latex allergy Response can range from Type IV to Type I
what is type 4 delayed reactions( IV)
- antigens stijmulate t cells that release lymphokines, which cause inflamation and tissue dmg
- clinical manifestations: fever. erythema, itching
- examples: contact dermatitis, tubercuin skin test etc.
type 3 immune complex reactions
- immune complexes are deposited in tissues where they activate complement, which results in generalized inflammatory reactions
- clinical manifestations: urticaria, fever, joint paint
- examples: acute glomerulonephritis, etc
type 2 tissue specific reactions
- antibodies cause activation of a complement syste, -> tissue dmg
- clinical manifestations: may include dyspnea or fever
- eamples: transfustionr eaction, ABO incompatibility, hemolytic disease of the new born
type 1 localized or systemic reactions ( anaphylaxis)
- antibodies bind to certain cells causing rlease of chem substances that produce an inflammatory reaction
- clinical manifestation: htn, wheezing, gastro or uterine spasm, stridor, uticaria
- example: extrinsic asthma, hayfever
nursing intervention for latex allergy
- Early identification of allergy
- Remove source of allergy from patient’s environment
- NURSING INTERVENTIONS: Initiate treatment forreaction which may range from redness, itching and hives to wheezing, stridor or anaphylaxis
- Antihistamine, epinephrine
- IV access, respiratory support if needed
what are the hematologic topics?
- Iron Deficiency Anemia
- Sickle Cell Anemia
- Immune (Idiopathic) thrombocytopenia Purpura (ITP)
- Meningococcemia ( spina bifida)
what is iron deficiency anemia?
Most common type of anemia – can be caused by blood loss, malabsorption, or occur during periods of rapid growth but most common cause is poor nutritional intake of iron
who is at risk for iron deficiency anemia?
- poor maternal diet in pregnancy
- preemie who did not get to store iron
- starting iron-rich solid foods after 6 month
- inadequate diet at any age
- those in puberty growth spurt
clinical findings of iron deficiency anemia?
- Nail bed deformities
- New heart murmur
- Slowed growth on growth chart
how is anemia diagnosed
- Blood tests:Hematocrit, hemoglobin, RBC
- Serum iron, ferritin, transferrin levels
- Diet History
management of anemia with vitamin rich foods and vitamin c foods
- Iron rich:
- Meats, fish, poultry
- Dried fruits
- Enriched grain products
- Whole-grain cereals
- Iron-fortified dry cereals
- vitamin c rich foods:
- Citrus fruits
- Green leafy vegetables
- Some dry cereal
management of anemia
- Iron replacement – oral preparations
- Teaching about color change in stool and constipation, protect teeth from discoloration
- Oxygen therapy
- Bed rest
- Intravenous replacement if severe
- Blood transfusion if severe enough
nursing considerations with iron therapy
- Give Fe+ with Vitamin C
- Stools may be tarry - teach patient/family
- Take with meals to prevent Nausea /Vomiting
- Use straw or P.O. syringe: dyscoloration
- Brush teeth ASAP
- Use Z track if parenteral: pull back so fluid doesnt fall out
- Dietary counseling
sickle cell anemia
- Normal hemoglobin (Hgb) is replaced by abnormal sickle hemoglobin (Hbs)
- Usually found in people of African or Mediterranean descent Autosomal recessive genetic pattern Can carry trait only and be asymptomatic
clinical manifestation of sickle cell
sicke cell crisis
Caused by some situation that decreases oxygenation
- surgery, high altitude, flu, asthma attack
- sequestration crisis-
- aplastic crisis
- acute chest syndrome ( box 23-3)
what is the vaso-occlusive crsis?
s&s sequestration crisis?
- unusual sleepiness
- looks pale
- fast heart beat
- big spleen
- pain on the left side of abdomen
what is sequestration crisis?
- Acute splenic sequestration is the sudden pooling of blood in the spleen resulting in anemia, which may be life threatening.
- This type of crisis occurs most often in young children between 10 and 27 months of age in whom auto infarction of the spleens has not yet happened
- . In its most severe form, acute splenic sequestration results in life-threatening anemia, hypovolemia, and shock. Decreases in the levels of hemoglobin <4 g per/dL are associated with 35% mortality rates. It is estimated that as much as 50% ofthe patient’s red cells can be sequestered in the spleen. Approximately 50% ofpatients who survive an episode of acute splenic sequestration will experience a recurrence. Emergency management is aimed at restoring circulatory blood volume and hemodynamic stability. Although therapy may begin with crystalloid resuscitation, red blood cell transfusions must be given promptly.
- Long-term management is complicated because there is a high rate ofrecurrence of either acute or subacute sequestration. Splenectomy has been advocated when recurrent episodes occur.
S&s of aplastic crisis?
- "not feeling good"
- low blood count ( anemia)
- recent upper resp infection
- passing out ( fainting)
sickle cell diagnosis?
- Often diagnosed by testing cord blood of newborn
- • Need to test wider population, not just African Americans and Hispanic populations
- • Over 6 months old, Sickledex test is used for diagnosis
sickle cell anemia management?
- Early Diagnosis – early testing for condition
- Prevention of crises: stay healthy and avoidprecipitating factors
- Hand washing to avoid colds, infections
- Vaccines on time
- Avoid stress
- Stay hydrated
management of crsis
- Pain management
- Hydration (to dilute sickled cells)
- Oxygen administration
- Prophylactic antibiotics at times
- Blood Transfusions if needed
- Stem Cell Transplants from identical donor if possible has been helpful
- Psychosocial concerns – genetic aspect of condition, achronic illness
- Every person has one of the following blood types: A, B,AB, or O. Also, every person's blood is either Rh-positive or Rh-negative. So, if you have type A blood, it's either A positive or A negative.
- The blood used in a transfusion must work with your bloodtype. If it doesn't, antibodies (proteins) in your blood attackthe new blood and make you sick.
- Type O blood is safe for almost everyone. About 40 percentof the population has type O blood. People who have this blood type are called universal donors. Type O blood is usedfor emergencies when there's no time to test a person's bloodtype.
- People who have type AB blood are called universal recipients. This means they can get any type of blood.
- If you have Rh-positive blood, you can get Rh-positive or Rh-negative blood. But if you have Rh-negative blood, you can only get RH- negative blood. SO O negative is best for emergencies ( because anyone can use this)
Blood is transfused either as whole blood (with all its parts) or, more often, as individual parts. The type of blood transfusion a patient receives depends on thesituation.
when does a person get whole blood
Whole blood: used to replace blood after /during a large hemorrhage
when does a person get RBC
if there has been blood loss due to surgery or an injury. Also may need this type oftransfusion if you have severe anemia due to a diseaseor blood loss.
when does a person need platelets and clotting factors?
helps stop bleeding,including internal bleeding that cannot be seen. Some illnesses can prevent the body from making enough platelets or clotting factors.
when does a person need plasma?
Plasma is the liquid part of blood. It is mainly water, but it also contains proteins, clotting factors, hormones,vitamins, cholesterol, sugar, sodium, potassium, calcium, andmore.
If a person has been badly burned or has liver failure or a severe infection, a plasma transfusionmay be given.
blood transfusion reactions?
- uticaria, flushing, wheezing, laryngeal edema
- chills, shaking, flank pain, red/black urine, N/V
- fever, chills
- Circulatory Overload
- precordial pain, dyspnea, rales, productive cough,distended neck veins
what are the nursing responsibilities r/t blood product administration?
If reaction occurs, stop blood and replacewith normal saline infusion
- -Verify blood type and Rh of donor with recipient’s type with another RN before administration
- -Warm blood
- -VS every 15 minutes for first hour
- -Administer first 20mL of volume SLOWLY and observe for reaction
- -Administer with normal saline – NO Dextrose-Use filter
- -Use IV pump – depends on hospital policy and type ofinfusion pump
what is hemophelia
- A group of hereditary bleeding disorders that are caused by a deficiency in some type of clotting problem
- 85% of people with hemophilia have Hemophilia A, adeficiency of Factor VIII(8)
- 10% have Hemophilia B, or Christmas disease and lackFactor IX(9) These are both carried by Mom’s and given only to their sons, known as X-linked recessive traits May also be a new mutation, so there may be no family history
what is the goal of hemophilia and the clinical manifestations?
- Goal: prevent bleeding, provide safety
- Condition may be mild, moderate or severe
- Clinical manifestations:
- Spontaneous bleeding following falls, tooth eruption,epistaxis, easy bruising
- Hemarthrosis = bleeding into a joint, and can lead topermanent joint problems Assess for symptoms of bleeding, headache, slurredspeech, LOC, tarry stools,
- Promote normal development, teach First Aid
- Educate family, school, friends
- Clotting is the body's reaction to bleeding, & helps heal wound.
- The clotting factor works with platelets (small blood cell) and helps them stick together to block,or plug, cuts and wounds.
- With a low clotting factor, theplatelets cannot stick together,therefore the blood cannot clot;and there is continuous bleeding.
- Constant bleeding can lead to damaged organs, severe blood loss and even fatality (blood infusions with clotting factor may be necessary).
if you have a mother who is a carrier of hemophilia and a normal father
- there is a 25% chance that their daughter will be a carrier
- a 25% chance their son will have hemophilia
- and a 25% chance of having a normal daughter and son
if you have a father with hemophelia and a normal mother
- there is a 50% chance that their daughters will be carriers
- 50% chance that their sons will be normal
hemophilia symptoms in babies/toddlers
- may bleed excess amount after circumcision
- heavy bleeding and bruising in gums from baby teeth coming in
- bruises or bumps from falls as they learn to walk
- swelling or bruising from bleeding in joints, muscles and tissue
- nosebleeds without reason
older children s&s
- hemarthrosis (bleeding in joints)
- blood in urine or feces
- continuous bleeding from loss of tooth or cut in mouth
- nosebleeds without reason
- bleeding and bruises in tissues and muscles
Hemophilia Concentrated in Brain
- extremely long and painful headaches
- vomiting many and double vision
- changes in behavior, feeling very sleepy
- sudden weakness in limbs or difficulty walking
soft tissue bleeds and bruising:
no functional impairment
-tenderness, but no severe pain
pain, inability to extend the leg on affected side
treat with a major dose of factor
thigh/ calf bleeds
pain with/without swelling
- routine factor dose
- major factor dose if compartment syndrome is suspected
potential airway compromise
- treat with a major dose of factor
deltoid/forearm bleed and bruising
- routine factor dose
- major factor dose if compartment syndrome is suspected
- routine factor dose
- major factor dose if the leg on the affected side exhibits tingling or swelling
There are signs you should also look for if you suspectbleeding in the joints.
- Stiffness or tightness in the joints; no real pain.
- Tightness or stiffness shall continue with noticeable pain.
- The joint becomes swollen and is warm/hot to touch, and bending joint causes sharp pain.
- Swelling and bleeding continues, and movement of joint is limited (if any mobility) along with extreme pain.
- As joint is finally filled with blood, bleeding slows
prevention,growth and development concerns w/ hemophelia
- Avoid rectal temperatures
- Avoid IM and Subq injections
- Use paper tape only
- No aspirin
- Always be alert to activities/interventions that cause bleeding
- Chronic Illness……
Immune (Idiopathic) Thrombocytopenic Purpura
- Excessive destruction of platelets in spleen,although platelet production is normal
- Autoimmune origin
- Incidence between 1 and 10 years
- Acute phase often after a virus - flu or chickenpoxChronic - longer than 6 months, occurs in about 25% of patients
s&s of Immune (Idiopathic) Thrombocytopenic Purpura and dx treatment
- Usually a history of recent infection, then sudden bruising and petechiae
- Diagnosis by low platelet count (less than 20,000 mm3/dl)
- Treatment depends on progression of symptoms; if they resolve quickly, no Rx may be needed. But if they progress,Rx is needed
- In either case child needs to be protected from injury while platelet count is low.
- No contact sports, sedentary activities only
- IVIG (Intravenous immunoglobulin) ( like in KD)
- NO ASA!!
- Platelet transfusion only in acute situation (like intracranial hemorrhage)
- Splenectomy in chronic cases that do not respond to Rx within 6 months to 1 year
- A virulent disease that can occur in patients infected with gram-negative organism, usually through respiratory route
- Sudden onset ( more srs than meningitis)
- Petechial rash, fever, myalgias, weakness, headache,diarrhea, vomiting
- Quickly clotting process changes and bleeding and thrombosis occurs
- multisystem involvement
- IV antibiotics needed ASAP
- Watch kidney failure, provide skin care and TPN,
- If they recover, may need amputations