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Wong's Nursing Care of Infants and Children, 11th Ed., Hockenberry, Wilson & Rogers
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28 - The Child with Hematologic or Immunologic Dysfunction

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Wong's Nursing Care of Infants and Children, 11th Ed., Hockenberry, Wilson & Rogers | Registered Nurse (RN) School Study Aid

28 - The Child with Hematologic or Immunologic Dysfunction
29 Picmonics to Learn | 58 mins
WBC Differential Lab Value
White Blood Cells (WBC)
5-10 (5,000-10,000)
Leukocyte Differential
Neutrophils (50%-70%)
Bands (2%-5%)
Segs (50%-70%)
Lymphocytes (20%-40%)
Monocytes (4%-8%)
Eosinophils (2%-4%)
Basophils (0.5%-1.5%)
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2 mins
Whole Blood Composition
Characteristics
Plasma
Electrolytes And Other Solutes
Proteins
Albumin
Fibrinogen
Globulins
Water
Formed Elements
Buffy Coat
White Blood Cells (WBC)
Platelets
Red Blood Cells (RBC)
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2 mins
Erythropoietin
Mechanism
Stimulates RBC Production
Indications
Chronic Renal Failure
Anemia
Side Effects
Increased Risk of Thrombosis
Pelvic and Limb Pain
Hypertension
Considerations
Do Not Shake
Monitor Hemoglobin (Hgb) Weekly
May Accelerate Tumor Progression
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2 mins
Hemoglobin
Hemoglobin Has Four Iron Hemes
Lots Of Hemoglobin In Red Blood Cells
High O2 Levels Increase O2 Binding
High Temperature Reduces O2 Binding
High CO2 Levels Reduce O2 Binding
Low pH Reduces O2 Binding
Myoglobin Binds Oxygen in Muscle
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2 mins
Red Blood Cell Count (RBC) Lab Values
Women: 3.5-5.5 million cells/ MuL
Men: 4.3-5.9 million cells/ MuL
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1 min
Hematocrit (Hct) Lab Values
Women: 36% - 46%
Men: 41% - 53%
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1 min
Platelet Lab Value
150,000-400,000 Micro L
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40 secs
Types of Blood Products
Types
Whole Blood
Packed Red Blood Cells
Fresh Frozen Plasma
Immunoglobulins
Clotting Factors
Albumin
Platelets
Considerations
Use within 24 Hours
Washing Removes Antibodies
Irradiation Destroys WBCs
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2 mins
Blood Transfusion Administration
Proper Patient Identification
Large Bore Needle
Y Tubing
Baseline Vital Signs
Slow IV Infusion
Monitor During First 15 Minutes or 50 mL of Blood
Monitor for Reactions
Considerations
Do Not Add Anything To Same IV Line
No Dextrose or Lactated Ringers
Jehovah's Witnesses, No Transfusions
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3 mins
Transfusion Reactions
Acute Hemolytic
Febrile, Non-Hemolytic
Mild Allergic
Anaphylactic
Circulatory Overload
Sepsis Reaction
Transfusion-Related Acute Lung Injury (TRALI)
Massive Blood Transfusion
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2 mins
Warfarin Antidotes
Antidotes
Vitamin K
Fresh Frozen Plasma
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59 secs
Iron (Ferrous Sulfate)
Mechanism
Ferrous Salts
Indications
Anemia
Side Effects
GI Distress
Nausea and Vomiting
Dark Stools
Considerations
Take Between Meals
Liquid can Stain Teeth
Keep out of Reach from Children
Caution with GI Disorders
Avoid Antacids
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3 mins
Sickle Cell Anemia Assessment
Cause/Mechanism
Hemoglobin S (Genetic Defect)
Sickle Shaped RBCs
Assessment
Jaundice
Vaso Occlusive Crisis
Fever
Priapism
Severe Pain
Considerations
Prominent in African Americans
May be Asymptomatic
Increased Risk of Infection
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2 mins
Sickle Cell Anemia Interventions
Interventions
Increase Hydration
Analgesics
Oxygen
Warm Compress
Bone Marrow Transplant
Hydroxyurea
Considerations
Avoid High Altitudes
Prophylactic Antibiotics
Avoid Strenuous Exercise
Vaccines
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3 mins
Meperidine (Demerol)
Mechanism
Opioid Receptor Agonist
Indications
Moderate to Severe Pain
Post Anesthesia Shivering
Side Effects
Tremors
Constipation
CNS Depression
Sedation
Considerations
Short Term Administration
Increased Risk Serotonin Syndrome
Does NOT cause Miosis
Renal Failure Increases Toxicity Risk
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2 mins
Clotting Overview
Characteristics
Endothelial Cells are Damaged
Platelets Respond to Exposed Collagen and Stick
Platelets Release Recruiting Factors
More Platelets are Attracted
Soluble Fibrinogen Turns to Insoluble Fibrin
Fibrin Seals the Clot
Clot Dissolves
Liver Produces Clotting Factors
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2 mins
Hemophilia
Cause/Mechanism
Genetic Mutation
Assessment
Prolonged Bleeding
Pain
Hemarthrosis
Interventions
Clotting Factor Replacement Therapy
DDAVP (Desmopressin Acetate)
Antifibrinolytic Therapy
Analgesics
Considerations
Genetic Counseling
Prevent Injury
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3 mins
Bleeding Precautions
Things to Avoid
Hard Foods
Aspirin Products
Blowing Nose Forcefully
Straining During BMs
Enemas or Rectal Suppositories
Pads and Monitor Menstruation
Guidelines to Follow
Soft-bristled Toothbrush
Electric Razor
Limit Needle Sticks
Smaller Needle Size
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3 mins
Disseminated Intravascular Coagulation (DIC) Assessment
Mechanism
Improper Initiation of Clotting Cascade
Signs and Symptoms
Systemic Bleeding
Petechiae, Purpura, Ecchymosis
Change in LOC
Increased PT and PTT
Cyanosis
Increased Fibrin Degradation Products (FDP)
Decreased Platelets and Fibrinogen
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2 mins
Disseminated Intravascular Coagulation (DIC) Interventions
Complications
Risk for Shock
Renal Failure
Interventions
Treat Underlying Cause
Manage Bleeding
Maintain Fluid and Hemodynamic Balance
Transfusion
Oxygenation
Heparin Drip
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2 mins
Innate Immunity Cellular Response
Characteristics
Natural Killer Lymphocytes Attack Abnormal Cells
Neutrophils in Blood
Infected Cells Release Interferon
Complement Proteins Lyse Pathogens/Infected Cells
Dendritic Cells in Tissue
Macrophages in Tissue
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2 mins
Immune System Tissues
Characteristics
Bone Marrow
B Cells and T Cells Formed
B Cells Mature
Thymus
T Cells Tested For Self-Response
T Cells Mature
Lymph Nodes
Mature B Cells and T Cells Monitor Lymph For Pathogens
Spleen
Mature B Cells and T Cells Monitor Blood For Pathogens
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1 min
Innate Immunity Barriers
Skin Protects Against Pathogens
Normal Flora Outcompete Pathogens
Lysozyme in Saliva, Tears, and Mucus
Mucous Traps Pathogens
Cilia Remove Mucus
Acid and Digestive Enzymes in the Stomach Kill Pathogens
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2 mins
Humoral Adaptive Immunity
Characteristics
B Cell Binds Free Floating Antigen
B Cell Presents Antigen to Helper T Cell
Helper T Cells Help B Cells Develop Antigen Specificity
Plasma B Cells Secrete Antibodies
Memory B Cells Cause Faster Secondary Response
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2 mins
Cell-mediated Adaptive Immune Response
Characteristics
Macrophages and Dendritic Cells Present Antigens
T Cell Develops Antigen Specificity
Regulatory T Cells Suppress Response
Memory T Cells Cause Faster Secondary Response
Cytotoxic T Cells Lyse Infected Cells
Infected Cells Present Antigen On Surface
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2 mins
Human Immunodeficiency Virus (HIV) Assessment
Assessment
RNA Retrovirus
CD4+ Helper T Cells
Primary Infection
Flu-like Symptoms
Lymphadenopathy
Symptomatic Stage
Fatigue
Diarrhea
Unexplained Weight Loss
White Spots on Tongue
Persistent Fever
Night Sweats
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2 mins
Human Immunodeficiency Virus (HIV) Stages
Primary Infection
Within 3 Weeks
Flu-like Symptoms
Asymptomatic Stage
Years
Symptomatic Stage
CD4+ < 500
AIDS
Opportunistic Infections
CD4+ < 200
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2 mins
Human Immunodeficiency Virus (HIV) Diagnosis
HIV-1/2 Antigen/Antibody Immunoassay
HIV-1/2 Antibody Differentiation Immunoassay
Nucleic Acid Testing (NAT)
Viral Load
Polymerase Chain Reaction (PCR) in Neonates
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3 mins
Human Immunodeficiency Virus (HIV) Interventions
Interventions
Adequate Nutrition
Small Frequent Meals
IV Hydration
Emotional Support
HIV Medications
HAART
Considerations
Transmission Education
Strict Asepsis for Invasive Procedures
Treat Opportunistic Infections
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2 mins

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