Hematological Conditions
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| 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
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| What is the most common form of Anemia? | Iron Deficiency Anemia
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| 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
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| 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
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| 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
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| American Academy of Pediatrics Iron Deficiency Anemia Degree of Anemia defines severe anemia as hemoglobin ___ g/dL | Severe <8 g/dl
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| 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))
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| 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
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| 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
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| What is Pica? | craving of a iron in a non-food source like nails, metals, clay, etc. usualy 6-8 months old
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| 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)
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| 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
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| 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
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| 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
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| Everyone gets tested for iron deficiency anemia between ___ and ___? | 9 - 12 months
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| 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
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| T/F After toddler yrs iron deficiency anemia is usually due to dietary? | True
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| 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
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| 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
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| When do preterm infants get oral iron supplementation? | at 2 months of age (preterm considered if baby is less than 38 weeks)
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| 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
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| 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.
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| What are some HIGH iron rich foods? | red meat and oily fish
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| What are some Moderate iron rich foods? | beans, peas, fortified cereals, dark green veggies, nuts
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| What are some foods that decrease iron absorption? | excess cow's milk, tea
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| ___ is an iron suplament given PO? | Ferrous sulfate
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| Do not consume ferrous sulfate with ___,___, or ____? | Do not consume ferrous sulfate with milk, antacids, or tea
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| What enhances ferrous sulfate absorption? | ascorbic acid enhances absorption (orange juice/Vitamin C)
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| 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
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| 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.
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| What are the side effects of ferrous sulfate? | nausea, vomiting, diarrhea, constipation, anorexia
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| 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
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| 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
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| Parenteral iron and sometimes packed RBCs are given to pts with ____ anemia? | severe anemia
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| 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
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| 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)
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| 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
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| 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
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| What is the incidence of sickle cell anemia? | Most common is African American descent; Caribbean/Mediterranean; Arabian; India
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| 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
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| 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.
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| 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
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| 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
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| What are the 3 major types of sickle cell crisis? | Vaso-occlusive crisis; Splenic sequestration; and Aplastic crisis
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| What is daclylitis? | Dactylytis or sausage digit is a inflammation of an entire finger or toe,[1] and can be painful.
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| 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
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| 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
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| 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
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| 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
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| What are the 3 signs of sickle cell crisis? | Acute chest syndrome; Stroke; and Infection
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| 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
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| How do you treat Acute chest syndrome? | Hydration and pain management
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| Stoke is a sickle cell crisis. Sickle cells block major cerebral vessels. What are the s/s? | severe headache; slurred speech, unsteady walk
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| 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
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| 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.
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| 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
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| 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)
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| 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
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| What drugs do you want to use for severe pain in sickle cell pts? | Opioids parenterallyPCA or Continuous infusion pumps
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| What drugs do you wnat to use for Moderate pain in sickle cell pts? | Acetaminophen with codeine (vicoden) or ibuprofen
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| What drugs do you want to use for mild pain in sickle cell pts? | acetaminophen and ibuprofen
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| 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)
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| 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
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| In sickle cell anemaia what are some other forms of pain management besides medications? | Heat-NO cold; Rest-minimize O2 consumption and HYDRATION
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| 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
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| 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
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| What immunizations should a sickle cell anemia pt get? | Routine; Meningococal; Influenza; Pneumoccoccal (prevnar and Pneumovax)
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| 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.
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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)
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| 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
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| 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
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| 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
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| T/F Erythropoietin is given to sickle cell anemia pts? | True
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| 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
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| 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
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| What is the most common hereditary bleeding disorders? | Hemophilia and vonWillebrand's Disease
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| Hereditary Bleeding disorders result from what? | result from deficiencies/abnormalities of specific coagulation proteins
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| T/F Deficiency of one of the factors in blood causes problems in the whole clotting cascade? | True
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| hemophilia A is a ___ linked recessive trate that is a deficiency of factor ___? | Hemophilia ADeficiency of factor VIIIX-linked recessive
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| hemophilia B is a deficiency of factor ___ and is ___ linked recessive? | Hemophilia BDeficiency of factor IXX-linked recessive
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| VonWillebrand's Disease is a ____ trait that is a deficiency of vonWillebrand's ____? | Deficiency of vonWillebrand's protein; Autosomal dominant
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| 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
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| 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
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| 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
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| What are the clinical manifestations of Hereditary bleeding disorders? | Potential for bleeding anywhere in the body and Hemarthrosis
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| What are the manifestations of hemarthrosis? | oozing of blood into joint cavity; Joint- swollen, tender, painful; repeated hemorrhage
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| 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
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| What are the nursing interventions for hereditary bleeding disorders? | Administer missing clotting factor; Injury prevention; control bleeding and teaching
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| 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
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| 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
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| What type of protective equipment is need in a child/adolescent for injury prevention if they have clotting disorders? | knee pads, elbow pads, helmets
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| 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
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| Control bleeding in pts with clotting disorders with RICE. What does the R stand for? | Rest-immobilize for comfort and to prevent further bleeding
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| Control bleeding in pts with clotting disorders with RICE. What does the I stand for? | ICE-apply cold to promote vasoconstriction
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| Control bleeding in pts with clotting disorders with RICE. What does the C stand for? | COMPRESSION-pressure to encourage clot formation
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| Control bleeding in pts with clotting disorders with RICE. What does the E stand for? | Elevation-elevate joint
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| 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.
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| 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
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| What are signs of major bleeding? | Headache (HA); blurred vission, vomiting, lethargy, seizures
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| What are some things you can do to prevent bleeding? | soft toothbrush, no rectal temp, activity restrictions, environmental safety
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| 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)
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| 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
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| Idiopathic Thrombocytopenic Purpura (ITP) is a _____ hemorrhagic disorder? | Acquired hemorrhagic disorder
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| 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
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| 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
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| 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
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| Chronic form of ITP is most common in older ___ and women between __ & ___ years old? | Older children and women between 20 and 40 years old
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| What are teh clinical manifestations of ITP? | Bleeding of integument; mucous membrane bleeding; potential internal blood loss; and intracranial hemorrhage (<1%)
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| 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
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| Platelet count of ITP is decreased below ____? | 150,000
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| If platelets are <50,000 it can cause prolonged ....? | prolonged bleeding from trauma or injury
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| If platelets are <20,000 it can cause ____? | can cause spontaneous life-threatening hemorrhage
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| What are the nursing interventions of ITP? | Primarily supportive, prevent &/or minimize bleeding, and administer medications
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| What 4 medications are given in ITP patients? | Predisone, IVIG, Anti-D antibody (WinRhoD), and Immunosuppressive Therapy
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| What is the Gold standard for treatment of ITP? | Predisone and IVIG are the gold standard for treatment of ITP
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| ___ 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
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| ___ 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
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| Anti-D Antibody (WinRhoD) lessens ___ of platelets? | Anti-D Antibody (WinRhoD) lessens phagocytosis of platelets
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| In ITP Immunosuppressive Therapy lessens ___ production? | lessens antibody production
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| ____ is usually self-limited and has indications of splenectomy? | ITP prognosis is usually self-limited and has indications of splenectomy
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| 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
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| What are some sources of lead poisoning? | Lead-based paint; soil, dust, air w/ lead particles; Water; Occupation & hobbies; Dinnerware; Cosmetics and fold remedies
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| What are the effects of lead on the cardiovascular system? | Hematopoietic --> anemia
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| What are the neurologic effects of lead? | Neurologic-> mental retardation, seizures, coma, and death
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| Waht are the renal effects of lead? | Renal--> acute renal failure, chronic renal failure
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| What does BLL stand for? | Blood Loss Level
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| Lead poisoning is defined as BLL ___ or greather than ____? | Lead poisoning is defined as BLL equal to or greater than 10 mcg/dl
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| Children with BLL greater than or equal to 10mcg/dl considered lead exposed and worthy of ___? | intervention
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| 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
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| 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
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| 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
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| 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
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| 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
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| ___ should be done in children with BLL 10 mcg/dl or above? | enviromental evaluation
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| Child with BLL above 25 mcg/dl needs ____? | needs chelation therapy
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| 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
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| 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
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| 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
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| 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
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| 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
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| What are the 3 forms of Chelation Therapy? | Calcium EDTA IM or IV; Gritish antilewisite (BAL) IM; and Succimer (DMSA) Oral
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| 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)
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| British antilewisite (BAL) IM used with ___ and monitor ___ & ___? | British antilewisite (BAL) IM used with EDTA and monitor labs & ECG
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| 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
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| Adequate hydration is very important since ___ are excreted via kidneys? | Adequate hydration is very important since chelates are excreted via the kidneys
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| 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
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