Nursing Management of Children with Hematologic, Immunologic, and Metabolic diseases

Question 0

RBC’s are unusual BECAUSE:

Answer 0

• Strange Shape
• No Nucleus
• changes shape to squeeze through capillaries
• contains HGB to transport O2
• 120 day lifespan & liver and spleen remove with the help of macrophages
• Men have more RBC’s then women

Question 1

Red Blood Cells

Answer 1

• NO nucleus
• Bioconcave
• most abundant cells in the body
• account for approximately 40-45% of blood
• HEMATOCRIT measures the % of blood made up of RBC

Question 2

Three Sizes of RBC:

Answer 2

• Normocytes
• Microcytes
• Macrocytes

Question 3

Three RBC Shapes:

Answer 3

• Globular Cells
• Sickle Shaped Cells
• Other Irregularly shaped cells

Question 4

Neutrophils:

Answer 4

• Most Prevalent
• 54-62% of WBC
• PRIMARY DEFENSE IN BACTERIAL INFECTIONS

Question 5

LYMPHOCYTES:

Answer 5

• *25-33% of WBC
• Contain Histamin, Heparin, Seratonin
• INCREASE BLOOD FLOW TO AREAS OF INJURY
• PREVENT EXCESSIVE CLOTTING

Question 6

MONOCYTES:

Answer 6

• 3-7% of WBC
• Large Phagocytic cells (EATING Cells)
• INVOLVED IN EARLY STAGES OF INFLAMMATORY REACTIONS

Question 7

EOSINOPHILS:

Answer 7

• 1-3% of WBC

* INCREASED IN ALLERGIC DISORDERS, PARASITIC DISEASE, AND NEOPLASMS

Question 8

BASOPHILS:

Answer 8

• 0.75% of WBC
• Contain Histamine, Heparin Seratonin
• INCREASE BLOOD FLOW TO AREAS OF INJURY
• PREVENT EXCESSIVE CLOTTING

Question 9

ANC:

Answer 9

• % Neutrophils / Bands
• Indicates body’s capability to handle bacterial infection
• *Increased bands = body working really hard to fight infection

Question 10

Platelets

Answer 10

• Cellular fragments needed for blood clotting

* Normal count 150-400,000 platelets/mm3 of blood

Question 11

Plasma

Answer 11

Liquid portion of blood that contains clotting factors that helps make bleeding stop

Question 12

Complete Blood Count (CBC): MCV

Answer 12

• 77-95 Cubic Microns

- -Mean Volume (size) of red blood cell

Question 13

CBC: MCH

Answer 13

• 25-33% mcg/cell

- -Average weight of hemoglobin in single red blood cell

Question 14

CBC: MCHV

Answer 14

• 31-37% grams per cell

- -Average Concentration of Hemoglobin in red blood cell

Question 15

Anemias

Answer 15

*Basic pathologic process: Decrease the oxygen carrying capacity of the blood
NURSING FOCUS:
*Assess Child’s energy needs
*Decrease tissue oxygen needs
*Adjust child’s exertion level to allow child to do as much as possible
*Balance how much 02 comes in with how much they use.

Question 16

Iron Deficiency Anemia

Answer 16

• ANEMIA CAUSED BY INADEQUATE SUPPLY OF DIETARY IRON
• Most prevalent nutritional disorder in the US
• Children as particularly susceptible
  
  • preterm infants
  • Children 12-36 mo
  • Adolescents

Question 17

Iron Deficiency Anemia Pathophysiology:

Answer 17

• Decreased Supply
• impaired absorption
• increased need for iron
• affects synthesis of Hgb

Question 18

Causes of Iron Deficiency:

Answer 18

• Blood Loss
• Excessive milk ingestion
• Depletion of fetal iron stores after birth

Question 19

Iron Deficiency: Therapeutic Management

Answer 19

Focus: INCREASE AMOUNT OF SUPPLEMENTAL IRON
--Dietary counseling
--Administration of supplemental iron 
   **Oral (preferred)
   **Parenteral
PROGNOSIS:
   --Very Good
   --Severe and longstanding > cognitive, behavioral, and motor impairment

Question 20

Misc Iron Deficiency therapeutic Management:

Answer 20

• Dietary increase is not sufficient
• Oral supplements administered for 3 mo
• Adequate dosage indicated by tarry green stools
• Iron Therapy can cause nausea and diarrhea but given with meals is good.
• Absorption enhanced with Vit C or Citric Acid