Nursing Care of Children with Immunologic Disorders

Perennial Allergic Rhinitis

• Occurs when the allergen is present year-round, such as house dust mites or pet hair
• Affects children year-round

Atopic Dermatitis (Infantile Eczema)

• Primarily a disease of infants, beginning as early as the second month of life and possibly lasting until the child is 2 to 3 years old
• Common locations: scalp, forehead, cheeks, neck, behind the ears, and extensor surfaces of the extremities
• Symptoms:
  • Dry skin
  • Itchininess, which may be severe, especially at night
  • Red to brownish-gray patches on hands, feet, ankles, wrists, neck, upper chest, eyelids, and inside the bend of the elbows and knees
  • Small, raised bumps that may leak fluid and crust over when scratched
  • Thickened, cracked, scaly skin
  • Raw, sensitive, swollen skin from scratching
• Risk factors: personal or family history of eczema, allergies, hay fever, or asthma
• Diagnosis: no lab test is needed, suspect a certain food caused the child's rash, ask about identifying potential food allergies
• Medications: creams to control itchiness and help repair the skin, antibiotics for infection, oral drugs to control inflammation, therapies (wet dressings, light therapy, counseling, relaxation, behavior modification)

Treatment for Eczema in Babies (Infantile Eczema)

• Identify and avoid skin irritants
• Avoid extreme temperatures
• Lubricate skin with bath oils, creams, or ointments

Diaper Rash

• Characterized by a skin in the diaper area appearing reddish and sore
• More common in babies below 15 months of age

Contact Dermatitis

• Type of eczema triggered by contact with a particular substance
• Causes:
  • Allergic contact dermatitis: occurs when the skin develops an allergic reaction after being exposed to a foreign substance
  • Irritant contact dermatitis: occurs when the skin comes in contact with a toxic material
  • Photocontact dermatitis: occurs when the active ingredients in a skin product are exposed to the sun and result in irritation

Causes of Acne

• Overactive sebaceous glands and/or fungal infection
• Sebaceous glands produce an oil-like substance (sebum) that carries dead skin cells through the follicles to the surface of the skin
• Skin cells, sebum, and hair can clump together into a plug, which gets infected with bacteria, leading to swelling and pimple formation
• Other causes:
  • Some medications that contain androgen and lithium
  • Greasy cosmetics
  • Hormonal changes
  • Emotional stress
  • Menstruation

Treatment for Mild Acne

• Over-the-counter (OTC) medications, such as gels, soaps, pads, creams, and lotions, that are applied to the skin
• OTC acne remedies may contain:
  • Resorcinol: helps break down blackheads and whiteheads
  • Benzoyl peroxide: kills bacteria, accelerates the replacement of skin, and slows the production of sebum
  • Salicylic acid: assists the breakdown of blackheads and whiteheads, and helps reduce inflammation and swelling
  • Sulfur: exact mechanism unknown
  • Retin-A: helps unblock pores through cell turnover
  • Azelaic acid: strengthens cells that line the follicles, stops sebum eruptions, and reduces bacterial growth

Treatment for Moderate to Severe Acne

• Corticosteroid injection
• Oral antibiotics
• Oral contraceptives
• Topical antimicrobials
• Isotretinoin

Cellulitis

• A common infection of the skin and the soft tissues underneath
• Risk factors:
  • Trauma to the skin
  • Diabetes
  • Circulatory problems
  • Liver disease like chronic hepatitis or cirrhosis
  • Skin disorders such as eczema, psoriasis, or infectious diseases that cause sores, like chickenpox
• Causes:
  • Injuries that tear the skin
  • Infections after surgery
  • Long-term skin conditions such as eczema or psoriasis
  • Foreign objects in the skin
  • Bone infections underneath the skin
• Common symptoms:
  • Redness
  • Red streaks
  • Swelling
  • Warmth
  • Pain or tenderness
  • Leaking of yellow, clear fluid or pus
• Signs and symptoms:
  • High fever or chills
  • Nausea and vomiting
  • Enlarging or hardening of the reddened area
  • Increased pain
  • Numbness
  • Other medical problems that may be affected by even a minor infection
• Diagnosis:
  • Medical history
  • Physical examination
  • Blood test
  • X-ray if there's a foreign object in the skin or the bone underneath is possibly infected
  • Culture and sensitivity test
• Treatment for mild cases:
  • Rest the area
  • Elevate the area to ease swelling and discomfort
  • Use over-the-counter pain relievers like acetaminophen or ibuprofen to ease the pain and keep for fever
  • Antibiotics for a week to 14 days
• Treatment for severe cases:
  • IV or intramuscular antibiotics if:
    • Infection is severe
    • Have other medical problems
    • Very young or very old
    • The cellulitis covers large areas, on hands, or is close to body parts like the eyes
    • The infection worsens even after taking antibiotics for 2 to 3 days

Thrush (Oropharyngeal Candidiasis)

• Occurs when the Candida yeast spreads in the mouth and throat, causing an infection
• Most common in newborns, the elderly, and people with weakened immune systems
• Signs and symptoms:
  • White or yellow patches on the tongue, lips, gums, roof of mouth, and inner cheeks
  • Redness or soreness in the mouth and throat
  • Cracking at the corners of the mouth
  • Pain when swallowing, if it spreads to the throat
• Treatment:
  • Antifungal medicines like nystatin, clotrimazole, and fluconazole
  • Rinsing the mouth with chlorhexidine (CHX) mouthwash may help prevent infections in people with weakened immune systems

Genital Yeast Infection

• A yeast infection that typically occurs when the balance in the vagina changes
• Signs and symptoms:
  • Extreme itchiness in the vagina
  • Redness and swelling of the vagina and vulva
  • Pain and burning when voiding
  • A thick, white "cottage cheese" discharge from the vagina
• Treatment:
  • Antifungal medicines

Tinea Infections

• Superficial fungal infections caused by three species of fungi collectively known as dermatophytes
• Types of tinea infections:
  • Tinea corporis (general skin), also known as ringworm
  • Tinea cruris (groin), also known as "jock itch"
  • Tinea pedis (feet)
• Diagnosis:
  • History and clinical appearance
  • Microscopy of potassium hydroxide prep
  • Culture or histologic examination
• Treatment:
  • Skin moisture
  • Antifungal agent
  • Allylamine medication (Naftifine (Naftin) and terbinafine (Lamisil))
  • Inherent anti-inflammatory properties or the use of a combination antifungal/steroid agent