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

Key immune structures, like the thymus and lymph nodes, are also analyzed in the context of child development. The text thoroughly explores the assessment phase, detailing crucial historical data (e.g., recurrent infections, growth failure) and diagnostic tests, including immunoglobulin electrophoresis, T-cell quantification, virologic assays (PCR/NAT for HIV), and delayed hypersensitivity skin testing. Specific immune disorders are examined, such as Primary Immunodeficiencies like Severe Combined Immune Deficiency (SCID) and Wiskott-Aldrich Syndrome, which often necessitate hematopoietic cell transplantation, and management often involves prophylactic measures and intravenous immune globulin (IVIG). Secondary immunodeficiency, focused primarily on HIV infection, stresses the importance of antiretroviral therapy (ART) to prevent the progression to HIV encephalopathy, alongside rigorous infection prevention protocols. Autoimmune disorders covered include Systemic Lupus Erythematosus (SLE), a multisystem disease causing vasculitis; Juvenile Idiopathic Arthritis (JIA), where inflammation targets the joints; and neuromuscular disorders like Myasthenia Gravis and Guillain-Barré Syndrome, with the latter requiring critical respiratory monitoring due to ascending paralysis risk. Finally, the chapter addresses IgE-mediated allergies, outlining the identification and management of food allergies and the emergency treatment of anaphylaxis using epinephrine (EpiPen), emphasizing the critical role of family education and continuous psychosocial support for children facing chronic immune challenges.