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N218 Exam #3
This is a study guide for N218 Exam #3. The chapter is 49, Hematologic and Immunologic Dysfunction.
Terms in this set (82)
A reduction of RBCs or Hgb concentration to levels below normal for age; disorders are classified either by etiology and physiology or by morphology. Can be d/t a circulatory loss or destruction of cells as well as impaired number of RBC production.
The nurse's role in treatment of anemia is to...
Assist in establishing a diagnosis, prepare the child for laboratory tests, administer prescribed medications, decrease tissue oxygen needs, implement safety precautions, and observe for complications.
What is the main nursing goal in prevention of nutritional anemia?
The most common predisposition for iron deficiency anmeia is inadequate supply of dietary iron. Parents should be educated regarding correct feeding practices.
Sickle Cell Anemia (SCA)
A hereditary hemoglobinopathy caused by normal adult Hgb (HbA) being partly or completely replaced by sickle Hgb (HbS).
What does nursing care of the child with SCA focuse on?
Teaching the family how to prevent and recognize sickle cell problems; managing pain during crises; and helping the child and parents adjust to a lifelong chronic disease.
What does nursing care of the child with B-thalassemia (Cooley's Anemia) include?
Administration of blood transfusions. Observing for complications of multiple blood transfusions, assisting the child in coping with the effects of illness, and fostering parent-child adjustment to long-term illness.
What are the 3 processes that clotting depends on?
Vascular spasm, platelet aggregation, and coagulation and clot formation.
Nursing care of the child with hemophilia involves:
Involves preventing bleeding by decreasing the risk of injury, recognizing and managing bleeding with factor replacement, preventing the crippling effects of joint degeneration, and preparing and supporting the child and family for home care.
What are the goals in caring for the child with leukemia?
To prepare the family for diagnostic and therapeutic procedures, prevent complications of myelosuppression, manage problems of irradiation and drug toxicity, and provide continued emotional support.
The Lymphomas include:
Hodgkin's lymphoma and NHL and are disorders involving the lymphoid system.
What are the effects of immunodeficiency disorders?
Immunodeficiency disorders render the affected individual unable to fight infectious organisms.
In chldren, how is HIV acquired?
HIV infection is primarily acquired in infants during pregnancy or birth from an infected mother and in adolescents from engaging in high risk behaviors.
What do blood transusions supply?
Blood transfusions supply needed blood components.
What does HSCT do?
HSCT replaces the diseased or malfunctioning bone marrow with viable blood stem cells.
What is Apheresis?
The selective removal of a blood component. It can be used to supply cellular elements needed for therapy (i.e., platelets or stem cells) or to remove diseased components.
The single unit of Inheritance
Sickle Cell Trait
Heterozygous people who have hemoglobin containing HbA as well as abnormal HbS (sickle hemoglobin)
The process that stops bleeding when a blood system vessel is injured.
A condition in which the number of red blood cells and/or hemoglobin concentration is reduced below normal: oxygen-carring capacity of the blood is diminished; less oxygen is available to the tissues.
At birth the normal full-term newborn has maternal stores of iron sufficient to last how long?
The first 5 to 6 months of life.
Therepeutic management of sickle cell crisis generally includes:
Hydration for hemodilution through oral and IV therapy.
In controlling severe pain related to vasoocclusive sickle cell crisis, the plan of care will most likely use:
IV or Oral opoids
Treatment of the child with aplastic anemia will most likely include:
Bone Marrow Transplant
A 5-year-old with sickle cell anemia is admitted because of diminished RBC production triggered by a viral infection. The episode is characterized by distal ischemia and pain. What sickle cell crisis is this most likely to be?
Primary prophylaxis in hemophilia patients involves the infusion of factor VIII:
Regularly at home before the onset of joint damage.
A 5-year-old boy previously diagnosed with hemophilia A is being admitted with hemarthrosis. His plan of care is likely to include:
VII...Teaching him how to administer AHF to himself (I, II, V, VI)
The cancer that occurs with the most frequency in children.
Treatment of mouth ulcers in young children may include:
Children who develop moon face from short-term steroid therapy used to treat cancer may experience this:
Altered body image.
A method used to control the transmission of infection in the inmmunocompromised child during hospitalization.
In what age is the incidence of Hodgkin's disease increased?
Between the ages of 15 and 19
Reed-Sternberg cell is a...
Characteristic of Hodgkin's disease
Children infected with HIV who are receiving immunizations as recommended by the American Academy of Pediatrics may not respond to...
The measles-mumps-rubella vaccine
What is the diagnosis of severe combined immunodeficiency disease (SCID) is primarily based upon?
Susceptibility to infection
The most notable effect of Wiskott-Aldrich syndrome at birth is...
Idiopathic Thrombocytopenia Purpura
An acquired hemorrhagic disorder characterized by excessive destruction of platelets and a discoloration caused by petechiae beneath the skin with normal bone marrow.
Describe the best way to manage pain during a sickle cell crisis that will help avoid clock watching and undermedicating.
Analyze the drug and dosage and administer medication on a regular schedule. Suggest changes to prevent rather than treat pain after it occurs.
Emergency measures (with rationales) that are used when a child with hemophilia starts to bleed.
Apply pressure to area of bleeding for 10 to 15 minutes to allow for clot formation. Immobilize and elevate area above the level of the heart to decrease blood flow. Apply cold to promote vasoconstriction.
Interventions (with rationales) that the nurse should use to maintain skin integrity in a child with a diagnosis of leukemia.
Provide meticulous skin care, especially in the mouth and perianal regions because they are prone to ulceration. Change position frequently to stimulate circulation and relieve pressure. Encourage adequate calorie/protein intake to prevent negative nitrogen balance.
List the precautions necessary for parents of a 4-month-old infant with AIDS to use when coming into contact with the infant's body fluids.
Wear gloves and wash hands carefully; wear gowns, masks, and eye protection. Use needle precautions and precautions with trash and linen.
How would you explain the action of platelets to an 8-year-old child?
Tell them that platelets help your body stop bleeding by forming a clot (scab) over the hurt area.
What is an expected finding in someone who is taking an iron preparation?
Stools that are tarry green in color. There may also be staining of teeth so oral care is crucial.
Signs of chest syndrome:
A child with sickle cell anemia develops severe chest pain, fever, a cough, and dyspnea. Practioner/MD should be notified.
What is the most appropriate action for stopping an occasional episode of epistaxis (nose bleeding)?
Have the child sit up and lean forward.
What are the most common signs and symptoms of leukemia related to bone marrow involvement?
Petechiae, infection, fatigue
Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include:
Good hand washing.
Nursing considerations related to the administration of chemotherapeutic drugs include:
Many chemotherapeutic agents are vesicants that can cause severe cellular damage if drug infiltrates.
What is appropriate mouth care for a toddler with mucosal ulceration related to chemotherapy?
Mouthwashes with normal saline
A child with lymphoma is receiving extensive radiation therapy. The most common side effect of this treatment is:
What should you teach a parent about the administration of oral iron preparations?
The iron solution should be given through a straw and as far back in the mouth as possible so that it does not come inot contact with the teeth d/t staining. Child should brush teeth after oral iron. Ferrous sulfate is better absorbed and may be taken with vitamin C to promote absorption. Milk and antiacids MAY INHIBIT ABSORPTION.
Replenishes hemoglobin and depleted iron stores. Administer IV or deep IM in upper/outer quadrant of buttox only using z-track method to minimize staining and leaking out of muscle. rotate sites. Very expensive and painful. Watch for hypersensitivity, allergic reactions, or enlarged lymph nodes.
Sickle Cell Anemia
People who are homozygous with predominantly HbS (sickle hemoglobin). Primarily seen in blacks, 1 in 12 have it and 1 in 12 are carriers. Autosomal recessive disorder. If both parents have the trait, each offspring will have a 1 in 4 likelihood of having the disease. NEVER GIVE DEMEROL to a child with SCA because it can cause seizures.
Choice drugs in the treatment of pain r/t Sickle Cell Anemia include:
Oxycodone, methadone, morphine, and dilaudid.
Therapeutic treatment of SCA includes:
Agressive treatment of infections, possible prophylactic antibiotic for 2-5 months, blood transfusion, monitor reticulocyte count regularly to evaluate bone marrow function, administration of NS, O2, comfort measures, rest, and analgesics ATC or use PCA pump. Monitor for s/s of worsening anemia, shock and altered neurological function.
What is iron chalation therapy used for?
Removal of excessive iron d/t blood transfusions (iron overload in tissues).
Causes of acquired Aplastic Anemia include:
Primary cause is Fanconi Syndrome (congenital). Secondary causes include: Irradiation, drugs, industrial and household chemicals, infections, and infiltration and replacement of myeloid elements; however, most cases are idiopathic.
Also called neoplastic anemia. All formed elements of blood are simultaneously depressed (pancytopenia) as a result of bone marrow failure. Profound depression of RBC's but normal WBC's and platelets.
An X-linked trait expressed as a carrier in females and affected in males. When females inherit the trait from their father, they have a 50% chance of transmitting it to their sons.
Idiopathic Thrombocytopenic Purpura (ITP)
Excessive destruction of platelets with normal bone marrow. Most common bleeding disorder in children. Ages 2-5. Usually develops 1-3 weeks after a viral infection such as chicken pox, measles, or rubella. Can be acute and self-limiting or chronic.
Pathophysiology of Leukemia
Unrestricted proliferation of immature WBC's...Bone marrow infiltration crowds out stem cells that normally produce RBC's and paltelets...Anemia and thrombocytopenia occurs...WBC's that are produced are immature and incapable of fighting infection...Spleen, liver, and lymph nodes become infiltrated and enlarged...CNS is at risk for infection...Clinical manifestations are directly r/t areas of involvement such as bone pain from marrow proliferation...Prognosis is based on initial WBC and is more favorable if WBC is below 50,000 and also if diagnosed between the age of 2-20.
S/S of kids that present with Leukemia include:
Low grade fever...Pallor...Bruising and Petechiae...Bone pain (#1 symptom)...Unsteady gait...Constipation...Hematuria...Enlarged kidneys...Enlarged testicles...Anorexia
Types of bone marrow transplants
Autologous (patient's own bone marrow)...Syngeneic (bone marrow utilized from identical twin)...Allogeneic (bone marrow from another individual)
S/S of Hodgkin's Disease
Classification A--Asymptomatic with enlarged cervical or subcervical lymphatic tissue nonotender and firm...Classification B--Temp of greater than 38*C for 3 consecutive days, night sweats, unexplained weight loss of 10% or more over previous six months, cough, delayed sexual maturation, ABD. discomfort and anorexia.
Carry the oxygen you breath from your lungs to all parts of your body.
Help keep germs from causing infection
Small parts of cells that help make bleeding stop by forming a clot (scab) over the hurt area.
The liquid portion of blood, which has clotting factors that help make bleeding stop.
Increased RBC Loss
Pallor, Fatigue/headache, Muscle weakness, Cool skin, Tachycardia, Decreased peripheral pulses, Low blood pressure (late sign of shock)
Acute Blood Loss
Epistaxis, Hemophilia, Hypersplenism, ITP, DIC
Decreased RBC Production
Pallor, Tachycardia/Headache, Fatigue/Shortness of breath, Muscle weakness, Systolic heart murmur, Pica (eating clay, paper, paste)
Bone Marrow Failure
Aplastic anemia, Red cell aplasia, Malignancy, ALL/neuroblastoma, Infection (parvovirus, CMV)
Increased Red Blood Cell Destruction
Icteric sclera/pallor, Fatigue/headache, Tachycardia, Dark urine, Splenomegaly, Hepatomegaly, Frontal bossing
Number of RBCs/cu mm of blood. Reflects function of bone marrow. (4.5-5.5 million/cu mm)
Number of WBCs/cu mm. (4.5-13.5 X 1000 cells/cu mm)
Differential WBC Count
Inspection and quantification of WBC types present in peripheral blood. Values are expressed as percentages; to obtain absolute number of any type of WBC, multiply its respective percent by total number of WBCs.
Primary defense in bacterial infection; capable of phagocytizing and killing bacteria (54%-62%)
Immature neutrophils (3%-5%)
Named for their staining characteristics with eosin dye. Increased in allergic disorders, parasitic diseases, certain neoplasms, and other diseases. (1%-3%)
Named for their characteristic basophilic stippling. Contain histamine, heparin and serotonin; believed to cause increased blood flow to injured tissues while preventing excessive clotting. (0.075%)
Involved in development of antibody and delayed hypersensitivity (25%-33%)
Large phagocytic cells that are involved in early stage of inflammatory reaction (3%-7%)
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