Hematology and Immunity of Children Flashcards
(110 cards)
1
Q
reduced number of red blood cells
decreased availability of hemoglobin
reduced volume of packed red blood cells
A
anemia
2
Q
how is anemia caused
A
blood loss or destruction of RBCs
3
Q
inadequate suply or loss of iron
A
iron deficiency anemia
4
Q
who are at higher risk for iron deficiency anemia
A
infancy to 36mos
adolescence
5
Q
what are general signs of iron deficiency anemia
A
irritability anorexia lethargy tachycardia pallor fatigue
6
Q
in iron deficiency anemia why would an infant be over weight?
A
called “milk babies” because they are getting excessive milk intake and not enough iron is in the milk
7
Q
what 3 interventions are used for iron deficiency
A
diet
iron supplements
blood transfusion is severe
8
Q
when giving iron supplementation what should be given with it
A
vitamin c because it helps absorption
9
Q
when giving iron what should you NOT give with it
A
vit d (milk) it decreases absorption
10
Q
how should oral iron supplements be given
A
at side of mouth towards back of teeth
and brush teeth after administration!! iron causes tarry green stools too
11
Q
boomerang looking RBCs blocking blood flow
A
sickle cell anemia
12
Q
what are the 4 triggers to vaso-occlusion in sickle cells anemia
A
hypoxemia
dehydration
change in body temp
infection
13
Q
can sickled RBCs reverse itself over and over
A
yes! until the point in time it stays sickeled
14
Q
in sickle cell anemia why do we not see any symptoms until middle to late infancy
A
because the fetal hemoglobin cells do not sickle and are with them until 6mos of age
15
Q
what are the general signs of sickle cell anemia
A
smaller in height/weight than peers
delay in sexual maturation
chronic anemia
16
Q
how is sickle cell tested after birth
A
finger or heel stick that gets results in 6 min
sickledex
17
Q
what are the 4 “crises” of sickle cell anemia (we will only be tested over the first one)
A
vaso-occlusive
sequestration
aplastic
hyperhemolytic
18
Q
this crisis of sickle cell anemia is known as the “pain event or episode”
A
vaso-occlusive crisis
19
Q
in the vaso-occlusive sickle crisis very painful and symptoms of pain are a result of
A
the obstruction at THAT SITE (lasting 4-6 days)
20
Q
what are sickle cell crisis management
A
rest hydrate analgesics lyte replacements blood replacement (temporary) antiobiotics
21
Q
what medication is used for sickle cell crisis
A
hydroxyurea (increases fetal Hgb)
and short term oxygen therapy (* remember it does NOT reverse sickling but will help them breath and relax) *prolonged oxygen use can depress been marrow
22
Q
why do vaso-occlusive crisis pts not become addicted to meds
A
because their crisis only lasts about 4-6 days
*since we are not worried about them becoming addicted, their pain meds should be admin on a schedule!
23
Q
what is important teaching of sickle cell pts
A
seek early tx for fever 101.3 or greater prophylactic med (penicillin and immunizations) adequate hydration avoid COLD compresses avoid low O2 environments avoid contact sports rest
24
Q
body makes less HGB than normal because RBCs are damaged, no beta protein, so the RBC is destroyed prematurely
A
B thalassemia aka
Cooley’s anemia aka
mediterranean anemia
25
B thalassemia kids rely on frequent ______ ______ and because of this and hemolyzed RBC we get _____ overload. ____ ______ tries to make more RBCs and there is a build up in the _____ ______ making the _____ bigger
blood transfusions; iron; bone marrow; bone marrow; bones
26
what does a child with B thalassemia look like
large head, enlarged maxilla, protrusion of the lip and upper teeth, shorter in stature
skin takes on bronze appearance (excess iron)
27
excess iron storage in tissues of the body
hemosiderosis
28
excess iron storage in tissues that results in cellular death
hemochromotosis
29
what is the goal for B thalassemia pt
maintain adequate HGB levels by transfusion program
| *lifelong and are usually every 3-5wks
30
in B thalassemia pt what is used to remove iron from the body
chelating agents (deferoxamine)
31
what teaching is done for deferoxamine (removes iron from body in B thalassemia pt)
admin at night while sleeping for 8-10 hrs
can be IV or Subq for 5-7 days
admin with vit C
avoid iron wish foods
turns urine reddish
*deferasirox is the same thing but is PO and used for children older than 2
32
if a child with B thalassemia has a splenectomy what is important to teach the family/pt
contact health professional of all fevers of 101 or greater * risk for sepsis in a child with asplenia
33
what are the main differences in sickle cell anemia and B thalassemia
sickle cell anemia the RBCs sickle
and are characterized by crisis
B thalassemia anemia the RBCs are fragile, chronic hypoxia, and iron overload due to blood transfusion
34
what children are at higher risk for lead poisoning
```
less than 6y/o
poverty
living in older rent prop
urban setting
children with anemia
```
35
what are general signs of anemia
pallor
tachycardia
fatigue
weakness
36
how is lead poisoning assessed
universal screening at 1 and 2 years of age
| target screening
37
why is lead poisoning so bad
crosses the BBB and causes severe neurological effects
| *serum lead tests should be taken and if suspected then X-rays can be taken
38
if a child has <10mcg of lead in their blood what should be done
```
reassess/rescreen in 3 months
environmental assessment (ask)
```
39
if a child has 10-44mcg of lead in their blood what should be done
```
reassess/rescreen <3months
environmental investigation (go look)
```
40
if a child has >45mcg of lead in their blood what should be done
```
chelation therapy (removes lead)
consider hospitalization
```
41
what should nurse teach when it comes to prevention of lead poisoning
HH
damp mop floors and window seals
frequent washing of pacifiers and toys
42
why is chelating therapy given more than one dose and for a period of time
because lead moves between blood, soft tissues, organs, bones, and teeth. make sure it gets it all
43
during chelation therapy in lead poisoning how should you protect kidneys
adequate hydration
44
what is important to know about lead poisoning tx succimer
oral for 19 days and it comes in capsule or sprinkle
45
what is important to know about lead poisoning tx calcium disodium edetate
IM or IV but its very painful IM so you should apply EMLA an hour before injection
46
prolonged bleeding anywhere from the body
hemophilia
47
what is the hallmark sign of hemophilia
hemarthrosis= bleeding into a joint capsule, "target joints"
48
what are symptoms of hemarthrosis (in hemophilia)
swelling
redness
pain
loss of movement
49
what is important for you to NOT do when a child has a swollen area at a joint (due to hemophilia)
NEVER aspirate it will just cause more bleeding
50
how can we prevent bleeding (hemophilia)
exercise and PT (no contact activity tho)
water pick for teeth
if IM needed hold pressure for 15 min
venapuncture instead of heel/finger sticks
51
what does a child usually say they feel if they are experiencing hemophilia in certain are
feels pressure and "bubbling"
52
for bleeding (hemophilia) what is the first thing done
```
factor replacement but while we wait RICE should be done
rest
ice
compress
elevate
```
53
what is important to know about admin of factor replacement
admin 2-3x per week as prophylactic but DO NOT have it premixed because it has a short lifespan
54
in a hemophilia pt what med is contraindicated
aspirin because it will cause them to bleed more *acetaminophen can be used
55
excessive destruction of platelets and usually follows a viral illness
Immune thrombocytopenia
56
what are symptoms of immune thrombocytopenia
easy bruising
petechiae
bleeding from MMM
prolonged bleeding from abrasions
57
when should you restrict activities in pt who have IT
when their platelets are <50,000
58
what meds are given for IT pt
steroids
immune globulin
anti D antibody
*goal of all 3 is to prolong survival rate of the existing platelets
59
why is a splenectomy put off until about 5 years of age in a pt who has IT
to decrease chance of infection
60
decreases and eventually eliminates a persons immune system
HIV
61
for children under 13 the transmission of HIV is ______ spread
vertical (late in pregnancy
L and D
breastfeeding)
62
why are infants born to HIV mothers test positive for HIV
due to antibodies from the mom (maternal antibodies persist up to 18 months)
63
what are CM of HIV in children
```
lymphadenopathy
hepatosplenomegaly
oral candidiasis
chronic reoccurent diarrhea
FTT
developmental delay
parotitis
```
64
How will HIV be managed with meds
ART and treating opportunistic infections (due to low immune system) *tx will be LIFELONG
65
in pt with HIV what type of vaccines will they be able to receive
they are very immunocompromised so live vaccines should NOT be given
66
what are cardinal signs of cancer in children
```
unusual mass or swelling
unexplained paleness and loss of energy
sudden tendency to bruise
persistent localized pain or limping
prolonged fever or illness
frequent HA with vomiting
sudden eye or vision changes
excessive rapid weight loss
```
67
cancer arising from the sympathetic nervous system *more common in abdomen
neuroblastoma
68
firm, nontender, irregularly shaped mass in the abd that CROSSES the midline
neuroblastoma
69
why is a neuroblastoma called the silent tumor
because the dx has been made after it has already been metastasized to other location
70
what is the preferred method to see neuroblastoma tumor
CT
71
immature WBCs crowd out the other components of blood and depress the bone marrow production of RBCs
path of leukemia
72
what are the symptoms of leukemia
```
pallor
listlessness
irritability
fever
anorexia
weight loss
petechiae
bruising
bone/joint pain
```
73
what is the definitive dx of leukemia
bone marrow aspiration *after dx a lumbar puncture is done to see if there is brain involvment
74
for pt with leukemia, the _______ the leukocyte count at dx the _______ the prognosis
higher; worse
75
cancerous tumor arising out of the retina
retinoblastoma
76
cat's eye reflex is hallmark of (white pupil)
retinoblastoma
77
what is the tx for retinoblastoma
radiation
removal of the eye
chemotherapy
78
for pt with retinoblastoma what should you prepare the parents of
expect to see an empty socket after sx
79
fast growing, asymptomatic, firm, lobulated mass located to ONE side of abd
wilm's tumor
80
why should you not palpate the abd of a child who has wilm's tumor
can dislodge cells and spread to adjacent and distant tissue
81
most frequent malignant bone tumor type in children
osteosarcoma
82
what are the primary tumor sites of osteosarcoma
long bones, especially the legs and distal femur
83
what is the definitive dx tests for osteosarcoma
radiologic studies and elevated alkaline phosphatase with some bone tumors
84
2nd most common malignant bone tumor in children and adolescents
arises in marrow frequently in femur, tibia, ulna, humerus etc
ewing sarcoma
85
in ewings sarcoma prognosis is best if no _______ has occurred at the time of dx
metastasis
86
what lesions of ewing sarcoma have the best potential for cure
distal lesions
87
what is the preferred site for bone marrow aspiration
posterior superior iliac spine
88
what are the phases of chemo
induction therapy
central nervous system prophylaxis
intensification/consolidation therapy
maintenance therapy
89
what is the goal for induction therapy
remission
90
what is the goal for central nervous system prophylaxis
prevent leukemia cells in CSF
91
what is the goal for intensification/consolidation therapy
destroy any residual leukemia
92
what is the goal for maintenance therapy
remain in remission
93
at the first sign of infiltration why should you immediately stop chemotherapy infusion
because its a sclerosing agent and can literally eat through the skin
94
how can you prevent anaphylaxis to chemo
thorough hx of allergies
have emergency meds and mask/bag ready
recognizing hypotension, wheezing and urticaria
95
what are side effects of radiation therapy
```
anorexia
nausea
vomiting
extreme fatigue
skin reactions
```
96
changes DNA so that it cannot reproduce and is scheduled over 1-6 weeks
radiation therapy
97
what is important to teach about radiation
do not try to wash mark off of site
do not expose radiated area to sun or heat
no cream or lotion on site (can misdirect radiation)
98
what is point of nadir
bone marrow suppression at its greatest, neutrophil count at its lowest
99
what do neutrophils do
fight bacterial infections
100
an ANC below _____ warrants evaluation
1500
101
ANC below _____ places child at greatest risk for infection
500
102
what is the ANC formula
(segs+bands)xWBCx10
103
prophylaxis against bacteria
trimethoprim-sulfamethoxazole
104
prophylaxis against fungi
nystatin
105
prophylaxis against virus
no live immunizations
106
infection increases the tendency toward bleeding
thrombocytonpenia
107
most likely have no conception of death
infants and toddlers
108
death as temporary, a departure, a kind of sleep
preschoolers
109
death is irreversible but not necessarily inevitable and may fear mutilation
schoolage
110
death is inevitable, irreversible
adolescents
