Pediatrics: The Child With Hematologic Or Immunologic Dysfunction

Front 1

What is the most common hematologic disorder in children?

Back 1

Anemia

Front 2

What is the normal reticulocyte count

Back 2

2-5%

Front 3

What age is at higher risk for anemia?

Back 3

4-6 months

Front 4

Who should not drink cow's milk and why?

Back 4

Children under 1 year old because it causes microscopic bleading

Front 5

What happens when anemia develops slowly

Back 5

The child adapts

Front 6

What are the effects of anemia in the circulatory system?

Back 6

Hemodilution, may have a murmur, CF, cyanosis, growth retardation, pallor, and weakness.

Front 7

What foods are rich in iron?

Back 7

Egg yolk, legumes, nuts, meat, liver chicken, dried fruit, ground beef

Front 8

Why is vitamin C given with iron?

Back 8

To help with absorption

Front 9

Should iron be given on an empty or full stomach

Back 9

Empty

Front 10

Teaching parents about iron intake

Back 10

drink with a straw and rinse mouth after because iron stains the teeth.

Child will have dark stools, diarrhea followed by constipation.

Front 11

What is the desired milk intake for a child?

Back 11

Less than 1 quart per day

Front 12

How can you feed a child?

Back 12

Have children eat their food first, give milk one hour after

Front 13

What is the problem that happen to the child having recurrent blood transfusions?

Back 13

Hemosiderosis (iron in the tissues)

Front 14

What is the treatment for Hemosiderosis?

Back 14

Iron chelation such as feroxamine+ vit C to promote iron excretion

Front 15

What is the treatment with hyperkalemia?

Back 15

Kayexalate

Front 16

At what age do infant start eating what amount of portions of cereals?

Back 16

4-6 months old should have 4-5 cereals and formula for adequate supply of iron.

Front 17

Why are adolecents at risk for iron deficiency anemia?

Back 17

Rapid growth and poor eating habits.

Females are at higher risk because of menstrual periods

Front 18

What is recommended to prevent anemia in children AT RISK?

Back 18

Treat with diet

Front 19

IF ANEMIC, how do we treat them?

Back 19

IRON and teach about diet. Diet takes months to correct, iron works faster.

Front 20

What are the manifestations and complications of sickle cell anemia?

Back 20

RBC sickles leading to increased blood viscosity, obstruction of blood flow, and tissue hypoxia.

Front 21

What offspring will be born with sickle cell anemia?

Back 21

Only if both parents have the trait

Front 22

What are S/S for chronic hypoxia?

Back 22

headache, irritability, precordial and bone pain, exercise intolerance, anorexia, apistaxis

Front 23

What is epistaxis and how do you treated?

Back 23

Nose bleed

Have child sit up, head tilted slightly forward, press nares together for 5-10 min, breathe through mouth, apply ice across the bridge of the nose.

Front 24

Client education to prevent epistaxis?

Back 24

keep fingernails short

use a humidifier during the winter

open mouth when sneezing

Front 25

When does epistaxis becomes an emergency?

Back 25

Bleeding for more than 30 minutes

Front 26

What is the name of the screening test done to identify sickle cell anemia and trait?

Back 26

Sickledex

Front 27

If the screening test comes positive what test should be done to differentiate sickle cell anemia from the trait?

Back 27

Hgb electrophoresis

Front 28

What is avascular necrosis and were would you see this in the body?

Back 28

Necrotic area in the bone most common at the shoulder and the hip

Front 29

what is splenic sequestration crisis and how do you know is happening?

Back 29

Excessive pooling of blood in the spleen

Abdominal distection

Life threatening

Front 30

What is autosplenectomy?

Back 30

??

Front 31

What does autosplenectomy puts the client at risk for?

Back 31

Infection

Front 32

What is dactylitis?

Back 32

also known as hand foot syndrome

Causes painful swelling of the fingers and toes

Front 33

Fetal hemoglobin protects the infant until what age?

Back 33

6 months

Front 34

What is the leading cause of death in young children with sickle cell anemia?

Back 34

Infection

Front 35

What are the presipitating factors for SCA?

Back 35

Anything that increases the body's need for oxygen or alters transport of oxygen:

Trauma, infection, fever, physical and emotional stress, increased blood viscosity due to dehydration and hypoxia.

Front 36

Patients with SCA need ___ to decrease blood viscosity?

Back 36

Hydration...

Push fluids!

Front 37

What can cause hypoxia in SCA pts?

Back 37

high altitudes, airplanes, hypoventilation, vasoconstriction due to hypothermia.

Front 38

What are the type or crisis for SCA?

Back 38

Vaso-occulusive (VOC)

Splenic sequestrattion

Aplastic crisis

Front 39

What is vaso-occlusive crises?

Back 39

Most common type of crisis, very PAINFUL

fever, pain, tissue engorgement, pain of hands, feet, and joints.

Front 40

S/S for splenic sequeastration

Back 40

Life threatening!

Profound anemia, hypovolemia, and shock

Front 41

What is aplastic crisis?

Back 41

Diminished production and increased destruction of RBC's.

Profound anemia and pallor

Triggered by VIRAL infection or depletion of FOLIC ACID

Front 42

Nursing action for SC crisis?

Back 42

Give short term O2 to break cycle

Blood transfussions

Front 43

if the reticulocyte count is less than 3 what is the child at risk for?

Back 43

Parvovirus infection

Front 44

The second most common reason fro hospitalization for a pt with SCA is:

Back 44

Acute chest sydrome

40% of pt with SCA will have this

Front 45

What is acute chest syndrome?

Back 45

Surgical crisis!

Tachypnea, coughing and wheezing, fever, chest pain

Sickling in ribs and chest

Front 46

Treatment for acute chest syndrome?

Back 46

Fluids and O2

Antibiotics

Repeated transfusions to replace blood

Front 47

Why would 2 months to 5 years age child with SCA will be on antibiotics?

Back 47

Prophylactic

They are exposed to other kids (daycare, preschool)

Front 48

What conditions are caused by folic acid deficiency?

Back 48

Spinal Bifida, Cleft palate, aplastic anemia

Front 49

mnemonic SICKLE

Back 49

S= spleen stroe

I= infections (#1 cause of death)

C= crisis

K= kidneys

L= liver

E= eye problems

Front 50

Pathophysiology for sickle cell anemia:

Back 50

cell sickles, hypoxia, tissue hypoxia, vessel occlusion, decrease oxygenation to the tissue, tissue die and becomes fibrotic mass

Front 51

What is hemophilia?

Back 51

A disease with deficiency in factor VIII

Front 52

What sex is primarily affected by hemophilia

Back 52

Males/ its an X-linked recessive trait

Front 53

When do symptoms for hemophilia begin? Why?

Back 53

6 months

Mobility leads to injuries from falls and accidents

Front 54

Sickle cell anemia: nursing management

Back 54

-Strict I &O

-Check hydration: mucus membranes, turgor in abdomen

-no DEMEROL

-Specific gravity

-HIGH folic acid diet

-Position HOB no higher than 30 degrees to promote venous return

-Give O2 when hypoxic

Front 55

what is the med name for joint bleeding

Back 55

Hemarthrosis

Front 56

What are manifestations for hemophilia?

Back 56

Hemarthrosis, echymosis (no petechiae), intracraneal bleeding-altered LOC, epistaxis, blleding after procedures. Bleeding into neck, chest, mouth.

Front 57

What is the #1 cause of death in hemophilia?

Back 57

Intracraneal bleeding

Front 58

What kind of bleeding is considered a medical emergency?

Back 58

Bleeding into neck, chest, mouth: may compromise airway

Front 59

Recommendation to keep nose moist:

Back 59

Put vaseline on Q-tip and apply inside noce once a week

Front 60

Laboratory results for hemophilia?

Back 60

low factor VIII or IX, prolonged PTT,

Normal: platelet count, PT, and fibrinogen

Front 61

Tx for hemophilia

Back 61

DDAVT, factor VIII (Kogenate), Blood transfusions, Steroids to help decrease inflammation specially in hemarthrosis.

Front 62

What is Kogenate

Back 62

Rises factor VIII production to help in clotting

Give daily for severe hemophilia. Reduces joint problems 6x and bleeding 8x.

Front 63

How to manage hemarthtosis?

Back 63

Elevate and immobilize the joint, ice, analgesics ROM 4 days after to prevent contractures, physical therapy, avoid obesity to minimize joint stress, strenghten muscles, give SQ injections, no heparin, NO ASPIRIN, no silk tape, use foam toothbrush.

Front 64

What does RICE stand for?

Back 64

R= rest

I= immovilize

C=compression for 15-20 minutes

E= elevate

Front 65

Can we administer NSAIDs with hemophilia?

Back 65

Yes

Front 66

Parent teaching:

Back 66

-How to recognize bleeding: tell child to tell people about funny sensation on chest and tummy.

-Infants and todlers: pad surfaces, double carpets-area rugs, fireplaces.

-Older child: no contact sports, use helmets, knee and elbow pads.

Front 67

What factor is missing in von Willebrand Disease (vWD)

Back 67

Factor IX

Front 68

What sex is affected in vWD?

Back 68

Both female and male

Front 69

Laboratory findings for vWD:

Back 69

Decrese factor IX, decrease PLATELET agglutination, prolonged bleeding time

PTT may be normal or prolonged

Front 70

Can we administer aspirin or NSAIDs with vWD?

Back 70

No because they increase bleeding time and inhibit platelet function.

Front 71

Tx for vWD

Back 71

DDAVT, factor IX, aminocarproic acid (to treat bleeding in mucus membranes)

Front 72

What does deodorant with aluminum chloride does?

Back 72

Stops bleeding: causes hemostasis

Front 73

What is the most common type of anemia?

Back 73

hypocromic microcytic anemia