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Pediatrics

Hematological Conditions

QuestionAnswer
Iron Deficiency Anemia is a ____ anemia brought about primarily by ___ dietary intake for normal RBC formation? Iron deficiency anemia is a hypochromic microcytic anemia brought about primarily by inadequate dietary intake for normal RBC formaiton
What is the most common form of Anemia? Iron Deficiency Anemia
IDA Diagnostic Criteria for Iron Deficiency Anemia for children between ___ months to ___ years is Hemoglobin ___ and Hematocrit ___ and you need both to diagnosis? IDA Diagnositc Criteria children 6 months to 2 years Hemoglobin < 11g/dL Hematocrit < 33% Both needed to diagnose
American Academy of Pediatrics Iron Deficiency Anemia Degree of Anemia defines mild anemia as hemoglobin ___ to ___ g/dL 9.5-11 g/dL 80% of cases are mild deficiency anemia
American Academy of Pediatrics Iron Deficiency Anemia Degree of Anemia defines moderate anemia as hemoglobin ___ to ___ g/dL Moderate iron deficiency Anemia hemoglobin 8 to 9.4 g/dL
American Academy of Pediatrics Iron Deficiency Anemia Degree of Anemia defines severe anemia as hemoglobin ___ g/dL Severe <8 g/dl
General etiologic factors of iron deficiency anemia is Inadequate dietary intake of ___; ___ malabsorption; Low ___ stores at birth (due to mothers ___ or ___) and significant ___ loss? Inadequate dietary iron intake; iron malabsorption; low iron stores at birth (due to mothers intake or anemia) and significant blood loss (especially teenage girls (puberty))
Premature/Low birth weight risk factors for iron deficiency anemia? Poor iron stores at birth; maternal iron stores last approx 4 months; 50% of iron in maternal milk is absorbed; and 10% of iron in cow's milk is absorbed
Infant/Child risk factors for iron deficiency anemia: Rapid ___ in body size and blood volume; Insufficient ___ formula/foods; Excessive intake of ____ milk; ____ without dietary iron; Pica; ___ eater; nonmeat diet in a ___-__ year old; Malnutrition Rapid increase in body size and blood volume; Insufficient iron rich formula/foods; Excessive intake of whole cow's milk; Breastfed without dietary iron; Pica; Picky eater; nonmeat diet in a 2-5 year old; malnutrition
What is Pica? craving of a iron in a non-food source like nails, metals, clay, etc. usualy 6-8 months old
Adolescent risk factors for iron deficiency anemia are: rapid ___ during puberty; increased muscle mass and circulating ___ volume; Unbalanced __ and ___ eating habits; Menarche/heavy menstruation (usually __-__ years of age) Rapid growth rate during puberty; Increased muscle mass and circulating blood volume; unbalanced diet and porr eating habits; menarche/heavy menstuation (usually 12-14 years old)
What are the adult risk factors for iron deficiency anemia? Premenopausal women; pregnant women; chronic blood loss; low socioeconomic background (iron filled foods usually more expensive); older adult
What are the clinical manifestations of iron deficiency anemia? Lethargy/fatigue; irritability; pallor; frequent infections; inability to concentrate; heavy menses; conjunctiva pale; mucous membranes pale; cardiac problems; developmental delays; and weight variable
What is pale conjunctiva and what are the cardiac problems seen in iron deficiency anemia? conjunctiva pale is where the inside of the eye lid is not red and the cardiac problems are increased cardiac demands due to low/decreased hgb
Everyone gets tested for iron deficiency anemia between ___ and ___? 9 - 12 months
American Academy of pediatrics recommendations for screening of ____ everyone tested between 9-12 months; only if child is symptomatic: 1 and 5 years; 5 and 12 years; and between 14 and 20 years? iron deficiency anemia
T/F After toddler yrs iron deficiency anemia is usually due to dietary? True
Breast milk has a ___ concentration of iron; Bioavailability greater, and progressive decline in ___ content? Low concentration of iron, bioavailability greater, and progressive decline in iron content
Some breastfed infants depleate the iron stores by __ to __ months? They need a source of iron by ___ months like cereal? Without iron source __ to ___ will develop iron deficiency anemia by ___ months? Some deplete iron stores by 4-6 months; Need source of iron by 6 months like cereal; without iron source 17-28% will develop iron deficiency anemia by 9 months
When do preterm infants get oral iron supplementation? at 2 months of age (preterm considered if baby is less than 38 weeks)
Oral iron supplementation is needed if the baby is _____ beyond 6 months of age; infant receiving formula not fortified with iron; child with hemoglobin level below ___? EXCLUSIVELY BREASTFED beyond 6 months of age; infant receiving formula not fortified with iron; child with hemoglobin level below 11
Formula with iron is given until ___ months then Whole cow's milk after ___ months? Limit intake of whole milk to ___ or less in a child from 1-5 years? Formula with iron until 12 months then whole cow's milk after 12 months. Limit intake to 24 oz/day or less in children 1-5 years of age. This amount is sufficient to meet calcium needs. Whole milk should be given because of the fat content in it.
What are some HIGH iron rich foods? red meat and oily fish
What are some Moderate iron rich foods? beans, peas, fortified cereals, dark green veggies, nuts
What are some foods that decrease iron absorption? excess cow's milk, tea
___ is an iron suplament given PO? Ferrous sulfate
Do not consume ferrous sulfate with ___,___, or ____? Do not consume ferrous sulfate with milk, antacids, or tea
What enhances ferrous sulfate absorption? ascorbic acid enhances absorption (orange juice/Vitamin C)
If taking a liquid preparation of ferrous sulfate use dropper or straw to avoid _____ and be sure to ____ after? liquid preparations use dropper or straw to avoid staining of teeth and be sure to brush teeth after
When do you wnat to give ferrous sulfate and what will the stools look like? Give between meals especially if meal contains milk; stools dark (greenish-black)Only time you give it with meals is if a pt has side effects of it like upset stomach.
What are the side effects of ferrous sulfate? nausea, vomiting, diarrhea, constipation, anorexia
when a pt is on iron supplements when should their hemoglobin return to normal? It should also come up 1.0 g/dL or more in ___ months? Return to normal within 4-6 weeks; come up 1.0 g/dL or more in 1 month
Contine iron supplement/therapy at least ___ months after return of hemoglobin to normal; Tx should not exceed ___ months with exception to ___? Continue at least 3 months after return of hemoglobin to normal; Tx should not exceed 5 months with the exception of older adults who may require life long supplementation
Parenteral iron and sometimes packed RBCs are given to pts with ____ anemia? severe anemia
What is the prognosis of iron deficiency anemia? What are some problems/prognosis if it is longstanding/severe? Prognosis is usually good. If longstanding/severe can lead to cognitive impairment; delayed G & D; Decreased exercise tolerance (decreased Hgb & o2 carrying RBC); Impaired immunity
Sickle cell Anemia is a ___ inheritance? It has an Abnormal form of hemoglobin within the erythrocyte. It has Hemoglobin ___ instead of the normal adult hemoglobin ___? Sickle cell anemia is an autosomal recessive inheritance; abnormal form of hemoglobin within the erythrocyte--Hemoglobin S instead of the normal adult hemoglobin (Hgb A)
What is the normal lifespan of RBCs? What is it in Chronic Hemolytic Anemia (sickle cell anemia)? Normal lifespan is around 90 days. in chronic hemolytic anemia red cell life span 10-20 days
Sickle cell anemia is an autosomal recessive inheritance. If Both parents heterozygous for trait what is the chance that the baby will be normal, a carrier, or have the disease? 25% chance will have normal hgb A; 50% chance infant will be carrier (Hgb SA)and 25% chance infant will have disease Hgb SS
What is the incidence of sickle cell anemia? Most common is African American descent; Caribbean/Mediterranean; Arabian; India
American Black population sickle cell anemia Disease is ___ to ___ live births and Trait is __ in ___? Disease is 1:400 to 1:500 live births; Trait 1 in 12
What are some situations/Stressors that promote O2 deprivation? Hypoxia and acidosis; Environmental (low O2 concentration) High altitudes; weather; Emotional stress and physical stress and there are some unknown causes as well.
Hemoglobin S+ situations causing ____ leads to Sickled cells clumping togehter (cells __ and ___ can't flow through vessles) leads to small blood vessels becoming ____--> what side effects does this leed to? Hemoglobin S+ situations causing Oxygen deprivation (ie stressors)-->Sickled cells clup together (cells hard and sticky-can't flow through vessels)--> small blood vessels become occluded-->Ischemia, Necrosis, Pain
Sickle cell disease is frequently not apparent until after __ to ___ months of age because of the continuing presence of ____? Sickle cell disease is frequently not apparent until after 4 to 6 months of age because of the continuing presence of fetal hemoglobin
What are the 3 major types of sickle cell crisis? Vaso-occlusive crisis; Splenic sequestration; and Aplastic crisis
What is daclylitis? Dactylytis or sausage digit is a inflammation of an entire finger or toe,[1] and can be painful.
What is the most common sickle cell crisis and what are its side effects? Vaso-occlusive Crisis is most common. Painful episode; clumping of RBCs, ischemia, infarction, pain
Splenic Sequestration is a sickle cell crisis; pooling of blood in ___-LIFE THREATENING; Decreased intravascular blood volume--> ____and if it is recurrent it will lead to ___? Pooling of blood in SPLEEN-->LIFE Threatening; Decrased intravascular blood volume--> SHOCK; if recurrent it will lead to SPLENECTOMY
In a Aplastic crisis a ___ infection triggers it; RBC production ___ -->___ anemia; and it is usually self-limited? Aplastic crisis Viral infection triggers; RBC production stops-->profound anemia; Usually self-limited
You are a nurse in an adult ED. A 24 yr old cl with sickle cell disease comes to the ER at least every 2 weeks complaining of pain and requesting pain meds. what do you need to do? Analyze why this cl is being seen so often. Can't control at home; Look for stressful things in their life; List potential interventions like how to reduce stress
What are the 3 signs of sickle cell crisis? Acute chest syndrome; Stroke; and Infection
What is Acute chest syndrome and what are the s/s? Acute chest syndrome is the sickling of small blood vessels of lungs; s/s Pain; temp 38.3 (101 F) or higher; Cough; Dyspnea/Tachypnea; Respiratory distress
How do you treat Acute chest syndrome? Hydration and pain management
Stoke is a sickle cell crisis. Sickle cells block major cerebral vessels. What are the s/s? severe headache; slurred speech, unsteady walk
What are the leading cause of death under 10 years of age with a sickle cell pt? Sepsis and Meningitis are the leading sickle cell cirisis deaths in pts under 10 years of age
Sickle cell crisis-Infection: Impairment of splenic function-Spleen replaced by ___ tissue related to infarcts in spleen (autosplenectomy)-loss of filtering system ___ susceptibility to infection--Nonfunctional by ___ years of age? Spleen replaced by fibrotic tissue related to infarcts in spleen (autosplenectomy)-loss of filtering system increases susceptiblity to infection-nonfunctional by 5 years of age.
T/F Infection in sickle cell crisis basically means decreased functioning of spleen until it becomse absolete. so it doesn't do what it is suppose to do. True
What is the most common organism for infection in sickle cell crisis for children under 5? Over 5? Under 5 years-pneumococcalOver 5 years- gram negative (eg E.coli leading cause of UTI, Salmonella)
Nursing interventions for sickle cell anemia are ___management; Prevent/manage __; promote ___; Minimize tissue ___ & ___; drug therapy and patient/family ____? Pain mangement (most important); prevent/manage infections; promote hydration; minimize tissue deoxygenation and minimize crises; drug therapy and patient/family education
What drugs do you want to use for severe pain in sickle cell pts? Opioids parenterallyPCA or Continuous infusion pumps
What drugs do you wnat to use for Moderate pain in sickle cell pts? Acetaminophen with codeine (vicoden) or ibuprofen
What drugs do you want to use for mild pain in sickle cell pts? acetaminophen and ibuprofen
In managing pain it is important to observe for pain every __ to __ hrs? What do you want to ask them about their pain? observe for pain every 2-4 hrs. Ask about location of pain, intensity, duration, and character (pounding)
T/F you don't need to use a pain intensity rating tool to monitor pain? False use a pain intensity rating tool it monitor effetiveness of pain management
In sickle cell anemaia what are some other forms of pain management besides medications? Heat-NO cold; Rest-minimize O2 consumption and HYDRATION
If a sickle cell anemia who is between ages 3 months and 12 years of age has to have dental work done what do they need to do? Take Prophylactic penicillin; Pen VK
What are some ways to prevent infection in sickle cell anemia pts? Prophylactic pennicllin; handwashing (very important); Isolation-as appropriate (not recommended unless absolute necessary); Immunizations; Teach
What immunizations should a sickle cell anemia pt get? Routine; Meningococal; Influenza; Pneumoccoccal (prevnar and Pneumovax)
What do you want to teach a sickle cell anemia pt to report immediately if they are having? If they are having these symptoms prompt treatment with parenteral antibiotics like what? Fever of 101 F (38.3 C); Lethargy; Irritability, Vomiting, Diarrhea. If they are having these symptoms prompt treatment with parenteral antibiotics like ceftriaxone.
T/F Hemodilution is not important in a sickle cell anemia pt? False it is VERY IMPORTANT it reduces blood viscosity and prevents sickling IV + PO = 1 to 1.5 maintenance
What do you want to teach the family about hydration in a sickle cell anemia pt? signs of dehydration-treat promptly; Child unable to concentrate urine-->low specific gravity leads to dehydration; Enuresis is common-DONT DECREASE FLUIDS
What do you want to teach the TEACHER of a sickle cell anemia child? Teach them to allow child to drink fluids during class and to permit frequent use of bathroom
How do you minimize tissue deoxygenation in a sickle cell anemia pt? Bed Rest-very important during acute crisis (need to maintain o2 level); Avoid stressors; Monitor O2 saturation; Administer O2 in a child with hypoxemia
How do you minimize crises in a sickle cell pt? Avoid stressors; Report s/s of crises IMMEDIATELY; Frequent medical supervision; Adequate nutrion; Administer Blood transfusion if needed
Why would you want to give a blood transfusion in a pt with sickle cell anemia Acute splenic sequestration? In Aplastic Crisis? In Post CVA? Acute splenic sequestration (correct hypovolemia); Aplastic crisis (PRBC to increase hemoglobin); Post CVA (reduce blood viscosity)
T/F Administering oxygen in a child with hypoxemia and sickle cell anemia will reverse the sickling? False it does not reverse sickling it may prevent more sickling from occuring
Why do you want to give folic acid to a sickle cell anemia pt? They have increased folate requirements caused by hemolysis and to prevent megaloblastic anemia
Hydroxyurea is used with frequent ___ episodes in sickle cell anemia pts? What does it do? Hydroxyurea is used with frequent pain episodes in sickle cell anemia pts. It elevates Hemoglobin F which decreases sickling
T/F Erythropoietin is given to sickle cell anemia pts? True
Patient/Family education of a sickle cell pt includes educating about all aspects of the disease; encourage ___ counseling; encourage family to promote normal ___; Allow expressions of feelings about the disease; Identify ___ and ___ resources? Educate about all aspects of the disease; Encourage genetic counseling; encourage family to promote normal G&D; Allow expression of feelings about the disease; Identify community and national resources like kids w/ same disease and camps
The prognosis of sickle cell anemia is variable (depends on severity). What is the median survival age of Hgb SS Disease? Men 42 years and Women 48 years both age groups keeps going up. The improved survival is due to Screening; Follow-up care; and early intervention
What is the most common hereditary bleeding disorders? Hemophilia and vonWillebrand's Disease
Hereditary Bleeding disorders result from what? result from deficiencies/abnormalities of specific coagulation proteins
T/F Deficiency of one of the factors in blood causes problems in the whole clotting cascade? True
hemophilia A is a ___ linked recessive trate that is a deficiency of factor ___? Hemophilia ADeficiency of factor VIIIX-linked recessive
hemophilia B is a deficiency of factor ___ and is ___ linked recessive? Hemophilia BDeficiency of factor IXX-linked recessive
VonWillebrand's Disease is a ____ trait that is a deficiency of vonWillebrand's ____? Deficiency of vonWillebrand's protein; Autosomal dominant
Hemophilia is a x-linked recessive disorder. What does this mean for a woman who is a carrier for the disorder and her partner does not have the disorder? 50% chance each pregnancy-son will have the disease and 50% chance daughter will be a carrier. Depends on which X chromosome is passed on by mom
Impact of Factor VIII deficiency: Severe ___ factor activity and spontaneous bleeding w/out trauma; Moderate: __ to __ factor activity-bleeding with trauma; Mild: __ to __ factor activity-bleeding with severe trauma or surgery Severe <2% factor activity-Spontaneous bleeding without trauma; Moderate: 2-4.9% factor activity-bleeding with trauma; Mild: 5-40% factor activity-bleeding with severe trauma or surgery
T/F With hereditary Bleeding disorders there is not a potential for bleeding anywhere in the body? False there is a potential for bleeding anywhere in the body
What are the clinical manifestations of Hereditary bleeding disorders? Potential for bleeding anywhere in the body and Hemarthrosis
What are the manifestations of hemarthrosis? oozing of blood into joint cavity; Joint- swollen, tender, painful; repeated hemorrhage
What can a repeated hemorrage of hemarthrosis in a hemophilia pt do? Damage to synovial membrane, degerneration of cartilege & cysts; Contractures; and severe crippling is possible
What are the nursing interventions for hereditary bleeding disorders? Administer missing clotting factor; Injury prevention; control bleeding and teaching
Factor VIII Replacement: Administer ___ clotting factor as soon as possible with injury; New recombinat factor-has no human product in it (don't have to wory about diseases); Teach family & child how to ___; Implanted ___ access device may be necessary? Administer missing clotting factor ASAP with injury; New recombinant factor-has no human product in it (don't worry about diseases); Teach family how to administer it at home; Teach child to self administer; Implanted venous access device may be necessary
hereditary Bleeding disorders Infant injury prevention: ___ crib; ___ feeding utensils; Wall-to-wall carpeting/pad edges of furniture; safe toys; approved car seat; ___ when learning to walk? Pad crib; nonbreakable feeding utensils; wall-to-wall carpeting/pad dges of furniture; safe toys; approved car seat; helment when learning to walk
What type of protective equipment is need in a child/adolescent for injury prevention if they have clotting disorders? knee pads, elbow pads, helmets
What kind of activities and sports can children/adolescents with clotting disorders do? NO CONTACT SPORTS; No sports that cause too much strain on knees & ankles (hemarthrosis); Swimming is ok for young child; Swimming, golf, bowling, bike riding (with protective equipment) is okay for older child
Control bleeding in pts with clotting disorders with RICE. What does the R stand for? Rest-immobilize for comfort and to prevent further bleeding
Control bleeding in pts with clotting disorders with RICE. What does the I stand for? ICE-apply cold to promote vasoconstriction
Control bleeding in pts with clotting disorders with RICE. What does the C stand for? COMPRESSION-pressure to encourage clot formation
Control bleeding in pts with clotting disorders with RICE. What does the E stand for? Elevation-elevate joint
How do you prevent contractures in a pt with clotting disorders? Hint Gentle active ROM-only after __ stopped (w/in 24-48hrs) and allow cl to control own ___ tolerance; DO NOT do passive exercise-could __ joint capsule & could cause __w/ acute episode. Gentle active ROM-only after bleeding stopped (w/in 24-48hrs) and allow cl to control own pain tolerance; DO NOT do passive exercise-could stretch joint capsule and could cause bleeding with acute episode.
What do you want to teach the family of a hemophilia or vonWillebrands's disease? Home infusion therapy; signs of major bleeding; prevent bleeding; how to control bleeding; control pain; regular exercise & PT--strenghten muscles around joints; support family
What are signs of major bleeding? Headache (HA); blurred vission, vomiting, lethargy, seizures
What are some things you can do to prevent bleeding? soft toothbrush, no rectal temp, activity restrictions, environmental safety
What do you want to use to control pain in a Hemophilia pt and what do you NOT want to use? Use acetaminophen (NO Asprin because it thins blood which would lead to increased risk of bleeding)
Life Expectancy of Hemophillia or vonWillebrands's disease is that it approaches that of ____ population and the major cause of death is _____? approaches that of general population and major cause of death is intracranial hemorrhage
Idiopathic Thrombocytopenic Purpura (ITP) is a _____ hemorrhagic disorder? Acquired hemorrhagic disorder
The potential Etiology of ITP is ____ response to disease-related antigens; ___ produced & attached to platelets; ___ of antibody coated platelets; and increased destruction of platelets (thrombocytopenia) in the ____? Autoimmune response to disease-related antigens; Autoantibodies produced & attached to platelets; Phagocytosis of antibody coated platelets; and increased destruction of platelets (thrombocytopenia) in the spleen
The Acute Form of ITP is self-limmiting resolving within ___ with or without ____? It occurs __ to ___ weeks after viral infection (eg URI, measles, mumps, rubella, chickenpox, human parovirus); Incidence is most common in ____? Self limiting resolving within 6 months with or without treatment (depends on how low the platelet count goes); occurs 1 to 4 weeks after viral infection (URI, measles, mumps, rubella, chickenpox, human parovirus); Incidence most common in children
Chronic form of ITP last longer than ___? What do you need to rule out? Last longer than 6 months. Need to rule out immunodeficiency disorder; autoimmune disease; and neoplasm
Chronic form of ITP is most common in older ___ and women between __ & ___ years old? Older children and women between 20 and 40 years old
What are teh clinical manifestations of ITP? Bleeding of integument; mucous membrane bleeding; potential internal blood loss; and intracranial hemorrhage (<1%)
Bleeding of integument can be ___,___, & ____ they don't blanche? Bleeding of integument can be Petechiae (<3 mm-pinpoint red dots); Purpura (up to 1 cm); and Ecchymoses (>1cm) and they don't blanche
Platelet count of ITP is decreased below ____? 150,000
If platelets are <50,000 it can cause prolonged ....? prolonged bleeding from trauma or injury
If platelets are <20,000 it can cause ____? can cause spontaneous life-threatening hemorrhage
What are the nursing interventions of ITP? Primarily supportive, prevent &/or minimize bleeding, and administer medications
What 4 medications are given in ITP patients? Predisone, IVIG, Anti-D antibody (WinRhoD), and Immunosuppressive Therapy
What is the Gold standard for treatment of ITP? Predisone and IVIG are the gold standard for treatment of ITP
___ is a medication that is inexpensive, may be given PO or IV and there is an ____ platelet survival and a ___ production of antiplatelet antibodies? Predisone is inexpensive may be given PO or IV, increase platelet survival and a decrease production of antiplatelet antibodies
___ is an expensive medication that blocks ____ that results in ___ of platelets? IVIG is an expensive medication that blocks antibody that results in destruction of platelets
Anti-D Antibody (WinRhoD) lessens ___ of platelets? Anti-D Antibody (WinRhoD) lessens phagocytosis of platelets
In ITP Immunosuppressive Therapy lessens ___ production? lessens antibody production
____ is usually self-limited and has indications of splenectomy? ITP prognosis is usually self-limited and has indications of splenectomy
What are some indications of splenectomy? Hint unresponisve to ___; High doses of ____ are needed to maintain adequate platelet count, Manifestations for ___ or longer; and Decrease risk of _____ w/ chronic form of ITP unresponisve to prednisone; High doses of prednisone are needed to maintain adequate platelet count, Manifestations for 1 yr or longer; and Decrease risk of hemorrhage w/ chronic form of ITP
What are some sources of lead poisoning? Lead-based paint; soil, dust, air w/ lead particles; Water; Occupation & hobbies; Dinnerware; Cosmetics and fold remedies
What are the effects of lead on the cardiovascular system? Hematopoietic --> anemia
What are the neurologic effects of lead? Neurologic-> mental retardation, seizures, coma, and death
Waht are the renal effects of lead? Renal--> acute renal failure, chronic renal failure
What does BLL stand for? Blood Loss Level
Lead poisoning is defined as BLL ___ or greather than ____? Lead poisoning is defined as BLL equal to or greater than 10 mcg/dl
Children with BLL greater than or equal to 10mcg/dl considered lead exposed and worthy of ___? intervention
CDC recommends universal screening or target screening of lead poisoning based on each states determination of need. What is MOs? Not mandated but required at 1 yr
Child/sibling w/ elevated past BLL; Lives in/regularly vists house build before 1959 or house built before 1978 w/ recent or ongoing renovation/remodeling in the last 6 months are all high risk children for ____? High risk children for lead poisoning
Children who live in a building where other children are being followed or treated for elevated lead level; parents have occupational exposure are all high risk for ___? lead poisioning
Child lives near an active lead smelter, or other industry likely to release lead into the environment (WV has high incidence) are all at high risk for ____? lead poisioning
Red Flags of Lead poisioning: Foreign body ____, ___ seizures, neurological symptoms, ___ pain, Growth ___, Developmental ___ or hyperactivity? Red flags of lead poisioning: foreign body ingestion/pica, unexplained seizures, neurological symptoms, abdominal pain, growth failure, developmental delay, or hyperactivity
___ should be done in children with BLL 10 mcg/dl or above? enviromental evaluation
Child with BLL above 25 mcg/dl needs ____? needs chelation therapy
T/F strategies to reduce enviro lead hazards: keep child away from chipping, peeling, and flaking paint--temporarily cover this with contact paper, duct tape True
T/F Wep mops floors, windows, and DO vacuum hard surface floors, window sills are all strategies to reduce enviro lead hazards? False Wet mop floors, windows, etc. DO NOT vacuum hard surfaced floors, windows sills--spreads dust
T/F Washing toys &/or pacifiers often; wash childs face & hands often (especially before eating) and hose down places where children play (porch, driveway, sidewalk) are all strategies to reduce environmental lead hazards? True
T/F Utilize warm water for drinking, cooking, formula preparation and avoid ceramic ware and lead crystal for food storage are all strategies to reduce environmental lead hazards? False Utilize only COLD water for drinking, cooking, formula preparation and avoid ceramic ware and lead crystal for food storage
In a lead poisoned pt it is important to provide regular meals? why? Iron and calcium counteract ___ of minerals through lead exposure. Regular meals important --> more lead absorbed on empty stomach. Diet high in Iron and Calcium counteract loss of these minerals through lead exposure
What are the 3 forms of Chelation Therapy? Calcium EDTA IM or IV; Gritish antilewisite (BAL) IM; and Succimer (DMSA) Oral
Calcium EDTA IM or IV: Im painful-give deep, mix with ___, warm compress; monitor labs _____? Calcium EDTA IM or IV: Im painful-give deep, mix with procaine, warm compress; monitor labs (eg BLL, electorlytes, liver function test)
British antilewisite (BAL) IM used with ___ and monitor ___ & ___? British antilewisite (BAL) IM used with EDTA and monitor labs & ECG
Succimer (DMSA) Oral may give as outpatient, ___ is very important because it is excreted by kidneys? BLL > 45 May give as outpatient and hydration is very important because it is excreted by kidneys. BLL > 45
Adequate hydration is very important since ___ are excreted via kidneys? Adequate hydration is very important since chelates are excreted via the kidneys
Prognosis of lead poisoning is variable and the major problems relate to ____? Prognosis of lead poisoning is variable and the major problems relate to encephalopathy: academic problems; delinquency; mental retardation; behavior changes; paralysis and seizures
Created by: cgwayland