Pedi Hematologic Disorders Flashcards

1
Q

Epistaxis

Risk Factors

A
trauma
low humidity
allergic rhinitis
upper resp. infection
meds that affect clotting factors
von Willebrand disease, hemophilia, idiopathic thrombocytopenia purpura, leukemia
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2
Q

Epistaxis

Manifestations

A
hx of bleeding gums or blood in body fluids/stools
hx of trauma
illness
allergies
placing foreign bodies in nose
active bleeding from nose
restlessness/agitation
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3
Q

Epistaxis

Nursing Interventions

A

calm demeanor
child sit up with head tilted slightly forward
apply pressure to lower nose - 10 mins
cotton/tissue packed
child breathe through mouth
ice across bridge of nose
water-soluble jelly or petroleum inserted after nosebleed

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4
Q

Epistaxis

Client Education

A

short fingernails
cool-mist humidifier during winter
recurrences - sit up and slightly forward
bleeding stops within 10 mins

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5
Q

Epistaxis

Complications

A

Hemorrhage - seek medical care if bleeding lasts longer than 30 mins

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6
Q

Iron Deficiency Anemia

Risk Factors

A

premature birth - decreased iron stores
excessive intake of cows’ milk in toddlers (not good source of iron, take place or iron-rich foods)*
adolescents at risk due to poor diets, menses, obesity
*
malabsorption disorders - prolonged diarrhea
poor dietary intake of iron
increased iron requirements (blood loss)
chronic disorders - folate deficiency, sickle cell anemia, hemophilia

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7
Q

Iron Deficiency Anemia

Manifestations

A
SOB
pallor
brittle, spoon-shaped fingernails
fatigue, irritability, muscle weakness
systolic heart murmur, enlarged heart, HF
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8
Q

Iron Deficiency Anemia

Labs

A

CBC - decreased RBC count, H&H
RBC indices - decreased, indicating microcytic/hypochromic RBC’s
reticulocyte count - decreased
serum ferritin level - decreased, iron store

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9
Q

Iron Deficiency Anemia

Nursing Interventions

A

iron supplements for preterm and low-birth-weight by age 2 months
iron supplements for exclusively breastfed by age 4 months
iron-fortified formula for not breastfed
high iron, vitamin C, protein diet
limit toddlers’ milk to 32oz/day
give milk AFTER meal
toddler should not carry bottles/cups of milk
frequent rest

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10
Q

Iron Deficiency Anemia

Medications

A

Iron supplements - 1 hr before or 2 hr after milk or antacid; GI upset common at start give with meals reduced dose; prefer admin on EMPTY stomach; admin with vitamin C; liquid prep use straw; Z-track IM do NOT massage

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11
Q

Iron Deficiency Anemia

Client Education

A

iron supplements may cause diarrhea, constipation, nausea
supplement admin
increase fiber and fluids
dietary sources of iron - infants: iron-fortified cereals and formula; children: dried beans/lentils, peanut butter, green leafy veggies, iron-fortified breads/flour, poultry, red meat
prevent overdose - store only 1month supply in childproof bottle
allow child to rest
if hgb levels don’t increase after 1 month of tx further evaluation needed
follow-up tests

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12
Q

Iron Deficiency Anemia

Complications

A
HF - increased demands on hear to deliver O2 to tissues (teach family how to monitor pulse rates)
developmental delay (improve nutrition)
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13
Q

Sickle cell anemia

Risk factors

A

Autosomal recessive genetic disorder
African Americans
Parent with sickle cell trait

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14
Q

Sickle cell anemia

Manifestations

A
Family hx of SCA or trait
Pain
SOB/fatigue 
Pallor/pale mucous membranes 
Jaundice 
Cool hands and feet
Dizziness 
Headache
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15
Q

Sickle cell anemia

Labs

A

Screening mandatory
CBC to detect anemia
Sickledex (sickle turbidity) presence of HbS - will not differentiate trait from disease
Hgb electrophoresis - definitive DX
Sickle-cell crisis - (decreased Hgb; elevated WBC; elevated bilirubin and reticulocyte; peripheral blood smear reveals sickled cells)

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16
Q

Sickle cell anemia

diagnostic procedures

A
transcranial doppler (TCD) test - risk of CVA
performed annually children 2-16 yo
17
Q

Sickle cell anemia

Nursing Care

A
rest
O2
fluid and electrolyte balance
pain
heat to painful joints
packed RBCs
ABX
hand hygiene
oral prophylactic penicillin
pneumococcal conjugate vaccine (PCV)
meningococcal vaccine (MCV4)
yearly influenza
18
Q

Sickle cell anemia

Medications

A

Opioids

19
Q

Sickle cell anemia

patient education

A
support
manifestations of crisis and infection
rest
nutrition
hand hygiene
fluid intake requirements
medical IDs
20
Q

Sickle cell anemia

Complications

A

CVA (seizures, abnormal behavior, weakness, slurred speech, visual changes, vomiting, severe headache) - blood transfusions q3-4 weeks to prevent repeat
Acute chest syndrome (chest, back, abdominal pain; 38.5/101.3 fever; cough; tachypnea; dyspnea; retractions; decreased oxygen saturations)

21
Q

Hemophilia A

A

deficiency of factor VIII
classic hemophilia
80% of cases

22
Q

Hemophilia B

A

deficiency of factor IX

Christmas disease

23
Q

Hemophilia

risk factors

A

x-linked recessive

24
Q

Hemophilia

manifestations

A

excessive bleeding, joint pain/stiffness, impaired mobility, easy bruising, activity intolerance
active bleeding, hematomas, hemarthrosis, headache, slurred speech, decreased level of consciousness

25
Q

Hemophilia

Labs

A

aPTT - prolonged partial thromboplastin time

factor-specific assays to determine deficiency

26
Q

Hemophilia

Diagnostic

A

DNA testing - classic hemophilia trait in females

27
Q

Hemophilia

Nursing Care

A

avoid rectal temps, unnecessary skin punctures
surgical aseptic technique
pressure 5 mins after injections, venipuncture, needle stick
monitor urine, stool, nasogastric fluid for occult blood
admin factor replacement (adverse signs: headache, flushing, low sodium, alterations in HR and BP)
rest
immobilize affected joints
elevate and ice joints

28
Q

Hemophilia

Medications

A

1-deamino-8-d-arginine vasopressin (DDAVP) - synthetic form of vasopressin increases plasma factor VIII; for mild cases; can be given prior to dental or surgical procedures
Factor VIII, pooled plasma, recombinant products - prevent and treat hemorrhage; IV infusion; can require numerous doses
Corticosteroids - hematuria, acute episodes of hemarthrosis, chronic synovitis
Nonsteroidal anti-inflammatory agents - chronic synovitis; caution due to potential inhibition of platelet function; take WITH food

29
Q

Hemophilia

Client education

A
padded crib
safe home free of clutter padding on corners
dress in extra layers
activity restrictions
soft-bristled toothbrushes
after active bleeding - exercise and PT
immunizations
medical IDs
RICE to control bleeding
support group
30
Q

Hemophilia

Complications

A
Uncontrolled bleeding (intracranial hemorrhage, airway obstruction) - conduct neurologic assessment
Joint deformity (most often elbows, knees, ankles) - hemarthrosis impaired ROM, pain, tenderness, swelling - rest, immobilize, elevate, ice during active bleeding; ideal weight; PT
31
Q

Iron Deficiency Anemia

Expected ranges of H&H

A
Age         Hgb         Hct
2 mos     9-14         28-42
6-12 yr   11.5-15.5  35-45
12-18 yr 13-16 m    37-49
12-18 yr 12-16 f      36-46