Pediatric Heme and Neoplastic Flashcards
(55 cards)
Calcium can inhibit iron absorption. Vitamin C can increase iron absorption. What should you teach parents to give and to not give with iron supplements?
- Don’t give with milk
- Can take with orange juice to increase absorption
- Remember oral hygiene after to prevent damage to teeth
Because maternal iron stores in the infant are depleted by 4-6 months, you should begin iron supplementation around this time. What alterations might you change in their diet?
- No cow’s milk before 1 year (And no more than 24oz/day)
- Add iron-fortified cereals to breast milk (ie: rice cereal)
- Iron-fortified formula
- Breastfeeding mothers should increase iron intake or supplements
Which foods are high in iron?
- Red meats
- Fish
- Iron-fortified cereals and grains
- Dried beans
- Leafy green veggies + peas
- Dried fruit (raisins)
What alterations should you make to the diet of a child with lead poisoning?
Increase calcium and iron intake to reduce absorption and effects of lead in the body.
Lead poisoning can cause…
Iron deficiency anemia
Lead competes with the transporter needed for Iron uptake in the GI tract.
In those with sickle cell anemia, the RBCs are not sickle-shaped as soon as they are formed. Aside from the genetic component, what event causes the normal shaped cell to sickle?
Exposure to low levels of oxygen
Explain how sickling takes place. (Hint: This is why O2 is an important management option)
When the RBC is exposed to low oxygen levels, the mutated S hemoglobin molecule folds into a stiff strand, creating the rigid, sickled cell.
Why is hydration an important intervention for sickle cell crisis?
Increases fluid around the cells in the vascular space to minimize clumping and occlusion. So dehydration makes it worse, obvi.
What is another term for Sickle Cell Crisis?
Vaso-occlusive crisis
What is a priority nursing intervention for Vaso-Occlusive crisis?
Monitoring SpO2
Promoting oxygen utilization prevents further sickling and allows for adequate oxygenation of surrounding tissues.
What is a Vaso-occlusive crisis?
Sickled cells clump together and block small blood vessels. This blocks perfusion and causes tissue damage and subsequent severe pain.
Why is bed rest an intervention for vaso-occlusive crisis?
It will decrease energy expenditure and thus decrease oxygen demand.
Vaso-occlusive crisis do’s and dont’s:
Do/Don’t:
- Apply cold compresses to painful areas
- Give the kid popsicles
Do- Give popsicles (Kids willing to accept this for fluid intake)
Don’t- Cold compress. (Vasoconstriction + already clogged blood vessels = bad)
A sequestration crisis in an individual with sickle cell can ultimately lead to shock. Explain what this crisis is. (Hint: It involves the spleen and relates to why those with SCA are at increased risk for infx. Can also happen in liver.)
The sickled blood cells get trapped while passing through the spleen, causing blood to accumulate there. This blood is no longer part of the circulating blood volume, causing hypotension and normal hypovolemic shock manifestations.
Prevention measure for vaso-occlusive crisis? Why?
Fluid administration. Decreases blood viscosity. (Viscous due to clumping cells)
What are priority interventions to prevent serious infx in individuals with SCA?
- Keep them up to date with immunizations
- Prophylactic abx against pneumococcal infx from 2 months to at least 5 years
- Damage to spleen limits its function and puts them at higher risk for serious infx, especially strep pneumoniae. They may have had a splenectomy as treatment.
What will you do to prevent overwhelming sepsis and meningitis in the SCA child?
- PCV13 series in infancy as usual
- PLUS PCV23 yearly after age 2 years
- Then obviously meningococcal vaccine
-Influenza yearly after 6 months (B DR HIP In 6 months)
What typically triggers aplastic crisis in SCA? (General and specific)
- Viral infx
- Human parvovirus
____________ crisis is when the body can’t keep up with the rate of RBC destruction, causing severe anemia in the SCA patient. In contrast, ________ anemia/crisis is when the body stops making RBC’s due to infx, causing extreme anemia.
- Hyperhemolytic
- Aplastic crisis
Aplastic means?
- Not formed
- A = Not, Plastic= Formed or molded
How much fluid can you give to promote hemodilution in vaso-occlusive crisis?
150ml/kg OR double the daily fluid maintenance alottment (100/50/20)
Which two drugs can you give to help with RBC and hemoglobin development in SCA?
- Hydroxyurea for hemoglobin F development (Will give RBC’s the correct shape)
- Folic acid for RBC production
Immediate action following limb/joint injury in child with hemophilia?
- RICE (Rest, ice, compression, elevate)
Do NOT perform ________ ________ exercises on a child with hemophilia. Will increase risk of tearing and thus increase bleeding.
- Passive ROM
