Exam 4 (Hematologic, integumentary, child maltreatment, FTT)

What is the condition where the body lacks enough iron to produce hemoglobin, leading to a decreased oxygen delivery to tissues?

Iron Deficiency Anemia

What age range is more at risk for developing iron deficiency anemia?

6 months to 2 years

Why are toddlers more at risk for iron deficiency?

They have diets high in cow milk, which is low in iron and can also inhibit iron absorption and cause GI building.

What is needed for the formation of hemoglobin?

Iron

What condition manifests as muscle weakness, fatigue, severe SOB, poor feeding, pale skin, nails, mucus membranes, tachycardia, hair loss, and weight?

Iron deficiency anemia

What condition manifests as headache, dizziness, irritability, altered thought process, decreased attention span, decreased attention span, and depression?

Iron deficiency anemia

What protein is bound to iron?

Ferritin

What are the 4 labs for diagnosing iron deficiency anemia?

low RBCs, low H&H, low ferritin levels and low MCV

Is iron better absorbed in breast milk or formula?

breast milk

when should you start giving cow milk to pediatrics?

after 12 months of age

what ways can iron be given?

PO or IM

How many times are iron supplements given and when?

BID between meals

what do you have to watch out for with liquid iron medication and what can be done to either prevent or help with it?

it can stain the teeth .

give the medication through a straw and really thoroughly brush their teeth

what helps facilitate absorption in iron supplements?

Vitamin C

What are some side effects of taking oral iron supplements?

Dark/black stools, GI upset and constipation

What condition is associated with the presence of abnormal Hgb gene?

Sickle Cell Disease

What causes inflammation, vase-occlusion, local hypoxia, ischemia, and infarction?

Sickle Cell Disease

What triggers sickling of red blood cells?

Hypoxia, dehydration, acidosis, infection and cold temperatures

When are the manifestations of sickle cell disease asymptomatic?

the first 4-6 months of life

What are the two types of crises in sickle cell disease?

• vaso-occlusive crisis

• sequestration crisis

What crisis is characterized by ischemia, occurs less than once a year to 15 times a year, is extremely painful, and has pain lasting from hours to weeks with duration of 4-6 days?

Vaso-occlusive crisis

What condition manifests as hand-foot syndrome (tender, warm and swollen hands/feet), CVA, symptoms similar to pneumonia, priapism, lumbosacral spine, knee, shoulder, elbow or femur pain?

Vaso-occlusive crisis in sickle cell disease.

What is usually the first sign of a vaso-occlusive crisis In pediatric patients and what can that lead to if not treated properly?

hand foot syndrome.

can lead to ulcerations

What crisis is characterized as excessive pooling of blood in the spleen and often in the liver, can lead to decreased circulation volume, CV collapse, and shock?

Sequestration crisis

What type of crisis is most commonly seen in children under 3 years old?

Sequestration crisis

How is sickle cell disease diagnosed?

• prenatal diagnosis

• newborn screening

• CBC

• Sickledex

• Hemoglobin electrophoresis

What are some ways to manage sickle cell disease in children!

• avoid stimuli

• immunizations

• prophylactic antibiotics

• blood transfusions

• O2 to maintain Sats <93%

• hydration

What are some stimuli to avoid in kids with sickle cell disease?

• fever

• infection

• acidosis

• dehydration

• hypothermia

What pain management should not be used in pediatric patients with sickle cell anemia and why?

No meperidine/demerol because it can lead to seizures

What can help with increasing fetal hemoglobin in pediatric patients with sickle cell disease?

Hydroxyurea

What are ways to medically manage pediatric patients with sickle cell disease?

• bedrest

• hydration through oral and IV therapy

• electrolyte replacement

• blood replacement

• antibiotics

• warm compresses

• family support

What condition is caused by a deficiency in Factor VIII (produced by the liver and necessary for the formation of thromboplastin in the coagulation process)?

Hemophilia A

How can hemophilia A compromise the airway?

Bleeding can occur in the neck, mouth and/or thorax

What condition manifests as bruising easily, bleeding into joints (hemarthrosis), persistent bleeding from minor lacerations, pain/limited movement in elbows, knees and ankles, hematuria and epistaxis?

Hemophilia A

How is hemophilia A diagnosed in pediatric patients?

• history of bleeding episodes

• evidence of x-linked inheritance

• prolonged Pt/PTT

• specific levels of clotting factors

Why would DDAVP be used in a patient with hemophilia A?

it is a synthetic anti-diuretic.

to increases factor 8 in the circulatory system

What are some ways to therapeutically manage pediatric patients with hemophilia A?

• factor VIII concentrate

• DDAVP

• Rest, Ice, Compression, Elevate (RICE)

• regular program of exercise and physical therapy

• medic alert bracelet

• school nurse

What is the difference between primary skin lesions and secondary skin lesions?

Primary skin lesions - initial skin changes occurring due to a disease process or injury and they present at the onset of the skin condition

Secondary skin lesions - developed after a primary skin lesion due to external factors (such as scratching, infection or healing processes)

What bacterial infection is highly contagious, superficial, and caused by either staphylococcus aureus or group A beta-hemolytic streptococci?

Impetigo

What condition is this?

Impetigo contagiosa

what condition is this?

Bullous impetigo

What impetigo involves crusted lesions?

impetigo contagious

What impetigo involves fragile bullae?

Bullous impetigo

How do impetigo lesions start out as?

Small red macule, progressing to thin-roofed vesicles or pustules that rupture easily and expose weeping, denuded skin

What does impetigo lesion drainage look like?

honey color and it forms crust

how does bulls impetigo start off as?

small red macule but progresses rapidly to vesicles that enlarge to form bullae

where do impetigo lesions usually appear?

face, around the mouth and nares.

also on extremities and buttocks

How to gently remove the crusts of impetigo?

soak in warm, soapy water

How long should a child remain out of school when they have impetigo?

24-48 hours

What bacterial infection causes inflammation of the skin and subcutaneous tissues commonly caused by streptococcus, staphylococcus, and H. influenza?

Cellulitis

What condition manifests as intense redness, swelling, firm infiltration of the affected area, fever, malaise and lots of pain?

Cellulitis

what antibiotics can be used for cellulitis?

cephalosporins and penicillins (broad spectrum)

What condition is this and how dangerous can it be?

cellulitis (perioribital)

it can cause vision changes and due to the infection being so close to the eye, it is close to the brain and can lead to meningitis

what infection is caused by Candida albicans and grows in chronically moist areas?

Candidiasis

what condition manifests as inflamed areas with white exudate, peeling, easy bleeding and can be pruritic?

Candidiasis

what condition is this?

candidiasis

how is candidiasis managed?

Nystatin

what condition is an erythematous scaling patch that spreads peripherally and generally round or oval?

Ringworm

what is tine corporis?

ringwormm

how is ringworm usually acquired?

from infected pets or other animal origins

What infection is caused by trichophyton rubrum, trichophyton mentagrophytes or M. Canis?

Tina corporis (ringworm)

What condition is erythematous scaling patch spreading peripherally usually more localized in the medial proximal aspect of thighs and crural fold, and can also involve the scrotum?

tine cruris (jock itch)

what condition is caused by epidermophyton floccosum, T. rubrum, or T. mentagrophytes?

Tina curries (jock itch)

what can be soothing for pediatric patients with ring worm or jock itch?

warm compresses

What condition manifests as maceration/fissuring between the toes, patches with pinhead sized vesicles on plantar surface, and pruritic?

Tinea pedis (athlete’s foot)

what condition is caused by T. rubrum, trichophyton interdigitale, or E. floccosum?

Tina pedis (athlete’s foot)

What are highly contagious disorders that may epidemic, effects of these parasites often create discomfort and embarrassment for the child and the caregiver?

Infestations

What is pediculosis capitis?

Head lice

What condition manifests as persistent itching of the scalp, located in the occipital area, behind ears, nape of neck, mild fever, lymphadenopathy and malaise?

Head lice (pediculosis capitis)

How is head lice spread and what is the patho?

sharing hair supplies and products.

female’s eggs are attached to the root of the air in egg casings that are held to the hair shaft by a water-insoluble, glue like substance.

nymphs emerge from the eggs in 7-10 days and mature into adults in another 7-14 days,

How is head lice treated?

• permethrin kills both the lice and nits after one apllication

• use a fine-toothed comb to remove all of the nits and lice

What are ways to prevent further infestation?

• machine wash all clothing, towels, bed lines in hot water and dry in hot dryer

• thoroughly vacuum carpets, car seats, stuffed animals and pillows

• soak combs, brushes, hair accessories in lice-killing products or boil for 10 minutes

• discourage sharing of items

What condition is transmitted primarily by close person to person contact, caused by infestation of the scabies mite, sarcoptes scabiei?

Scabies

when do symptoms start for someone with scabies?

begins 30-60 days after initial contact

what happens when scabies mite are on the human skin?

the mites burrow into the stratum corneum of the epidermis to deposit eggs and feces?

what condition manifests as pruritic (especially at night), erythematous, maculopapular rash, small grayish-brown, threadlike, burrow tracks with black dot at the end of the burrow, extent of the lesions range from a few to hundreds?

Scabies

what condition is this?

scabies

what condition is this?

pediculosis capitis (head lice)

What treatment can be used for scabies?

Scabicide lotion and creams?

Can you get scabies medication OTC or do you need a prescription?

Prescription is needed

What be used for pruritis in scabies?

Antihistamines like diphenhydramine

what condition is caused by skin breakdown occurring due to a d-consequence of prolonged contact with physical and chemical irritants? the resulting injury places the infant at risk for overgrowth of microorganisms, including Candida albicans?

Diaper dermatitis

what condition is this?

diaper dermatitis

What condition initially appears as a shiny erythema which covers convex surfaces, and in severe cases (vesicles, papules and scaling)?

Diaper dermatitis

what condition manifests as beefy red central erythema with satellite pustules?

Candidal diaper dermatitis

What are some ways to treat diaper dermatitis? (what to avoid and what medications)

• avoid over washing of skin

• avoid baby powder

• use barrier creams to protect skin from moisture and irritant

• low dose steroid creams

what can be used to protect the skin from moisture and irritant?

barrier creams

what condition manifests with lesions that are typically thick, adherent, whitish-yellowish, scaly, oily patches and may be mildly pruritic?

Seborrheic dermatitis (cradle cap)

where is seborrheic dermatitis usually found on infants?

found on the scalp

where is seborrheic dermatitis usually found on adolescents?

lesions begin on the scalp and can involve eyebrows, forehead, eyelids, external ear canals and inguinal region

how to treat seborrheic dermatitis in infants?

• washing hair daily with mild medicated shampoo

• let shampoo, white petroleum jelly or mineral oil in place for a few hours to help loosen the scales, then remove the scales with a fine-toothed comb

how to treat seborrheic dermatitis in adolescents?

• may use medicated shampoo containing sulfur or salicylic acid

• topic corticosteroid lotion with or without sulfur precipitate or salicylic acid can be used BID for resistant lesions

What is child maltreatment?

A broad term that includes intentional physical, emotional, or sexual abuse, and neglect of a child.

What is the most common form of child maltreatment?

Neglect

Which parental characteristics are associated with a higher risk of child maltreatment?

• young/single parent

• substance abuse

• history of being abused

• low income, little education

• social isolation

what child characteristics may increase risk for abuse?

• age <1 year

• prematurity

• physical or cognitive disabilities

• hyperactive or difficult temperament

• unwanted child

Name 3 environmental risk factors for abuse

• chronic stress in the home

• crowded living conditions

• involvement of multiple caregivers

A child presents with bruising on the thighs and back. What does this suggest?

These are non-bony, concealed areas, which may indicate deliberate injury rather than accidental trauma

What are red flags in the history that may indicate abuse?

• history that doesn't match injury

• delayed presentation

• conflicting stories

• bruises in various stages of healing

• parent’s affect is inappropriate or defensive

what specific injury might raise concern for abuse in infants?

torn frenulum ( often from forced feeding), posterior rib fractures, or bruising on a non-mobile infant