Chapter 42 The Child with an Immunologic Alteration Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Nonspecific Immune Function  Chemical barriers  Inflammation  Increased capillary permeability  Vasodilation  Phagocytosis  Elimination of cellular waste products 2Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Specific Immune Function  Humoral response  Cell-mediated response  Development of immunity  Actively acquired  Passively acquired 3Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Immunologic Imbalance  Under function  Increased susceptibility to infection  Over function  Produces antibodies against cells of the body  Allergies  Autoimmune disease 4Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Acquired or Congenital Immunodeficiency  Increased vulnerability to viral or bacterial infections  Appropriate hand hygiene and infection control practices  Three guiding principles  Prevent contact was organisms.  Create barriers if contact is unavoidable.  Kill organisms if contact is made. 5Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

HIV Infection  Best known acquired immunodeficiency disease  Causes a widespread spectrum of illnesses in children  Symptoms range from mild to severe 6Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Transmission of HIV  HIV can be spread by the following:  Unprotected sexual activity  Sharing of needles  An infected mother to her baby  Breastfeeding  Open wounds (if there is blood-to-blood contact) 7Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Treatment of HIV  Modified immunization program  Antiretroviral therapy  Pneumocystis carinii pneumonia (PCP) prophylaxis  Aggressive use of antibiotics 8Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Nursing Challenges  Respiratory management  Promoting normal growth and development  Preventing infection  Providing comfort  Supporting families  Infection transmission  Medication adherence 9Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

The Child Taking Oral Corticosteroids  Both immunosuppressive and antiinflammatory properties  During cessation of therapy, gradually taper the dose to allow for a gradual return of adrenal function. 10Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Immune Complex and Autoimmune Disorders  Immune complex  Kawasaki disease  Glomerulonephritis  Autoimmune disorders  Systemic lupus erythematosus (SLE) 11Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

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Types of Allergic Reactions  Type I: immediate (anaphylactic) hypersensitivity  Examples: allergic rhinitis, acute anaphylaxis, hives, eczema, asthma  Type II: cytotoxic hypersensitivity  Examples: transfusion reaction after receiving incompatible blood 13Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Types of Allergic Reactions (cont.)  Type III: arthus hypersensitivity (immune complex)  Examples: serum sickness, glomerulonephritis  Type IV: delayed cell-mediated hypersensitivity  Examples: contact dermatitis (poison ivy) 14Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Initial Symptoms of Impending Anaphylaxis  Sneezing  Tightness, tingling of mouth or face, with subsequent swelling of lips and tongue  Severe flushing, urticaria, and itching, especially on head and upper trunk  Rapid development of erythema  Sense of impending doom 15Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Managing Anaphylactic Shock  Ensure an adequate airway, possibly by endotracheal intubation.  Administer epinephrine.  Administer oxygen if available.  Administer corticosteroids and antihistamines as ordered.  Keep the child warm and lying flat or with feet slightly elevated.  Start an intravenous (IV) line. 16Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Question Which intervention is a priority for a nurse caring for a child with anaphylaxis? A. Providing supplemental oxygen B. Ensuring an adequate airway C. Initiating IV access D. Administering corticosteroids 17Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.