Hematology+Round+1

=Hematology Pediatric Round 1 =

**Hematology system** allows for oxygen transport, minimizes hemorrhage and helps fight infection. Blood transports substances needed for cell metabolism, regulates acid/base balance, protects against infection and injury.

**Blood components**- **plasma, cellular elements**.

Plasma - water, solutes, Cellular elements - cells proteins.

** Cellular elements -** erythrocytes (RBCs), leukocytes (WBCs), thrombocytes (platelets).

Prior to birth the blood cells are produced in the liver and spleen. After birth new blood cells are produced from stem cells in the bone marrow (hematopoiesis).

** Red Blood Cells ** - (RBCs) - Supply tissues with oxygen, most abundant cells in blood. Remain in circulation for 120 days then removed by the spleen. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">RBCs do not replicate, new ones are produced by the bone marrow. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Their biconcave shape and small size allows them to reach all cells. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Each RBC has an oxygen carrying protein hemoglobin. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Hemoglobin allows RBCs to transport 100 xs more oxygen than could be transported in plasma alone.

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<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">**White Blood Cells** <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">(WBCs) - <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Remove debris and defend against invaders. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">The circulatory system delivers the WBCs to the site of injury or infection. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Invasion of foreign body first stimulates infection and then an immune response. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Lymphocytes are responsible for the immune response. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Monocytes, macrophages, neutrophils, eosinophils and basophils are responses to inflammation. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">* CBC with differential measures the WBC levels* <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%; line-height: 0px; overflow: hidden;">

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">** Platelets ** – <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Disc shaped cytoplasmic components <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Not cells <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Live for 10 days then removed by the spleen <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Facilitate blood coagulation by adhering to injured vessel wall and release biochemicals.

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">** Anemia ** – <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Not a disease <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Decrease in the oxygen carrying capacity of blood. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Most common blood disorder of children. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Prevalence over 13% in children under 5. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Microcytic, normocytic and macrocytic describe the size of RBCs <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Hypochromic, normochromic and hyperchromic describe color and hgb content <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Size differences are related to production problems <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Color differences are related to hgb content. <span style="color: #c82226; font-family: 'Times New Roman',Times,serif; font-size: 180%;">Anemia caused by:

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 140%;">*Production decrease (erythropoieisis) <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Due to nutritional deficiency (iron, folate, B12, copper) <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Due to bone marrow failure (aplastic anemia, ALL, parvovirus, CMV, malignancies)

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 140%;">*Destruction of RBCs increased (hemolysis) <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Due to hemoglobiopathies (sickle cell, thalassemias) <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Or drugs, toxic substances or infection

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 140%;">*Increased red blood cell loss <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Due to acute blood loss (epistaxis, hemophilia, DIC)

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 180%;">Signs & Symptoms are related to the cause and severity- mild <11, mod <7, severe <3. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Pallor <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Tachycardia <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Headache <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Fatigue <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Shortness of breath <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Muscle weakness <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Irritability <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Lack of interest in play <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Anorexia <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Murmurs <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Low grade fever <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Yellowish skin (blood destruction) <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Grayish look suspect resp. because of pallor <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Hair falls out, nails are brittle and spoon shaped <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Spleen and/or liver enlargement <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Cool skin, decreased peripheral pulses <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">These children can be underweight, normal weight or overweight. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">If not resolved physical and developmental delays may occur.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;"> Diagnosis: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">history, clinical symptoms and labs. ? recent blood loss, diet

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;"> Nursing Diagnosis: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Ineffective tissue perfusion <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Imbalanced nutrition <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Deficient caregiver knowledge <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Activity intolerance

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;"> Nursing Outcomes: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Child will maintain an adequate Hgb <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Child will consume minimum RDA iron each day <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Caregiver can describe feeding guidelines <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Child will be able to engage in age appropriate play without fatigue

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;"> Nursing Interventions: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Correct underlying problem, treat the cause! <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Caregiver education - Why adequate iron is necessary <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Dietary and supplemental education <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Breastfeeding (or iron fortified formula) till 4-6 months (more bioavailable) then 1mg/kg/day of iron <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Age 4-6 months 2 or more serving of iron fortified infant cereal <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> By 6 months 1 feeding per day vitamin C rich fruit /day. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> After 6 months pureed meats <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Children age 1-5 no more than 24 oz. cows, goats, soy milk per day. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Consumption of iron rich foods <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Cook acidic foods in iron pan <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Give exact amount of iron supplement, more is not better <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> *Keep iron locked up to prevent overdose <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Avoid side effects by taking with or after meals <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Stools tarry green color <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Be aware constipation may occur <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">***Liquid iron may stain teeth use straw, or dropper or syringe <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Avoid fluoride, antacids, coffee, tea, milk, dairy, bread within 1 hour, interferes with absorption

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 140%;"> *Interesting alternative* >
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Scientists in India have experimented with adding iron to inexpensive candies. These were given to at risk 3-6 year old children once a week with improvement noted.
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Iron deficiency- adolescent rapid growth and poor diet, preg. Adol. Esp. needs more, most common inadequate intake. School age child blood loss. 3rd world country hook worms.

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<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 160%;">Dietary sources of iron: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Meats: Lean beef, veal, pork, lamb, poultry, liver <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Seafood: Clams, oysters, shrimp <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Grains: Whole grain bread, fortified cereals, brown rice, enriched pasta, tofu, soybeans <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Vegetables: Spinach, okra, sweet potatoes, winter squash, white potatoes <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Fruits: Tomato, prune juice, prunes, raisins, figs <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Legumes: Dried peas, dried beans, legumes <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Miscellaneous: Molasses, egg yolk, nutritional yeast

=<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 27px;">Case Study: Anemia =

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 160%;">//Super Nanny has done a good job teaching this family where to start to address the child's anemia. It is your job to explain the mechanism. People will only change their behavior when there is a logical reason. If you don't explain the link between diet and food these changes will not last.// =====


 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px; line-height: 27px;">Explain the role between blood, hemoglobin and iron.
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px; line-height: 27px;">What physical symptoms can anemia produce? Name some corresponding nursing diagnoses.
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px; line-height: 27px;">What is a good hemoglobin level? A bad one?
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px; line-height: 27px;">Who is at risk for this disorder?
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px; line-height: 27px;">What is the treatment and corresponding nursing interventions? Be specific in covering teaching topics.
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px; line-height: 27px;">Reiterate where sources of iron can come from.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Hematology Round 2 <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Sickle Cell Anemia


 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">Three types: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Sickle Cell Anemia

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Sickle Cell Hemoglobin C

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Sickle Cell Thalassemia disease

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">Incidence and Etiology:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Autosomal recessive disorder - If both parents do not have the gene the child will be a carrier or will not have the gene

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Carriers - Sickle Cell Trait (SCT), 1/14 African Americans carriers

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Traced back thousands of years, children with SCT survived malaria epidemics

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">Pathophysiology:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Sickle cell gene has sickle hemoglobin, hemoglobin S

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">This abnormal hemoglobin aggregates in the RBC causing it to elongate into a cresent or sickle shape.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">These cells are stiffer and less able to change shape.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">This results in them being unable to pass through microcirculation causing vaso-occlussion, pain and infarction.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">These cells are destroyed or pool in the spleen and only survive 10-20 days.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Thus anemia.



<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">Sickling of RBCs:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Hypoxemia - decreased oxygen tension of blood

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Increased Hydrogen ions (decreased ph)

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Increased plasma osmolarity (increased solutes in blood)

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Decreased plasma volume (increased viscosity)

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Low temperatures (vasoconstriction)

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">Manifestations:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">First 6 months of life asymptomatic because hemoglobin F (fetal) doesn't sickle, as hemoglobin S replaces F sickling occurs.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Pallor, irritibility, fatigue, shortness of breath, jaundice,

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">* pain * can occur in any body organ or joint especially during vaso-occlusive crisis



<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">Vaso-occlusive crisis:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Accumulation of sickled cells in a vessel causing obstruction, if not reversed infarction can occur.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Pain can last several hours to several weeks

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Painful crisis - bone marrow ischemia, deep pain, lumbosacral, spine, knee, shoulder, elbow, femur

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Hand-Foot Syndrome - tender, warm, swollen hands and feet

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Acute chest syndrome - infection, pain in chest, infarction, respiratory distress

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">11-20% can experience cerebral vascular accident (CVA), stroke, before age 18 (preceded by headache and decreased school performance)

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Priapism - obstruction of penile veins, persistent erection, urinary retention

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">Sequestration crisis:

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Mortality rate of 50%

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Excessive pooling of blood in the liver and spleen - as blood leaves circulation results in shock

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">This can be fatal as the spleen can hold 1/5 bodies blood supply

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Treatment for repeated sequestration crises removal of spleen.

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<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">Aplastic Crisis:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Decrease in erythropoiesis, despite shortened life of sickle RBCs and need for increase.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Often preceded by infection, human parovirus B19

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Decreased blood flow to organs (eyes, GI, kidneys, spleen, heart, brain, lung) can result in blindness, GI upset, abdominal pain, enuresis, immune suppressed, rheumatism, paralysis, pnuemonia.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">* Children with SCA and SCT can have vaso-occlussive episodes and hypoxia caused by shock, exercising at high altitudes, cold temperatures, or undergoing anesthesia.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Diagnosis:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">In newborn metabolic testing <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Lab work as a result of symptoms

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Nursing Diagnosis:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Acute Pain <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Ineffective tissue perfusion <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">High-risk for infection <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Ineffective coping of child and family

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Outcome Identification:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Child will report relief of pain <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Child's anemia will improve <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Child will be afebrile <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Caregivers are aware of resources

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Nursing Interventions, Planning And Implementation:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Pain management around clock, not prn <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">IV, hydration <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Sequestration crisis results in the administration of RBCs <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Spleenectomy if frequent sequestration <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Prevention of sickling by avoiding infection, acidosis, dehydration, constricting clothing, exposure to cold, high altitudes <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Immunizations <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Prophylactic oral penicillin until age 5 <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Blood transfusions ( watch for iron overload) <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Heating pad, not cold to painful areas <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Activity prn <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Passive R.O.M. exercises <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">IV fluids <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">frequent handwashing <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">blood administration per protocol <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Possibly oxygen administration <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Resource identification, coping assistance

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Family education:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Why sickling occurs? <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Importance of good nutrition, handwashing, prevention through antibiotics and immunizations <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Maintaining hydration <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">What to look for: fever, pallor, pain, enlargement of spleen <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">School needs to be aware <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Sports take care with injuries and hydration

<span style="font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">//Here is your patient for today. Isn't she beautiful. Katelin has sickle cell disease.// //She is a bright active young lady.// media type="youtube" key="4dq7ieN3xqw?version=3" height="477" width="578" align="center"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Katelin is doing a paper in her life science class about Sickle Cell Disease, while she is pretty adept at handling her disease, she has some questions about the actual physiological cause and mechanisms. Explain to her why the cells sickle and why that causes problems.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Explain to Katelin how she can best manage her disease with her athletics. She often is outside for these events, what implications does this have on her care?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Katelin wants to be a nurse. We need nurses! Teaching is a huge part of a nursing career. Teach Katelin about the physiology behind her disease.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">When discussing management of her sickle cell disease during a crisis, what might you expect Katelin to say?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Her friend has had a stroke and a spleenectomy. Is this common for this disease? Explain why? What are some other complications which can occur?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Is there a cure? The promise of stem cells from cord blood

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Your sickle cell patient today:

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Splenic Sequestration located at <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">http://youtu.be/-8AKGLgSFfw

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Fox News 5 Reports on Sickle Cell located at <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">http://youtu.be/4dq7ieN3xqw

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Cord blood Stem Cell Transfusion located at <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">http://youtu.be/SGpQI2yvBcM

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Sickle cell crisis https://youtu.be/8lLCEs1DMbo https://youtu.be/Y3eWxtKUE90