NURSING CARE OF THE CHILD WITH A HEMATOLOGIC ALTERATION

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NURSING CARE OF THE CHILD WITH A HEMATOLOGIC
ALTERATION
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Disorders of the red blood cells

• RBCs are pale and smaller
• Iron Deficiency Anemia
• Most common anemia caused by improper iron intake
• Giving cows 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

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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 goats milk
• Defective absorption
• S/S
• Poor weight gain
• Chronic diarrhea
• Management
• Folic acid

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• 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 HH 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

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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 Willebrands disease
• Autosomal dominant
• Factor VIII defect, inability of platelets to
  aggregate, and inability of blood vessels to
  constrict

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• 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

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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

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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