PEDIACTRICS NURSING EXAM 3 ANEMIAS/Growth and development

Sickle cell anemia Nursing interventions

Hydration (IVF)

Opioids do not under treat- comfort measures (morphine)

Bed rest to minimize energy loss

Antibiotics for infections

Monitor spleen and I&O

RICE (rest,ice,compress,elevate)

Early recognition of internal bleeding

Hemophilia

Hereditary disorder X- linked recessive trait

Males are more effected

2 types

Deficiency, dysfunction, lack of coagulation proteins or factors

Interventions for Hemophilia

IV infusions of missing clotting factor

DDAVP (Desmopressin) IV or nasal

EACA (Epsilon- aminocaproic acid)

Corticosteroids

Hemophilia nursing education

Inject subs substituted for IM if possible

Venipuncture for blood draws instead of heel sticks

Supportive measures RICE, EARLY RECOGNITIONS OF BLEEDING

Factor replacement

AVOID ASA products

Iron deficiency anemia

Most common hematologic disorder of childhood not a disease but indication or manifestation of an underlying process

Iron deficiency anemia

Last trimester iron transferred from mother to fetus

Most Fe stored in circulating erythrocytes of fetus remainder stored in fetal liver, spleen, bone marrow

If iron deficient hemoglobin production is decreased and causes low o2 carrying capacity of blood

Hemophilia patient teaching

Medical alert bracelet

Genetic counseling

Decrease risk of injury

Dental hygiene/ razor safety

Teach RICE

Complications of Hemophilia

Uncontrolled bleeding

Shock joint deformity

Hemarthrosis episodes

Iron deficiency anemia

Iron supplements are needed in exclusively breast fed infants

Iron store are sufficient for 5-6 months babies

Formulas are fortified with iron

Wean from bottle by age 1 years old

Transition from formula to cow milk, limit cow milk to 16-24 oz a day

Sickle cell Anemia Treatments

Blood transfusion

Bone marrow transplant

Hydroxyurea makes RBC larger for O2

Splenectomy for splenic sequestration

Sickle cell Anemia Patient Education

signs and symptoms of early bleeding, infection

Maintain uptodate immunizations

Avoid sick people, good hand hygiene

Frequent rest breaks

Avoid contact sports when spleen is enlarged Avoid high altitudes

Administer clotting factor IV

Medical alert bracelet

Encourage fluids

Hemophilia

Episodes of prolonged bleeding, active bleeding, joint pain, stiffness, warmth, swelling, loss of ROM, decreased LOC

Sickle cell anemia Signs and symptoms

Pain/fatigue/dizziness/headache

SOB

Delayed puberty/growth

Organ dysfunction

Cold extremities

Chronic anemia

Iron Supplements in Pediatrics 12 month old infant

Avoid giving the iron supplements with milk or milk products

Be sure to brush her teeth after giving the iron supplements to avoid staining

Children her age should not have more than 16-24 oz of milk per day

Skills for 6-12 year old Fine motor

School Aged

Write sentence

Chores

Gross motor skills 6-12 year olds

Ride a bike

Scooter

Chores

School age Cognitive skills 6-12 years olds

More focus ability

Piaget- concrete

Learn to tell time

School age 6-12 years old language skills

Full sentences

Understand rules

Understand grammar

School age 6-12 years old social skills

Understand different meanings

Learning to like to play with others

Develops friendships (w/ same genders)

School age child 6-12 years old play style

Develop hobbies

Competitive play

Video games

Read books

Associative

Board games

Changes in body School age 6-12 years

Height: 2.5 inches per year

Weight: 4.5-7 pounds a year

Teeth: loosing baby teeth, visit dentist every 6 months)

Onset of puberty: Girls go first (8-13), Boys is (9-13)

Self concept School age 6-12 years

Attains goals

Figure out how they fit in

Can lead to depression if we don’t help them feel proud of selves

Bullying with school aged 6-12 years

School/online

Self coping

Boys- more physical

Girls- mocking, rumors, teasing

Notice it in grades

Obesity School aged 6-12 years old

Poor food choices (cause)

Exercise (need to)

1 hour more of vigorous activity (daily)

Safety School aged 6-12 years old

Swimming (Avoid diving if they can’t see how deep water is)

Falling

Burns (cooking)

Poisons (possible)

Guns safety

Motor vehicles Crashes (seatbelts, sit in the back, booster seat)

Drugs/Alcohol ALWAYS SAY NO

School aged 6-12 years Outcome hospitalization

Isolation for peers

Think they might die, pain

Modesty depending on where injury is at

Interrupts school routine

Separate from friends

School aged 6-12 years Ericksons

Industry VS inferiority

Focus on accomplishments not failures

School aged 6-12 Piagets

6-7 proportional

7-12 concrete operations

Decreased egocentric

Concrete thinkers

School aged 6-12 years Kohlbergs

Follow rules they are good

They don’t know why they are following rules they just follow rules

7-10 generally follow rules

10 generally obey laws

Adolescent 12-18 years old Puberty in girls

Ages 8-13

Ovaries develop can now have babies

Breast development HAPPENS FIRST

Hair growth on pits and pubic area

Increase weight and fat stores

Increase height

Stop growing after 2 years after menstruation

Emotional

Adolescents 12-18 years old Puberty in boys

Ages 9-14

Testes and penis enlarge FIRST

Hair on pits and pubic area

Voice changes

Increase muscle mass

Stop growing at 20

Skin- acne

Rage with testosterone levels increased

Adolescent 12-18 Teeth education

May have braces

Have wire cutters for emergency in ER

See dentist twice a year

Adolescent 12-18 years Social life

Dating

Doing stuff without parents

On apps on socials with phone

Body image

Staying up to date

Adolescent 12-18 years Eating disorders

Anorexic

Bulimia

Body image

Adolescent 12-18 year old Safety

Sports injuries (safety gear)

Firearms (suicide)

Burns (fireworks)

Tanning beds (wearing sunscreen)

Drugs

Sex (pregnancy)

Driving (texting and driving, wear seat belts)

Adolescents 12-18 years Sleep and Exercise

Sleep 8-10 hours a day

Exercise 1 hour a day

Adolescent 12-18 years old FEARS being hospitalized

Lose control (talk to them)

Separate from peers

Privacy invaded (maintain privacy)

Death

Deformity (body image)

Don’t make false promises

Ericksons for 12-18 year old Adolescent

Identity VS Role

Who they are

Independence

Goal: productive stable member of society

Piagets for Adolescent 12-18 years old

12 years and up Adulthood

Abstract thinker

Solves problems

Plans Future