Child & Adolescent Health Nursing Lecturer. Dr.

Rayyan Ibrahim Khaleel

University of Mosul / College of Nursing

Child and Adolescent Health Nursing

Year Three /Semester One

General Nursing Program

2021-2022

Prepared by

Lecturer. Dr. Rayyan Ibrahim Khaleel

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 Child & Adolescent Health Nursing Lecturer. Dr. Rayyan Ibrahim Khaleel

Nursing Care of a Family When a Child Has a Hematologic Disorder

O B J E C T I V E S:

1. Describe the major hematologic disorders of childhood..

3. Formulate nursing diagnoses for a child with a hematologic disorder.

4. Plan nursing care for a child with a hematologic disorder.

Hemophilia

It is a congenital coagulation disorder leading to severe bleeding.

Types of hemophilia:

1-Hemophilia A due to deficiency of clotting factor 8.

2-Hemophilia B due to deficiency of factor 9.

Mode of inheritance: as sex linked recessive disorder, however spontaneous mutation may

have occurred. In children bleeding frequently occur into the joint (haemoarthrosis) which is

extremely painful.

management of haemoarthrosis:-

1-Sedation or narcotic.

2-Immobilizadion with splint or traction.

3-Application of cold sponge to the affected part.

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 Child & Adolescent Health Nursing Lecturer. Dr. Rayyan Ibrahim Khaleel

4-Physiotherapy with careful handling to prevent bleeding.

5-Replacement therapy to increase the level of factor 8,plasma can be given also or blood

transfusion.

Responsibility of the nurse:

1-Teach the parents and patient how to administer factor 8 at home.

2-Health education about the disease including:

a- methods of preventing injuries that cause bleeding.

b- careful handling of the child is necessary.

c- medication is given orally, however if injection is necessary the site is carefully chosen and

rotated, the medication is injected slowly and pressure is applied for at least 5 minutes.

d- if blood is to be drawn superficial veins are used.

e- the child's toys must be soft.

f- the child must be protected from falling.

g- if removal of teeth becomes necessary the child is hospitalized for the procedure.

Leukemia:

It is a malignant neoplasm involving all blood forming organs and causing an over production

of any type of WBC. During childhood acute leukemia is the commonest form.

The onset may be rapid or gradual, wide spread petechiae, the child is pale and has anorexia,

vomiting, weight loss, weakness and fatigue. The temperature is elevated. The child bleeds

easily and a slight bruises result in a large ecchymotic area.

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 Child & Adolescent Health Nursing Lecturer. Dr. Rayyan Ibrahim Khaleel

Responsibility of the nurse:

The nursing care of a child having leukemia is based not only on the sign, symptom,

complication of the disease itself but also on the side effect of the drug used in the treatment.

1) Protection from infection and treatment of any infection.

2) Since the child who has leukemia also has anemia, he gets tired easily and need frequent

rest period. He should have well balanced meals, an adequate fluid intake is important.

3) Since the child has low platelet count he should be observed carefully for hemorrhage.

4) Good oral hygiene is important.

5) The child is observed carefully for any indication of CNS involvement such as changes

in his behavior, nausea, vomiting, irritability and headache.

6) The child must be observed for convulsion and any toxic manifestation of the drug used.

7) Bone marrow aspirate is necessary for diagnosis and treatment of leukemia. Bone

marrow is obtained from the sternum or iliac crest.

8) The child must be given physical and emotional support.

9) When the critically ill child lapse into unconsciousness, the nurse must remain with the

parents at his bed side so that they know that everything possible is being done for his

comfort.

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 Child & Adolescent Health Nursing Lecturer. Dr. Rayyan Ibrahim Khaleel

Treatment of leukemia:

A - Supportive treatment: includes the administration of blood, antibiotics, sedative may also

be given to make the child comfortable.

B -Chemotherapy: specific therapy involves the use of Chemotherapeutic agents(cytotoxic

drugs) which produce certain side effects when used.

THALASSEMIA:

It is a chronic congenital hemolytic anemia characterized by deficient synthesis of specific

globulin chains of the hemoglobin molecule- in the case of beta thalassemia, the most common

type, of beta chains.

Etiology and incidence:

1. Thalassemia is an inherited autosomal recessive disease.

2. It occurs in three clinical forms:

a- Thalassemia major, the homozygous form (also known as Cooley's anemia).

b. Thalassemia minor, the heterozygous form(carrier).

c. Thalassemia intermediate

Pathophysiology:

1- In beta-thalassemia, deficient beta-chain synthesis impairs hemoglobin synthesis.

2- In response the body attempts to compensate through continual production of fetal

hemoglobin beyond the neonatal period.

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 Child & Adolescent Health Nursing Lecturer. Dr. Rayyan Ibrahim Khaleel

3- This results in formation of RBCs that are fragile and easily destroyed leading to severe

anemia and hypoxia.

4- No known cure exists; children with beta-thalassemia major rarely live to adulthood

although those with thalassemia minor may have a normal life span.

Assessment findings:

1. Thalassemia minor commonly produces only mild to moderate anemia that may be

asymptomatic and often goes undetected.

2. Thalassemia major commonly produces the following clinical manifestations , usually first

noted around age 6 months .

a. Progressive pallor, poor feeding and protruding abdomen secondary to hepatosplenomegaly.

b. Signs and symptoms of chronic hypoxia such as headache, lethargy, bone pain, anorexia,

and exercise intolerance.

Laboratory test results may reveal:

1- Blood test:

a) Characteristic changes in RBCs, such as microcytosis, hypochromia, target cells.

b) Decreased hemoglobin, hematocrit and reticulocyte count.

c) Fetal hemoglobin with or without a small amount of normal adult hemoglobin.(Hb variant)

2- Screening for thalassemia trait is very important (premarital screening).

Planning and implementation:

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 Child & Adolescent Health Nursing Lecturer. Dr. Rayyan Ibrahim Khaleel

- Care for the child receiving blood transfusions.

- Teach the parents techniques for administration of deferoxamine.

- Chronic toxicity may result from usually high doses of deferoxamine and resulting into

hearing loss renal calcium loss.

- Blurred vision, decrease visual acuity and night blindness may occur. Blurred vision should

be immediately reported. Periodic ophthalmologic examinations are recommended.

- Inform the parents and child that deferoxamine discolors urine to a reddish color.

- Diet is normal for age and should include folic acid and ascorbic acid (vit C). Iron should not

be administered and foods rich in iron should be avoided.

- If the child has undergone a splenectomy, the risk for infection is increased. Teach the parents

and child infection control measures, including proper hand washing and aseptic technique for

infusion.

-Explain that prophylactic antibiotics and pneumococcal, meningococcal and haemophilus

influenza vaccines are given to prevent complications before splenectomy.

- Provide parents information about thalassemia and it's treatment and encourage them to obtain

genetic counseling.

- The nurse provides emotional support to the child and parents and assists them in coping with

a chronic life threatening illness.

- Encourage parents to take an active role in the child's treatment regimen and to provide

opportunities for physical activities, such as swimming that do not increase the risk of fracture.

- Collaborate with the family and school to establish individualized health and education plans.

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 Child & Adolescent Health Nursing Lecturer. Dr. Rayyan Ibrahim Khaleel

- Discuss potential body image changes with the child and provide an opportunity for the child

to express concerns.

Treatment of thalassemia:-

1-Frequent blood transfusion to maintain the Hb level above 10 gram/dl.

2-Splenectomy may be helpful. It lessen the discomfort from enlarged

spleen, it also help to prolong the interval between blood transfusion.

3-Desferal administration subcutaneously daily for 5 days every week by infusion pump over

8-12 hours.

4-Vitamin C given orally at the same time of desferal injection.

5-Folic acid is necessary for every chronic hemolytic anemia.

6-Bone marrow transplantation .

7-Gene therapy in the recent future.

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