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Peds Chap. 20, week 8 ppt. , quiz 2

Terms in this set (75)

Hematology
- Study of blood and blood-forming tissues
- Blood composed of plasma and blood cells
- Ability to deliver oxygen and other nutrients
- Regulation of fluids, electrolytes, and acid-bases
- Protection of body through clotting, infection control
Hematopoiseis
process in which blood cells are produced in the bone marrow
Plasma
Clear, fluid portion of circulating blood
Reticulocytes
immature red blood cells in bone marrow
Erythrocytes
red blood cells RBCs
Erythropoiesis
formation or production of red blood cells
Hemolysis
destruction or dissolution of red blood cells, with subsequent release of hemoglobin
Leukocytes
white blood cells WBCs
Thrombocytes
- Also known as platelet
- assists the body's clotting mechanism
Most similar IV fluid to blood
LR
Commonly used on someone healthy
% of Plasma in Blood
55%
% of WBCs and platelets in Blood
1%
% of RBCs in blood
45%
Reasoning for any bleeding disorder
Not enough clotting factors or not enough platelets
The Lympthatic System
- Transports and filters lymph and fluids
- Carries away debris from destroyed bacteria
- Infection causes swelling of lymph nodes
- Consists of lymph, lymph capillaries, ducts, nodes
- Lymph contains leukocytes
History Assesment of Hematologic and Lymphatic Systems
- Complaints of weakness, fatigue
- Recent illness, infection, fever
- Exposure to illness or infection
- Bleeding or bruising, weight loss or gain
- Family history of cancer, anemia, lymph disorders
Physical Assessment of the Hematologic and Lymphatic Systems
Observe for bruising
- not location, size, color
Palpate lymph nodes
- Note size, mobility, consistency, tenderness, temperature
- Soft, firm, tender, warm?

*** Will easily bruise, big ugly bruising
Hemophilia
- Bleeding into soft tissue and joints
- Prolonged bleeding with invasive procedures
- Joint pain, tenderness
- Bruising, nosebleeds, hematuria
** Severe bleeding in the knees and elbows, hips, thighs, calves, deltoid forearm.
Hematuria
blood in the urine
Rare X-linked recessive disorder
Hemophilia
(chromosomal, hereidtary)
Diagnosing of Hemophilia
- History, physical exam
- Decreased factor VIII or IX
- Prolonged activated partial thromboplastin time (PTT)
* Prolonged clotting time
Treatment of Hemophilia
- Administer transfusion of clotting factors
- Administer desmopressin acetate or DDAVP
- Administer aminocaproic acid to stop bleeding
Nursing Interventions for Hemophilia
- Prevent bleeding
* Apply pressure to bleeding area
* Elevate the site, apply ice to wound
* Monitor vital signs
* Start intravenous access to administer clotting factors
- Teach safety measures to prevent injury
- Teach to avoid medicatoins that alter clotting
- Teach to wear medic-alert bracelet
- Avoid rectal temperatures, rectal suppositories
- Avoid unnecessary invasive procedures
Things Child Should Not do With Hemophilia
NO ASPIRIN
NO PLAYING SPORTS
Should wear med-alert bracelet
Abnormal vital signs you may notice with hemophilia
Tachycardia
Low blood pressure
all due to bleeding
Petchiae
Little dots of bleeding under the skin (red freckles)
Purpura
redness
ecchymosis
bruising
Idiopathic Thrombocytopenic Purpura (ITP)
- Purpura, petechiae, hematuria, blood in stool
- Nosebleeds, ecchymosis
- Recent viral infection
- May have spontaneous remission
Diagnosing Idiopathic Thrombocytopenic Purpura (ITP)
- History, phsyical finding
- Decreased platelets
- Presence of antinuclear antibodies
- Positive direct Coombs' test
Treatment of Idiopathic Thrombocytopenic Purpura (ITP)
- Corticosteroid therapy
- Intravenous immuneglobulin
- Transfuse platelets if hemorrhagig
- Perferm splenectomy
Nursing Interventions for Idiopathic Thrombycytopenic Purpura (ITP)
- Control bleeding
- Teach measures to decrease risk of bleeding
- Teach signs and symptoms of occult bleeding
Occult bleeding
hidden bleeding
we don't know where it is
Tachycardia and Low blood pressure may be present
Black Tarry stool
Iron Deficiency Anemia
- Pale, tired, irritable
- Tachycarida, muscle weakness, systolic heart murmur
- Growth retardation, mentally delayed
- Deformed nail beds
Diagnosing Iron Deficiency Anemia
- History, physical examination
- Decreased hemoglobin, hematocrit, reticulocyte count
- Decreased serum ferritin
- Increased RBC count
Treatment for Iron Deficiency Anemia
- Oral supplemental iron preparations
- Arrange dietary counseling for iron intake
- Reevaluate laboratory studies in 2 months
- Decrease iron and reevaluate in 6 months
Nursing Interventions for Iron Deficiency Anemia
- Teach parents high-iron diet
- Feed infants formula containing iron
- Administer liquid iron preparations
* Dilute and give through straw
* Avoid constipation, overdose
Food high in iron
Meat
Liver
Green Leafy Veggies
Helps absorption of Iron
Grapefruit Juice
Vitamin C
How do we give iron to children?
Liquid form
Diluted
Through a straw or dropper to prevent staining their teeth
Sickle Cell Anemia
- Hereidtary disorder affecting the formation of hemoglobin
- Infant asymptomatic until 3-4 months
- Severe pain localized to vaso-occlusion area
- Discoloration of skin, pallor, coolness
- Nausea, fever, swelling, and painful joints
- Vomiting, anorexia, diarrhea
- Hereditary recessive trait often effects African Americans
- RBCs are S or C shaped (crescent shaped)
- RBCs have trouble moving through the capillaries
- Symptoms usually start around 4-6 months
Pica Cravings
Symptom of Anemia
Crave dirt, glue, hair, ice, clay
3 Different Types of Anemia
Sickle Cell
Iron Deficiency
Thalassemia
Symptoms for Iron Overdose
- Abdominal pain
- vomiting
- Blood diarrhea
- Shortness of breath
- Shock
Diagnosing Sickle Cell Anemia
- Hemoglobin electrophoresis for infants
- Sickledex test over 6 months
- If positive Sickledex, do hemoglobin electrophoresis
- Decreased hemoglobin
- Increased reticulocyte count
Lifespan of Sickled RBC
10-20 days
Lifespan of Normal RBC
120 days
Treatment for Sickle Cell Anemia
- Blood transfusion, clotting factors, albumin
- Parenteral analgesics
- intravenous fluids
- oxygen therapy
- prophylactic antibiotics
Risk Factor for putting someone into a sickel cell crisis
DEHYDRATION
Reasoning for adminstering oxygen for Sickle Cell Anemia
Their blood count is low so their oxygen carrying abilities are lower.
Nursing Interventions for Sickle Cell Anemia
- Observe for pallor, fatigue, lethargy, irritability
- Encourage diet high in calories, protein, fluids
- Prevent infection, hand washing, avoid infected people
- Administer immunizations, prophylactic antibiotics.
- Administer blood products, watch for reaction
- Administer pharmacologic and non pharmocologic pain relief
- Ensure compliance with preventative measures
- Help child family with coping measures
- Refer to support groups
Nonpharmacologic techniques
relaxation techniques
massage
heat or cold
3 different types of sickle cell crisis
Vaso- Occlusive (Thrombotic) Crisis
Splenic Sequestration
Aplastic Crisis
Vaso-Occlusive Crisis
- Most common; painful
- Caused by stasis of blood with clumping of cells in the microcirculation, ischemia, and infarction.
- Signs include fever, pain, and tissue engorgement
Splenic Sequestration Crisis
- Life-threatening crisis; death can occur within hours
- Caused by pooling of blood in the spleen
- Signs include profound anemia, hypovolemia, and shock
Aplastic Crisis
- Diminished production and increased destruction of red blood cells
- Triggered by viral infection or depletion of folic acid
- Signs include profound anemia and pallor
Thalassemia
- Inherited disorder caused by abnormal hemoglobin synthesis
- Blood transfusions every 2-4 weeks
- Watch for iron overload or toxicity
- If enlarged spleen have removed
- Prevent infection, conserve energy, keep hydrated, parent-child teaching
Hodgkin's Lymphoma
- Nontender, firm, enlarged lymph nodes
- Fever, night sweats, weight loss
- Respiratory distress from mediastinal lymph nodes
Location of Mediastinal Lymph Nodes
Sternum area
What areas are effected with Hodgkin's Disease in Children?
Lymph nodes
Organs
Diagnosing Hodgkin's Lymphoma
- Family history Hodgekin's disease
- Elevated erythrocyte sedimentation rate, leuocyte counts
- Lymph node biopsy, staging laparotomy
- CT or MRI scans, lymphangiogram
- Blood counts, bone marrow biopsy
Treatment for Hodgkin's Lymphoma
- Four or Five antineoplastic agents
- Observe for side effects of antineoplastic agents
- Low-dose radiation
(antineoplastic = chemotherapy)
Side Effects of Antineoplastic Agents
- Fatigue
- Alopecia
- Immuno Suppressed
Nursing Interventions for Hodgkin's Lymphoma
- Give psychosocial support
- Teach to avoid exposure to infection
- Assist RN to adminster intravenous antineoplastic agents
- Assess for signs of inection, open lesions
- Teach caretaker to prevent contamination of body fluids
Most Common Leukemia of Children
Acute Lymphoblastic Leukemia (ALL)
Highest in Caucasion boys 3-4 yrs. old
Acute Myelogenous Leukemia (AML)
- Infections, especially chronic respiratory problems
- Signs of anemia
- Bleeding gums, bruising
Leukemia is classified by
how quickly it progresses
Acute Leukemia
fast-growing and can overrun the body within a few weeks or months
Chronic Leukemia
Slow-growing and progressively worsens over years
Common Symptoms of Leukemia
- Recurrent infections, especially upper respiratory infections
- Bleeding gums
- Bruising
- Fatigue
- Signs of Anemia
Diagnosing Leukemia
- Elevated leukocytes
- Abnormal lymphoblasts in bone marrow aspirate
- Decreased red blood cell count
- Decreased platelet count
Acute Lymphoblastic Leukemia (ALL)
- Overproduction of immature lymphocytes
- Most common childhood cancer
Acute Myelogenous Leukemia (AML)
- Cancer cells develop in the bone marrow
-Cancer cells replace bone marrow
- Left untreated life expectancy of a child is several weeks to 6 months
Treatment for Leukemia
- Administer antiobiotics, blood replacement, chemotherapy, radiation
- Perform bone marrow transplant
- Maintain sterile environment after transplant
Nursing Interventions for Leukemia
- Assessment of bruising, bleeding, fever, infection
- Monitor specific gravity, intake and output
- Obtain daily weight
- Monitor nausea, vomiting, constipation, mouth sores
- Assess nutrition status, fluid balance
- Assist with side effects of medications
- Assure rest periods safe, activities
- Provide support and teaching
- Organize interdisciplinary resources
- Refer to support groups
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