Care Of The Child

WITH A HEMATOLOGICAL DISORDER

Objectives
1. Describe selected hematologic disorders that affect children.
2. Discuss noted assessment findings for selected hematologic disorders affecting children
3. Discuss select medications and treatments used in selected hematologic disorders
affecting children
4. Discuss rationales for use of selected medications and treatments in hematological
disorders
5. Analyze laboratory data and report abnormal findings
6. Discuss the rationale for abnormal laboratory findings
7. Identify priority nursing interventions for selected hematological disorders affecting
children
8. Prepare a teaching plan for the child and family that focuses on selected hematological
disorders affecting children.

Review the diagram on the process of blood cell

formation:

Laboratory
data
RED BLOOD CELL PRODUCTION

HEMOGLOBIN

IRON

http://faculty.weber.edu/nokazaki/Human_Physiolog
y/Class%20notes/Blood_files/image003.gif

Plan of Care for a Child with a

Hematological disorder
Dependent upon the issue
Includes all aspects of the nursing Process
Most Common Treatment
Medications

Other
Blood transfusion
Splenectomy
Bone marrow or stem cell transplant

General
Signs and symptoms can easily be missed
Consider growth, skin color, level of activity, change in mental status

Health History
In addition to the basic information need to ask about administration of Vitamin K
at birth, inherited disorders, lead exposure, diet
Ask about fatigue, color, appetite, bruising, difficulty with bleeding, pain or swelling

Physical Exam
Color, weight, clubbing, murmurs, bruises, petechiae, purpura, oxygen saturation,
WOB, increase in HR or RR, change in BP, LOC, assessment of liver and spleen

Common Labs
CBC
Reticulocyte count
Iron
Ferritin
Clotting studies
Coagulation studies
Hgb electrophoresis
Type and cross match for blood transfusion

Anemia
DEFINED AS :
A condition in which the number or the concentration of Hgb is below the normal values for age.

Not a disease but rather a manifestation of another pathologic process

Look at the Shape, size and color of the RBC
Classification
Decreased RBC production
Increased RBC loss
Increased RBC destruction

Consequences of Anemia
Decreased oxygen carrying capacity
Decreased oxygen available to the tissues
Slow onset does allow for some adaptation

Effects of Anemia
Hemodilution
Decreased peripheral resistance
Increased cardiac circulation and turbulence
Cyanosis
Growth retardation

Common clinical manifestations

Pallor
Decreased energy
Fatigue
Anorexia
Murmur may be auscultated
Dyspnea with exertion
Decreased concentration

NURSING
Assessment
Collaborative Management
Recognize symptoms and risk factors
Correction of anemia
Prevent complication

Common interventions
Nutrition
Medications
Transfusion
Supportive care
Oxygen
IV fluids
bed rest

Iron deficiency anemia

Defined as
inadequate iron in diet which causes changes to the RBC
microcytic/ hypochromic
Common s/s
pallor, decreased energy, irritability, tachycardia, systolic murmur
often picked up on routine exam
Treatment
Diet
Medication

Lead poisoning
What is it?
How does this happen?
Consequences of Lead ingestion
Collaborative management
screening
medications
Nursing considerations

Sickle Cell Disease

Etiology
Inheritance pattern
Diagnosis
Cord blood
Sickle turbidity

Pathophysiology

Crisis
Vaso-occlusive thrombotic
Splenic sequestration
Aplastic
Goal of therapy is to prevent sickling events and manage complications of
sickling events
Medical management
Nursing considerations

Hemophilia
Defined as a group of hereditary bleeding disorders
caused by a deficiency of specific clotting factors (8 or
9)
Hemophilia A
Hemophilia B
Severity
Severe
Moderate
Mild

Management
Replacement
Education
Medication
safety

Blood Administration
When
What
Goals
Correct the problem
Safe administration of blood without complications

Nursing
Process for hanging blood
Observation of transfusion reactions
Interventions for transfusion reactions