PEDS: Chapter 44: Nursing Care of a Family when a Child has a Hematologic Disorder Prep-U

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with sickle cell anemia. The nurses in the group make the following statements. Which statement is most accurate regarding sickle cell anemia?

"If the trait is inherited from both parents the child will have the disease." Explanation: When the trait is inherited from both parents (homozygous state), the child has sickle cell disease, and anemia develops. The trait does not skip generations. The trait occurs most commonly in African Americans. Either sex can have the trait and disease.

The health care provider has prescribed ferrous sulfate 4 mg/kg/day in three divided doses for a child weighing 15 lb (6.8 kg). The ferrous sulfate is supplied as 15 mg/ml. How many milliliters will the nurse administer to the child for one dose? Record your answer using one decimal place.

0.6 Explanation: To determine the amount of milliliters to administer for one dose, use the child's weight in kilograms. Then multiply 6.8 kg by 4 mg to equal 27.2 mg/day. Next, divide 27.2 by three, because the daily dose is divided into three smaller doses, to equal 9.06 mg. Then divide 9.06 mg by 15 mg to determine the needed milliliter per dose, which is 0.6 ml.

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child include which actions? Select all that apply.

Administering oxygen Administering analgesics Maintaining fluid intake Explanation: Treatment for a crisis is supportive for each presenting symptom, and bed rest is indicated. Oxygen may be administered. Analgesics are given for pain. Dehydration and acidosis are vigorously treated. Prognosis is guarded, depending on the severity of the disease. Platelets are not given

An 8-month-old girl appears pale, irritable, and anorexic. On blood testing, the red blood cells are hypochromic and microcytic. The hemoglobin level is less than 5 g/100 mL, and the serum iron level is high. Which symptom should the nurse most expect as a result of excessive iron deposits?

An enlarged spleen Explanation: The child with thalassemia major may have both an enlarged spleen and liver due to excessive iron deposits, fibrotic scarring in the liver, and the spleen's increased attempts to destroy defective RBCs.

A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode?

Apply heat to the site of bleeding. Explanation: Ice or cold compresses, not heat, would be applied to the site of bleeding. Direct pressure is applied until the bleeding stops. The injured part is elevated unless elevating would contribute to further injury. Factor VIII replacement is given to replace the missing clotting factor.

The nurse is caring for a 10-year-old boy with hemophilia. He asks the nurse for suggestions about appropriate physical activities. Which activity would the nurse most likely recommend?

Baseball Explanation: Children with hemophilia should stay active. Good physical activities would be swimming, baseball, basketball, and bicycling (with a helmet). He would still need to be careful about falls and sliding into base. Intense contact sports like football, wrestling, and soccer should be avoided.

A nurse is administering a blood transfusion to a child. About 35 minutes after beginning the transfusion, the child develops pruritus and urticaria. Some wheezing is noted. Which action would the nurse take first?

Discontinue the transfusion. Explanation: The child is experiencing a transfusion reaction; the first step with any transfusion reaction is to discontinue the transfusion. Oxygen should be given, and the nurse should anticipate the need for an antihistamine to reduce the child's symptoms. An iron-chelating agent would be given for hemosiderosis after repeated transfusions. A blood culture would be obtained if the child developed a fever.

When evaluating the hemogram of an 8-month-old infant, the nurse would identify which type of hemoglobin as being the predominant type?

Hemoglobin A Explanation: Three types of normal hemoglobin are present at any given time in the blood: A, F, and A2. By 6 months of age, hemoglobin A is the predominant type. Hemoglobin S is associated with sickle cell disease.

A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor?

Infection Explanation: Factors that may precipitate a sickle cell crisis include: fever, infection, dehydration, hot or humid environment, cold air or water temperature, high altitude, or excessive physical activity. Respiratory distress and pallor are general signs and symptoms of a sickle cell crisis.

A child is prescribed monthly injections of vitamin B12. When developing the teaching plan for the family, the nurse would focus on which type of anemia?

Pernicious anemia Explanation: Monthly injections of vitamin B12 are used to treat pernicious anemia. Aplastic anemia is characterized by a decrease in all blood cells necessitating a bone marrow transplant. Folic acid deficiency anemia is treated with dietary measures and possible folic acid supplementation. Sickle cell anemia is treated supportively with a focus on preventing sickling crisis, infection, and other complications.

The nurse is caring for a child with idiopathic thrombocytopenic purpura with a platelet count of 24,000 mm3. Which health care provider prescription will the nurse question?

Provide ibuprofen as needed for pain. Explanation: The child with idiopathic thrombocytopenic purpura (ITP) should not receive ibuprofen or salicylates because this prevents platelet aggregation, which can cause increased bleeding. Administration of platelets may be used as a temporary measure to increase the platelet count. Because ITP is thought to be an autoimmune illness, prednisone (a corticosteroid) is used to decrease the immune response. IVIG is used to treat ITP.

The nurse is caring for a 3-year-old boy with suspected iron-deficiency anemia. Which test would the nurse expect to be ordered to confirm the diagnosis?

Serum ferritin Explanation: Serum ferritin is a measure of ferritin (the major iron storage protein) in the blood. It is the most sensitive test for determination of iron-deficiency anemia. Hemoglobin electrophoresis is indicated for sickle cell anemia and thalassemia and measures the percentage of normal and abnormal hemoglobin in the blood. Reticulocyte count measures the number of immature red blood cells (RBCs) in the blood and indicates the bone marrow's ability to respond to anemia with production of RBCs. The iron test evaluates iron metabolism.

Iron-deficiency anemia could be virtually eliminated if all infants were breastfed and those infants who are formula-fed were fed iron-fortified formula for the full first year.

True Explanation: The infant must ingest adequate quantities of iron either from breast milk or from iron-fortified formula in early infancy and other food sources in later infancy.

A 14-year-old girl who is a vegetarian has recently developed anemia. Blood smear results show large, fragile, immature erythrocytes. She claims to take an iron supplement regularly and is surprised to learn that she is anemic, as she is otherwise healthy. The nurse recognizes that this is the likely cause of this type of anemia:

Vitamin B12 deficiency Explanation: Vitamin B12 is necessary for the maturation of RBCs. Pernicious anemia results from deficiency or inability to use the vitamin, resulting in RBCs that appear abnormally large and are immature megaloblasts (nucleated immature red cells). Thus, pernicious anemia is one of the megaloblastic anemias. In children, the cause is more often lack of ingestion of vitamin B12 rather than poor absorption. Adolescents may be deficient in vitamin B12 if they are ingesting a long-term, poorly formulated vegetarian diet as the vitamin is found primarily in foods of animal origin.

The nurse is administering iron-dextran to a child diagnosed with iron-deficiency anemia. The most appropriate method of administration of this drug would be:

intramuscular. Explanation: Because of its irritating nature, an iron-dextran mixture should be administered in the vastus lateralis by intramuscular injection using the Z-track method to avoid leakage into the subcutaneous tissues. It is not given through IV, rectally, nor subcutaneously.

The nurse is assessing a child and notices pinpoint hemorrhages appearing on several different areas of the body. The hemorrhages do not blanch on pressure. The nurse documents this finding as:

petechiae. Explanation: Petechiae are pinpoint hemorrhages that occur anywhere on the body and do not blanch with pressure. Purpura are larger areas of hemorrhage in which blood collects under the tissues and appear purple in color. Ecchymosis refers to areas of bruising. Poikilocytosis refers to the variation in the size and shape of the red blood cells commonly found in children with thalassemia.

While assessing an adolescent, the nurse notes pallor and a beefy red tongue. Upon questioning, the adolescent reports eating a vegetarian diet to help with weight loss. Which health care provider prescription will the nurse anticipate?

vitamin B12 injections Explanation: Children with pernicious anemia have a vitamin B12 deficiency and have symptoms such as pallor, irritability, beefy red tongue, and diarrhea. Children with iron-deficiency anemia require ferrous sulfate. Folic acid is needed for children with macrocytic anemia. Hydroxyurea could be prescribed for a child with sickle cell anemia.

The mother of a 5-year-old girl brings the child to the clinic for an evaluation. The mother tells the nurse, "She seems to be so tired and irritable lately. And she looks so pale." Further assessment reveals pale conjunctiva and oral mucous membranes. The nurse suspects iron-deficiency anemia. Which additional finding would help provide additional evidence for this suspicion?

Spooned nails Explanation: Spooning or concave shape of the nails suggests iron-deficiency anemia. Other findings would include decreased oxygen saturation levels, tachycardia, and possible splenomegaly.

The nurse is caring for a 12-year-old boy with idiopathic thrombocytopenia. The nurse is providing discharge instructions about home care and safety recommendations to the boy and his parents. Which response indicates a need for further teaching?

"He can resume participation in football in 2 weeks." Explanation: The nurse must emphasize to the parents that they need to prevent trauma to their son by avoiding activities that may cause injury. Participation in contact sports like football is not recommended. Aspirin, nonsteroidal anti-inflammatory drugs, and antihistamines should be avoided because they could precipitate anemia. Swimming, a noncontact sport, is an appropriate choice.

A nurse is conducting a physical examination of a 5-year-old with suspected iron-deficiency anemia. How would the nurse evaluate for changes in neurologic functioning?

"Will you show me how you walk across the room?" Explanation: Neurologic effects of iron deficiency may be demonstrated when the child's ability to sit, stand, and walk are impaired. Inspecting the mouth, looking for bruises, and checking the hands and feet provide information about signs of petechiae, purpura, or pallor.

The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management?

Initiate pain assessment with a standardized pain scale. Explanation: The nurse should first initiate pain assessment with a standardized pain scale upon admission and provide frequent evaluations of pain. Administering NSAIDs or meperidine and the use of nonpharmacologic pain management techniques are all appropriate. However, the first action is to assess the child's pain to provide a baseline for future comparison.

After teaching the parents of a child diagnosed with pernicious anemia about the disorder and treatment, the nurse determines that the teaching was successful when the parents state:

"He'll need to have those vitamin shots for the rest of his life." Explanation: Monthly injections of vitamin B12 are required for life. Although diet is important, diet alone will not cure the anemia. Iron used to treat iron-deficiency anemia can lead to constipation. Bone marrow transplant is used to treat aplastic anemia.

The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning?

"I mix ferrous sulfate with milk in a bottle." Explanation: Ferrous sulfate may not be absorbed if taken with milk or tea, and if the parent mixes the medicine with milk in a bottle, there is also concern that if the child does not drink the entire amount of medication. Ferrous sulfate may be taken after meals to prevent gastrointestinal irritation. Dark stools are a common side effect of ferrous sulfate. Parents should be encouraged to brush the child's teeth thoroughly to prevent teeth staining.

The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching?

"She has been down, but playing in soccer camp will cheer her up." Explanation: Following a sickle cell crisis, the child should avoid extremely strenuous activities that may cause oxygen depletion. Fluids are encouraged, pain management will be needed, and the child's legs may be elevated to relieve discomfort, so these are all statements that indicate an understanding of caring for the child who has had a sickle cell crisis.

A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering the iron supplement, which statement by the parents indicates the need for additional teaching?

"We will place the liquid in the front of her gums, just below her teeth." Explanation: When giving liquid iron supplements, the liquid should be placed behind the teeth because it can stain the teeth. Iron can lead to constipation, so increased fluid and fiber intake is appropriate. The dosage needs to be measured carefully to prevent overdosing the child, leading to iron toxicity. Reference:

The caregiver of a child with sickle cell disease asks the nurse how much fluid her child should have each day after the child goes home. In response to the caregiver's question, the nurse would explain that for the child with sickle cell disease, it is best that the child have:

1,500 to 2,000 mL of fluid per day. Explanation: Prevention of crises is the goal between episodes. Adequate hydration is vital; fluid intake of 1,500 to 2,000 mL daily is desirable for a child weighing 20 kg and should be increased to 3,000 mL during the crisis.

The nurse is reviewing the results of a clotting study for a healthy 6-year-old. What would the nurse document as a normal prothrombin finding?

11.0 to 13.0 seconds Explanation: The nurse would identify a prothrombin time of 11.0 to 13.0 seconds as normal for a healthy child. A result of 21.0 to 35.0 seconds would be the expected range for partial thromboplastin time and activated partial thromboplastin time. Findings of 6.0 to 9.0 seconds and 16.0 to 18.0 seconds are outside the normal range.

A nurse is reviewing laboratory test results from several children, looking specifically at their thrombocyte levels. The nurse would identify that the child with which platelet level might be at risk for bleeding? Select all that apply.

80,000 per cubic millimeter 110,000 per cubic millimeter Explanation: Normal thrombocyte level ranges from 150,000 to 300,000 per cubic millimeter. Therefore, a child with a thrombocyte level of 80,000 and 110,000 per cubic millimeter would be at risk for bleeding. Reference:

The nurse is caring for a 10-year-old girl with iron toxicity. What would the nurse expect the physician to order?

Deferasirox Explanation: Deferasirox is indicated for iron toxicity. It binds with iron, which is removed via the kidneys. Dimercaprol is indicated for blood lead levels greater than 45 mcg/dL. It removes lead from soft tissues and bone, allowing for its excretion via the renal system. Edentate calcium disodium is indicated for blood lead levels greater than 45 mcg/dL. The medication removes lead from soft tissues and bone, allowing for its excretion via the renal system. Succimer is indicated for blood lead levels greater than 45 mcg/dL; it removes lead from soft tissues and bone, allowing for its excretion via the renal system.

The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority?

Ensure neutropenic precautions are in place. Explanation: With stem cell transplants, children are at greatest risk for infection and sepsis. The nurse should ensure neutropenic precautions are used to reduce the change of infection. Monitoring laboratory values, reminding the parent to contact the school, and encouraging therapeutic play are important, but preventing infection in the immunocompromised child is a priority.

A toddler who is beginning to walk has fallen and hit his head on the corner of a low table. The caregiver has been unable to stop the bleeding and brings the child to the pediatric clinic. The nurse is gathering data during the admission process and notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed. This child most likely has a deficiency of which blood factor?

Factor VIII Explanation: The most common types of hemophilia are factor VIII deficiency and factor IX deficiency, which are inherited as sex-linked recessive traits, with transmission to male offspring by carrier females.

In hemophilia A, the classic form, only females manifest a bleeding disorder.

False Explanation: The classic form of hemophilia is caused by deficiency of the coagulation component factor VIII, the antihemophilic factor, and transmitted as a sex-linked recessive trait. In the United States, the incidence is approximately 1 in 10,000 white males. A female carrier may have slightly lowered but sufficient levels of the factor VIII component so that she does not manifest a bleeding disorder. Males with the disease also have varying levels of factor VIII; their bleeding tendency varies accordingly, from mild to severe.

Which of the following would the nurse be least likely to assess in a child with a hematologic disorder?

Fever Explanation: Pediatric hematologic alterations usually are characterized by atypical hemostasis, anemia, and/or neutropenia. Fever suggests infection which may or may not be present with a hematologic disorder

The nurse is reviewing the chart of a child scheduled for a stem cell transplant. The child will be receiving a syngeneic transplant. The nurse understands that which of the following would be the donor?

Identical twin Explanation: Synergeneic transplantation involves a genetically identical donor and recipient (ie, identical twins). Allogeneic transplantation involves the transfer of stem cells from an immune-compatible (histocompatible) donor, usually a sibling, although a national registry allows compatible volunteer donors to be located. Autologous transplantation involves use of the child's own stem cells.

The child with thalassemia may be given which classification of medication to prevent one of the complications frequently seen with the treatment of this disorder?

Iron-chelating drugs Explanation: Frequent transfusions can lead to complications and additional concerns for the child, including the possibility of iron overload. For these children, iron-chelating drugs such as deferoxamine mesylate may be given. Vitamin and potassium supplements would not be given to treat the iron overload. Factor VIII preparations are given to the child with hemophilia.

The nurse is developing a plan of care for a child who is to have a transfusion. Which would the nurse expect to administer because it is the most common form of transfusion?

Packed red blood cells Explanation: Various forms of blood are available, including whole blood, packed red blood cells (RBCs), washed RBCs (as much "foreign" matter is removed as possible to reduce the possibility of blood reaction), plasma, plasma factors, platelets, white blood cells (WBCs), and albumin. Packed RBCs represent the most common form of transfusion used with children because they help minimize the risk of fluid overload.

When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a splenectomy, which would the nurse identify as the priority?

Risk for infection Explanation: Removal of the spleen places the child at significant risk for infection. Although the child's skin integrity is disrupted due to the surgery, this is not the priority nursing diagnosis. Loss of fluids occurs during surgery and adequate hydration is important to prevent a sickle cell crisis, but this diagnosis is not the priority in the postoperative period. Although the child is at risk for delayed growth and development, the priority postoperatively is to prevent infection.

For the child diagnosed with iron deficiency anemia, what would the nurse anticipate being done in treating this disorder?

The child would be given ferrous sulfate with orange juice between meals. Explanation: Treatment consists of improved nutrition, with ferrous sulfate administered between meals with juice (preferably orange juice, because vitamin C aids in iron absorption). For best results, iron should not be given with meals.

The nurse is caring for a child admitted to the hospital for an open fracture of the femur following a motor vehicle accident. The nurse notes the following lab values: white blood cells 10,000mm3, hemoglobin 7.9 g/dL (79 g/L), hematocrit 28%, platelets 151,000 mm3. Which nursing action is priority?

Transfuse 1 unit of packed red blood cells. Explanation: In a situation where the child exhibits signs of anemia related to acute hemorrhage, the nurse should anticipate administering a transfusion of packed red blood cells to improve oxygenation and circulation. Administration of antibiotics, pain assessment, and family education can be performed after the beginning the blood transfusion.

The primary intervention for beta-thalassemia is a chronic transfusion program of packed white blood cells with iron chelation.

False Explanation: The primary intervention for beta-thalassemia is a chronic transfusion program of packed red blood cells with iron chelation. Such a program facilitates adequate oxygenation of body tissues and practically eliminates all symptoms of thalassemia.

A nurse is leading a discussion with a group of new mothers about newborn nutrition and its importance for growth and development. One of the mothers asks, "Doesn't the baby get iron from me before birth?" Which response by the nurse would be most appropriate?

"Because the baby grows rapidly during the first months, he uses up what you gave him." Explanation: In the term infant, a period of physiologic anemia occurs between the age of 2 and 6 months. This is due to the fact that the infant demonstrates rapid growth and an increase in blood volume over the first several months of life, and maternally derived iron stores are depleted by age 4 to 6 months of age. Sufficient iron intake is critical for the appropriate development of hemoglobin and RBCs. Therefore, the infant must ingest adequate quantities of iron either from breast milk or from iron-fortified formula in early infancy and other food sources in later infancy.

A nurse caring for an 8-year-old with a bleeding disorder documents the following nursing diagnosis: ineffective tissue perfusion related to intravascular thrombosis and hemorrhage. This diagnosis is most appropriate for a client with:

Disseminated intravascular coagulation Explanation: Disseminated intravascular coagulation (DIC) is an acquired coagulopathy that, paradoxically, is characterized by both thrombosis and hemorrhage. The goal is for the child to maintain adequate tissue perfusion of all body systems affected by DIC and regain adequate laboratory values for hemostasis.

In discussing the causes of iron-deficiency anemia in children with a group of nurses, the following statements are made. Which of these statements is a misconception related to iron-deficiency anemia?

"Milk is a perfect food, and babies should be able to have all the milk they want." Explanation: Babies with an inordinate fondness for milk can take in an astonishing amount and, with their appetites satisfied, may show little interest in solid foods. These babies are prime candidates for iron-deficiency anemia. Many children with iron-deficiency anemia, however, are undernourished because of the family's economic problems. A caregiver knowledge deficit about nutrition is often present. Because only 10 percent of dietary iron is absorbed, a diet containing 8 to 10 mg of iron is needed for good health. During the first years of life, obtaining this quantity of iron from food is often difficult for a child. If the diet is inadequate, anemia quickly results.

When assessing a child for a possible hematologic disorder, which would the nurse need to keep in mind as most important?

Multiple body sites can be affected. Explanation: The nurse needs to keep in mind that hematologic alterations can affect multiple body sites, so assessment needs to address all body systems. A child's nutritional status may be helpful in assessing certain hematologic disorders such as iron deficiency anemia, but this information is not the most important to remember. Sequelae commonly occur with hematologic alterations, especially chronic conditions such as hemophilia or sickle cell disease. The child's demographic data are important, because some hematologic diagnoses are more commonly associated with a certain age group, sex, race, or geographic location.

The parents of a 6-year-old male with idiopathic thrombocytopenic purpura (ITP) ask the nurse conducting an assessment of the child what causes the disease. What is the nurse's best response?

"ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." Explanation: Idiopathic thrombocytopenic purpura (ITP) is primarily an autoimmune disease, which is an acquired, self-limiting disorder of hemostasis characterized by destruction and decreased numbers of circulating platelets. Hemophilia A and hemophilia B are distinguished by the particular procoagulant factor that is decreased, absent, or dysfunctional. Iron deficiency anemia occurs when the body's iron stores are depleted. Hereditary spherocytosis (HS) is characterized by loss of surface area on the red blood cell membrane.

A client with severe chronic anemia is receiving ongoing transfusion therapy. The nurse frequently assesses the client for what major complication of this therapy:

Development of toxic iron overload Explanation: The major complication of an ongoing transfusion therapy program is the development of toxic iron overload, which leads to pathologic changes in body systems, including the hepatic, endocrine, and cardiac systems.

The nurse is reinforcing teaching with a group of caregivers of children diagnosed with iron-deficiency anemia. One of the caregivers tells the group, "I give my child ferrous sulfate." Which statement made by the caregivers is correct regarding giving ferrous sulfate?

"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." Explanation: When ferrous sulfate is administered, it should be given between meals with juice (preferably orange juice, because vitamin C aids in iron absorption). For best results, iron should not be given with meals. Ferrous sulfate can cause constipation or turn the child's stools black.

A mother asks the nurse why her infant who was born at 34 weeks' gestation is being prescribed ferrous sulfate. Which response by the nurse is most appropriate?

"Preterm infants are at risk for iron-deficiency anemia." Explanation: Infants born prematurely are at risk for iron-deficiency anemia because iron stores are built during the last few weeks of gestation. Although some infants with pyloric stenosis may require an iron supplement, such as ferrous sulfate, not all infants will. Infants with excessive diarrhea may develop iron-deficiency anemia, and ferrous sulfate helps improve red blood cell formation, but this does not explain why a preterm infant is being prescribed an iron supplement.

The nurse is caring for a 13-year-old girl with von Willebrand disease. After teaching the adolescent and her parents about this disorder and care, which response by the parents indicates a need for additional teaching?

"We should administer desmopressin as often as needed." Explanation: The parents need to know that desmopressin spray Stimate is used for controlling bleeding; the other brands are used for homeostasis and enuresis. Additionally, Stimate should only be used 3 days in a row as lessening of the response (tachyphylaxis) occurs with frequent use. Stimate should be used before dental work. Menorrhagia and nosebleeds may occur.

The child is prescribed liquid ferrous sulfate. The nurse should encourage the child to take which action immediately after each dose to best eliminate possible side effects?

Brush his or her teeth Explanation: To prevent staining of the teeth, the child should brush the teeth after administration of iron preparations such as ferrous sulfate. There is no need to remain upright, drink milk or to refrain from eating or drinking for one hour.

Individuals with hemophilia B have a deficiency in factor IX, which can cause excessive blood loss. What is another name for this clotting factor?

Christmas factor Explanation: Factor IX is also known as plasma thromboplastin component or Christmas factor; factor X is Stuart factor; factor VIII is antihemophilic factor; and factor VII is proconvertin.

The nurse is assessing a child with aplastic anemia. Which findings are anticipated? Select all that apply.

Ecchymoses Tachycardia Guaiac-positive stool Epistaxis Explanation: Assessment findings associated with aplastic anemia include ecchymoses, epistaxis, guaiac-positive stools, and tachycardia. Severe pain and warm tender joints are most often associated with sickle cell crisis.

The nurse is collecting data from the caregivers of a child brought to the clinic setting. The parents tell the nurse that the child's skin seems to be an unusual color. The nurse notes that the child's skin appears bronze-colored and jaundiced. This observation alerts the nurse to the likelihood that this child has which disorder?

Thalassemia Explanation: In the child with thalassemia the skin may appear bronze-colored or jaundiced. The child with hemophilia may have bruised areas on the skin. The skin color in children with sickle cell disease may be pale in color, and with Kawasaki disease the child may have a rash on the trunk and extremities.

In caring for a child with sickle cell disease, the highest priority goal is:

The child's fluid intake will improve. Explanation: The highest priority goals for this child are maintaining comfort and relieving pain. The child is prone to dehydration because of the kidneys' inability to concentrate urine, so increasing fluid intake is the next highest priority. Other goals include improving physical mobility, maintaining skin integrity, reducing the caregivers' anxiety, and increasing the caregivers' knowledge about the causes of crisis episodes, but these goals are not the highest priority.

A nurse is providing care for a child with disseminated intravascular coagulation (DIC). What would alert the nurse to possible neurologic compromise?

Widely fluctuating blood pressure Explanation: A key aspect of the nurse's role is to assess the child for signs and symptoms of impaired tissue perfusion in the various body systems that may be affected by DIC. Unstable or abnormal blood pressure such as wide fluctuations in blood pressure or unequal pupil size may suggest neurologic compromise. Hematuria would suggest renal compromise. Petechiae would be indicative of bleeding into the skin.