Hematologic and Immunologic Dysfunction Flashcards
The most common hematologic disorder of childhood
Develops slowly - children slowly adapt to it; not sudden thing identified - not realize until blood drawn; small things that add up: trouble concentrating/sleeping - smaller red flags
Not disease but indication/mainfestation of underlying process - figure out reason why anemic
Increased risk for infection: tissue hypoxic weakening body’s defense against infection
Decrease in number of RBCs or hemoglobin (Hgb) concentration below normal, or both
Decreased oxygen-carrying capacity of blood
Anemia - RBC disorders
Depletion of RBCs or Hgb, or both
Causes and physiology - Classification of anemias
Characteristic changes in RBC size, shape, or color, or a combination of these
Morphology - Classification of anemias
Sometimes defined as Hgb <10 or 11 g/dL; however, this cutoff may be inappropriate for children
Diagnostic evaluation - Classification of anemias
Hemodilution
Due to decreased RBC
Thinner blood
Decreased PVR - greater quantity of blood returning to heart
Increased cardiac circulation and turbulence
Murmur
Severe cases can lead to cardiac failure
Growth restriction
Children with this lack energy, easily fatigued, pallor - chronic thing - very slow to grow - deprived of iron cannot have the growth spurts - grow at slower rate
Nurse: need know what is causing anemia
Consequences of anemia in ped pop - Classification of anemias
decrease red blood cell production or side of the decreased red blood cell production The increased red blood cell loss or increased red blood cell destruction okay we need to know those three things and what they lead to some calm and sign common signs and symptoms of anemia your tachycardia, palpation, dyspnea, SOB, dizziness, lightheadness, diaphoresis, changes in skin color, looks fatigued - acting different - signs
Increased RBC loss
Bleeding: acute blood loss - nose bleeds; hemophilia
Increased Cardiac workload: notice in times of exercise stress or illness - see increased episodes of that to tachypnea, palpitations - red flag - figure out what is going on
Nurse: need know what is causing anemia
Diagnosis
Treatment of underlying cause
Supportive care
Therapeutic management of anemia
History and physical
ask all the normal questions you know when did the start what’s what have you noticed what things are different
CBC
we’re going to check that hemoglobin check that hematocrit look at those red blood cells
Diagnosis
Have to treat the underlying cause - do we need to have a transfusion; need to have a nutritional intervention;
transfusions in the Pediatric population hospitals
double checking for you before you give blood always going to double check it with another nurse
want to give that blood within 30 minutes of receiving it
make sure they have that ID
Ensure you’ve got all your supplies so as soon as it comes to your unit you’re ready to get it hooked up and going
scan your blood which is very helpful you still always going to check it with another nurse
going to get your vitals every 15 minutes and then you’re definitely going to watch for fever chills and irritability right those are pretty standard practices one difference especially with the younger much younger population is we don’t give it through that filter tubing
we pull it up through that tubing but we put it in a regular syringe and then just hook it straight up to some IV tubing and put it straight to the baby okay we don’t leave it in that filter tubing and we don’t hang it with any other fluids
can get fluid overloaded very quickly - kidneys are Half Baked
Transfusion after hemorrhage if needed
Nutritional intervention for deficiency anemias
Treatment of underlying cause
going to give IV fluids if we need to increase therapy if needed and we are going to have bed rest
need to be doing age appropriate care if they’re older we can show them their slide - should show them how their cells are different especially that later school age
if we have to start that IV give them some emela cream on there trying to make that not hurt as much - pick color want - give as many choices as can
Intravenous (IV) fluids to replace intravascular volume
Oxygen therapy
Bed rest
Supportive care
Generally preventable
Pathophysiology
Therapeutic management
Prognosis
Nursing care management
Iron deficiency anemia
Iron-fortified cereals and formulas for infants
Special needs of premature infants
Adolescents at risk because of rapid growth and poor eating habits
Generally preventable
Caused by any number of factors
“Milk babies”
Caused by inadequate supply of dietary iron
most common type in our pediatric population
not having enough hemoglobin and you have to have iron to produce hemoglobin so if you don’t have iron you’re not going to produce this hemoglobin
caused by an inadequate supply of dietary iron and can typically be preventable
if the baby is premature okay remember iron babies get their iron from Mom and that last trimester especially that last 4 weeks so if a mom is anemic if that Mom doesn’t have iron then they don’t have iron to give the baby so we always check our iron in our moms because I want our babies to get their iron
if the baby is premature they’re not getting the iron from that Mom or what iron they have gotten they’re going to burn through it very quickly so premature infants are almost always on an iron supplement
adolescents are also at risk because they’re rapid growth and they’re poor eating habits
breast milk is not a good source of iron there’s just a very very small amount of iron that is passed through breast milk
good amount of iron in the formula - not really worried about iron deficiency anemia
cows milk is a very poor source of iron and it can fill babies up very quickly all right and remember toddlers starting around a year are extremely picky so they don’t want to eat a lot of food they don’t like healthy foods necessarily and they just don’t eat a lot they would be happy just drinking milk but they can’t they’re not going to get their iron from that okay so what we need to do is we need to give them solids first and then give them milk after their solids
Pathophysiology
Increase in the amount of iron the child receives
iron supplement and typically this is an oral supplement that we can give
can cause staining on the teeth
take with ascorbic acid or vitamin C - that helps the absorption of it
not going to give it with dairy cuz that’s going to inhibit the absorption it likes the acidic environment
can cause dark colored stools and can cause constipation so we may need to start with a smaller amount and slowly work our way up to what they need
iron can be poisonous for kids so we need to be very careful about how parents store this we need to educate them on making sure kids do not have access to this
Therapeutic management
Diet
Iron supplementation
follow-up so usually a month after we’ve got this diagnosis when we started them on some type of supplementation - going to draw Labs again and see where their levels are - if it is not improving we need to figure out what is going on Administration - figure out why things not improving
Nursing care management
Autosomal recessive disorder
Clinical features
Pathophysiology of sickle cell anemia
has to do with the breakdown of red blood cells
have a decrease in oxygen carrying capacity
body is going through these red blood cells a lot faster than they should
have trouble keeping up a normal hemoglobin
do need transfusions especially
9% of African-Americans are carriers (have sickle cell trait)
40% of native Africans are carriers
If both parents have trait, each of their children has a 25% chance of having disease
Autosomal recessive disorder
chronic joint swelling aching bones
fatigue frequent infections they’re going to be small for their age either small kiddos okay and they’ll have enlarged spleens
Obstruction caused by sickled RBCs
The vascular inflammation
Increased RBC destruction
Abnormal adhesion, entanglement, and meshing of rigid sickle-shaped cells
Local hypoxia
Cellular death
Clinical features
Universal screening of newborns in the United States
do screen for on all newborns
Management
No cure (except possibly bone marrow transplantation)
Supportive care/prevention of sickling episodes
Frequent bacterial infections because of immunocompromise
common complications include stroke acute chest syndrome retinal damage nerve and organ damage
Bacterial infection: Leading cause of death in young children with sickle cell disease
Usual life span: Into the fifth decade
EDUCATION!
Diagnosis and management of SCD
Prevent sickling
goals are to avoid crisis relieve symptoms and prevent complications
issues the sickling of cells and it blocks the blood flow - leads ischemia that pain we want to prevent sickling we are going to have these kids rest and minimize their energy expenditure we are going to make sure they are always hydrated if they are in pain we are going to treat their pain
are going to have to replace blood product if needed these kids will be at an increased risk of iron buildup if they’re getting a lot of transfusion so it’s important that we test their iron levels
May avoid activities due to that fear of that pain and that crisis they may avoid doing something and this is going to delay their normal growth and development - pay attention to that when we do our education we have to educate parents and what we need to do to make sure they are developing appropriately for their age
Rest and minimize energy expenditure
Hydration
Electrolyte replacement
Analgesia
Blood replacement
Antibiotics
antibiotics - if the kids are under five they’re going to be on prophylactic antibiotics and typically we use penicillin for this - no cure our goal is to against support and prevent sickling bacterial infections - issues because they are immunocompromised bacterial infections are the leading cause of death and young children with sickle cell disease because we know this we can prevent we can teach ways to prevent getting sick and still lead a semi-normal life
Management
