CV-Heme Flashcards
What is cardiac output?
Volume of blood pumped by heart in one minute
What is stroke volume?
Volume of blood pumped by heart in one beat
Formula for Cardiac Output?
HR x Stroke Volume
What is the most important vital sign that indicates how child is doing?
Heart Rate
What is Foramen Ovale?
Opening on wall between right and left atrium on septal wall
Blood from left and right atrium to mix.
Closes after birth
What is ductus arteriosus?
Connects the pulmonary artery to the aortic arch.
It closes off and turns into ligamenum arteriosus after birth
What is the most common heart anomaly?
Atrial septal defect (ASD)
Some causes of congenital heart disease?
Drug exposure: ~Lithium ~Depakote (valproic acid) ~ETOH ~Tobacco
Infection
~Rubella
Advanced maternal age (40 yrs +)
Chromosomal abnormalities ~Trisomies ~Turner ~Marfan ~DiGeorge
In Congenital Heart Disease, pressure within the heart is ___
Right side greater than left side
There is less resistance in pulmonary circulation than ____ circulation
systemic
Blood flows from area of ___ to ____ pressure
high
low
Abnormal connections change pressure result in ___ and ___
Left-to-right shunt
Right-to-left shunt
What defects cause increase in pulmonary blood flow?
ASD
VSD
PDA
What defects cause obstruction of blood flow from ventricles? (blood cannot get out of ventricles)
Coarctation of aorta
Aortic stenosis
Pulmonic Stenosis
What defect causes decreased pulmonary blood flow? (less blood going to lungs)
Tetralogy of Fallot
What defect causes mixed blood flow?
oxygenated and unoxygenated blood mixing together.
Transposition of great arteries
Hypoplastic left heart syndrome
What is the most common hematologic disorder of childhood?
anemia
What is anemia defined as?
Decreased RBC’s and/or Hgb concentration below normal.
Why does it take a while to notice anemia in children?
they adapt so well
What are causes of decreased red blood cell production?
Nutritional deficiency
Bone marrow failure
What are causes of increased red blood cell loss?
Acute blood loss
What are the causes of increased red blood cell destruction?
Intracorpuscular (Sickle cell disease)
Extracorpuscular (chemo, immunologic, infection)
How do we treat anemia?
Treat underlying cause
Supportive care
~Oxygen
~Bed rest
~IV fluids to replace volume
Nursing care management for anemia?
Prepare child and family for lab tests
Decrease O2 demands
~assess energy level
~minimize excessive demands
Prevent infection
Support family
Is iron deficiency anemia preventable?
Yes
Why are adolescents at risk for iron deficiency anemia?
Rapid growth and poor eating habits
Why are premature infants at risk for iron deficiency anemia?
Did not have chance to build iron stores during last trimester
Why are children 12-36 months at risk for iron deficiency anemia?
Dietary changes from formula or breast feeding to cows milk.
Milk is not high in iron.
Why do we give vitamin C with iron?
helps absorb iron
Which iron is best to give?
Ferrous iron
How do we administer oral iron?
use straw, or medicine dropper, and put in back of throat.
How is iron injection given?
Z track
deep IM
Do not massage
1 mL in one site
Can iron turn stool dark?
Yes
If both parents have sickle cell trait, each offspring will have what chance of having disease?
25%
1 in 4
Which hemoglobin replaces regular hemoglobin in sickle cell anemia?
Hgb S
Which hemoglobin replaces regular hemoglobin in sickle cell anemia?
Hgb S
What is the leading cause of death in young children with sickle cell disease?
bacterial infection d/t immunocompromise
What are precipitating factors for a sickle cell crisis?
Anything that increases body’s need for oxygen or alters transport of oxygen.
What are signs of a sickle cell crisis?
Fever
Pain
Tissue enlargement
What is a splenic sequestration?
Blood pools in liver and spleen and not enough blood can get in to circulation.
Life threatening
What are signs of splenic sequestration?
Profound anemia
weakness
hypovolemia
shock
How is sickle cell disease diagnosed?
Cord blood in newborn
Newborn screen
Genetic testing
Sickle-turbidity test, electrophoresis
May be diagnosed as a toddler after acute respiratory or GI infection
What is the medical management for sickle cell?
Aggressive treatment of infection
Prophylactic abx from 2 mo to 5 years
Monitor Retic count to evaluate bone marrow function
Blood transfusion (may reduce ischemia if given early in crisis)
Why do we give iron chelation treatment for sickle cell?
Frequent transfusions increases iron in tissues (hemosiderosis). Iron is building up in tissue - chelation therapy binds to iron and gets excreted
What drug is given to sickle cell patient?
hydroxurea
CYTOTOXIC
What are the main treatment goals for sickle cell
Pain Management Oxygen Hydration (oral or IV) Rest electrolyte replacement
Hemophilia is an __-linked recessive gene
X
Affects only boys
Which hemophilia is considered “classic”
A
What factor is deficient in hemophilia A?
factor 8
Which hemophilia is called “Christmas disease”?
Hemophila B
What factor is deficient in hemophilia B?
factor 9
What are some manifestations of hemophilia?
Mild to severe bleeding
ecchymosis, epistaxis, hematuria
Why do hemophilia symptoms often not show up until 6 months of age?
mobility leads to injuries from falls/accidents
What is hemarthrosis?
Bleeding into joint spaces of knee, ankle, elbow. Can lead to problems with mobility.
How is hemophilia diagnosed?
Amniocentesis
Genetic testing
Labs: low levels of factor 8 or 9, PTT
normal: platelet count, PT, fibrinogen
What is the medical management for hemophilia?
Limiting bleeding and preventing complications
Replace missing clotting factors
Corticosteroids if hemarthrosis
Transfusions
What is the drug to treat hemophilia
desmopressin (DDAVP)
What does DDAVP do?
Causes 2 to 4 times increase in factor 8 activity
Used for mild hemophilia
Is there a cure for hemophilia?
No
What are some interventions for hemophilia patients?
Close supervision and safe environment. Injury prevention
Dental procedures in controlled situation
Shave only with electric razor
Superficial bleeding: pressure for 15 min and ice to vasoconstrict
If significant bleeding, need transfusion
What is the priority care for hemophilia patient?
Prevent bleeding!!!
What is the treatment when hemophilia patient is having hemiarthrosis?
Elevate and immobilize joint
Ice
Analgesic
ROM after bleeding stops to prevent contractures
PT
Avoid obesity to minimize joint stress
What is the most commonly diagnosed cancer in children under age 14?
Leukemia
What are the two main types of leukemia?
ALL
AML
What is Acute lymphoblastic leukemia?
~Most common
~Peak onset 2-3 years of age
~Most common in caucasian and boys
What is acute myelogenous leukemia?
Most common in children under 2 and adolescent
More common in males and Asians/Pacific Islanders
What is the pathophysiology of leukemia?
Stem cells in bone marrow produce immature WBC that do not function properly
These cells fill bone marrow and spill into circulatory system, replacing normal WBC, RBC, & Platelet
What are the clinical manifestations of leukemia?
Standard anemia clinical manifestations, but also:
large bone/joint pain
hepatosplenomegaly
lymphadenopathy
IF CNS INVOLVEMENT: HA vomiting papilledema testicle enlargement
How is leukemia diagnosed?
Blood counts (anemia, thrombocytopenia, neutropenia)
Bone marrow biopsy (immature/abn lymphoblasts)
Elevated Ca+, K+, Phosphorus
What is the treatment for leukemia?
Radiation and chemotherapy
HSCT for AML
HSCT for ALL after relapse
What is the prognosis for leukemia?
90% survival rate for low-risk
75-80% survival rate for high-risk
What is the nursing management for leukemia?
Assessment!! Signs of bleeding/bruising/petechiae Signs of infection Renal function: spec grav, I*O, daily weight Nutrition: diet, n/v, constipation Oral mucosal ulcers Behavioral changes Pain/procedural pain
What is the nursing intervention for leukemia?
Prevent infection!!
Monitor kidney function (watch for hematuria). Keep spec grav low to make sure they are hydrated
Teach: med administration, side effects, worsening condition
Family support: coping, support groups
