenta as IgG

💥Hib immunization

shots at 2, 4, 6 months and sometimes booster 12-15 months age.

💥wiskott-aldrich syndrome

x-linked disorder, affects only males

💥influenza immunization

yearly

💥warning signs primary immunodeficiency

4+ otitis media per year, 2+ sinusitis, treatment for antibiotics for 2+ months w/o progress, 2+ pneumonia, failure to thrive as infant, recurrent deep skin/organ abscesses, persistent oral thrush/candidiasis after 1 years old, history requiring IV antibiotics, 2+ serious infections (including sepsis), family history immunodeficiency

💥food allergy

A true food hypersensitivity or allergy is defined as an immunologic reaction resulting from the ingestion of a food or food additive. This type of reaction is an IgE-mediated response to a particular food.

11. The nurse is monitoring the CD4 count of an infant who has contracted HIV from the mother in utero. The nurse is concerned that treatment with antiretroviral therapy is not effective when noting which CD4 level? 1700/mm3 1900/mm3 1300/mm3 1500/mm3

1300/mm3 Normal is 1500/mm3

💥Hepatitis B Immunization

3 shots 1: at birth 2: 1 month later (1-2 months age) 3: 6 months later (6-18 months age)

7. The nurse is caring for a 6-month-old infant with Wiskott-Aldrich syndrome. Which teaching does the nurse provide the parent? "Do not use a tub bath for daily cleansing." "Do not encourage a pacifier due to possible oral malformation." "Do not insert anything in the rectum." "Do not use a sponge bath for light cleaning."

Do not insert anything into the rectum

3. When providing discharge instructions to a child who was admitted to the hospital following stridor, wheezing, and urticaria after taking penicillin, which nursing action is priority? Advise the parents to have their child evaluated for atopic diseases. Question the child about the amount of penicillin that was taken. Educate the parents about possible side effects of penicillin in children. Encourage the child to wear a medical alert bracelet for penicillin.

Encourage the child to wear a medical alert bracelet for penicillin

6. The parent of a school-age child comments to the nurse, "Every time my child eats enchiladas at our local Mexican restaurant the child gets a rash. It just does not make sense to me." How should the nurse respond? "Has your child ever been tested for a peanut allergy?" "Maybe it is an allergy to something else and you just notice after eating there by coincidence." "That is odd. Does anyone else in your family react that way?" "Is your child allergic to milk?"

Has your child ever been tested for a peanut allergy

10. The nursing instructor has completed a presentation on normal immune function. Which statement by a student would suggest a need for further education? "Humoral immunity is generally functional at birth." "Phagocytosis is the process in which phagocytes swallow up and break down microorganisms." "Cellular immunity is cell-mediated immunity controlled by T cells." "Humoral immunity is immunity mediated by antibodies secreted by B cells."

Humoral immunity is generally functional at birth Humoral immunity, which involves antibodies secreted by B cells, is not fully developed at birth. While some passive immunity is passed from the mother to the infant

8. The nurse is teaching the parents of a child with a suspected diagnosis of juvenile idiopathic arthritis about the disease. Which statement by the parents demonstrates the need for further teaching? "If our child does not have a positive rheumatoid factor, our child does not have the disease." "It is important to control our child's inflammation and pain." "Swimming is a good activity that will help our child maintain joint mobility." "A warm bath at bedtime and warm compresses can increase our child's comfort."

If our child does not have a positive rheumatoid factor, our child does not have the disease

18. The nurse has completed an education session with parents of children diagnosed with food allergies. Which statement by a parent would indicate a need for additional education? "The grey part of the EpiPen® should never be removed until right before we use it." "I have found a website that makes medical alert bracelets in my daughter's favorite color." "If we need to use the EpiPen® we will need to notify her physician's office the next business day." "I will make sure my daughter always has her EpiPen® with her all the time."

If we need to use the EpiPen we will need to notify her physician's office the next business day is FALSE

12. The nurse is caring for a child who is receiving a skin test to determine the presence of allergies. A positive skin test for one particular allergen shows the mediation of which type of immune globulin? IgE IgM IgG IgA

IgE

19. The nurse is providing family education about the administration of cyclosporine A. Which response by the family indicates a need for further teaching? "We should monitor for signs of infection." "It is okay to take cyclosporine with dairy products." "We need to adhere to the schedule for routine follow-up blood work." "The medication is best absorbed with the vitamin C in citrus juices."

The medication is best absorbed with the vitamin C in citrus juices is FALSE

💥humoral immunity

antibodies produced by native B-cell lymphocytes

💥Passive immunity

antibodies receive external source (mother to baby, IVIG)

💥effect of allergen in body

antibody exposure to antigen (allergen) rapid cell activation (mediators & cytokine released) changes in BV, bronchi, mucous secreting glands

💥management of allergen

antihistamine epinephrine albuterol IV fluids

💥IgA bind to b-lymphocytes? function

doesn't bind b-lymphocytes, expressed in mucus-releasing tissues found in breast milk

💥IgE bind to b-lymphocytes? function

doesn't bind b-lymphocytes, involved in allergic reactions

💥IgG bind to b-lymphocytes? function

doesn't bind to b-lymphocytes, most abundant antibody & most effective for fighting infection Passes placenta

💥extent of allergic responses is determined by

duration, rate, and amount of exposure to allergen

13. Food allergies have become more and more common in the last few decades. What are some common food allergies of childhood? Select all that apply. Eggs Peanuts Apples Milk Cheerios

eggs peanuts milk

1. The nurse is helping the parents of a toddler identify foods that are causing allergic symptoms in the child. Which strategy should the nurse encourage the parents to use? Elimination diet Corticosteroid challenge testing Complete dietary protein restriction Hyposensitivity testing

elimination diet