UNIT 9 HEMATOLOGIC DISORDERS Flashcards
What Blood type is the Universal Recipient?
A. AB+
B. AB-
C. AB
D. O-
A. AB+
What Blood type is the Universal Donor?
A. O-
B. AB+
C. D
D.B
A. O-
A. O-
What blood type is compatible for Blood type A-?
A- O-
What blood type is compatible for Blood type O-?
O-
What blood type is compatible for Blood type O+?
O- O+
What blood type is compatible for Blood type A+?
O+ A+ A- O-
What blood type is compatible for Blood type AB-?
A- B- AB- O-
What blood type is compatible for Blood type AB+?
A+ A- B+ B- AB+ AB- O+ O-
What blood type is compatible for Blood type B-?
O- B-
What blood type is compatible for Blood type B+?
B+ B- O+ O-
Blood transfusion
Blood transfusions used to treat various diseases
Verify identity of recipient and donor’s blood group
Monitor vital signs
Use appropriate filter
Use blood within 30 minutes of arrival
Infuse over 4 hours maximum
A patient has been prescribed a b blood transfusion. You noticed the new grad nurse received the blood pack 5 hours ago at 1300 it is currently 1800. What is the priority nurse intervention?
A. Intervene and request that she get a new blood pack from the blood bank due to the blood 4-hour shelf life.
B. Administer the blood pack without her supervision.
C. Instruct her that she will not be able to administer the blood after 1900 due to shelf life.
D. Assist the new grad nurse with the blood transfusion.
A. Intervene and request that she get a new blood pack from the blood bank due to the blood 4-hour shelf life.
Use blood within 30 minutes of arrival
Infuse over 4 hours maximum
Which of the following is a symptom of Anemia?
A. Hypertension
B. Hyportension
C. HGB of 16
D. bradycardia
A. Hypertension
RBC or Hgb concentration below normal range
Characterized by etiology (depletion) or
morphology (size & shape)
Anemia causes increased cardiac workload; may
cause murmur
RED BLOOD CELL LAB VALUE
4.5-4.5 millon
HEMOGLOBIN LAB VALUE
11.5- 15.5
HEMATOCRT LAB VALUE
35-45
Is Reb blood cells increased or decreased with a patient diagnosed with anemia?
decreased
S/S of Anemia
Pallor
Fatigue
Tachycardia
Murmurs
Growth retardation
Activity intolerance
slight jaundice if red blood cell destruc-
tion occurs
Shortness of breath
Dysrhythmias
Chest pain
Cool extremities
Management of Anemia
Treat underlying cause
Transfusions,
nutritional
interventions
*Supportive care: IVF,rest,
*decrease O2 demands (keep child calm), *O2 as PRN
What foods would you recommend for a child with anemia
- Encourage the client to eat foods rich in folic
acid,
such as green leafy vegetables, meat, liver, fish, legumes, peanuts, orange juice, and avocado. - Administer folic acid as prescribed.
What is the cause of iron deficiency Anemia?
Most prevalent and preventable nutritional disorder in US
Most often caused by nutritional deficiency
Children 12-36 months at risk
poor diet increase intake of calcium rich foods
2. Commonly results from blood loss, increased metabolic demands, syndromes of gastrointestinal malabsorption, and dietary inadequacy.
How can you treat iron deficiency anemia? What foods would you recommend
Iron rich foods and supplements
Dried beans
Dried fruits
Egg yolks
Iron-fortied cereals
Liver
Meat (especially lean red meat, poultry) Oysters
Salmon
Tuna
Whole grains
Iron Supplement teachings for Patient/ Parent education
Liquid preparations of iron may temporarily stain the teeth. If possible, the medication should be taken through a straw or given through a syringe or medicine dropper placed toward the back of the mouth. Brushing the teeth after administration of the drug lessens the discoloration.
Cow’s milk contains substances that bind the iron and interfere with absorp- tion. Iron supplements should not be administered with milk or milk products
. Oral iron should be given as prescribed in two di- vided doses between meals, when the presence of free hydrochloric acid is greatest, because more iron is absorbed in the acidic environ- ment of the upper gastrointestinal (GI) tract. A citrus fruit or juice taken with the medication aids in absorption.
Give supplements on empty stomach
Black/green tarry stools normal with supplements
Give to exclusively breast-fed babies by 4 months
Is sickle cell anemia a congenital disorder?
A. No
B. Yes
B. Yes
Hereditary presence of HbS; an autosomal recessive trait
Pathophysiology
Sickling causes obstruction of vessels, vascular inflammation, RBC destruction
S/S of Sickle cell disorder
Effects of Sickle cell
Hemolysis
CVA (stroke) Paralysis Death
Retinopathy Blindness Hemorrhage
Avascular necrosis (shoulder)
Hepatomegaly Gallstones
Splenomegaly Splenic sequestration Autosplenectomy
Hematuria Hyposthenuria
(dilute urine) Avascular necrosis (hip) Abdominal pain
Dactylitis (hand-foot syndrome)
Priapism
Anemia Pain Osteomyelitis
Chronic ulcers (rare in children)
What are the risk factors of Sicle cell crisis
*infection,
*stress,
*dehydration,
*trauma
Types of crises
Types of crises
Vaso-occlusive- “painful episode”
Splenic sequestration - pooling of blood in the spleen
Aplastic - decreased production of RBCs
Focus: Prevent sickling and treat crisis
Oral/IV hydration
Enuresis possible
Decrease O2 demands
O2 use?
Pain management
Prevent infection
Immunizations, PCN prophylaxis, hydroxyurea
Splenectomy
Blood transfusions
Stem cell transplant
Considered curative
Teaching: S/S of infection, Acute Chest Syndrome, CVA
What is Hemophilia
Bleeding disorder resulting from deficiency o dysfunction of factors (proteins) needed for clotting
What are patient deficient in when they’ve been diagnosed with hemophilia
Factor 8
Pathophysiology
Deficiency of factor VIII, produced by liver
S/S OF Hemophilia?
Prolonged bleeding
Hemorrhage
Bruising
Hemarthrosis(swelling of blood in joints)
Spontaneous hematuria
Diagnostics
History of bleeding episodes
Evidence of inheritance
Labs: clotting factors, DNA
Treatment
Prevent bleeding
Replace clotting factor
Meds
Corticosteroids
NSAIDS- used cautiously!
DDAVP
Regular exercise and Physical Therapy
Control bleeding
RICE
Rest,
Ice,
Compression,
and Elevation
Support/educate family
Are patients diagnosed with hemophilia susceptible to nose bleeds
A. Yes
B. No
A. Yes
Does a patient with Hemophilia has an increase bleeding time
a. yes
b. no
a. yes
normal range PTT
Both Sexes: 20-30 sec
normal range INR
0.9-1.2 sec
normal range pt
11-12.5sec
The nurse is preparing home care instructions for the parents of a 10-year-old child with hemophilia. Which sport activity would the nurse suggest for this child?
1. Soccer
2. Basketball
3. Swimming
4. Field hockey
- Swimming
The clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors re- lated to sickle cell crisis. Which, if identied by the parents as a precipitating factor, indicates the need for further instruction?
1. Stress
2. Trauma
3. Infection
4. Fluid overload
- Fluid overload
A 10-year-old child with hemophilia A has slipped on the ice and bumped the knee. The nurse would prepare to administer which prescription?
1. Injection of factor X
2. Intravenous infusion of iron
3. Intravenous infusion of factor VIII
4. Intramuscular injection of iron using the Z-track
method
- Intravenous infusion of factor VIII
The nurse is preparing to instruct the parents of a child with iron-deciency anemia regarding the administration of a liquid oral iron supplement. Which instruction would the nurse give the parents?
1. Administer the iron in-between mealtimes.
2. Administer the iron through a straw.
3. Mix the iron with cereal to administer.
4. Add the iron to formula for easy administration.
- Administer the iron in-between mealtimes.
- Laboratory studies are performed for a child sus- pected to have iron-deciency anemia. The nurse reviews the laboratory results, knowing that which result indicates this type of anemia?
- Elevated hemoglobin level
- Decreased reticulocyte count
- Elevated red blood cell count
- Red blood cells that are microcytic and hypochromic
- Red blood cells that are microcytic and hypochromic
The nurse is reviewing a pediatrician’s prescriptions for a child with sickle cell anemia who was admitted to the hospital for the treatment of vase-occlusive crisis. Which prescriptions documented in the child’s record would the nurse question? Select all that apply.
1. Restrict fluid intake.
2. Position for comfort.
3. Avoid strain on painful joints.
4. Apply nasal oxygen at 2 L/minute.
5. Provide a high-calorie, high-protein diet.
6. Give meperidine, 25 mg intravenously, every 4 hours for pain.
- Restrict fluid intake.
- Give meperidine, 25 mg intravenously, every 4 hours for pain.
