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latex allergy Response can range from Type IV to Type I
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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.
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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
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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
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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
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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
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what are the hematologic topics?
- Iron Deficiency Anemia
- Sickle Cell Anemia
- Hemophilia
- Immune (Idiopathic) thrombocytopenia Purpura (ITP)
- Meningococcemia ( spina bifida)
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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
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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
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clinical findings of iron deficiency anemia?
- Pallor
- Nail bed deformities
- Fatigue
- Irritability
- Tachycardia
- New heart murmur
- Slowed growth on growth chart
- Pica
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how is anemia diagnosed
- Blood tests:Hematocrit, hemoglobin, RBC
- Serum iron, ferritin, transferrin levels
- Diet History
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management of anemia with vitamin rich foods and vitamin c foods
- Iron rich:
- Meats, fish, poultry
- Vegetables
- Dried fruits
- Legumes
- Enriched grain products
- Whole-grain cereals
- Iron-fortified dry cereals
- vitamin c rich foods:
- OJ
- Citrus fruits
- Strawberries
- Tomatoes
- Broccoli
- Green leafy vegetables
- Potatoes
- Some dry cereal
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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
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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
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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
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clinical manifestation of sickle cell
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sicke cell crisis
Caused by some situation tha t decreases oxygenation - surgery, high altitude, flu, asthma attack
pain crisis - sequestration crisis-
spleen involved - aplastic crisis
- acute chest syndrome ( box 23-3)
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what is the vaso-occlusive crsis?
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s&s sequestration crisis?
- irritability
- unusual sleepiness
- looks pale
- weakness
- fast heart beat
- big spleen
- pain on the left side of abdomen
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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.
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S&s of aplastic crisis?
- paleness
- lethargy
- "not feeling good"
- headache
- fever
- low blood count ( anemia)
- recent upper resp infection
- passing out ( fainting)
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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
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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
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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
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- 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)
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blood transfusions
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.
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when does a person get whole blood
Whole blood: used to replace blood after /during a large hemorrhage
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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.
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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.
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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.
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blood transfusion reactions?
- Allergic
- uticaria, flushing, wheezing, laryngeal edema
- Hemolytic
- chills, shaking, flank pain, red/black urine, N/V
- Febrile
- fever, chills
- Circulatory Overload
- precordial pain, dyspnea, rales, productive cough,distended neck veins
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what are the nursing responsibilities r/t blood product administration?
- -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
If reaction occurs, stop blood and replacewith normal saline infusion
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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
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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
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clotting
- 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).
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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
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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
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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
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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
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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
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soft tissue bleeds and bruising:
no functional impairment
-tenderness, but no severe pain
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iliopsoas bleeds
flexed hip
pain, inability to extend the leg on affected side
treat with a major dose of factor
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thigh/ calf bleeds
pain with/without swelling
impaired mobility
- routine factor dose
- major factor dose if compartment syndrome is suspected
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neck swelling
potential airway compromise
- emergency!
- treat with a major dose of factor
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deltoid/forearm bleed and bruising
- routine factor dose
- major factor dose if compartment syndrome is suspected
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buttock bleeds
pain
with/without swelling
- routine factor dose
- major factor dose if the leg on the affected side exhibits tingling or swelling
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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
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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
- ? Play……
- ? School…….
- ? Chronic Illness……
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Immune (Idiopathic) Thrombocytopenic Purpura
(ITP)
- 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 chickenpox?Chronic - longer than 6 months, occurs in about 25% of patients
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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
- Treatment:
- ? Prednisone
- ? 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
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MENINGOCOCCEMIA
- 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
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