Pediatrics Exam #2 Notes PDF

lOMoARcPSD|24716557 Peds EXAM #2 - notes I took included ATI, the textbook, and additional information from professors Pediatrics (Felician University) Scan to open on Studocu Studocu is not sponsored or endorsed b...

lOMoARcPSD|24716557 Peds EXAM #2 - notes I took included ATI, the textbook, and additional information from professors Pediatrics (Felician University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Ana Inc ([email protected])  lOMoARcPSD|24716557 STUDY GUIDE Pediatrics EXAM 2 Head Injury Brain tumor Increased Intracranial Pressure (ICP) Hodgkin’s lymphoma Autism Anorexia Parathyroidism Nephroblastoma SIADH and DI Thrombocytopenia ADHD HIV Hypothyroidism Cushing Hemophilia Seizure Leukemia - all forms Addison’s disease Iron deficiency anemia Sickle cell Diabetes type 1 & 2 Lupus Chemotherapy Palliative Care Child Maltreatment Hydrocephalus Ventriculoperitoneal shunt Bacterial meningitis Downloaded by Ana Inc ([email protected])  lOMoARcPSD|24716557 Mental Health - ADHD WHAT IS IT? Attention Deficit Hyperactivity Disorder (ADHD) is inattentiveness, hyperactivity, and impulsiveness, usually revealed prior to age 7. It is common in childhood and can persist into adulthood. - A child must meet diagnostic criteria for diagnosis of ADHD: manifestations are present between the ages of 4 and 18 yrs, evidence of social and academic impairment, 6 or more findings from a category are present S/S - Failing to pay close attention to detail or making careless mistakes - Blocking incoming stimuli - Difficulty sustaining attention - Does not seem to listen - Failing to follow through on instructions - Difficulty organizing activities - Avoiding or disliking activities that require mental effort for a period of time - Losing things, forgetfulness, impulsivity, easily distracted - Fidgeting, failing to remain seated, inappropriate running, difficulty in engaging quiet play, seeming to be busy all the time, talking excessively - Blurting out responses before questions are asked - Difficulty waiting turns, interrupting often, striking out, biting, shouting INTERVENTIONS/MANAGEMENT - Meds are CNS stimulants or amphetamines: methylphenidate or dextroamphetamine, give 30 minutes before meal, give early in day to prevent insomnia, monitor for anorexia, hypo or hypertension, tachycardia, and anemia - Use modeling to demonstrate acceptable behavior - Obtain the child attention before giving directions - Set clear limits on unacceptable behaviors and be consistent - Positive reinforcement. Child Maltreatment WHAT IS IT? Child maltreatment is categorized as physical, emotional, and sexual abuse; exposure to domestic violence and neglect - Risk factors can be environmental like financial problems, low education, unemployment alcohol and drug use, mental illness S/S - Multiple fracture - Bruises of different healing stages - STI’s - Enuresis - Vague somatic complaints INTERVENTIONS/MANAGEMENT Downloaded by Ana Inc ([email protected])  lOMoARcPSD|24716557 - Use forensic medical team to collect evidence of physical abuse and a Sexual Assault Nurse Examiner to collect evidence of sexual abuse - Nurses are mandated reporters of suspected abuse and violence - Prevention is the best treatment - Radiographs, CT scans, and other examinations to determine signs of abuse Autism Spectrum Disorder WHAT IS IT?: a continuum of neurobiological symptoms that result in difficulty with communication, behavior, and social interaction. - There are 4 categories: autistic disorder, Asperger disorder, childhood disintegrative disorder, and pervasive developmental disorder CLINICAL PRESENTATION - Deficits in communication, behavior, and social interaction - Usually present by 3 years old - Repetitive movements and obsessive behaviors - Stereotypy: Hand flapping, head banging, self-biting - Problems tolerating loud noises, bright environments, and touching or hugging - avoid eye contact and avoid social interaction - Communication difficulties are also a hallmark - Echolalia - Most communication deficits are clinically apparent by 18 months of age ASSESSMENT AND DX - Pay close attention to milestones - Heritability of ASD: Conduct a thorough family history to determine the presence of additional siblings or other family members with ASD - Routine screening - Particularly at 18-24 mos wellness visit INTERVENTIONS - Early identification - Early intervention program - Assist the child and family in planning educational activities that will limit overstimulation of the senses, collaborating with school personnel, as needed, to align the child’s needs for maximal learning and limited distress Anorexia WHAT IS IT? Eating disorder that is characterized by fear of gain weight or becoming overweight - Typically seen in late adolescence - Results from a combination of physiological and psychological factors, including the influence of societal pressures and ideals and genetic components - Most seen in females S/S - Anxiety, low self-esteem - Depression - Suicidal thoughts Downloaded by Ana Inc ([email protected])  lOMoARcPSD|24716557 - Low body mass index - Lanugo - Cold intolerance - Crying and compulsive exercising INTERVENTIONS/MANAGEMENT - Nutritional support - Can be performed in inpatient or outpatient settings - Treat fluid and electrolyte imbalances and monitor for cardiovascular involvement - Involve family in the counseling - Focus on gradual weight gain 2-3 lbs per week - May need to implement nasogastric feedings Neuro - How would you assess, intervene, educate - Head Injury WHAT IS IT? The pathological result of any mechanical force to the skull, scalp, meninges, or brain. - Open head injury occurs when there is a fracture of the skull or penetration of the skull by an object. - Closed head injury is the result of blunt trauma which can lead to increased ICP; this type of injury can also be caused by shaken baby syndrome. S/S (manifestations depend on the type of injury and the subsequent amount of increased ICP) - Early signs: slight changes in vital signs, slight change in LOC, irritability, high-pitched cry, bulging fontanel, increased head circumference, headache, nausea, vomiting, visual disturbances (diplopia), seizures - Late signs: significant decrease in LOC, bradycardia, decreased motor and sensory responses, alteration in pupil size and reactivity, decorticate (flexion) posturing, decerebrate (extension) posturing, cheyne-stokes respirations, coma. INTERVENTIONS - Monitor the airway; administer oxygen as prescribed - Assess the injuries, position the client so that the head is maintained midline to avoid jugular vein compression to prevent increase of ICP - Monitor vital signs and neurological functions (Glascow coma scale) - Notify the HCP if signs of ICP occur - Keep stimuli to a minimum attempt to minimize crying in an infant - Withhold sedating medications during the acute phase of the injury so that changes in LOC can be assessed - Initiate seizure precautions - Maintain NPO - Assess drainage of CSF from nares or ears and test for glucose, if positive let HCP know - Ventriculoperitoneal shunt Downloaded by Ana Inc ([email protected])  lOMoARcPSD|24716557 - The CSF drains into the peritoneal cavity in front of the lateral ventricles to a location where it may be reabsorbed. - Indications: hydrocephalus, ^ ICP - Shunt revision may be necessary as the child grows - Pre-op interventions: monitor I&O’s, small, frequent feedings until NPO status is prescribed, reposition head frequently and use special devices such as egg crate mattress under head to prevent pressure sores, prepare pt and family for procedure, obtain baseline HC and abdominal circumference b/c paralytic ileus is a complication of the surgery. - Post-op interventions: monitor VS and neuro signs, position child on unoperated side to prevent pressure on the shunt valve. Keep the child flat if prescribed to avoid rapid reduction of intracranial fluid, observe for ^ ICP, with ^ ICP elevate H.O.B. 15-30 degrees, measure HC, monitor for signs of infection, and assess dressings for drainage. - In an infant, high shrill cry, lethargy, and feeding poorly may indicate shunt malfunction or infection. - In a toddler, headache and lack of appetite are signs of shunt malfunction - Older children, alt. of LOC is an indicator of shunt malfunction. - Increased Intracranial Pressure WHAT IS IT?: A brain injury or another medical condition can cause growing pressure inside your skull. The pressure can further injure your brain or spinal cord. Could lead to neurologic dysfunction. Expected range: over 10 S/S - NB - Bulging or tense fontanelles - Increased head circumference - High-pitched cry - Distended scalp veins - Irritability - Bradycardia with respiratory changes - Children - Increased irritability - Headache - Nausea, vomiting - Seizures - Diplopia - Bradycardia - Respiratory changes NURSING INTERVENTIONS - Position no greater than 30 degrees - Avoidance of coughing, straining - Low environmental stimuli Downloaded by Ana Inc ([email protected])  lOMoARcPSD|24716557 - Minimize bright lights - Vitals ICP MONITORING INDICATIONS - Glasgow Coma Scale score of 8 - Glasgow Coma Scale score of less than 8 with respiratory assistance - Deteriorating neurological condition - Subjective judgment MEDICATIONS - Mannitol - Seizures WHAT IS IT?: an electrical disturbance within the brain and is classified according to the area of the brain that is affected - Epilepsy is a condition in which one experiences seizures that are recurrent and unprovoked TRIGGERS - Stress - Sleep deprivation - Strobe lights - Stimulants - Low sugar/sodium S/S - Focal: the abnormal electrical activity is in only one hemisphere (side) of the brain - may be aware during the seizure - may have impaired awareness - may be unconscious - Jerking in one extremity - lip smacking - stiffness on one side of the body - inappropriate mannerisms - buzzing sounds or tingling Downloaded by Ana Inc ([email protected])  lOMoARcPSD|24716557 - feeling anxious, fearful, or angry - seeing flashing lights. - Generalized: Involves both hemispheres - Tonic- Tense, tight - Clonic- Contractions, convulsions - Tonic-Clonic- Tight and contractions - Loss of consciousness - Falls to ground - Stiffened body (10-20 seconds) - Extremities jerk - Tired and sleepy - Atonic- Lack of tension - Myoclonic- Short muscle twitching - Absent- Daydreaming, “spaced out” - Educate parents. Maybe confused for ADHD. - Monitor for brief interruptions in consciousness Epilepsy - When a child has seizure activity that is recurrent and unprovoked - Dx w/ any one of the following: - At least two unprovoked or reflex seizures occur more than 24 hours apart. - One unprovoked or reflex seizure occurs with a probability of having another seizure related to risk factors (e.g., abnormal activity on an encephalogram or a brain abnormality found on imaging) over the next 10 years. - An epileptic syndrome is present. - Considered resolved: - when the child with an age-dependent syndrome is older than the age in which the syndrome is considered active - the child has not had seizure activity for 10 years or more and has been off all antiepileptic medications for 5 years or more - Medications - Phenytoin is the #1 drug for epilepsy - Take folic acid, Vitamin D, and Calcium with med - Gingival hyperplasia, bradycardia, hypotension is expected Status Epilepticus - MEDICAL EMERGENCY - A seizure that is prolonged or a series of seizures within a short period in which the child does not recover between episodes - Lasts longer than 5 minutes or a series of seizures occurring within a 5-minute period INTERVENTIONS - #1 PRIORITY IS TO STOP SEIZURE - given oxygen - antiepileptic medications (IV if access or Rectal) Downloaded by Ana Inc ([email protected])  lOMoARcPSD|24716557 - IV fluids and provide support. - Some children must be placed into an induced coma to stop the seizure activity - Record time, loss of consciousness, neuro assessment, vitals, prepare for suction Febrile seizures - Triggered by a high fever (>101.2) - Most common between the ages of 6 months and 3 years - Prognosis is good. Has not been found to cause brain damage - Bacterial Meningitis WHAT IS IT?: Infection of meninges caused by bacterial pathogens such as Streptococcus pneumoniae, Neisseria meningitidis, Escherichia coli, or Haemophilus influenzae type B CLINICAL PRESENTATION - Fever - Headache - complaints of a stiff neck (nuchal rigidity) - Photophobia - Lethargy or irritability - Infants may be inactive or slow in movement, poor feeding - High pitched cry - Bulging fontanelles at rest - Sunset eyes (sclera visible above iris) - Complication: Hydrocephalus DX - Kernig’s: Lay the child supine with the hips flexed. Try to straighten a leg out—the test is positive if pain behind the knee is experienced when the leg is extended. Younger children may cry out or resist leg extension - Brudenski: Lay the child flat. Attempt to raise the child’s head toward the chest and place the chin on the chest. Meningeal irritation is present if the child indicates pain or resistance or the child immediately flexes the hips and knees - Lumbar Puncture - Increased WBC - Increased Protein - Decreased Glucose - Cloudy - CBC INTERVENTIONS - Place on Droplet precautions - PPE: Surgical mask, goggles, single room - Draw labs within 30 minutes of admission: Culture and Sensitivity - Priority is to ADMINISTER ATB - Neuro and vitals checks, Assessing LOC and GCS - Decrease environmental stimuli Downloaded by Ana Inc ([email protected])  lOMoARcPSD|24716557 - Set seizure precautions (pads, suction at bedside, etc) - HOB 30 degrees to decrease pressure on brain - Keep NPO if nausea/vomiting are prominent - NSAIDs, antipyretics - Lumbar Puncture care - EMPTY BLADDER BEFORE procedure - Knees to chest and keep back rounded - Instruct parents to keep child in flat position for 30 mins to 1 hour after procedure - Notify HCP if there is CSF leak - Hydrocephalus WHAT IT IS: Buildup of cerebrospinal fluid in patients brain - Infants produce roughly 25 mL of CSF per day, whereas older children produce between 25 and 500 mL per day - involve a blockage of CSF, but the rate of formation does not change significantly or is only slightly decreased when hydrocephalus is present CLINICAL PRESENTATION - Consistent with ICP - Dilated scalp veins - Pale scalp skin and separation of cranial sutures - Macewen’s sign: tapping on the skull near the junction of the frontal, temporal, and parietal bones produces a resonant sound - Difficulty holding the head upright - Frontal bossing (an enlarged forehead) - Sunsetting eyes - Bulging fontanel - Emesis and/or poor feeding - Irritability - Sixth nerve palsy - Periods of apnea - Headaches, nausea and vomiting, which may be worse in the morning upon rising - Lethargy - Irritability - a decline in school performance - gait disturbances DX - U/S prenatally - Finding on physical assessment (Increased HC) - CT/ MRI - Cisternogram: identifies abnormality in CSF flow - Lumbar puncture is CONTRAINDICATED Downloaded by Ana Inc ([email protected])  lOMoARcPSD|24716557 INTERVENTIONS - Aimed at relieving ICP - Surgical placement of VP shunt - Measuring Head Circumference is CRITICAL Oncology - Leukemia - Acute Lymphoblastic Leukemia (ALL) - > 20% lymphoblasts (immature wbc that don’t function correctly, lowering ability to fight infection, which is why fever and lymphadenopathy develop; ^ WBC; common 2-5 yrs, rf: down syndrome, epstein barr - Patho: rapid abnormal production of WBC w/in bone marrow; they occupy space limiting RBC production - Manifestations: petechiae, hepatosplenomegaly, lymphadenopathy, high fever, fatigue, night sweats, bone and joint pain, loss of appetite, nasal congestion - Labs/Diagnostics: LOW WBC, RBC, platelets; CBC, CMP, ^ lymphoblasts (>20%); bone marrow biopsy [confirms diagnosis], lumbar puncture, ECG, EEG, FACES scale for pain if preschooler, - Treatment/Care: CVC (for blood draws and med admin) do not eat before placement), chemo, mouth care q4 hrs to prevent sores developing to infection (nystatin, chlorhexidine), encourage child to play to extent possible; neutropenic precautions of count is less than 1,500 and give G-CSF b/c stimulates prod. Of WBC (done after 24 hrs of chemo); alternate therapies are not recommended to use until consolidation phase - Acute Myelogenous Leukemia (AML) - Does not respond to treatment as well as ALL; intense chemo regimens that cause prolonged bone marrow suppression; many require bone marrow or stem cell transplantation for survival. excessive # of myelocytes (immature, nonfunctioning myeloid cells) - Patho: excessive # of myeloblasts from bone marrow, these are immature non functioning myeloid cells. The malignant myeloblasts result in depletion of functional WBC, RBC, platelets. - Manifestations: - subcutaneous nodules - s/s of DIC: excessive bleeding, ecchymosis, purpura, epistaxis, gingival bleeding, ^ HR, decrease BP, chest pain, muscle or back pain - Chloromas (tumors made of leukemic cells outside of bone marrow) - ALL s/s petechiae, hepatosplenomegaly, lymphadenopathy. - Diagnostics: bone marrow biopsy, bone marrow aspiration (PAINFUL) - Treatment/Care: monitoring and treating side effects of chemo *Absolute neutrophil count: Polys + bands / 100 * WBC (< 500 neutropenic precautions) in unit 8* Downloaded by Ana Inc ([email protected])  lOMoARcPSD|24716557 - Palliative Care WHAT IS IT? An interprofessional approach that focuses on the improving quality of life rather than prolonging life when cures are not possible. Focus is on control of managing the client’s manifestations and offering supportive care. NURSING INTERVENTIONS - Plan care for the entire family and it’s individuals in addition to the client - Provide an environment that is as close to being like home as possible - Consult with the client and the family for desired measures - Respect the family’s cultural and religious preferences and rituals - Provide and clarify information and explanations - Encourage physical contact; address feelings; and show concern, empathy, and support - Provide comfort measures - Provide frequent mouth and oral hygiene - Provide adequate nutrition and hydration - Control pain: give meds on a regular schedule, treat breakthrough pain, increase doses as necessary to control pain, encourage use of relaxation, imagery, and distraction to help manage pain - Chemotherapy WHAT IS IT? Treatment for cancer that can administered intravenous, oral, or intratracheal. A central venous access must be available and used. Safe handling and administration is ensured. SIDE EFFECTS - Nausea, vomiting, alopecia, infection, prevent hemorrhage, anemia, pain, inadequate nutrition, anorexia, slowed growth and development, stomatitis, mucositis DOSING - is based on weight and body surface area. - Use a nomogram to determine body surface area - Use a formula if nomogram is not available INTERVENTIONS - Monitor for infection, high risk due to myelosuppression, monitor WBC, neutropenic precautions, administer granulocyte colony-stimulating factor - Manage anemia, red blood count suppression, encourage iron consumption, administer blood transfusions and epoetin alfa - Prevent hemorrhage, platelet suppression, monitor for s/s of internal bleedings, avoid high impact activities, avoid rectal temp, rectal meds or other procedures - Manage nausea and vomiting, antiemetics before the infusion and around the clock, nonpharmacological interventions: ginger root, peppermint oil, acupuncture, and craniosacral therapy - Cluster nursing care to minimize interruptions - Promote pain relief administer meds before painful procedures Downloaded by Ana Inc ([email protected])  lOMoARcPSD|24716557 - Maintain adequate nutrition, treat mucositis, consult dietician for diet recommendations (may have food aversions) - Provide opportunities for social interaction, encourage participation in ADLs when safe and possible - Provide emotional and psychological support! - Hodgkin’s Lymphoma WHAT IS IT? Characterized by the presence of Reed Sternberg Cells, B lymphocytes that have loss their immune function. It starts in the lymph nodes and spreads through the lymph system S/S - Swollen, painless, and rubbery lymph nodes - Fever - Night sweats - Cough - dyspnea INTERVENTIONS/MANAGEMENT - Treat with chemo and low radiation - F - Brain Tumor (Neuroblastoma) WHAT IS IT? It arises from embryonic cells of the peripheral nervous system. Can be a benign or malignant mass in the brain. Can occur anywhere in the sympathetic nervous system but most common in the medulla or in the adrenal gland S/S - Signs and symptoms vary on severity and tumor location - Increased ICP - Headaches - Ataxia - Behavioral changes - Memory loss - Vision changes - Asymptomatic swelling INTERVENTIONS/MANAGEMENT - Treatment depends on type, size, and location of the tumor but can include chemo, radiation, and surgery - Only certain chemo cross the blood brain barrier - Provide preop and postop care and monitor for increased ICP - May use biological therapy and immunotherapy if recurrent Downloaded by Ana Inc ([email protected])  lOMoARcPSD|24716557 Endocrine - Diabetes Indipidus (DI) WHAT IS IT? A disorder of the posterior pituitary that involves ADH produced by the hypothalamus which detects dehydration and/or fluid volume excess MANIFESTATIONS - Polyuria, polydipsia, hypernatremia (increased sodium), diluted urine (increased serum osmoality), dehydration, failure to thrive, poor feedings, sunken fontanels, urine speciic gravity is 200 mg/dL, fasting glucose level of > 126 mg/dL, 2-hour plasma glucose level > 200 during 75g oral GTT or HbA1C > 6.5%. Downloaded by Ana Inc ([email protected])  lOMoARcPSD|24716557 - Treatment/Care: insulin, maintaining proper nutrition, pt and family education, glucose monitoring. Carbohydrate counting (10 g of carbs is covered by 1 unit of insulin). three , high fiber meals should be spaced out by smaller snacks. With mild hyPOglycemia, give glucose tablets or paste give OJ and crackers. - Insulin therapy: short acting IV insulin 0.1-0.2 units /kg of body weight/hr - Give glucose concurrently with insulin to prevent worsening acidosis; as levels normalize it is replaced carefully with monitored food intake. Subqu. Injections are continued for a few days. In days following initial presentation, intermediate acting insulin is added to help with long-term management. - Glucose monitoring: w/ crisis its every hour; those using subqu. Insulin requires blood glucose to be checked before meals and at bedtime and more frequently With s/s. Teach how to perform glucose finger stick test - Have child watch a show, sing, play on phone t distract and alleviate some of the pain and anxiety of the injection - HbA1C is used to assess long-term management of glucose. Diabetes type 2 - Adult-onset; often occurs in school-aged and teenagers - Patho: pancreas produces insulin, but it is unable to be utilized by the body (insulin resistance). As a result the pancreas works harder to produce more unusable insulin (hyperinsulinemia); in time the pancreas no longer can produce insulin, and the result is a body with no insulin, similar to that of a person with type 1 diabetes. Onset of puberty is believed to contribute b/c of the change in sex hormones and thus need for more insulin production. - Manifestations: progression is slower - Acanthosis nigricans, shint velvet like patches most often seen on back of neck, inner thighs, axillae (may think it is dirt but it is not) Downloaded by Ana Inc ([email protected])  lOMoARcPSD|24716557 - Obese, high BMI, large waist circumference - Diagnostics: assess islet cell autoantibodies - Normal levels of islet cell autoantibodies - HTN, dyslipidemia - Treatment/Care: diet and exercise initial treatment for type 2 diabetes. If they do not help, then treatment progresses to use of metformin (improves sensitivity to target cells to insulin in the liver and muscle cells) it slows production of glucose by the liver. Admin metformin with meals. 60 min of physical activity. Home glucose monitoring, HbA1C are obtained to measure the efficacy of blood glucose control over the preceding 2-3 months. Poor management puts children at risk for long-term vascular complications. Hematology - Hemophilia WHAT IS IT? It is a blood disorder in which clotting factors are missing. Typically inherited by sons of mothers who carry the trait. - Hemophilia A: CLASSIC HEMOPHILIA, Factor VIII deficiency, X-linked recessive disorder, most common form - Hemophilia B: Factor IX deficiency Christmas disease S/S - Spontaneous or traumatic bleeding - Bleeding can be internal or external INTERVENTIONS/MANAGEMENT - Monitor clotting times and coagulations studies - Factor replacement - Reconstitute and administer IV - Desmopressin intranasal - RICE - Monitor signs of internal bleeding Sickle Cell Disease WHAT IT IS: Presence of an abnormal Hgb gene known as the Hgb sickle (Hgb S) gene, which results in sickle-shaped RBCs that tend to clump together, leading to occluded blood vessels, impaired oxygen delivery, pain crises, premature RBC death, and anemia - Autosomal Recessive Inheritance - Common in African-Americans, Middle-eastern descent, Indian, Mediterranean Downloaded by Ana Inc ([email protected])  lOMoARcPSD|24716557 S/S - First manifestation is Vaso Occlusive crisis - Most common cause of hospitalization - 10 - infections that produce fever and acidosis - Prophylactic ATB - Keep up to date on vaccines - Early tx for s/s of infection - Dehydration - Isotonic solutions - Promote rest to decrease O2 consumption - O2 as ordered - Pain management - Warm compresses 15-20 mins - Motrin/Tylenol - Opioids: codeine, morphine, oxycodone, hydromorphone, methadone - Watch for respiratory depression - Use of PCA pump - Hydroxyurea (to increase fetal hemoglobin) - Watch for neutropenia, WBC - Deferoxamine (bind iron) - Bone Marrow Transplant - Emotional support Iron Deficiency Anemia Downloaded by Ana Inc ([email protected])  lOMoARcPSD|24716557 WHAT IT IS: The production of hemoglobin requires iron. Iron deficiency results in decreased hemoglobin levels. Results from inadequate dietary supply of iron S/S - Tachycardia - Pallor - Brittle, spoon-shaped fingernails - Fatigue, irritability and muscle weakness - Systolic heart murmur - Cravings for non-nutritive substances (ice, dirt, paper) AKA pica LABS - CBC - HbG - RBC: decreased - Retic count: can be decreased (indicates bone marrow production of RBCs) - Total iron binding capacity: elevated - Trasnferrin < 10 - Stool analysis: guaiac test INTERVENTIONS - Provide iron supplements - Give 1 hour before or 2 hours after milk, tea, or antacid - GI upset common - If tolerated, administer on empty stomach - Give with Vitamin C to increase absorption - Use straw to prevent teeth staining - Stools will turn tarry, green color Downloaded by Ana Inc ([email protected])  lOMoARcPSD|24716557 - SGA babies by the age of 2 mos - Term infants by 4-6 mos - Iron-fortified formula - Diet high in iron and vitamin C - Monitor formula intake - Limit to 32oz/day - Iron fortified cereals - Frequent rest periods - IV Ferrous sulfate - Expected to be painful - Foods - Infants: iron-fortified cereals, formula, or exclusive breastfeeding - Children: Dried beans, lentils, peanut butter, green, leafy vegetables, iron-fortified breads and flour, poultry, red meat Thrombocytopenia WHAT IT IS: Decrease in platelets. Normal 150-400. Anything