NURSING 6500 - Peds Exam 4 Study Guide.

Nursing 6500 Exam 4 Notes


The Child with Hematologic Dysfunction

Cellular Elements & Their Primary Function

 Red Blood Cells
o To transport oxygen from the lungs to the tissues
 White Blood Cells
o To provide protection against infection
 Platelets
o To protect against bleeding by promoting clotting

Red Cell Disorders

 Anemia
o Decreased RBCs
o Decreased quantity of Hgb
o Decreased volume of packed RBCs below normal
o Causes
 Loss or destruction of existing RBCs
 Hemorrhage
 Hemolytic anemias (RBCs destroyed faster than they are produced)
 Impaired or decreased rate of production
 Bone marrow fails to produce RBCs
 Leukemia or other malignancy
 Chronic renal disease: ↓ erythropoietin → ↓ RBC development
 Inadequate intake of iron
 Underlying disorder
 Lead poisoning
 Hypersplenism
o Types:
 Iron Deficiency Anemia
 Most common type of anemia and most common nutritional deficiency
in children
o Body requires iron for Hgb production
 Insufficient quantities of iron limits hemoglobin production
o In turn affects production of RBCs
 Causes
o Blood loss
o Malabsorption
o Poor nutritional intake
 Who is at risk for poor nutritional intake?
 Rapidly growing adolescents: diets may be high
in fat and low in vitamins and minerals
 Infants who do not take in adequate solid foods
after 6 months or fed only breast milk or
formula not fortified with iron

,Nursing 6500 Exam 4 Notes


o Neonatal stores can be depleted at this
time
 Adolescent females who have heavy periods
may also be at risk
o Increased internal demands—rapid growth periods
 S/Sx:
o Clinical presentation and severity of symptoms are directly
related to the amount of iron deficiency
o Pallor
o Fatigue
o Irritability
o Prolonged anemia:
 Nail bed deformities
 Growth retardation
 Developmental delays
 Tachycardia/heart murmurs
 Diagnostics
o Lab studies
 Hgb
 Serum iron
 RBC count
 Reticulocyte count
o Diet history
 Therapy
o Oral elemental iron preparations
 Ferrous sulfate: 1-2months
 Oral iron can causes constipation/GI distress so
diet high in iron (over recommended
allowances) should be followed at the same
time, that way oral supplements can be tapered
once food intake can supply the needed iron
o Diet high in iron—in conjunction with oral supplementation
 Nursing Management
o Nursing care focuses on:
 Screening for the disorder
 9-12 months of age, 15-18 months of age, and
again at adolescence
 Education with patients and families on causes of
 Iron deficiency anemia
 Dietary management
 Importance of complying with iron supplements
 Height and weight measurements
 Diet history
 Developmental screening tests

,Nursing 6500 Exam 4 Notes


 Aplastic Anemia
 All formed elements of the blood are simultaneously depressed—
pancytopenia
 Failure of the bone marrow to produce adequate amounts of circulating
blood cells
 Congenital
o Fanconi’s anemia: rare recessive syndrome
 At risk for AML so bone marrow transplant is the
treatment of choice
 Acquired
o Idiopathic
o From a drug reaction
 Sulfonamides, benzene solvents (in glue), or lead
o Result of infectious process (such as vital hepatitis or
mononucleosis)
 S/Sx:
o Related to the degree of bone marrow failure and deficiencies in
circulating blood cells
o RBCs: S/Sx of anemia
 Pallor, weakness, dizziness, HA, fatigue, tachycardia
o WBCs: at risk for infection (bacterial, viral, and fungal)
o Platelets: at risk for bleeding and clotting problems
 Petechiae, purpura, bleeding, bruising
 Diagnostics & Therapy
o Labs
 CBC
 Shows neutropenia and usually
thrombocytopenia/pancytopenia
 Bone marrow aspirate/biopsies
 Bone marrow will be yellow/fatty vs. healthy
red bone marrow
o Therapy
 Involves preventing complications from pancytopenia
 Treatment of any complications
 Antibiotics, antifungals, and antivirals
 Immunosuppressive drug therapy
 Antithymocyte globulin (ATG)
 Cyclosporine
 Bone marrow (BMT)/stem cell transplant
 Nursing Management
o Nursing actions focus on preventing or treating complications
from pancytopenias
o When children undergo bone marrow transplant it is important
that the nurse knows new marrow takes anywhere from 1-2

, Nursing 6500 Exam 4 Notes


weeks to start to recover after BMT—old marrow destroyed and
not producing any cells so need the blood product support until
new marrow takes hold
 Pre and post-BMT: administering blood product support
o Support activities of daily living—grouping cares
o Collaborate with physical therapy
o Psychosocial support for patient and family
 Lead Poisoning
 Presence of elevated serum lead levels that cause toxic effect on
multiple organ systems
 Level of toxicity is > 10 mcg/dL
 Young children are more susceptible
o Hand-mouth behaviors
o Immaturity of body systems
 Children absorb and retain more lead proportionally than adults
 Sources
o Presence of lead-based paint—is in all homes built before 1960
o Contaminated soil—around homes, along busy streets,
neighborhoods around certain industrial plants
o Some folk remedies and cosmetics
o Parental occupations that involve exposure to lead: plumbing,
battery manufacturing, construction, furniture refinishing,
pottery making
 Effects of Lead on Body
o Anemia due to impairment of hemoglobin synthesis
o Irreversible brain damage:
 Decreased intelligence
 Developmental delays
 Learning disabilities
 Impaired hearing
o Impaired growth and stature
 Adversely effects the absorption of vitamin D and
calcium, impairing growth
o Behavior problems
o Lead accumulates in the blood, soft tissues (kidneys, bone
marrow, liver, brain), bones, and teeth
 Lead absorbed by bones and teeth is released slowly,
thus even small amounts over time can lead to high
levels and complications
 Screening for Lead
o All children at age 9-12 months and at 2 years
o 3-6 years old if at high risk and not previously screened
o Indicators of risk
 Spending much time in a home built prior to 1960.