Jenna Cohen Final Exam Study Guide Hematologic and Immunologic Dysfunction Part 1 Assessment Physiology RBC s Function supply oxygen to tissues maintain acid base balance by removing CO2 from tissues main supply supplying oxygen to tissues Life Span 120 days removed from circulation by spleen Production regulated by ability of RBC s to transport O2 to tissues not circulating RBC s Reticulocytes immature RBC s when you have hypoxia your kidneys and bone marrow kicks in and will produce RBC s and then a good amount of reticulocytes baby ones coming on and become new rbcs good thing if they have a good number of retic s that is a good thing CBC HGB WBC PLT HCT WBC 4000 17000 Life span 13 20 days PLT 150 450 000 Life span 8 10 days shortest life span o No DNA don t replicate HGB 11 15 g dL Life span 120 days HCT 35 45 ratio of cells to fluid Background Physiology Anemias Assessment Most common blood disorder in children Indication of an underlying problem Not a disease iron deficiency we treat the nutritional problem Hgb 11 0 g dL Hct 33 Classify according to etiology or morphology size and color Abnormal size indicates alteration in RBC formation MCV with anemia we look at rbc s under icroscope we want them to be bright red and a certain size if it stoo small that tells the providers something if it s a pale color that makes it something else too so you can determine the type of anemia the child has Abnormal color indicates alteration in Hgb content MCHC Assessment of Anemia Decreased viscosity leads to decreases peripheral resistance and increased flow to the heart blood thinner can slosh around more compared to blood that has a lot of components in it murmurs due to the blood flowing really fast and making turbulent sound o Murmur due to increased turbulence in the heart If long term may have growth retardation including sexual maturation increased infections clubbing infections bc children just aren t that healthy clubbing due to hypoxia and can effect growth and development Signs Symptoms o Pallor not usually cyanotic no color from RBC s pale and not cyanotic bc they don t have perfusion to go to the cells not a problem with perfusion just nowhere to perfuse o Increased HR RR blood thinner can go faster decreased resistance o Decreased saturation possibility may or may not depending on condition o Decreased energy inattention behavior problems think if child hasn t eaten well o If severe lethargy LOC risk of strokes or hypoxic damage all bc of increased turbulence in the brain grades may slip may go to sleep during class may be very thin slow to go through puberty Analysis for Anemia Possibilities depending on cause and severity Imbalanced Nutrition Less than Body Requirements Risk for Injury hypoxia strokes Delayed Growth and Development Activity Intolerance Impaired Gas Exchange Ineffective Tissue Perfusion Safety Prvnt of Injury Nutrition Growth Dvlpmnt Oxygenation Perfusion Mobility Iron Deficiency Anemia Most common hematologic disorder in infancy and childhood Screen at 9 12 months 11 21 years 9 12 months because most children are switching over to table food picky eaters and the parents may may not have money to pay for good foods 11 21 years time when girls start their period babies at 5 months old stop using iron they got from the mother during pregnancy US incidence has decreased in past 20 30 years due to fortified food milk cereal wick food and milk to new mom Newborn Pathophysiology Iron Deficiency Anemia Iron transferred from mom to baby during last trimester Stored in erythrocytes of fetus in liver spleen bone marrow Stores last 5 6 months in healthy newborn 2 3 mo in premature or multiple births if you re a preemie or twin the iron has to be divided so even earlier NB rapidly uses iron stores due to growth rate and increased blood volume the babies triple their weight by one year important to have iron fortified foods Etiology of Iron Deficiency Anemia Dietary Intake shouldn t have milk as being the only thing taken in the baby isn t getting other nutrients if just drinking milk o Early and or excessive intake of milk a poor source of iron Breast milk has less iron but 49 is absorbed in contrast to 10 from cow s milk BM is poor source of iron after 5 months so begin iron supplements for all BM babies breast milk is important but after 5 months mom has depleted her source of iron so need to start supplementing the iron breast milk will be a poor source of iron o Overall poor nutritional intake Blood Loss Impaired Absorption less common cause irritable bowel syndrome child lactose intolerant if child isn t able to afford nutritionally well foods First Priority Interventions Iron Deficiency Anemia Administer teach about supplemental ferrous iron o Available PO IM or IV Absorbed equally well but PO has less side effects but cheaper and easier to give IV can cause anaphylaxis so have to monitor very carefully some teens who wouldn t take iron but some children couldn t absorb it or if severe developmental delay would give it IV o PO S E greenish black tarry stools constipation vomiting cramps nausea stains teeth important to take with juice and citrus put past teeth so it wont stain if old enough can take with straw o IM use Z tract method don t massage because less irritating absorbed better and sometimes it might cause damage to the muscles so doing the z tract method it wont cause problems in the muscle subq tissue o Vitamin C supplementation to increase absorption o DO NOT give with cow s milk Ca decreased Absorption o Cont supplement for at least 2 months after normal lab levels bc that s when it stabilizes in the system If Hgb level fails to rise after 1 mo check to see if given properly at 6 week check up want to see green black tarry stools if we don t then either not absorbed properly or parent may not be giving it correctly Dietary measures during and after supplement o Infant o Children Maintain breast feeding with iron supplements OR Iron fortified formula to 1 yr AND Fe fortified cereal from 4 mo to 1 yr Limit milk to appropriate amount no more than 2 cups per day in general not their primary drink can also have water juices etc Balanced diet of food offerings Iron rich food choices daily red meats tuna salmon eggs spinach green leafy vegetables iron settles in your liver kidneys heart and spleen Evaluation for Iron Deficiency Anemia Tolerates activity within age normal alert at school grades advancing compared to previously Continues growth and