Peds Exam 3a - Hem Flashcards
what to do when platelets are between 100,001- normal
-no contact sports
-protective equipment like helmets when riding bikes
what to do when platelets are between 50,000-100,000
-padding w/ activity
-protective equipment like helmets
what to do when platelets are <50,000
-extreme caution as kids can spontaneously bleed in their head
-quiet activities
no scooters or bikes
what to do when platelets are >20,000
-kids can return to school
absolute neutrophil count
tells use the body’s ability to fight off infection
be able to calculate
-above 1000 is ok
-500-1000: lowered immune system
-<500: critically low
nursing interventions for neutropenia (<1000)
-monitor vitals
temp >/100 is a medical emergency
-wash hands
-assess skin & mouth
-no flowers or plants in room
-low bacteria diet
-change dressing & lines w/ sterile technique
-no live virus vaccines
-avoid sick people & wear mask when leaving the room
what is the low bacteria diet
-hot foods must be hot
-cold food must be cold
-no skins on fruits & vegetables
-no pepper
what are the live vaccine
-flu mist
-varicella
-MMR
nursing considerations for anemia
-lab tests
-decrease oxygen demands
-good hand washing & mouth care
-maintain normal body temperature
-prevent complications
-support family
iron deficiency anemia (IDA)
-inadequate iron stores at birth (mom hemorrhaged)
or
- deficient dietary intake (rapid growth, excessive milk intake, poor eating habits, exclusive BF after 6mo)
or
-impaired iron absorption (iron inhibitors, malab disorders, chronic diarrhea)
therapeutic mgt of IDA
-nutritional supplements by 6mo
-iron fortified formula or cereal
-iron supplements
-blood transfusions for severe cases
prevention of IDA
-breastmilk or commercial infant formula for first 12mo of life
-limit formula to </1L/d (32oz)
-limit milk to </24oz/d
precautions for giving liquid iron
-best absorbed in acidic environment (give w/ orange juice)
-give w/ straw to push it past the teeth then rinse & brush
-teach accurate measuring & increasing fiber + fluids
-avoid antacids, coffee, tea, dairy products, eggs, or whole grains 1hr before or 2 hr after admin
it tastes bad
what do you need to do with medicine or vitamins containing iron
lock it up -> kids love the gummies and can overdose on iron
adverse effects of oral iron
-N/V/D/gastric irritation
-anorexia
-staining of teeth
-tarry stools
overdose is lethal
why is drinking large quantities of milk a risk factor for IDA
children might be drinking milk all day in their sippy cups and then become too full which leads them to not intake enough iron
eat meals (w/ dark leafy greens) first then drink
iron rich foods
-lentils
-green leafy vegetables
-hamburger
aplastic anemia
child is not making red blood cells or increased destruction
seen commonly with leukemia
S/s: profound anemia, pallor
sickle cell anemia
the body makes red blood cells but instead of them being rounds they are sickled (looks like boomerang) which then get lodged in vessels causing a crisis
sickle cell: vaso occlusive crisis
the joints get enlarged because the blood flow is blocked in the smaller area (pain, fever, joint engorgement)
a clog of sickle cells
sickle cell: splinic sequestration
the spleen gets enlarged with blood causing abdominal pain, pneumonia like symptoms, an erection that wont go away, chronic ulcers and high risk for stroke bc clot
(profound anemia, hypovolemia, shock)
Life threatening, usually remove spleen before age 5
complications of sickle cell anemia
-acute painful episodes (SC crisis)
-stroke (doppler scans yearly)
-sepsis
-acute chest syndrome (like pneumonia)
-reduced visual acuity
-chronic leg ulcers
-delayed G&D&puberty
-priapism
-enuresis
precipitating factors for a sickle cell crisis
-anything that increases the body’s need for oxygen
-trauma
-infection, fever
-physical & emotional stress
-increased blood viscosity d/t dehydration
-hypoxia
if your spleen is removed, what needs to be done
penicillin before invasive procedure after removal
medical mgt SCA
dx at birth so prevention of crisis
-prevent dehydration, being cold, high altitudes, high stress
-transfusion (can lead to an iron overdose)
medical mgt of a sickle cell crisis
hydration first which increase vasculature which helps everything
-maintain oxygenation
-pain mgt
-support the child & family
thalassemia
-the body is not synthesizing or not making hemoglobin as you should
-autosomal recessive disorder
-alpha & beta (beta is more common)
how to treat thalassemia
repeated iron infusion
can lead to overdose
thalassemia clinical manifestations
-severe anemia
-bronze skin
-growth retardation & delayed puberty
-cardiac enlargement w/ murmur -> HF
-bone pain, skeletal deformities, fractures
thalassemia death is usually related to
heart failure or iron overdose
medical mgt of thalassemia
giving repeated infusion and then treat w/ iron-chelating drugs like deferoxamine which binds to the excess iron for excretion by the kidney + give oral vit C to facilitate binding of iron
thalassemia nursing interventions
-packed RBC safely
-general anemia measures
-monitor chelation therapy: N/V/D, low app, rash, inc liver enzymes, neutropenia
-measures to increase self esteem & body image
-measures to increase health maintenance at home
what is vital for chelation therapy
adequate hydration & kidney function bc the extra iron is peed out
clinical manifestation of ITP
-sudden onset of easy bruising, purpura & petechiae
-epistaxis
-platelet count <20,000
-prolonged bleeding time
idiopathic thrombocytopenic purpura (ITP)
platelet count is low and we do not know why -> can give IVIG but usually resolves on own, if repeated episodes then spleen will be removed
steroids can help and anti D antibody is usually given to help clear out RBCs
can you give anti D antibodies to someone who is anemic
no -> will drop RBCs even lower
before giving need to check RBC
ITP nursing interventions
-educate parents about low platelet counts & monitoring
-assess for bleeding
-prevent trauma
-avoid unnecessary procedures, sticks, suppositories, rectal temps
-pressure for 5mins after venipuncture
-follow up care
proper care for epistaxis (nose bleed)
-sit up leaning forward
-apply pressure for 10 min
-apply ice bag to bridge of nose
seek medical care if lasts longer than 30mins
hemophilia
a group of hereditary bleeding disorders that result from deficiencies of specific clotting factors
(x linked so usually seen in males)
hemophilia manifestations
-bleeding into joint spaces of knee, ankles, and elbows which lead to mobility issues, range from mild to severe
-often have nose bleeds & bleeding after procedures
when is hemophilia usually diagnosed
around 6mo when infant starts to get teeth and they bleed excessively
medical mgt of hemophilia
-prevent bleeding
-replacement of deficient factor (factor VIII concentrate or desmopressin)
-regular exercise & pt
nursing interventions of hemophilia
-measures to prevent bleeding like safe environment, avoid aspirin, SQ vs IM, soft
tooth brushes
-recognize & control bleeding
wear med alter bracelet & tell school
how to recognize &control bleeding
-pressure x15min for frank bleeding
-RICE
-be suspicious of headache, slurred speech, altered LOC & black tarry stools
children are aware of internal bleeding and can tell you
RICE
rest (immobilize), ice, compression, elevation
if child comes to you and say they feel tingly and think they are having a bleeding episode then RICE it
how to prevent side effects of bleeding
-active ROM after the acute phase
-physical therapy
-nutritional counseling
SCID
boy in a bubble
-do not have T or B cells
-no immune system
bone marrow transplant is the best intervention we have, IVIG can help if exposed to infection
no immunizations
HIV differences from adults
-will appear sicker than adults bc weaker immunes system
-usually contracted by the mother (off meds during 1st trimester and then restart, this allows organs to develop), blood transfusions or unprotected sex in adolescents
-children are very irritable
treatment of HIV
-aggressive antibiotics for infections & prophylactic antibiotic
-modified immunization schedule
prevent is key
dx of HIV
if infant is suspected to have it or acquire it, antiretrovirals for the first month of life and then PCR test -> if neg then can stop virals
HIV children & school
children can go to school but standard precautions are needed (gloves for nose bleeds & bodily fluids)
nutrition for HIV
increased kcals & proteins
