Hematology and Immunity of Children Flashcards Preview

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Flashcards in Hematology and Immunity of Children Deck (110):
1

reduced number of red blood cells
decreased availability of hemoglobin
reduced volume of packed red blood cells

anemia

2

how is anemia caused

blood loss or destruction of RBCs

3

inadequate suply or loss of iron

iron deficiency anemia

4

who are at higher risk for iron deficiency anemia

infancy to 36mos
adolescence

5

what are general signs of iron deficiency anemia

irritability
anorexia
lethargy
tachycardia
pallor
fatigue

6

in iron deficiency anemia why would an infant be over weight?

called "milk babies" because they are getting excessive milk intake and not enough iron is in the milk

7

what 3 interventions are used for iron deficiency

diet
iron supplements
blood transfusion is severe

8

when giving iron supplementation what should be given with it

vitamin c because it helps absorption

9

when giving iron what should you NOT give with it

vit d (milk) it decreases absorption

10

how should oral iron supplements be given

at side of mouth towards back of teeth
and brush teeth after administration!! iron causes tarry green stools too

11

boomerang looking RBCs blocking blood flow

sickle cell anemia

12

what are the 4 triggers to vaso-occlusion in sickle cells anemia

hypoxemia
dehydration
change in body temp
infection

13

can sickled RBCs reverse itself over and over

yes! until the point in time it stays sickeled

14

in sickle cell anemia why do we not see any symptoms until middle to late infancy

because the fetal hemoglobin cells do not sickle and are with them until 6mos of age

15

what are the general signs of sickle cell anemia

smaller in height/weight than peers
delay in sexual maturation
chronic anemia

16

how is sickle cell tested after birth

finger or heel stick that gets results in 6 min
(sickledex)

17

what are the 4 "crises" of sickle cell anemia (we will only be tested over the first one)

vaso-occlusive
sequestration
aplastic
hyperhemolytic

18

this crisis of sickle cell anemia is known as the "pain event or episode"

vaso-occlusive crisis

19

in the vaso-occlusive sickle crisis very painful and symptoms of pain are a result of

the obstruction at THAT SITE (lasting 4-6 days)

20

what are sickle cell crisis management

rest
hydrate
analgesics
lyte replacements
blood replacement (temporary)
antiobiotics

21

what medication is used for sickle cell crisis

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

why do vaso-occlusive crisis pts not become addicted to meds

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

what is important teaching of sickle cell pts

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

body makes less HGB than normal because RBCs are damaged, no beta protein, so the RBC is destroyed prematurely

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