objective 10.7

Question 1

OCCUR WHEN BLOOD VALUES EXCEED OR FAIL
TO FORM CORRECTLY OR FAIL TO MEET
NORMAL STANDARDS

Answer 1

blood dyscrasias

Question 2

• “WITHOUT,” AND EMIA, “BLOOD”)
• A REDUCTION IN THE AMOUNT OF CIRCULATING HEMOGLOBIN (HGB)
  REDUCES THE OXYGEN-CARRYING ABILITY OF THE BLOOD
• LEVELS BELOW 80 G/L RESULTS IN AN INCREASED CARDIAC OUTPUT AND A
  SHUNTING OF BLOOD FROM THE PERIPHERY OF THE BODY TO THE VITAL
  ORGANS

Answer 2

anemias

Question 3

what are the different underlying causes of anemias?

Answer 3

• BLOOD LOSS (TUMORS, ULCERS, TRAUMA)
• DESTRUCTION OF RBC (HEMOLYTIC ANEMIA)
• NUTRITIONAL DEFICIENCIES (IRON DEFICIENCY, VIT B12)

Question 4

• COMMON NUTRITIONAL DEFICIENCY OF CHILDREN
• INCIDENCE IS HIGHEST DURING INFANCY (FROM 9TH-24TH
  MONTH) AND ADOLESCENT

Answer 4

iron-deficiency anemia

Question 5

what are the causes of iron deficiency anemia?

Answer 5

• Severe hemorrhage
• Inability to absorb iron received
• Excessive growth needs
• Inadequate diet, poorly planned
  meals, large quantities of
  milk/day
• Outgrow iron reserve in body
• Decrease intake of iron fortified
  formula and cereal
• Feeding problems
• Feeding cows milk to an infant
  can lead to GI bleeding, which
  can then result in anemia

Question 6

what are the S&S of iron deficiency anemia?

Answer 6

• Pallor, irritability, anorexia,
  decrease in activity level,
  overweight, SOB, slight murmur,
  enlarged spleen
• Labs might include: RBC,
  reticulocytes, hgb, hct, cell
  structure changes and iron
  concentration. Stools for occult
  blood might be collected and a
  diet history is taken.

Question 7

what is the treatment of iron deficiency anemia?

Answer 7

• IRON, USUALLY FERROUS SULFATE, ORALLY
  2 TO 3 TIMES A DAY
• VITAMIN C AIDS IN ABSORPTION
• DIET HIGH IN IRON SUCH AS GREEN LEAFY
  VEGETABLES, LEAN MEATS, CHICKEN,
  TURKEY, WHOLE EGGS, CEREALS, ETC

Question 8

• ONE OF THE OLDEST HEREDITARY DISEASES
  KNOWN TO MAN
• A BLEEDING DISORDER- BLOOD DOES NOT CLOT
  NORMALLY, EVEN THE SLIGHTEST INJURY CAN
  CAUSE SEVERE BLEEDING
• CONGENITAL DISORDER CONFINED ALMOST
  EXCLUSIVELY TO MALES
• (SEX LINKED RECESSIVE TRAIT CARRIED ON X
  CHROMOSOME, TRANSMITTED BY SYMPTOM-FREE
  FM!)

Answer 8

hemophilia

Question 9

what are the 2 common types of hemophilia?

Answer 9

hemophilia B
hemophilia A

Question 10

• CAUSED BY A DEFICIENCY OF COAGULATION FACTOR VIII, OR
  ANTIHEMOPHILIC GLOBULIN (AHG)
• SEVERITY DEPENDENT ON LEVEL OF FACTOR VIII IN THE PLASMA
• AIM OF THERAPY IS TO INCREASE LEVEL OF FACTOR VIII TO
  ENSURE CLOTTING
• THIS IS CHECKED BY A BLOOD TEST CALL PARTIAL
  THROMBOPLASTIN TIME (PTT)

Answer 10

hemophilia A

Question 11

what are the manifestations of hemophilia?

Answer 11

• CAN BE DIAGNOSED AT BIRTH BECAUSE FACTOR VIII CANNOT
  CROSS THE PLACENTA AND BE TRANSFERRED TO THE FETUS
• NORMAL BLOOD CLOTS IN 3 TO 6 MINUTES
• ANEMIA, LEUKOCYTOSIS, MODERATE INCREASE IN PLATELETS
  MAY BE SEEN IN HEMORRHAGING; MAY ALSO BE SIGNS OF
  SHOCK
• SPONTANEOUS HEMATURIA IS SEEN
• DEATH CAN RESULT FROM EXCESSIVE BLEEDING, ESPECIALLY IF
  IT OCCURS IN THE BRAIN OR NECK

Question 12

what are the circumstances that lead to hemophilia?

Answer 12

• A NOSEBLEED THAT WILL NOT STOP
• LOSS OF A DECIDUOUS TOOTH
• HEMATOMAS DEVELOP AT THE INJECTION
  SITE OF AN IMMUNIZATION
• HEMORRHAGE INTO THE JOINT CAVITY
  (CONSIDERED A CLASSIC SYMPTOM)
• A CLASSICAL SYMPTOM OF HEMOPHILIA IS
  BLEEDING INTO THE JOINTS (HEMARTHROSIS)

Question 13

what is the treatment of hemophilia?

Answer 13

• IF FAMILY HISTORY EXISTS DO NOT DELAY PROCEDURES IN NEWBORN
  INSTEAD USE THE SMALLEST NEEDLE AND APPLY PRESSURE FOR 10 MINS
  AFTER
• PRINCIPAL THERAPY- PREVENT BLEEDING BY REPLACING THE MISSING
  FACTOR
• RECOMBINANT ANTIHEMOPHILIC FACTOR
• DESMOPRESSIN ACETATE (DDAVP)
• PROPHYLACTIC CARE MUST BE PROVIDED BEFORE PLANNED INVASIVE
  PROCEDURES
• MULTIDISCIPLINARY APPROACH
• DRUGS THAT CONTAIN SALICYLATES ARE CONTRAINDICATED FOR CHILDREN
  WITH HEMOPHILIA

Question 14

• AN ACQUIRED PLATELET DISORDER (DECREASE IN THE
  NUMBER OF PLATELETS) THAT OCCURS IN CHILDHOOD
• MOST COMMON OF THE PURPURAS
• PLATELETS BECOME COATED WITH ANTIPLATELET ANTIBODY,
  ARE SEEN AS “FOREIGN,” AND ARE EVENTUALLY DESTROYED
  BY THE SPLEEN
• ITP OCCURS IN ALL AGE-GROUPS, WITH MAIN INCIDENCE
  BETWEEN 1 AND 4 YEARS OF AGE

Answer 14

idiopathic thrombocytopenic purpura

Question 15

what are the manifestations of ITP?

Answer 15

• CLASSIC SYMPTOM IS EASY BRUISING
• PETECHIA- FLAT PINPOINT RED SPOTS
• ECCHYMOSIS- BRUISING
• HEMATURIA- BLOOD IN URINE
• GINGIVAL BLEEDING- BLEEDING GUMS
• NOSE BLEEDS
• SLOWED CLOTHING AND LOW PLATELETS
• RECENT HX OF VIRAL RESPIRATORY ILLNESS
• ANEMIA MAY BE PRESENT IF BLEEDING OCCURRED, BUT ALL OTHER BLOOD
  COMPONENTS ARE NORMAL
• IF WBCS PRESENT, DO BONE MARROW ASPIRATION TO RULE OUT LEUKEMIA

Question 16

what is the treatment of ITP?

Answer 16

• NEUROLOGICAL ASSESSMENTS ARE A PRIORITY
• TREATMENT IS NOT INDICATED IN MOST CASES- IF INDICATED,
  PREDNISONE (1ST) , IV GAMMA GLOBULIN (2ND), AND ANTI-D ANTIBODY
  ARE SOME OF THE TREATMENT OPTIONS
• IN CASES OF CHRONIC ITP, A SPLENECTOMY MAY BE REQUIRED
  DRUGS THAT INTERFERE WITH PLATELET FUNCTION SHOULD BE
  AVOIDED, IE: ASA.
• ACTIVITY IS LIMITED DURING ACUTE STATES TO AVOID BRUISING
• PLATELETS ARE USUALLY NOT GIVEN BECAUSE THEY ARE DESTROYED
  BY THE DISEASE PROCESS

Question 17

what are the complications of ITP?

Answer 17

• BLEEDING FROM THE GI TRACT
• HEMARTHROSIS
• INTRACRANIAL HEMORRHAGE
• PREVENTION MAY BE HELPED BY
• IMMUNIZING ALL CHILDREN AGAINST THE VIRAL DISEASES
  OF CHILDHOOD

Question 18

• MOST COMMON FORM OF CHILDHOOD CANCER
• A GROUP OF MALIGNANT DISEASES OF THE BONE MARROW &
  LYMPHATIC SYSTEM
• RESULTS IN UNCONTROLLABLE GROWTH OF WBC
• IMMATURE WBC TAKE OVER AREAS IN BONE MARROW THAT ARE
  RESPONSIBLE FOR PRODUCTION OF RBC WHICH RESULTS IN:
• DEC. RBC PRODUCTION- ANEMIA
• DEC. PLATELET COUNT- BRUISING/BLEEDING
• BONE MARROW WEAKEN= PATHOLOGICAL FRACTURES
• WBC IMMATURE- INC RISK OF INFECTION

Answer 18

leukemia

Question 19

what are the types of leukemia?

Answer 19

acute lymphocytic leukemia
acute nonlymphocytic leukemia
acute myelocytic leukemia

Question 20

• REPEATED INFECTIONS
• LOW-GRADE FEVER
• PALLOR
• BRUISING TENDENCY
• LEG AND JOINT PAIN
• LISTLESSNESS
• ABDOMINAL PAIN
• ENLARGEMENT OF LYMPH NODES

Answer 20

early phase of leukemia

Question 21

• SKIN MAY HAVE A LEMON-YELLOW COLOR
• PETECHIAE AND PURPURA, ANOREXIA, VOMITING, WEIGHT LOSS, AND DYSPNEA ARE ALSO
  COMMON
• WBCS NOT FUNCTIONING NORMALLY, INCREASES RISK OF INFECTION (PATIENT WHO PRESENTS
  WITH NEUTROPENIA IS AT RISK FOR INFECTION)
• ULCERATIONS DEVELOP AROUND THE MUCOUS MEMBRANES OF THE MOUTH AND ANAL
  REGIONAL
• GUMS TEND TO BLEED

Answer 21

late (progressed) leukemia

Question 22

what are the 2 stages of leukemia?

Answer 22

early phase
late phase

Question 23

what is the diagnosis of leukemia?

Answer 23

• BASED ON HISTORY AND SYMPTOMS
• RESULTS OF EXTENSIVE BLOOD TESTS
• DEMONSTRATE PRESENCE OF LEUKEMIC BLAST CELLS IN THE BLOOD,
  BONE MARROW, OR THEIR TISSUES
• X-RAY FILMS OF THE LONG BONES SHOW CHANGES
• SPINAL TAP MAY BE DONE TO CHECK FOR CNS INVOLVEMENT
• KIDNEY AND LIVER FUNCTION STUDIES ARE DONE
• THE ADEQUACY OF THEIR FUNCTION IS ESSENTIAL TO THE OUTCOMES OF
  CHEMOTHERAPY

Question 24

what is the treatment of leukemia?

Answer 24

• CHEMOTHERAPY
• BONE MARROW TRANSPLANT
• STEROIDS

Question 25

what is the nursing care of the child with leukemia?

Answer 25

• ENCOURAGE THE CHILD TO VERBALIZE FEELINGS
• GIVE PERMISSION TO DISCUSS HIS/HER CONCERNS, WHICH WILL
  HELP CLEAR UP MISCONCEPTIONS AND DECREASE FEELINGS OF
  ISOLATION
• FREQUENTLY OBSERVE CHILD FOR INFECTION
• MONITOR VITAL SIGNS AND FOR SYMPTOMS OF
  THROMBOCYTOPENIC BLEEDING (A COMMON COMPLICATION OF
  LEUKEMIA)
• METICULOUS MOUTH AND SKIN CARE