Nur125 Peds Test 3 D - Anemias

Front 1

What is normal RBC?

Back 1

3.9-5

Front 2

What is normal Hgb?

Back 2

10-13

Front 3

What is normal HCT?

Back 3

31-39

Front 4

What is normal for platelets?

Back 4

200-400,000

Front 5

Hct in the 20's is...

Back 5

low

Front 6

Another name for RBC

they live for _____ days

Back 6

erythrocytes

120

Front 7

Who removes old RBC from circulation?

Back 7

spleen

Front 8

What are baby RBC's called?

Back 8

reticulocytes

Front 9

Anemia is not a __________ but a term used to describe a __________ in the _________ carrying capacity of the blood.

Back 9

Anemia is not a DISEASE, but a term used to describe a DECREASE in the OXYGEN carrying capacity of the blood

Front 10

Lab values that indicate anemia:

Hg
Hct

Back 10

Hg below 10
Hct below 31

Front 11

General causes of anemia
1.
2.
3.
4.

Back 11

1. Excessive Blood Loss
2. Destruction of RBC
3. Decreased or impaired production of RBC or components
4. Another disorder that this a symptom

Front 12

Symptoms of anemia include:
cardio -
respiratory -
CNS -
Skin -

Back 12

cardio - tachycardia, decreased cap refill

respiratory - hypoxemia, increased RR, activity intolerance

CNS - decreased LOC

Integumentary - pale mm, skin and nailbeds

Front 13

Why is there tachycardia with anemia?

Back 13

because heart is pumping faster in effort to get oxygen to cells

Front 14

What are the diseases with anemia?

List 7

Back 14

Iron Deficiency Anemia

Sickle Cell Anemia

Beta Thalassemia Major

Aplastic Anemia

Hemophilia

von Willebrand Disease

Immune Thrombocytopenic Purpura (ITP)

Front 15

Iron Deficiency Anemia is the most common heme disorder in kids. It peaks in what age?

Back 15

6 months - 2 years

and reemerges as a problem in teens

Front 16

Iron Deficiency Anemia causes:

preemies -

toddlers -

adolescents -

Back 16

premies - inadequate iron stores at birth

toddlers - excessive intake of milk

Adolescents - poor dietary choices, menses

Front 17

What are the numbers for

mild anemia (Fe)

moderate anemia (Fe)

severe anemia (Fe)

Back 17

mild - hg 9-11

moderate hg 7-9

severe hg below 7

Front 18

Mild Fe deficiency anemia can be asymptomatic, but moderate shows these manifestations:

mild Hgb 9-11
moderate Hgb 7-9

Back 18

irritability
easily fatigued
doesn't want to play

Front 19

Severe Iron Deficiency anemia has the following manifestations.

Hgb below 7

Back 19

pallor, heart murmur, spoon nails, hair falls out, speen enlargment,

FLOW MURMUR
PALE

Front 20

Newborns have stored iron that lasts this long...

premies use up their stores by __________ weeks.

Back 20

Full term infant stores last up to 20 weeks (5 months)***this is when we add RICE cereal

Premies use up their stores by 6-12 weeks

Front 21

What do the RBC's look like with iron deficiency anemia?

Back 21

microcytic, hypochromic

Front 22

With Fe Deficiency Anemia, what is level of Hct and Hg?

Serum Iron and Serum Ferritin?

Back 22

Hct down
Hg down

Serum Iron down
Serum Ferritin down

Front 23

What is retic count? How does it pertain to anemia?

Back 23

Reticulocytes are immature or newly released red blood cells. Elevated retic count means the bone marrow is responding to anemia by releasing new RBC's into circulation.

Front 24

What is supplement to be given for Fe deficient anemia?

Back 24

Ferrous sulfate

Front 25

What increases absorption of iron?

Back 25

orange juice

Front 26

How long do you continue therapy for iron deficiency anemia?

Back 26

continue therapy for AT LEAST 2 MONTHS after labs return to normal

Front 27

Side Effects of iron supplements

Back 27

n/v cramps
CONSTIPATION
diarrhea
black/green stools

Front 28

Iron is absorbed better ___________ food.

Back 28

without

Front 29

What type of inheritance is SCA?

Back 29

autosomal recessive

Front 30

What type of Hemoglobin does SCA patient have?

What type of Hemoglobin does infant have?

Why do these relate?

Back 30

HbS

HbF - does not sickle, so asymptomatic until 6 months of age

Front 31

What does Hydroxurea do for the SCA patient?

Back 31

bumps up Hbf in your blood

Front 32

How do you screen for SCA?

Back 32

sickledex, if positive, then do hemoglobin electrophoresis which detgermines the amount of Hbs in the blood.

Prenatal is done with amnio

NB test is done with PKU

Front 33

What does HbS do to blood?

Back 33

sickled hemoglobin HbS causes the RBC to stretch into a crescent or sickled shape under certain conditions.

Front 34

How long do sickled RBC's live?

Back 34

10-20 days

Old cells are collected in the spleen - can lead to splenic malfunction

Front 35

In general, these two situations cause sickling...

Back 35

oxygen deprivation or interference of transport of oxygen to cells

(exercise, outside, dehydration)

Front 36

Why does cold cause sickling?

Back 36

vasoconstriction narrows vessels, obstructs RBC, decreases blood flow, decreases oxygen, causes pain

Front 37

The breakdown of sickled cells on a 10x faster rate than non sickled cells causes a predisposition to....

Back 37

anemia and further hypoxia, which causes more sickling....viscious cycle

Front 38

There are three types of sickle cell crisis

Back 38

vaso occlusive (retic count high)

sequestration

aplastic (retic count low)

Front 39

What is the deal with aplastic crisis of SCA?

Back 39

stops making cells....this leads to low retic count

Front 40

What is the deal with vaso occlusive crisis with SCA?

Back 40

precipitated by dehydration, exposure to cold, acidosis or localized hypoxemia

Front 41

What causes a vaso occlusive crisis in SCA?

Back 41

stasis of blood...

Hand Foot Syndrome is common in infants

Front 42

How do you treat sca crisis?

Back 42

blood transfusions
oxygen
hydrate
pain management PCA, not PRN
Bed rest
reduce infections

Front 43

If patient is experiencing a sequestration crisis with SCA, the blood is pooling in the liver and the spleen. What is important to realize about the spleen?

Back 43

Spleen is infection control organ, so might treat with low abx prophylactically for a long time, and provide vaccines to help

Front 44

Main important three things to prevent sickling:

Back 44

1. Avoid infection
2. Prevent Dehydration
3. Avoid low oxygen supply

Front 45

What MED is a no no for sca kids?

Back 45

demerol - meperidine

Morphine is good and ok.

Demerol is DUMB! Seizures

Front 46

What are the main things to monitor for when administering a blood transfusion?

Back 46

allergic reaction
hemolytic reaction


itching, respiratory distress, fever, chills, hematuria, headache, chest pain, can progress to shock

Front 47

What is main intervention to do if you determine there is a reaction during a blood transfusion?

Back 47

stop the transfusion!!!!!

call md
give antihistamines
vitals
iv

Front 48

In a vaso occlusive crisis what are your interventions?

Back 48

hydration status
basal rate of med on PCA, lower pain level. get fentanyl
-diversional activities

Front 49

What is the deal with hydroxyurea?

Back 49

It is a treatment for Sickle cell anemia that increases HgF, so it decreases sickling

Front 50

Describe Beta-Thalssemia Major

Back 50

autosomal recessive

severe anemia - decreased production of matures cells, increased destruction of defective cells requiring frequent transfusion

Front 51

What will CBC look like for Beta Thalassemia Major?

Back 51

NORMAL IRON

low Hg & Hct
Normal Reticu count

microcytic hypochromic

Front 52

What are two main problems with Beta Thalassemia Major?

Back 52

chronic hypoxia

iron overload from transfussions (hemosiderosis)

Front 53

What is hemosiderosis?

Back 53

iron overload

-splenomegaly (often we remove spleen to stop RBC killing)

-Live enlargement, heart failure

-Growth and retardation

-BIG HEAD

Front 54

What is tx for BTM?

Back 54

blood transfussions often maybe q 2-3 weeks

Deferoxamine (to bind iron to get it out)

THESE KIDS WILL HAVE AN IMPLANTED PORT

Front 55

What type of hemoglobin is increased in BetaT?

Back 55

HgF

Front 56

What is aplastic anemia?

Back 56

Bone marrow fails to produce enough cells

Front 57

What type of mans do you have with aplastic anemia?

Back 57

Remember it is related to the low number of all cells, but if platelets low, then bleeding, petechiae and purpura

pallor, fatigue, fever bacterial infections

Front 58

What are some tx for aplastic anemia?

Back 58

BONE MARROW TRANSPLANT if other treatments don't work.

You can also replace RBC's and plateletes

Front 59

What causes hemophilia?

Back 59

hereditary deficiency of a blood factor essential for coagulation (factor #8)

Front 60

CHristmas Deficiency is not #8, what is it?

Back 60

number 9

Front 61

How is hemophilia passed on?

Back 61

x linked recessive

Front 62

What lab test will be out of wack (CBC) with hemophilia?

Back 62

PTT prolonged clotting

but PT normal
platelet count normal

Front 63

Why is platelet count normal?

Back 63

not a problem with platelets, not an anemia, but a factor deficiency

Front 64

What is main intervention for hemophilia therapy?

Back 64

stop bleeding and prevent crippling effects

drugs are used, factor replacements

Front 65

What type of disease is vonWillebrand disease?

Back 65

hereditary, bleeding disorder

vWF deficient (which is a carrier for factor8)

Autosomal dominant, both sexes

Front 66

What is important when comparing vonWillebrand with hemophilia?

Back 66

vonWilly is not as serious, no spontaneous bleeds, not found usually until a surgery or heavy menstration

Front 67

What is tx for vonWilly?

Back 67

same as hemophilia drug DDAVP...it increases clotting factors

Front 68

ITP is all by itself. It is not anemia, not bleeding. Instead it is...

Back 68

an autoimmune reaction that follows a VIRAL illness

spleen and lymph tissue make antibodies that TURN on their own platelet friends

Front 69

What is diagnostic lab that is out of wack with ITP?

Back 69

platelet count will be below 20,000

Front 70

If you looked at platelets under a microscope for a person with ITP, what would you see?

Back 70

not very many

large and immature

Front 71

What is the term for large and immature platelets?

Back 71

megakaryocytes

BIg Young Red Platelet Sticks

Front 72

Who often presents with ITP?

Back 72

2-5 year olds. This lines up with the big dumb platelet sticks. Think of a toddler holding a red long john donut. He has peteiche that doesn't blanche all over his face

Front 73

What would treatment include for ITP?

Back 73

r/o leukemia

Give IVIG and steroids

may take out spleen if doesn't recover

***BIG DEAL _ 90% resolve spontaneously

Front 74

If ITP patient or anyone has a platelet count under 10,000 - what is your concern?

Back 74

spontaneous bleeds

Front 75

Make sure you do not give these drugs to ITP and hemophilia?

Back 75

avoid aspirin, suppositories, injections, hep flush

Front 76

With vonWilly you do not have __________ ____________.

Back 76

spontaneous bleeds

Front 77

If patient with hemophilia or ITP starts to bleed, what is tx?

Back 77

control bleeding.

rest, ice, apply pressure for 10 minutes. elevate extremity

Front 78

What type of activities can a hemophilia/ITP do?

Back 78

nothing contact