NUR 254 PEDS Exam 4 Review
Anemia
- Important to know what is causing the Anemia in order to treat it. It could be caused by etiology,
morphology, RBC depletion, destruction of RBC’s.
- Anemia causes increased cardiac workload! So make sure to cluster care and do small frequent
feeds!!
- It can cause a murmur and tachy!!! due to the increased viscosity of the blood. (it is thicker and
causes a turbulence)
- Transfusion reaction- Vitals, before, 15 mins in, after. Cannot leave room for 1st 15 minutes. Use
blood within 30 minutes of arrival, infuse over 4 hrs maximum. Appropriate filter. Verify right
patient and donor.
LABS to look for: CBC, Hgb, Hct (know general ranges)
Hgb:
- 1-6 yr: 9.5-14 g/dL
- 6-18 yr: 10-15.5 g/dL
S/S:
• Pallor (always check H & H when a child is pale and has pallor)
• Fatigue (Due to decreased oxygen)
• Tachycardia (heart is trying to compensate)
• Murmurs (due to turbulence)
• Growth retardation (due to be tired and not meeting milestones)
TX: Treat underlying cause
• Transfusions, nutritional interventions
• Supportive care: IVF, rest, decrease O2 demands, O2 as PRN
• Iron fortified cereals started at 6 months
• Give fluids, rest, decrease 02 demands, increase supplemental 02!! (help them with self care)
• We don’t routinely give oxygen, only give if they NEED it!!
• Iron drops are given after 4 months of age
Iron Deficiency Anemia
- Most common type of anemia in the US. Mostly due to nutritional deficiency.
, - Children 12 – 36 months are at the highest risk.
- Don’t give cows milk until 12 months of age (cant digest and not a good source of iron) can
also lead to a GI bleed!
- Even at 12 months limit the amount
-
Tx for iron deficiency Anemia:
- Give iron supplements and foods high in iron. (Meat, green leafys, beans/lentils) - GIVE
IRON WITH VITAMIN C (OJ) AND ON AN EMPTY STOMACH!!
- Also have them use a straw due to STAINING OF THE TEETH!
- They can have BLACK/GREEN TARRY STOOL!
- Give to exclusively breast-fed babies by 4 months!!
Sickle Cell Anemia (1/4 chance if both parents have)
- Can lead to ischemia (causes pain in arms legs and abdomen!!)
- It can also destroy you good RBC’s (hemolysis)
- Newborn screening, “BROKEN CANOES, not carrying O2 well, dehydration/vasoconstriction
causes issue. Keep them hydrated!!!!!
Sickle cell crisis caused by infection, dehydration, stress, and trauma, vasoconstriction Types
of crises:
- Vaso-occlusive- “painful episode” can last days to weeks!! (caused by infection)
- Splenic sequestration - pooling of blood in the spleen (can lead to hypovolemic shock and
death!!) splenomegaly!!
- Aplastic - decreased production of RBCs (typically follows a VIRAL infection!)
Complications of Sickle cell:
• Pneumonia symptoms (acute chest syndrome) leading cause of death in children with sickle
cell! Parent needs to advocate and watch for these S/S…
• STROKE! (CVA)
TX: ‘HOP to it”. Hydration (IV fluids), Oxygen, and Pain meds! (hydration is big!!)
• Staying away from infection! Use of antibiotics (penicillin) prophylaxis!
• PCA pump for pain!! Monitor for RESP depression! (give Narcan if pt. in RESP depression)
, • Only give oxygen however they require it! (don’t automatically slap 02 on them)
• Educate about symptoms of infection and acute chest syndrome and stroke symptoms.
Prevent infection—Vaccines, PCN prophylaxis, hydroxyurea
Parent teaching—Recognize CVA symptoms, acute chest syndrome, genetic counseling
Hemophilia (Deficiency of factor VIII, produced by liver) Bleeding disorder resulting from
deficiency of factors (proteins) needed for clotting!!!!! They KEEP bleeding!!!!
- Mostly in boys!! 2/3 cases are familial…..
S/S :
- Prolonged bleeding!!
- Hemorrhage
- Bruising
- Hemarthrosis (bleeding in joints) common for these kids
- Spontaneous hematuria
- Labs: clotting factors, DNA
- Meds: Corticosteroids, DDAVP, clotting factors replaced
TX:
- They cant do contact sports and you have to teach safety (can do swimming, golf, bowling)
- They will have their clotting factors replaced!!! (they can do this at home prophylactically at
time of bleeding episode) KNOW!!
- RICE: rest, ice, compression, elevation for controlling the bleeding!
- Don’t give NSAIDS, Tylenol. Regular exercise and PT!!!!!
- Educate family about s/s of bleeding internally such as black tarry stools. If pt. has slight head injury it is
priority to bring them to the ER right away because we don’t know if they have an internal brain bleed!!
Childhood cancers: Unknown etiology, if patient has long periods of sickness, unusual mass or
swelling, fatigue, easy bruising, weight loss, headaches etc.…could be a sign of cancer.
- Treatment can cause neutropenia (prevent infection being in private room with door closed to
protect them), Wash hands/ good skin care, Sterile invasive procedures will be done, High
calorie/ high protein diet. , Avoid greasy heavy foods, Constipation from pain meds etc. altered
nutrition due to sores in the mouth and vomiting. (give soft foods)
Anemia
- Important to know what is causing the Anemia in order to treat it. It could be caused by etiology,
morphology, RBC depletion, destruction of RBC’s.
- Anemia causes increased cardiac workload! So make sure to cluster care and do small frequent
feeds!!
- It can cause a murmur and tachy!!! due to the increased viscosity of the blood. (it is thicker and
causes a turbulence)
- Transfusion reaction- Vitals, before, 15 mins in, after. Cannot leave room for 1st 15 minutes. Use
blood within 30 minutes of arrival, infuse over 4 hrs maximum. Appropriate filter. Verify right
patient and donor.
LABS to look for: CBC, Hgb, Hct (know general ranges)
Hgb:
- 1-6 yr: 9.5-14 g/dL
- 6-18 yr: 10-15.5 g/dL
S/S:
• Pallor (always check H & H when a child is pale and has pallor)
• Fatigue (Due to decreased oxygen)
• Tachycardia (heart is trying to compensate)
• Murmurs (due to turbulence)
• Growth retardation (due to be tired and not meeting milestones)
TX: Treat underlying cause
• Transfusions, nutritional interventions
• Supportive care: IVF, rest, decrease O2 demands, O2 as PRN
• Iron fortified cereals started at 6 months
• Give fluids, rest, decrease 02 demands, increase supplemental 02!! (help them with self care)
• We don’t routinely give oxygen, only give if they NEED it!!
• Iron drops are given after 4 months of age
Iron Deficiency Anemia
- Most common type of anemia in the US. Mostly due to nutritional deficiency.
, - Children 12 – 36 months are at the highest risk.
- Don’t give cows milk until 12 months of age (cant digest and not a good source of iron) can
also lead to a GI bleed!
- Even at 12 months limit the amount
-
Tx for iron deficiency Anemia:
- Give iron supplements and foods high in iron. (Meat, green leafys, beans/lentils) - GIVE
IRON WITH VITAMIN C (OJ) AND ON AN EMPTY STOMACH!!
- Also have them use a straw due to STAINING OF THE TEETH!
- They can have BLACK/GREEN TARRY STOOL!
- Give to exclusively breast-fed babies by 4 months!!
Sickle Cell Anemia (1/4 chance if both parents have)
- Can lead to ischemia (causes pain in arms legs and abdomen!!)
- It can also destroy you good RBC’s (hemolysis)
- Newborn screening, “BROKEN CANOES, not carrying O2 well, dehydration/vasoconstriction
causes issue. Keep them hydrated!!!!!
Sickle cell crisis caused by infection, dehydration, stress, and trauma, vasoconstriction Types
of crises:
- Vaso-occlusive- “painful episode” can last days to weeks!! (caused by infection)
- Splenic sequestration - pooling of blood in the spleen (can lead to hypovolemic shock and
death!!) splenomegaly!!
- Aplastic - decreased production of RBCs (typically follows a VIRAL infection!)
Complications of Sickle cell:
• Pneumonia symptoms (acute chest syndrome) leading cause of death in children with sickle
cell! Parent needs to advocate and watch for these S/S…
• STROKE! (CVA)
TX: ‘HOP to it”. Hydration (IV fluids), Oxygen, and Pain meds! (hydration is big!!)
• Staying away from infection! Use of antibiotics (penicillin) prophylaxis!
• PCA pump for pain!! Monitor for RESP depression! (give Narcan if pt. in RESP depression)
, • Only give oxygen however they require it! (don’t automatically slap 02 on them)
• Educate about symptoms of infection and acute chest syndrome and stroke symptoms.
Prevent infection—Vaccines, PCN prophylaxis, hydroxyurea
Parent teaching—Recognize CVA symptoms, acute chest syndrome, genetic counseling
Hemophilia (Deficiency of factor VIII, produced by liver) Bleeding disorder resulting from
deficiency of factors (proteins) needed for clotting!!!!! They KEEP bleeding!!!!
- Mostly in boys!! 2/3 cases are familial…..
S/S :
- Prolonged bleeding!!
- Hemorrhage
- Bruising
- Hemarthrosis (bleeding in joints) common for these kids
- Spontaneous hematuria
- Labs: clotting factors, DNA
- Meds: Corticosteroids, DDAVP, clotting factors replaced
TX:
- They cant do contact sports and you have to teach safety (can do swimming, golf, bowling)
- They will have their clotting factors replaced!!! (they can do this at home prophylactically at
time of bleeding episode) KNOW!!
- RICE: rest, ice, compression, elevation for controlling the bleeding!
- Don’t give NSAIDS, Tylenol. Regular exercise and PT!!!!!
- Educate family about s/s of bleeding internally such as black tarry stools. If pt. has slight head injury it is
priority to bring them to the ER right away because we don’t know if they have an internal brain bleed!!
Childhood cancers: Unknown etiology, if patient has long periods of sickness, unusual mass or
swelling, fatigue, easy bruising, weight loss, headaches etc.…could be a sign of cancer.
- Treatment can cause neutropenia (prevent infection being in private room with door closed to
protect them), Wash hands/ good skin care, Sterile invasive procedures will be done, High
calorie/ high protein diet. , Avoid greasy heavy foods, Constipation from pain meds etc. altered
nutrition due to sores in the mouth and vomiting. (give soft foods)
