Ricci Ch 47 - Nursing Care of the Child With an Alteration in Immunity or Immunologic Disorder

Cellular immunity

Cell-mediated immunity controlled by T cells.

Dermatomyositis

Chronic systemic immunological disease involving inflammation of the skin, connective tissue, and muscles. Therapeutic management involving the use of high-dose glucocorticoid or other immunosuppressants is necessary to prevent the complications of painful calcium deposits under the skin, as well as joint contractures. Methotrexate, IVIG, and cyclosporine may also be used.

While providing care to a 5-month-old girl whose family has a history of food allergies, the nurse instructs the parents about foods to be avoided in the first year of life. Which response by the parents indicates a need for further teaching? A) "She cannot have any cow's milk." B) "I should continue breastfeeding until at least 6 months." C) "Peanuts in any form should be avoided." D) "Any kind of fruit is acceptable."

D) "Any kind of fruit is acceptable."

A child is diagnosed with juvenile idiopathic arthritis and is receiving several different medications listed in the medication administration record. Which agent would the nurse identify as being used to prevent disease progression? A) Aspirin B) Prednisone C) Ibuprofen D) Methotrexate

D) Methotrexate

A group of nursing students are reviewing information about humoral and cellular immunity. The students demonstrate understanding of this material when they identify which of the following as involved in cellular immunity? A) B cells B) Antibodies C) Antigens D) T cells

D) T cells

The nurse is caring for a newborn whose mother is HIV positive. The nurse would expect to administer a 6-week course of which medication? A) Lopinavir B) Ritonavir C) Nevirapine D) Zidovudine

D) Zidovudine

Children with immune disorders often show a _________ response to delayed hypersensitivity skin testing (e.g., the tuberculosis test).

Decreased or absent.

Live vaccinations

Dont give to immunocompromised patients.

HIV infection in children often results in?

Encephalopathy and developmental delay.

If child is allergic to peanuts avoid

Fast food cooked in peanut oil, many Asian foods, baked goods with nuts, or foods processed on equipment that also processes peanuts. Brown gravy, barbeque sauce, meat sauce, egg rolls, enchilada sauce, hot chocolate.

SLE symptoms

Fatigue; joint aches; myalgias; keratoconjuctivitis sicca; butterfly rash; malar rash; renal involvement; oral and nasal ulcers; leukopenia, anemia, thrombocytopenia; gastritis; peptic ulcers.

IgM

First antibody produced

Immunoglobulins

Gamma globulin and Antibody proteins.

Latex Allergy

IgE-mediated response to exposure to latex, a natural rubber product used in many common items (especially gloves in the health care setting).

Azathioprine (Imuran)

Immunosuppressant. Purine analog. Stops replication on insertion. Tx: RA, transplant rejection prevention (Kidney esp). Also tx of Ocular Myasthenia = SEs: seconday lymphomas. So not used much.

Signs and symptoms of myasthenic crisis

Include severe muscle weakness, respiratory difficulty, tachycardia, and dysphagia. Signs and symptoms of cholinergic crisis include severe muscle weakness, sweating, increased salivation, bradycardia, and hypotension.

Pauciarticular JRA

Involves fewer than 5 joints

Nursing interventions in the management of juvenile idiopathic arthritis?

Managing pain, maintaining mobility, and administering disease- modifying medications.

Tickling

May be a successful technique for assessing the level of paralysis in the child with Guillain-Barré syndrome, either initially or in the recovery phase.

Secondary immunodeficiencies

May occur as a result of chronic illness, malignancy, use of immunosuppressive (lowering the immune response) medication, malnutrition or protein-losing state, prematurity, or HIV infection.

Explain to the child with severe allergy the importance of wearing?

Medical ID alert bracelet or necklace.

IgG

Most abundant

Vertical transmission HIV

Mother to child transmission

Horizontal transmission

Person to person (IV drugs, tattoos) or sexual contact.

RNA or DNA—nucleic acid (NAT) or polymerase chain reaction (PCR) test:

Positive in infected infants who are not breastfed at 1 month of age, and in all infected infants at 6 months of age.

HIV infection may be prevented in infants by?

Prenatal screening and maternal treatment, as well as postnatal treatment with zidovudine.

Nursing management of lupus focuses on?

Preventing flare-ups and complications.

Phagocytosis

Process by which phagocytes swallow up and break down microorganisms.

Uticaria

Rash notable for pale red, raised, itchy bumps aka hives.

enlarged lymph nodes

Response to viruses.

primary immunodeficiency

Result of a genetic abnormality.

Use only cytomegalovirus (CMV)-negative, irradiated blood or platelets if transfusion is necessary in the infant with

Severe combined immune deficiency (SCID)

Humoral immunity

Specific immunity produced by B cells that produce antibodies that circulate in body fluids.

Antibodies

Specific immunity.

Antigen

Substance that stimulates an immune response.

Guillain-Barré syndrome (GBS)

The disorder occurring most often is a one in which an immune response within the body attacks the peripheral nervous system but does not usually affect the brain or spinal cord. GBS results in inflammation and demyelinization of the peripheral nerves. Weakness and paralysis occur in a progressive fashion. Progression is usually complete in 2 to 4 weeks, followed by a stable period leading to the recovery phase, which lasts for a few weeks to months in most cases but can take years.

Food Allergies

This type of reaction is an IgE-mediated response to a particular food. Most common allergens are milk, eggs, peanuts, tree nuts, fish and shellfish, wheat, and soy

True/False Infants and young children have large lymph nodes, tonsils, and thymus compared with adults.

True.

Wiskott-Aldrich syndrome

X-linked genetic disorder that results in immunodeficiency, eczema, and thrombocytopenia. It affects males only. Complications include autoimmune hemolytic anemia, neutropenia, skin or cerebral vasculitis, arthritis, inflammatory bowel disease, and renal disease.

IVIG

-Assess vital signs and check for adverse reactions every 15 minutes for the first hour, then every 30 minutes throughout the remainder of the infusion. -Many children who have had previous reactions to IVIG can tolerate the infusion without reaction if they are premedicated and if the infusion is given at a slower rate. -Prescribed as milligrams of IVIG per kilogram of body weight per minute.

How to use EpiPen or EpiPen jr

1. Grasp the EpiPen or EpiPen Jr with the black tip pointing downward, forming a fist. 2. With the other hand, pull off the gray safety release. 3. Swing and jab the EpiPen firmly into the outer thigh at a 90-degree angle and hold firmly there for 10 seconds. 4. Remove the EpiPen and massage the thigh for 10 seconds.

To prevent the development of food allergies, infants should be breastfed for at least the first how many months of life?

6. months.

Hypogammaglobulinemia

A below normal concentration of gamma globulin in the blood associated with a decreased resistance to infection. -Therapeutic management is periodic administration of intravenous immunoglobulin (IVIG). -Palpate for enlarged lymph nodes and spleen

Systemic lupus erythematosus (SLE)

A multisystem autoimmune disorder that affects both humoral and cellular immunity. SLE can affect any organ system, so the onset and course of the disease are quite variable.

Toxoplasmosis

A parasite that is most commonly transmitted from pets to humans by contact with contaminated animal feces. *Cat litter*

The nurse is providing home care instructions for a 13-year-old girl recently diagnosed with systemic lupus erythematosus. Which response by the girl indicates a need for further teaching? A) "I need to wear sunscreen in the summer to prevent rashes." B) "I need to eat a healthy diet, exercise, and get plenty of sleep." C) "I need an eye examination every year." D) "I need to be careful when it is cold; I should always wear gloves."

A) "I need to wear sunscreen in the summer to prevent rashes."

A nurse is caring for a 12-year-old girl with a severe peanut allergy. The girl's parents are upset because the school does not permit her to carry her EpiPen with her. It must remain in the school's office per school regulations. Which response by the nurse would be most appropriate? A) "She is allowed by law to carry her EpiPen with her; I will talk to school authorities." B) "Let's file an action plan and keep it in the school office in the event of anaphylaxis." C) "Make sure she wears a medical alert bracelet so that school staff know she has allergies." D) "I will be happy to train school authorities and staff to recognize anaphylaxis."

A) "She is allowed by law to carry her EpiPen with her; I will talk to school authorities."

Which of the following would the nurse expect to find in a male infant with Wiskott-Aldrich syndrome? A) Eczema B) Thrombocytosis C) Lymphadenopathy D) Pneumonia

A) Eczema

A child is diagnosed with a food allergy to milk. When teaching the parents about this allergy, which of the following would the nurse suggest as possible substitutions? Select all answers that apply. A) Fruit juice B) Rice milk C) Yogurt D) Nondairy creamers E) Soy milk

A) Fruit juice B) Rice milk E) Soy milk

A nurse is assessing a child who may have a latex allergy. The nurse asks the child about allergic reactions with certain foods. Which foods if identified by the child as experiencing an allergic reaction would help support the suspected latex allergy? Select all answers that apply. A) Peaches B) Plums C) Carrots D) Tomatoes E) Apples F) Lettuce

A) Peaches B) Plums C) Carrots D) Tomatoes

The nurse is reviewing the laboratory test results of a child who is suspected of having systemic lupus erythematosus (SLE). Which of the following would the nurse identify as supporting this diagnosis? Select all answers that apply. A) Positive antinuclear antibody (ANA) B) Increased C3 levels C) Thrombocytopenia D) Leukopenia E) Increased hematocrit

A) Positive antinuclear antibody (ANA) C) Thrombocytopenia D) Leukopenia

The nurse is caring for a child undergoing highly active antiretroviral therapy (HAART) for HIV infection. The nurse is preparing to administer the prescribed medication. In addition to the nucleoside analog reverse transcriptase inhibitors (NRTIs) and the nonnucleoside analog reverse transcriptase inhibitors (NNRTIs), the nurse is cognizant that the child will be taking which additional medication as part of the three-drug regimen? A) Protease inhibitors B) Corticosteroids C) Cytotoxic drugs D) Disease-modifying antirheumatic drugs (DMARDs)

A) Protease inhibitors

A child with hypogammaglobulinemia is to receive intravenous immunoglobulin (IVIG). Which of the following would be least appropriate for the nurse to do? A) Shake the vial after reconstituting it B) Premedicate the child with acetaminophen C) Obtain preinfusion vital signs D) Check serum blood urea nitrogen and creatinine levels

A) Shake the vial after reconstituting it

When reviewing the history of a child with suspected primary immunodeficiency, which of the following would the nurse be least likely to find? A) Weight appropriate for height B) Antibiotic therapy for the past 3 months without effect C) 10 episodes of otitis media in the last year D) Three bouts of sinusitis within a year's time

A) Weight appropriate for height

A nursing student is reviewing information about primary immunodeficiencies. The student demonstrates understanding of the material by identifying which of the following as affecting only males? Select all answers that apply. A) X-linked agammaglobulinemia B) Wiskott-Aldrich syndrome C) Selective IgA deficiency D) X-linked hyper-IgM syndrome E) IgG subclass deficiency F) Severe combined immune deficiency

A) X-linked agammaglobulinemia B) Wiskott-Aldrich syndrome D) X-linked hyper-IgM syndrome

If child is allergic to eggs avoid

Albumin, globulin, ovalbumin. Some egg substitutes and foam toppings for drinks, commercially cooked pastas

Nasal, palatal, or throat pruritus and difficulty breathing may indicate?

Anaphylactic reaction

Anaphylaxis

Anaphylaxis is an acute IgE-mediated response to an allergen that involves many organ systems and may be life-threatening. Epinephrine is usually required, and intramuscular or intravenous diphenhydramine is used secondarily.

Autoantibodies

Antibodies produced by B cells that mistakenly attack and destroy "self" cells belonging to the patient; autoantibodies are the pathophysiologic agent of most autoimmune disorders.

Severe Combined Immune Deficiency

Any of a group of rare, sometimes fatal, congenital disorders characterized by little or no immune response. Can occur in girls or boys, characterized by absent T-Cell and b-Cell function.

The nurse is talking to the parents of a child who has been diagnosed with severe combined immune deficiency. Which statement by the parents best indicates that they understand their child's condition? A) "He'll need to receive intravenous immunoglobulin routinely." B) "We'll need to prepare him and ourselves for a bone marrow transplant." C) "He'll need to receive several different types of antiviral medications." D) "We'll make sure that he has his EpiPen with him at all times."

B) "We'll need to prepare him and ourselves for a bone marrow transplant."

When teaching a group of new parents about newborn care and development, which immunoglobulin would the nurse explain as being primarily responsible for the passive immunity exhibited by newborns? A) IgA B) IgG C) IgM D) IgE

B) IgG

A nurse is preparing a plan of care for a child with a primary immunodeficiency. Which nursing diagnosis would the nurse most likely identify as the priority? A) Imbalanced nutrition, less than body requirements related to poor appetite B) Ineffective protection related to impaired humoral defenses C) Acute pain related to inflammatory processes D) Risk for delayed growth and development related to chronic illness

B) Ineffective protection related to impaired humoral defenses

The nurse is caring for a child who is taking corticosteroids for systemic lupus erythematosus. The nurse closely monitors the child based on the understanding that corticosteroids exert which major action? A) They increase liver enzymes. B) They can mask signs of infection. C) They cause bone marrow suppression. D) They decrease renal function.

B) They can mask signs of infection.

After teaching a class about humoral and cellular immunity, the nurse recognizes that the additional teaching is needed when the class states which of the following? A) Humoral immunity crosses the placenta. B) Cellular immunity involves the T lymphocytes. C) Cellular immunity recognizes antigens. D) Humoral immunity does not destroy the foreign cell.

C) Cellular immunity recognizes antigens.

The school nurse is walking through the lunchroom when one of the children says she feels strange after switching her lunch with her friend. Which assessment would be most important? A) Asking if she has a rash anywhere B) Checking if she has any nausea C) Determining if her throat itches D) Asking if she has abdominal pain

C) Determining if her throat itches

The nurse is administering intravenous immune globulin (IVIG). The nurse assesses vital signs and for adverse reactions every 15 minutes for the first hour of administration. After the first hour, the nurse most likely would continue to assess the child at which frequency? A) Every 30 minutes B) Every 45 minutes C) Every 60 minutes D) Every 2 hours

C) Every 60 minutes

The nurse is assessing a child with pauciarticular-type juvenile idiopathic arthritis. Which of the following would the nurse expect to assess? A) Fever B) Rash C) Eye inflammation D) Splenomegaly

C) Eye inflammation

The nurse is caring for a child who has undergone stem cell transplantation for severe combined immune deficiency. Which of the following would the nurse interpret as indicative of graft-versus-host disease? A) Presence of wheezing B) Splenomegaly C) Maculopapular rash D) Chronic or recurrent diarrhea

C) Maculopapular rash

Which exercise would the nurse suggest as most helpful to maintain mobility in a child with juvenile idiopathic arthritis? A) Jogging every other day B) Using a treadmill C) Swimming D) Playing basketball

C) Swimming

Graft-versus-host disease (GVHD)

Monitor the child who had a bone marrow or stem cell transplant closely for a maculopapular rash that usually starts on the palms and soles.

Chemotaxis

Movement of neutrophils towards microorganisms. Adult level by 3-6months.

Immunodeficiency

(incapacity to mount an appropriate immune response), autoimmune, and allergic disorders have a significant impact on the lives of affected children.

Avascular necrosis

(lack of blood supply to a joint, resulting in tissue damage) may occur as an adverse effect of long-term or high-dose corticosteroid use. Teach families to report new onset of joint pain, particularly with weight bearing, or limited range of motion to their physician or nurse practitioner.

CD4 counts

(low in HIV infection)

Cyclophosphamide

Akylating agent used to treat cancers

The nurse is caring for a child who is having an anaphylactic reaction with bronchospasm. The nurse would expect to administer which of the following for bronchospasm as ordered? A) Epinephrine B) Corticosteroid C) Albuterol D) Diphenhydramine

C) Albuterol

Nevirapine

NNRTI, avoid st. johns wart

Systemic JRA

accompanied by fever, rash, arthritis, and visceral involvement also known as *stills disease*

Polyarticular JRA

involves more than five joints.

IgE

Allergic reactions

Various forms of hypogammaglobulinemia may be treated with?

Exogenous immunoglobulin administered intravenously every several weeks, allowing children to lead a healthier life with fewer infections.

If child is allergic to milk avoid

Artificial butter flavor, casein, lacta.lbumin, nougat, pudding, whey, yogurt, ghee. Some deli meats and hot dogs, nondairy products, coffee whiteners.

A child with systemic lupus erythematosus is receiving high-dose corticosteroid therapy over the long term. The nurse would instruct the parents and child to report which of the following? A) Difficulty urinating B) Visual changes C) Joint pain D) Rash

C) Joint pain

myasthenia gravis (MG)

Autoimmune neuromuscular disorder characterized by weakness of voluntary muscles. Therapeutic management generally involves the use of anticholinesterase medications such as pyridostigmine, which blocks the breakdown of acetylcholine at the neuromuscular junction and enhances neuromuscular transmission.

If child is allergic to wheat avoid

Cereal extract, couscous, durum, semolina, spelt. Some imitation crab meat and wheat flour shaped to look like shrimp, beef, or pork especially in Asian dishes.

Opsonization

Enhancement of phagocytosis.

How do you cure SCID and Wiskott-Aldrich syndrome?

Bone marrow or stem cell transplant.

Pruitis

Itching