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CH 23 Hematology disorders - pediatric nursing

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1.

The most common


type of anemia &
most common
nutritional
deficiency in
children

Iron Deficiency Anemia: IDA

12.

What are nursing


considerations
related to
administration of
Ferrous sulfate for
IDA?

Side effects: GI, constipation, black


tarry stools, Monitor: bowel sounds
and increase fluids and fiber; mix with
juice and have child drink through
straw.

2.

What are the


causes of iron
deficiency anemia?

blood loss, malabsorption, poor


nutritional intake or increased growth
spurts

13.

define Aplastic
Anemia

3.

What pediatric non


infant population
is at risk?

Teens, if diet is high in fat and low in


vitamins; Children undergoing a
growth spurt due to increased
physiological demand; teen girls menses; Chronic blood loss

Deficiency of blood cells due to failure


of the bone marrow to produce
adequate numbers of circulating
blood cells; can be Congenital or
acquired

14.

What are common


causes of acquired
aplastic anemia?

List the infant


populations at risk
of IDA

Infants not taking adequate solids after


6 mo or formula not fortified with iron;
Breastfed only infants after 6 months
age; Preterm, multiple births, mothers
with poor nutrition;

environmental exposure such as


medications; an individual's genetically
determined response to the causative
environmental agent

15.

What is a concern
with Parvo V19 "5th disease" ?

exposure in a child with Sickle cell


disease can cause aplastic anemia

16.

5.

Body requires iron


for production
of____

hemoglobin

List agents which


may cause acquired
aplastic anemia

ingestion of sulfonamides, insecticides,


chloramphenicol, quinacrine, lead,
benzene solvents (i.e. model airplane
glue)

6.

How does IDA


affect oxygenation
and hemoglobin
production?

Insufficient quantities of iron limit Hgb


production, decreased production of
RBC's less O2 reaching cells / tissues

17.

List illnesses which


may cause acquired
aplastic anemia

viral hepatitis or mononeucleosis

18.

7.

What are Clinical


Manifestations of
IDA, Iron deficient
anemia?

severity directly related to amount of


iron deficiency ; common: Pallor, fatigue,
irritability; Pica

List s&s of aplastic


anemia

Purpura (bleeding in the tissues),


Petechiae (pinpoint lesions) -always a
BAD sign in anyone; Bleeding, fatigue,
pallor

19.

8.

What labs can be


expected when
testing for IDA?

CBC w/ differential ; Reticulocyte


immature RBC) count; Iron profile:
serum iron, TIBC (total iron binding
capacity), ferritin

How will CBC


present in aplastic
anemia

Neutropenia (decreased neutrophils)


or anemia; Thrombocytopenia (low plt
count)...progresses..; Pancytopenia
(decreased number blood cell
components)

9.

Describe the
appearance of
RBC's related to
IDA in a
microscopic study

RBCs are microcytic (small) and


hypochromic (pale)

20.

In aplastic anemia,
bone marrow
aspiration reveals___

Yellow fatty bone marrow instead of


healthy, red bone marrow

21.

10.

What is the goal of


treatment for IDA?

Correct iron deficiency within 4 months


of oral treatments

What is the
treatment of choice
for aplastic anemia?

11.

What is an
appropriate
teaching when
child is on oral
iron?

mix with Vitamin C juice to increase


absorption, use a straw to prevent
teeth staining; recheck labs in 6 months
for recurrent anemia

HSCT (compatible sib/family member);


HSCT is Hematopoietic stem cell
transplantation, a medical procedure
involving transplantation of bone
marrow or other blood-forming cells.

22.

List supportive
treatments of the
child with aplastic
anemia

Immunosuppressive therapy;
Antibiotics of infection confirmed,
transfusion Packed RBC/platlets/both

23.

Why is
immunosuppressive
therapy use to treat
aplastic anemia?

Meds used are antitymocyte globulin


(ATG) & cyclosporine; it is thought the
child's immune system is reacting
against the bone marrow.

4.

24.

Name the
three phases
of HSCT?

Pretransplant phase, transplant phase, post


transplant phase

25.

What are the


goals of
therapy for
aplastic
anemia?

preventing complications associated with


neutropenia, thrombocytopenia, and anemia

26.

Describe
hemophilia

Group of hereditary disorders: deficiency of


specific clotting factors; X linked inheritance;
Males are affected and females are carriers

27.

List the 3
types of
hemophilia

type A (most common): 'Classic'; deficient


Factor VIII, type B "Christmas disease",
deficient Factor IX; C deficient Factor XI,
autosomal recessive

28.

How do
female
carriers of
the
hemophilia
trait
present?

FEMALE CARRIERS MAY HAVE NO SYMPTOMS


AND OFTEN DO NOT FIND OUT UNTIL CHILD
BIRTH; THEY ALSO HAVE PROLONGED
BLEEDING TIMES FROM SURGERY, DENTAL
WORK OR TRAUMA

29.

When does
hemophilia
present in
children?

Circumcision; Begin when infant more mobile


after 6 months old

30.

What areas
of bleeding
are of most
concern?

Mouth/neck/throat due to obstruction of


airway; retroperitoneal and intracranial are
life threatening

S&S of
hemophilia

Spontaneous bleeding; Hemarthrosis


(bleeding into joint space); Deep tissue
bleeding; Hematuria, chronic synovitis

A
hemophiliac
should use
Steroids and
NSAIDS___

cautiously to treat inflammation

Goals of
management
for a
hemopheliac

Prevent and treat hemorrhage (prophylactic


or demand therapy); replace clotting factors
such as VIII or IX

List blood
products
given for
hypovolemic
shock

Whole blood, packed RBC, albumin

Which blood
products
will be given
as volume
expanders?

Fresh frozen plasma, albumin

31.

32.

33.

34.

35.

36.

Which type of
hemophilia is
treated by Factor
VIII concentrate?

Type A and Von Willebrand disease to


treat Factor XIII deficiency

37.

Which type of
hemophilia is
treated by Factor
IX concentrate?

Type B to treat Factor IX deficiency

38.

What are
important nursing
interventions
when caring for a
child with
hemophilia?

No rectal temps, Caution with BP &


pressure of cuff, No IM or SQ injections;
Use peripheral fingerstick vs
venipuncture, Use NS lock for blood
access; No heparin, ASA, NSAIDs
(affects platelet aggregation); Extra
clothing for padding ; Gentle oral
hygiene

39.

The hemophiliac
child will need
what prophylactic
measure prior to
dental work or
surgery?

DESMOPRESSIN (DDAVP)- an analog of


vasopressin, stimulates the release of
factor VIII from the blood vessels

40.

Define Von
Willebrand Disease

A bleeding disorder that impairs


clotting and bleeding control ;
Insufficient / dysfunctional /absent Von
Willebrand factor - a plasma protein
which is a carrier for clotting Factor VIII;
treatment similar to hemophilia

41.

S&S of Von
Willebrand Disease

CARRIER MAY NOTICE THEY BLEED


WITH ORAL CARE, BRUISE EASILY OR
HAVE HEAVY MENSES

42.

What is Idiopathic
Thrombocytopenic
Purpura (ITP)?

Increased destruction of platelets even


though platelet production in bone
marrow generally normal; this is the
most common bleeding disorder in
children.

43.

How does the


platelet
destruction affect
the child with ITP?

Circulating platelets decreases; Blood


clotting slows....bleeding into mucosa
and tissues

44.

What causes ITP?

Cause is unknown; Usually follows viral


infection: Epstein-Barr virus, varicella or
HIV; Can occur after MMR vaccine

45.

S&S of ITP

Multiple ecchymoses and petechiae;


Bleeding in mouth or nose

46.

What could
happen if child
receives a trauma?

Intracranial hemmorhage, internal


bleeding

47.

List considerations
- ITP

no contact sports until platelets are


stable; greater than 6 mos considered
chronic; greater than a year is
candidate for splenectomy

48.

Medications used for Treatment


of ITP

Corticosteroids, IVIG and IV anti-D immunoglobin

49.

list additional treatments - ITP

Platelet transfusion not indicated unless intra-cranial hemorrhage; Platelet therapy temporarily
control bleeding, as administerd plts soon destroyed

50.

Surgical treatment for severe or


chronic ITP

Splenectomy may be necessary as plts destroyed in spleen; NOTE: PT WILL REQUIRE PROPHALAX
ANTIBIOTICS BECAUSE CHILD WILL BECOME IMMUNOCOMPROMISED

51.

PARENT TEACHING FOR ITP (3 bleeding, pain, sports)

Measures to decrease bleeding; Use acetaminophen to manage pain / fever; Avoid contact sports /
other activities that could cause bleeding

52.

S&S FOR INTERNAL BLEEDING TEACHING FOR PARENTS OF


CHILD WITH ITP

CHANGE IN MENTAL STATUS - INTERNAL BLEED; DARK STOOL, PINK URINE

53.

NURSING CARE FOR BLOOD


INFUSION

DRAW TYPE AND CROSS BLOOD; 2 PERSON INDEPENDENT CHECK OF PATIENT AND PRODUCT;
BASLINE VS PREMEDS PRN; NS WITH A Y SET FOR TRANSFUSION; TEACHING AND S/S OF VOLUME
OVERLOAD OR INCOMPATIBILITY