Exam 2: NUR203/ NUR 203 (New 2024/ 2025
Update) Pediatric Nursing Review| Questions
and Verified Answers| 100% Correct| A
Grade – Fortis
QUESTION
overview assessment with children with hematological issues
Answer:
Observe the color of skin, is it pale or dusky. What is their general appearance, are they thin or
Obese. Look at the nail beds to see if you can get a capillary refill less than 3 seconds. Check the
Palms of hands and sole of feet and look for pallor for clubbing of fingers. Clubbing occurs when
Children have chronic hypoxemia. Check the conjunctiva and notice pay attention to see if mom
Or caregiver states that the child always wants to eat ice. Eating ice in young children is a pica
And indicates low iron. Listen for bilateral breath sounds. If lack or absent sounds it may
Indicate that the lungs can be filled with fluid or blood. Listen to heart sounds for s1 and s2.
Report extra sounds like a swish or murmur, anything abnormal. Feel for peripheral pulses, if
They are equal. Check bp, palpate abdomen. Children may have hepatomegaly or splenomegaly,
do not push on that so it does not rupture. Check skin turgor. Most important labs are hgb and
Hct, and platelet count
QUESTION
iron deficiency anemia
Answer:
This is a condition of rbc and hgb level below normal. It's
The most common hematological disorder in infancy and childhood. Occurs when body does not
Have enough iron to produce hgb. Hgb is made up of protein and globulin. Occurs between 6 to
20 months, and may reoccur in puberty especially in young woman beginning menses. Cow's
Milk is definite contributor to iron deficiency anemia because of lack of iron available in cow's
Milk which is actually minimal. It's important that parents understand that not to always give
Their children a bottle of milk. Breast milk is better if breast feeding. Along with having poor
Iron in diet that can create gastritis, it creates inflammation and sets child up for infection. It can
Be mild and it's usually asymptomatic, children may try to eat ice cubes. Moderate clinical
,Manifestations are general irritability or weakness due to the fact hgb production decreases
Secondary to decreased iron. Low iron means decrease oxygen carrying capacity. If there is a
low
Oxygen capacity for a long period of time you will see symptoms of nail bed pallor, clubbing,
Greater than 3 second capillary return. Hgb is responsible for transfer of oxygen and nutrients to
The cells. If there is low oxygen and it progresses, it's associated with cognitive delays and
Behavioral changes. Signs and symptoms in 5 and 6 years old is poor schooling. Severe iron
Deficiency anemia requires children to be treated with iron and it's usually around 4 to 6
Mg/kg/day in 3 divided doses. Iron is always given with meals. This is because it's an irritant. It
Can manifest in cardiac murmurs and they sound like "lub-shee-dub". Chf children are very
Pale, white eyelids when pulled down. They have impaired healing due to lack of oxygen to the
Tissues, hair is thin, dry and brittle, they have abdominal pain due to hepatomegaly and
QUESTION
sickle cell anemia
Answer:
In children it's similar to other anemia. They have delayed growth
And development. If rbc are not carrying normal amount of hgb, they will carry a less effective
Type of hgb. This is genetically recessive gene. This is most common in africans,
Mediterranean, and middle eastern and indian descent. 1 out of 400 african americans have
Sickle cell anemia and 8% have traits and are carriers. High rbc destruction, when rbc are
Destroyed they take on a sickle shaped, which makes it difficult to get though the circulatory
System and they can clump up. When they clump up they create a stroke. Abnormal stem cells
Produce an adequate erythrocytes, leukocytes, and platelets and this is a cause of aplastic crisis.
This causes a rbc to be a discus shape and cause strokes. It can also cause vaso occlusive crisis
Leading to local tissue hypoxia, which leads to tissue breakdown and infections. Children with
Sickle cell anemia look at it if they have a painful swelling of the hands, feet, and joints. Vaso
Occlusive crisis have decrease visual acuity related to decrease in retinal blood flow. This is
Diagnosed by family history, seeing sickle cells, decreased hgb, peripheral blood smears,
Erythrocyte sedimentation rate (esr) which is elevated, high platelet, and abnormal lft's.
Treatment= it's not curable, can treat it by preventing rbc sickling by encouraging of fluid
Intake, avoid things that are too hot or cold, more fluids means less dehydration, and an increase
In fluid will decrease chances of rbc to be a discus shape. Use prophylactic oral penicillin until
age 5. This treatment is primary for pain control when children have a crisis, and it's done by
Medication and o2 administration. Children who are not treated can die before age 5. It's
Important to be aware of s: s of children that have sickle cell anemia disease especially wh
QUESTION
beta thalassemia major
, Answer:
This is a genetic disorder, seen around the mediterranean sea
Border. It's inherited autosomal recessive inheritance. Beta globin chain in the hgb synthesis is
Reduced or absent which causes unstable globin chain to accumulate. Than the rbc become
Rigid and they hemolysis or break apart easily. This rapid breakdown apart of rbc release iron in
Blood stream. Iron than is deposited in skin, which cause bronze pigmentation to children. You
Will see severe anemia, cells in spleen, impaired growth and development similarly related to
Blood disorder. Children die by 5 or 6 year without treatment. Transfusions can increase children
Life-span and they require frequent transfusions. They are monitored often for hgb, hct, and iron.
They are transfused with packed rbc at intervals.
QUESTION
aplestic anemia
Answer:
This is a failure of bone marrow to produce cells, a condition of abnormal
Stem cells. Clinical manifestations= hemorrhaging. It can be severe which results in death. S: s=
Impaired growth and development and can develop leukemia. It's diagnosed by blood count,
Granulocytes count less than 500 (normal is 2,500-6,000), platelet less than 20,000 (normal is
Approximately 200,000), reticulocytes less than 1% (normal is 3% to 6% in infants).
Reticulocytes are packed rbc. Bone marrow transplants are done from matched sibling donors.
They also do immunosuppressive therapy with high doses of cyclophosphamide. Nursing care
And family education are done to prevent injury to help prevent bleeding. Small falls with small
Bruising on children with aplastic anemia will create a huge hematoma. Also prevent anal
Fissures from constipation, give children stool softeners. Biggest thing for patient education is to
Prevent injury to the child to prevent bleeding, also regular follow up by the pediatric
Hematologist every 3 months to monitor blood levels.
QUESTION
hemophilia
Answer:
This is a recessive disorder resulting in deficiency in one of the coagulation
Factors in the blood. Hemophilia a is most common, and it's called factor 8. Hemophilia b or
Factor 9 and are referred to as christmas disease. We see bleeding episodes in clotting
Deficiencies. Platelets help stop the blood running if we have a cut, but if platelets are altered,
