Peds final Flashcards
What are the types of play?
infant-Solitary
Toddler-parallel
Preschooler-associative
School age-cooperative
normal assessment findings-infant
Weight=5-9lbs
Height: 19-21 cm
HC:33-35cm
normal motor development-infant
4 mo- head control, hold things with both hands rolls back to side
6 mo-rolls back to front
9mo-creeps on hands and knees, sits unsupported, crude pincer grasp
12 mo-stand with one hand, two block tower
feeding recommendations-infant
breastfeed 6 mo
Solids 4-6mo
New food every 3-5 days
Iron fortified formulas
Introduce foods (rice cereal, veggies, fruits)
toddler-nutrition, language development, car safety
picky eaters-food jags
Developmental anorexia
30-500
Car seat rear facing until 2
If no backseat, air bags must be off
preschooler-normal cognitive development, normal social development
Initiative vs guilt and shame
Magical thinking
Animism
Time related to events
school age normal social development, normal assessment findings
Puberty girls 9-10 boys 10-11
Industry vs inferiority
cares about peer perception of them and comparison
adolescent nutrition promotion and care for hospitalization
2,000 calories
1,300mg calcium
11mg iron boys
15mg iron for girls
hypoxemia plan of care- assessment findings
TACHYPNEA=first sign!
Cyanosis, clubbing, resp distress signs (Nasal flaring, grunting, retractions), restlessness, adventitious lung sounds, LOC changes, low O2 sat
hypoxemia plan of care-Management
oxygenation
hypoxemia plan of care-POC
Oxygen(at lowest rate that corrects), O2 sat monitoring(95-100%,<91%=intervene,<86%=life threatening), suction, chest physiotherapy
asthma nursing assessment
wheezing, low O2 sat, panic/apprehension, retractions, nasal flaring, hypoxia/hypoxemia
asthma management
Albuterol and corticosteroids, O2 sat monitoring, oxygen as prescribed if necessary
asthma diagnostics
Allergy/RAST testing:triggers
Low SpO2 (normal if mild episode)
CXR: hyperinflation/infiltrates (air trapped)
PFT-lung vol capacity and overall lung function , not useful in acute episode
PIFR-flow meter used daily to monitor management for s/s and acute- amt air forcefully exhaled in 1 sec
asthma labs
CBC: inc WBC (eosinophils)
ABG:inc CO2 and dec O2 (can sometimes get air in, but cannot get air out bc of constricted lumen and spasming bronchi)
asthma meds- prevention
LABA (formoterol), inhalation corticosteroid (fluticasone), mast cell-stabilizer (cromolyn), leuokotriene receptor antagonists (montelukasts)
Asthma meds- acute
SABA(Albuterol) with anticholinergic (Ipatropium), IV/PO corticosteroids (prednisone)
status asthmaticus meds
possible intubation, theophylline, Mg Sulfate IV, Heliox, Ketamine
cystic fibrosis med management-resp
chest PT w/postural drainage (ACT, airway clearance therapy)
-pulmonary enzyme Dornase (dec secretion thickness)
-Bronchodilators and anticholinergics
-IV/nebulized ABG
-O2 as RX
-Monitor for CO2 retention
Cystic fibrosis management-GI
high protein high calorie diet
-encourage fluids
-supplement with fat-soluble vitamins ADEK
-admin pancreatic enzymes within 30 in of eating meal or snack(dose adjusted until 1-2stools/day)
-infants=open capsule and sprinkle on acidic type food (applesauce)
Cystic fibrosis S/S
resp: thick, tenacious sputum, air obstruction/trapping
Chronic cough, URI
Unable to clear secretions
R sided HF (cor pulmonale)
Clubbing/barrel chest
GI: dehydration, thicker bile (cirrhosis/gallstones)
Decreased pancreatic enzymes (thick mucous)
Steatorrhea(abd distension, difficulty passing stool, bulky and fatty greasy stools
Poor weight gain
Cystic fibrosis
epithelial cells do not conduct chloride, altering water transport>thick, tenacious mucus in resp tract, pancreas, GI tract, and other exocrine tracts/ducts
cystic fibrosis diagnostics
sweat chloride test:
>40-infatns (<3mo)
>60-all other ages
Sodium >90
(Gold standard)
KUB-detects meconium ileus
Stool analysis: fat and enzymes
CXR:hyperinflation,bronchial wall thickening, atelectasis, infiltrates
PFT: dec forced vital capacity/expiratory vol
croup physical findings
barking cough
Inspiratory stridor
Infants-nasal flaring, intercostal retractions
Tachypnea
Sudden onset at night, gone in am, self limiting
Lasts 3-5 days
(URI>laryngotracheobronchitis)
croup nursing management priorities
can be managed at home
Cool mist humidifiers
Steamy bathroom to reduce inflammation in trachea
Meds- dexamethasone (corticosteroids) and racemic epi (Dec edema), lasts up to 2 hr
HF nursing priorities
oxygenation/ventilation:
Promote rest
Promote nutrition
promote nutrition management
150cal/kg/day, small frequent feedings
Feedings limited to 20 min then remainder OG/NG
Gavage feedings
Human milk fortifier to inc cal
Formula fed infants addition of poly code/vegetable oil inc cal
promote rest HF management
cluster care, provide request rest periods, bathing PRN, quiet diversional activities
oxygenation/ventillation HF management
flowers/semi fowlers
Suction and CPT PRN
Humidified O2 only as orders, monitor SpO2, intubation with PEEP if severe
HF med management-metoprolol
Dec HR and BP promotes vasodilation
Monitor HR and BP prior to admin
S/E=dizziness, hypotension, HA
Hf med management- captopril/enalapril
reduced after load w vasodilation=dec pulm and systemic resistance (monitor BP before and after admin)
Dry cough-report if unbearable
HF med management- lasix
manage edema (rids body of excess fluid and sodium)
-K+wasting
-monitor BP
-monitor I&O
-monitor weight daily
S/E=hypokalemia, N/V, dizziness, ototoxicity
HF med management-Digoxin
inc contractility of heart muscles
-count apical pulse 1 min, hold if <90bpm infant, <70 child, <60 adult
-monitor serum levels (0.8-2ng.mL)
-signs of toxicity: N/V anorexia, bradycardia, dysrhythmias
Antidote- digoxin immune fab
coarctation of aorta
narrowing of aorta
coarctation of aorta assessment findings
-assess all pulses
-Full bounding pulses in UE and weak/absent in LE
-Soft/moderately loud systolic murmur at base or left axilla
BP different
coarctation of aorta diagnostics
Ultrasound, cardiac ultrasound
tetralogy of fallot
four fatales of fallout:
VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy
-unoxygenated blood mixing, amt of blood going to be oxygenated Dec, ineffective pumping to body, blood shunting
tetralogy of fallot clinical characteristics
fainting, SOB, difficulty breathing, easily fatigued, color changes with feeding and crying and activity
-loud harsh systolic murmur
-polycythemia (elevated RBC)
TET spells (blue baby)-esp in am(cyanosis, hypoxemia, dyspnea, agitation»progresses to anoxia and unrepsonsiveness)knee to chest position
tetralogy of fallot Nursing management
knee to chest position for TET spells-shunts blood appropriately
Calm them down, sedation
-promoting oxygenation and ventillation
0promoting nutrition: small frequent meals 150cal/kg/day
kawasaki disease
Acute febrile systemic vasaculitis in blood vessels due to inflammation and edema, especially in coronary arteries
Kawasaki disease assessment findings
chills, HA, malaise, extreme irritability, V/D, abd pain, joint pain
-High fever for at least 5 days unresponsive to abx
Significant bilateral conjunctivitis without exudate
Mouth and throat dry, fissured lips, strawberry tongue, pharyngeal/oral mucosa edema
Desquamation (peeling)of fingers and toes and peri area
kawasaki disease treatment
-immunoglobulin (IVIG)-boost immune system
-High-dose aspirin-followed by low dose after fever breaks indefinite if aneurysms develop , anti coagulation /preventing aneurysm and clotting
-Acetaminophen for fever
Kawasaki disease comfort care
Strict I&O
Cool cloths
Daily weight
Promote rest and calm/quiet environment
Lip lubricants and mouth care
Clear liquids and soft foods-popsicles
IVF
cardiac arrhythmias-sinus tach
Associated with pain, dehydration, fever, hypoxia
Infants <220bpm (160-220)
Children <180 (130-180)
Beat-to beat variability, P wave and QRS present and normal
Tx=focused on underlying cause (pain, fever, dehydration)
cardiac arrhythmias-sinus brady
most common bradyarrhythmia
P wave and QRS normal
Brief drops with vagal stim and recovers spontaneously
Life threatening bradyarrhythmia
HR<60 with signs of altered perfusion (resp compromise, hypoxia, shock)
Sustained bradycardia=commonly associated with arrest and is an ominous sign
Does not spontaneously pop back up
cardiac arrhythmias-SVT
-Cardiac conduction issue HR extremely rapid w reg rhythm
-Infants >220 children >180 w abrupt onset and termination
-P wave flattened, QRS narrow
Tx:compensated=well perfused A&O= vagal maneuvers first ice on face or blow through straw
Uncompensated=no perfusion, altered LOC, weak pulse lethargic= adenosine (restarts)
dehydration assessment findings
sunken fontanelle
No tears
Less UOP/dry diapers
Tenting
Tachycardia
Dry MM
Sudden weight loss (severity measured)
dehydration oral rehydration
attempted first for mild and moderate case
Sodium and glucose (pedialyte)
-No tap water milk undulated fruit juice or broth
-Mild: 59mL/kg within 4 hrs
-Moderate: 100mL/kg within 4 hrs
-Diarrhea losses=10mL/kg/stool
dehydration IV rehydration
severe cases or if oral not tolerated
20mL/kg of NS bolus with maintenance fluids
pyloric stenosis
pylorus muscles hypertrophies and thickens on luminal side of pyloric canal causing gastric outlet obstruction
pyloric stenosis assessment
-forceful, projectile vomiting, nonbilious vomiting not associated with position
-hunger soon after emesis, weight loss with FTT
-dehydration subsequent lethargy
-olive-shaped moveable mass in RUQ, if palpated no further tests needed
Labs- abnormal electrolytes and metabolic alkalosis from dehydration from vomiting
pyloric stenosis nursing management
-IVF for electrolytes and dehydration
-NGT decompression, NPO, strict I&O
-Post op care wound care (four tiny incisions)
-Resume PO feedings 1-2 days
hirschsprung’s
lack of ganglionic cells- helps with peristalsis for bowel movement
-often in sigmoid colon near rectum
“Megacolon”
hirschsprung’s exxpected findings
Current past medical HX of Down syndrome, chromosomal abnormalities
-NB failure to pass meconium in 24-48 hr after birth, vomiting bile, refusal to eat, abd distension
-Infant/child:FTT, constipation, V/D, abd distension, visible peristalsis, palpable fecal mass, foul-smelling ribbon-like stool
hirschsprung’s Tx
Resection-Ostomy while it heals with re-anastomosis
Hirschsprung management
observe for signs of enterocolitis(stool sits in one place and causes inflammation and infection)-> fever, abd distension, chronic diarrhea/explosive stool, rectal bleeding, straining-notify provider immediately
-Routine post op care-ileostomy/colostomy care
Post-op teaching about stoma care, enterocolitis, and meds. Wound care consult for new ostomy teaching
acute glomerulonephritis physical findings
recent pharyngitis/strep throat or skin infection
-fever, lethargy, irritability, HA, Dec UOP, abd pain, vomiting, anorexia
General and periorbital edema(FVO and CHF), elevated BP r/t poor kidney function and fluid elimination
acute glomerulonephritis
immune mechanism injure glomeruli=inflammation resulting in Dec GFR (post acute strep A beta hemolytic streptococcus)
acute glomerulonephritis lab findings
Hematuria and proteinuria- tea colored and frothy
-inc BUN/creatinine
-inc ESR
-ASO titer positive(strep antibodies)
acute glomerulonephritis nursing management
hemolytic uremic syndrome
E.coli verotoxins that attacks kidney; water parks, uncooked beef, animals, Public pools
-causes hemolytic anemia, thrombocytopenia, and renal insufficiency
hemolytic uremic syndrome assessment findings
watery diarrhea w/ cramping that becomes bloody over several days, possible vomiting(E. Coli)
-pallor, toxic appearance
-edema, oliguria, Anuria
-Irritability, altered LOC, seizures, posturing or coma
-dark urine, possible petechiae, hematemesis
hemolytic uremic syndrome nursing management
maintain fluid balance, managing HTN acidosis, and electrolyte abnormalities
-contact precautions for E. coli (shed for ~17 days)
-strict I&O=progression of RF
-monitor for bleeding ,fatigue, pallor
-PRBCs and PLT (only for active bleeding/severe thrombocytopenia), IVIG may be considered
hypospadias physical findings
urethral opening on ventral surface below glans penis
hypospadias tx
surgical intervention
-Post-op care
-Not circumcised at birth bc foreskin used to cover
-urethral stand/drainage tubing taped with penis upright to prevent stress on urethral incision
-analgesics for pain mngmnt/bladder spasms
-double diapering to protect stent/catheter and prevent stool from touching catheter
growth hormone deficiency clinical manifestations
-Disruption of vertical growth, retarded bone growth
-Large prominent forehead under developed jaw
-Dec muscle mass
-high-pitched voice
-delayed sexual maturation
-delayed dentition/skeletal maturation
-
growth hormone deficiency clinical Tx
Biosynethetic GH daily sub a 0.18-.3mg/kg/week
-Monitor s/e
-Monitor effectiveness measure height every 3-6 mo
-Continues until growth rate <1in/yr or bone age is >16 in boys and >14 yrs in girls
-Growth stops when epiphyseal plates close
congenital hypothyroidism clinical manifestations
-poor sucking reflex
-Hypothermia
-Constipation
-Lethargy
-Hypotonia
-Periorbital puffiness
-Cool, dry,scaly skin
-Bradycardia
-Large fontanelles, delayed closure
-Macroglossia
-T4 low, TSH high
DKA S/S
BS>330mg/dL
-Polydisia,polyphagia, polyuria
-Late sign=oliguria
-N/V, abd pain, warm dry flushed skin
-Dry MM
-Confusion
-Hyporeflexia
-Kussmaul respirations
-Fruity breath
-glucosuria and ketonuria, metabolic acidosis, elevated BUN/Creatinine, Ca, Mg, PO4-,Ma+,K
DKA management
PICU admission
-Hourly glucose monitoring to prevent BS falling more than 100mg/dL/hr (causes cerebral edema)
-IVF->dehydration, correct Na+ and K+, improve peripheral perfusion
-IV reg insulin via drip and sliding scale protocol
hydrocephalus physical cues
Ventricular dilation and inc ICP due to excessive SCF within cerebral ventricles and or subarachnoid spaces
-irritability, lethargy, poor feeding, projectile vomiting, inc HC, HA or vision loss, giant change, altered or diminished LOC, bulging fontanelles, thin and shiny scalp w prominent visible scalp veins, sunset eyes
Hydrocephalus management
CT/MRI(shows enlarged ventricles or obstructed CSF flow)
-ventriculoperitoneal (VP)shunt- gives fluid a way to move, does not cure or treat underlying cause but manages hydrocephalus symptoms
S/S shunt infection/obstruction
-fever >101
-HA, stir neck, bulging fontanelle
-Poor feeding, vomiting
-Inc HC
-Dilated pupils on same side as pressure build up
-High-pitched cry, change in behavior and or sleep patterns
seizures nursing care
Put them on their side
Remove glasses
DO NOT restrain them
NOTHING in their mouth
Loosen restrictive clothing
Do not open jaw or insert airway
Remain calm
After:
-maintain side lying position
-monitor breathing, VS, head position, tongue
-assess for injuries
-re-orient child and calm them
-do not offer food/fluids until fully awake and swallowing reflexes has returned
seizures precautions
Padding side rails, clear bed, oxygen and suction at bedside, side rails raised at all times while kid is in bed, supervision, protective helmet during activity, medical alert bracelet
inc ICP physical cues
-cushing’s triad (irregular breathing, HTN, bradycardia)-late
-Bulging fontanelle
-Shrill high pitch cry
-Prominent scalp veins
-Tachycardia (early)
-Posturing
-Blurred/double vision
-Projectile vomiting
-Sunset eyes
inc ICP management
-keep head midline with bed 30 degrees, avoid extreme flexion and extension or rotation of head
-calm quiet room limit visitors
-avoid coughing or blowing nose
-stool softener
-Seizure precautions
-Monitor I&O’s
Bacterial meningitis
-Kernig and Brudzinski sign
LP inc WBC, Dec glucose, protein inc, cloudy urine
Bacterial meningitis mngmt
ICU
Strict droplet isolation until 24 hr of abx/orders d/c
-IV broad spectrum abx after all CX obtained
-ventilator support
-measures to reduce ICP
-Dec stimuli
-seizure precautions/control
-manage hyperthermia with NSAIDs, cooling blankets, cool compress, tepid baths
Kernig sign
Hip and knee flexed 90 degrees while supine and extension of knee is painful or limited
brudzinski sign
passive flexion of the neck elicits hip and knee flexion (stretches meninges)
Reye syndrome
results in encephalopathy causes cerebral edema and liver failure. Aspirin given during infection with virus-> liver failure->elevated ammonia levels-> encephalopathy
reye syndrome manifestations
-severe/continual vomiting
-Lethargic confusion and irritability
-Hyperreflexia
-Red, macular rash may be present
-signs of IICP
-signs of Liver failure (jaundice, ascites, poor appetite)
Reye syndrome labs
-LFTs inc, serum ammonia inc
Nursing management Reye syndrome
-supportive care for liver failure and measures to Dec ICP
-Hyperammonemia-lactulose (laxative that absorbs ammonia into stool to excrete)
-Hypocoagulapathy- FFP or vit K
-Hypoglycemia-dextrose containing fluids
spina Bifida cystica mngmt
myelomeningocele-more severe, spinal nerves and cord within sac-motor and sensory deficits
Meningocele-no spinal involvement
Surgical correction
spina Bifida cystica nursing care
keep sac moist monitor for leaking or inc ICP
Prone positioning
Warmer
No swaddling or diapers
Promote child-parent bond
Cerebral palsy
-nonprogressive impairment of motor function
-Primary goal=maintaining mobility, cardiopulmonary function, prevent compilations, max quality of life
nursing CP mngmt
oxygenation/ventilation: positioning, suctioning, IS, aspiration prevention
Paint mngmt-manage muscle spams
Nutrition, skin care, communication, psychosocial, developmental support
CP meds
Baclofen: centrally acting skeletal muscle relaxant
Botox(botulinum toxin A): reduces spasticity in specific muscle groups (usually quadriceps)
Carbidopa: dopaminergic promotes relaxation of muscles
FX
pediatric considerations:
Buckle fractures=most common bc bones are more flexible
-fractures=2nd most common injury in physical abuse
-suspicious signs: rib Dx, scapular, Sternal, femur fx(esp nonmobile)
-Multiple fx, esp bilateral
-Any infant w unexplained fx
Fx complications
compartment syndrome- 5P’s pain, pallor, paralysis, pulselessness, paresthesia
Osteomyelitis-fever tachycardia edema constant pain inc with movement refuse to use extremity swelling warmth tenderness
Amblyopia
-lazy eye, poor vision development in one eye that leads to visual acuity loss and blindness
-Can be caused by strabismus, truama, cataracts, ptosis
-Patch the stronger eye or put atropine drops in stronger eye to make the weaker eye work more
Vision therapy
acute otitis media S/S
rubbing or pulling on ear
Crying
Irritability/fussiness
Ear pain poor feeding difficulty sleeping
TM dull red bulging or opaque
Purulent drainage may be visible behind eardrum or in canal if TM ruptured
Lymphadenopathy of head or neck
Dec or no TM movement
acute otitis media mngment
otalgia and fever management
-acetaminophen and ibuprofen(unless <6 mo) for mild-moderate pain
-Benzocaine drops if TM not ruptured to numb pain
-Warm cool compresses
Abx therapy 10-14 days
Amoxicillin or augmentin
fever management
assess temp every 4-6 hrs or 30-60 min after given antipyretic
Same site and device
Assess fluid intake and encourage fluids or admin IVF, keep linens and clothes dry
pertussis
paroxysmal cough (10-3- times in a row), red face, cyanosis, drooling, protruding tongue
“Whooping cough”
DTaP status, sick contacts
pertussis therapeutic management
-macrolide abx
-Abx for infants >1mo azithromycin if <1mo
-High humidity environment
-push fluids
-abx compliance
-droplet/standard precautions
Lyme disease
rash(7-10 days after bite), fever, malaise, joint pain, erythema migrans at site of bite. Neck stiffness
lyme disease management
abx as ordered
-teach to take as directed until completed
-doxycycline if started early (>8yrs)
-amoxicillin if <8yrs to prevent teeth discoloration or cefuroxime if allergic
Tx=14-28 days
SCID
severe combined immune deficiency
Absent B and T cell function
SCID management
bone marrow transplant with HLA-matched sibling or donor
-IVIG Dec bacterial infections
“Bubble boy”
Infection prevention:
-hand washing
-no exposure to sick
-limit visitors
-no live vaccines
-adequate nutrition
-no live flowers
-no raw fruits or veggies
Atopic dermatitis
-antigen response
-Skin red dry lesions with weepy papules or vesicles
-Elevated IgE levels
-Possible wheezing
-response to environmental factors, temp change, sweating
atopic dermatitis meds
topical corticosteroids and immune modulators (tacrolimus)
-antihistamines HS may assist with itching
atopic dermatitis management
-avoid hot water and bathe 2x/day in warm water
-avoid soaps containing perfumes, dyes, fragrances
-pat skin dry and leave moist while apply moisturizers multiple times daily
-100% cotton clothing and bed linens, avoiding synthetics and wool, keep fingernails short
Behavior modification during waking hours (clickers, distraction, -reward)
Skin injuries
-abrasions-superficial rub or wearing off due to friction, limited to epidermis
-Laceration-penetrates skin and soft tissue
-bites
-bruises=damage to underlying vessels
-burn=contact with thermal chemical electrical agents cause coagulation of tissue leading to cellular death
risk factors for intentional skin injuries
poverty
Prematurity
Chronic illness
Intellectual disability
Parent with abuse of alcohol or substances
Extreme stressors
Parent with abuse Hx with partner or unrelated partner
be suspicious if…skin injuries
-injuries in uncommon locations
-Bruises in infants <9mo
-Multiple injuries other than LEs
-Frequent ED visits delay in care
-Inconsistent stories
-Unusual caregiver child interaction
burns
-fluid resuscitation important in first 24 hrs, based on BSA burned
-LR in early stage recovery, dextrose added for small children
-most of calculated fluids given in first 8hr, remainder over 16 hr
-Child reassessed after 24 hrs
-Maintain UOP 1-2mL/kg/hr
-Daily weights and monitoring electrolytes
Complication=hypovolemic shock
Adequacy of fluid replacement in burn therapy is determined by…
evaluating urinary output
burns-wound care
-initial clean with mild soap and water
-Leave blisters intact
-Apply PPE and remove loose skin and eschar wsterile scissors and forceps
-Pre medicate for pain prior to wound care
Local analgesia, sedatives, anesthesia may be needed for wound care
-Medicate 30-45 min prior to wound care morphine with midazolam IV for severe burns
nutritional Support-burns
-inc calorie, protein intake
-Enteral or parenteral therapy
-Vit A and C (cell growth) and zinc (for wound healing)
JIA-juvenile idiopathic arthritis
-Hx of irritability or fussiness may be first sign
-joint stiffness and pain after sleep or inactivity
-fever
-pale red nonpruritic macular rash
-Limping gait
-Joint with edema ,warmth, erythema, tenderness
-Eye inflammation
JIA labs
-CBC:mild to moderate anemia, elevated WBC
-inc ESR and CRP
-positive ANA with pauciarticular type
-Positive rheumatoid factor (RF)-severe cases
WBCs
neutrophils-acute bacterial infection/severe stressor
Eosinophils-allergic rxns
Lymphocytes (B and T)= viral infections or chronic bacterial infection
Erythrocyte sedimentation rate
inflammation marker
C-reactive protein
inflammation marker
Immunoglobulins
IgG-only one that crosses placenta and breast milk. Protects against viruses, bacteria, and toxins
IgA-defense against respiratory, GI, GU pathogens
IgM- indicates active infection
IgE-inc in allergic states, severe allergic rxns, parasitic rxns
Complement C3- elevated indicated immune system is active from infection or injury
Hemophilia A
lack of factor 8
-swollen or stiff joints(hemarthrosis)
-multiple bruises
-hematuria
-bleeding gums
-bloody sputum or emesis
-tarry stools
-chest/abd pain (internal bleeding)
hemophilia A lab cues
PTT- only one elevated
PT and PLT are NOT effected
Possible low H&H if bleeding has been happening
hemophilia A mngment of bleeding episodes
-FIRST factor VIII admin (slow IV push)
-Apply direct pressure to external bleeding if joint bleeding, apply ice or cold compresses and elevate (RICE)
-prophylaxis for mild cases=desmopressin (DDAVP) IV SQ intranasal triggers endothelium of blood vessels to release factor VIII
anemia (iron deficient)
Body does not have enough iron to produce hemoglobin
- 12-24mo= picky eaters and transitions from formula to cows milk
-lethargic, weak, dizzy, pallor, SOB, pica, difficulty feeding, spooning of nails
iron deficiency anemia labs
RBC, H&H, iron, mean cell vol, mean cell Hgb,ferritin low
Red cell distribution width (RCDW) high
Iron Deficiency anemia management
-feed only formula fortified with Fe
-Fe supplements for breast-fed infants by 4-
5mo
-Encourage BF mothers to inc Fe in diet
-Limit Cow milk in children >1yr to 24oz/day
-Encourage Fe rich foods
Liquid iron-stains teeth (behind teeth), mixed with juice or drink with straw
Iron causes green stool and constipation do not give with milk or dairy products=dec absorption
sickle cell S/S
-extreme fatigue, irritability
-pain abd, thorax, joints, digits
-Dactylitis(toes and finger joints swell)
-Cough, Inc WOB, fever, tachypnea, hypoxia
-Splebomegaly (splenic obstruction)
Jaundice(from hemolysis) or pale conjunctiva, palms, soles, skin
Vaso-occlusive crisis management
-pain control- regular assessments, NSAIDs or acetaminophen for less severe, severe=opioids,-
warm compresses to inflamed joints
-hydration: get blood flowing, up to double maintenance fluids
Hypoxia: IS to Dec incidence of ACS
-O2 via NC if SpO2 <92% (O2 given in absence of Pyxis may inhibit erythropoeisis)
BMA
Prone position
Iliac crest=bone of crest (tibia for babies)
Local/topical anesthetics and conscious sedation (fentanyl/versed)
-explain procedure/comfort/infection prevention/sterile procedure
-hold pressure(5-15 min)/pressure dressing and monitor for bleeding and infection
-Diagnostic tool for ALL
neutropenic precautions
-Private room
-Hand hygiene
VS q4, assess for s/s infection ache and PRN
Avoid rectal temps, enemas’suppositories, urinary catheters, invasive procedures
No raw fruits, veggies, fresh flowers, live plants in room
Mask on child when outside room
Soft toothbrush
chemo a/e
anemia-limiting blood draws using synthetic Epoetin, iron rich foods
Thrombocytopenia- avoid rectal temps and meds, avoid IMs or LPs, avoid ASA or NSAIDs-Tylenol instead
Neutropenia-private room, hand hygiene, prophylactic abx, ANC<1000
N/V/anorexia-offer bland dry foods frequent small meals, Ofer ice, carbonated drinks, popsicles, complimentary remedied like relaxation guided imagery
ALL S/S
low grade fever
Signs of infection
Pallor
Bruising, petehciae, purport
Enlarged liver
Enlarged lymph nodes
ALL mngmt
-chemo or stem cell transplant
-Prevent infection, treating pain, anemia, prevent bleeding
blood transfusions=severe anemia and blood must be CMV-, Leuko-depleted, and irradiated prior
ALL lab cues
CBC low H&H, low RBCs, low PLT
Blood smear=blasts
LP-leukemia cells in CNS
LFTS, BUN/creatinine-guides chemo to use
CXR detect PNA or mediastinal mass
BMA=most definitive diagnostic if lymphoid or myeloid and cell type
