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parent/child: ch 43
| Question | Answer |
|---|---|
| What comments made by parents offer clues to the more common disorders affecting the blood? | Lack of energy, food diary of poor sources of iron, frequent infections, & bleeding that is difficult to control |
| Shift to the left | Refers to the presence of immature neutrophils in the peripheral blood from hyperfunction of the bone marrow, as seen during a bacterial infection |
| Anemia | Reduction in RBCs &/or hemoglobin concentration compared with normal values for age; most common hematologic disorder of infancy & childhood & are not diseases but an indication or manifestation of an underlying pathologic process |
| Anemia classification | Etiology or physiology - manifested by erythrocyte or Hgb depletion Morphology - the characteristic changes in RBC size, shape, or color |
| Consequences of anemia | May produce a murmur, cardiac failure may ensue, cyanosis is typically not evident, growth retardation & coexisting anorexia are a common finding in chronic severe anemia, & it is frequently accompanied by delayed sexual maturation in the older child |
| Diagnostic evaluation pertaining to anemia | Hx & physical examination findings: lack of energy, easily fatigued, & pallor Labs: decreased RBCs, Hgb, & hematocrit (sometimes defined as Hgb < 10 or 11, but varies) |
| Therapeutic management of anemia | Nutritional: the specific deficiency is replaced Blood loss: RBC transfusion Severe: oxygen therapy, bed rest, & IV fluids |
| Iron-deficiency anemia | Occurs more frequently in toddlers between 12 & 36 months old & during the growth spurt of adolescence |
| Nursing assessment interview for anemia | 1) Nutrition 2) Hx of chronic, recurrent infection 3) Eating habits, particularly pica 4) Bowel habits & presence of blood in stools 5) Familial hx of hereditary diseases |
| Decreased RBC production (Pg. 1271) | Pallor Tachycardia, headache Fatigue, SOB Muscle weakness Systolic heart murmur Pica Can lead to nutritional deficiency or bone marrow failure |
| Increased RBC loss (Pg. 1271) | Pallor Fatigue, headache Muscle weakness Cool skin Tachycardia Decreased peripheral pulses Low BP (late sign of shock) Can lead to acute blood loss |
| Decreased incidence of iron-deficiency anemia in infants & young children | Promotion of iron supplement in the exclusively breastfed infant, introduction of iron-fortified infant formula & cereal, weaning from the bottle by 1 year of age, limiting intake of cow’s milk to 16 to 24 oz/day, & delayed intro of cow’s milk |
| Adolescents at risk for iron deficiency | Because of their rapid growth rate combined with poor eating habits, menses, obesity, or strenuous activities |
| Iron-deficiency anemia pathophysiology | Can be caused by any number of factors that decrease the supply of iron, impair its absorption, increase the body’s need for iron, or affect the synthesis of Hgb |
| “Milk babies” | Overweight because of excessive milk ingestion. These children become anemic for 2 reasons: 1) milk, a poor source of iron, is given almost to the exclusion of solid foods 2) increased fecal loss of blood |
| Therapeutic management of iron-deficiency anemia | Focuses on increasing the amount of supplemental iron the child receives |
| Nursing care management of iron-deficiency anemia: teaching | Side effects: nausea, gastric irritation, diarrhea or constipation, & anorexia. Should take with meals if vomiting & diarrhea occurs Advised to take in divided doses & in between meals Take with vitamin C & NOT milk Tarry green/black stools are normal |
| Liquid preparations of iron | May temporarily stain the teeth -> take through a straw or give through a syringe or medicine doppler placed toward the back of the mouth; brushing the teeth after administration lessens the discoloration |
| Diet teaching for iron-deficiency anemia | Reinforce the importance if administering iron supplementation to exclusively breastfed infants by 4 months of age; great sources: iron-fortified formula & cereal |
| Sickle cell anemia (SCA) | One of a group of diseases collectively called hemoglobinopathies in which normal adult Hgb is partly or completely replaced by abnormal sickle Hgb |
| Sickle cell disease (SCD) | Refers to a group of hereditary disorders, all of which are related to the presence of HbS - Sickle cell anemia - Sickle cell C-disease - Sickle cell - hemoglobin E disease - Sickle cell ischemia disease |
| Heterozygous vs. homozygous | Hetero -> have both normal HbA & abnormal HbS; said to have sickle cell trait Homo ->have predominantly HbS & have SCA |
| Sickle cell trait | If both parents have the trait, each of their children have a 25% chance of having the disease |
| Sickle cell anemia pathophysiology | The clinical manifestations of SCA are primarily the result of 1) obstruction caused by the sickle RBCs with other cells 2) vascular inflammation 3) increased RBC destruction (All the different crises are listed on pg. 1275) |
| Sickleturbidity test (Sickledex) | Screening for sickle cell; done by finger or heel stick |
| Therapeutic management of sickle cell | Rest, hydration, electrolyte replacement, analgesia, blood replacement (2 - 5 weeks), & antibiotic therapy (penicillin prophylaxis is recommended by 2 months old to reduce the chance of pneumococcal sepsis); splenectomy, & monitor reticulocyte count |
| Family education in regards to sickle cell | 1) seek early intervention for problems 2) give penicillin as ordered 3) recognize s/s of stroke, splenic sequestration, & respiratory probs 4) treat the child normally |
| Enuresis | Bedwetting; increased fluids combined with impaired kidney function can cause this to result |
| Cure for sickle cell disease | Bone marrow transplant + chemo |
| Beta thalassemia (Cooley anemia) | Genetic disorder; ***Mediterranean people*** |
| Hemophilia | Refers to a group of bleeding disorders resulting from congenital deficiency or dysfunction or absence of specific coagulation proteins or factors; genetic from mom (X chromosome) |
| Hemophilia A | Classic; deficiency of factor VIII (8!) |
| Hemophilia B | “Christmas disease;” deficiency of IX (9!) |
| Von Willebrand disease (vWD) | Another hereditary bleeding disorder characterized by a deficiency, abnormality, or absence of the protein called von Willebrand factor (vWF) & factor VIII; females can be affected |
| Therapeutic management of hemophilia | Replacement of missing clotting factors (home infusion), Desmopressin (IV or nasal spray, increases factor VIII, used if mild), Aminocaproic acid (prevents clot destruction), prevention (safety & dental hygiene), RICE if bleeding, & genetic counseling |
| Hemophilia teaching | Noncontact sports are encouraged; there is no cure |
| Disseminated Intravascular Coagulation | “Death is coming;” bleeding everywhere |
| Epistaxis (nosebleeding) teaching/treatment | - Sit up & lean forward - Apply pressure to tip of nose for at least 10 min - Do not insert cotton or tissue - No nose blowing, picking, or rubbing - Ice pack or cold cloth - Keep calm & quiet |
Created by:
tatianalopez03
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