Ch. 21: Hematologic Disorders- Epistaxis & Iron Deficiency Anemia Flashcards
What are 4 blood disorders that may affect children?
Epistaxis
Iron deficiency anemia
Sickle cell anemia
Hemophilia
What kind of trauma can cause epistaxis?
Picking, rubbing nose–can cause the fragile, vascular mucus membranes in the nose to tear and bleed
What are some other things that cause nose bleeds?
Low humidity Allergic rhinitis URI Blunt injury Foreign body
Epistaxis: Medication that affect ______ can increase bleeding
Clotting
What diseases can epistaxis be the result of?
Von Willebrand
Hemophilia
ITP
Leukemia
Epistaxis: How should the child be positioned to prevent aspiration of blood?
Head tilted slightly forward
Epistaxis: Where do we apply pressure and how long?
Lower nose with the thumb and forefinger for at least 10 min
Epistaxis: Is it okay to put cotton or tissue into the side of the nose that is bleeding?
How should we tell the child to breathe during a nose bleed?
Yes; through the mouth
Epistaxis: What do we do if bleeding continues?
Apply ice across the bridge of the nose
Epistaxis: What may be inserted after a nose bleed to prevent crusting of the blood and possible recurrence of bleeding episode?
Water soluble jelly or petroleum
Epistaxis: What should we instruct parents of child to do during winter months?
Cool-mist humidifier
Iron deficiency anemia (IDA): How common is this in the US?
*IDA is not real abbreviation, but its how i’m referring to it in these flashcards
Most common anemia in US
**Iron deficiency anemia: Children ages _____ are at risk due to consuming a diet high in _____ without adequate intake of foods high in ___
12-36 months–due to consuming a diet high in COWS MILK without adequate intake of foods high in IRON
Why would adolescents be at risk for iron deficiency anemia?
Poor diets
Menses
Obesity
Iron deficiency anemia results in decreased ____
Hgb levels
What are 6 risk factors for iron deficiency anemia?
- Premature birth (results in decreased iron stores)
- Too much cow milk in toddlers
- Malabsorption disorder due to prolonged diarrhea
- Poor intake of iron
- Increased iron requirements (blood loss)
- Chronic disorders (folate deficiency, sickle cell anemia, hemophilia)
Iron deficiency anemia characteristics:
- How is the breath?
- Skin color?
- Fingernails?
- Energy or no energy?
- How’s the heart?
- Shortness of breath
- Pallor
- Brittle, spoon shaped fingernails
- Low energy: fatigue, irritability, muscle weakness
- Systolic heart murmur, enlarged heart, and/or HF
IDA: What is expected reference range of HGB for 2 months? 6-12 years? 12-18 years?
2 months: 9-14 g/dL
6-12 years: 11.5-15.5 g/dL
12-18 years: 13-16 g/dL (male); 12-16 g/dL (female)
IDA: What is the expected reference range of HCT for 2 months? 6-12 years? 12-18 years?
2 months: 28-42%
6-12 years: 35-45%
12-18 years: 37-49% (male); 36-46% (female)
IDA: What is mean corpuscular volume (MCV)?
Average size of RBC
IDA: What is mean corpuscular Hgb (MCH)?
Average weight of RBC
IDA: What is mean corpuscular Hgb concentration (MCHC)?
Amount of Hgb relative to size of cell
IDA: What will the CBC show?
Decreased RBC count, Hgb, and Hct
IDA: The reticulocyte count indicates bone marrow production of RBC. Would this be decreased or increased?
May be decreased
IDA: Serum ferritin level is an indicator of iron stores. Would this be decreased or increased?
Decreased
IDA: Provide iron supplements for preterm and LBW infants by the age of ___
2 months
IDA: Provide iron supplements to infants who are exclusively breastfed by the age of ___
4 months
IDA: What about for infants who are not being breastfed..when do they get iron?
Recommend iron-fortified formula
IDA: How much milk should toddlers get a day? Describe how milk should be given throughout the day to toddlers?
32 oz/day (950 mL)
- Delay giving milk until AFTER a meal
- Dont allow toddlers to carry bottles or cups of milk
IDA: When should we give iron supplements? Is it okay to give with meals?
1 hour before or 2 hours after milk or antacid to prevent decreased absorption
If tolerated, give on EMPTY stomach–give with meals at the start with reduced dose and gradually increase if GI distress occurs
IDA: What is common at the start of iron supplementation? Does it get better or worse with time?
GI upset (diarrhea, constipation, nausea) common at START of therapy–these will DECREASE over time
IDA: What can we give to help increase the absorption of the iron supplement?
Vitamin C
IDA: Why do we use a straw to give liquid iron supplements?
Liquid iron can stain the teeth
IDA: What method do we use if we are giving a parenteral injection of iron? Ok to massage the site afterward?
Z-track into deep muscle for parenteral injections; do not massage after injection
IDA: Client teaching..what should be included?
- Expect stools to turn a tarry green color
- Brush teeth after oral dose to minimize or prevent staining
IDA: At the start of iron supplementation therapy, iron may cause GI distress, such as constipation. If this occurs, what should we tell the client to do?
Increased fiber and fluids if constipation develops
IDA: What are examples of iron sources in infants?
Iron fortified cereal and formula
IDA: What are examples of iron sources for older children?
Dried beans and lentils PB Green, leafy vegetables Iron fortified bread and flour Poultry Red meat
IDA: What are 2 complications of iron deficient anemia?
HF
Developmental delay
A nurse is providing teaching about the management of epistaxis to a child and his family. Which of the following positions should the nurse instruct the child to take when experiencing a nose bleed?
A. Sit up and lean forward
B. Sit up and tilt the head up
C. Lie in a supine position
D. Lie in a prone position
A
A nurse is providing teaching about epistaxis to the parent of a school-age child. Which of the following should the nurse include as an appropriate action to take when managing an episode of epistaxis? (SATA)
A. Press the nares together at least 10 min
B. Breathe through the nose until bleeding stops
C. Pack cotton or tissue into the naris that is bleeding
D. Apply a warm cloth across the bridge of the nose
E. Insert petroleum into the naris after the bleeding stops
A, C, E
A nurse is providing teaching to the parent of a child who has a new prescription for liquid oral iron supplements. Which of the following statements by the parent indicates an understanding of the teaching?
A. I should take my child to the ED if his stools become dark
B. My child should avoid eating citrus fruits while taking the supplements
C. I should give the iron with milk to help prevent an upset stomach
D. My child should take the supplement through a straw
D
A nurse is preparing to administer iron dextran (proferdex) IM to a school-age child who has iron deficiency anemia. Which of the following by the nurse is appropriate?
A. Administer the dose in the deltoid muscle
B. Use the Z-track method when administering the dose
C. Avoid injecting more than 2 mL with each dose
D. Massage the injection site for 1 min after administering the dose
B
