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42 Cards in this Set
- Front
- Back
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What should be assessed in a hematologic assessment?
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skin for petechi, bruising, pallor
Enlarged organs: spleen, liver, kidneys Labs: ** |
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What is anemia?
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low number of RBC and Hgb: the heme portion of RBC can't carry oxygen
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What are the effects of anemia on the circulatory system?
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hemodilution
dec peripheral resistance inc cardiac circulation and turbulence - murmur can lead to failure Cyanosis Growth retardation |
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What causes iron deficient anemia?
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dec iron intake
inc demand of iron (growth spurt) dec in RBC or Hgb (<10) blood loss malabsorption |
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What are iron sources for iron deficient anemia?
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fortified cereal
leafy green veges red meat no cows milk for 1yr (post yr <24oz/day) if BF, mom eat iron beans grains dried fruits Vit C for absorption |
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What are the nursing considerations for iron supplementation?
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no milk
stools will be tarry black stain teeth (use straw) diarrhea/vomiting |
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What is the patho of sickle cell disease SSD?
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in infancy: Hbg F converts to Hgb A
In SSD, Hgb S replaces Hgb A The Hgb S can't pass through the vessles blocking them and die 15-20 days |
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Why doesn't SSD show up in an infant?
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bec the Hgb A isn't being converted until >1yr
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In what cultures does SSD occur in?
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AA
mediterranean indian middle eastern |
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What are the main problems in SSD?
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obstruction: hypoxia, infarction
Destruction: of RBC |
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WHat is the genetic component of SSD?
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25% no disease
25% have disease 50% carriers |
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What systems are affected in SSD?
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pg 917
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What is the diagnosis of SSD?
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DNA prenatal
Sickledex: performed at birth with PKU (NOT DX) if +, electrophoresis confirms (fingerprint of protein) |
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What are the precipitating factors of sickle cell crisis?
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dehydration
infection change in weather stress (physical and emo) RR with asthma Trauma BASICALLY ANYTHING THAT ALT BODY"S NEED FOR OXYGEN |
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What are the Cx of SSD?
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Crisis:
Vaso-occlusive Crisis Acute Chest Syndrome Splenic Sequestration Hemolysis Infection: penicillin for 2mo post testing Stroke |
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What is important to understand about vaso-occlusive Crisis?
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fever and pain
often in joints (swollen) |
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What is important to know about acute chest syndrome?
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impaired gas exchange/hypoxia
s.s of pneumonia |
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What is important to understand about splenic sequestration Hemolysis?
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pooling of blood in spleen
pain inc abd girth weak L abd pain HR inc |
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What is the tx for SSD?
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Hydration: 150cc/kg/day
Pain management iron checks or iron chelation PCN until age 5 Hydroxurea (Rx inc Hgb F) Transfusion Ox to treat acidosis avoid cold immunizations (yes) stem cell transplant |
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What is the prognosis of SSD?
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no cure (except bone marrow transplant)
supportive care (prevent crisis) bacterial infections may reoccur due to immunocomprimise (causing death) |
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What is Thalassemia Anemia?
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Autosomal recessive Hgb synthesis disorder
RBC structurally impaired hemolasized quickly - inc bilirubin and jaundice inc iron hypoxic spleen and liver engorged with blood |
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How is thalassemia anemia dx?
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by 1yo
6wk dx with electrophoresis found in Mediterranian |
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What is the management of thalassemia?
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transfusion, H&H, iron levels - chelation therapy
Desferol qPM SQ via I-Med (chelation) Spleenectomy Bone marrow transplant |
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What is the prognosis of thalassemia?
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retarded growth
delayed or absent secondary characteristics expect to live well into adulthood with proper clinical management |
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What is aplastic anemia?
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blood disorder in which the bone marrow fails to produce RBCs WBC and platelets
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What are the types of aplastic anemia?
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Aquired:
Rx Infection: HPV, Hep Chemo in utero radiation immune disorder household cleaners lymphomias Congenital |
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What are the s/s of aplastic anemia?
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epistaxis
gum oozing ecchymoses petechiae purpura tachycardia tachypnea blood in urine and stool fatigue bleeding |
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What is the management of aplastic anemia?
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avoid hemorrhage
assist with bone marrow transplant prevent infection from bleeding |
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What are the types of clotting disorders?
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Idiopathic Thrombocytopenia Purpura
DIC Hemophilia Von Willebrand Disease |
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What is hemophilia?
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group of disorders with deficiency of clotting factors causing prolonged bleeding with trauma or spontaneously
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What is the genetic component of hemophilia?
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x linked recessive
females carrier males affected can be spontaneous mutation |
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What are the s/s of hemophilia?
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bleeding
might not occur until 6mo Hemarthrosis Ecchymosis Epistaxis Bleeding post minor procedures can cause large SQ or IM hemorrhages to occur |
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What is the dx for hemophilia?
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Dx during pregnancy
genetic testing for family Labs |
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What is the nursing management for hemophilia?
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prevent bleeds
emergency for bleed in neck, chest, mouth (airway) Replacement of deficient factor (DDAVP) exercise/PT (dec spontaneous bleed) avoid obesity no contact sports |
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What is the management of a bleed?
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pressure
ice elevation splint rest |
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What is Von Willebrand Disease VWD?
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congenital bleeding disorder with deficiency of vWF causing prolonged bleeding time (no platelet plug) from membranes
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What are the interventions for vWD?
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no ASA or NSAIDS (inhibit platelet fx)
manage bleeding with prompt infusion therapy normal life expectancy |
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What is Idiopathic Thrombocytopenic Purpura?
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autoimmune hemorrhagic disorder with <20,000 platelets found in 2-10yo
theres destruction of platelets |
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What are the manifestations of ITP?
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Follows viral respiratory infection (unvaccinated MMR or polio)
self limiting petechiae prolonged bleeding purpura bruising appears well: WBC normal Epistaxis Black stools hematemisis Menorrhagia |
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What are nursing interventions for ITP?
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prevent bleeding
no asa or NSAIDS Steroids and IV immunoglobulin if <20,000 Teach S/S of bleeding |
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WHat does recurrent epistaxis mean?
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Vascular abnormality
leukemia ITP clotting deficiencies |
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What are interventions with epistaxis?
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be calm
lean forward pressure for 10 mins |
