Pedi Exam 2 Review by chapter[1].docx

Pedi Exam 2 Review by chapter[1].docx - Chapter 26 The...

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Chapter 26: The Child with Hematological or Immunological Dysfunction (16 questions) Labs WBC (4.5-13.5 x 10 3 cells/mm 3 ) o Helps protect against infection RBC (4.5-5.5 million/mm3) o Indirectly estimates Hgb content of blood. Reflects function of bone marrow. Hgb (11.5-15.5 g/dL) o Total blood Hgb primarily depends on number of circulating RBCs but also on amount of Hgb in each cell. Hct (35%-45%) o Percent volume of packed RBCs in whole blood. Platelets (150-400 x 10 3 /mm 3 ) o Cellular fragments that are necessary for clotting to occur. ITP (Idiopathic Thrombocytopenia Purpura) Defect in hemostasis Acquired hemorrhagic disorder Thought to be autoimmune response to disease related antigens Increased platelet destruction caused by antiplatelet antibodies Acute o Seen after URI, Measles, rubella, mumps, varicella, parvovirus (fifth disease) Chronic (>6 months) Signs and Symptoms o Petechiae (smaller dots) o Purpura (bigger dots) o Bruising o Mucocutaneous bleeding o Epistaxis o Hemarthrosis o Menorrhagic Management o Supportive o Activity restriction o Prednisone Helps suppress autoimmune response. Take continuously SE: Moon face, increased blood sugar o IV immune globulin (IVIG) o Anti-D antibody WinRho o Splenectomy Nursing care o Identify complications o Avoid aspirin, NSAIDs o Restrict activities o Educate parents No contact sports Signs and symptoms of bleeding Management of bleeding Medical alert bracelet
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o Contraindicated nursing interventions NO rectal temps!! NO injections NO tampons Hemophilia Defect in hemostasis Congenital x-linked deficiency of clotting (Factors VIII or IX) Males predominantly affected Females are carriers Hemophilia A (classic) o Factor VIII deficiency Hemophilia B (Christmas disease) o Factor IX deficiency Signs and Symptoms o Prolonged bleeding o Excessive bruising o Hemarthrosis Esp. knees, elbows, ankles Swelling, warmth, redness, pain, loss of ROM Crippling deformities, bony changes o Soft tissue bleeding o Hematomas o Intracranial hemorrhage (high risk!!) Management o Replaces clotting factors Nursing Care o Prompt treatment of bleeding Factor replacement RICE o Patient safety o Prevent/identify complications o Educate family Administration of factor Safety Medical alert bracelet Future outlook IDA Red blood cell disorder Microcystic, hypochromic anemia (little pale cells) High risk groups o 12 to 36 months o Pre-term infants o Adolescents (mense, poor diet) Pathophysiology o Decreased iron supply o Impaired absorption o Increased demand for Fe (pregnant, growth spurt) o Impaired synthesis of hgb Signs and symptoms
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o Asymptomatic o Decreased Hgb and Hct o Irritability, fatigue, delayed motor development, SOB, decreased activity level, and pale skin o Pica o Moderate to severe: systolic murmur, hepatomegaly, CHF o * Check capillary refills, mucous membrane Management (Know!!) o Dietary counseling
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