Hematologic Conditions - moderate (5-7 questions)

Question 1

Anemia acute symptoms

Answer 1

• muscle weakness
• fatigue
• pallor
• headache
• increased HR
• lightheadedness

kids at risk = premature infants & multiple births
- ID excessive milk intake or early intro of whole milk (poor iron source)

blood transfusion –> Hgb < 7.0-8.0
Iron supp –> Hgb > 7.0-8.0

Question 2

normal hemoglobin

Answer 2

11.5 - 14.5 g/dl

Question 3

anemia chronic symptoms

Answer 3

• compensated
• growth retardation
• delayed sexual maturation
• increased HR
• heart murmur

blood transfusion not usually until Hgb <6.0

Question 4

intervention for acute anemia

Answer 4

iron supplementation

• can temp stain teeth - give w/dropper; brush teeth after
• absorption = best between meals; citrus fruit/juice
• stools may be tarry green or black = OK

Question 5

sickle cell anemia (Hemoglobin SS)

Answer 5

normal RBC = 90-120 days

sickle cell RVC = 20 days

Question 6

vaso-occlusive crisis/pain treatment

Answer 6

Hydration (IV and PO)
O2
Pain management - meds; heat; massage

Question 7

preventing vaso-occlusive crisis/pain

Answer 7

hydration

avoid/minimize - extreme hot/cold; hypoxia

Question 8

Fever in sickle cell patient

Answer 8

• caused by splenic failure (decreases ability to fight infection)
• fever first sign of bacteremia == needs medical evaluation

Question 9

treatment of bacteremia in sickle cell pt

Answer 9

• hx, physical, VS, CBC
• IV abx
• monitor for s/s of sepsis
• pt & family education = temp taking, when to call MD

Prevention - penicillin prophylaxis (does work of spleen); pneumococcal vaccine

Question 10

Immune/Idiopathic Thromcytopenic Purpura (ITP) - what is is/who gets it

Answer 10

• acquired hemorrhagic disorder –> autoimmune destruction of platelets in spleen
• 80% of kids are 2-10 years old
• recover completely w/in 6 mos

Question 11

Immune/Idiopathic Thromcytopenic Purpura (ITP) - assessment

Answer 11

• decreased plt (< 20,000) [normal 150,000-400,000]
• assess for petechiae
• note bruises & other bleeding (urine, gums)

Question 12

Immune/Idiopathic Thromcytopenic Purpura (ITP) - treatment

Answer 12

Platelets <20,000 –> IVIG (3-6 hour infusion; 10-12 hr response; expensive) OR Anti-D antibody (WinRho) (5-10 min infusion; 48 hour response; inexpensive

Splenectomy for chronic, unresponsive ITP

Question 13

Immune/Idiopathic Thromcytopenic Purpura (ITP) - interventions

Answer 13

bleeding precautions - avoid trauma, injections, ibuprofen

Safety measures - no contact sports

Question 14

Hemophelia - assessment/intervention

Answer 14

• s/s of bleeding
• give Factor VIII or IX
• immobilize & elevate joint/affected area
• after injury/bleeding subsides –> range of motion exercises
• prevention of bleeding

Question 15

Disseminated Intravascular Coagulation (DIC) etiology

Answer 15

• trauma / transfusion rxn / cancer

(consumption of clotting factors & platelets –> massive bleeding –> hypovolemia)

Intervention - transf of FFP & platelets; usually in ICU

Question 16

PRBC admin

Answer 16

• take VS before starting / use NS PB / use filters
• stay w/patient
• assess for rxn

Question 17

Blood transfusion rxns

Answer 17

Types:

• hemolytic - flank pain, sever HA, SOB, shock/renal failure, fever/chills
• allergic - hives and itching
• febrile - fevers and chills

Intervention:

• stop transfusion
• flush w/NS/keep IV open
• monitor VS
• contact MD/PNP