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Pediatric CCRN > Hematology/Immunology > Flashcards

Hematology/Immunology Flashcards

1
Q

Anemia

A

-Defined as Hgb less than 12
-Causes: Anemia, bleeding, decreased production, frequent phlebotomy, iron or b12 deficiency, chronic illness
-Generally transfuse for Hgb of 7 or less

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2
Q

Iron Deficient Anemia

A

-From insufficient iron intake or iron malabsorption
-Risk factor: increased milk intake

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2
Q

Signs of IDA

A

-Fatigue
-Pallor
-SOB
-Tachycardia

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3
Q

Treatment for IDA

A
  • Give ferrous sulfate
  • Give iron dextran w/ Z-track method
    -Encourage intake of iron rich foods (green veg, meat, raisins)
    -Increase vitamin C intake
    -Decrease calcium intake
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4
Q

Sickle Cell Anemia

A

Autoimmune recessive genetic disorder that causes chronic anemia, pain, infection, and organ damage

Abnormal sickled hemoglobin changes shape of RBCs

Leads to occlusion of blood vessels and tissue hypoxia

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5
Q

Signs of Sickle Cell Anemia

A

-Pain
-Fatigue
-Pallor
-SOB
-Jaundice

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6
Q

Diagnosis of Sickle Cell Anemia

A

-Sickle turbidity test
-HGB electrophoresis

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7
Q

Treatment of Sickle Cell Anemia

A

-Pain management: PCA or scheduled opioids
-Antibiotics for infection
-Administer IV fluids to dilute blood
-Educate patient on fluid intake and prevent dehydration

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8
Q

Types of Sickle Cell Crises

A
  • Vaso-Occlusive
    -Splenic Sequestration
    -Aplastic
    -Acute Chest Syndrome
    -Hyperhemolytic Syndrome
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9
Q

Vaso-Occlusive Crisis

A

Type of sickle cell crisis

Symptoms: severe pain, swelling of hands and feet

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10
Q

Splenic Sequestration Crisis

A

Type of sickle cell crisis

Blood flow is blocked out of spleen

Symptoms: splenomegaly, hypovolemia

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11
Q

Aplastic Crisis

A

Type of sickle cell crisis

Severe anemia related to viral infection

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12
Q

Acute Chest Syndrome

A

Type of sickle cell crisis

Blood flow to lungs is impaired

Symptoms: Dyspnea, fever, cough

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13
Q

Hyperhemolytic Crisis

A

Type of sickle cell crisis

Rapid decrease in Hgb and Hct levels

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14
Q
A
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15
Q

PRBCs

A

-Stored at 4°C
-21 day shelf life
-Preservatives in stored blood:
-Citrate: binds to calcium for anticoagulation, monitor serum Ca+
levels, replace C+ every 3-4 PRBCs
-Phosphate: used to increase O2 saturation
-Dextrose: used as fuel for blood cells

Can be leukocyte reduced to decrease likelihood of transfusion reaction or washed to reduce leukocytes and plasma, reducing reactions from plasma proteins

15
Q
A
16
Q

Universal Blood Donor Type

A

O Negative

17
Q

Universal Blood Recipient Type

A

AB +

18
Q

Hemolytic Reaction

A

PRBC transfusion reaction
- caused by ABO incompatibility
-usually due to human error
-takes less than 5mL to see reaction

Symptoms: fever, tachycardia or bradycardia, dyspnea, chest pain, lower back pain, hypotension, blood in urine

19
Q

Types of WBCs

A

-Neutrophils
-Elevated count indicates infection or inflammation
-Bands can indicate infection
-Monocytes
-Big phagocytes that scavenge for bacteria
-Lymphocytes
-Responsible for adaptive immune response
-Eosinophils
-Elevated counts indicate parasitic infection

20
Q

Leukopenia

A

Defined as decreased number of WBCs
-immunocompromised
-seen in infection with rapid consumption of WBCs
-increases risk of infection

21
Q

Platelets

A

-Normal: 150,000-400,000
-AKA thrombocytes
-Essential for clotting
-65% are circulated in blood, 35% in the spleen
-Lifespan of platelet is 10 days

22
Q

Thrombocytopenia

A

-PLT less than 150,000
-Caused by: sepsis, DIC, dialysis, CRRT
-Signs: petechiae, ecchymosis

23
Q

Medications that cause platelet dysfunction

A

-aspirin
-clopidogrel
-penicillin
-cephalosporins
-ATP
-heparin
-calcium channel blockers
-nitroglycerin
-nitroprusside
-ketorolac

24
Q

Warfarin/Coumadin

A

-Acts on extrinsic and common coagulation pathways
-monitor PT/INR, will be elevated when on warfarin
-PT: 11-13
-INR: 0.8-1.1
-Antidote: Vitamin K & FFP
-give vitamin K slowly
-INR will decrease in 8-12hrs

25
Q

Heparin

A

-Acts on intrinsic and common coagulation pathways
-monitor PTT and Anti-Xa
-normal 25-38 sec
-elevated with heparin
-Antidote: Promatine sulfate
-reactions include: bradycardia, hypotension, n/v, anaphylaxis
w/fish allergy

26
Q

Low Molecular Weight Heparin

A

Less incidence of HIT
Longer half life: 4-6 hrs

27
Q

ITP

A

Immune Thrombocytopenic Purpura
-autoimmune d/o where spleen disorders platelets
- PLT <20,000
-Primary disorder or secondary due to meds or autoimmune disorders like lupus
-Symptoms: petechiae, purpura, epitaxia, splenomegaly
-Treatment: steroids, IVIG, remove spleen

28
Q

DIC

A

Disseminated Intravascular Coagulation
-hypercoagulation secondary to widespread endothelial damage
-use up all clotting factors then you bleed
-microvascular thrombus formation

-Causes: sepsis, trauma, obstetric complications

-Symptoms: bleeding from multiple sites, ecchymosis, purpura lesions, bloody stool, bleeding gums and mucous membranes

-PLT <50,000
-Decreased fibrinogen <100
-Increased D-Dimer
-Increased PTT and PT

Treatment: 80% mortality, all treatment is supportive. Treat bleeding w/PLTs and cryoprecipitate (fibrinogen)

29
Q

Consumptive Coagulopathy

A

-Decreased PLT
-Increased fibrinogen markers
-prolonged PTT
-Decreased fibrinogen

30
Q

HIT

A

Heparin Induced Thrombocytopenia

Patients have IGG antibodies to heparin, decreased PLT by 50% from baseline within 5-10 days of exposure to heparin

Symptoms: fever, chills, tachypnea, tachycardia, erythematous lesions around SQ injection sites

31
Q

Types of HIT

A

1: 1-2 days after exposure to heparin, PLT count normalizes with continuous therapy, non-immune disorder than results from direct effect of heparin on PLT activation
2: Occurs 4-10 days after exposure to heparin, immune-mediated disorder that causes clotting, life and limb-threatening thrombotic complications

32
Q

Types of Thrombus

A
  • Systemic thrombus
    -DVT
    -Pulmonary embolism
    -Arterial thrombus
    -Stroke

Risk after orthopedic or heart surgery

33
Q

Diagnosis of HIT

A

-clinical exposure to heparin
-decreased PLT
-heparin assay

34
Q

Treatment for HIT

A

-Immediately stop heparin infusions
-Draw heparin antibody panel
-Give alternate anticoagulation medications
-direct thrombin inhibitors:
-argatroban (cleared by liver)
-bivalirudin (cleared by kidneys)
-warfarin
-don’t use during active HIT, give after recover
-never give heparin again

35
Q
A

Pediatric CCRN (8 decks)

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