Peds Exam 2- NUR
230
1. Nursing Care SCD: The nurse teaches the importance of adequate hydration to prevent
sickling and delay the vasooculusion and hypoxia-ischemia cycle. Advise parents not to force fluids but
give specific instructions on how many daily glasses or bottles required.
Sometimes the fluids combined with impaired kidney function result in the problem of enuresis.
Remind the child to urinate freq during the day and prior to bedtime may be helpful as may be waking
the child during the night.
Families often fear addiction, nurses can foster this unfounded fear. Very few children who recieve opioids
become behaviorally addicted to the drug. Dependency is rare and should never be used as a reason to
withhold pain medication.
Advise parents to be particularly alert to situations in which dehydration may be possible (hot weather,
playing sports) Instead of saying "crisis" say "pain episode"
RN is responsible for monitoring for any signs of transfusion reaction. Hypervolemia from too rapid of
an infusion can increase workload of the heart, nurse must be alert for cardiac failure
Also to gently measure size of the spleen as splenomegaly is an ominous sign.
Record I&O signs of Acute Chest Syndrome
-severe chest, back or abdomen pain
-fever of 101.3 or higher
-cough
-dyspnea, tachypnea
-retractions
-declining oxygen sat
signs of CVA
-severe unrelieved headaches
-severe vomitting
-jerking, twitching
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160
, Peds Exam 2- NUR
230
-seizures
-strange abnormal behavior
-inability to move arm or leg
-stagger/unsteady walk
-slurred speech
-weakness in extremities
-changes in vision
The only predictive tests consistently associated with severe SCA outcome are elevated TCD velocities and
increased reticulocyte count
2. Shift to the Left: a common term used in describing an abnormal CBC which refers to the
presence of
immature neutrophils in the peripheral blood from hyperfunction of the bone marrow as seen
during a bacterial infection
3. Anemia: is a reduction in red blood cell (RBC) mass per volume and/or hemoglobin concentration
compared
with normal values for age.
Most common hematologic disorder of infancy and childhood.
Anemias can be classified using 2 approaches:
etiology/phisiology= manifested by erythrocyte or Hgb
depletion morphology= characteristic changes in RBC size,
shape or color
morphology is useful for lab evaluation, etiology provides direction for planning nursing care
4. Consequences of Anemia and Diagnostic Eval: a decrease in the oxygen-
carrying capacity of blood reduces the amount of oxygen available to the body cells.
The viscosity of the blood depends on the concentration of RBCs; the resulting hemodilution of
severe anemia decreases peripheral resistance, causing greater quantities of blood to return to the
heart. The increased circulation and turbulence within the heart may produce a murmur.
2/
160
, Peds Exam 2- NUR
230
Cardiac workload is greatly increased
Growth retardation resulting from decreased cellular metabolism and coexisting anorexia is a common
finding in
3/
160
, Peds Exam 2- NUR
230
chronic severe anemia. Delayed sexual maturation in older child freq
seen. Exam findings= lack of energy, easy fatigability and pallor
Lab findings= decreased RBCs and decreased Hgb and Hct
stool examination using the Hemoocult test for occult blood can identify chronic intestinal bleeding that
results from a primary or secondary lactase deficiency
5. Red Blood Cell Morphology: Size (variation in RBC sizes)
-Normocytes= normal cell size
-Microcytes= smaller than normal cell size
-Macrocytes= larger than normal cell size
Shape (variation in RBC shapes/poikilocytosis)
-Spherocytes=globular cells
-Drepanocytes= sickle-shaped cells
6. RBC count: 4.5 - 5.5 million
indirectly estimates Hgb content of blood; Reflects function of bone marrow
7. Hgb: 11.5 - 15.5
total blood hgb primarily depends on number of circulating RBCs but also on amount of hgb in each cell
8. Hct: 35-45%
percent of packed RBCs in whole blood; is approx 3x hgb content
9. MCV: 77-95 fl
Avg or mean volume size of a single RBC. MCV is expressed as femtoliter (fl)
10. MCH: 25-33 pg/cell; Avg or mean quanity/weight of Hgb in a single RBC; is expressed as
picogram (pg)
Whereas MCV and MCH depend on accurate counts of RBCs, MCHC does not making it more reliable
11. The objective of medical management in anemia is to: reverse the
anemia by treating the underlying cause
In nutritional anemias, the specific deficiency is replaced
In blood loss from acute hemorrhage, RBC transfusion may be given
4/
160
230
1. Nursing Care SCD: The nurse teaches the importance of adequate hydration to prevent
sickling and delay the vasooculusion and hypoxia-ischemia cycle. Advise parents not to force fluids but
give specific instructions on how many daily glasses or bottles required.
Sometimes the fluids combined with impaired kidney function result in the problem of enuresis.
Remind the child to urinate freq during the day and prior to bedtime may be helpful as may be waking
the child during the night.
Families often fear addiction, nurses can foster this unfounded fear. Very few children who recieve opioids
become behaviorally addicted to the drug. Dependency is rare and should never be used as a reason to
withhold pain medication.
Advise parents to be particularly alert to situations in which dehydration may be possible (hot weather,
playing sports) Instead of saying "crisis" say "pain episode"
RN is responsible for monitoring for any signs of transfusion reaction. Hypervolemia from too rapid of
an infusion can increase workload of the heart, nurse must be alert for cardiac failure
Also to gently measure size of the spleen as splenomegaly is an ominous sign.
Record I&O signs of Acute Chest Syndrome
-severe chest, back or abdomen pain
-fever of 101.3 or higher
-cough
-dyspnea, tachypnea
-retractions
-declining oxygen sat
signs of CVA
-severe unrelieved headaches
-severe vomitting
-jerking, twitching
1/
160
, Peds Exam 2- NUR
230
-seizures
-strange abnormal behavior
-inability to move arm or leg
-stagger/unsteady walk
-slurred speech
-weakness in extremities
-changes in vision
The only predictive tests consistently associated with severe SCA outcome are elevated TCD velocities and
increased reticulocyte count
2. Shift to the Left: a common term used in describing an abnormal CBC which refers to the
presence of
immature neutrophils in the peripheral blood from hyperfunction of the bone marrow as seen
during a bacterial infection
3. Anemia: is a reduction in red blood cell (RBC) mass per volume and/or hemoglobin concentration
compared
with normal values for age.
Most common hematologic disorder of infancy and childhood.
Anemias can be classified using 2 approaches:
etiology/phisiology= manifested by erythrocyte or Hgb
depletion morphology= characteristic changes in RBC size,
shape or color
morphology is useful for lab evaluation, etiology provides direction for planning nursing care
4. Consequences of Anemia and Diagnostic Eval: a decrease in the oxygen-
carrying capacity of blood reduces the amount of oxygen available to the body cells.
The viscosity of the blood depends on the concentration of RBCs; the resulting hemodilution of
severe anemia decreases peripheral resistance, causing greater quantities of blood to return to the
heart. The increased circulation and turbulence within the heart may produce a murmur.
2/
160
, Peds Exam 2- NUR
230
Cardiac workload is greatly increased
Growth retardation resulting from decreased cellular metabolism and coexisting anorexia is a common
finding in
3/
160
, Peds Exam 2- NUR
230
chronic severe anemia. Delayed sexual maturation in older child freq
seen. Exam findings= lack of energy, easy fatigability and pallor
Lab findings= decreased RBCs and decreased Hgb and Hct
stool examination using the Hemoocult test for occult blood can identify chronic intestinal bleeding that
results from a primary or secondary lactase deficiency
5. Red Blood Cell Morphology: Size (variation in RBC sizes)
-Normocytes= normal cell size
-Microcytes= smaller than normal cell size
-Macrocytes= larger than normal cell size
Shape (variation in RBC shapes/poikilocytosis)
-Spherocytes=globular cells
-Drepanocytes= sickle-shaped cells
6. RBC count: 4.5 - 5.5 million
indirectly estimates Hgb content of blood; Reflects function of bone marrow
7. Hgb: 11.5 - 15.5
total blood hgb primarily depends on number of circulating RBCs but also on amount of hgb in each cell
8. Hct: 35-45%
percent of packed RBCs in whole blood; is approx 3x hgb content
9. MCV: 77-95 fl
Avg or mean volume size of a single RBC. MCV is expressed as femtoliter (fl)
10. MCH: 25-33 pg/cell; Avg or mean quanity/weight of Hgb in a single RBC; is expressed as
picogram (pg)
Whereas MCV and MCH depend on accurate counts of RBCs, MCHC does not making it more reliable
11. The objective of medical management in anemia is to: reverse the
anemia by treating the underlying cause
In nutritional anemias, the specific deficiency is replaced
In blood loss from acute hemorrhage, RBC transfusion may be given
4/
160
