Nursing Care of

a Family When
a Child Has an
Immune Disorders
Part 2

Ivy Royo Go, DScN

Level 2 Faculty
• Allergic diseases occur as a result of an abnormal
antigen–antibody response.
• Symptoms can be:
1. Chronic and Minor – Allergic/Seasonal Rhinitis
2. Acute and Severe - Anaphylactic reaction.
 ALLERGY
• HYPERSENSITIVITY

• Type 1 – occur immediately

• Type II, III & IV (humoral
response)
• Type IV – (cell mediated
response)
Assessment
1. A Family History
2. Obtain exact symptoms
3. Time of the Year
4. Allergy symptoms are vague
DIAGNOSTIC TESTS

1. IgE serum antibodies

2. Stool specimen for

ova and parasites
DIAGNOSTIC TEST
3. A Radioallergosorbent test
(RAST)
- the child's serum IgE is
allowed to react with specific
allergens
DIAGNOSTIC TEST
4. Skin Testing
-applied thru patch or
scratch
-intracutaneous
Therapeutic Management
3 Goals of Therapy
1. Reduce the child's exposure to
the allergen.
2. Hyposensitize
3. Use of a pharmacologic agents
(Antihistamines: Diphenhydramine
HCL, Cetirizine & Loratadine)
COMMON IMMUNE REACTIONS:
1. ANAPHYLAXIS SHOCK

• an acute reaction
characterized by
extreme vasodilation
that leads to
circulatory shock and
extreme
bronchoconstriction
that decreases the
airway lumens.
ASSESSMENT
Emergency Measures for Anaphylactic Shock

1. Anaphylaxis is an emergency, and fast action is

necessary.
2. Position the child
3. Administer aqueous epinephrine (Adrenalin, EpiPen)
4. Nebulized bronchodilators such as albuterol.
5. Administer oxygen by mask or nasal cannula.
6. Notify the cardiac arrest team.
EMERGENCY MEASURES FOR ANAPHYLACTIC
SHOCK
7. Anticipate use of diphenhydramine (Benadryl)
IM or IV.
8. Anticipate the need IV fluid line
9. If the child is experiencing seizures, prepare to
administer phenobarbital or diazepam.
10. Be prepared to administer corticosteroids as
second-line drugs.
COMMON IMMUNE REACTIONS:
2.Urticaria and
Angioedema
Urticaria, or hives, refers to flat
wheals surrounded by erythema
arising from the chorion layer of
skin;
ATOPIC DISORDERS
1. Atopic Dermatitis
(Infantile Eczema)
• a disease of infants, 2ND
month up to age 2- 3 years.
• food allergy (formula-fed
infants)
• fed solid food before 6
months.
• Sweating, heat, tight clothing,
and
• contact irritants
Therapeutic Management

1. Reducing allergen exposure.

2. Use of elimination diets .
3. Hydrate the skin (bath or applying wet
dressing).
4. Hydrating emollient such as petroleum jelly
(Vaseline) or even vegetable shortening
(Crisco)
5. Antihistamine to reduce itching. Topical
steroids, 1% hydrocortisone cream
2. Atopic Dermatitis in the Older Child

•occurs at puberty or late

adolescence (Yan, 2003).
•flexor surface of the
extremities and on the dorsal
surfaces of the wrists and
ankles. & eyebrows;
•Depigmentation or
hyperpigmentation is usually
present, and lichenification is
marked.
Atopic Dermatitis in Older Children

Therapeutic Management
• Stop scratching.
• use only a prescription soap
• avoid swimming in
• take a shower to remove
chlorinated pools.
perspiration, which is
• encourage them to shower irritating to skin.
well afterward to remove
• Avoiding tight clothing at the
chlorine from the skin and
flexor portions of the
• apply a skin emollient and extremities may also help
moisturizer such as Eucerin • hydrocortisone cream
after swimming. • Phototherapy with ultraviolet light
 3. ALLERGIC RHINITIS
A common allergic reaction that causes
inflammation in the lining of the nose.

CAUSE: Type 1 or immediate hypersensitivity

immune
response.
-occurs in 10% to 15% of children
(Cohet et al., 2004).

Dx. Test- Nasal Discharge Smear and RAST

ASSESSMENT
Therapeutic Management

1. Avoidance of allergens.
2. Use of pharmacologic agents
(antihistamines, leukotriene
inhibitors, or corticosteroids), or
3. Immunotherapy.
A food allergy is an abnormal
immune response to food.

Symptoms: MILD to SEVERE

itchiness, swelling of the tongue,

vomiting, diarrhea, hives, trouble
breathing, or low BP.

occurs within minutes to several

hours of exposure.
Therapeutic Management

1. Eliminate offending foods.

2. Read labels carefully when
doing purchases.
3. Help school-age children learn
to choose foods they can safely
eat .
TOXIC REACTION
SIDE EFFECTS
ALLERGIC EFFECTS
Stinging Insect Hypersensitivity
Assessment
• local edema at the site
• generalized urticaria, pruritus, and edema may develop.
• may progress to wheezing and dyspnea.
• severe shock and death result.
• The progression of symptoms may be slower to fatal
symptoms may occur as early as the second or third
exposure.
• IDENTIFIED AND GIVEN MEDS IMMEDIATELY TO
COMBAT SHOCK.
• TRANSPORT FOR EMERGENCY CARE.
TREATMENT
• subcutaneous injection of epinephrine
(EpiPens are available for self-injection);
• caution parents that the child will need to
learn to administer this to himself or
herself, or be certain that a responsible
adult accompanying the child will be able
to do it
CONTACT DERMATITIS
-an example of a delayed or type IV
hypersensitivity response
a reaction to skin contact with an allergen.
-diaper, cosmetics, earrings, poison ivy, latex
gloves
THERAPEUTIC MANAGEMENT
Remove the allergens.
Dressings moistened with water, saline, or Burow's
solution
Calamine or Caladryl lotion
Hydrocortisone lotions or creams
Baths with baking soda or oatmeal
a sedative
Here’s the last piece of
slide before we end…
Let us wrap up our
discussion.

Have a blessed day SNs.