Hematology
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| Fe deficient anemia is most common from __ to __ yrs and also in ____ | 6mo-2 yrs. Common in 12-20 y.o.
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| 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
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| 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
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| Normal Fe values | 2 mo (9-14), 6-12 yrs (11.5-15.5), 12-18 yrs (12-16)
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| 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.
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| Milk should not be given to toddlers until | After a meal
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| 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
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| Hgb lvls can take up to __ to increase | 3 months
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| PO Fe can take up to __ months to get good Hct levels | 6 months. (Will see bump in 6-8 wks)
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| Diet sources of Fe | Cereal, fortified formula. Dried legumes, dried fruits, nuts, green leafy veggies, fortified breads, fortified flour, red meat
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| Thalassemia definition | Genetic D/O causes deficiencies in rate of production of globin chains in hgb causing RBC destruction
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| 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
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| Tx of thalassemia | Early transfusions, chelating therapy
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| Overload of Fe often occurs _____ c. thalassemic pt. | After infection
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| Outcomes for thalessemia | Family support for chronic illness
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| Sickle cell definition | Genetic, abnormal HbS. Increased viscosity, obstructed blood flow, tissue hypoxia d/t sickling
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| Risk factors for sickle cell | Found primarily in African Americans.
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| 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)
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| Vasoocculsive episodes last typically | 4-6 days
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| Acute vasooclusion s/sx | Severe pain (bones/jts/abdm), swollen jts/hands/feet, anorexia, vomiting, fever, hematuria, obstructive jaundice, visual disturbance
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| Chronic vasooclusion s/sx | Increased risk of resp infxn or osteomyelitis, retinal detachment/blindness, systolic murmurs, renal failure/enuresis, liver failure, seizures, skeletal deformities
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| Sequestration of vasooclusion | Excess pool of blood in liver, spleen. Tachycardia, dyspnea, weakness, pallor, shock
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| RN care for sickle cell | Promote rest, admin O2 if hypoxia, FLUIDS, PAIN MANAGEMENT, admin blood products, Tx/prevent infxn
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| RN care after D/C | Emotional support, s/sx infxn/crisis, good hygiene, specific fluid intake requirements, encourage updated immunizations, med ID tags
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| Complications of sickle cell | Enlarged spleen/liver, pain crisis, progressive renal failure, CVA
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| Hemophilia d/t | Genetic deficiency of clotting factors. Easy bruising, uncontrolled bleeding
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| 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.
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| 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
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| Complications of hemophilia | Shock, uncontrolled bleeding (intracranial hemorrhage, airawy obstruction from bleeding in mouth/neck/chest)
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