heamatology

Question 1

platelets: >100,000 - normal

Answer 1

no contact sports, protective equip

Question 2

platelets: 50 - 100,000

Answer 2

padding, protective

Question 3

platelets: <50,000

Answer 3

quiet activities, extreme caution

Question 4

platelets: >20,000

Answer 4

return to school

Question 5

ANC calculation

Answer 5

% segs + % bands x wbc
>1000 is ok
< 500 = severe risk of infection

Question 6

neutropenia nc

Answer 6

anc < 1000
VS (temp >100 = emergency), HH, inspect skin and mouth, no flower or plants, decrease bacteria in food (right temp, no skins, no pepper), changes dressings and lines with sterile technique, no live vaccines, avoid contact with ill, wear mask outside room

Question 7

anemia cm

Answer 7

anorexia, pallor, skin breakdown, jaundice, tachy x2, altered neuro or behavior change, weak or low exercise tolerance, gum hypertrophy, smooth tongue, blood in urine or stool, infection, cold intolerance

Question 8

anemia tm

Answer 8

treat cause (transfusion, nutrition)
supportive: IV fluids, O2, bed rest

Question 9

anemia nc

Answer 9

prep for lab test, decrease O2 demands, dafety, HH and oral care, body temp, prevent complications, support fam

Question 10

anemia Fe deficiency cm

Answer 10

irritable, anorexia, pallor, mild growth retardation, exercise intol, infection, cognitive delay and behavior challenge

Question 11

anemia Fe deficiency tm

Answer 11

prevent: breast milk or formula till 12 mo, but dont fill up on milk
supplement: 6 mo, cereal, formula
blood transfuions

Question 12

anemia Fe deficiency nc

Answer 12

assess, cause, anemia NC, Fe rich foods, supplement, parenteral, Fe safety, follow up

Question 13

anemia Fe deficiency nc - oral Fe

Answer 13

acidic env (orange juice), with straw, rinse after, measure accurately, increase fluids and fiber, avoid antacid, coffee, tea, dairy, egg, whole grain 1 hr before and 2hrs after
SE: n, gastric irritation, cd, anorexic, teeth stain, tarry stool, OD lethal - lock up flinstones vits

Question 14

sickle cell cm

Answer 14

asymptomatic till 6 mo (hgbF)
viscous blood, hgbS less soluble, leads to micro obstructions and engorgement, delayed g+d, tissue ischemia, hard time crossing capillary bed

Question 15

sickle cell complications

Answer 15

acute painful episodes, cva (yearly head scan), sepsis, acute chest syndrome (pna like), decreased vision, chronic leg ulcers, delayed g+d and puberty, priaprism, enuresis (dilute)

Question 16

sickle cell complications - acute painful episodes

Answer 16

vary in severity and frequency
rf: increased O2 need, trauma, infection, fever, stress, dehyd (viscous), hypoxia (altitude, hypothermia)
vasoocclusive thrombotic
splenic sequestration
aplastic crisis

Question 17

vasooclusive thrombotic

Answer 17

no clot - no heparin
stasis and clumping of cells = ischemia = infarction
s: fever, pain, tissue engorge
heat good, manage pain (higher tolerance)

Question 18

splenic sequestration

Answer 18

life threatening
blood pools in spleen (rupture)
s: anemia, hypovolemia, shock, palpable spleen
tm: spleen usually removed, scar, non functioning, fibrosis

Question 19

aplastic crisis

Answer 19

decreased production and increased destruction of rbc, triggered by viral infection or depletion of follic acid
s: anemia, pallor

Question 20

sickle cell complications - acute chest syndrome

Answer 20

pna like
VOC or infection causes sickling in lungs, chest
s: chest, pain, fever, cough, tachypnea, wheeze, hypoxia
repeated episodes can lead to pulmonary htn
tm: manage pain, abx, ventillation, transfusion

Question 21

sickle cell tm

Answer 21

palliative: erythropoietin or hydroxyuria to increase hbgF, penicillin prophylaxis daily, doppler transcranial annually, spleen out, manage crisis (hydrate), hyper transfusion (excess Fe), bone marrow transfusion

Question 22

sickle cell crisis management

Answer 22

hydration - will decrease pain
oxygenation - rest and remove restrictive clothes
atc pain management - chronic, morphine, tolerance
support - temp, fearful, anx, chronic

Question 23

beta thalassemia cm

Answer 23

disorder of hemoglobin synthesis
cm: pallor, ftt, hepatosplenomegaly, severe anemia
cm beta major: anemia severe, bronze skin, decreased growth, delayed puberty, cardiac enlargement with flow murmur leading to HF, bone pain and deformities (frontal bossing), death (HF or Fe overload)
chronic hypoxia: HA, irritable, precordial and bone pain, exercise intol, anorexia, epistasis

Question 24

beta thalassemia tm

Answer 24

diagnose with hgb electrophoresis
blood transfution frequent - Fe build up (hemosiderosis - treat with Fe cheleating multiple times/week and oral vit C

Question 25

beta thalassemia nc

Answer 25

safe admin, anemia measures, enhance self esteem and home health maintenance monitor cheleation therapy: nvd, decreased appetite, rash, liver enzymes. neutropenia, adequate hydration

Question 26

idiopathic thrombocytopenic purpura cm

Answer 26

abnormal autoimmune destruction of platelets in spleen cm: sudden bruise, purpura, petechiae; epistaxis, platelet <20,000, prolonged bleed

Question 27

idiopathic thrombocytopenic purpura tm

Answer 27

supportive - precautions IVIG (boost immune), steroids, anti D antibody (attack cells that cause body to destroy platelets - need good rbc count bc it causes anemia) chronic: splenectomy with IVIG

Question 28

idiopathic thrombocytopenic purpura nc

Answer 28

educate parents, assess for bleeding, prevent trauma (padding), avoid uneccessary procedures, apply pressure 5 minutes post puncture, follow up care

Question 29

hemophilia cm

Answer 29

asympt till 6 mo (mobility and teeth - injuries), hemarthrosis (bleeding into joints, no mobility, stiff, tingle, ache, decreased mobility, warm, red, swell, pain), ecchymosis, ptt increased, epistaxis, bleed post procedure (SQ and IM hemorrhages, bleed into neck, chest, mouth, airway)

Question 30

hemophilia tm

Answer 30

prevent bleed (padding, soft floors, contact sports, puppy), replace factor VIII or desmopressin, regular exercise and PT

Question 31

hemophilia nc

Answer 31

prevent bleed (safe env, no aspirin, SQ and IM, soft toothbrush, venipuncture no fingerstick, no suppository), recognize and control bleed (RICE, P 15 min, children know internal bleed, HA, slurred speech, LOC, bloody stool), prevent SE of bleeding (active ROM, PT, nutrition - overweight bad), fam support and home care (school admin, med alert bracelet), swim!

Question 32

SCID cm

Answer 32

no humoral or cell mediated immunity early frequent infections, ftt, cd, thrush, adventitious sounds, decreased immunoglobulin, graft v, host reaction to any foreign tissue

Question 33

SCID tm

Answer 33

IV immunoglobulin, sterile, bone marrow transplant, prevent exposure, support and educate family

Question 34

HIV (AIDS) differences

Answer 34

even faster progression, kids haven't been exposed to as much, mode of transmission differs (mom)

Question 35

HIV (AIDS) cm

Answer 35

increased size of liver and spleen, oral thrush, c or recurrent d, ftt, developmental delay, parotitis AIDS: serious recurrent infetion, pna, PCP, candidal esophagitis, CMV, encephalopathy, wasting syndrom, cryptosporidosis, herpes simplex

Question 36

HIV (AIDS) diagnose

Answer 36

PCR at 1 month (on antivirals until 1 mo and test -)

Question 37

HIV (AIDS) tm

Answer 37

antiretroviral until 1 mo, mom on retroviral 2nd and 3rd trimester (not first - organs), aggressive abx with infections, modified immunization schedule (based on wbc numbers), prophylaxis

Question 38

HIV (AIDS) nc

Answer 38

prevent, infection risk (neutropenic), knowledge deficit (teach transmission, med storage), altered nutrition (increased protein and cal, preferred foods, supplements, altered g+d, caregiver anx, pain,