Pediatrics- Hematologic Disorders Flashcards
What is Epistaxis
Blood nose
What is ridk factor for a bloody nose
Trauma(picking or rubbing the nose)
Low humidity
What injury?
Medication, side effect, clotting factors
What should the nurse do if a child has a bloody nose
Maintain, calm demeanor
Have child sit up with head, tilted slightly forward to prevent aspiration of blood
Apply pressure to the lower nose
If needed pet cotton into side of nose, that’s bleeding
Encourage breathing through their mouth
Apply ice
How should a patient be sitting if they have a bloody nose
Slightly forward sitting up
Why are adolescence at risk to iron deficiency anemia
Poor diet
Rapid growth
Menses
Obesity
Strenuous activity
What are risk factors for getting iron deficiency anemia
Premature birth
Excessive cow milk
Poor diet
Infants : Gerd, pyloric stenosis
Older children : G.I. polyps, colitis
Adolescence : menorrhagia
Findings in a patient with iron deficiency anemia
Pallor
Riddle, spoon shaped fingernails
Muscle weakness
Craving nonnutritive substances
How does milk affect iron deficiency anemia?
Milk is not a good source of iron
Milk takes the place of iron, rich, solid foods
By what age should you provide iron supplements for premature low, birthweight infant
By age of two months
Play what age should you supply iron supplements if full-term baby is anemic
4 to 6 months
What should the infants diet include if they are iron deficient, anemia to help absorb iron?
High iron in vitamin C
How do you give iron supplements?
One hour before or two hours after milk to prevent decreased absorption
G.I. upset is common
Give with meals
Give with vitamin C
You strong with liquid to prevent staining of teeth
What do you teach a patient who is taking iron supplements?
Expects stools to turn Tary Green
Brush teeth after oral dose to prevent staining
What should infants be taking as their dietary source of iron
Iron fortified cereals in formula
What is sickle cell disease?
A group of diseases in which abnormal sickle hemoglobulin replace his normal adult hemoglobulin
What is sickle cell anemia?
The most common form of sickle cell disease, results of RBC sickling, which leads to increased blood viscosity obstruction of blood flow in tissue hypoxia
What is the sickle cell trait
Child has genes but is asymptomatic
What is sickle cell crisis?
Is the acute exacerbation of sickle cell anemia
What does risk factors of sickle cell anemia?
Recessive genetic disorder
African-American
Children who have a tree, but do not manifest. The disease can pass to their offspring.
Expected findings in a child with sickle cell anemia
Family history
Reports of pain
SOB
Pallor
Hands and feet cool to touch
Dizziness
What is a vaso-occlusive crisis
A painful episode of sickle cell anemia
What is an acute crisis of sickle cell anemia?
Usually related to dehydration and decreased oxygen
Severe pain
Swollen joints
Abdominal pain
Hematuria
Visual disturbances
What is a chronic crisis of sickle cell anemia?
Increased risk of respiratory infection and osteomyelitis
Retinal detachment in blindness
Systolic murmur
Renal failure
Liver cirrhosis
What is this Sequestration
Excessive pooling of blood primarily in the spleen, and sometimes in the liver
What can happen when sequestration occurs?
Where do circulating blood volume results in hypervolemia and can progress to shock
What is hypovolemic, shock signs and symptoms
Irritability
Tachycardia
Pallor
Decrease urinary output
Tachypnea
Cool extremities
Thready pulse
What is in aplastic crisis in sickle cell anemia?
 Extreme anemia, as a result of temporary decrease RBC production
Typically triggered by an infection
What does hyper hemolytic crisis?
Increase rate of RBC destruction, leading to anemia, jaundice, or reticulosytosis
How do you detect, sickle cell anemia?
CBC
What is a transcranial Doppler test
Assess intracranial vascular flow and detect the risk for cerebrovascular accident CVA
Annually performed on children ages 2 to 16 who have sickle cell disease
What should the nurse do for a patient who has sickle cell anemia?
Promote rest to decrease oxygen consumption
Administer oxygen, if hypoxia is President
Administer IV fluids with electrolyte
Caution, potassium replacement
Administer packed red blood cells
Medication’s for sickle cell anemia
Opioids and HydroXyurea
Increases oxygenation to the cells
How can sickle cell anemia cause stroke?
Sickle cells can occlude blood vessels
What are signs and symptoms of stroke?
Seizures
Abnormal behavior
Weakness, or an ability to move extremity
Slurred speech
Visual changes
What is a life-threatening complication of sickle cell anemia?
Acute chest syndrome
Common in adolescence
Look for pain
Fever of, 101.3 or higher.
Wheezing
Retractions
Decrease oxygen saturation
What should the nurse do if a patient is in acute chest syndrome
May need a blood transfusion
What is hemophilia?
 Bleeding disorders characterized by difficulty, controlling, bleeding, and deficiencies in clotting factors
When is bleeding tendencies recognized in infancy
During circumcision
What is hemophilia a
Deficiency of factor VIII
REFERRED TO AS CLASSIC HEMOPHILIA
Most common
What is hemophilia B
Deficiency of factor IX
Referred to as Christmas disease
What is von Willebrand hemophilia?
Inherited lack of the von Willebrand factor proteins, characterized by the inability of platelets to aggregate
Expected, finding in patient with hemophilia
Episodes of bleeding
Excessive bleeding
Impaired mobility
Easy bruising
Activity intolerance
Bleeding gums
Tarry stools
How do you diagnose hemophilia
DNA testing detects classic hemophilia trait in females
What are you do for a patient who has hemophilia?
Administer injections subcutaneous instead of IM
Venipunctures our preferred
Monitor for blood in urine and stool
Do not administer aspirin
What is DDAVP
Form of vasopressin that increases plasma factor VIII to treat hemophilia a
What should you teach the patient about
Hemophilia
Environment should be as safe as possible to prevent injury
Set activity restrictions to avoid injury
Low contact sports
Soft, bristle, toothbrush
Up-to-date identification
Where medical identification
How to control bleeding in hemophilia
Use Acreman, RICE
Rest
Ice
Compression
Elevation
What can happen if there’s uncontrolled bleeding and hemophilia
Impending shock
A nurse is providing teaching about the management of epistaxis to an adolescent, which of the following position should the nurse instruct the adolescent to take when experiencing a nosebleed
Set up an lean forward
Set up until the head up
Lying supine position
Lie in a prone position
Sit up and lean forward
A nurse is providing teaching about Epistaxis to the parent of a school age child which of the following should the nurse include as an action to take when managing an episode of epistaxis (select)
Press the nares together for at least 10 minutes
Breathe through the nose until bleeding stops
Pekka in or tissue into the nearis that is bleeding
Apply warm cloth across the bridge of the nose
Insert petroleum into the Nare after the bleeding stops
Press, the nares together for at least 10 minutes
Pet, cotton or tissue into the nares that is bleeding
A nurse is providing teaching to the parent of a child, who has a new prescription for liquid, oral iron supplements, which of the following statements by the parent indicates an understanding of the teaching
“ I should take my child to the emergency department if his stools become dark”
“ my child should avoid eating citrus fruits while taking the supplements”
“ I should give the iron with milk to help prevent an upset stomach”
“ my child to take supplement through the straw”
My child should take the supplement through a straw
A nurse is preparing to administer iron dextran IM to a school age child who has iron deficiency anemia, which of the following actions by the nurse is appropriate
Administer the dose in the deltoid muscle
Use the Z track method when administering the dose
Avoid injection more than 2 mL with each dose
Massage the injection site for one minute after administering the dose
 Use the Z track method when administering the dose
A nurse is caring for an infant who is screening test reveals a potential diagnosis of sickle cell disease, which of the following test should be performed to distinguish is the infant has a tree or the disease
Sickle cell solubility test
Hemoglobin electrophoresis
Complete blood count
Transcranial Doppler
Hemoglobin electrophoresis
