1229 Exam 7: childhood anemia Flashcards
HGB
13-18 males
12-18 females
Newborn 14.5. - 22.5
Measures amount of iron
RBC
4.2 - 5.9 # RBC Reflect bone marrow function
HCT
42-50% male
48-50% females
% of RBC
MCV
80-94 mcm3
Mean size of one RBC
WBC
5-10
Total number of WBC
Retic count
0.5 % -1.5%
Erythrocytes
Reflects bone marrow production
Is the number of immature red blood cells
Childhood anemia diet hx
Reflects inadequate amounts of dietary iron sources
Breast milk without supplemental iron
Newborns have stored iron that will last ———
4-6 months
S/s of childhood anemia
Tachycardia Headache Fatigue Shortness of breath Systolic murmur Pica Overweight, underweight , chubby Pale 5-6 months old Decreased HgB < 10 or 11 cells are small microcytic
Administration of ferrous sulfate
Give through straw or syringe Sid elf mouth Brush teeth afterwards Give with citrus source such as orange juice Vit C increase absorption Give between meals DO NOT GIVE WITH MILK milk blocks uptake
What to teach about ferrous sulfate
BM will be dark tarry green
IM iron must be given z tract DO NOT MASSAGE SKIN AFTER
iV - a lot of anaphylaxis and stains skin must be tested 1st
ferric form is not as absorbable as ferrous kind
Meat has formed heme leafy greens is preformed heme.
Sickle cell
Suckling of RBC which occlude micriocirculation
Increase RBC destruction
Vasoocclusive , acute splenic sequestration
Sickle cell in genetics
Autosomal recessive
African American
If both parents are carriers of the trait what percentage of their children are more than likely going to have the disease?
25%
If both parents are carriers of the disease what is the percentage of their child being a carrier ?
50%
S/s of sickle cell
Vasoocclution Acute splenic sequestration Aplastic Hyper hemolytic (destruction of blood cells) CVA Chest syndrome Infection
Assessment for sickle cell anemia
Racial background Results of screening (sickle turgidity / sickledex) Tachycardia Dark urine Enlarged spleen Enlarged liver Frontal bossing Decreased activity Pain SOB Slurred speech/altered mobility Increase for infection Enuresis Visual disturbances Skeletal deformities Osteomyelitis - bone infection
Nursing DX sickle cell
Risk for infection Acute pain Impaired gas exchange Impaired physical mobility Impaired cardiac output Activity intolerance Self deficit Altered growth
What is the number 1 killer of sickle cell patients?
Infection
Painful erection in young boys
Pripism
PO fluids
100ml/ kg for 1st 10 kg
50 mL/ kg for 2nd 10 kg
20 mL/ kg for remainder
What pain med do you not give children with sickle cell
Demerol
To much iron
Iron overload
Hemochromatosis
Removing heavy metals from the blood is called ?
Chelation
Why no Oxygen therapy for sickle cell patients?
It prevents production of red blood cells
Why will sickle cell children have enuresis ?
Small kidney have small nephrons so bed wetting is more frequent.
Beta thallesemia
Aka Cooley anemia Major defect HEM A chain Autosomal recessive Homozygous form Defective HgB with short lifespan Structurally impaired RBC
Ethnicity of thallesemia
Mediterranean decent, Greek, Italian , Syrian
S/s of thallesemia
Pallor Fever Poor feeding Enlarged liver/spleen Headache Small structure delayed sexual maturation Bronzed freckled skin if no chelation Older children( large heads ) Bossing frontal bones Check bones Protrusion of lips Teeth dont set correctly Osteoporosis
Nursing Dx
Risk for infection Impaired cardiac output Impaired gas exchange Activity intolerance Knowledge deficit Anxiety r/t multiple painful procedures.
Goal for thalassemia HGB?
> 9.5
A Heavy metal antagonist antidote
Desferal
Oral- defersx
________is rubbed on the skin to decrease pain of needle sticks
eMLA
Hemophilia
X linked recessive 80% are classic
Deficiency of factor VIII by liver
Primary males
Vonwille brand vWF deficiency effects both male and females ( treated with DDAVP )
Can a female have hemophilia?
Yes
Assess
Assess inheritance pattern Review results of clotting studies Assess for bleeding in joints Assess joints and mobility Assess for signs of bleeding (warmth , redness , pain)
Nursing Dx for hemophilia
Risk for hemorrhage
Risk for injury
Deficient knowledge
Acute pain
Signs of bleeding ?
P, R increase
bP decreases
What do you reconstitute factor VIII with before you administer?
Sterile water
Keeps clots from breaking down.
Given for oral surgery and trama
Amicar
Which is better vein puncture or heal stick for hemophilia patients ?
Veinipunture
RICE
Rest
Ice
Compression
Elevate
