NUR4467C Exam 3

Peds Content - Blueprint

Iron Deficiency Anemia (IDA)

Most common cause of anemia during childhood, can be caused by decreased iron intake or increased iron loss, reduced chances if cord clamping is delayed by 1 to 3 minutes

Manifestations of Iron Deficiency Anemia

Extreme pallor with porcelain-like skin, pale-mucous membranes and conjunctiva, tachycardia, tachypnea, lethargy, fatigue, and irritability

Diagnostics of Iron Deficiency Anemia

Complete health history with focus on diet, CBC that may indicate low hemoglobin levels, reticulocyte count may be normal or slightly elevated, ferritin and iron levels are usually low

Reticuloctye

Immature blood cells that are produced in the bone marrow, which mature within 1 to 2 days, low count indicates anemia

Why is IDA common in children

When RBCs go through hemolysis, iron is released into circulation. The growth of children are very rapid so there is a need for more iron for the synthesis of new hemoglobin

Dietary and IDA

Lack of absorption of iron by the GI tract can contribute to IDA, especially when cow’s milk is introduced into the diet earlier than it should

Sickle Cell Disease (SCD)

Inherited, lifelong disease, autosomal recessive condition in which the RBC are sickle shaped due to deoxygenation

Manifestations of SCD

Chronic hemolytic anemia, pallor, jaundice, fatigue, choleslithiasis, delayed growth, renal dysfunction

Manifestations of Sickle Cell Crisis

Infection, dehydration, hypoxia, trauma, general stress

Types of scikle cell crisis

Vaso-occlusive crisis, acute sequestration and aplastic

Vaso-occlusive event

Blood flow in tissues is obstructed, leads to hypoxemia and ischemia and pain

Acute sequestration even

Blood flow from an organ is obstructed, organs become engorged with blood leading to anemia and acute chest syndrome

Acute chest syndrome

Most common cause of death, pneumonia-like complication that consists of fever, chest pain, and blockage of blood vessel, need IV hydration, anitbiotics, and oxygen

Aplastic event

Either increased destruction or decreased production of RBCs, increased destruction is related to fever or infection, decreased production is related to viral infection such as Parvovirus

Management of SCD

Prophylactic daily penicillin therapy for all children, routine vaccination against influenza and hepatitis B, morphine for pain, hydroxyurea increases fetal hemoglobin

Major complication of SCD

Stroke due to vaso-occlusion of blood vessels in brain

Thalassemia

Group of inherited disorders characterized by an abnormality in hemoglobin synthesis

Beta-Thalassemia

Also known as thalassemia major or Cooley anemia, most common and severe form of thalassemia, autosomal recessive

Manifestations of Beta-Thalassemia

Pallor, growth deficits, pubertal delay, severe anemia, hepatosplenomegaly, bronze skin tone

Diagnostic of Beta-Thalassemia

DNA testing, CBC, reticulocyte count

Characteristics of Thalassemia

Frontal bossing, maxillary prominence, wide-set eyes with flattened nose, greenish yellow skin tone

Therapeutic management of Beta-Thalassemia

Erythrocyte transfusions, chelation therapy to prevention hemosiderosis, and splenectomy

Hemosiderosis

Deposition of excess amount of iron tissue, usually caused by increased transfusions

Chelation therapy of Beta-Thalassemia

Deferoxamine, sub or IV to increase iron levels to normal level

Cure of Beta-Thalassemia

Bone marrow transplantation

Hemophilia

Lifelong X-linked autosomal recessive blood disorder with NO CURE

Hemophilia A

Deficiency of coagulation factor VIII, classic hemophilia

Hemophilia B

Deficiency of coagulation factor IX, Christmas disease

Manifestation of Hemophilia

Bleeding occurs spontaneously for children with severe disease, bruise easily, episodes of epistaxis, some hematuria, hemarthrosis, swelling, pain, stiffness

Diagnostic studies for Hemophilia

PT, PTT, bleeding time, fibrinogen level, platelet count, factor VIII and IX assays

Management of Hemophilia

Highly individual, therapy aims to prevent bleeding and tissue damage, prophylaxis are standard of care, avoidance of activities that induce bleeding

HIV in chidlren

Progression of HIV to AIDS is faster in infants and children, physically and developmental failure to thrive, opportunistic infections, digital clubbing, hypoxia, PJP

Children exposed to HIV…

Must have virologic tested when the infant is 14 to 21 days old, 1 to 2 months, and 3 to 6 months of age

Ongoing monitoring of HIV

Low CD4 counts indicate reduced immune function, infants infected perinatally have a high viral burden that decreases over several years

Management of HIV

IV ARV is given to the mother during labor, ZDV therapy is given to infants 6 to 12 hours after birth

At Risk in HIV-exposed infants

PJP, certain strains of Tb, bacterial and viral infection, fungal infections

Rubeola (Measles)

Highly contagious virus that slowly spreads through the body

Rubeola Manifestations

Prodrome period with fever that rises and the 3 C’s (coryza, cough, conjunctivitis), Koplik spots that appear 1 to 4 days before rash that appears on day 14 on the face and neck

Koplik spots

Small, blue white spots with red base that cluster near the molars on the buccal mucosa

Rubeola Management

Symptomatic treatment using fluids, humidification and antitussives, rest and quiet activities,

Prevention of Rubeola

Two doses of measles, mumps and rubella (MMR) vaccine are required

Rubella (German Measles)

Also known as the 3-day measles, mild disease in children and adults with a rash that last 14 to 21 days, often asymptomatic until rash

Manifestations of Rubella

Nasal drainage, malaise, N/D, rash, anorexia, sore throat, fever, rash across face, scalp, and neck

Forchhemier sign

Petechiae that occur on the soft palate in Rubella affected children

Congenital Rubella Syndrome (CRS)

Crosses the placenta and occurs after maternal infection during the first 12 weeks of pregnancy, causes intrauterine growth retardation where the infant weighs less than 2500 grams and failure to thrive

Management of Rubeulla

Self-limiting with resolution in 5 days, recommend children to stay home 7 days after rash starts and for CRS infected children to do urine tests for negative rubella virus

Erythema Infectiosum (Fifth Disease, parvovirus B19)

Mild systemic diseased most common in children 5 to 15 years old

Class sign for Fifth Disease

Slapped cheek appearance where there is a fiery-red edematous rash on cheeks, followed by rash on trunck and extremities

Manifestations of Fifth Disease

Headache, runny nose, fever, malaise

Complications of Fifth Disease

Patients with SCD or Beta-thalassemia are at risk foranemia and aplastic crisis

Management for Fifth Disease

Usually benign and self-limiting, treatment is symptomatic and supportive

Varicella-Zoster Infection (Chickenpox)

Virus that is non-life threatening

Manifestations of Chickenpox

Slightly elevated body temperature, malaise, headache and anorexia, rash

Complications of Chickenpox

Secondary bacterial infection of skin lesions from Strep or Staph, Reye syndrome has been known to occur if aspirin is given

Management of Chickenpox

Sympotmatic and sypportive tx, acteaminiphen for fever, acy