Peds Exam 1

oral route medication safety

if liquid form is unavailable, crush tablet and mix with fluid

do not mix tablets with essential fluids like formula → can cause feeding refusal

allow child to make choices to give sense of control → what pill first, what drink

use dropper or syringe → drop alongside the tongue and hold child upright

nasal route medication safety

blow nose first

med should be room temperature

tilt head back

push up gently on nose

instruct child to breathe through mouth

aim dropper towards back of nostril

keep head tilted back for 1 minute

optic route medication safety

room temperature

clean away eye secretions

tilt head back and have child look at ceiling

drop into conjunctival sac and have the child open their eye

apply ointment from inner canthus to outer canthus

• have child close their eye without rubbing

wipe away first drop in case contaminated

may cause blurred vision for a short time

otic route medication safety

room temperature

child on side with affected ear up

children younger than 3: pinna down and back

children older than 3: pinna up and back

lie still for 1 minute

rectal route medication safety

Sims’ position

L side with R knee flexed up to the chest

hold buttocks together for 5 minutes to prevent expulsion

keep child in Sims’ position for 20 minutes

subcutaneous route medication safety

places of injection: abdomen, lateral and posterior upper arm or thigh, scapular area on the back, upper ventrodorsal gluteal areas

IM injection places

vastus lateralis, rectus femoris, ventrogluteal, dorsogluteal, deltoid

calculations for fluid

20 mL/kg for fluid bolus given over 30 minutes

maintenance fluids:

• first 10 kg: 4 mL/kg/hr

• next 10 kg: 2 mL/kg/hr

• remaining kg: 1 mL/kg/hr

acetaminophen dose

15 mg/kg/dose

ibuprofen dose

10 mg/kg/dose

normal temperatures for different ages

3 months: 99.5 axillary or rectal route

6 months: 99.9 axillary or rectal route

1 year: 99.0 axillary or rectal route

3 years: 98.6 axillary, tympanic, oral or rectal route

5 years: 98.6 axillary, tympanic, oral or rectal route

7 years: 98.2 oral, axillary, or tympanic route

9 years: 98.1 oral, axillary or tympanic route

11 years: 98.1 oral, axillary, tympanic route

13 years: 97.9 oral, axillary, tympanic route

normal pulse by age

newborn (birth-4 weeks): 110-160/min

infant (1-12 months): 90-120/min

toddler (1-2 years): 80-120/min

preschooler (3-5 years): 70-110/min

school-aged (6-12 years): 65-110/min

adolescent (13-18 years): 60-95/min

normal respiratory rate by age

newborn (birth-4 weeks): 30-60/min

infant (1-12 months): 25-30/min

toddler (1-2 years): 25-30/min

preschooler (3-5 years): 20-25/min

school-aged (6-12 years): 20-25/min

adolescent (13-18 years): 16-20/min

blood pressures by age

newborn (birth-4 weeks): 64/41

infant (1-12 months): 85/50

toddler (1-2 years) male: 85-91/37-46

toddler (1-2 years) female: 86-89/40-49

preschooler (3-5 years) male: 91-98/46-53

preschooler (3-5 years) female: 89-93/49-52

school-aged (6-12 years) male: 96-106/55-62

school-aged (6-12 years) female: 94-105/56-62

adolescent (13-18 years): <120/<80

physical development for infant (birth to 1 year)

gain 5-6 oz/wk for the first 6 months

grow 2.5 cm (1 inch) monthly for first 6 months

head circumference increases 1.5 cm/month for first 6 months

posterior fontanelle closed by 2 months, anterior fontanelle closes at 12-18 months

5-6 months = first tooth

5-6 months birth weight should be doubled, by 1 year it triples and length increases by 50%

erikson psychosocial development infancy (Birth-1 year)

trust vs mistrust

• based on quality of caregiver-infant relationship and care received by the infant

basic needs: nourishment, attachment, attention

• met with crying

• begins to learn delayed gratification, failure to learn delayed gratification leads to mistrust

• trust is developed by meeting comfort, feeding, stimulation, and caring needs

mistrust develops if needs are inadequately or inconsistently met, or if needs are continuously met before being vocalized by the infant

mouth and pleasure

hands/feet = play

solitary play - plays by self

infant development (birth-1 year) motor development

gain head control at 2 months

turn from stomach to back at 4 months

turn back to stomach and sit unattended at 6 months

locomotion, crawling and creeping at 8 months

cruising, start to make steps at 10 months

walking at 12 months

fine motor:

• grasp reflex until 2-3 months

• pincer grasp at 8-9 months

• transferring objects hand to hand at 6-8 months

sensory development infant (birth-1 year)

fix on moving object at 1 month

search to locate sound at 2 month

beginning to have hand eye coordination at 4 months

responding to own name at 7 months

vocalization in infancy (birth-1 year)

babbling at 3 months

begins consonant sounds at 4 months

responds to simple commands and comprehends no at 9 months

can say dada/mama and understands meaning, may say one word at 10 months

3-5 words besides mama/dada at 12 months

social/cognition in infancy (birth-1 year)

social smile at 2 months old → reaction from others

stranger anxiety at 6-7 months

object permanence at 10 months

biologic development for toddlers (1-3 years old)

trend height, weight and head circumference to find dips or accelerations

motor development for toddlers (1-3 years old)

pull self up and take 2-3 steps independently by 12 months

jumps, kicks ball, pedals tricycle by 2-3 years

fine motor:

• hold crayon by 1 year

• draw simple shapes by 2-3 years

Play: parallel play: play by each other but do not interact

300 words by 2 years old

multiword sentences by 3 years old

erikson’s psychosocial development toddlers (1-3 years)

autonomy vs shame and doubt

learn to do things on own without parents help → independence is paramount for toddlers who are attempting to do everything for themselves

learn to control environment with their words → love the word no

• often use negativism, or negative responses, as they begin to express their independence

toilet training occurs

imitate previously seen activities

• ritualism, or maintaining routines and reliability, provides sense of comfort for toddlers as they begin to explore the environment beyond those most familiar to them

biologic development preschool years (3-5 years)

more graceful, no longer squat and potbellied

height and weight growth slow

motor development preschool years (3-5 years)

rides the tricycle at 3 years

hops on 1 foot at 4-5 years

fine motor:

• draw discernable pictures and use scissors at 4-5 years

copy figures on paper

dress independently

associative play

make judgements based on visual appearance

2100 words by 6 years old

erikson psychosocial development preschool years (3-5 years)

initiative vs guilt

expresses desire to take part in activities

• energetic learners, despite not having all of the physical abilities necessary to be successful at everything

guilt can occur when preschoolers believe they misbehaved or when they are unable to accomplish a task

learn about environment through play

• guiding preschoolers to attempt activities within their capabilities while setting limits is appropriate

have them clean up toys, sweep, etc.

“magical thinking” → tricycle is bad if they fell off

play: associative play - play side by side, but not together

health promotion for preschoolers (3-5 years)

sleep: 10-12 hours/day with 1 nap

• nightmares/terrors

• favorite stuffed animals/blankets

encourage enrollment in nursery school

assess school readiness

motor vehicle, water and fire safety

dental health

immunizations

biological development school aged children (5-12 years)

slow and steady

• do not want big jumps in height/weight until tween years

beginning of school age - boys are taller and bigger than girls

end of school age - girls are taller and bigger than boys

tell time

see others perspectives

solve problems

competitive and cooperative play

preadolescence

8/9-12 years old

rapid growth period

• 4/5th grade in girls

• 9-14 years old in boys

want to play multiple sports and promote body positivity

onset of sex characteristics

• breast buds in girls

• testicle enlargement in boys

Erikson psychosocial theory school ages (5-12 years)

industry vs inferiority

• sense of industry is achieved through the development of skills and knowledge that allows the child to provide meaningful contributions to society

• sense of accomplishment is gained through the ability to cooperate and compete with others

build self esteem

new skills, responsibilities, sense of confidence

• should be challenged with tasks that need to be accomplished, and be allowed to work through individual differences in order to complete the tasks

• creating systems that reward successful mastery of skills and tasks can create a sense of inferiority in children unable to complete the tasks or acquire every skill

play: strong association with peers

• peer pressure and bullying

• playing with same sex

• should be taught that not everyone will master every skill

health promotion for school aged children (5-12 years)

encourage personal responsibility for hygiene, nutrition, exercise, recreation, sleep and safety

injury prevention:

• safety helmets

• protective eye and mouth wear in sports

• protective padding

biologic development for adolescents (12-21 years)

physical growth spurt for 2-3 years

• girls:

  • 15-55 lbs

  • 2-8 inches → stops 2 years after first period

  • must gain weight to start period

• boys:

  • 15-65 lbs

  • 4.5-12 inches

puberty

sex hormone secretion (estrogen, progesterone, androgens) prompts the development of secondary sex characteristics

• males: growth of penis and scrotum

• females: breast tissue and body hair

eriksons psychosocial development of adolescents (12-21 years)

identity vs confusion

• who am I?

• often try different roles and experiences to develop a sense of personal identity, and come to view themselves as unique individuals

develops personal values, wants to be adult but needs support from caregivers

interested in sexuality and gender roles

self image depends on others

• group identity: adolescents become part of a peer group that greatly influences their behavior

believes he or she is special:

• believes they are invincible

• anything that happens to them happens to no one else

• on a stage and everyone is watching them

upper airway differences peds vs adults

shorter and narrower → can get clogged easier

small, oral cavities and larger tongues

long, floppy epiglottises

larynx and glottis higher in neck

cartilage in neck is more flexible

increased airway resistance

lower airway differences peds vs adults

mainstem bronchi separates higher (T3 vs T6)

fewer, immature alveoli → harder time getting O2 into body

narrower bronchioles

diaphragm used for inspiration if < 6 years (belly breathers)

immature intercostal muscles → causes more retractions

what do the changes in respiratory system in kids mean

children have higher work of breathing

can cause

• tachypnea, retractions, nasal flaring, stridor (upper) or wheezing (lower), hypoxemia or hypercapnia if severe

respiratory assessment

respirations → rate and rhythm

• rate goes up first when problems arise in order to get more O2 in

• depth and symmetry

• effort

cough

• characteristics, effort, timing

color

• location and shade

• effect of crying

• cyanosis

  • central is worse than peripheral

pain

• location and origin

• severity

adventitious lung sounds

• wheeze

• stridor

• crackles

• odors of breath and mucus

positioning

• are they trying to sit forward

respiratory distress compensatory mechanisms

cannot get adequate O2

retractions → assist with ventilation

hyperextension of head and neck → opens airways

grunting → keeps alveoli open

nasal flaring → increase diameter of air passage

head bobbing → assist with ventilation → sign of impending failure

position of comfort (leaning forward) → maximize tidal volume

other symptoms

• restlessness → altered mental status → especially with air hunger

• tachypnea and tachycardia

• diaphoresis

respiratory failure

occurs suddenly when compensation fails

preceded by hypoventilation in the alveoli, followed by respiratory arrest if not treated

respiratory failure signs and symptoms

cyanosis/gray color

tachypnea, then bradypnea

severe retractions and apnea

AMS → unresponsive

extreme tachycardia then bradycardia

unable to maintain O2 level

acidotic pH → retaining CO2

oxygen assessment

pulse ox

• quick assessment of respiratory status

• 95-100% is normal

• <91% intervention necessary

• <86% life threatening

oxygenation

newborns are nose breathers

• 4 month olds start mouth breathing

NC: 24%-36% O2; 0.25-6L

Simple face mask: 35%-50%; 5-10L

Non-rebreather: 70%-100%; 10-15L

BiPAP, then CPAP, then intubation

interventions for oxygenation

aerosolized nebulizer therapies:

• bronchodilators, corticosteroids, mucolytics, antibiotics

• care: slow deep breaths, lasts 10-15 minutes, mask/mouthpiece, assess pre/post vitals (increase in pulse ox)

metered-dose inhalers:

• bronchodilators and corticosteroids

• care: shake well, inhale deeply, wait 1 min between puffs, hold breath 3-5 seconds

• if using steroid wash mouth after

chest PT

oxygen therapy

• hypoxia

• care: consider mode of delivery, humidify and warm it, put pt in semi-fowler or fowler’s, assess respiratory status, provide oral care and possible ABGs

suctioning

• excessive secretions removed orally, nasally, or endotracheally

• care:

  • oral: clean technique, mushroom cap

  • nasal: clean technique, hard tip catheter

  • ETT: follow policy

artificial airways:

• airway adjuncts utilized for respiratory failure or arrest

tonsillitis

acute tonsillitis - inflammation and redness of bilateral tonsils

RF: exposure to illness

s/s: complaining of sore throat with difficulty swallowing, mouth odor, mouth breathing, snoring, nasal sounding voice, fever, beefy red swollen tonsils that can close off back of throat

treatment: pain meds (tylenol), antibiotics for GABHS; surgery → high risk of hemorrhage and dehydration post op (watch for frequent swallowing and offer ice chips)

laryngotracheobronchitis (LTB) → croup

most common croup disorder

occurs in 3 months - 8 years

viral infection in upper airway causes upper airway inflammation, can cause complete closure

signs and symptoms of croup

gradual onset, slow progression → will wake up with cough

brassy, seal-like, barky cough

dyspnea

stridor

tachypnea

retractions

low-grade fever

steeple sign (narrowing of airway)

treatment for croup

keep child calm, more crying = more inflammation

steroids:

• dexamethasone 0.6 mg/kg x1

• prednisolone if given before cough starts

racemic epi

• inhaled epi

• 0.05 mL/kg per dose (max 0.5 mL) diluted to 3 mLs run over 15 min

• can repeat Q15-20 min, usually Q1-2 hours

FLUIDS

epiglottitis

inflammation and swelling of epiglottis in < 6 hours (cannot intubate) → MEDICAL EMERGENCY

causes: HiB, bacterial infection

prevention: HiB vaccine

signs and symptoms of epiglottitis

rapid onset!

toxic appearance

tripoding

drooling → cannot swallow

stridor

croaking sounds

high fever, cherry red epiglottis

thumb sign on Xray

treatment for epiglottitis

keep calm, avoid crying and anxiety

immediate ETT for airway patency → goal is to recognize it early enough to put one in

antibiotics, steroids

humidified O2

nursing interventions for epiglottitis

NEVER DO SWAB OR TONGUE DEPRESSOR

humidified O2

keep calm, position of comfort (sitting forward)

prepare intubation with difficult airway cart

antibiotics, steroids

defer procedures until airway is patent

croup vs epiglottitis

croup:

• low grade fever

• stridor

• tachypnea

• retractions

• barky cough

• gradual onset

• cause: virus

• x-ray: steeple sign

• treat with steroids/support airway

epiglottitis:

• high fever

• stridor

• tachypnea

• retractions

• drooling

• sore throat

• sudden onset

• cause: bacteria

• x-ray: thumb sign

• treat with abx and intubate

foreign body aspiration

inhalation of object into respiratory tract

• where it lands changes signs and symptoms

  • cough, dyspnea, stridor, hoarseness

  • severe respiratory distress

button batteries

• will cause erosion and fistula

• emergency

treatment

• foreign body removal

• prevent with anticipatory guidance

bronchiolitis/RSV

usually in babies between 2-6 months

cells in bronchioles die and accumulate and obstruct

• every time they get sick for the next 3-4 years they get reactive airway disease

bornchiolitis/RSV signs and symptoms

mild cough, rhinorrhea and congestion

worsening symptoms after 2 days

apnea (reflex apnea)

• presenting symptom in 20% of infants admitted to hospital with RSV

• requires CPAP

severe hypoxemia

bronchiolitis/RSV treatments

self limiting

CPAP or other positive airway ventilation

symptomatic treatment

caused by virus → not a lot of treatments

bronchitis

inflammation of trachea, bronchi and bronchioles

usually viral

bronchitis signs and symptoms

coarse barking cough, chest pain, thick sputum

sort of life reactive airway disease (Asthma)

bronchitis treatment

self limiting → treat symptomatically (humidification)

may vomit thick mucus

asthma

most common chronic condition in children

intermittent bronchoconstriction, increased mucus production, airway remodeling

diagnose with pulmonary function test

asthma signs and symptoms

wheezing

triggers: pollen, mold, dander, tobacco smoke, exercise, anxiety

asthma treatment

albuterol inhaler

avoid triggers

interventions based on peak flow meter results

status asthmaticus

if left untreated can progress to cardiac and respiratory arrest

signs and symptoms

• wheezing, labored breathing, nasal flaring, lack of air movement in lungs, use of accessory muscles, tachycardia, tachypnea, hypoxia

treatment

• 3 nebulizer treatments of albuterol q20-30 minutes apart or continuously

• ipratropium bromide can also be added

• mag sulfate IV bolus (relaxes lungs)

• ICU level care

  • heliox

  • ketamine to intubate

  • non-invasive ventilation or invasive if cardiac arrest

cystic fibrosis

autosomal recessive genetic disorder creating abnormalities in body’s salt, water and mucous making cells

diagnosis

• sweat chloride test > 60 mmol

• tested on newborn screen

cystic fibrosis signs and symptoms

no stool before leaving hospital as newborn → steattorhea

failure to thrive, tachypnea, wheezing, retractions, recurrent pneumonia

thick sticky mucus builds up in lungs, sinuses, liver, pancreas, intestines and reproductive organs

cystic fibrosis treatment

pancreatic enzyme replacement (creon)→ ensure it is taken with every meal and snack

percussion and drainage

mucolytics

• Guaifenesin

• Sodium citrate

• acetylcysteine

• dornase alfa

• pulmozyme

diet: high protein, high calorie, high fat

respiratory medications

bronchodilators

• SA: albuterol

• LA: salmeterol

leukotrine modifiers

• montelukast

anticholinergics

• Ipratropium

• theophylline

corticosteroids

• methylprednisolone

• prednisone

• fluticasone

mast cell stabilizers

• cromolyn

monoclonal antibodies

• omalizumab

mag sulfate → moderate to severe attacks

cognitive and mental health assessment

subjective

• birth history

• past medical history

• family history

• social history

• behavioral symptoms

objective

• developmental screenings

• physical examination

• diagnostic testing to assess for organic causes

nursing interventions for mental health

provide supportive care

• play therapy: a form of psychotherapy that encourages children to express feelings and emotions through play

• play therapy is used for children 3-12 years of age

• therapeutic play: a technique employed by child life specialists for hospitalized children

• art therapy: incorporates creativity in healing and expressing childhood emotions (all ages)

maintaining a safe environment:

• ensure safety from self-harm

• environmental assessment (no sharp objects or tubing, standard safety measures, adult supervision)

• assess the safety of the home environment if outpatient and hospital environment if inpatient

learning disabilities

difficulties in receiving and processing information and generating appropriate responses

most common is dyslexia, which is receptive language that creates difficulty using letters to decode written language

learning disabilities manifestations

may not appear until children enter school

slower acquisition of language and math skills, difficulty recognizing letters and numbers, and problems with reading comprehension

identify through standardized developmental evaluation and create individualized education plan (IEP)

child abuse and neglect signs and symptoms

nonspecific condition (vomiting or pain) that does NOT have a clear medical cause

injury pattern consistent with abusive mechanism (bites, loop of cord, slap marks, immersion burns, cigarette/lighter burns)

highly suspicious injury for abuse (subdural hematoma, rib fractures, femur fracture in non-walking child, pancreatic and proximal small bowel injury, immersion burns)

inconsistent history with injury pattern (denial of trauma despite serious injury)

implausible mechanism to explain severity of injury

timeline or story keeps changing (unexplained delay in seeking treatment when seriously injured)

developmentally improbable behavior of the child (spiral fracture in a non-mobile child)

anxiety disorder

SSRIs, fluoxetine

use standardized anxiety rating scales and structured diagnostic reviewing to diagnose

worry, fear, and anxiety extend past normal adaptive coping mechanisms and cause stress and significant impairment

anxiety disorder s/s

abdominal pain

nausea

palpitations

dyspnea

aggression

defiance

vomiting

dizziness

anxiety treatment

exposure-based cognitive behavioral therapy to treat separation anxiety disorder and school refusal

SSRIs

fluoxetine is most common in children

SSRIs can increase the risk of suicide in pediatric patient

autism spectrum quick reference sheet

a continuum of neurobiological symptoms that result in difficulty with communication, behavior, and social interaction that are usually present by age 3

increased incidence in bodys

presentations are varied and exist along a spectrum

autism spectrum disorder (ASD) risk factors

genetic basis combined with environmental factors

• no link to vaccinations

screening tools:

• MCHAT

• ages and stages

autism manifestations

stereotypy (repetitive movements)

obsessive behavior

difficulty with sensory integration

echolalia (Repetition of words without meaning)

avoidance of eye contact

autism treatment

early identification and referral to early intervention programs are the cornerstones of effective treatment

plan educational activities that limit overstimulation of the senses

utilize a multidisciplinary approach (behavioral health specialists, speech therapy, developmental pediatricians, occupational therapists)

• collaborate with school personnel to align the child’s needs for maximal learning and limited distress

• consult with speed therapist to improve communication skills

shaken baby syndrome

poor feeding

irritability

lethargy

vomiting

seizures

periods of apnea

retinal hemorrhage

emotional abuse

extreme behavior

delayed physical or emotional growth

sexual abuse

difficulty sitting or walking

strange or advanced sexual behavior for age

STD/STI/UTI

new onset bedwetting

nursing care for child maltreatment

assess ASAP

immediate care for injuries

detailed documentation

interview patient and caretaker separately

must report suspicion of abuse

help pt develop safety plan

munchausen syndrome by proxy (MBP)

imposer is often mother but can be any parent or caregiver

misinterpretation or presentation of exaggerated or absent symptoms in a child to gain entry into the medical setting

contributing factors (in the perpetrator)

• past history of abuse

• personality disorders

• somatic symptom disorder

• pathological lying

manifestations

• frequent medical visits for fictious symptoms

• purposeful inducement of physical symptoms

• manipulation of laboratory tests to produce clinical signs of disease

ensure childs safety and incorporate treatment (in home therapy, foster home placement, incarceration)

elements of blood normal values

WBC 5-15

RBC 4-5.5

Hgb 10-15

Plt 150k-450k

hemoglobin by age

1-3 days: 14.5-22.5

2 months: 9-14

6-12 years: 11.5-15.5

12-18 years male: 13-16

12-18 years female: 12-16

anemia causes

reduction of RBC volume and/or hemoglobin concentration

excessive bleeding

increased destruction of RBCs

impaired or decreased rate of RBC production

bone marrow failure

deficiency of essential nutrients

anemia signs and symptoms

related to decreased O2 carrying

muscle weakness

fatigue, inability to concentrate

palpitations, tachycardia

dyspnea on exertion

pallor

PICA

dry brittle nails

concave, spoon nails

growth retardation

CNS:

• dizziness, HA, lightheadedness, irritability, decreased attention span, depression

anemia diagnosis

screen Hgb/Hct

• infancy (9-12 months)

• early childhood (1-5 years)

• late childhood (5-12 years)

• adolescence (14-20 years)

history and physical

CBC and iron studies

• says why you are anemic

reticulocytes → is the body making new RBCs

bone marrow aspiration → is another blood cell production overtaking

anemia treatment

prepare child for labs

treat underlying cause

• replace blood or nutrients, review blood transfusion

• decreased oxygen tissue needs → rest

iron deficiency anemia

anemia caused by inadequate supply of iron essential for RBCs

patho: iron is required for production of Hgb, so decreased iron = decreased Hgb

etiology:

• low iron stores at birth

• maternal iron stores in infant become depleted

• inadequate dietary intake of iron

• prominent in rapid growth age groups

signs and symptoms of iron deficiency anemia

anemia symptoms

milk baby

• glossitis → tongue inflammation

• angular stomatitis → small cracks in corner of mouth

• koilonychia → spoon shaped nails

• impaired neurocognitive function

treatment for iron deficiency anemia

prevent and screen

only breastmilk or formula for first 12 months

• limit cowsmilk

iron supplements → ferrous sulfate

• 2-3x per day

• between meals

• vitamin C increases absorption

• brush teeth

  • use straw for iron

• dark green/black stools are normal

• can cause GI upset

iron rich foods

if IM iron dextran → use Z track method

blood transfusions

follow adult protocol and:

• first 50mL or 20% of volume (whichever is smaller, goes slower)

signs of reaction:

• sudden, severe HA

• chills

• shaking

• fever

• pain at needle site and vein

• N/V

• sensation of chest tightness

• red/black urine

• flank pain

• hives

sickle cell anemia

abnormal Hgb S present → try to keep <40% with transfusions

patho:

• dehydration, acidosis, hypoxia or extreme temps cause Hgb to sickle and cannot slide through veins

blockages:

• in spleen → enlargement

• chest → acute chest syndrome

  • pneumonia like illness

  • Chest pain, cough, fever, low O2, substances in the lungs

  • occurs when sickle cells block blood vessels in the lungs

• brain → stroke

• liver → failure and necrosis

• kidney → impairment (hematuria, impairment of concentration ability)

• eyes → retinopathy

• osteomyelitis

• heart → chronic stress from anemia, cardiomegaly, murmur

sickle cell anemia signs and symptoms

growth retardation

delayed sexual maturation

chronic anemia (6-9 Hgb)

susceptible to infection and sepsis

sickle cell anemia diagnosis

sickle cell turbidity test

gold standard: hemoglobin electrophoresis

sickle cell crisis

vaso-occlusive:

• ischemia = pain

• signs and symptoms depend on area involved

  • extremities: dactylitis (Sausage like fingers) (6 months-2 years)

  • abdomen: extreme surgery like pain

• acute chest syndrome

• acute splenic sequestration

  • pooling of blood in spleen can lead to shock

sickle cell anemia treatment

prevent sickling

• avoid triggers like cold temperatures, elevations

pain relief (morphine) (Scheduled)

adequate hydration

• decreases viscosity of blood

transfusions for anemia

antibiotics for infections

oxygen therapy in crisis

prophylactic penicillin before 3 month old-5 years to reduce pneumococcal risk

vaccines