Ch. 14 Flashcards
iron deficient anemia
- most prevalent nutritional disorder in the USA
- varied causes
- age dictates treatment/restriction
- lower H&H
- total binding capacity is higher because body tries to compensate for a long time; once the reserve is gone, start to see more changes (skin, hair, nails)
iron deficient anemia clinical presentation
- HGB <10 g/dL in children
- r/o GI bleeding
- s/sx may be absent initially
iron deficient anemia treatment
- PO treatment; parenteral available
- Transfusion in severe cases
who is high risk for iron deficient anemia? (and why)
- premies: GI system is premature; breastmilk does not have iron in it! (breastmilk is good but need to add supplement)
- toddlers: picky eaters- whole milk, no meat, green vegetables
- teens: FAD diet, don’t want to eat something with iron in it, eating disorder, menses
iron deficient anemia risk factors
- unresolved iron deficiency as baby
- picky eating causing low intake of iron rich foods
- consistent high milk intake
- certain conditions that affect nutrient absorption
- poorly planned vegan or vegetarian diets
ferrous sulfate: dosing/administration
- typically PO BID x3 months
- admin btwn meals when HCL levels are lowest
- often used with excl. breastfed babies beginning around age 4-6 months
- avoid giving supplement with milk or dairy- dairy prohibits absorption of iron (ie for toddler- give with citrus base/water or empty stomach)
ferrous sulfate: side effects
- black stools- indicate iron is being absorbed (yellow indicates not getting supplement)
- temporary change in bowel habit until body adjusts to med
- teeth staining
- mouth care- can stain teeth
- kid that is big enough- use cup or straw
- baby use syringe
- special cup/straw: 9 months can start with cup/sippy cup/cup with straw
ferrous sulfate: nutrition
- admin with Vit C if possible (citrus)
- avoid milk-feeding phenomenon: once the child is a toddler and can receive milk, want nutrition to be coming from other sources: water, half strength juice, grapes, watermelon, vegetables, meats
- iron-fortified cereals: for baby
what is ferrous sulfate used for?
iron deficient anemia treatment
prevention of iron deficient anemia
- nutrition teaching:
*do not give baby cow’s milk until over 12 months old
*formula w/ iron; BF add iron supplement at 4 months
*after 12 months old, avoid more than 2 cups of whole cow’s milk/day
*feed older children diet with iron
*encourage the while family to eat citrus fruits or eat other foods high in Vit C - WIC program: make sure good foods
- Early screening: finger sticks around 9 months; toddlerhood; every visit during school-age and adolescent
- Supplemental
- Weaning off: goal is to get >10 in 1 month, goal is to be off within 6 months
hemophilia A
- x-linked recessive bleeding disorders: transferred from mom to son
- deficiency of factor VIII
- age of dx is related to severity
- often discovered by hemarthrosis = bleeding into a joint space
- females are carriers (not usually symptomatic, bleeding tendencies possible in 1/3 of carriers)
- more internal bleeding
mild deficiency of factor VIII
> 5% , <50% (5-40% of normal)
- rare spontaneous bleeding
- severe bleeding only with major trauma or surgery
- treatment: nasal spray
moderate deficiency of factor VIII
1-5% (1-5% of normal)
- occasional spontaneous bleeding
- may not know until teething
- prolonged bleeding after trauma or surgery (dental)
- hematoma when falls
severe deficiency of factor VIII
< 1% (<1% of normal)
- spontaneous bleeding into joints or muscles
- treatment: infusion (preventative injections into the vein)
hemophilia A: dx labs
- prolonged bleeding time (PTT)
- low clotting factor assay (VIII)
hemophilia A s/sx
Excessive bruising: bumped nose and gets two black eyes
Prolonged bleeding
Hemarthrosis: bleeding into a joint; decreased ROM, fx in the joint
Hematomas (when a normal child would just get a bruise)
Hematuria: blood in urine
Blood in stool
Hemorrhage (ex. brain)
hemophilia A treatment
Replace missing factor (VIII)
DDAVP
Steroids- to control swelling
use Tylenol if needed for fever
don’t use NSAIDS-caution as they inhibit platelet function
hemophilia A nursing goals
Prevent bleeding (amicar before dentist)
Recognize/control bleeding
- 1st action: RICE: rest, ice, compression, elevation
Prevent effects of bleeding
- RICE, then infusion
Teaching/home management
hemathrosis: manifestations and treatment
- ankles, elbows (common injury areas)
- DDVAP or factor VIII
activities for a child with hemophilia A
- golfing
- swimming
- track
*anything that is not direct contact
circumcision and hemophilia
- if we don’t know they have hemophilia: it will be a blood bath
- if we know they are hemophiliacs: talk to parents about risks and benefits; best to defer
ecchymosis, petechiae, purpura: manifestations and treatment
- tight clothing or accessories, tight equipment (ie sports, medical)
- venipunctures instead of fingersticks, padding, paper or silk tape
epistaxis: manifestations and treatment
- prolonged bleeding from one or both nostrils
- want head forward because we don’t want the blood to go back into throat
- pressure on the the nose for 10 minutes- no breaks
- ice could be helpful depending on location
hematuria/melana: manifestations and treatment
- bloody urine and stool
- need to be seen in hospital
dental procedures (oral): manifestations
- bleeding gums
other bleeding associated with Hem A: manifestations and treatment
- orifices, neck, chest, brain, rectal
- can be from regular activities (shaving- electric razor, venipunctures)
- menses: double pad
- avoid ASA, NSAIDS
- avoid injections
- no rectal temps or supp
- razor selection
von willebrand disease
another type of bleeding disorder
deficiency in vWF
- genetically transmitted
- more external bleeding, usually mild
von willebrand disease clinical presentation
- more external bleeding, usually mild
bruising
epistaxis
menorrhagia (pubescent): heavy menses
von willebrand disease treatment/mngmnt
Similar to hemophilia, but more external bleeding/milder
vWF infusion*
Desmopressin (DDAVP)*
BCP*
Tranexamic acid* to prevent pregnancy
- possible to outgrow if start with mild form young, as pt grows the vWF increases with growth
2021 guidelines for prophylaxis (EBP)
BAT (bleeding assessment tool) screening at primary care visits
Better blood testing available
Prophylaxis depends on a female’s interest in conceiving
Can outgrow with age (in some cases)
vWF serves two functions:
- to bind with factor VIII, protecting it from breakdown,
- and to serve as the “glue” that attaches platelets to the site of injury.
- Deficiency in this factor results in a mild bleeding disorder.
ITP (immune thrombocytopenic purpura)
- Unknown cause
- Most common bleeding disorder in children
- Usually affects age 2-10 yrs (toddler-school-age)
- Follows viral infection (i.e. respiratory, measles, chickenpox)
ITP (immune thrombocytopenic purpura) clinical presentation
Multiple ecchymoses and petechiae (purpura)
Low platelet count (thrombocytopenia) <20,000
- <10,000 think spontaneous bleeding is happening
- may look like child abuse originally: bleeding/bruising but with no breaks
ITP (immune thrombocytopenic purpura) treatment
- Steroids
- IVIG (blood product/over longer period of time/super expensive)
- Anti-D Antibody (cheaper/quicker (few minutes)/have to have a certain blood type)
*If not resolving-splenectomy (severe cases, over 5 yrs. of age)
ITP (immune thrombocytopenic purpura) nursing care
- Self-limiting illness
- Medication administration (treat IVIG as blood transfusion….)
- IVIG
- Limited activities with PLT 50-100,000 (<100,000)
- High bleed risk, no invasive procedures, monitor for signs/symptoms of bleeding as they are life threatening
- No contact sports
- No NSAIDS-Tylenol based pain mgmt.
- NSAIDS result in higher risk for bleeding and do not allow for clotting
ITP (immune thrombocytopenic purpura) chronic tx
- Romiplostim (Nplate)- help marrow to produce platelets after other measures have not resolved ITP
- Rituximab (Rituxan) an immunotherapy not chemotherapy agent that decreases the immune response to spare platelets
sx of spontaneous bleeding that would be cause for concern with ITP
- changes in VS
- GI sx
- increased ICP presentation
- pupils will not be equal/reactive to light
- seizures
plumbism
Exerts toxic effects on the bone marrow, erythroid cells, nervous system, and kidneys.
Interferes with biosynthesis of heme→anemia
Results in behavioral problems, learning difficulties. (Extremely high levels can result in encephalopathy, seizures, and brain damage)
Can affect any part of the body including renal, hematologic, and neurological systems. It often settles in bone and teeth. Interferes with calcium.
lead level in the blood: <5 mcg/dL (interventions)
- education, reassess and screen
lead level in the blood: 5-14 mcg/dL
repeat test in 1 month; (monthly then q3-4 months follow up) parent/caregiver education
lead level in the blood: 15-19 mcg/dL
- surveillance of environment, education, re-test and follow guidelines based on blood levels. involve social, refer to local health dept for investigation of home. follow up testing in one month. continued F/U based on levels
lead level in the blood: 20-44 mcg/dL
education, lead center referral, clinical and environment management; consider chelation therapy
lead level in the blood: 45-69 mcg/dL
- confirm results in 1-2 days- dx testing: parent/caregiver education; chelation therapy; health dept refer as above. aggressive management
lead level in the blood: >70 mcg/dL
- hospitalization is required; immediate testing, chelation therapy; no d/c until lead source is removed from home, school, or other environments
s/sx of anemia in young children
- pallor
- irritable
- FTT
- tachycardia/tachypnea (parents may not notice)
- frequent infections (sick all the time)
- poor feeding
- integumentary changes to skin/hair/nails if prolonged
s/sx of anemia in older children
- pallor
- fatigue/tired all the time
- tachycardia/tachypnea
- cool extremities/digits (feel cold all the time)
- behavioral problems
- PICA (craving non-nutritive substances)
- glossitis: tongue feels swollen
- integumentary changes to skin/hair/nails if prolonged
when do we give blood to a patient with iron deficiency anemia? (what is the hgb level)
around 5 g/dL
30 minutes before blood infusion
give acetaminophen and definhydrahmine (Benadryl): to counteract fever and allergic reaction (itching)
take VS
- again 15min after infusion started
- q15min until first 50mL is infused
- q1h until done
- blood can only be on that pump for max of 4hr (“expires” at 4 hr mark)
ways to limit lead exposure
- bottled water
- no shoes through the house
effects of lead on: bones
slow growth in children
effects of lead on: kidneys
- kidney failure
- bloody urine
- fever
- nausea
- drowsiness
- coma
- weight gain
- confusion
- rash
- urinary changes
effects of lead on: blood
- fatigue
- lightheadedness
- rapid heartbeat
- dizziness
- SOB
effects of lead on: heart
- adults have high blood pressure risk 50 years later after lead poisoning as a child
effects of lead on: reproductive system
- lower sperm count
- damage to sperm
effects of lead on: stomach
- abdominal pain
- cramping
effects of lead on: hormones
- impair cell growth
- disrupts vit D levels
- maturation
- tooth and bone development
effects of lead on: brain
- lowered IQ, ADHD, hearing loss, damaged nerves
- loss of body movement
- coma
- stupor
- hyperirritability
- death
