Chap 44 - TeacherWeb
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Transcript Chap 44 - TeacherWeb
Chapter 44 Hematologic Disorders
Assessment- pg 1283 & 1290
Review structure & function of blood
Bone marrow aspiration
Sites-iliac crests or spines due to
larger marrow compartments in
childhood. Neonates-anterior tibia
Position-prone
Topical anesthetic
Conscious sedation may be used
Pressure to site followed by pressure
drsg
Transfusion
Packed RBC’s-help minimize risk of
fluid overload
Rate-10 -15 ml/kg/hr
Signed consent
VS every 15 min first hr, then every
30 min.
Reactions-1287
Transplantation
IV infusion of hematopoietic stem
cells from bone marrow obtained
from bone marrow aspiration or
peripheral or umbilical blood from a
donor
Common procedure for aplastic
anemia, sickle-cell, thalassemia, &
leukemia
Cytoxan IV to prevent rejection
Fever & chills most common reaction
Tylenol, valium, & benadryl may be
given
Restrictions r/t immunosuppression
Splenectomy
Laparoscopic surgery
Susceptible to infections
Penicillin prophylactic for 1-2 yrs
Pneumococcal & meningococcal & HIB
vaccines as well as others
Report any S&S of infection-cough,
fever, general malaise
Anemias
Sickle cell & hemophilia-inherited
Iron-deficiency-preventable
Aplastic anemia-congenital or
acquired
Disorders of RBC’s
Acute blood loss-control bleeding by
correcting underlying cause. Supine
position, keep warm, administer NS or RL
IV, infuse plasma or blood
Aplastic anemia-mgt-bone marrow
transplantation
Iron-deficiency-most common-iron fortified
formula first yr of life. Iron supplements.
Older children-other diseases & diets
Feosol(1294)
Hemolytic Anemias
Sickle Cell-autosomal recessive defect
among African Americans
Begins to produce signs at about 6 mons of
age-fever, anemia, swelling of hands & feet
& protruding abdomen. Sclera becomes
yellow & susceptible to infections
Sickle cell crisis-sudden, severe onset of
sickling usually following an URI or
dehydration
Chart-pg 1297;
Mgt-Pain relief, adequate hydration &
oxygenation. Tylenol, IVF’s, IV
morphine, hydroxyurea(antineoplastic
agent), monitor I&O, blood
transfusion, oxygen
Focus on preventing recurring crisis
Immunizations
Penicillin as prophylaxis
Care Plan 1297-1299
Thalassemias-abnormalities of beta
chain of adult hemoglobin frequently
Mediterranean descent-also African &
Asian heritage
Minor-produce both normal &
defective hemoglobin. Only sign may
be pallor, require no tx, & life
expectancy is normal
Major (Cooley’s or Mediterranean).
Effects-pg 1302
Mgt-digitalis, diuretics & low sodium
diet. Transfusion of packed RBC’s
every 2-4 weeks. Splenectomy may
be necessary. Bone marrow or stem
cell transplantation can offer a cure
Disorders of Blood Coagulation
ITP-result of a < in the # of circulating
platelets-may result from increased rate of
platelet destruction d/t antiplatelet
antibody that destroys platelets
Assessment-miniture petechiae or lg areas
of asymmetric ecchymosis most prominent
over legs. Epistaxis or bleeding into joints
may also occur. Platelet count as low as
20,000
Mgt-oral prednisone & IV
immunoglobin. May require platelet
transfusion.
Usually limited to 1-3 mons. Prevent
from injury
Henoch-Schonlein Syndrome-caused by
increased vessel permeability
Assessment-purpural rash typically on
buttock’s, posterior thighs & extensor
surface of arms &. legs. Lesions change to
pink maculopapules, become bright red
then fade leaving brown macular spots.
Joints tender & swollen, abd pain, N&V,
bloody stools.
Mgt-prednisone & tylenol. Course of 4-6
wks. Chronic nephritis possible
complication
Blood Coagulation Disorders
DIC-acquired disorder of blood
clotting that results from excessive
trauma or some underlying stimulus.
An imbalance exists between clotting
activity & fibrinolysis. Increased
coagulation & a bleeding defect at the
same time
Assessment-uncontrolled bleeding from
puncture sites from injections or IV’s.
Ecchymosis & petechiae from on the skin.
Toes & fingers appear pale, cyanotic or
mottled & feel cool.
Mgt-Stop underlying insult causing
bleeding. IV heparin to discourage blood
coagulation, fresh frozen plasma, platelets,
& fibrinogen may be administered.
Hemophilia A (Factor VIII
Deficiency)Male child’s factor VIII is
deficient-not absent-varying degrees
from mild-severe. Blood will
eventually coagulate. Often
recognized first after circumcision
Assessment-lower extremities usually
become bruised (bumping into things).
Joints become swollen & painful-may result
in loss of mobility. May have severe
bleeding into GI system
Mgt-Administration of Factor VIII.
Powdered forms can be stored at homereconstituted when needed. DDAVPstimulates the release of Factor VIII may
also be helpful. May also give Factor IX .
Prevent injury, apply ice & immobilize area
injured. Don’t give Ibuprofen.
Von Willebrand’s Disease-affects both
sexes, Along with Factor VIII
deficiency-there is also an inability of
platelets to aggregate. Blood vessels
can’t constrict, bleeding time is
prolonged.
Epistaxis is a major problem
Mgt-factor VIII & DDAVP
Christmas Disease (Hemophilia B,
Factor IX Deficiency)
Mgt-concentrated factor IX
Hemophilia C (Factor XI Deficiency)
Mgt-DDAVP or transfusion of fresh
blood or plasma