Chapter 42: Immune Disorders in Children Nursing Care

Immune Disorders in Children Nursing Care details the structure and function of the pediatric immune system, exploring the dramatic physical and psychosocial consequences that arise when children develop immune disorders. The foundational discussion covers immunological components, including essential organs and specialized cells like T and B lymphocytes. B lymphocytes mediate humoral immunity by producing immunoglobulins (IgM, IgG, IgA, IgE), while T lymphocytes drive cell-mediated immunity through cytotoxic and helper T cells. The text classifies immune disorders into three main categories: immunodeficiency (underactive systems), hypersensitivity/allergy (overactive systems), and autoimmunity (self-target response). Immunodeficiency disorders are categorized as primary, resulting from inherited defects (such as Severe Combined Immunodeficiency or Selective IgA deficiency), or secondary, acquired through external factors like stress, severe infection, or Human Immunodeficiency Virus (HIV) infection. The chapter extensively covers HIV/AIDS, a retroviral condition that targets CD4 helper T cells, detailing transmission risks, especially perinatal exposure, management strategies involving continuous antiretroviral therapy (such as zidovudine), and the importance of prophylactic antibiotics against opportunistic infections. Furthermore, the chapter thoroughly addresses hypersensitivity reactions, which are classified into four types, with Type I immediate hypersensitivity being the most dangerous, leading to life-threatening anaphylactic shock. Management of anaphylaxis, often triggered by foods (especially peanuts) or insect stings, mandates immediate intervention with intramuscular epinephrine and requires a written emergency action plan. Common pediatric atopic disorders, including allergic rhinitis and atopic dermatitis (eczema), are examined, highlighting their IgE-mediated nature and familial tendency. Nursing management for immune disorders utilizes the nursing process and integrates Quality and Safety Education for Nurses (QSEN) competencies, focusing on assessment for symptoms, formulating diagnoses (for example, Infection risk, Impaired skin integrity), establishing outcomes, and implementing patient-centered care. Key interventions include extensive family education on allergen avoidance through environmental control measures, appropriate use of pharmacologic agents (antihistamines, steroids), and considering immunotherapy (hyposensitization) when avoidance is insufficient. The chapter also emphasizes public health relevance by outlining specific Healthy People 2030 goals related to reducing airborne toxins and increasing tobacco-free school environments to support children with immune sensitivities.