Chapter 44 Pilliterri Family Final HEME
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 loves popsicles, so I'll let her have them as a snack or for dessert." "I bought the medication to give to her when she says she is in pain." "She has been down, but playing in soccer camp will cheer her up." "I put her legs up on pillows when her knees start to hurt."
"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.
The nurse is educating parents of a child with acute kidney injury about expected outcomes for erythropoietin treatment. Which statement by the parents indicates that FURTHER EDUCATION is needed? "Our child's red blood cells will increase." "This will cause increased urine production." "We may notice an improved activity tolerance." "Erythropoietin works by stimulating bone marrow."
"This will cause increased urine production." Explanation: Acute kidney injury can cause decreased production of erythropoietin, which results in decreased production of red blood cells. Erythropoietin is a hormone released by the kidneys that works by stimulating bone marrow to produce red blood cells, which can improve activity tolerance. Erythropoietin will not improve the kidney injury or increase urine production.
A 1-year-old child is diagnosed with pernicious anemia due to lack of intrinsic factor and is prescribed vitamin B12 injections. After teaching the child's parents about this treatment, the nurse determines that the teaching was successful based on which statement? "We should give our child the injection daily for one month and then stop it." "We will give the injection once a month for the rest of our child's life." "We must give the injection on the days when our child doesn't eat well." "The injections are a temporary measure until our child outgrows the condition."
"We will give the injection once a month for the rest of our child's life." Explanation: If the anemia is identified as being caused by a diet deficient in vitamin B12, temporary injections of vitamin B12 will reverse the symptoms. If the anemia is caused by a lack of the intrinsic factor, lifelong monthly intramuscular injections of vitamin B12 may be necessary.
A nurse is reviewing the above laboratory results for a 6-year-old child during a pediatric clinic visit. Based on the laboratory results, what question is most appropriate for the nurse to ask the parents? (Low Hemoglobin) "What has your child's activity level been like recently?" "Has your child been exposed to any illnesses lately?" "Have you noticed any unexplained bruising on your child?" "Have you noticed any color changes in your child's bowel movements?"
"What has your child's activity level been like recently?" Explanation: The hemoglobin/hematocrit levels and red blood cell count indicate anemia. Anemia can cause fatigue, hence the most appropriate question would be to ask about the child's activity level. If the white blood cell count was high, that might indicate infection. Unexplained bruising would be reflected in a low platelet count (178 ×103/μL; 178 ×109/L is the low end of normal).
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? "Open your mouth so I can look inside your cheeks and lips." "Do you have any bruises on your feet or shins?" "Will you show me how you walk across the room?" "Let me see the palms of your hands and soles of your feet."
"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 reviewing the results of a clotting study for a healthy 6-year-old. What would the nurse document as a normal prothrombin (not partial thromboplastin) finding? 11.0 to 13.0 seconds 6.0 to 9.0 seconds 21.0 to 35.0 seconds 16.0 to 18.0 seconds
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.
The nurse begins administering blood to a pediatric client with hemoglobinopathy. During the transfusion, the nurse notes: a rash on the child's chest, face, and extremities; temperature 101.8°F (38.8°C); respirations 34 breaths/minute; and the child reports nausea. Which actions will the nurse take? Select all that apply. Stop the blood transfusion. Administer only IV normal saline (NS). Assess the child's vital signs. Monitor the child's urine output. Call the child's primary health care provider.
ALL choices were correct Based on the findings, the nurse would suspect an adverse reaction to the blood transfusion. The nurse would immediately stop the transfusion, administer NS IV to the client, send the blood and tubing to the laboratory, and notify the health care provider. The nurse would continue to monitor the child by assessing vital signs and monitor urine output as a decrease in kidney function could indicate acute kidney failure.
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 An enlarged heart Enlarged lymph nodes An enlarged thyroid gland
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 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? Fluid overload Infection Respiratory distress Pallor
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.
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? ] Administer a nonsteroidal anti-inflammatory drug (NSAID) as ordered. Use guided imagery and therapeutic touch. Administer meperidine as ordered. Initiate pain assessment with a standardized pain scale.
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.
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 Negative splenomegaly Oxygen saturation: 99% Bradycardia
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.
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 Equal pupillary response Hematuria Petechiae
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 BP fluctuations) or unequal pupil size may suggest neurologic compromise. Hematuria would suggest renal compromise. Petechiae would be indicative of bleeding into the skin.
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? sibling identical twin national registry donor child himself
identical twin Explanation: Syngeneic transplantation involves a genetically identical donor and recipient (i.e., 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 the use of the child's own stem cells.
A child is receiving a blood transfusion. Which sign or symptom would alert the nurse that the child is experiencing a hemolytic reaction? urticaria respiratory distress diaphoresis lower back pain
lower back pain Explanation: With a hemolytic transfusion reaction, lower back or abdominal pain is noted. Urticaria may be seen with a hemolytic reaction or an allergic reaction. Respiratory distress is associated with an allergic reaction. Diaphoresis is associated with a febrile reaction.
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. purpura. ecchymosis. poikilocytosis.
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? hydroxyurea orally ferrous sulfate daily folic acid supplement vitamin B12 injections
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 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? "We should avoid aspirin and drugs like ibuprofen." "He can resume participation in football in 2 weeks." "Swimming would be a great activity." "Our son cannot take any antihistamines."
"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.
The nurse is caring for a child who weighs 44 lb (20 kg). The health care provider has prescribed a transfusion of 1 unit of packed red blood cells. The nurse gathers blood and the blood tubing. Calculate the rate of milliliters per hour at which the nurse infuses the blood. Record your answer using a whole number. ml/hr
200 Explanation: The commonly accepted rate for blood transfusions in a child is 10 ml/kg/hr. To determine the rate, use the child's weight in kilograms. Then multiply 10 ml by 20 kg to determine the appropriate ml/hr for transfusion. 10 ml/hr × 20 kg = 200 ml/hr.
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 von Willebrand disease Hemophilia Iron-deficiency anemia
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. Hemophilia and von Willebrand disorders are genetic and symptoms are caused by a deficiency in a factor needed for clotting. Iron-deficiency anemia occurs when there is not enough iron for adequate hemoglobin capacity in the red blood cells.
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 V Factor VIII Factor X Factor XIII
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.
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 Football Wrestling Soccer
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.
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? Vitamin supplements Iron-chelating drugs Factor VIII preparations Potassium supplements
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.
A group of students is reviewing information about glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. The students demonstrate understanding of the material when they identify what as the cause of the disorder? X-linked recessive inheritance Deficiency in clotting factors An excess supply of iron Autosomal recessive inheritance
X-linked recessive inheritance Explanation: G-6-PD deficiency is an X-linked recessive disorder that affects the functioning of the red blood cells. A deficiency in clotting factors is associated with disorders such as idiopathic thrombocytopenic purpura, DIC, or hemophilia. An excess supply of iron refers to hemosiderosis, a complication of thalassemia, an autosomal recessive disorder.
A nurse is caring for a 4-year-old male child brought to the emergency department (ED) for symptoms of influenza. The parents state the child has "had high fevers for the past 3 days even though we have been giving our child acetaminophen and they do not really want to eat or drink anything and has been very sleepy." Client opens eyes to voice, follows simple commands, and skin is very warm, ruddy, and dry. Vital signs: 101.5°F (38.6°C); heart rate, 138 beats/min; oxygen saturation, 95% on room air. Laboratory values: white blood cell (WBC) count, 43 × 103 cells/mm3 (43 × 109/l); hemoglobin, 10 mg/dl (100 g/l); hematocrit, 32% (0.32); platelets, 20,000/ml (20 × 109/l); neutrophil bands, 48/mcl (0.05 × 109/l); lymphoblasts, 33 (NA). Complete the following sentence(s) by choosing from the lists of options. The nurse should first address Select... risk for bleeding risk for respiratory risk for impaired tissue perfusion Select... by Select... initiating intravenous (IV) fluids normal saline at 100 ml/hrimplementing bleeding precautions applying 100% nonrebreathing maskSelect....
The child's platelet count is very low at 20,000/ml (20 × 109/l), placing the child at high risk for bleeding. Because the child is at high risk for bleeding, the nurse should implement bleeding precautions. There are no signs or symptoms that the child is at risk for developing respiratory arrest. The child may be at risk for impaired tissue perfusion if bleeding occurs due to low platelets. Intravenous (IV) fluids for children should be based on weight. Normal saline at 100 ml/hr would be too high a flow rate for this child. Because the child's oxygen saturation is 95%, the child does not require oxygen at this time.
In caring for a child with sickle cell disease, the highest priority goal is: the caregiver's anxiety will be reduced. the child's skin integrity will be maintained. the family will verbalize understanding of the disease crisis. The child's fluid intake will improve.
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 caregiver's anxiety, and increasing the caregiver's knowledge about the causes of crisis episodes — but these goals are not the highest priority.
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 10,000/mm3, hemoglobin 7.9 g/dl (79 g/L), hematocrit 28%, platelets 151,000/mm3. Which nursing action is priority? Ask the child to rate pain on a scale 0 to 10. Administer antibiotics intravenously stat. Transfuse 1 unit of packed red blood cells. Provide the family with preoperative instructions.
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.
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. As the nurse considers all of the data in the case, which anemia will the nurse discuss when collaborating with the primary healthcare provider? vitamin B12 deficiency iron deficiency sickle-cell disorder acute blood loss
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 have a long-term, poorly formulated vegetarian diet, as the vitamin is found primarily in foods of animal origin. Since the client is taking iron, iron deficiency anemia is ruled out. The blood cells in a client with sickle cell anemia are crescent-shaped and do not display the characteristics noted. There are no symptoms of blood loss or acute bleeding, as the client is otherwise healthy.
The parents of a 6-year-old child 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 which the immune system attacks and destroys the body's own platelets, for an unknown reason." "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional procoagulant factor." "ITP occurs when the body's iron stores are depleted due to rapid physical growth, inadequate iron intake, inadequate iron absorption, or loss of blood." "ITP is characterized by the loss of surface area on the red blood cell membrane."
"ITP is primarily an autoimmune disease in which 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. The child will exhibit symptoms of excessive petechiae, purpura, and bruising. 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 nurse is providing teaching to the parents of a child diagnosed with sickle cell anemia. The discussion is focused on precipitating factors for sickle cell crisis. Which statement by the parents requires the nurse to reinforce the teaching? "I make sure my child wears a good warm coat and gloves during winter." "Our family is taking a fun hiking trip up in the mountains next week." "We always take water along when we are on an outing." "I make sure our child is up to date on all immunizations."
"Our family is taking a fun hiking trip up in the mountains next week." Explanation: High altitudes are a contributing factor for sickle cell crisis and should be avoided, as should flights in planes that are not pressurized. Extreme temperatures (hot or cold) are also triggers for a crisis so keeping warm during the winter is important. Dehydration and exposure to infection or other illness are precipitating factors for sickle cell crisis. Adequate hydration and keeping up with immunizations are imperative for health and wellness in a child diagnosed with sickle cell anemia.
The nurse in the emergency department is caring for a 10-year-old female child with sickle cell crisis. Child rates pain 10 on a scale of 0 to 10. Vital signs: 99.8°F (37.6°C); heart rate, 122 beats/min; blood pressure, 92/50 mm Hg; respiratory rate, 26 breaths/min; oxygen saturation, 92% on room air. The nurse receives orders for the child. SATA needs to be implemented immediately. Orders: Administer acetaminophen for headache or temperature greater than 101°F (38.3°C). Administer oxygen to maintain oxygen saturation greater than 95%. Start normal saline continuous intravenous (IV) infusion at 200 ml/hr. Administer 100 mcg/kg morphine IV for pain prn q4 hours. Initiate a regular diet as tolerated.
Administer oxygen to maintain oxygen saturation greater than 95%. Start normal saline continuous intravenous (IV) infusion at 200 ml/hr. Administer 100 mcg/kg morphine IV for pain prn q4 hours.
The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority? Encourage therapeutic play activities. Monitor daily complete blood count (CBC). Ensure neutropenic precautions are in place. Remind parents to contact the child's school.
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 nurse is providing care to a child with idiopathic thrombocytopenic purpura with a platelet count of 18,000/mm3 μl (18,000 x 109/L). Which medication would the nurse most likely expect to be ordered? Folic acid Intravenous immune globulin Dimercaprol Deferoxamine
Intravenous immune globulin Explanation: Intravenous immune globulin would be used to treat idiopathic thrombocytopenic purpura. Folic acid is used to treat folic acid deficiency anemia. Dimercaprol is used to remove lead from the soft tissue and bone to allow for excretion by the kidneys. Deferoxamine is used to treat iron toxicity.
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? Aplastic anemia Pernicious anemia Folic acid anemia Sickle cell 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.
A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first? Document the presence of hemarthrosis in the client's chart Notify the client's primary health care provider Assess the client's urine and stool for blood Prepare to administer factor replacement medication
Prepare to administer factor replacement medication Explanation: Many clients with hemophilia have repeated episodes of hemarthrosis or bleeding into the joints, and develop functional impairment of the joints, despite careful treatment. To assist in limiting impairment, the nurse would prepare to administer factor replacement medications, such as plasma, recombinant clotting factor VIII, or a clotting promotor medication. The nurse would document the finding, notify the health care provider, and assess the client for additional symptoms after limiting the amount of blood loss.
What nursing action should the nurse take when caring for a child with aplastic anemia? Assess the child's blood pressure every hour. Ensure the child is offered a low-fiber diet. Encourage visits from friends and family. Provide toys that do not have sharp corners or edges.
Provide toys that do not have sharp corners or edges. Explanation: For a child with aplastic anemia, safety is of the utmost concern, with injury prevention essential to prevent hemorrhage. Toys and games with sharp edges/corners may injure the child during play. The low level of platelets would cause bleeding. High-fiber foods would be offered to prevent anal fissures associated with constipation. The child's blood pressure would not be assessed every hour because the inflation of the cuff would cause bruising/injury. Visitors would be limited to avoid exposing the child to visitors who are sick or ill.
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 Impaired skin integrity Deficient fluid volume Risk for delayed growth and development
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.
A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. What does this prescription indicate to the nurse? The child requires a prophylactic dose of iron. The child has mild to moderate iron deficiency. The child has severe iron deficiency. The child is being prepared for packed red blood cell administration.
The child has mild to moderate iron deficiency. Explanation: The recommended dosage for iron supplementation for a child with mild to moderate iron deficiency is 3 mg/kg/day of ferrous fumarate. A prophylactic dose is 1 to 2 mg/kg/day of up to a maximum of 15 mg elemental iron per day. Severe iron deficiency requires 4 to 6 mg/kg/day of elemental iron in three divided doses. Transfusion of packed red blood cells is reserved for the most severe cases. Prior to the transfusion of packed red blood cells, the nurse would follow specific blood bank guidelines.
A child is admitted with a diagnosis of aplastic anemia. The nurse is creating a plan of care for the child. Which intervention(s) will the nurse include in the plan of care? Select all that apply. adequate rest and activity age-appropriate activities increased iron intake neutropenic precautions administration of hydroxyurea
adequate rest and activity age-appropriate activities neutropenic precautions Explanation: Whether acquired or congenital, aplastic anemia results in the body's inability to produce one or all of the blood components (red blood cells, white blood cells, platelets). This can result in fatigue, skeletal and other congenital anomalies, and impaired growth/development. Nurses should include strategies to promote adequate rest, age-appropriate activities, and neutropenic precautions. Hydroxyurea is not a medication used to treat aplastic anemia. Because the pathophysiology of aplastic anemia involves the ability of the bone marrow to produce blood components, increasing iron intake will not aid treatment.
While inspecting the skin of a child, the nurse notes blotchy areas of hemorrhage. When notifying the health care provider, the nurse would identify the client's skin as having: petechiae. purpura. ecchymoses. hematomas.
ecchymoses. Explanation: Blotchy areas of hemorrhage in the skin are ecchymoses and suggest a vascular disorder. Petechiae are small reddish purplish spots (macules) appearing on the skin. Purpura is purplish or reddish-brown discoloration easily visible through the epidermis; it includes petechiae, ecchymoses, and hematomas. A hematoma is a localized collection of blood creating an elevated ecchymosis.
The nurse is assessing a child in the pediatric intensive care unit. Which assessment finding(s) warrants immediate action? Select all that apply. increased D-dimer assay painful joints petechiae clubbing of the nail beds persistent oozing from venipuncture site
increased D-dimer assay petechiae persistent oozing from venipuncture site In disseminated intravascular coagulation (DIC), thrombin is generated, fibrin is deposited into the circulation, and the platelets are consumed. Diagnostic testing is positive for the disorder if there is an increased D-dimer assay, a decreased antithrombin III, increased fibrinogen/fibrin degradation products, and an increased fibrinopeptide A level. Assessment findings for DIC include signs of bleeding such as petechiae or purpura, blood in the urine or stool, or persistent oozing from venipuncture. Painful joints and clubbing of the nail bed are not assessment findings consistently associated with DIC and are not assessment findings that warrant immediate action but do warranted further follow up.
The nurse is assessing a 3-year-old child and documents a dusky pallor, irritability, poor feeding, and developmental delay. The parents tell the nurse that they are vegetarians and serve only vegetarian meals. Based on this criterion, what will the nurse suspect? megaloblastic anemia acquired aplastic anemia iron-deficiency anemia von Willebrand disease
megaloblastic anemia Explanation: Megaloblastic anemia is a nutritional anemia that most often results from a deficiency of either vitamin B12 or folate due to inadequate intake, malabsorption, or a metabolic disorder. Vitamin B12 deficiency is more likely to occur among people who are strictly vegetarian than among those who eat meat and other animal products. Symptoms of megaloblastic anemia include pallor, weakness, unsteady gait, irritability, poor feeding, failure to thrive, and developmental delay. Iron-deficiency anemia occurs when there is a deficiency of iron in the system. Aplastic anemias result from the depression of the hematopoietic activity in the bone marrow. Von Willebrand disease is a clotting disorder.
