Peds - Hematology_Oncology - PEDIATRIC – Child Health...

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PEDIATRIC – Child Health Nursing Hematology/Oncology Iron Deficiency Anemia Most common type of anemia easy to treat Causes: blood loss (like heavy periods), malabsorption, poor nutritional intake, increased metabolic demand Highest incidence of anemia between 9 – 24 months and during adolescence (rapid growth periods) S/S: pallor, fatigue, irritability S/S chronic anemia : nailbed deformities, delayed growth/ dev’t, muscle weakness, tachycardia, HA, systolic heart murmur (heart tries to compensate by pumping harder) What do we do about it? Identifying the anemia and treat it with meds/ diet Iron (ferrous sulfate) TID with citrus juice (for better absorption) give with straw d/t discoloration of teeth (brush teeth after administration) Stools will turn tarry green Iron OD: give milk or eggs Foods rich in iron: liver, dark leafy vegetables, whole grains Sickle Cell Anemia (hemolytic anemia) Genetically transmitted autosomal recessive disorder affecting the Hgb of RBC’s Hemoglobin A = healthy; hemoglobin S = sickled Crescent shaped RBC’s have decrease O2 carrying capacity lifespan: 16-20 days (versus 120 days for normal RBC) get trapped in circulatory system S/S: chronic anemia, delayed growth/ dev’t, increased risk for infection/ sepsis, increase risk for stroke Sickle cell crisis: ischemia (d/t vaso-occlusion), pain Most common sites: bones, lungs, liver/ spleen (jaundice), brain (risk for stroke), penis (priapism) Treatment: avoid temperature extremes/ hypoxic situations (NEVER apply ice), short-term O2 for hypoxia, blood transfusions (monitor Fe levels), hydration / pain management (morphine = opioid of choice), prophylactic ABX/ vaccinations, folate, hydroxurea Major complications: o Splenic sequestration spleen can hold up to 20% of circulating blood o Infection (leading cause of death) sicklers functionally asplenic by age 1 zero filter function/ antibody production PCN prophylaxis o Acute chest syndrome emergency: fever, chest/ back pain, low O2 sats. Treat with O2, ABX, steroids, IV fluids, pain/ fever meds, transfusions
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Aplastic Anemia Bone marrow failure syndrome depletion of ALL marrow elements Congenital or acquired S/S: abnormal bleeding, bruising, petechiae (d/t thrombocytopenia), fever/ infection (d/t neuropenia), and pallor, fatigue, irritability (d/t anemia) Treatment of choice: BMT if not a candidate: antithymocyte globulin (ATG) Methylprednisolone & cyclosporine (immuno-suppressants): not very successful Blood transfusions should be irradiated and LPF (leukopoor filtered) Appropriate ABX used to treat infections Nursing Care: assess for s/s of bleeding/ infections, avoid IM’s and suppositories (rectal tear rectal abscess deadly for these patients) Hemophilia X-linked recessive bleeding disorders mom carries the gene/ son gets it Hemophilia A: most common (80% of cases) deficiency of clotting factor VIII
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