ATI chapter 21 hematologic disorders pediatrics

Short, isolated occurrences are common. Another word for nose bleed.

Risk factors for epistaxis
Trauma such as picking or rubbing nose
low humidity
allergic rhinitis
upper respiratory infection
blunt injury or foreign body
may be the result of an underlying disease

What underline diseases can occur with epistaxis
Von Willebrand disease
idiopathic thrombocytopenia purpura

Assessment findings of epistaxis
Active bleeding from nose
restlessness and agitation

Nursing care for epistaxis
Maintain calm demeanor
have child sit up with head tilted slightly forward
apply pressure to lower nose with thumb and forefinger for at least 10 minutes
if needed cotton or tissue can be packed inside the nose
encourage the child to breathe through their mouth
put ice across the bridge
water soluble jelly or petroleum can be inserted after a nosebleed

Complications of epistaxis
Hemorrhage and instruct child and family to seek medical care if bleeding last longer than 30 minutes and that repeated episodes require for evaluation for bleeding disorders

The most common anemia in the United States
Iron deficiency anemia

Why are children at risk for iron deficiency anemia
Children’s age 12-36 months are at risk due to consuming a diet high cow milk without adequate intake of foods with high iron
adolescents are at risk due to poor diet, menses, and obesity

Risk factors for iron deficiency anemia
Premature birth resulting in decreased iron stores excessive intake of cow’s milk
poor dietary intake of iron
increase iron requirements chronic disorders

Subjective and objective data of iron deficiency anemia
Shortness of breath
brittle, spoon-shaped fingernails
irritability, and muscle weakness
systolic heart murmur,
enlarge heart, and/or heart failure

Expected reference range of hemoglobin and hematocrit for 2 months
Haemoglobin 9.0 – 14.0 haematocrit 28% to 42%

Expected range of hemoglobin and hematocrit 4/6 – 12 years
Haemoglobin 11.5 – 15.5 hematacrit 35% to 45%

Expected range of hemoglobin and hematocrit for ages 12 to 18 years
Male hemoglobin 13.02 16.0 male haematocrit 37% to 49%
female hemoglobin 12.0 – 16.0 female hematacrit 36% to 46%

Nursing considerations for iron supplements
Give one hour before or 2 hours after milk or an acid to prevent the increase absorption
GI upset is common
if tolerated administer iron supplements on an empty stomach
vitamin C to increase absorption
use a straw with liquid preparation to prevent staining of teeth
use z track method into deep muscle for parenteral injections

Complications of iron deficiency anemia
Heart failure
developmental delay

Nursing actions for heart failure due to iron deficiency anemia
Treat anemia
monitor cardiac rhythm
give cardiac medications as prescribed

Nursing actions for developmental delayed due to iron deficiency anemia
Assess level of functioning
improving nurtitional intake
refer to the appropriate Developmental Services

A group of diseases which abnormal sickle hemoglobins replaces normal adult hemoglobin
Sickle cell disease

If a homozygous and most common form of sickle cell disease
Sickle cell anemia

Manifestations of sickle cell anemia
Not apparent until later infancy
tissue hypoxia which causes tissue ischemia which results in pain.
Increase description of red blood cells.
Sickle cell crisis with exacerbation of sickle cell anemia

Subjective and objective data of sickle cell anemia
Family history reports of pain
shortness of breath
pallor/pale mucous membranes
hands and feet cool to touch

Acute vaso-occlusive crisis
Severe pain usually in bones, joints, and abdomen swollen joint, hands, and feet
vomiting, and fever
obstructive jaundice
visual disturbances usually last four to six days

Chronic vaso-occlusive crisis
Increase risk of respiratory infections and osteomyelitis retinal detachment and blindness
systolic murmur
renal failure and enuresis
liver cirrhosis hepatomegaly
skeletal deformities
shoulder or hip avascular necrosis

This is excessive pulling a blood primarily in the spleen and sometimes in the liver. Reduced circulating blood volume results in hypovolemia and progressed to shock.

Signs and symptoms of hypovolemic shock
pallor, decrease urinary output,
cool extremities,
thready pulse,

Extreme anemia as a result of decreased red blood cell production. Typically triggered by an infection.

Increased rate of red blood cell destruction leading to anemia, jaundice, and/or reticulocytosis
Hyper hemolytic

Lab results for sickle cell crisis
Hemoglobin is decreased
white blood cell count is elevated
bilirubin and reticulocyte levels are elevated
peripheral blood smear reveals sickle cell

Used to assess intracranial vascular flow and detect the rest for cerebral vascular accident performed annually on children ages 2 to 16 years to have this disease
Transcranial Doppler test used for people with sickle cell disease

Nursing care sickle cell disease
Promote rest
administer oxygen
maintain fluid and electrolyte balance
pain management
administer blood products
treat and prevent infection
monitor and report lab results

Codeine morphine sulfate oxycodone hydrocodone and methadone provide analgesia for pain management administered orally or IV administer on a regular schedule use patient-controlled if appropriate
Opioids used for sickle cell

Complications for sickle cell anemia
acute chest syndrome

Manifestations of CVA
abnormal behavior
weakness of or inability to move extremity
slurred speech
visible changes
severe headache

manifestations of acute chest
Life-threatening report:
chest back or abdominal pain
fever of 101.3 or higher
decreased oxygen saturations

A group of disorder is characterized by difficulty to control bleeding

Deficiency of factor 8 referred to as classic hemophilia accounts for 80% of cases
Hemophilia A

Deficiency of factor 9 referred to as Christmas disease
Hemophilia B

Physical assessment findings of hemophilia
Active bleeding which includes bleeding gums epitaxis hematuria or tarry stools
hematomas or bruising even with minor injuries human arthrosis is evidenced by joint pain stiffness warm swelling redness
loss of range of motion and deformities
slurred speech and decreased level of consciousness

Nursing management for hemophilia in the hospital
Avoid taking temperature rectally
avoid unnecessary skin punctures
apply pressure for five minutes after injections
monitor urine stool and nasal gastric fluid for occult blood control
localize bleeding

A synthetic form of vasopressin that increases plasma factor 8

Effective for mild but not severe haemophilia not effective for hemophilia B can be given prior to dental or surgical procedures

Factor 8
Used to prevent and treat hemorrhage administer by IV infusion instruct the child and family that treatment can require numerous doses periodic administration has proven effective

Used to treat hematuria, acute hepatitis of Hema arthrosis, and chronic synovitis

Used to treat chronic synovitis monitor for infection administer cautiously due to potential inhibition of platelet function

Complications of haemophilia
Uncontrolled bleeding
joint deformity

Nursing actions for uncontrolled bleeding
Monitor vital signs
take measures to control administer appropriate Factor
administer blood transfusion
conduct and nuero assessment
provide prophylaxis treatment

Nursing actions for joint deformity
Take appropriate measures to rest immobilized elevate and apply ice
encouraged active range of motion and encourage maintenance of ideal weight and encourage maintenance of regular exercise

A nurse is providing teaching about the management of epitaxis to a child in his family. Which of the following positions should the nurse instruct the child to take when experiencing a nosebleed?
Sit up and lean forward

A nurse is providing teaching about epitaxis 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?
A. press nares together at least 10 min
B. breather though nose until bleeding stops
C. pack cotton or tissue into nares
D. apply warm cloth
E. insert petroleum into nares after bleeding stops

A nurse is providing teaching to the parent of a child with 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 ER if stools become dark
B. my child should avoid eating citrus fruits while taking supplements
C. i should give iron with milk to help prevent upset stomach
D. my child should take supplements through a straw
My child should take the supplements through a straw

A nurse is preparing to administer iron dextran I am to school age child who has iron deficiency anemia. Which of the following actions by the nurse is appropriate?
A. administer in deltoid
B. use z track method
C. avoid injecting more than 2mL each does
D. massage injection site for 1 min administering the dose
Use the z-track method when administering the dose

A nurse is caring for an infant who screening test reveals that he may have sickle cell disease. Which of the following tests should be performed to distinguish if infant has the trait for the disease?
Hemoglobin electrophoresis

Sickle Cell Anemia Vaso-occlusive Crisis (painful episode) Usually lasts 4 to 6 days Acute, Severe pain, usually in bones, joints, and abdomen, Swollen joints, hands, and feet, Anorexia, vomiting, and fever, Hematuria, Obstructive jaundice Visual disturbances Sickle Cell Anemia Sequestration …

The nurse is caring for a patient with anemia. Which blood component is deficient in this patient? a. plasma b. platelets c. red blood cells d. white blood cells C red blood cells A patient is diagnosed with anemia and …

Normal RBC range female = 4.2-5.4 Normal RBC range male = 4.7-6.1 WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample ↓ level of RBCs = anemia Normal WBC range …

* Lily, a 4-year-old Caucasian female, has she been complaining of being tired all the time. She is pale and is a picky eater. Her mother is a single mom with a small budget to feed a large family. Lily …

The parents of a 7-month-old girl with a sickle cell crisis ask why the nurses keep giving their daughter pain medication so often. Which response best explains the rationale for the nurses’ action? “We are trying to control her pain …

A patient has been diagnosed with thrombocytopenia. What teaching point should the nurse include in the patient’s plan of care? 1.The patient should be instructed to avoid crowds. 2.The patient should be instructed to alternate periods of activity with periods …

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