Week 7: Hematology- Clotting and WBC Disorders

Describe the clotting cascade in simple terms.

Blood vessels gets smaller, a platelet plug is made, clotting factors take over, and make a fibrin clot

What is adhesion?

Platelets sticking to wall of torn blood vessel

What is activation and secretion?

Platelets change shape to connect with other platelets

What is aggregation?

Platelets stick to each other and to the blood vessel

What is idiopathic Thrombocytopenic Purpura (ITP)?

Autoimmune destruction of platelets in the spleen

What is the prognosis of idiopathic thrombocytopenic purpura?

Most recover spontaneously in 6-12 months

What are s/s of idiopathic thrombocytopenic purpura?

easy bruising, sudden onset of purpura and petechiae, epistaxis, platelet count <20,000, prolonged bleeding time (hard time stopping bleeding)

What does treatment look like for idiopathic thrombocytopenic purpura?

Supportive therapies, course of steroids, anti D antibody (make sure they aren’t already anemic bc will cause temporary anemia)

What are nursing interventions for idiopathic thrombocytopenic purpura?

Educate parents, assess for bleeding, safety measures to prevent trauma, avoid unnecessary procedures (needle sticks), avoid anything rectal (temp, suppositories, enemas), use soft toothbrush, use an electric razor, not regular one

When discharging a child with ITP from the hospital with a platelet count of 40,000, it is most important for the parents to understand the importance of what?

Seeking immediate medical attention for severe headache, vomiting, or cognitive changes

What are nursing interventions for epistaxis?

Seek medical attention for a nose bleed longer than 30min, sit up leaning forward, apply pressure for 10min, apply ice bag to bridge of the nose

What is hemophilia?

A group of hereditary bleeding disorders that result from deficiencies of specific clotting factors (missing factor/s)

What is hemophilia A?

Classic hemophilia; deficiency of factor VIII

What is hemophilia B?

Christmas disease; deficiency of factor IX

What are s/s of hemophilia A?

Internal bleeding, prolonged bleeding time, hemarthrosis (bleeding into joint spaces), ecchymosis, epistaxis, bleeding after procedures, bleeding into neck/chest/mouth may compromise airway

What are s/s of hemarthrosis?

Stiffness, tingling, and ache followed by decreased mobility, warmth, redness, swelling, and severe pain

What is treatment for hemophilia?

prevent bleeding (soft carpet, knee/elbow pads, padded bed), replacement of deficient factor, regular program of exercise and PT

What are nursing interventions of hemophilia?

Safe environment, teach use of protective equipment, avoid aspirin, SQ injections instead of IM, no suppositories, electric razors, avoid contact sports, soft toothbrush, RICE, monitor for headache/slurred speech/altered LOC/black tarry stools, prevent S/E of bleeding, family support, home care, iron-rich diet

What does RICE stand for and what is it used for?

Rest (immobilize), Ice, compression, elevation; used for hemophilia (clotting disorder)

What is Severe Combined Immunodeficiency Disease (SCID)?

Absence of both humoral and cell-mediated immunity (No B or T cells when born)

What are s/s of Severe Combined Immunodeficiency Disease (SCID)?

Early frequent urinations, failure to thrive, persistent thrush (white patches), adventitious sounds related to pneumonia, very low levels of immunoglobulins

What is treatment for Severe Combined Immunodeficiency Disease (SCID)?

IV immunoglobulin, sterile environment, bone marrow transplant, prevent exposure to infections, very limited visitors, support, education for family

Why might children get HIV?

Get from mother or unprotected sexual intercourse; children do not have antibodies yet so they get sick more easily

What are s/s of HIV in children?

Lymphadenopathy, hepatosplenomegaly, oral candidiasis, chronic diarrhea, failure to thrive, developmental delay

What are s/s of AIDS in children?

Recurrent bacterial infections, pneumonia, candida esophagitis, cytomegalovirus, herpes simplex disease, HIV encephalopathy, wasting syndrome, diarrhea

What can expecting mothers do to help prevent their child from getting AIDS?

Mom stops her antiretrovirals in the 1st trimester of pregnancy but takes them for the 2nd and 3rd trimester

How is HIV diagnosed?

Polymerase chain reaction (PCR)- detection of proviral DNA

Should mothers with HIV breastfeed?

No, they should only use formula

What does treatment for HIV look like?

Antiretroviral therapy, aggressive antibiotic therapy for infections, modified immunization schedule, prophylactic medications against opportunistic infections

What are nursing interventions for HIV?

Prevention, risk for infection, safety issues, educate parents about storage of medications, need increased protein and calories, neutropenic precautions, universal precautions, encourage child to participate in activities with other kids, manage pain