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111 Cards in this Set

  • Front
  • Back
What are the components of blood?
1. Plasma
2. Formed elements
What is the composition of plasma?
1. 90% water

2. 10% solutes
What solutes make up plasma?
1. Albumin
2. Electrolytes
3. Proteins
What are the major hemopoietic (blood-forming) organs of the body?
1. Red bone marrow (myeloid tissue)
2. Lymphatic system
What are the components of the lymphatic system?
1. Lymph (fluid)
2. Lymphatic vessels
3. Lymphoid structures (lymph nodes, spleen, thymus, and tonsils)
What is the function of the lymph nodes?
Regulate the manufacture of WBCs
What is the significance of the formed elements of the blood?
All of them, except the agranulocytes, are believed to be produced in myeloid tissue during postnatal life
What is a totipotential stem cell?
A cell that has the ability to self-replicate and transform into all the blood components
What is a pluripotential stem cell?
A second-generation stem cell that is committed to produce erythroblast, myeloblast, monoblast, lymphoblast, or megakaryoblast
What is a reticulocyte count?
A simple laboratory test frequently used to indirectly analyze hemopoiesis
What is the total proportion of circulating reticulocytes?
0.5% to 1.5%
What is the usual life span of a mature erythrocyte?
120 days
What happens to erythrocytes after 120 days?
As RBCs grow old, their membranes become fragile and eventually rupture. The contents of the cell fragment as they circulate through the blood vessels and are phagocytized by the macrophages in the spleen, liver, and bone marrow
What is the basic regulator of erythrocyte production?
Believed to be tissue oxygenation and renal production of erythropoietin
What is the normal range of Hgb?
11.5 to 15.5 g/dL
What is the normal range of Hct?
35% to 45%
What are the two classes of leukocytes?
1. Granulocytes
2. Agranulocytes
What are the types of granulocytes?
1. Neutrophils
2. Basophils
3. Eosinophils
Where are granulocytes produced?
Bone marrow
What reflects the presence of a severe risk of infection?
The absolute neutrophil count (ANC) less than 500/mm since the ANC is an indication of the body's ability to handle bacterial infections
What are the types of agranuocytes?
1. Monocytes
2. Lymphocytes
Where is the origin of agranulotcytes?
1. Bone marrow
2. Lymph nodes
3. Spleen
4. Liver
5. Thymus
6. Subepithelial lymphoid tissue (tonsils, vermiform appendix, and intestinal lymphoid tissues)
7. Connective tissues (mesenchymal cells of the reticuloendothelial system)
What is the half-life of granulocytes?
6 to 8 hours in the blood and, after entering the tissues, die over a period of 4 to 5 days
What is the function of neutrophils and monocytes?
Phagocytosis
What is neutrophilia an indication of?
The increased numbers of neutrophils indicates acute inflammation
What is monocytosis an indication of?
The increased number of monocytes indicates chronic conditions
What is the function of eosinophis?
Still unknown, but to some extent are involved in allergic reactions and have parasiticidal properties
What is the function of basophils?
Still unknown, but basophilia (increased numbers of basophils) occurs during the healing phase of inflammation and during prolonged inflammation
What is the life span of platelets?
About 8 to 10 days
What is the normal range of platelets?
150,000 to 400,000/mm^3
What is the function of platelets?
Clotting, by adhering to the wet endothelium and to each other
What is serotonin?
A vasoconstrictor that produces vascular spasm to decrease the blood flow to the injured area
What is anemia?
A reduction in the number of RBCs and/or Hgb concentration compared to normal values for age
What are the classification of anemias?
1. Etiology as manifested by erythrocyte or Hgb depletion

2. Morphology, the characteristic changes in RBC size, shape, and color
What are the main causes of anemia?
1. Inadequate production of RBCs and RBC components

2. Increased destruction of RBCs

3. Excessive loss of RBCs through hemorrhage
What are the types of RBC sizes?
1. Normocytes (normal cell size)

2. Microcytes (smaller than normal)

3. Macrocytes (larger than normal)

4, Anisocytosis (variation in sizes)
What are the types of RBC shapes?
1. Spherocytes (globular cells)

2. Drepanocytes (sickle-shaped cells)

3. Numerous other irregularly shaped cells

4. Poikilocytosis (variation in shapes)
What are the types of RBC colors?
1. Normochromic (sufficient or normal amount of Hgb per RBC)

2. Hypochromic (reduced amount of Hgb per RBC)

3. Hyperchromic (increased amount of Hgb per RBC)

4. Variation in Hgb concentration in the RBC
When is cyanosis evident?
When hemoglobin levels generally exceed 5 g/dL
What are the central nervous system manifestations of anemia?
1. Headache
2. Dizziness
3. Light-headedness
4. Irritability
5. Slowed thought process
6. Decreased attention span
7. Apathy
8. Depression
What is the first clue indicative of anemia?
Decreased numbers of RBCs and decreased levels of Hgb & Hct
What Hgb level defines anemia?
Below 10 or 11 g/dL
What is the objective of medical management of anemia?
To reverse the anemia by treating the underlying cause
What areas should the nurse emphasize in interviewing the family?
1. Nutrition
2. Past hx of chronic, recurrent infection
3. Eating habits, especially pica
4. Bowel habits and presence of blood in stools
5. Familial hx of hereditary diseases, such as sickle cell disease or thalassemia
How should the nurse prepare the child for laboratory tests?
1. Explain significance of each test
2. Physically remain with child during procedure(s)
3. Allow child to "play out" the procedure on dolls or actively participate in the procedure
What are the signs and symptoms of anemia?
1. Pallor
2. Tachycardia
3. Fatigue (SOB, frequent resting)
4. Muscle weakness
5. Systolic heart murmur
6. Icteric sclera
7. Jaundice
8. Dark urine
9. Splenomegaly
10. Hepatomegaly
11. Low BP (late sign of shock)
12. Cool skin
13. Decreased peripheral pulses
What is an important nursing responsibility/intervention regarding anemia?
Minimize tissue oxygen needs by continual assessment of child's energy level


(same intervention used for nursing dx of fatigue and activity intolerance)
What is the purpose of diversional activities?
Promote rest and prevent boredom and withdrawal
What are some diversional activities?
1. Listening to music
2. Watching TV
3. Playing video games
4. Reading or listening to stories or comics
5. Continuing a favorite hobby
6. Coloring or drawing
7. Board games or card games
8. Being wheeled in a carriage or chair
What diversional activity is important for infants?
Presence of parents
What is the MAIN complication associated with anemia?
Cardiac decompensation, due to increased metabolic needs or cardiac overload
What are the signs and symptoms of cardiac failure?
1. Tachycardia
2. Dyspnea
3. Rales
4. Moist respirations
5. Cough
6. Sweating
What other complication is associated with anemia?
Infection because tissue hypoxia causes cellular dysfunction and the disturbed metabolic processes weaken the host's defenses against foreign agents
What precautions are taken to prevent infection?
1. Thorough hand-washing
2. Selecting a noninfectious room
3. Restricting presence of visitors or hospital personnel with active infection
4. Maintaining adequate nutrition
What helps prevent anemia in lower-income inner city children?
Iron-fortified formula and cereals
Why are adolescents also at risk for iron deficiency anemia?
Because of their rapid growth rate, menses, poor eating habits, and obesity
What are the causes of iron deficiency anemia?
1. Inadequate dietary intake
2. Inadequate stores at birth
3. Impaired iron absorption
4. Blood loss
5. Excessive demands required for growth
How long are maternally derived iron stores good for?
1. First 5 to 6 months in full-term infants

2. About 2 to 3 months in premature infants or infants of multiple births
What is the diagnostic evaluation of reticulocyte in anemia?
1. The reticulocyte count is usually normal or slightly reduced because of decreased iron stores

2. However, in severe anemia, the reticulocyte count may elevate to 3% or 4%
What causes Vitamin B12 deficiency?
Gastric mucosa failing to secrete sufficient amounts of intrinsic factor, which is essential for absoprtion of vitamin B12
What is the nursing objective regarding anemia?
Prevent nutritional anemia through family education
What is hereditary spherocytosis?
The most common hemolytic disorder
What causes hereditary spherocytosis?
A defect in the proteins that form the RBC membrane
What are the laboratory findings of hereditary spherocytosis?
1. Hgb level between 7 and 10 g/dL
2. Reticulocyte count of 3% to 15%
3. An increase in osmotic fragility
What is sickle cell anemia (SCA)?
The homozygous form of the disease (HgbSS), in which valine, an amino acid, is substituted for glutamic acid at the sixth position of the beta chain
What is sickle cell C disease?
A heterozygous variant of sickle cell disease (HgbSC), characterized by the presence of both HgbS and HgbC, in which lysine is substituted for glutamic acid at the sixth position of the beta chain
What is sickle thalassemia disease?
A combination of sickle cell trait and beta-thalessemia trait. In the beta plus form some normal adult Hgb can still be produced. In the beta zero form, there is no ability to produce normal adult Hgb.
What are the clinical manifestations of SCA?
1. Obstruction caused by the sickled RBCs
2. Increased RBC destruction
3. Possible growth retardation
4. Marked susceptibility to sepsis
5. Enlarged spleen
6. Liver failure and necrosis
7. Kidney abnormalities
8. Bone hyperplasia
9. Changes in CNS
10. Heart murmurs
What is the most common type of non-life-threatening crisis?
Vasocclusive crisis
What are the goals of therapeutic management of sickle cell anemia?
1. Prevent sickling phenomenon which is responsible for the pathologic sequelae

2. Treat the medical emergency of the sickle cell crisis
What is the only potential cure for sickle cell disease?
Hematopoietic stem cell transplantation (HSCT)
What are the main objectives of medical treatment of a sickle cell crisis?
1. Bed rest to minimize energy expenditure and to improve O2 utilization

2. Hydration through oral and IV therapy

3. Electrolyte replacement because hypoxia results in metabolic acidosis, which also promotes sickling

4. Analgesia for severe pain from vasoocclusion

5. Blood replacement to treat anemia and to reduce the viscosity of the sickled blood

6. Antibiotic therapy to treat any existing infection
What signs and symptoms require immediate medical attention?
1. Fever of 38.3 degrees C (100.9 degrees F) or higher
2. Increase in spleen size
3. Severe pallor
What techniques minimize tissue deoxygenation?
1. Taking frequent rest breaks during physical activities

2. Avoiding contact sports to prevent hemorrhage

3. Avoid environments with low O2 concentration, such as high altitudes and nonpressurized airplane flights

4. Avoid known sources of infection
What is the most common and debilitating symptom experienced by patients with sickle cell disease?
Pain
What is thalassemia?
A common genetic blood disorder characterized by deficiencies in the rate of production of specific globin chains in the Hgb
What are the clinical effects of thalassemia major?
1. Defective synthesis of HgbA
2. Structurally impaired RBCs
3. Shortened life span of the erythrocyte
What are the nursing diagnoses for sickle cell anemia?
1. Risk for injury
2. Risk for fluid volume deficit
3. Acute pain
4. Risk for infection
5. Knowledge deficit
What is hemosiderosis?
Excess iron storage in various tissues of the body, especially the spleen, liver, lymph glands, heart, and pancreas, but without associated tissue injury
What is the objective of supportive therapy of thalassemia?
Maintain sufficient hemoglobin levels to prevent bone marrow expansion and bony deformities and to provide sufficient RBCs to support growth and normal physical activity
Should a patient with hemosiderosis be given vitamin C?
NO
What is a major complication of a splenectomy?
Infection
What are the objectives of nursing care for thalassemia?
1. Promote compliance with transfusion and chelation therapy

2. Assist the child in coping with the anxiety-provoking treatments and the effects of the illness

3. Foster the child's and family's adjustment to a chronic illness

4. Observe for complications of multiple blood transfusions
What causes bone marrow failure?
1. Replacement of bone marrow by fibrous tissue or by neoplastic cells, such as leukemia

2. Depression of marrow activity by irradiation, chemicals, or drugs

3. Interference with one marrow activity caused by systemic disorders such as severe infection, chronic renal disease, widespread malignancy, collagen diseases, or hypothyroidism
What is aplastic anemia?
A condition in which production of all formed elements of the blood is simultaneously depressed
What is hypoplastic anemia?
Profound depression of RBC formation but normal or slightly decreased production of WBCs and platelets
What are the treatments of aplastic anemia?
1. Blood transfusion
2. Splenectomy
3. Corticosteroids
What are the main causes of death in anemias?
1. Cardiac failure
2. Hepatitis from transfusion therapy
3. Sepsis
What is Fanconi syndrome?
Aplastic anemia characterized by pancytopenia, hypoplasia of the bone marrow, and patchy brown spots due to deposition of melanin
What are the common causes of acquired aplastic anemia?
1. HPV, hepatitis, or overwhelming infection
2. Irradiation
3. Drugs such as chemotherapeutic agents or antibiotics (i.e. chloramphenicol)
4. Industrial or household chemicals
5. Infiltration and replacement of myeloid elements
6. Idiopathic (70% of all cases)
What are the treatments of aplastic anemia?
1. Immunosuppressive therapy to counter the presumed immunologic responses that prolong aplasia

2. Replacement of bone marrow through transplantation
What is the rationale for using ATG to treat aplastic anemia?
Because of the possibility that aplastic anemia may be a result of autoimmunity. ATG suppresses T-cell-dependent autoimmune responses but do not cause bone marrow suppression.
What are the nursing considerations during ATG therapy?
1. Prevent extravasation
2. Observe for fever and skin rash
3. Observe for ecchymosis in the oral cavity
What is hemophilia?
A bleeding disorder resulting from congenital deficiency of specific coagulation proteins
What is the mode of transmission of hemophilia?
An X-linked recessive disorder
What is the basic defect of hemophilia A?
A deficiency of factor VIII (an antihemophilic factor)
What produces factor VIII?
The liver, and is necessary for the formation of thromboplastin in phase I of blood coagulation
What is the most common form of internal bleeding?
Hemarthrosis, bleeding into the joint cavities
What is the major bleeding cause of death?
Intracranial hemorrhage
What is the main therapy for hemophilia?
Replacement of the missing clot factor
What are the other therapeutic management for hemophilia?
Other drugs such as corticosteroids and NSAIDs
What are the signs of internal bleeding in children?
1. Headache
2. Slurred speech
3. Loss of consciousness (from cerebral bleeding)
4. Black, tarry stools (from GI bleeding)
How is oral bleeding prevented in hemophilia?
1. Using a water irrigating device
2. Softening the toothbrush with warm water before brushing
3. Using a sponge-tipped disposable toothbrush
What supportive measures may be implemented to treat hemophilia?
1. R = Rest
2. I = Ice
3. C = Compression
4. E = Elevation
What is neutropenia?
1. A reduction in the number of circulating neutrophils

2. Absolute neutrophil count (ANC) < 1000/mm^3 in infants and < 1500/mm^3 in children
What are the most common clinical manifestations of chronic benign neutropenia?
Oral ulcerations and skin infections
When are parents advised to seek medical help?
If their child has a fever of 38.3 degrees C (= 101 degrees F) or higher OR if skin lesions develop
What is the therapeutic management of neutropenia?
Mainly supportive
What are the prevention techniques of perinatal transmission of HIV?
1. Zidovudine therapy
2. Elective cesarean delivery
3. Avoidance of breast-feeding for HIV-infected mothers
4. Nevirapine therapy
What is the pathophysiology of HIV?
HIV infects CD4+ T lymphocytes and monocytes causing suppression of cell-mediated immunity and rendering a person at risk for opportunistic infections
What are the common clinical manifestations of HIV in children?
1. Lymphadenopathy
2. Hepatosplenomegaly
3. Oral candidiasis
4. Chronic or recurrent diarrhea
5. Failure to thrive (FTT)
6. Developmental delay
7. Parotitis