ATI Ch.21 Hematologic Disorders
Terms in this set (38)
A nurse is providing teaching about the management of epistaxis to a child and his family. Which of the following positions should the nurse instruct the child to take when experiencing a nosebleed?
A. Sit up and lean forward.
B. Sit up and tilt the head up.
C. Lie in a supine position.
D. Lie in a prone position.
A. CORRECT: The nurse should instruct the child to sit up and lean to prevent aspiration when experiencing a nosebleed.
A nurse is providing teaching about epistaxis to the parent of a school‑age child. Which of the following should the nurse include as an appropriate action to take when managing an episode of epistaxis? (Select all that apply.)
A. Press the nares together for at least 10 min.
B. Breathe through the nose until bleeding stops.
C. Pack cotton or tissue into the naris that is bleeding.
D. Apply a warm cloth across the bridge of the nose.
E. Insert petroleum into the naris after the bleeding stops.
A. CORRECT: Pressing the nares together for at least 10 min is an appropriate action to take when managing an episode of epistaxis.
C. CORRECT: Packing cotton or tissue into the naris that is bleeding is an appropriate action when managing an episode of epistaxis.
A nurse is providing teaching to the parent of a child who has a new prescription for liquid oral iron supplements. Which of the following statements by the parent indicates an understanding of the teaching?
A. "I should take my child to the emergency department if his stools become dark."
B. "My child should avoid eating citrus fruits while taking the supplements."
C. "I should give the iron with milk to help prevent an upset stomach."
D. "My child should take the supplement through a straw."
D. CORRECT: The child should take the supplement through a straw to prevent or minimize staining of the teeth.
A nurse is preparing to administer iron dextran IM to a school‑age child who has iron deficiency anemia.
Which of the following actions by the nurse is appropriate?
A. Administer the dose in the deltoid muscle.
B. Use the Z‑track method when administering the dose.
C. Avoid injecting more than 2 mL with each dose.
D. Massage the injection site for 1 min after administering the dose.
B. CORRECT: The nurse should use the Z‑track
method when administering the dose.
A nurse is caring for an infant whose screening test reveals that he might have sickle cell disease. Which of the following tests should be performed to distinguish if the infant has the trait or the disease?
A. Sickle solubility test
B. Hemoglobin electrophoresis
C. Complete blood count
D. Transcranial Doppler
B. CORRECT: The hemoglobin electrophoresis test should be performed to distinguish if the infant has the trait or the disease
Iron deficiency anemia
-most common type of anemia in US
-adolescents at risk bc poor diet, rapid growth, menses, strenuous activity and obesity
-will cause low hemoglobin levels (need iron to make Hgb)
Risk factors for Iron deficiency anemia
excessive intake of cow's milk in toddlers
Clinical manifestations for Iron deficiency anemia
brittle spoon shaped nails
systolic heart murmur
Laboratory tests for Iron deficiency anemia
Reticulocyte counts: decreased
Total iron binding capacity: elevated
Nursing considerations for Iron deficiency anemia
-iron fortified formula/cereals
-Diet high in iron and vit C
-might need PRBC
Nursing considerations when giving iron supplements
-give 1 hr before or 2 hr after milk or antacid
-GI upset is a common side effect: N/V/D
-If constipation then increase fiber and fluids
-Try to give on an empty stomach
-Give with vit C
-Use straw if liquid bc stain teeth and brush teeth after PO supp
-Z track method for IM
-Stools will be tarry green
What are examples of iron rich foods?
dried beans and lentils, peanut butter, green leafy vegetables, iron fortified breads and flour, poultry and red meat
Sickle cell anemia (SCA)
most common form of sickle cell disease
RBC sickling leads to increase blood viscosity, obstructs blood flow and cause tissue hypoxia thus ischemia.
-primarily affects AA
Sickle cell disease (SCD)
is a group of diseases in which abnormal sickle Hgb S replaces normal adult Hgb A
Autosomal recessive genetic disorder
Sickle cell crisis
exacerbation of sickle cell anemia
What are the clinical manifestations of sickle cell anemia?
Reports of pain
Pallor, pale mucous membranes
Dizziness and headache
What are the clinical manifestations of a vaso-occlusive crisis?
lasts 4-6 days
ACUTE: severe pain, swollen joints, abd pain, hematuria, jaundice and visual disturbances
CHRONIC: risk for respiratory infections and osteomyelitis, retinal detachment, blindness, murmurs, renal failure, hepatomegaly, seizures
What is sequestration?
excessive pooling of blood (splenomegaly or hepatomegaly) leading to hypovolemia
S/S of hypovolemic shock
irritability, tachycardia, pallor, dec UO, tachypnea, cool extremities, thready pulse and HypoTn
extreme anemia bc decreased RBC production triggered by viral infection
increase rate of RBC destruction leading to anemia, jaundice, retinulocytosis
screening tool to detect the presence of HbS but will not differentiate the trait from the disease
separates the various forms of Hgb and is the definitive diagnosis of sickle cell anemia
What are the expected lab values during a sickle cell crisis?
Bilirubin and reticulocyte levels elevated
Peripheral blood smear shows sickled cells
How is sickle cell anemia diagnosed?
Transcranial doppler (TCD) test
Nursing considerations for sickle cell anemia
-Rest to decrease O2 consumption
-Tx infection: oral prophylactic penicillin, PCV, MCV, HIB
Nursing considerations for pain mgt for sickle cell disease
Acetaminophen or Ibuprofen
Opioid analgesics: PCA
Warm packs for joints
Complications with sickle cell disease
CVA: monthly blood transfusions can prevent repeat CVA
Acute chest syndrome can be life threatening
What is Hemophilia?
is a group of bleeding disorders characterized by difficulty controlling bleeding bc lack of clotting factor
X linked recessive disorder
deficiency of factor VIII
most common 80% of cases
deficiency of factor IX
also called Christmas disease
Clinical manifestations for hemophilia
episodes of excessive bleeding, joint pain and stiffness, impaired mobility and easily bruised
(epistaxis, hematuria, tarry stools, hematomas, hemarthrosis)
Decreased LOC, headache, slurred speech
What are expected lab findings for hemophilia?
deficiency of specific factor
platelets and PT and INR are in expected range
How is hemophilia diagnosed?
What are nursing considerations for hemophilia patient?
-Subcut injections are preferred route or no skin puncture
-monitor for occult blood
-NO aspirin, instead Acetaminophen
-Control bleeding with factor replacement, RICE
What medications are used for Hemophilia?
1-deamino-8-d-arginine vasopressin (DDAVP): increases plasma factor VIII
Factor VIII by IV infusion to prevent and tx hemorrhage
Corticosteroids: to tx hematuria, episodes fo hemarthrosis and chronic synovitis
NSAIDs: for chronic synovitis but monitor for platelet inhibition
Client education for Hemophilia patients
-prevent bleeding with a safe home and play area
-low contact sports are ok
-wear protective equipment
-soft bristle tooth brushes
-regular exercise and PT
Complications for Hemophilia patients
Uncontrolled bleeding: intracranial hemorrhage, aspirating blood
Joint deformity at major joints from repeated episodes of hemarthrosis so make sure to rest, use RICE, encourage ROM, and keep a healthy weight
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