Peds Test # 3 Blood Dyscrasias Flashcards
What are the 4 methods used to diagnose Sickle Cell Anemia (SCA)?
1) Prenatal amniocentesis
2) Newborn screening: Sickledex
3) Hemoglobin electrophoresis - Differentiates trait from the disease.
4) Transcranial Doppler (TCD) - Assesses intracranial vascular flow (ages 2-16).
What is the result of RBC sickling?
RBC sickling > blood flow obstruction > tissue hypoxia > tissue ischemia > pain
What are the 6 SxS of Sickle Cell Anemia which usually starts around 6 months of age?
1) Shortness of breath > fatigue
2) Tachycardia
3) Pallor
4) Impaired healing and frequent infections
5) Delayed growth
6) Systolic heart murmur and heart failure
What are the 3 conditions that cause RBCs to sickle?
1) ⬇ O2 concentrations
2) Acidosis
3) Dehydration
What are the 7 SxS of an Acute Vaso-Occlusive Crisis resulting from SCA?
1) Sever pain in bones, joints and abdomen
2) Swollen joints, hands and feet
3) Anorexia, vomiting and fever
4) Hematuria
5) Jaundice
6) Visual disturbances
7) CVA
What are the 8 SxS of an Chronic Vaso-Occlusive Crisis resulting from SCA?
1) Respiratory infections
2) Blindness
3) Systolic murmurs
4) Renal failure and enuresis
5) Liver enlargement/failure
6) Spleen enlargement/infections
7) Seizures
8) Skeletal deformities
List the 6 nursing diagnoses discussed in lecture that are appropriate for a patient with SCA.
1) Acute pain
2) Altered tissue perfusion
3) Fluid volume deficit
4) Risk for injury
5) Risk for infection
6) Delayed growth and development
What are the 8 methods of treatment used to manage SCA?
1) Bedrest
2) Hydration
3) Pain management
4) Electrolyte replacement
5) Give blood products
6) Antibiotics
7) Heat and passive ROM
8) Give O2
What are the 3 methods used to prevent SCA complications?
1) Transfusion Program - Every 4-5 wks to maintain Hgb
2) Hydroxyurea - Oral med used to ⬆ fetal hemoglobin a that don’t sickle.
3) Bone Marrow Transplant - Only cure
What are the 7 appropriate patient teachings for a patient with SCA?
1) Take frequent rest periods
2) No contact sports if spleen is enlarged
3) Avoid infections
4) Avoid low oxygen environments
5) Ensure adequate hydration (even though it may cause enuresis)
6) Apply heat to painful area
7) Maintain vaccination schedules
Describe the disorder of Hemophilia.
It is a group of bleeding disorders from a congenital deficiency of specific coagulation proteins. It is an X-linked recessive disease carried by females (mothers) and transmitted to sons.
How is Hemophilia diagnosed in males? How is the trait identified in females?
1) Males - Ptt
2) Females - DNA testing for trait
What are the 6 SxS of Hemophilia?
1) Prolonged bleeding
2) Hemorrhage
3) Excessive bruising
4) Spontaneous Hematuria
5) Hemarthrosis (bleeding into joint cavity)
6) Hematomas (swelling, pain, limited ROM)
What 4 methods are used to prevent complications from hemophilia?
1) Primary - Regular schedule of factor VIII
2) Secondary - Factor infusion after joint bleed
3) Mild Cases - DDAVP: A des oppression nasal spray which ⬆ factor VIII.
4) Antifibrinolytic Agents (Amicar) - Inhibits breakdown of fibrin
What 6 methods are used to manage Hemophilia?
1) Blood transfusions - Includes FFP or PRBCs
2) RICE - Rest, Ice, Compression, Elevation
3) Aspiration - For severe bleeding
4) Pain Management - No NSAIDs
5) Use bleeding precautions
6) Active ROM (not passive)
Describe the disorder of Immune Thrombocytopenic Purpura (ITP)?
ITP is an autoimmune disorder that destroys platelets via platelet antibodies. The antibodies bind to the plasma membrane of platelets causing them to be removed from circulation in the spleen and liver.
What are 3 common etiologies/causes of ITP?
1) Viral infections
2) Drugs
3) Collagen vascular diseases (lupus)
What are the two types of ITP?
1) Acute - Majority of cases, self limiting, resolves in days to weeks.
2) Chronic - Lasts > 6 months
How is ITP diagnosed?
There are no definitive tests to diagnose ITP but the patient usually has platelet count < 20,000.
What are the 6 different methods used to manage ITP?
1) Restrict activity
2) Anti-D antibody
3) Platelet placement
4) IVIG (an immunoglobulin)
5) Prednisone
6) Splenectomy for chronic severe form
Describe the disorder of Aplastic Anemia.
When all formed elements of the blood are depressed.
⬇ RBCs
⬇ WBCs
⬇ Platelets
What two methods are used to diagnose Aplastic Anemia?
1) Bone marrow aspiration
2) Labs - ⬇ RBCs, ⬇ WBCs, and ⬇ platelets
What 3 methods are used to manage Aplastic Anemia?
1) Immunosuppressive therapy
2) Colony stimulating factors
3) Bone marrow transplant
What are the 7 SxS of Anemia?
1) Petechiae and Ecchymosis
2) Pallor
3) Epistaxis
4) Fatigue & Weakness
5) Tachycardia
6) Anorexia
7) Infection
What are the 4 factors that contribute to Iron Deficiency Anemia (IDA)?
1) ⬇ Iron intake
2) ⬇ Iron stores
3) ⬆ Iron loss
4) Poor utilization of iron by body
What are 5 the SxS of IDA?
1) Overweight milk baby
2) Pallor
3) Pale mucous membranes
4) Content
5) Tired/fatigued
What are the 4 methods used to diagnose IDA?
1) ⬇ Hbg
2) ⬇ Hct
3) ⬇ Serum iron level
4) ⬆ TIBC (Total Iron Binding Capacity)
What are the 3 methods of treatment used for infants and children with IDA?
1) Give Iron formula, supplements and foods
2) Limit milk intake to < 32 oz/day for infants and 24 oz/day max for children older than 12 months.
3) Limit activities (need rest)
What 7 patient teachings should be taught to your patient who is taking Iron Supplements?
1) Take on an empty stomach
2) Use dropper to avoid teeth stains
3) Stools may be tarry and constipation may ⬆
4) Do not take with dairy products
5) For max effect, give in 3 divided doses/day
6) OD can be fatal - child proof supplements
7) Over 6 months of age - give with citrus to ⬆ absorption
