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Peds Exam 3 > Anemia part 2 > Flashcards

Anemia part 2 Flashcards

1
Q

What is the main issue with Hemophilia?

A

It is a disease where you lack the ability to clot due to not enough coagulation proteins

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2
Q

How is hemophilia passed down?

A

Familial in nature and genetically passed down in females

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3
Q

What fraction of hemophilia is from gene mutation though?

A

1/3 from mutation

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4
Q

Types of hemophilia?

A

Hemophilia A

Hemophilia B

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5
Q

Explain Hemophilia A

A

Deficiency in factor 8

- the most common

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6
Q

Explain Hemophilia B

A

Deficiency of factor 9

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7
Q

Where are factors produced?

What is the patho of the factors?

A

In the liver. And those with hemophilia do have some factors just not enough.

Factors should release in order to get to fibrinogen. If there’s no factor = no fibrinogen or clotting

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8
Q

Signs and symptoms of Hemophilia
Joints?

What will clotting factors test be like

A

Bruising easily
Bleeding too much
- can be internal or external

Also Hemarthorosis
- stiff, achy, red, edema, and loss of function of joints

Clotting factor test will be abnormal

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9
Q

What replacement can help treat hemophilia?

Where can they get treatment?

A

Replacing the factor 8 or 9

  • can either give the actual factor
  • or give plasma w that factor capability

Can do it in home for convenience

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10
Q

What is factor replacement treatment like with those who have mild hemophilia?

What if it is moderate to severe hemophilia?

A

Mild - receive infusion at time of bleeding incident

Moderate or Severe - prophylaxis infusions

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11
Q

What hormone replacement can help treat hemophilia?

And which route?

A

Vasopressin (ADH) can increase the factors
- but this doesn’t work for everyone

Oral and nasal route of ADH can treat mild cases

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12
Q

What medication can be given for hemophilia to make sure clots aren’t dissolving?

A

You would first give the factor dose but then give Amicar

- especially anytime before a surgery or procedure

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13
Q

What can you substitute the factors with if someones body doesn’t recognize the proteins?

A

Can give Vlla or activated prothrombin complex concentrate

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14
Q

What can help with joint inflammation or Hemarthorosis that comes with hemophilia?

A

Corticosteroids can be used for the inflammation

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15
Q

In hemophilia, what do we need to educate parents about?

A

Educate parents about not letting their child do dangerous activities or ones that may make them bleed.
- instead of playing football, have them do cross country.

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16
Q

What medications should those with hemophilia avoid? And why?

A

They need to avoid aspirin and nsaids.

They thin the blood and can increase the amount they bleed even more.

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17
Q

Nursing care for Hemophilia acronym

A

Factor replacement

Rest

Immobilize so you don’t dislodge clots and ice

Compression

Elevation

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18
Q

How expensive is factor replacement?

Is this an issue?

A

You pay per factor so very expensive.

Children get state health care but when they become an adult, this can be a problem.

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19
Q

What is Idiopathic Thrombocytopenia Purpura or ITP

A

Platelets are being destroyed which causes red poetical dots on the skin
- platelets are usually under 100k but can go lower

20
Q

What is the trigger of ITP or idiopathic thrombocytopenia purpura?

A

The platelets being destroyed is usually due to an autoimmune response that was triggered by an illness of some sort

  • may not even be an obvious correlation
  • usually from upper respiratory, human parvo, or varicella
21
Q

What education should we give with ITP?

A

Try to avoid dangerous activities here too

22
Q

What will be done if platelets get too low with ITP?

A

A transfusion

23
Q

Are there different types of ITP?

A

Either acute or chronic

24
Q

What types of treatment are given for acute ITP?

A

Try to treat trigger if possible but next best thing is supportive tx

  • restrict activity
  • IVIG IG to lower immune response
  • Anti-D antibody (but just know a hemodilution like anemia will occur but platelets will rise around 48 hours after
  • Prednisone to see if reducing immune response stops the trigger
  • Can do a transfusion of platelets if count gets too low
25
Q

What types of treatment will be used for chronic ITP?

A

Above all try to treat the trigger if possible

Can do a splenectomy if over 5 years old and not responding to other therapy since their spleen will be damaged already and that just makes immunity worse

Earlier immunizations but NO live viruses whatsoever

26
Q

With ITP should you use Nsaids (ibuprofen)?

A

No - use Tylenol instead.

27
Q

What is Disseminated Intravascular Coagulation or DIC

A

When micro clots and excessive bleeding are occurring at the same time

28
Q

What triggers the abnormal clotting in DIC?

A 
Hypoxia
Endothelial injury like burns
Acidosis
Shock
Severe systemic diseases
29
Q

What is the order of the clotting cascade with DIC?

A

Trigger > more thrombin > more fibrinogen > fibrin

30
Q

What is the patho of DIC?

A

Accelerated clotting > micro clots in vessels > tissue ischemia > loss of organ function and limbs > fibrinolytic mechanism activated

  • and then you have the break down of clots leading to bleeding)
31
Q

What risks can occur with DIC due to the clots in the vessels?

A

stroke or MI or anything that occurs when blood flow is occluded

32
Q

How to control bleeding in DIC?

A

Plasma factor- replacement is an option

Cryoprecipitate - accumulated antibody given to stop autoimmune responses

Platelet transfusion - done only if count is super low but do so cautiously

Fibrinogen - can be given but just depends on situation

33
Q

In DIC , will they give heparin to prevent the clotting?

A

Controversial. If they prevent the clotting, that person can bleed.

34
Q

Things to monitor with people who have DIC?

A

Monitor vitals, O2, and fluids if in the hospital

Illness should be monitored for so check temp.

Check their limbs for signs of problems. Don’t want any amputations

35
Q

Should we use nitroglycerin paste for those with DIC?

A

Well it dilates vessels to help with any obstruction from clots BUT it won’t dissolve the clot. It’ll just let the clot keep going.
Wouldn’t we rather let the clot form and know where it is in the body? Rather than have to guess where it is?

36
Q

Basic instructions for Pediatric CPR

A

Push hard and fast
Minimize interruptions (10-15 sec max for pulse check)
Full chest recoil
Don’t hyperventilate

37
Q

For CPR , there’s one rescuer. What is the ratio

How long should all respirations be?

A

30 compressions ; 2 breaths

Respirations should be 1 sec - no matter how many rescuers. You only need 10 per minute

38
Q

We have two rescuers for CPR. What is the ratio

How often should you rotate jobs

A

15 compressions ; 2 breaths

Rotate every 2-3 minutes

39
Q

How many compressions should be given per minute

A

100 compressions/minute

40
Q

Depth of compression for older kids?

Depth of compression for infants and young children?

A
  1. 5 - 2 inches

0. 3 - 0.5 of the AP diameter

41
Q

When a child goes into cardiac arrest - what is the cause

A

Respiratory issue & then they fail to compensate leading to the cardiac arrest

42
Q

How old does an infant have to be to use the AED?

Will an aed shock someone back to life?

A

1 years old at least

No. If a person is dead meaning no electrical activity going on in the heart, there is nothing you can do.
- there must always be some sort of electrical activity left to work

43
Q

What part of your body do you use when doing compressions for infants?

For older children?

A

Use your thumbs while supporting them with your hands
(sort of hold them like your reading a book)

Older children - use one hand

44
Q

If there is a code going on, what should someone try to establish?

What if it is hard to establish?

A

IV access.

Use intraosseous site if it is hard to establish

Insertion device may be available
- driven by facility policy

45
Q

If it comes down to using an endotracheal kit or bag and mask in CPR, what should you pick

A

Bag and mask

Peds Exam 3 (5 decks)

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