Pedi Hematologic Disorders Flashcards
Epistaxis
Risk Factors
trauma low humidity allergic rhinitis upper resp. infection meds that affect clotting factors von Willebrand disease, hemophilia, idiopathic thrombocytopenia purpura, leukemia
Epistaxis
Manifestations
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
Epistaxis
Nursing Interventions
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
Epistaxis
Client Education
short fingernails
cool-mist humidifier during winter
recurrences - sit up and slightly forward
bleeding stops within 10 mins
Epistaxis
Complications
Hemorrhage - seek medical care if bleeding lasts longer than 30 mins
Iron Deficiency Anemia
Risk Factors
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
Iron Deficiency Anemia
Manifestations
SOB pallor brittle, spoon-shaped fingernails fatigue, irritability, muscle weakness systolic heart murmur, enlarged heart, HF
Iron Deficiency Anemia
Labs
CBC - decreased RBC count, H&H
RBC indices - decreased, indicating microcytic/hypochromic RBC’s
reticulocyte count - decreased
serum ferritin level - decreased, iron store
Iron Deficiency Anemia
Nursing Interventions
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
Iron Deficiency Anemia
Medications
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
Iron Deficiency Anemia
Client Education
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
Iron Deficiency Anemia
Complications
HF - increased demands on hear to deliver O2 to tissues (teach family how to monitor pulse rates) developmental delay (improve nutrition)
Sickle cell anemia
Risk factors
Autosomal recessive genetic disorder
African Americans
Parent with sickle cell trait
Sickle cell anemia
Manifestations
Family hx of SCA or trait Pain SOB/fatigue Pallor/pale mucous membranes Jaundice Cool hands and feet Dizziness Headache
Sickle cell anemia
Labs
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)
Sickle cell anemia
diagnostic procedures
transcranial doppler (TCD) test - risk of CVA performed annually children 2-16 yo
Sickle cell anemia
Nursing Care
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
Sickle cell anemia
Medications
Opioids
Sickle cell anemia
patient education
support manifestations of crisis and infection rest nutrition hand hygiene fluid intake requirements medical IDs
Sickle cell anemia
Complications
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)
Hemophilia A
deficiency of factor VIII
classic hemophilia
80% of cases
Hemophilia B
deficiency of factor IX
Christmas disease
Hemophilia
risk factors
x-linked recessive
Hemophilia
manifestations
excessive bleeding, joint pain/stiffness, impaired mobility, easy bruising, activity intolerance
active bleeding, hematomas, hemarthrosis, headache, slurred speech, decreased level of consciousness
Hemophilia
Labs
aPTT - prolonged partial thromboplastin time
factor-specific assays to determine deficiency
Hemophilia
Diagnostic
DNA testing - classic hemophilia trait in females
Hemophilia
Nursing Care
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
Hemophilia
Medications
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
Hemophilia
Client education
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
Hemophilia
Complications
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
Iron Deficiency Anemia
Expected ranges of H&H
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
