Pediatrics Exam 4 PDF

Pediatrics Exam 4 Type I Diabetes Patho Not preventable Autoimmune disease that destroys the pancreatic cells that produce insulin S/S Polyuria Polydipsia Polyphagia Weight Loss Diagnosis Blo...

Pediatrics Exam 4 Type I Diabetes Patho Not preventable Autoimmune disease that destroys the pancreatic cells that produce insulin S/S Polyuria Polydipsia Polyphagia Weight Loss Diagnosis Blood glucose Hemoglobin A1C Hypoglycemia Hyperglycemia Irritable Lethargic Nervous Confused Difficulty concentration Double vision Shaky feelings Thirst Hunger Weakness Pallor Flushed skin, dry & crusty Sweating Deep rapid Kussmaul Headache respirations Tachycardia Fruity acetone breath Shallow respirations Paresthesia Managing a Hypoglycemic Crisis Check blood glucose level If blood glucose is below 70 mg/dL, rapidly give one of the following sources of carbohydrates (about 10 to 15 grams each) the right amount to treat hypoglycemia ○ 1/2 to 3/4 cup of orange or grape juice (a juice box is good when one is away from home) ○ 2 glucose tablets or 2 doses of glucose gel ○ 2 to 4 pieces of hard candy ○ 5 gumdrops ○ 1 to 2 tablespoons of honey ○ 1 small box of raisins ○ 6 oz regular (not diet) soda (about half a can) ○ 2 tablespoons of cake icing Therapeutic Management Blood glucose monitoring Insulin administration  Nutritional choices Sick Day Rules Education/Discharge Hypoglycemia/hyperglycemia interventions and prevention Blood glucose monitoring Ketone monitoring Insulin Types Rapid acting (Humalog/Novalog) Short acting (Regular) Intermediate acting (NPH) Long acting (Lantus) Complications Diabetic ketoacidosis (DKA) Diabetic Ketoacidosis (DKA) Patho Presenting complaint in newly diagnosed type I DM Acidosis resulting from severely deficient insulin S/S Acetone odor of the breath (fruity) Kussmaul respirations Fatigue Malaise N/V 3 P’s Weight loss Fever Abdominal/back pain Diagnosis Blood glucose > than 250 mg/dL Ketonuria Sodium bicarbonate levels < than 18 mEq/L pH < than 7.34 Prevention Consistent monitoring & control of blood sugars Infection prevention Therapeutic Management Fluid volume delivery Electrolyte replacement Insulin administration ○ Begun at 0.1 units/kg/hr Respiratory & neuro assessment Hourly blood glucose monitoring K+ monitoring q 2 - 4 hr ○ K+ is usually given 20 - 40 mEq/L Place on EKG monitor  Type II Diabetes Patho Body’s resistance to recognize & use insulin ○ Unlike DM type I → deficient production of insulin S/S May have no signs Obesity Fatigue Frequent infections Can also have the 3 P’s Diagnosis Obesity >85th percentile for age, sex, weight Plus 2 additional R/F ○ Family history (1st or 2nd degree relative) ○ race/ethnicity (Native American, African American, Latino, Asian, Pacific Islander) ○ Insulin resistance (acanthosis nigricans), HTN, dyslipidemia, PCOS, SGA ○ Maternal history of DM or gestational DM 2 random blood sugars > 200 mg/dL Prevention Healthy lifestyle ○ Diet ○ Physical activity ○ Healthy weight Therapeutic Management Blood glucose monitoring Hemoglobin HbA1c Insulin ○ Rapid, short, intermediate, long Oral hypoglycemic (Metformin) Education/Discharge Blood glucose monitoring Insulin & other hypoglycemic administration (Metformin) Nutritional choices - carb counting Exercise Complications Growth failure Delayed puberty Menstrual disturbances Emotional disturbances Cataracts Impaired cognitive dysfunction Hyperlipidemia breakdown/buildup of subQ tissue @ injection site  Phenylketonuria (PKU) Patho Autosomal recessive gene Inherited error in metabolism No prevention S/S No s/s @ birth Developmental delays Intellectual disabilities seizures Diagnosis Metabolic newborn screening Therapeutic Management Phenylalanine-free diet Eliminate proteins -including breast milk & formula Foods they can eat in moderation Fruits & vegetables → apples, bananas, berries, cabbage, carrots, tomatoes ○ Many fruits & vegetables naturally contain low levels of Phe Low protein foods → low protein bread & pasta, cornstarch, tapioca, arrowroot Fats → butter, margarine, vegetable oil, coconut oil, ghee Sweeteners → sugar, honey, maple syrup, molasses Drinks → coffee, green/black tea, fruit juice Medical foods, shakes, & powders designed for PKU Foods to Avoid High protein foods → meat, fish, poultry, eggs, beans, nuts Dairy Certain grains → wheat, oats, rye, barley, & quinoa Foods & drinks that contain aspartame Phe = Phenylalanine Hypothyroidism Patho Thyroid insufficiency Too little thyroid hormone produced/released S/S Subtle at birth Infant Child prolonged jaundice short stature poor feeding delays in developmental Constipation milestones cool/mottled skin weight gain Hypotonia Hypotonia Sleepiness puffy facial features larger fontanels mental retardation decreased crying protruding abdomen large thick tongue sparse, coarse, dry, or brittle hair Diagnosis Newborn screening: TSH levels Abnormally low T4 and high TSH levels Therapeutic Management Thyroid hormone replacement therapy (Levothyroxine → DON’T MIX WITH ANYTHING) Education/Discharge Detailed treatment plan Administration of medication Follow-up labs frequently to test serum levels ○ every 4-6months during the first year ○ every 2-4 months thereafter Precocious Puberty Patho Overactivity of the pituitary gland Caused by CNS abnormalities, lesions/tumors, or brain injury S/S Early development in girls and boys Boys Girls Both facial hair breast development axillary hair penile growth onset of menarche pubic hair increased masculinity ovary enlargement body odor testicular cysts on ovaries Acne enlargement emotional lability voice changes mood swings growth spurts Diagnosis Blood tests CT or MRI if CNS involvement Therapeutic Management No prevention, but should avoid any products that contain external sources of estrogen or testosterone -soy milk contains estrogen Growth charts Facilitating blood levels Followed by endocrinologist Medical/Surgical Care CNS tumor removal Medication (gonadotropin-releasing hormone) GnRH-Injections either ○ Daily ○ every 3-4 weeks ○ every 3 months Histrelin or Supprelin LA- ○ permanent implant device that automatically releases inhibitors over the course of the year ○ Return each year for a new implant Education/Discharge Psychosocial, body image Be sure the family follows chronological age, not developmental age Complications/Consequences Early sexual activity Depression Body image/self-esteem issues Relational Aggression Conduct Problems Delinquency Substance abuse Developed body without equal brain development Attention Deficit Hyperactivity Disorder (ADHD) Patho The cause is unknown however, the neurotransmitters dopamine (DA) and norepinephrine (NE) are thought to be involved. S/S Inattention Behaviors displaying hyperactivity Impulsivity Diagnosis Medical & developmental histories Physical exam Vision & hearing assessment Detailed neurologic evaluation. Behavioral checklists Therapeutic Management Three-pronged approach  Pharmacologic therapy Behavioral therapy Environmental Psychostimulants Prevention of Manipulation ○ Methylphenidate undesired Environment ○ Dextroamphetamine behavior/parenting modified to allow ○ Amphetamine skills the child to be ○ lisdexamfetamine Counseling successful Prescribed dose based on Peer group work resolution of symptoms, not Family therapy child’s weight Down’s Syndrome/Trisomy 21 Patho Most common chromosomal abnormality: 47 chromosomes present, usually as Trisomy of the 21st pair Changes in the development of the body and brain S/S Poor muscle tone Slanting eyes Hyper flexibility of the joints Flat bridge of the nose Short neck with extra folds of skin Small Stature Low-set ears Simian crease →→ Protruding tongue Diagnosis Chromosomal blood test Therapeutic Management Assist new parents with information and resources Early intervention Autism Spectrum Disorder (ASD) Patho Continuum of disorders involving limitations in social relatedness, verbal & nonverbal communication, & range of interest & behaviors Etiology → Unknown (not immunizations!) S/S Impairment in social reciprocity Inability to maintain eye contact Impaired communication Restrictive or repetitive behaviors, interests, or activities Diagnosis “First Signs” Program Therapeutic Management  Early intervention Be aware of the child’s physical boundaries and reluctance to be touched by others Routine is VERY important for these patients Gonna have to get creative with these kids Education CDC ALARM acronym is a means of understanding autism and its treatment ○ A → autism is prevalent ○ L → listen to patients/parents ○ A → act early ○ R → refer ○ M → monitor Maltreatment of Children Includes abuse and neglect of a child less than 18 years of age by anyone who is a caregiver or custodial role It can consist of physical, sexual, or emotional abuse and/or neglect Nursing Care Identify risk factors related to maltreatment Teach parents and caregivers appropriate ways to discipline the child about the use of alcohol and drugs during pregnancy, discourage caregivers from substance use Educate children and adolescents about the body and personal boundaries Report suspected child abuse to local enforcement agency and/or follow clinical  agency guidelines for reporting Acne Patho Caused by Propionibacterium acnes Onset of adrenal androgenic hormones is the primary reason for acne S/S Mild, moderate, or severe Increased sebum production Inflammation with papules, pustules, or nodules Diagnosis Skin assessment Complete history Prevention Avoid oil-based cleansing and moisturizing products Avoid oil-based make-up Do not pick, rub, or touch the acne Stress management Therapeutic Management Medications Antimicrobials Retinoids Hormones Education Clean gently Medication management Take at night Side effects Do not cover with moisturizers or oil-based make-up Atopic Dermatitis/Eczema Patho Not contagious Associated with allergies and asthma S/S Crusty lesions that may weep Diagnosis H&P Therapeutic Management Nursing care Family history of allergies or eczema Assess skin lesions Apply a cool compress or medications Education Lukewarm bath without harsh soaps Apply emollient lotions Dress in light, soft, non-irritating clothing  Keep child’s nails short and smooth Identify and remove potential irritants Impetigo Contagiosa Patho Bacterial infection around the nose and/or mouth Caused by Staphylococcus aureus Not usually painful Highly contagious S/S Vesicles, pustules Exudate dries to crusty, sticky residue Mild edema Erythema Pruritic lesions Diagnosis Assessment of the skin Prevention Good handwashing Keep the child home for 24 hours AFTER the start of antibiotics Therapeutic Management Medications ○ Topical-apply with cotton tip swab ○ Oral Education Medication Education Patient Education Good hand hygiene → imperitive Stay home for 24 hours Change pillowcases nightly Cutaneous Candidiasis Patho Fungal infection caused by Candida albicans Can occur in Infants or Children who use corticosteroid inhalers S/S Oral ○ Whitish grey plaques that can not be removed on the tongue or oral mucosa Skin ○ Fine, red, or pink papules with scalloped borders Diagnosis History Visualization of the lesions Fungal culture Prevention Clean nipples from bottles with soap and water  Keep diaper area dry and use barrier creams Rinse mouth after corticosteroid inhalers Therapeutic Management Medications → nystatin, clotrimazole, miconazole Education Apply oral medication to the insides of both cheeks with a cotton tip applicator. Apply topicals to areas Medication education Tinea Capitus, Tinea Corporis, Tinea Cruris, Tinea Pedis Patho Fungal infections affecting the scalp, skin, groin, feet Capitus ○ scaly pruritic patches on the scalp. ○ Hair loss may occur in the area of the rash Corporis ○ round to oval lesion with a maculopapular border with central clearing “ringworm.” Cruris ○ red, scaly skin that involves the inner thighs, inguinal creases, or perineal area “jock itch” Pedis ○ red, scaly, pruritic skin that may develop weeping. Involves the webbed area of the toes and feet, “athlete’s foot.” Diagnosis Visual inspection using a Wood’s lamp Prevention Check family pets Good hand washing Bathe after sports Do not share towels, combs, hats, helmets Therapeutic Management Antifungals Must be taken for at least 6 weeks Education Patient Education ALL family must be treated Complete ALL medications and treatments Wear lightweight dry socks for pedis Clean/disinfect shower/bath Contact Dermatitis Patho Occurs when an allergen or irritant is encountered ○ Diaper area ○ Children playing outside ○ Jewelry  ○ Plants (poison ivy, sumac, oak) S/S Irritated, inflamed, pruritic rash Vesicles and bullae may be present Vesicles may weep serous fluid Diagnosis History of contacts Biopsy of vesicles Rule out impetigo and varicella Prevention Wear long sleeves, long pants and socks Avoid known allergens Wash well Therapeutic Management Medications → Antipruritic (atarax), oral, or topical steroids Administer medications, topical anesthetics Cool baths Frequent diaper changes in infants Education Prevention Medication management Pediculosis Capitis / Head Lice Patho Common childhood condition Scalp, body, pubic area Lice pierce the skin and suck the blood S/S Live lice Louse eggs It can be found anywhere near the shaft of the hair Pearlescent teardrop in shape Initially laid at the base of the hair shaft Fluorescent blue under a Wood’s lamp Diagnosis Clinical presentation, visualization of louse or egg, persistent itching Prevention Don’t share hats, combs, pillows, headbands Clean sports headgear well between child Treat child and family Therapeutic Management Application of pediculicides and manual removal of the nits. Permethrin 1% cream rinse (Nix) Education  Wash hair according to shampoo instructions Petrolatum and food oils (olive oil) Good house cleaning Clean ALL hats, helmets, and toys Wash everything in boiling water. If unable to wash, bag for 14 days Usually, home from school until lice-free. Recheck in 7-10 days. Bites & Stings Patho Mosquito ○ red, edematous papule ○ Pruritic ○ burning pain Spider ○ red, edematous papule, wheal, or pustule ○ often solitary, pruritic ○ pain → mild to severe, local ○ necrosis of the skin Tick ○ a small reddish area that may or may not be raised ○ sometimes pruritic ○ may still be attached ○ systemic symptoms → Rocky Mountain Spotted Fever, Lyme Disease Bee, Wasp ○ red, edematous papule ○ pain at the time of the sting ○ allergic reaction → hives, flushing, angioedema with wheezing Diagnosis H&P Prevention Wear light-colored clothing minimal scents cover skin (when possible) use bug repellant do not play in dead foliage Therapeutic Management Medical → allergy medications Clean gently with soap and water Monitor for signs of infection Education Remove stingers Use repellant Remove ticks  Animal Bites Patho Dog bites are the most common Boys more than girls Highest in ages between 5-9 Interfering with feeding/taunting the animal S/S Dog ○ Scratches and abrasions ○ Deep lacerations or punctures ○ Crushing tissue and bone injury, including nerve/tissue/muscle and bone Cat ○ Scratches and abrasions ○ Puncture like bites ○ Complications →cat scratch disease, osteomyelitis, and septic arthritis Diagnosis Patient history Physical findings X-ray → looking for crush injuries Prevention Supervise children around animals Teach basic safety approaches Spay or neuter animals – can decrease aggressiveness Therapeutic Management Medical → Antibiotics Suturing larger wounds Obtain a history Clean with soap and water Topical antibiotic and clean dressing Tetanus booster Small wounds left open, unless on the face Human Bites Patho Quite common Most common in toddlers and young children Higher risk for infection S/S Teeth marks without penetration Cutting or piercing of the skin Bruising, swelling, or tenderness Erythema, pain, or fever Diagnosis H&P Prevention Monitor children when playing Swift intervention Positive reinforcement for good behavior Therapeutic Management Medical →Antibiotics Accurate history irrigate wound topical antibiotic dress wound elevate extremity monitor for infection Education Notify both families about the risk for blood-borne diseases Wound Care Signs of infection Give all antibiotics Cat Scratch Disease Patho Self-limiting, lasting 6-12 weeks S/S Tender lymphadenopathy of the head, neck, and/or upper limbs General malaise and low-grade fever Headache Papule at site of original bite Manifest 3-10 days after injury Diagnosis H&P lab work Prevention Discourage rough play with cats and kittens. Wash a bite or scratch immediately Therapeutic Management Medical – antibiotics, lymph node biopsy Nursing – administer antibiotics, dress wounds, and good hand hygiene Education Monitor the site for changes Teach signs of infection Proper medication administration Burns Patho Are the result of either thermal, radiation, chemical, or electrical insult Thermal – most common (hot metal or liquids, steam, fire) ○ Flame – fire (can cause inhalation injuries) ○ Flash – explosions (igniting gas/combustible liquid) ○ Scald – hot liquid, hot steam ○ Contact – touching a hot object Radiation – sunburn, radiation therapy, radioactive material  Chemical – corrosive chemical (sulfuric acid, lye, ammonia) Electrical – electricity ( chewing on an electrical cord, touching power lines, inserting a knife into an outlet) Child Development & Burn Injuries Infant – increasing gross motor skills ○ Scalds and burns from reaching for things on the stove, chewing electrical cords, flame or inhalation from house fire Toddler – exploring environment, increased independence ○ Scalds from a hot stove, hot water burns, trying to light a lighter or match, touching hot appliances, electrical cord in mouth, flame or inhalation from house fire Preschool – increased mobility and independence ○ Scald burns from running into the kitchen while parents are cooking, touching hot appliances, playing with electrical cords, flame burns from lighters/matches, or house fire. School-age/Adolescent – more freedom and access to adult items ○ Scald burns from cooking, flame from lighter/matches, experimenting with chemical agents (bleach, gasoline), climbing trees with electrical power lines Depth of Burns Superficial ○ Erythema and pain for 2-3 days (sunburn). Intact epidermis without blisters, peeling of skin after burn, heals without scarring. Superficial partial ○ Erythema and blister formation. Blisters may burst and weep. Bleeds easily and is very painful. Damage to the epidermis and the outer portion of the dermis. Heal spontaneously within 3 weeks. Scarring will occur Deep partial ○ White or pale color to injured tissue. Huge blisters, extremely painful, will heal within 3-9 weeks. Scarring will occur. Excision and grafting are performed. Full thickness ○ Destroys dermis and epidermis. Eschar is visible. It may damage nerves, bone, and muscle Extent of Burns Determined by total burn surface area. Rule of nines / Lund and Browder chart Phases of burns –Three phases ○ Burn shock/resuscitative – first 24-48 hours after injury, characterized by shock ○ Recovery/wound healing – close the wound as  quickly as possible. ○ Rehabilitative – prevent scar contractures. Enable the child to reenter his or her social environment. Burn Assessment History, initial assessment, remove clothing and jewelry, cover with blankets to keep warm, assess for depth, surface area, and severity Fluid Resuscitation (Professor T’s favorite → 0.9% NS) If 10% TBSA burn requires IV fluids Greater than 15% hypovolemic and cellular shock Urine output of 0.5 mL – 1 ml/kg/hr is the goal Prevention of Infection Caused by bacteria already on the patient’s skin or nosocomial Increase morbidity and mortality Dressing changes Pain Management Central Line Pain Meds before dressing changes Diversional activities, visualization Child participation Circulation Assess circulation to extremities Decompression Fasciotomy Escharotomy A balanced diet is necessary Possible TPN Pruritis Management Common issues in the rehabilitative phase Cool the burn scar Psychological Issues Greatest in the rehabilitative phase Children respond to people’s reactions about their appearance Rehabilitation Positioning and splinting Start active range of motion Regular massage Pressure garments Discharge Instructions/Care Will either go ○ Inpatient Rehab ○ Home *Visiting nurse, PT, and OT are necessary *Follow-up appointments – MUST go *The process of adjustment is gradual. *Can help normalize by play, school, work, and family Inhalation Injuries Patho Burns of the airway This causes the lungs to fill up with fluid, causing sudden acute pulmonary edema S/S Singed eyebrows, nasal hairs Stridor Hoarseness Burns around the nose and mouth Edematous lips Hypoxemia History of standing while clothes burned, being in an enclosed space in a fire Diagnosis H&P Symptoms of sudden acute pulmonary edema Sleep obstructive apnea, dyspnea that worsens when lying down, wheezing, gasping for breath Therapeutic Management Early intubation and ventilation Assess respiratory functioning Minimize the development of pneumonia Frequent turning Chest physiotherapy Chemical Burns Patho Burning continues until the chemical is removed S/S Mimic skin conditions (dermatitis) Diagnosis Based on history, physical and signs and symptoms Therapeutic Management  Priority care – remove the chemical – dilute or brush off DO NOT use another chemical Treatment is similar to thermal burns Monitor for renal failure Watch blood pressure Electrical Burns Patho Two categories ○ Low voltage → electrical cords in the mouth causing full-thickness burns to lips and fingertips ○ High voltage → power lines, survival based on the current type. Severity depends on the type of current Diagnosis History, physical, and signs and symptoms Therapeutic Management Outpatient for minor injuries Scar tissue may present a problem Minor Burns Usually treated in a clinic or outpatient Interprofessional team collaborates 6 “C’s” ○ Clothing → remove any clothing that is hot or has chemicals on it ○ Cooling → use cool saline-soaked gauze. DO NOT use ice ○ Cleaning → Wash with mild soap and water and rinse well ○ Chemoprophylaxis → Bacitracin, tetanus booster ○ Covering → Cover with nonadherent gauze ○ Comfort → Give acetaminophen or ibuprofen to decrease pain. Hemoglobin → 8 ain’t great, less than 7 going to heaven Anemia Patho The most common hematologic disorder of childhood Decreased circulating RBCs decrease the oxygen-carrying capacity of the blood It can be an indication of an underlying pathologic process S/S Fatigue SOB Lethargy Tachycardia Pale skin Irritability Dizziness Diagnosis H&P  CBC Reticulocyte count → body making new RBC Therapeutic Management Nursing Care →Blood transfusions Diet or vitamin supplement Supportive Care Best place to check → conjunctiva Education/Discharge Education on s/s of anemia Administration of iron Quiet play, frequent rest periods !!!RBC → 4-6, Hemoglobin → 12-18, Hematocrit → 37-47!!! Iron Deficiency Anemia Patho The most prevalent nutritional disorder worldwide Cause ○ Decreased iron supply ○ Increased iron demands ○ Blood loss S/S Irritability Fatigue Delayed motor development Tachycardia Shortness of breath Pale skin/conjunctival pallor Diagnosis H&P Lab tests Therapeutic Management Iron-rich foods Iron supplementation Lab work Education Breast milk or iron-fortified formula until 12 months of age Iron-fortified cereal from 6-12 months of age No cow’s milk before 12 months. After 12 months, limit cow’s milk Sickle Cell Anemia Patho Autosomal recessive C or S-shaped RBC’s S/S Pain Weakness Pallor Fatigue  Tissue hypoxia Diagnosis In utero - chorionic villus biopsy Newborn screening → both parents have to be carriers H&P Hemoglobin electrophoresis Prevention No Prevention Genetic counseling Follow-up genetic screening at birth Therapeutic Management HOP to it! Hydration, Oxygenation, Pain Control → PRIORITY Pain management →PCA pumps Education Chronic illness S/S of sickle cell crisis Prevention of complications Adequate hydration Sickle Cell Crisis Precipitating Factors ○ Anything that increases the body’s need for oxygen or alters the transport of oxygen ○ Trauma ○ Infection, fever ○ Physical and emotional stress ○ Dehydration ○ Hypoxia ○ Altitude 4 types Vaso-occlusive thrombotic (most common) Splenic sequestration “Painful crisis” Intrasplenic pooling of large amounts Ischemia causing mild - severe pain of blood Stasis of blood with clumping of cells 5 months - 2 years in microcirculation → distal ischemia Life-threatening: death can occur → infarction within hours Signs ○ Profound anemia, hypovolemia, shock Aplastic crisis Acute chest syndrome Diminished production & increased Lower level of O2 in the blood destruction of RBC’s Similar to pneumonia with the Viral infection presence of new pulmonary Signs infiltrates ○ Paleness, lethargy, HA, fever, Signs anemia, fainting, recent ○ Chest pain, tachypnea, fever, illness wheezing, cough, hypoxia No cure → keep them hydrated, vaccinated, stress management, & healthy diet  Hemophilia Patho The coagulation process cannot be completed, so bleeding is prolonged Hemophilia A ○ “Classic hemophilia” ○ Deficiency of factor VIII Hemophilia B ○ Caused by a deficiency of factor IX ○ Accounts for 15% of cases of hemophilia Bleeding tendencies range from mild to severe Symptoms may not occur until 6 months of age Mobility leads to injuries from falls and accidents Hemarthrosis ○ Most common form of internal bleeding ○ Bleeding into joint spaces of knee, ankle, elbow ○ Signs are swelling, warmth, redness, pain, and loss of movement S/S Bruising → not on bony prominences Excessive bleeding Intracranial hemorrhage: neonate Soft tissue bleeding Swelling or stiffness of joints, especially the knees Diagnosis PT/PTT → shows prolonged bleeding Direct assay of plasma factor activity level for Hemophilia A and B Prevention Genetic counseling Therapeutic Management Prompt treatment Patient safety, prevention of complications Factor Replacement Patient Education Education Administration of factor via IV Prevent bleeding Monitor patient for s/s of a cerebral bleed → altered LOC Close supervision and a safe environment Superficial bleeding: apply pressure for at least 15 minutes +RICE If significant bleeding occurs, transfuse for factor replacement Neutropenia (Lack WBC’s) Patho Absolute neutrophil count (ANC) < 1,000/L in infants