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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