PEDS Chapter 25: Nursing Care of the Child With an Alteration in Immunity/Immunologic Disorder

To avoid anaphylactic reactions in children, which question would be most important to ask a parent before administering penicillin to her infant? "Has she ever had penicillin before?" "Is there any family history of allergy to penicillin?" "What do you give her to alleviate itching?" "Do you have a telephone to call us immediately if she develops trouble breathing?"

"Has she ever had penicillin before?" Penicillin is a drug frequently involved in allergic reactions. The reaction occurs after the child has first been sensitized to the drug.

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?" "Is your child allergic to milk?" "That is odd. Does anyone else in your family react that way?" "Maybe it is an allergy to something else and you just notice after eating there by coincidence."

"Has your child ever been tested for a peanut allergy?" Enchilada sauce is an unexpected food that may contain a form of peanuts (such as peanut oil) that may be causing an allergic reaction in the child.

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

"Humoral immunity is generally functional at birth." Normal immune function is a complex process involving phagocytosis (process by which phagocytes swallow up and break down microorganisms), humoral immunity (immunity mediated by antibodies secreted by B cells), cellular immunity (cell-mediated immunity controlled by T cells), and activation of the complement system. Cellular immunity is generally functional at birth, and as the infant is exposed to various substances over time, humoral immunity develops.

The nurse is providing teaching about food substitutions when cooking for the child with an allergy to eggs. Which response indicates a need for further teaching? "I must not feed my child eggs in any form." "I can use the egg white when baking, but not the yolk." "1 tsp yeast and ¼ cup warm water is a substitute in baked goods." "1.5 Tbsp each of water and oil, plus 1 tsp baking powder, equals one egg in a recipe."

"I can use the egg white when baking, but not the yolk." The parents must understand that their child cannot consume any part of an egg in any form. The other statements are accurate.

An adolescent has just been diagnosed with systemic lupus erythematosus (SLE). Following education about the disease, which statement by the adolescent indicates the session was successful? "SLE is a rheumatic disease that mostly affects my joints." "SLE is an autoimmune disorder that I will always have, with times of flare-ups and times of minimal to no symptoms." "If my SLE has been found early enough in the disease process, there is a good chance that medication can cure it." "SLE only affects my skin. It seldom causes problems in any other organs."

"SLE is an autoimmune disorder that I will always have, with times of flare-ups and times of minimal to no symptoms." Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that can affect any organ system, including the skin. There is no cure for SLE, but with proper treatment and if the client cares for themselves properly, the disease can have periods of remission and fewer flare-ups.

The nurse is speaking with a teenager who has requested HIV testing. Which is the best statement by the nurse regarding HIV testing? - "The ELISA method detects antibodies so a person may have a false negative test for up to six months after exposure." - "Autoimmune disorders may cause you to have a false negative result on the ELISA test." - "Since you are a minor, this test is confidential." - "The ELISA test is a single test. It does not require you to be tested multiple times."

- "The ELISA method detects antibodies so a person may have a false negative test for up to six months after exposure." ELISA method detects only antibodies, so the test may remain negative for several weeks up to 6 months (false-negative) after exposure. A false-positive may result with autoimmune disease. The ELISA test requires serial testing. HIV test results are confidential.

Which client will the nurse assess first after receiving shift report? - A client with human immunodeficiency virus (HIV) whose temperature is 102.2°F (39°C) - A client with serum sickness stating, "I just feel bad all over." - A client newly diagnosed with allergic rhinitis prescribed loratadine 10 mg - A client with contact dermatitis who has blisters and mild edema on the lower extremities

- A client with human immunodeficiency virus (HIV) whose temperature is 102.2°F (39°C) Of the immunologic disorders, HIV infection is the most serious. This client is also exhibiting an unexpected manifestation, which could indicate an infection. The clients with serum sickness and dermatitis are exhibiting expected findings and would be seen last. The client newly diagnosed needs to be seen second to have the medication started and receive education.

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? - Question the child about the amount of penicillin that was taken. - Encourage the child to wear a medical alert bracelet for penicillin. - Advise the parents to have their child evaluated for atopic diseases. - Educate the parents about possible side effects of penicillin in children.

- Encourage the child to wear a medical alert bracelet for penicillin.

The mother of a child with myasthenia gravis has called the clinic and reports her child appears very anxious and the child's heart is beating very fast. What action by the nurse is indicated? - Instruct the child be brought to the emergency department promptly. - Make an appointment for the child to be seen by the physician within 24 hours. - Inquire about any changes in the child's normal routine. - Inquire about when the child's last dose of medication was taken.

- Instruct the child be brought to the emergency department promptly. Myasthenia gravis is an autoimmune disorder that is characterized by weakness and fatigue. There is no cure. The disease may be aggravated by stress, exposure to extreme temperatures, and infections, resulting in a myasthenic crisis. Myasthenic crisis is a medical emergency with symptoms including sudden respiratory distress, dysphagia, dysarthria, ptosis, diplopia, tachycardia, anxiety, and rapidly increasing weakness. The symptoms reported are consistent with a crisis and prompt care is indicated. Waiting 24 hours to have the child seen by the physician is not appropriate. Questions about changes in routine and medication compliance may be asked but the first priority is to have the child seen.

The nurse is caring for a young child with HIV. Which nursing intervention is priority for this child? Administer prescribed medications. Assist the child with daily activities. Assess pain after invasive procedures. Review laboratory CD4 counts daily.

Administer prescribed medications. Although assisting with activities, assessing pain, and reviewing CD4 counts are all important, the priority when caring for a child with HIV is to administer prescribed medications. Prescribed medications prevent progressive deterioration of the immune system and provide prophylaxis against opportunistic infections.

The nurse is caring for a child who is beginning to show signs and symptoms of anaphylaxis. Which intervention would be the priority? Administering IV diphenhydramine Assessing patency of the airway Administering corticosteroids Obtaining brief history of allergen exposure

Assessing patency of the airway The priority nursing intervention is to assess patency of the airway and breathing. If the child is stable, the next step would be to obtain a brief history of allergen exposure. If epinephrine is required, it would be administered prior to diphenhydramine. Corticosteroids would be used to prevent late-onset reactions.

The nurse is caring for a child who is receiving an intravenous immunoglobulin treatment. The client calls the nurse and reports she vomited. What action should be completed first? Discontinue the infusion. Take the client's vital signs. Check the physician's orders for an antiemetic. Contact the physician.

Discontinue the infusion. Clients receiving intravenous immunoglobulin are at risk for anaphylaxis. Vomiting can signal an allergic response. The first action would be to stop the infusion. The remaining activities are appropriate for inclusion in the plan of care but are not of the highest priority.

The registered nurse (RN) and unlicensed assistive personnel (UAP) are caring for a pediatric client with an immune disorder receiving a stem cell transplant. Which action by the UAP will cause the RN to intervene? The UAP takes a rectal temperature on the client. The UAP assists the client to ambulate in the room. The UAP places a lunch tray in the client's room. The UAP wears a mask when entering the client's room.

The UAP takes a rectal temperature on the client. Precautions must be taken to protect the client from infection. The RN would intervene if the UAP takes a rectal temperature because this increases the client's risk for infection. The client should not receive rectal suppositories as well. The RN would ensure meticulous oral care is provided and encourage appropriate and adequate nutrition. Delivering a meal tray, wearing a mask when entering the room, and assisting the client to ambulate in the room are all appropriate actions by the UAP.

The nurse is planning to administer IVIG to a child for the first time. What actions related to this therapy are indicated? Select all that apply. a. After mixing, roll the vial of medication. b. Store the vial in the refrigerator until use. c. Promote hydration prior to administration. d. Medicate with acetaminophen prior to administration. e. Check for the presence of adverse reactions 60 minutes after the infusion has finished.

a, b, c, d IVIG must be reconstituted. After the diluent is added to the powder, gently roll the vial between your hands to mix. Shaking will damage the medication. Reconstituted IVIG may be refrigerated overnight but should be brought to room temperature prior to infusion. Premedication with acetaminophen may be indicated in children who have never received IVIG. The child should be well hydrated prior to the administration. Adverse reactions should be monitored for within 15 minutes of the initiation of the infusion.

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: has polyarticular JIA. has systemic JIA. has pauciarticular JIA. is at 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.

A nurse is giving a talk to high school students about preventing the spread of human immunodeficiency virus (HIV). What does the nurse identify as ways in which HIV is spread? Select all that apply. a. Exposure to blood and body fluids through sexual contact b. Sharing contaminated needles c. Sharing the same bathroom d. Transfusion of contaminated blood e. Perinatally from mother to fetus f. Through breastfeeding

a, b, d, e, f (all but c) HIV is spread by exposure to blood and other body fluids through sexual contact, sharing of contaminated needles for injection, transfusion of contaminated blood, perinatally from mother to fetus, and through breastfeeding. It cannot be contracted by using the same bathroom. It must be direct contact.

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. Include the child when discussing foods that contain peanuts. Offer the parents information about a community support group. Remind parents to report the allergy to the child's school teacher.

Include the child when discussing foods that contain peanuts. Involving school-age children in education related to their allergy helps them play an active role in their own care. Involving the child in teaching also helps to plan nursing care that meets QSEN competencies and also best meets the family's needs. Although advising parents the child may benefit from skin testing of other allergies, informing the child's school of the peanut allergy, and offering information about community support groups are important, involving the child in education is the best method to prevent exposure to the allergen.

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? Assess the client for signs of anaphylactic shock Administer epinephrine Determine if the client was stung Apply an ice compress to the site

Assess the client for signs of anaphylactic shock First, the nurse will assess the client for signs of anaphylactic shock and then administer epinephrine if warranted. Epinephrine counteracts histamine release to decrease bronchospasm and difficulty breathing. If there were no signs of anaphylactic shock, the nurse would determine if the child was actually stung. The nurse would apply ice to promote vasoconstriction once the client was stable.

A school nurse is called to the school cafeteria after a 13-year-old child is reported to have sudden difficulty breathing. The child has a history of asthma and allergies to peanuts. The focused nursing assessment reveals difficulty breathing, inspiratory and expiratory wheezing, swelling of lips, and a rash on the face. The child reports feeling nauseated, having chest tightness, and feeling faint. The nurse should first address the child's ___________ then ___________.

Wheezing; swelling of the lips The nurse addresses the airway first; wheezing indicates constriction of the airways. The nurse next addresses the child's swollen lips (angioedema) to ensure there is no additional swelling in the mouth that may occlude the airway. Once the nurse addresses the child's airway, breathing, and circulation, the nurse can address the child's nausea. Because the rash does not interfere with the child's airway, breathing, or circulation, and it will resolve once the allergic episode resolves; this can be addressed later. The child's chest tightness is most likely due to the bronchial constriction. Once the airway constriction resolves, the chest tightness should resolve. The child feeling faint is most likely due to the bronchial constriction reducing airflow. Once the airway constriction resolves, the child should not feel faint.

The nurse is providing education regarding 2030 Health Goals to reduce the incidence of acquired immunodeficiency syndrome (AIDS) within the community. Which goal will the nurse choose as a primary prevention strategy? - Refer at-risk community members to the clinic for HIV/AIDS screening. - Increase the number of schools with an indoor air management system. - Provide education to sexually active females about proper condom usage. - Reduce the baseline level of allergens in dust within homes and buildings.

- Provide education to sexually active females about proper condom usage. Primary prevention strategies focus on preventing a disease before it occurs, which includes condom usage to prevent being exposed to AIDS. Screening for the presence of AIDS is a secondary prevention strategy because it does not prevent an individual from contracting AIDS, but would allow for early identification. Improving air quality and reducing allergens are goals to prevent allergies.

A nurse is preparing a presentation for a group of new parents and is planning to discuss nutrition during the first year. As part of the presentation, the nurse is planning to address foods that should be avoided to reduce the risk of possible food allergies. Which foods would the nurse most likely include? Select all that apply. a. Eggs b. Shrimp c. Peanuts d. Carrots e. Potatoes f. Bananas

a, b, c Foods that should be avoided in children younger than 1 year of age include cow's milk, eggs, peanuts, tree nuts, sesame seeds, and fish and shellfish (i.e., shrimp). Carrots, potatoes, and bananas are not considered problematic.

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? immunoglobulin electrophoresis lymphocyte immunophenotyping T-cell quantification erythrocyte sedimentation rate (ESR) 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.

A pediatric client is admitted to the hospital. The primary health care provider suspects a problem with the child's immune system. The nurse anticipates preparing this client for which test initially? stem cell analysis serum blood testing bone marrow biopsy lumbar puncture

serum blood testing When there is a deficiency of immunocompetent cells, an assessment will focus on analysis of blood components, particularly white blood cells, T cells, and immunoglobulin levels. The results of these tests will indicate the need to additional testing. A stem cell analysis would be completed if a stem cell transplant was indicated. This test helps determine compatibility. A bone marrow biopsy is done to determine if the bone marrow is healthy and making normal amounts of blood cells. A lumbar puncture is done to collect cerebrospinal fluid for diagnostic testing. The main reason for a lumbar puncture is to help diagnose diseases of the central nervous system.