Hematological Conditions
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| Iron Deficiency Anemia is a ____ anemia brought about primarily by ___ dietary intake for normal RBC formation? | show 🗑
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| What is the most common form of Anemia? | show 🗑
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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? | show 🗑
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| American Academy of Pediatrics Iron Deficiency Anemia Degree of Anemia defines mild anemia as hemoglobin ___ to ___ g/dL | show 🗑
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| American Academy of Pediatrics Iron Deficiency Anemia Degree of Anemia defines moderate anemia as hemoglobin ___ to ___ g/dL | show 🗑
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| show | 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? | show 🗑
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| Premature/Low birth weight risk factors for iron deficiency anemia? | show 🗑
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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 | show 🗑
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| What is Pica? | show 🗑
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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) | show 🗑
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| What are the adult risk factors for iron deficiency anemia? | show 🗑
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| show | 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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| show | 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 ___? | show 🗑
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| show | iron deficiency anemia
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| T/F After toddler yrs iron deficiency anemia is usually due to dietary? | show 🗑
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| Breast milk has a ___ concentration of iron; Bioavailability greater, and progressive decline in ___ content? | show 🗑
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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? | show 🗑
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| When do preterm infants get oral iron supplementation? | show 🗑
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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 ___? | show 🗑
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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? | show 🗑
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| What are some HIGH iron rich foods? | show 🗑
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| show | beans, peas, fortified cereals, dark green veggies, nuts
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| What are some foods that decrease iron absorption? | show 🗑
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| ___ is an iron suplament given PO? | show 🗑
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| show | Do not consume ferrous sulfate with milk, antacids, or tea
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| show | 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? | show 🗑
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| show | 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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| show | 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? | show 🗑
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| show | 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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| show | severe anemia
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| show | 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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| show | 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)? | show 🗑
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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? | show 🗑
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| What is the incidence of sickle cell anemia? | show 🗑
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| show | Disease is 1:400 to 1:500 live births; Trait 1 in 12
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| show | 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? | show 🗑
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| Sickle cell disease is frequently not apparent until after __ to ___ months of age because of the continuing presence of ____? | show 🗑
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| What are the 3 major types of sickle cell crisis? | show 🗑
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| show | 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? | show 🗑
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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 ___? | show 🗑
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| In a Aplastic crisis a ___ infection triggers it; RBC production ___ -->___ anemia; and it is usually self-limited? | show 🗑
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| show | 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? | show 🗑
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| show | 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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| show | Hydration and pain management
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| show | severe headache; slurred speech, unsteady walk
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| show | 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? | show 🗑
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| show | True
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| show | 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 ____? | show 🗑
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| show | Opioids parenterallyPCA or Continuous infusion pumps
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| What drugs do you wnat to use for Moderate pain in sickle cell pts? | show 🗑
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| show | acetaminophen and ibuprofen
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| show | observe for pain every 2-4 hrs. Ask about location of pain, intensity, duration, and character (pounding)
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| show | False use a pain intensity rating tool it monitor effetiveness of pain management
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| show | 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? | show 🗑
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| show | 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? | show 🗑
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| show | 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? | show 🗑
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| show | 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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| show | Teach them to allow child to drink fluids during class and to permit frequent use of bathroom
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| show | 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? | show 🗑
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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? | show 🗑
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| T/F Administering oxygen in a child with hypoxemia and sickle cell anemia will reverse the sickling? | show 🗑
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| show | 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? | show 🗑
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| T/F Erythropoietin is given to sickle cell anemia pts? | show 🗑
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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? | show 🗑
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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? | show 🗑
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| What is the most common hereditary bleeding disorders? | show 🗑
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| show | 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? | show 🗑
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| show | Hemophilia ADeficiency of factor VIIIX-linked recessive
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| hemophilia B is a deficiency of factor ___ and is ___ linked recessive? | show 🗑
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| show | Deficiency of vonWillebrand's protein; Autosomal dominant
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| show | 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 | show 🗑
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| show | False there is a potential for bleeding anywhere in the body
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| What are the clinical manifestations of Hereditary bleeding disorders? | show 🗑
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| show | 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? | show 🗑
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| What are the nursing interventions for hereditary bleeding disorders? | show 🗑
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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? | show 🗑
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| show | 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? | show 🗑
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| show | 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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| show | Rest-immobilize for comfort and to prevent further bleeding
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| show | ICE-apply cold to promote vasoconstriction
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| show | 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? | show 🗑
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| show | 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? | show 🗑
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| What are signs of major bleeding? | show 🗑
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| show | soft toothbrush, no rectal temp, activity restrictions, environmental safety
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| show | 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 _____? | show 🗑
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| Idiopathic Thrombocytopenic Purpura (ITP) is a _____ hemorrhagic disorder? | show 🗑
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| show | 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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| show | 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? | show 🗑
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| Chronic form of ITP is most common in older ___ and women between __ & ___ years old? | show 🗑
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| What are teh clinical manifestations of ITP? | show 🗑
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| show | 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 ____? | show 🗑
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| show | prolonged bleeding from trauma or injury
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| If platelets are <20,000 it can cause ____? | show 🗑
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| What are the nursing interventions of ITP? | show 🗑
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| What 4 medications are given in ITP patients? | show 🗑
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| show | 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? | show 🗑
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| ___ is an expensive medication that blocks ____ that results in ___ of platelets? | show 🗑
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| show | Anti-D Antibody (WinRhoD) lessens phagocytosis of platelets
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| show | lessens antibody production
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| show | ITP prognosis is usually self-limited and has indications of splenectomy
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| show | 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? | show 🗑
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| show | Hematopoietic --> anemia
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| show | Neurologic-> mental retardation, seizures, coma, and death
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| Waht are the renal effects of lead? | show 🗑
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| What does BLL stand for? | show 🗑
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| Lead poisoning is defined as BLL ___ or greather than ____? | show 🗑
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| show | 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? | show 🗑
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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 ____? | show 🗑
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| show | 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 ____? | show 🗑
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| Red Flags of Lead poisioning: Foreign body ____, ___ seizures, neurological symptoms, ___ pain, Growth ___, Developmental ___ or hyperactivity? | show 🗑
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| show | enviromental evaluation
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| show | needs chelation therapy
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| show | True
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| show | 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? | show 🗑
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| show | False Utilize only COLD water for drinking, cooking, formula preparation and avoid ceramic ware and lead crystal for food storage
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| show | 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? | show 🗑
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| show | 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 ___ & ___? | show 🗑
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| show | 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? | show 🗑
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| Prognosis of lead poisoning is variable and the major problems relate to ____? | show 🗑
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