Chapter 42: Nursing Care of a Family when a Child has an Immune Disorder

Which immune cells are disrupted when a child is infected with human immunodeficiency virus (HIV)? Select all that apply.

*T cells, B cells, phagocytes* Platelets and erythrocytes are not affected by the HIV virus because the disease affects primarily the immune system.

Which nursing intervention is priority when caring for a child with HIV?

*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.

A newborn is found to have DiGeorge syndrome and has misshaped ears, a small mandible, and an absent thymus. The nurse recognizes that this condition is associated with which of the following types of immunodeficiency disorders?

*T-lymphocyte deficiency* T-lymphocyte immunodeficiencies involve inadequate numbers or inadequate functioning of one or more types of T lymphocytes; this affects cell-mediated immunity and also, because of helper T-lymphocyte function, possibly humoral immunity as well. DiGeorge syndrome is a chromosomal disorder in which there is a deletion of a small piece of chromosome 22. This leads to not only a T-cell defect but misshaped or low-set ears, smaller than usual mandible, absent thymus, neonatal tetany, and congenital heart disease.

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 *wheezing* then *swelling of 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 preparing an informational brochure about risk factors for immune disorders. Which disease process can indicate a potential underlying immunologic disorder? Select all that apply.

*chronic cough, extensive eczema, persistent oral thrush* Occasional rhinorrhea is common and does not indicate an immune disorder. Illness with high fever is a sign of acute illness, rather than a chronic underlying disorder such as immune dysfunction.

The nurse is explaining to a parent some of the basic aspects of the immune system and its functions. She informs them that B cells, also known as _________ cells, will attack __________ antigens.

*humoral; bacterial* B cells are also called humoral cells and typically attack bacterial organisms. Another term for T cells is killer cells, and they most commonly attack viral organisms.

A child is scheduled to undergo hyposensitization. Which result confirms progress?

*increased concentration of IgG* Hyposensitization works by increasing the plasma concentration of IgG antibodies. IgG acts to prevent or block IgE antibodies from coming into contact with the allergen. IgE levels are not increased. Antihistamines block the release of histamine. Environmental control helps to reduce exposure to potential allergens.

The nurse is caring for a child and notes periorbital edema on the left eye with urticaria. Which action by the nurse is priority?

*Assess lung sounds bilaterally.* When a child has signs of angioedema, the nurse's priority is to ensure the airway is patent, by assessing breathing sounds, because angioedema can cause laryngeal obstruction and asphyxiation. Evaluating fluid volume status, asking about allergies, and administering a corticosteroid are all actions that could be performed after first ensuring the child was breathing.

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?

*IgG* IgG is acquired transplacentally, providing the newborn with passive immunity to antigens to which the mother had developed antibodies. IgA, IgD, IgE, and IgM do not cross the placenta and require an antigenic challenge for production.

A nurse is providing care to a child with HIV who is prescribed therapy with a nucleoside reverse transcriptase inhibitor. What would the nurse expect to administer?

*zidovudine* Zidovudine is a nucleoside reverse transcriptase inhibitor. Nevirapine and efavirenz are classified as nonnucleoside reverse transcriptase inhibitors. Ritonavir is a protease inhibitor.

The nurse is discussing food allergies with parents of a young child, explaining that a very effective way to determine which foods a child may be allergic to is to implement:

*an elimination diet* The food diary may identify foods the child does not tolerate well, but it lacks the objectivity of the elimination diet. Skin testing usually involves whole proteins and will not test for reactions to food breakdown products. A raw food diet does not apply to allergy identification.

A mother who is HIV positive is distraught when she learns that her 6-month-old baby is also HIV-positive. The child had undergone open heart surgery as a newborn and had received numerous blood transfusions. The nurse recognizes that the most likely means of transmission of the disease to this child was:

*placental spread during pregnancy.* Although it is decreasing in incidence, transmission of HIV from mother to child by placental spread is still the most common reason for childhood HIV infection in the United States. Children with hemophilia no longer have a high incidence of the disease because blood products are now screened for the virus. HIV is not transmitted by animals or through usual casual contact, such as shaking hands or kissing, or in households, day care centers, or schools. Infection via breast milk is possible but less likely than via placental spread.

The nurse is caring for a 6-month-old infant whose mother tested positive for HIV during her pregnancy. The infant had a positive polymerase chain reaction (PCR) for HIV at birth. Which medication would be prescribed for the prevention of pneumocystis pneumonia (PCP)?

*Trimethoprim-sulfamethoxazole* Trimethoprim-sulfamethoxazole (TMP) is the drug of choice for the prevention of pneumocystis pneumonia. Prophylaxis usually begins at the age of 6 months.

The mother of a child with a possible food allergy asks the nurse for information about how to test for it. Which response by the nurse would be most appropriate?

*"The best way is to eliminate the food from the diet and then look for improvement."* Food allergies are best identified by eliminating a suspected food from the diet and observing whether symptoms improve. After a time of improvement, the food is reintroduced and if the child is allergic to the food, the symptoms will return. Skin testing with either a patch or intracutaneous injection is ineffective for determining food allergies. Serum antibody levels can be measured but are not specific in helping to determine food allergies.

Which nursing problems could be associated with a child with primary immunodeficiency? Select all that apply.

*Altered skin integrity, risk for infection, delayed growth and development* All of these can be problems associated with immune system dysfunction. Fluid and electrolytes and GI function are not commonly associated with primary immunodeficiency.

A parent tells the clinic nurse that the family wants to go on vacation, but that they are afraid to go to their usual spot because their young child has problems with pollen-related allergies. What recommendation by the nurse is best?

*Plan the vacation at a time when the pollen count is lowest.* If a child's allergies involve pollen sensitivities, planning vacations at a time when the pollen count is lowest may make the vacation more pleasant for the family. This option allows the family to be at their favorite spot with the fewest symptoms. Remaining indoors or vacationing in the winter changes the characteristic of the favorite vacation. Antihistamines have side effects; minimizing use is important.

A client presents to the clinic for allergy testing. The nurse is reviewing current medications taken within the past 5 to 7 days. Which classification of medication, if taken by the client, will cause the nurse to reschedule the allergy testing appointment?

*antihistamine* If the client has taken an antihistamine within the past 5 to 7 days, the skin testing appointment will need to be rescheduled because antihistamines will provide false results to the testing. When an allergen is introduced into the client's skin, the client, sensitive to the allergen, will respond with redness and a wheal at the site, due to the release of histamine by local mast cells. Inhibiting this histamine release will result in a false negative. If the client has taken a drug from the other classifications listed, the skin testing may proceed. These medications are able to be taken concurrently with allergy testing.

The nurse is caring for a pediatric client who has a compromised immune system. When reviewing blood laboratory results, which bone marrow component(s) would the nurse report to the health care provider? Select all that ap

*T lymphocytes: 620 cells/mm3 (0.62 x 109/l), B lymphocytes: 85 cells/mm3 (0.09 x 109/l)* The nurse is correct to review all laboratory work for values of concern, which need to be reported to the health care provider. In this case, it is important to review values related to the immune system. The immune system's function is to recognize or react against foreign substances or antigens. A healthy bone marrow is important in developing cells that produce antibodies and immunoglobulins. When reviewing the data, the bone marrow produces B lymphocytes and T lymphocytes, which are essential components of the immune system. It is noted that this client's values are low. Identifying a dysfunction in these cells will impact the body's immune system. Macrophages are mature white blood cells involved with the phagocytosis of an invading pathogen. This client's value is on the low end but still within normal limits. Antigens are foreign substances capable of stimulating an immune response. IgG is the antibodies in the system and this client's value is within normal limits.