NURSING CARE OF THE CHILD WITH A HEMATOLOGIC ALTERATION

Disorders of the red blood cells –RBCs are pale and smaller Iron Deficiency Anemia –Most common anemia caused by improper iron intake »Giving cow’s milk instead of baby formula is main culprit during the first year »Adolescent girls are at risk because of menstruation »Causes poor growth, poor test scores later –Treatment »Ferrous Sulfate for two months »Restoration takes three months »Retic count will increase 7-10 days after starting therapy –Education »Give between meals for better absorption »Vit C increases absorption »Milk and tea with meals reduces absorption

Disorders of the red blood cells Macrocytic Anemias –RBCs are larger than usual –Megaloblastic Anemias Folic Acid Deficiency –Causes in children »Low birth weight »Intake of powdered or goat’s milk »Defective absorption –S/S »Poor weight gain »Chronic diarrhea –Management »Folic acid

–Megaloblastic Anemias Pernicious Anemia Causes –Lack of intrinsic factor, must be deficient ~ 2 years for symptoms to develop Management –Vitamin B12 1mg daily x 1-2 weeks, then once weekly until H&H are normal, then monthly for life –Hemolytic Anemias Sickle Cell Disease –Autosomal recessive, sickle shaped RBCs –Asymptomatic in infancy prior to 5-6 months –Clinical course characterized by episodic crises –Management »Pain relief, hydration, oxygenation

DISORDERS OF BLOOD COAGULATION Hemophilias –Hemophilia A (Factor VIII deficiency) Sex-linked recessive S/S –Soft tissue bleeding and bleeding into joints Management –Administration of factor VIII –Von Willebrand’s disease Autosomal dominant Factor VIII defect, inability of platelets to aggregate, and inability of blood vessels to constrict

Hemophilias continued S/S –Bleeding, esp, from m.m. Management –Factor VIII replenishment or DDAVP –Christmas disease (Hemophilia B, Factor IX deficiency) Sex-linked recessive Treated with factor IX –Hemophilia C (Factor XI deficiency) Autosomal recessive Symptoms are mild when compared to other types

Immune Thrombocytopenia Purpura Acquired disorder characterized by low platelet count Etiology –Can be drug-induced or follows a febrile illness S/S –Bruising and petechiae Therapeutic Management –Usually self-limiting but may require steroids, IV immunoglobulin, or splenectomy Nursing considerations –No IM injections –No rectal temps –Avoid meds that kill/interfere with platelet production

Aplastic Anemia Bone marrow ceases production of all cells S/S –Petechiae, pallor, fatigue, bruising Etiology –Congenital, exposure to drugs/chemicals, idiopathic Therapeutic Management –Transfusions, stem cell transplant, chemotherapy Nursing Considerations –Low-platelet considerations plus reverse isolation