Hematology

Question 1

Nursing care of hemarthrosis

Answer 1

Ice pack, Non weight bearing, elevate affected limb to heart, immobilization, no PROM exercises until acute injury phase is done

Question 2

Health promotion/ education for Hemarthrosis

Answer 2

sport choices (non contact), healthy weight and good fitness, normalization (chronic illness), use of prophylactic infusions

Question 3

Patient education for hemarthrosis

Answer 3

teach venipuncture and factor administration, stress that f.a. is never delayed, avoid aspirin (motrin ok) physical activity and exercise is fine and encouraged when not bleeding (choose sports carefully)

Question 4

Who is Hemophilia B named after?

Answer 4

Stephen Christmas, the first patient described outlining the symptoms of Hem B

Question 5

Why do cells sickle (what causes the clinical symptoms)

Answer 5

blood viscosity and hemoglobin increases and causes cells to sickle

Question 6

SCD labs

Answer 6

CBC – decreased HGB/Hct, increased reticulocyte count, increased WBC’s and platelets, increased total bilirubin, Kids with SCD usually “live” at a hgb of sometimes 6-7. will typically not be symptomatic

Question 7

What is hemoglobin electrophoresis?

Answer 7

lack of HGB A

Question 8

1 cause of death in SCD

Answer 8

infection

Question 9

1 cause of hospitalization in SCD

Answer 9

vaso-occlusive crisis

Question 10

SCD nursing care post splenectomy

Answer 10

PICU transfer, Immediate, conservative pRBC transfusion (<10cc/kg), Raise HGB to no higher than 8.0 to avoid autotransfusion, Pain management, Antibiotics, THESE CHILDREN MAY RAPIDLY DETERIORATE

Question 11

Nursing Care in Vaso Occlusive Crisis

Answer 11

Hydration: 1.5 x maintenance (not for every type of crisis!)
Analgesics- Opioid/NSAID combo, Appropriate dose, Appropriate time intervals
Antibiotics if infection is suspected
Oxygen is not routinely given unless there is an increased O2 demand/hypoxia

Question 12

Discharge Teaching for Vaso Occlusive Crisis

Answer 12

Assessment tools, Tapering PO analgesics, Side effects, Incentive spirometry, deep breathing, Tolerance vs addiction, Keep pain journal

Question 13

Genetics in SCD

Answer 13

Autosomal Recessive- 25% chance of getting

Question 14

Pain and Fever management for SCD- Pt ed

Answer 14

Monitor temp, give NSAIDs as needed, ATC regimen should be instituted, Usually Ketorolac (Toradol), Morphine, Motrin, Use PCA if needed, Use non pharmacological techniques as well (heating pads, guided imagery, distraction), Assess and reassess pain frequently, ADVOCATE, Monitor your own beliefs and LISTEN to your patient

Question 15

Pain management in kids

Answer 15

Pharm and non pharm methods
Pharm- Opioids and NSAIDs
Nonpharm- Psychological, Behavioral, Physical (slide 64)
Adjuvant medications given to calm child

Question 16

S&S of Anemia

Answer 16

Pallor, weakness, fatigue, decreased HGB, HCT, RBCs

Question 17

What is ITP

Answer 17

autoimmune destruction of platelets

Question 18

Lab data for ITP

Answer 18

Lab Data: low platelet count (< 20,000) & antiplatelet antibodies, normal Hgb, normal differential, normal bone marrow (only done if something else is suspected)

Question 19

Prognosis for ITP

Answer 19

usually good, most children recover with no long term consequences

Question 20

PT ed in Iron deficiency anemia

Answer 20

Give iron supplements with fruit, not with milk
Give liquid iron through a straw or perform oral care after administration
Monitor for constipation, pallor, weakness, fatigue

Question 21

Normal CBCs for kids

Answer 21

Normal hgb- 11-15
Normal Hct- 30-44%
Normal retic- 0.5-1.5%
Normal WBC- 4.5-11

Question 22

Parvovirus and staff education

Answer 22

Appears with Aplastic anemia, B19 titers are elevated
Staff- pregnant staff should avoid contact with these patients because infection can cause harm to the fetus

Question 23

Treatment of Beta Thalassemia

Answer 23

RBC transfusions, folic acid, chelation, splenectomy, BMT, cord blood, SCT
Gene therapy in the works
NO IRON

Question 24

Von Willebrand’s Nursing Care

Answer 24

Treatment is given pre-operatively with surgery/dental work or bleeding episodes
Desmopressin (DDAVP®)
vWF: FVIII concentrate (Humate P®)
Other Supportive Measures- Anti-fibrinolytics, Oral contraceptives, Topical hemostatic agents

Question 25

Management of nose bleeds

Answer 25

Teach pt/parent to manage nose bleed by leaning FORWARD and apply continuous pressure to tip of nose with thumb and forefinger for at least 10 minutes.
Avoid all temptation to pick or blow your nose after a bleed