week 5: caring for the child and family w hematological and immunological dysfunction Flashcards
Prodromal phase
it’s the beginning of the disease before you start showing symptoms
What is an indication that a pt needs to increase their pancreatic enzymes in the treatment of CF?
Pt stools noted to be greasy/fatty
The ability to resist invading organisms in children may be affected by cardiac abnormalities
true
what to look into for hematologic and immunologic dysfunction
- complete CBC
- history and physical exam
- comments by parent regarding child’s lack of energy
- food diary of poor iron sources
- frequent infections
- bleeding
Lethargic
Recurring Infection
Pale
CBC - extremely valuable to know in particular
- Would likely show: decreased RBC, hematocrit, mean RBC
Family history, vegetarian (poor iron), frequent bruising, more fatigue (with low iron)
If platelets are low they will bleed more, possible frequent nosebleeds, petechia (idk how to spell it)
what is anemia
- most common hematologic disorder of childhood
- decrease in # of RBCs and/or hemoglobin (Hgb) concentration below normal
- decreased oxygen-carrying capacity of blood
When do iron stores normally decrease
6 months, so at this time we introduce iron nutrient foods, cereals, formulas, etc.
anemia classified according too
- etiology and physiology: RBC and/or Hgb depletion
- morphology: characteristics changes in RBC size, shape, and/or colour
Is there a issue making RBCs?
Are the RBC size macro? Normal?
Looking at is it sickle cell shape? Normal?
Neonate anemia: prematurity, any hereditary disorders, infection
Older children: iron needs increase, diet
Is pt pale? Yellowing of the eyes?
Supplement with iron, possible IV fluids.
therapeutic management for anemia
- physical exam and diagnostics
- treat underlying cause: transfusion after hemorrhage if needed, nutritional intervention for deficiency anemias
- supportive care: IV fluids to replace intravascular volume, o2, bed rest
nursing care management anemia
- prepare child and family for lab tests
- decease o2 demands
- prevent complications
- support/educate family
iron deficiency anemia
- caused by inadequate supply of dietary iron
generally preventable: - iron-fortified cereals and formulas for infants
- iron supplementation for breastfed infants beginning at 4 months for term
- special needs of premature infants - supplementation at 2 weeks of age
- adolescents at risk bc of rapid growth and poor eating habits
- avoiding cow’s milk until age 12 mo and limit to no more than 600 mls daily
pathophysiology of iron deficiency anemia
caused by any # of factors
therapeutic management
3mg/kg of iron
increase amount of iron the child receives
Take iron w vitamin C
Stool colour changes (dark green/black)
Emphasize importance of iron in diet
Increase fluids because it can cause constipation
what is sickle cell anemia
group of inherited RBC disorders “hemoglobinopathies”
- normal adult Hgb is partly or completely replaced by abnormal Hgb
- most commonly affects black ppl - 9% incidence in Canada
Adaptation to prevent the body against malaria
pathophysiology on sickle cell anemia
- obstruction of sickled RBCs
- vascular inflammation
- increased RBC destruction
- abnormal adhesion + inflammatory process = vasoconstriction
- results in absence of blood flow to tissues causing local hypoxia, tissue ischemia, and infarction
clinical manifestations of sickle cell
- vary in severity and frequency
periods of exacerbation “crises” - vaso-occlusive crisis
- stroke
- chest syndrome
- acute splenic sequestration
- hyperhemolytic
- infection
management of sick cell crisis
- rest
- hydration
- o2
- electrolyte replacement
- pain management
- blood transfusions
- antibiotics
- education/support
What test determines lots of genetic abnormalities and is included in the newborn screening
Hydration: want to prevent blood from becoming clumpy
What should be included in teaching a mother of a 9 month old about administering liquid iron:
tarry green colour stool with adequate iron dosage
wait how long to give fortified foods or solids
6 months
What is primary cause of painful crisis experienced by individuals with sickle cell:
Vaso-occlusion
neoplastic disorders
leading cause of death from disease in kids past infancy
almost half of all childhood cancers involve blood or blood-forming organs