heamatology Flashcards
platelets: >100,000 - normal
no contact sports, protective equip
platelets: 50 - 100,000
padding, protective
platelets: <50,000
quiet activities, extreme caution
platelets: >20,000
return to school
ANC calculation
% segs + % bands x wbc
>1000 is ok
< 500 = severe risk of infection
neutropenia nc
anc < 1000
VS (temp >100 = emergency), HH, inspect skin and mouth, no flower or plants, decrease bacteria in food (right temp, no skins, no pepper), changes dressings and lines with sterile technique, no live vaccines, avoid contact with ill, wear mask outside room
anemia cm
anorexia, pallor, skin breakdown, jaundice, tachy x2, altered neuro or behavior change, weak or low exercise tolerance, gum hypertrophy, smooth tongue, blood in urine or stool, infection, cold intolerance
anemia tm
treat cause (transfusion, nutrition)
supportive: IV fluids, O2, bed rest
anemia nc
prep for lab test, decrease O2 demands, dafety, HH and oral care, body temp, prevent complications, support fam
anemia Fe deficiency cm
irritable, anorexia, pallor, mild growth retardation, exercise intol, infection, cognitive delay and behavior challenge
anemia Fe deficiency tm
prevent: breast milk or formula till 12 mo, but dont fill up on milk
supplement: 6 mo, cereal, formula
blood transfuions
anemia Fe deficiency nc
assess, cause, anemia NC, Fe rich foods, supplement, parenteral, Fe safety, follow up
anemia Fe deficiency nc - oral Fe
acidic env (orange juice), with straw, rinse after, measure accurately, increase fluids and fiber, avoid antacid, coffee, tea, dairy, egg, whole grain 1 hr before and 2hrs after
SE: n, gastric irritation, cd, anorexic, teeth stain, tarry stool, OD lethal - lock up flinstones vits
sickle cell cm
asymptomatic till 6 mo (hgbF)
viscous blood, hgbS less soluble, leads to micro obstructions and engorgement, delayed g+d, tissue ischemia, hard time crossing capillary bed
sickle cell complications
acute painful episodes, cva (yearly head scan), sepsis, acute chest syndrome (pna like), decreased vision, chronic leg ulcers, delayed g+d and puberty, priaprism, enuresis (dilute)
sickle cell complications - acute painful episodes
vary in severity and frequency
rf: increased O2 need, trauma, infection, fever, stress, dehyd (viscous), hypoxia (altitude, hypothermia)
vasoocclusive thrombotic
splenic sequestration
aplastic crisis
vasooclusive thrombotic
no clot - no heparin
stasis and clumping of cells = ischemia = infarction
s: fever, pain, tissue engorge
heat good, manage pain (higher tolerance)
splenic sequestration
life threatening
blood pools in spleen (rupture)
s: anemia, hypovolemia, shock, palpable spleen
tm: spleen usually removed, scar, non functioning, fibrosis
aplastic crisis
decreased production and increased destruction of rbc, triggered by viral infection or depletion of follic acid
s: anemia, pallor
sickle cell complications - acute chest syndrome
pna like
VOC or infection causes sickling in lungs, chest
s: chest, pain, fever, cough, tachypnea, wheeze, hypoxia
repeated episodes can lead to pulmonary htn
tm: manage pain, abx, ventillation, transfusion
sickle cell tm
palliative: erythropoietin or hydroxyuria to increase hbgF, penicillin prophylaxis daily, doppler transcranial annually, spleen out, manage crisis (hydrate), hyper transfusion (excess Fe), bone marrow transfusion
sickle cell crisis management
hydration - will decrease pain
oxygenation - rest and remove restrictive clothes
atc pain management - chronic, morphine, tolerance
support - temp, fearful, anx, chronic
beta thalassemia cm
disorder of hemoglobin synthesis
cm: pallor, ftt, hepatosplenomegaly, severe anemia
cm beta major: anemia severe, bronze skin, decreased growth, delayed puberty, cardiac enlargement with flow murmur leading to HF, bone pain and deformities (frontal bossing), death (HF or Fe overload)
chronic hypoxia: HA, irritable, precordial and bone pain, exercise intol, anorexia, epistasis
beta thalassemia tm
diagnose with hgb electrophoresis
blood transfution frequent - Fe build up (hemosiderosis - treat with Fe cheleating multiple times/week and oral vit C
beta thalassemia nc
safe admin, anemia measures, enhance self esteem and home health maintenance
monitor cheleation therapy: nvd, decreased appetite, rash, liver enzymes. neutropenia, adequate hydration
idiopathic thrombocytopenic purpura cm
abnormal autoimmune destruction of platelets in spleen
cm: sudden bruise, purpura, petechiae; epistaxis, platelet <20,000, prolonged bleed
idiopathic thrombocytopenic purpura tm
supportive - precautions
IVIG (boost immune), steroids, anti D antibody (attack cells that cause body to destroy platelets - need good rbc count bc it causes anemia)
chronic: splenectomy with IVIG
idiopathic thrombocytopenic purpura nc
educate parents, assess for bleeding, prevent trauma (padding), avoid uneccessary procedures, apply pressure 5 minutes post puncture, follow up care
hemophilia cm
asympt till 6 mo (mobility and teeth - injuries), hemarthrosis (bleeding into joints, no mobility, stiff, tingle, ache, decreased mobility, warm, red, swell, pain), ecchymosis, ptt increased, epistaxis, bleed post procedure (SQ and IM hemorrhages, bleed into neck, chest, mouth, airway)
hemophilia tm
prevent bleed (padding, soft floors, contact sports, puppy), replace factor VIII or desmopressin, regular exercise and PT
hemophilia nc
prevent bleed (safe env, no aspirin, SQ and IM, soft toothbrush, venipuncture no fingerstick, no suppository), recognize and control bleed (RICE, P 15 min, children know internal bleed, HA, slurred speech, LOC, bloody stool), prevent SE of bleeding (active ROM, PT, nutrition - overweight bad), fam support and home care (school admin, med alert bracelet), swim!
SCID cm
no humoral or cell mediated immunity
early frequent infections, ftt, cd, thrush, adventitious sounds, decreased immunoglobulin, graft v, host reaction to any foreign tissue
SCID tm
IV immunoglobulin, sterile, bone marrow transplant, prevent exposure, support and educate family
HIV (AIDS) differences
even faster progression, kids haven’t been exposed to as much, mode of transmission differs (mom)
HIV (AIDS) cm
increased size of liver and spleen, oral thrush, c or recurrent d, ftt, developmental delay, parotitis
AIDS: serious recurrent infetion, pna, PCP, candidal esophagitis, CMV, encephalopathy, wasting syndrom, cryptosporidosis, herpes simplex
HIV (AIDS) diagnose
PCR at 1 month (on antivirals until 1 mo and test -)
HIV (AIDS) tm
antiretroviral until 1 mo, mom on retroviral 2nd and 3rd trimester (not first - organs), aggressive abx with infections, modified immunization schedule (based on wbc numbers), prophylaxis
HIV (AIDS) nc
prevent, infection risk (neutropenic), knowledge deficit (teach transmission, med storage), altered nutrition (increased protein and cal, preferred foods, supplements, altered g+d, caregiver anx, pain,
