MB4 Peds Hematology Forsythe

Card Set Information

Author:
mthompson17
ID:
214619
Filename:
MB4 Peds Hematology Forsythe
Updated:
2013-04-20 13:31:13
Tags:
hematology pediatric nursing
Folders:

Description:
Peds hematology
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user mthompson17 on FreezingBlue Flashcards. What would you like to do?


  1. When is Fe deficiency anemia most likely to happen in peds?

    When is it rare?

    Why these ages?
    rare before age 4 yo 6 mo.  b/c still have maternal Fe stores.  These become depleted around age 9-24 months which is when Fe deficiency anemia is most often seen
  2. What is the main consideration with Fe deficiency anemia?
    compromised tissue oxygenation
  3. Why is tissue oxygenation compromised in Fe deficiency anemia?
    cannot make HgB -> RBC are broken down -> exceeds ability of the body to make new RBC
  4. What babies are at risk for IDA?

    Why?
    premature and low birth weight

    they did not store as much Fe from the mothers
  5. 5 etiologies of IDA?
    • 1. premature/low birth weight
    • 2. excessive intake of cows milk
    • 3. decreased Fe intake
    • 4. increased Fe lost
    • 5. periods of increased growth rate
  6. Therapeutic prevention of IDA in babies?
    start on Fe supplements around 2 months of age
  7. Why does intake of cow's milk cause Fe deficiency anemia?
    causes diarrhea and GI bleeding
  8. Prevention of FE deficiency anemia r/t milk intake?
    no cow's milk before 12 mo.

    CH < 12 mo - no more than 24 oz per day
  9. Who is most at risk for poor Fe intake?
    adolescents - poor habits
  10. What peds pt may be at risk for Fe deficiency anemia r/t iron loss?
    adol. girls - periods
  11. 2 periods of increased growth rate that may increase risk for Fe deficiency anemia?

    Why?
    • 1. adolescents
    • 2. premature and low birth weight babies

    growing rapidly = increased need for Fe
  12. Clinical manifestations of IDA?
    • 1. skin - pallor, pale/porcelain skin tone
    • 2. sclera pale
    • 3. MM - pale
    • 4. tachycardia
    • 5. cardiomegaly
    • 6. heart murmur (severe anemia)
    • 7. poor school performance
    • 8. koilonychias (spoon nail)
    • 9. lethargy & fatigue
    • 10. slow, strained movements
    • 11. difficulty sucking/too tired to eat
    • 12. sagging, limp posture
  13. Why does tachycardia occur in anemia?
    to compensate for RBC and decreased O2 to tissues
  14. How is murmur r/t anemia Tx?

    Nursing consideration?
    will reverse when anemia is treated

    Tell parents murmur whould go away
  15. Why may school performance suffer with anemia?
    no energy...no energy to eat
  16. How to assess a peds pt for fatigue r/t anemia?
    ask the pt if they act tired a lot or take a lot of naps or play differently or not at all
  17. How to assess anemia fatigue in an infant?
    ask parent about the infant's movements and how much it sleeps
  18. 6 Dx eval. for IDA?
    • 1. 24 h dietary Hx
    • 2. HgB
    • 3. RBC
    • 4. reticulocyte (immature RBC)
    • 5. Fe
    • 6. Fe binding capacity (Fe carrying proteins)
  19. What 2 things are included in a 24 h dietary Hx for Dx of IDA?
    • 1. foods eaten
    • 2. description of CH activities during that time
  20. Lab tests for Dx of IDA include those that measure _____, ________, ________.
    • 1. HgB
    • 2. morphologic changes in RBC
    • 3. Fe concentration
  21. HgB level in IDA?
    6-11 g/dL
  22. RBC appearance in IDA?
    microcytic and hypochromic (small and pale/decreased HgB content)
  23. Reticulocyte?

    What will they be like in IDA?
    immature RBC

    normal or slightly reduced due to decreased Fe stores

    may be elevated in severe anemia r/t hypoxia -> erythropeietic response
  24. Fe-binding capacity lab test?

    What will it be like in IDA?  Why?
    binding capacity/measurement of all proteins available for binding Fe

    increased in IDA b/c decreased Fe levels
  25. 2 Tx of IDA?
    • 1. increase Fe in diet
    • 2. Fe supplements
  26. Why are supplements used along with diet in IDA?
    b/c absorption of Fe from foods is unreliable
  27. Foods that inhibit Fe absorption?
    • 1. spinach
    • 2. sweet potatos
    • 3. coffee
    • 4. tea
  28. 7 iron rich foods?
    • 1. egg yolks
    • 2. dried beans
    • 3. cream of wheat
    • 4. dried fruit
    • 5. liver
    • 6. iron-fortified cereal
    • 7. green leafy veggies
  29. 4 examples of green leafy veggies rich in Fe?
    • 1. broccoli
    • 2. romaine lettuce
    • 3. collard greens
    • 4. mustard greens
  30. 5 considerations for Fe supplement admin?
    • 1. admin tid
    • 2. use a straw, dropper, or syringe
    • 3. place at back of mouth and away from the teeth
    • 4. brush teeth or wipe with wash cloth
    • 5. Admin with Vit C
  31. Nursing consideration when giving Fe supplements to children?
    stains the teeth
  32. 3 juices high in vitamin C?
    • 1. orange
    • 2. tomato
    • 3. grapefruit
  33. 3 juices low in Vit C?
    • 1. pear
    • 2. apple
    • 3. peach
  34. SCA and SCD?
    sickle cell anemia

    sickle cell disease
  35. 2 ways SCA and SCD are different?
    • 1. SCDs are broad category of hemoglobineamias
    • 2. SCA is one of the groups of SCDs
  36. Hemoglobinopathies?
    a genetic disease caused by or ass. with abnormal HgB
  37. 3 common forms of sickle cell disease?
    • 1. sickle cell anemia - homozygous HgBS
    • 2. sickle C disease - HbC
    • 3. sickle beta-thalassemia syndrome
  38. 2 general char of all 3 forms of SCD?
    1. inherited autosomeal recessive - 2 copies of an abnormal gene present

    2. life-long disease
  39. Normal HgB?

    Abnormal HgB in SCA?
    HgBA

    HgBS
  40. Inheritance of SCA?
    autosomal recessive
  41. 6 races that get SCA most?
    • 1. AA
    • 2. mediteranean-Italians & Greeks
    • 3. East Indian
    • 4. Middle Eastern
    • 5. Caribbean
    • 6. Central and South American
  42. _____ in 1000 AA have SCA and ______ have the trait.
    3 in 1000

    1 in 12
  43. Patho of SCA?
    sickled or elongated RBC -> stasis of RBC & increased blood viscosity -> obstructed blood flow -> tissue ischemia DISTAL to obstruction -> acute pain & cell infarction/death
  44. Where does blood flow obstruction r/t SCA usually occur?
    at bifurcations in BV
  45. Dx tests for SCA?
    • 1. HgB electrophoresis
    • 2. sickledex (sickle solubility test)
    • 3. reticulocyte count
  46. Definitive test for SCA?
    HgB electrophoresis - shows have SCA trait
  47. Purpose of Sickledex test?
    detects presence of HgBS but not the trait that causes SCA
  48. What will reticulocyte count be like with SCA?

    Rationale?
    elevated

    normal RBC lives for 120 days/4months.  Sickled RBC dies withing 12 days so need increased RBC production
  49. S/S of SCA are primarily the result of what 2 things?
    1. obstruction caused by the sickled RBCs and tissue ischemia/infarction distal to obstruction

    2. increased RBC destruction
  50. What is a sickle cell crisis?
    a broad term for several acute or exacerbating conditions occurring with sickle cell anemia
  51. Etiologies of SCA crisis?
    • 1. infection
    • 2. dehydration
    • 3. hypoxia
    • 4. trauma/phys stress
    • 5. general stress
  52. 3 types of SCA crisis/complications?
    • 1. vaso-occlusive crisis
    • 2. acute sequestration crisis
    • 3. aplastic crisis
  53. Char of carrier state in SCA?
    • 1. normally has no s/s
    • 2. under extreme stress may have s/s:  extreme vigorous exercise, high altitudes

    Denver/Colorado mountains
  54. Most common SCA crisis type?
    vaso-occlusive
  55. 5 s/s & complications of vaso-occlusive crisis?
    • 1. bone and joint pain
    • 2. dactylitis
    • 3. acute chest syndrome
    • 4. priapism
    • 5. CVA
  56. Most serious complication of a vaso-occlusive crisis?
    CVA
  57. 3 char of pain r/t vaso-occlusive crisis?
    • 1. in bone and joints
    • 2. can occur anywhere in body
    • 3. mild to severe
  58. Dactylitis?
    inflammed/red & edematous hands and feet
  59. 4 S/S of acute chest syndrome r/t vaso-occlusive crisis?
    • 1. chest pain
    • 2. fever
    • 3. cough if occluded in chest area
    • 4. severe abd pain
  60. Priapism?
    erection that won't go down
  61. 7 S/S of a CVA r/t vaso-occlusive crisis?
    • 1. altered LOC
    • 2. vision changes
    • 3. headache
    • 4. hemi or monoparesis
    • 5. aphasia/dysphasia
    • 6. ataxia
    • 7. seizures
  62. Hemiparesis?
    weakness on one side of the body
  63. Monoparesis?
    one limb is very weak but not paralyzed
  64. 2 S/S of acute sequestration crisis?
    • 1. splenic enlargement
    • 2. hypovolemic shock
  65. What is the main concern with acute sequestration crisis?
    blood volume r/t risk for hypovolemic shock
  66. Hemolytic anemia HgB level?

    Potential causes of hemolytic anemia?
    6 to 9 g/dL

    aplastic crisis
  67. Aplastic crisis?

    6 s/s?
    abnormal decrease in reticulocytes

    • 1. pallor
    • 2. fatigue
    • 3. lethargy
    • 4. fainting
    • 5. dyspnea/breathlessness
    • 6. HA
  68. 12 Tx for SCA crises?
    • 1. monitor V/S q 4 h or more prn
    • 2. bed rest
    • 3. maintain O2 sat >95% (96 or above)
    • 4. PAIN CONTROL
    • 5. age-app. non-pharmacologic pain relief
    • 6. apply heat to painful joints prn
    • 7. HYDRATION
    • 8. strict I&O
    • 9. perform passive ROM
    • 10. Meds
    • 11. admin of RBC
    • 12. instruct in foods high in folic acid
  69. Rationale for checking V/S q 4 h in SCA crises?
    CH with SCA more at risk for infection r/t splenic damage due to crisis of acute sequestration
  70. CH with SCA may have splenic dysfunction by age _____.
    5
  71. Why are SCA crisis pt put on bed rest?
    to reduce O2 expenditure
  72. Rationale for keeping O2 sat at 96 or above in SCA crisis?
    ease work of breathing & facilitate tissue oxygenation

    prevent more sickling - hypoxia can cause crisis
  73. Pain control in SCA crisis?

    Rationale?
    Morphine around the clock

    maintain cont analgesic blood level & reduce met. demand for O2 to help end sickling
  74. Why use non-pharm pain measures in SCA crisis?
    distraction!!
  75. Why apply heat to painful joints in SCA crisis?
    vasodilation - increase blood flow & O2 to the tissues
  76. Fluids used for SCA crisis?

    Why?
    D5W1/2NS 1 to 1/2 X the maintenance rate


    reduces viscosity of blood (water will go into cells) & provides glucose and fluid

    alleviating sites of vascular occlusion and preventing further sickling caused by dehydration
  77. D51/2NS is a _______-tonic solution.
    hypotonic
  78. 3 functions of D51/2NS in SCA crisis?
    cells hydrated, blood hydrated with free water, and gives glucose for energy
  79. Why monitor I&O in SCA crisis?

    Maintain UO at ______.

    How to assess I&O of a baby/child?
    monitor for kidney failure r/t infarction of renal artery

    1mL/kg/h

    weigh diapers or tell parents to catch it in hat/urinal
  80. 3 meds that may be used in SCA crisis and their functions?
    • 1. hydroxyurea - increases HgB levels
    • 2. folic acid - needed for RBC production
    • 3. RBC transfusion - last resort
  81. Why admin RBC in SCA crisis?
    to maintain HgB and increase O2 carrying capacity and decrease further sickling & microvascular ischemia
  82. What drug may given to SCA crisis pt prior to a blood transfusion?

    Why?
    immunosuppresors

    more at risk for transfusion reactions b/c receive so many of them & may dev hypersensitivity
  83. 8 foods high in folic acid?
    • 1. green leafy veggies
    • 2. broccoli
    • 3. oranges, canteloupe
    • 4. nuts
    • 5. peanut butter
    • 6. dried beans/peas
    • 7. enriched breads & breakfast cereal
    • 8. enriched pasta and grain
    • 9. probably need a suppement
  84. 2 interventions to decrease blood transfusion reactions in SCA crisis pt?
    • 1. give immunosuppressants before
    • 2. give leukocyte-poor/washed RBC to decrease reactions
  85. Major risk for _____ with SCA r/t ______.

    What age does this start and when may there be total dysfunction?
    infection r/t splenic dysfunction

    starts as early as 6 mo.

    5 years old
  86. Tx for immunocompromised state of SDA?
    daily penicillin starting at 2 months and ont. until at least 5 years or throughout childhood
  87. 3 immunizations that should be give to SCA child?
    • 1. pneumococcal
    • 2. meningococcal
    • 3. influenza
  88. 12 things to teach parents for home care of child with SCA?
    • 1. encourage fluids & increase for hot weather etc
    • 2. expect frequent urination
    • 3. provide rest
    • 4. avoid cold (crisis) & extreme heat(dehydration)
    • 5. avoid infectin
    • 6. avoid prolonged sun exposure
    • 7. monitor body temp & notify MD if increases - do not use antypyretics without talking to MD
    • 8. Admin penicillin qd
    • 9. avoid use of aspirin - acet/ibu alternatives
    • 10. avoid high altitudes
    • 11. call primary caregiver if s/s of infection
    • 12.know MD phone #
  89. Beta-thalassemia?

    AKA?
    autosomal recessive disorder char by abnormal HgB synthesis
  90. 3 races that have high incidence of BT?
    mediterranean, Asian, AA
  91. Onset of BT?

    When?
    insidious

    late infancy or early toddlerhood & lasts whole life
  92. Cause of death in BT?
    usually causes heart and/or liver failure by 20 to 30
  93. 4 S/S of BT?
    • 1. severe anemia
    • 2. growth maturation retardation
    • 3. facial features changed
    • 4. hepatosplenomegaly
  94. Why does growth maturation retardation occur in BT?
    excessive erythropoiesis
  95. 5 char. of BT facial features?
    • 1. enlarge head
    • 2. frontal & parietal bossing(enlargement)
    • 3. severe maxiallary hyperplasia (top bucked)
    • 4. malocclusion - teeth not aligned
    • 5. bronze skin tone
  96. 3 therapeutic management Tx for BT?
    • 1. erythrocyte transfusion
    • 2. chelation therapy
    • 3. splenectomy
  97. Why do BT need chelation?
    have build up of Fe from blood transfusions
  98. Hemophilia?
    Xplinked autosomal recessive disorder with a dificiency in one of blood coagulation factors - lifelong and genetic
  99. Hemophilia A & B? 

    Other factor that may be missing?
    • A - factor VII deficient
    • B- factor IX deficient
    • factor XI
  100. 3 bleeding classifications of hemophilia?
    • 1. mild - bleeding occurs with severe trauma
    • 2. moderate - bleeding occurs with minor trauma
    • 3. severe - bleeding occurs with NO traum.  Bleeds spontaneously!
  101. Who gets hemophilia?

    Women?
    men

    mostly carriers
  102. Can a man with hemophilia pass it to his son?
    no it is X-linked
  103. Clinical manifestations of hemophilia in a newborn? (2)
    • 1. abnormal bleeding from umbilical cord
    • 2. prolonged bleeding after circumcision
  104. 3 s/s of hemophilia?
    • 1. bruise easliy
    • 2. epistaxis
    • 3. bleeding anywhere
  105. Most common sites of bleeding with hemophilia?
    1. muscles and joints - hemarthrosis
  106. 4 Dx evals for hemophilia?
    • 1. Hx of bleeding in infants/toddlers
    • 2. test of hemostasis
    • 3. test blood clotting
    • 4. test clotting factor function
  107. 2 ways to test hemostasis?

    What will be the results in hemophilia?
    1. platelet aggretation- will be prolonged

    2. bleeding time - increased
  108. 2 ways to test blood clotting?

    results in hemophilia?
    • 1. PT - increased
    • 2. PTT - increased
  109. How is clotting factor function tested?
    fatory assays - will tell which clotting factor is affected
  110. Most definitive test for hemophilia?

    Why?
    factory assays that show if clotting factors are affected
  111. What vitamin increases the absorption of Fe?
    vitamin C
  112. Therapeutic management of hemphilia?
    no cure

    • 1. classification of bleeding
    • 2. type of deficient clotting factor
  113. Severe bleeding in hemophilia char & Tx?
    occurs spontaneously

    • 1. factor replacement w/ human blood or recombinant clotting factors
    • 2. RICE
  114. How is factor replacement with hemophilia given?

    When may a child admin own med?

    Cost?
    admin IV over 5 minutes

    8 years old

    100-200,000
  115. RICE in hemophilia?
    • rest 24-48 hours
    • ice
    • compression
    • elevation
  116. Tx of mild-mod bleeding in hemophilia?

    Route and action?
    DDAVP/desmopressin - stimultes release of factor VIII

    route:  intranasal
  117. Teaching for hemophilia child?
    • 1. Avoid toys with sharp edges, sharp scissors, straight razors, IM/IV meds, aspirin/ibup/finger sticks
    • 2. use soft toothbrusha dn water irrigating device
    • 3. use elc razor
    • 4. wear helmet with bike
    • 5. wear joint pads when playing
    • 6. padded crib sides
    • 7. med ID bracelet or necklace
    • 8. keep on hand at all times bags of ice or cold packs
  118. What may be used in place of finger sticks for hemophiliacs?
    venipuncture b/c causes less bleeding
  119. Immune thrombocytopenic purpura?

    AKA?
    low platelet count

    idiopathic thrombocytopenic purpura or hemorrhagic disorder
  120. 5 char of ITP?
    • 1. thrombocytopenia - <150,000
    • 2. pupuric rash, petechiae, echymoses
    • 3. normal bone marrow
    • 4. absence of identifiable cause
    • 5. autoimmune reesponse to disease
  121. Purpuric rash?
    any rash in which blood cells leak into the skin or MM
  122. Petechiae?
    pinpoint purpuric lesions
  123. Ecchymoses?
    larger hemorrhages into the skin=- bruising
  124. When is ITP usually seen?
    after upper resp infections or viral infections:  measles, rubella, mumps, chickenpox, 5th disease or parvovirus B19/slapped face
  125. 2 classifications of ITP?
    1. acute - self-limiting course (1 to 3 months)

    2. chronic - lasts longer than 6 months
  126. 2 Dx evals for ITP?
    1. thorough Hx including:  fam Hx, recent meds, recent vaccination w/ liv virus, recent viral infections o upper resp infection

    2. low serum platelet count - below 150,000
  127. 3 clinical manifestations of ITP?

    How will they begin?
    • 1. bruising, petechiae and/or ecchymosis
    • 2. bleeding gums
    • 3. heavy menstrual flow

    begin abruptly
  128. 2 goals in management of ITP?
    • 1. prevent rare, life-threatening bleeding events:  intracranial bleeding
    • 2. restore platelet count to above 200,000
  129. 4 nursing interventions for ITP?
    • 1. assess for s/s of bleeding from any body system
    • 2. monitor platelet count
    • 3. no IM injections, aspiring or aspirin containing products, NSAIDS
    • 4. restrict activity at onset:  no bikes, contact sports, etc
  130. Medical treatement of ITP?
    • 1. acute ITP:  watch and wait - monitor bleeding and monitor platelets
    • 2. oral or IV corticosteroids :  block autoimmune destruction of platelets
    • 3. IV admin of immunoglobulins (IVIG)
  131. Tx of chronic ITP that doesn't respond to meds?
    splenectomy

    will try to wait until at least 5 years old

What would you like to do?

Home > Flashcards > Print Preview