T3 - Blueprint 2 (Josh) Flashcards
Hallmarks of DIC are – and –
bleeding
clotting
What are the Vaso-occlusive complicatons w/ SCD?
Stroke
Pain assoc. w/ obstructed blood flow and ischemia
Why is the Spleen effected by SCD?
Splenic sequestration caused by pooled blood, which enlarges the spleen significantly.
Treat with blood transfusion.
Patho of DIC
When the clotting process gets started abnormally. Thrombin is made faster than body can neutralize it.
This is bad because the child is susceptible to uncontrollable hemorrhage into vital organs.
Why is iron deficiency anemia common in infancy?
cow’s milk too soon
Hemophilia A and B are X-linked recessive disorders which means that – are more likely to get it.
boys
- remember the Punnet Square
Pathophysiology of Kawasaki Disease
inflammation in the walls of medium-sized arteries throughout the body (including the coronary arteries, which supply blood to heart muscle)
What is the definitive test for SCD?
Hbg Electrophoresis
- mearsures the various HGBs
- differentiates b/t trait and anemia
— is a secondary disorder of coagulation that occurs as a complication of a number of pathologic processes.
DIC (Disseminated Intravascular Coagulation)
What is the analgesia of choice for SCD pain?
IV morphine
Why is Kawasaki Disease serious?
can lead to MI
S/S of RHD:
What is Erythema Marginatum
Classic eruption of RF
Flat, macular, circular, distinct wavy border (chicken wire–no itching) on trunk or arms
Prevention of RHD?
uses ASPIRIN for polyarthitits (inflammation f joints)
Hemophilia — is more common and is a deficiency in —
A (80% of cases)
Factor VIII
Stopping a nose bleed
sit up and slightly lean forward
pinch bridge of nose–hold about 5 minutes;
*****longer if hemophilia
What is the drug of choice to fight infection w/ SCD clients?
Penicillin
What is one of the first S/S of Vaso-occlusive complications w/ SCD?
Hand and Foot Syndrome (dactylitis)
- sausage finger
- inflammation of an entire digit (finger/toe)
SCD problems:
Aplastic Crisis is caused by — and leads to — and —-
human parvo virus
lowered Hgb
lethargy
S/S of RHD:
What is SubQ Nodules?
Small, hard, nontender swellings
Contain Aschoff bodies
What are the Ophthalmic complications with SCD?
hemmhorage and retinal detachment that can lead to blindness
S/S of RHD:
What is Sydenhams Chorea?
sudden, aimless, purposeles movements
- relieved by rest and sleep
RICE treatment for Hemophila
Rest
Ice
Compression
Elevation
Prevention for Hemophilia clients:
padded crib
clutter-free (tripping)
soft bristle toothbrushes
immunizations
RICE (rest, ice, compression, elevation)
Screening tests for Hgb are limited because…
they are not specific for trait or anemia
— is systematic vasculitis.
Kawasaki Disease
SCD is an — disease with an average lifespan of —
inherited
45 years
Hgb count for Iron Deficiency Anemia.
6-11 g/dL
What can be given to increase clotting w/ Hemophilia clients?
Factor VIII and Factor IX
via port-a-cath at home
S/S of Kawasaki Disease
High Fever
Red Eyes
Ring around Iris
Strawberry Tongue
Rash (skin peels off in flakes)
S/S of Endocarditis
Low grade, intermittent fever
Malaise
Joint Pain (arthralgia)
New Murmur
In Endocarditis, what happens tot the heart valve?
infection/inflammation makes it stenotic
- typically Mitral Valve
SCD clients will likely need a — due to severe pain.
PCA pump
Jones Criteria (Major/Minor Manifestations of Rheumatic Heart Disease)
memorize
Major:
- Carditis
- Polyarthritis
- Sydenham’s Chorea
- Erythema Marginatum
- SubQ Nodules
Minor:
- Fever
- Arthalgia
- Elevated Acute Phase Reactants
- Prolonged PR Interval
Complications from SCD
Ophthalmic Complications
Vaso-occlusive Crisis
Cardiomegally
Abd. Pain and GI dysfunction
ENLARGED SPLEEN
Stroke
Enlarged Spleen (caused by SCD) can lead to…
Anemia
Hypovolemic Shock
INFECTION
Normal RBCs live about –
Sickled RBCs live about –
3 mths
1 mth
What is the cure for SCD?
nothing
there is no cure, only treat symptoms
- controlling anemia
- relieving pain
In treating Sickle Cell Disease (SCD), what is key?
Hydration and Oxygenation
— is a symptom of Rheumatic Fever.
Endocarditis
- bacterial infection/inflammation of heart valves and inner lining
What should we avoid w/ Hemophilia clients unless absolutely necessary?
Rectal temp
Skin puncture
Normal Hgb is —.
With SCD, Hbg is —
Normal = 11 gm/dL
SCD = 2-5 gm/dL
S/S of Hemophilia
Active bleeding
Hematomas
Hemarthrosis
Headache
Slurred Speech
Decreased LOC
With Hemophilia, why avoid a Hot/Warm compress?
increases bleeding to the site!
S/S of DIC
Petechiae
Purpura
Bleeding from openings in venipuncture site and surgical incision
Bleeding from umbilicus or trachea (newborn)
Bleeding evidence in GI
Hypotension
Organ dysfunction from infarction and ischemia
Why is infection a problem with SCD?
Spleen filters out infection
Spleen is one of the major organs affected by SCD due to blood sequestering in the organ
What is the key sign of Hemophilia?
hemoarthritis
- treat immediately
- rest, immobilize, elevate, supply ice
Treatment for Kawasaki Disease
High dose of IVIG and Salicylate therapy
ASPIRIN
How common is stroke w/ SCD children?
10%
Nursing considerations when giving PO Iron.
If tolerated, give on empty stomach (with juice NOT MILK)
Give with meals and start with reduced dose and gradually increase if GI disturbance occurs
Give with Vitamin C to increase absorption
Use straw to prevent staining of teeth
Stools will be tarry green–this is normal
Brush teeth after dose to minimize/prevent staining
What helps keep SCD kids healthy?
good nutrition (folic acid) - (though they can eat normal food)
**important b/c even a little cold can make them very ill
Sickle Cell Crisis is triggered by — or — and signs include — and —
viral infection
depletion of folic acid
profound anemia
pallor
— – – follows strep when it is not treated properly.
Rheumatic Heart Disease
Treatment for Endocarditis
Prophylaxis Antibiotics (Penicillin best)
- especially BEFORE dentistry
In Kawasaki Disease, dilation of the Aorta from inflammation leads to —
aneurysm
