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Peds Hema


Fe deficient anemia is most common from __ to __ yrs and also in ____ 6mo-2 yrs. Common in 12-20 y.o.
Risk factors for Fe deficient anemia Premature birth (decreased Fe stores), excessive cow's milk in toddlers, malabsorption D/O, poor diet intake, periods of rapid growth, blood loss, infxn, chronic d/o
S/sx of Fe deficient anemia SOB, tachycardia, dizzy/faint c. exertion, pallor, nail bed deformities, fatigue, irritability, myo weakness, impaired healing, loss of skin elasticity, thinning hair, abdm pain, N&V, loss of appetite, low-grade fever, systolic <3 murmur, HF
Normal Fe values 2 mo (9-14), 6-12 yrs (11.5-15.5), 12-18 yrs (12-16)
RN care for iron deficiency Supplements for preterm, low birth infants. Encourage breastfeeding in infants <4-6mo. Fe-fortified formula. Restrict milk in toddlers. Diet: high Fe, vit C, protein. Allow frequent rest periods.
Milk should not be given to toddlers until After a meal
Fe supplement considerations Give 1-2h after milk/antacid to prevent decreased absorption. GI effects (constip, diarr, nausea) common initially but decrease later. Give after empty stomach or after meals. Vit C increases absorption. Straw to avoid teeth staining
Hgb lvls can take up to __ to increase 3 months
PO Fe can take up to __ months to get good Hct levels 6 months. (Will see bump in 6-8 wks)
Diet sources of Fe Cereal, fortified formula. Dried legumes, dried fruits, nuts, green leafy veggies, fortified breads, fortified flour, red meat
Thalassemia definition Genetic D/O causes deficiencies in rate of production of globin chains in hgb causing RBC destruction
Thalassemia s/sx Anemia (pre-Dx): pallor, unexplained fever, poor feeding, enlarged spleen/liver. Progressive (chronic hypoxia, HA, precordial/bone pain, decreased exercise tolerance, listlessness, anorexia). Small stature, delayed sex maturation, bronzed/freckled skin
Tx of thalassemia Early transfusions, chelating therapy
Overload of Fe often occurs _____ c. thalassemic pt. After infection
Outcomes for thalessemia Family support for chronic illness
Sickle cell definition Genetic, abnormal HbS. Increased viscosity, obstructed blood flow, tissue hypoxia d/t sickling
Risk factors for sickle cell Found primarily in African Americans.
Sickle cell s/sx Family Hx, reports of pain/crisis/management, SOB/fatigue, tachycardia, jaundice/pallor, nail bed deform, lethargy, irritability, myo weakness, impaired healing, loss skin elasticity, thinning hair, etc. (same as Fe deficient)
Vasoocculsive episodes last typically 4-6 days
Acute vasooclusion s/sx Severe pain (bones/jts/abdm), swollen jts/hands/feet, anorexia, vomiting, fever, hematuria, obstructive jaundice, visual disturbance
Chronic vasooclusion s/sx Increased risk of resp infxn or osteomyelitis, retinal detachment/blindness, systolic murmurs, renal failure/enuresis, liver failure, seizures, skeletal deformities
Sequestration of vasooclusion Excess pool of blood in liver, spleen. Tachycardia, dyspnea, weakness, pallor, shock
RN care for sickle cell Promote rest, admin O2 if hypoxia, FLUIDS, PAIN MANAGEMENT, admin blood products, Tx/prevent infxn
RN care after D/C Emotional support, s/sx infxn/crisis, good hygiene, specific fluid intake requirements, encourage updated immunizations, med ID tags
Complications of sickle cell Enlarged spleen/liver, pain crisis, progressive renal failure, CVA
Hemophilia d/t Genetic deficiency of clotting factors. Easy bruising, uncontrolled bleeding
RN care at hospital for hemophilia Avoid rectal temps, use surg aspetic tech, pressure for 5 min after puncture/inj/needle, control localized bleeding (factor replacement, rest/immobile). RICE for joints in localized bleeding.
D/C instructions for hemophilia Padded crib, safe environ, extra layers clothing, activity restrictions (low contact sports ok like tennis/swim/golf), soft-bristled toothbrush. Regular exercise/PT after bleeding controlled. ID band, support groups
Complications of hemophilia Shock, uncontrolled bleeding (intracranial hemorrhage, airawy obstruction from bleeding in mouth/neck/chest)
Created by: choel