PEDS NR 328 EXAM 2 STUDY GUIDE

HEMATOLOGIC DISORDERS: 7-10 questions  Identify general nursing strategies associated with altered anemia  Describe the morphology, pathophysiology, clinical manifestations, therapeutic management and nursing considerations of the following anemias: o ***Laboratory norms: 6-12 years of age  Hemoglobin:  11.5-15.5 g/dl  Hematocrit:  35-45%  MCV (mean corpuscular volume)  77-95 fL  Measure of average size of RBC  ↓ in microcytic; ↑ in macrocytic  MCHC (mean corpuscular Hgb concentration)  31–37 g/dl  Reflection of Hgb concentration  Refer to color; in hypo-, values are ↓  MCH (mean corpuscular Hgb)  25–33 pg/cell  Reflection of Hgb concentration  Refer to color; in hypo-, values are ↓ o Anemia  Condition where the hemoglobin content of the blood is insufficient to satisfy bodily needs  Causes:  Blood loss  Accelerated hemolysis  Decreased production  Typical Clinical Manifestations:  Fatigue  Dizziness  Weakness  Pallor  ↑ heart rate  ↑ breathing rate o Types:  Iron-deficiency anemia—MOST COMMON IN PEDS  Nutritional anemia  Microcytic-hypochromic—small, pale RBC  Who’s at risk? o Varied o Premature babies at ↑ risk b/c they don’t get that blood rush the mom gives the baby late in that 3rd trimester, b/c premies are born early—this is why premature infants need the iron supplements at 2-3 months, whereas term babies don’t need it until 4-6 months PEDS NR 328 o Multiples and twins at ↑ because only finite amount of blood available in that last rush of blood; so not all the babies get enough iron o Breast-fed exclusively babies at ↑ risk—breast milk doesn’t have same iron content as fortified iron formula o Kiddos with chronic blood loss—GI bleeders, hemophiliacs o Kiddos with poor dietary intake; whole milk doesn’t have same iron concentration as iron fortified formula  Pathophysiology: o Body stores iron that is used for erythropoiesis o Iron necessary mineral for erythropoiesis to occur o Not enough iron to transport to the bone marrow to make RBCs o Bone marrow still makes RBCs but they are very small and have a lower hemoglobin concentration  Clinical Manifestations: o Typical signs of anemia plus:  Irritability—due to tissue hypoxia/O2 craving  Pica (especially ice, dirt, chalk, powder or pure starch)—eating of substances that are not typical of kiddos to eat; however this could be hard to distinguish from this occurring normally in toddlerhood  Poor muscle tone  Growth retardation  Headache  Nail bed deformities called?? Spoon nail  Tachycardic; possible murmurs  Lab Values: o Everything is ↓↓↓↓ b/c its microcytic-hypochromic  Implementations: o EDUCATION***  Prevention*  High iron foods*  Foods that a toddler would eat; eggs, breads  Whole milk takes up room in belly!!! So kiddo may not intake enough ironrich food b/c they’re not hungry; remember whole milk does not have same iron concentration like fortified formula so if kiddo is drinking equal amounts of whole milk as he/she used to drink the formula he/she is not getting enough iron  Iron supplements  Best on an empty stomach  Best with Vitamin C  Don’t give with milk  If taking efficiently they will have black/green tarry stools  Lab values best indicator  Use a straw to prevent staining of teeth  Monitor for constipation & treat  Beta-Thallasemia  Hemolytic anemia; bone marrow issue is the underlying patho—blood cells are extremely unstable, RBCs lyse very easily  Not producing correct beta chains of hgb—alpha and gamma attempt to take over and produce RBCs that are fragile and prone to lysing  ***kiddos BM is not making right hemoglobin chains—they break down very quickly and easily  Microcytic-hypochromic  Defective synthesis of the protein component of hemoglobin  Who’s at Risk o Mediterranean descent—Italians and Greeks  Pathophysiology: o Hemoglobin synthesis is impaired o Fragile RBC w/short life o Severe anemia  Types: o Major  Most severe  Occurs in infancy  If kiddo doesn’t receive freq. transfusions and treatments they rarely survive childhood  Without treatment they die before age 7 o Intermediate  Develop normally into adulthood  Need to be treated  Delayed puberty o Minor  Carry the trait, don’t have it  Have normal life-span  Clinical Manifestations: * occurring b/c of BM involvement o Frequent epistaxis* o Osteoporosis* o Pathologic fractures* o Chronic CHF o Myocardia fibrosis o Murmurs