hematology peds

what are the three primary blood forming tissues

red blood cells, white blood cells, and platelets

what are red blood cells responsible for

they transport oxygen and carbon dioxide

what are white blood cells responsible for

they play a role in immunity and defending against

allergens

what are platelets responsible for

cell fragments which are responsible for blood clotting

what is another name for red blood cells

erythrocytes

what are white blood cells

granulocytes, lymphocytes, monocytes

where is red blood cell produced in the first 5 years of life

it occurs in the bone marrow

where is red blood cells produced beyond 5 years of life

marrow of the ribs, sternum, vertebrae, pelvis, skulls, scapulas, and clavicles

hematopoiesis

red blood cell production

iron deficiency anemia

results from inadequate supply of iron

what is the most common type of childhood anemia

iron deficiency anemia

what is the most common nutritional deficiency in children (second question)

iron deficiency anemia (second answer)

what can cause iron deficiency anemia

decreased iron intake, increased iron loss or blood loss, periods of increased growth

what helps decrease the prevalence of IDA in infants

promotion of iron-fortified formula vs cow’s milk during the first year of life

why are premature infants at risk for IDA

because they did not get benefit by building up iron storage in utero

why are 12 to 36 month olds at risk for IDA

due to ingestion of large amounts of cow milk and their diet

why are adolescents at risk for IDA

rapid growth and poor eating habits , obesity, strenuous activity and heavy menses

after 6 months why are these babies at risk of IDa

because they dont take enough iron through solid foods and iron fortified formula

what are some things you may notice when doing an assessment in a patient who has IDA

pallor, paleness of mucous membranes, tiredness, fatigue, low iron in their diet, greater intake of cows milk, pica habit

what is pica habit

craving dirt, ice, playdough

what are some lab values seen in IDA

decreased HgB

low serum iron level

elevated total iron binding capacity

what do you focus on when taking a history for someone with IDA

you focus on their dietary intake

what are some prevention measures for IDA

delayed cord clamping by 1-3 min, correcting any bleeding if that is the problem, folic acid helps convert from ferritin to hemoglobin

what can prolonged anemia cause

stress to the heart

what is the name for oral iron

ferrous sulfate

what should parents limit their childs milk intake to

less than 32 oz a day (960 ml)

what are some sources of iron for children

red meat, green leafy veggies, fish, liver, whole grains, legumes

what are some sources of iron for infants

iron fortified cereals and formula

iron rich foods

liver, dried beans, cream of wheat, iron fortified cereal, apricots, prunes and other dried fruit, egg yolks, and dark leafy veggies

what are some measures parents should take when administering ferrous sulfate

take on an empty stomach, take with OJ

what should patients taking ferrous sulfate avoid

milk and antiacids

what are some side effects that may happen when taking ferrous sulfate

may temporarily stain teeth, stools may become tarry and constipation may occur

what is sickle cell disease

autosomal recessive condition where by normal hemoglobin is partially or completely replaced by hemoglobin S

when does SCD usually occur

after 6 months of age

what promotes sickled cells

dehydration, when it is cold , decreased oxygen levels

what is a vasoocclusive crisis

blood flow to tissue is obstructed, it is painful

signs and symptoms of VOC

fever, severe abdominal pain, hand foot syndrome, arthralgia

arthralgia

joint stiffness

what are triggers of VOC

dehydration, hypoxia, fever, emotional/physical stress

Hand–foot syndrome (infants);

painful edematous hands and feet. Often fist painful VOC episode in 6 months- 2 years.

what should family do to prevent hypoxia

keep child from exercising strenuously, keep child away from high altitudes, avoid letting the child become infected and seek care at first sign of infection, use prophylactic penicillin if prescribed, keep child well hydrated, do not withhold fluids at night

what is done for a child who is hospitalized with a vasoocclusive crisis

administer iv fluids and electrolytes, monitor i/o, administer blood products, administer analgesics, administer PCA pump, use warm compresses, and administer prescribed antibiotics to treat infection

hemophilia

lifelong hereditary blood disorder, can be a result of spontaneously mutated genes, (x-linked recessive)

what can be done to identify carriers

genetic testing, chorionic villi sampling and amniocentesis

when can hemophilia be evident

after circumcision or when the child becomes mobile, bleeding can be mild, moderate, or severe

Hemarthrosis

bleeding in the joint , can become swollen and then become imobile

what can you notice in a nursing assessment with a patient who has hemophilia

hemarthrosis, spontaneous bleeding into muscles and tissues, loss of motions in joints, pain, prolonged bleeding into muscles and tissues

what are some lab values you may see with a patient who has hemophilia

prolonged PTT, low factor VII and factor IX

what are some nursing interventions that may be needed with hemophilia

no rectal temp, physical therapy can be initiated when bleeding is controlled, DDAVP is administered, injury prevention is key, use soft toothbrush, adolescents should use electric razors, avoid asprin, wear medical alert bracalet

lead poisoning

condition involving chronic ingestion or inhalation of materials containing lead, with mental and physical dysfunction

what should you assess when dealing with a child with lead poisoning

inquire sources of lead, signs of anemia, abdominal pain, vomiting, constipation, anorexia, headache, fever, lethargy, and central nervous system issues

diagnostic test for lead poisoning

blood lead level, erthrocyte protoporphyrin level

interventions for lead poisoning

prevent further exposure to lead, use only cold water, chelation therapy

chelation therapy

process of removing lead from blood and or organs, may be painful so child is given local anesthetic prior to therapy

neoplasm

tumor that arises from new abnormal cell growth

benign tumor

does not reoccur

malignant tumor

can reoccur and metastasize to other locations

categories that predispose children to cancer

genetic, enviornmental , microbal

s&s of cancer in children

unusual mass or swelling, unexplained paleness and loss of energy, easy bruising, presistant or localized pain, prolonged unexplained fever or illness, frequent headaches often with vomiting, sudden eye or vision changes, unexplained rapid weight loss

why can cancer be hard to diagnose

because parents dont want to think about their children having cancer, children may mask pain and symptoms

what is therapeutic management of cancer

surgery, radiation therapy, palliative

what is hematopoietic stem cell transplant

replacement of stem cells in the body

what can HSCT treat

aplastic anemia, malignant disorders, non malignant disorders, immunodeficiency disorders

HSCT complications

graft v. host disease

what is graft v. host disease

immune response related to difference in donor/recipient human lymphocyte antigens , the donors WBCs think the childs body is foreign and attack it

s&s of graft v. host disease

liver (elevated enzyme levels), skin(macular skin reactions), Gi tract(mild to copious diarrhea)

treatment of graft v. host disease

immunosuppressive drugs and steroids , (prednisone, cyclisporin, tacrolimus)

HSCT complications

pancytopenia, mucositis

Pancytopenia

reductions in red and white blood cells

Mucositis

inability to eat

if a pt has Pancytopenia what should you do

transfusions, bleeding precautions, and isolation, use electric razor, soft toothbrush, do not use tampons, do not use enemas

if a pt has mucositis what should you do

this pt will be on iv fluids and on TPN, will also be on stool softners

what is chemotherapy

use of antineoplastic agents to kill cancer cells

s&s of chemo (1)

affects the hematologic system, GI tract , and skin, anorexia, nausea and vomiting (1)

how should chemo be administered

must be given through a free flowing IV line and stopped immediately if any signs of infiltration occur

side effects of chemo (2)

bone marrow suppression, bruising and bleeding, alopecia, malaise/fatigue, anorexia, stomatitis

stomatitis

oral ulcers that are red, painful, and eroded in the mouth and pharynx

interventions for stomatitis

soft sponge toothbrush, frequently rinsing mouth with chlorahexidine mouthwash or sodium bicarb and salt mouth rinses , avoid lemons due to acidity

radiation s&s

skin reactions, bruising ,fatigue, bone marrow suppression, nausea and vomiting, anorexia

pediatric leukemia

cancer of blood forming tissues , malignant diseases of the bone marrow and lymphatic system in which bone marrow elements are replaced by abnormal immature blast cells

acute lymphocytic leukemia

most common form of childhood cancer, chromosome problems, prenatal exposure to radiation, snd chemo

s&s of ALL

pallor, tiredness, weakness, lethargy, petechia, bleeding, bruising, infections, fever, bone joint pain, enlarged lymph nodes, headache, vomiting, anorexia, weight loss

labs for ALL

bone marrow aspiration that reveals 80% to 90% immature blast cells

what is the most definitive way to diagnose leukemia

bone marrow aspiration

nursing interventions for leukemia

prevent infection, reduction of exposure to enviornmental molds and organisms from plants and fresh fruits, provide child with age appropriate explanations for diagnostic tests, examine child for infection, administer blood products, monitor for chemo, proper nutrition, promote self esteem, family and patient education

hodgkins disease

cancer in the lymph nodes

what is hodgkins disease charcterized by

reed sternberg

Hodgkin’s disease s&s

enlarged firm, nontender, moveable nodes often in supraclavicular or cervical area

Hodgkin’s disease s&s if metastasized

fever, weight loss, night sweats, cough, anorexia, nausea

diagnosis of hodgkin’s disease

lymph node biopsy , reed sternberg cells

diagnosis of hodgkin’s disease if metastisized

CBC, liver function, CT/MRI, chest X-ray, bone marrow biopsy

Hodgkin’s disease treatment

radiation , involved field, extended field, total nodal irradiation, and chemo

involved field

specific nodes

extended field

involved nodes plus those immediately adjacent

osteosarcoma

most common bone cancer in children due to growth, peaks at ages 10-25 and more than half occurs in femur

s&s of osteosarcoma

pain, edema, limping, inability to bear weight, palpable mass, and fracture

diagnosis of osteosarcoma

biopsy, X-ray, MRI, to rule out metastasis there needs to be a whole body PET scan, CT scan

osteosarcoma treatment

surgery (amputation) , chemo,

phantom limb pain

tingling, itching, and pain felt in amputated limb

retinoblastoma

most common intraocular malignancy in childhood