Blood Disorders
Lead Poisoning:
What are some s/sx of lead poisoning?
depends on level of toxicity
decreased IQ scores, cognitive deficits, impaired hearing, growth delays
Hemophilia:
What are some diagnostic and laboratory tests used to diagnose hemophilia?
diagnostic studies: before birth with CVS or anmiocentesis, genetic testing of family members, H&P
lab results:
- low levels of factor VIII or IX
- prolonged activated partial thromboplastin time (aPTT)
- prothrombin time (PT), thrombin time (TT), fibrinogen and platelet count normal
Immune Thrombocytopenic Purpura:
What is immune thrombocytopenic purpura?
aka idiopathic thrombocytopenic purpura; bleeding disorder in which there's excessive destruction of platelets in the spleen
cause is unknown but may follow an infectious process
Acquired Immune Deficiency Syndrome:
What is AIDS?
caused by human immunodeficiency virus, opportunistic infections destroy the immune system
Acquired Immune Deficiency Syndrome:
How many negative tests are required before excluding HIV? At how many months of age?
2 negative test
6 months or older
Lead Poisoning:
What are some tx of lead poisoning?
chelating agents bind to lead in blood allowing it to be excreted via urine
prevention and screening; CDC recommends screening at 1-2 years old, if risk high then more often
parent teaching
Hemophilia:
What are some nursing considerations for caring for hemophilia?
safety (prevent and control bleeding), replacement of missing clotting factors (factor VIII concentrate and desmopressin (DDVAP) is a synthetic form of vasopressin), limit joint involvement, manage pain, provide emotional support
Immune Thrombocytopenic Purpura:
What is the patho of immune thrombocytopenic purpura?
idiopathic but believed to be auto-immune response to disease related anitgens
Acquired Immune Deficiency Syndrome:
What is the patho of AIDS?
vertical transmission - transplancentally or during delivery, after birth through breastfeeding
HIV destroys Tcells, decreases cellular immunity and affects humoral immunity
Acquired Immune Deficiency Syndrome:
What are some goals for treating a patient with AIDS?
prevent transmission, prevent progression of disease if occurs, prevent and treat opportunistic infections, provide nutritional support, symptomatic treatment
Hemophilia:
What is hemophilia and which is the most common?
bleeding disorder in which there is a deficiency in a specific clotting factor
hemophilia A
Hemophilia:
What scenarios would require emergency response with patients diagnosed with hemophilia?
bleeding into head, neck, or digestive tract
sudden pain, swelling, and warmth of large joints and muscles of the arms and legs
bleeding with an injury
Immune Thrombocytopenic Purpura:
What are the s/sx of immune thrombocytopenic purpura?
easy bruising, multiple ecchymosis
petechiae
mucosal bleeding (epistaxis, bleeding gums)
internal hemorrhage (hematuria, hematemesis, melena, hemarthosis)
hematomas over lower extremities that may result in chronic leg ulcers
Acquired Immune Deficiency Syndrome:
What are the diagnostic tests used to diagnose AIDS?
prenatal screenings are essential
virologic testing to newborns born to mothers positive for HIV, HIV enzyme-linked immunosorbent assay(ELISA) or western blot immunoassay for children >18 months
younger than 18 months tests are HIV PCR DNA (polymerase chain reaction), RPA (recombinase polymerase amplification), any positive test is retested for confirmation
Acquired Immune Deficiency Syndrome:
What is HAART?
Highly active antiretroviral therapy is a combination of inhibitors to slow down the proliferation of the HIV virus
Hemophilia:
What is hemophilia A?
deficiency of the factor which is produced by the liver and needed for thromboplastin formation
Hemophilia:
What are some tx for hemophilia A?
NSAIDs (used with caution) - help with pain but inhibit platelet function
corticosteroids used judiciously to treat inflamation of joints and hematuria
AMICAR is used to prevent clot destruction - must first give a dose of factor concentrate, used for mouth trauma and surgery
Immune Thrombocytopenic Purpura:
What are the diagnostic studies and labs used to diagnose immune thrombocytopenic purpura?
Rule out systemic lupus erythematosus, lymphomas, leukemia
lab results: platelet count below 20k, normal hemoglobin and WBC count
Acquired Immune Deficiency Syndrome:
How do you manage pregnancy/birth of an AIDS patient?
antiretrovirals during pregnancy, may have planned a c-section, advise not to breastfeed
*without maternal treatment 25% chance newborn will be infected
Acquired Immune Deficiency Syndrome:
What are some considerations when treating a patient with AIDS?
respiratory: prophylaxis with TMP/SMZ to prevent PCP, protect from infection
immunizations: give pneumovax, flu, hep b
varicella if not severely compromised
can give live virus (MMR) 12-15 months if not severely
polio use the inactivated vaccine
Hemophilia:
What are the s/sx of hemophilia?
bleeding varies by degree of severity; bleed of longer periods of time, not faster
bleeding, hemorrhage from any trauma, epistaxis, subcutaneous and intramuscular hemorrhage, hemarthosis, hematomas and bleeding into the muscles, spontaneous hematuria or blood in stools
Hemophilia:
What are some patient/parent teachings for hemophilia A?
regular program of exercise - start early and continue through adulthood; active ROM, not passive
family taught to administer factor usually after age 3, child taught to self administer about 9-12
Immune Thrombocytopenic Purpura:
What are the some nursing interventions used to treat immune thrombocytopenic purpura?
primarily supportive, if platelet count <10k and little bleeding then observe, corticosteroids, IV immune globulin, IV anti-D immunoglobulin (cheaper and faster), platelet replacement (only if life-threatening), may need splenectomy
*if condition persists for 8-12 months, considered to have chronic ITP
Acquired Immune Deficiency Syndrome:
What are the s/sx of AIDS?
neonate asymptomatic at birth, lymphadenopathy, hepatosplenomegaly, oral candidiasis, failure to thrive, weight loss, delayed development, swelling of parotid gland, chronic diarhea, recurrent bacterial infections, lymphoid interstitial pnuemonitis, neurological deterioration, pneumocystis jiroveci peumonia
Acquired Immune Deficiency Syndrome:
What are some psychosocial considerations for AIDS?
mother/parents may be very ill or dying
may live with grandparents or other family
may be in foster care