Pedia

• Iron deficiency anemia:

  • Most common nutritional anemia in childhood
  • Results from the child not getting enough iron
  • Severe depletion of iron stores leads to low HGB level (iron stored for 6-9 months)
  • Often occurs due to increased milk intake (not iron fortified)
  • Lab results show low HGB, HCT, iron, ferritin
  • Symptoms include fatigue, headache, pallor, increased heart rate
  • Teach parents proper nutrition: include egg yolk, organ meat, raisins/potassium, prunes, green leafy vegetables
  • Calcium inhibits iron absorption, while Vitamin C enhances iron absorption
• • Management includes iron liquid (take with straw, tooth staining), iron injection (Z track), and Vitamin C to increase absorption
• Sickle cell disease:

  • Normal RBC has a flexible, round shape
  • RBC with HbS has a normal shape until oxygen is delivered to tissue, then a sickle shape occurs
  • Pathology involves the transition from Hgf to HgA to HgbA + HgBS
  • Complications include sickling crisis, vaso-occlusive crisis, splenic sequestration, aplastic crisis, and hyperhemolytic crisis
  • Nursing interventions: H - Hydrate, O - Oxygen, P - Pain management, I - Infection control, A - Altitude
• ABO incompatibility:

  • First baby is affected and subsequent pregnancies
  • Symptoms include erythroblastosis fetalis, jaundice, anemia
  • Management includes phototherapy (blue light) and exchange transfusion
• RH incompatibility:

  • Symptoms include erythroblastosis fetalis, jaundice, and hydrops fetalis
  • Hydrops fetalis is a condition with extensive swelling due to fluid buildup in tissues and organs
• Leukemia:

  • Increased WBC, decreased RBC, decreased HGB, decreased platelets
  • Normal bone marrow elements are replaced by immature WBC
  • ALL (Acute Lymphocytic Leukemia) and AML (Acute Myelogenous Leukemia) are common types
  • Symptoms include fatigue, infection susceptibility, bruising, petechiae, gingival hypertrophy
  • Diagnosis involves bone marrow aspiration and peripheral blood smear
  • Treatment includes systemic chemotherapy with side effects like vomiting, managed with antiemetics
• Hemophilia:

  • Little or no clotting factor
  • Types include factor 8 (Classic - Hemophilia A), factor 9 (Christmas disease - Hemophilia B), and factor 11 (Hemophilia C)
  • Complications include bleeding into muscle tissue and hemarthrosis causing joint pain and destruction
  • Management involves avoiding contact sports, replacing clotting factors, avoiding aspirin, and using "RICE" method
• Hydrocephalus:

  • Develops due to imbalance in production and absorption of CSF
  • Types include communicating (inadequate CSF absorption) and non-communicating (obstructive hydrocephalus due to tumor obstruction)
  • Symptoms include increased ICP, abnormally large head, bulging fontanel, Cushing's triad, high pitched cry, diplopia, projectile vomiting, prominent skull vein, sunset eyes
  • Management includes positioning to lessen ICP in a low semi-fowler position
• Signs and symptoms of increased intracranial pressure (ICP) include:

  • Increased ICP
  • Bulging fontanels
  • Increase in head circumference
  • Change in level of consciousness
  • Vomiting, seizures, coma
• Management of ventriculoperitoneal (VP) shunts:

  • Shunting can be done with an AV shunt (arteriovenous shunt) or VP shunt (Ventriculoperitoneal shunt)
  • Shave hair in the operating room to prevent the growth of microorganisms
• Signs of shunt dysfunction:

  • Increased ICP
  • Bulging fontanels
  • Increase in head circumference
  • Change in level of consciousness
  • Vomiting, seizures, coma
• Spina Bifida (Meningocele and Myelomeningocele):

  • Etiology is unknown, but genetic and environmental factors are considered (missing vertebrae)
  • Severity of clinical manifestations depends on the location of the lesion
• Neural tube defects:

  • Folic Acid deficiency can lead to conditions like Anencephaly, Encephalocele, and Spina Bifida
  • Spina Bifida is the most common condition where the spine and spinal cord don't form properly
• Myelomeningocele:

  • Manifestations include flaccid legs and hip dysplasia
  • Nursing interventions involve sterile dressing pre/post-op, monitoring for signs of infection, and avoiding stress on the sac
• Seizures:

  • Febrile seizures are common in children due to a rapid elevation in temperature
  • Management includes seizure precautions like suction, oxygen, and padded rails
• Cerebral Palsy:

  • Brain damage in pediatrics due to lack of oxygen (anoxia) during delivery
  • Common problems include delayed skills, abnormal muscle function, and high risk for aspiration
• Associated problems with Cerebral Palsy:

  • Mental retardation, hearing loss, speech defects, dental and orthopedic anomalies, GI problems, and visual changes
  • Nursing interventions focus on safety, special needs, and monitoring for symptoms like spasticity, athetosis, ataxia, tremor, and rigidity
• Tonsillitis:

  • Clinical manifestations include sore throat, mouth breathing, sleep apnea, difficulty swallowing, fever, and GABS
  • Management involves tonsillectomy (palatine, lingual, tubal) and adenoidectomy
• Cystic Fibrosis:

  • Dysfunction of the exocrine gland leading to a multi-system disorder
  • Clinical manifestations result from the obstructive process and include high sodium levels in sweat
  • Pancreatic involvement in 85% of CF patients, and the disease is ultimately fatal
• Pulmonary manifestations of Cystic Fibrosis:

  • Initial symptoms include wheezing and non-productive cough
  • Progressive symptoms include repeated lung infections, wet cough, emphysema, and barrel-chest
  • Diagnostic tests include aspiration of duodenal content, X-ray, stool exam, and sweat chloride test
• Child Psychiatrist - is a medical doctor trained to diagnose and treat mental health disorders in children and adolescents.
• They play an important role in educating parents about child health, development, and preventing childhood diseases.
• Neonatologist - is the pediatrician that deals with newborn babies, especially those born prematurely or with low birth weight.
• Pediatricians provide comprehensive primary care, including routine checkups, prevention, diagnosis and treatment of childhood illnesses.
• Nursing Considerations for Iron Deficiency Anemia


  • Liquid iron given through straw
  • Avoid milk, pancreatic enzyme, and vitamin E as they interfere with iron absorption
  • Ascorbic acid added to help with iron absorption
  • Iron supplements may cause dark green or black stool and constipation
• Sickle Cell Anemia is an inherited, autosomal-recessive genetic disease that occludes small vessels, causing pain and decreased function
• Precipitating Factors for Sickle Cell Anemia

  • Decreased O2 tension
  • Dehydration
  • Acidosis
• Clinical Manifestations of Sickle Cell Anemia

  • Sickle cell crisis
  • Vaso-occlusive crisis with distal ischemia and pain, hand-foot syndrome, priapism, acute chest syndrome, CVA
  • Sequestration crisis with pooling of blood in the liver and spleen, hepatosplenomegaly
  • Aplastic crisis with diminished RBC production
  • Hyperhemolytic crisis with accelerated rate of RBC destruction
• Diagnostic Tests for Hematologic Problems

  • Allergy skin testing
  • Bone marrow aspiration
  • Biopsy
  • CBC with differential
• Diagnosis of Iron Deficiency Anemia

  • Hgb < 11.3g/100ml
  • Hct <34%
  • RBC morphology at 1- and 2-year well-baby check-ups in at-risk population
  • Microcytic, hypochromic anemia with low MCV, MCH, MCHC
  • Decreased serum iron levels
• Diagnostic Evaluation for Sickle Cell Anemia

  • Screening with sickle turbidity test (SICKLEDEX)
  • Confirmatory with hemoglobin electrophoresis
• Therapeutic Management for Sickle Cell Anemia

  • Rest to minimize energy expenditure and O2 use
  • Hydration
  • Electrolyte replacement
  • Analgesics
  • Blood replacement with packed RBC
  • Antibiotics; Hydroxyurea to decrease number and severity of crisis
  • Oxygen
• Anemia appears between 4-6 months
• Clinical Manifestations of Iron Deficiency Anemia

  • Pale appearance and decrease in activity
  • History of prematurity and poor weight gain in toddlers
  • Fatigue
  • Inability to concentrate
  • Dyspnea on exertion
  • Craving on nonnutritive substances like ice or lead-based paint
  • Dry, brittle nails
  • Concave or “spoon-shaped” fingernails
• Human blood contains special proteins known as clotting factors
• Treatment for Iron Deficiency Anemia

  • Ferrous sulfate – oral with ascorbic acid (side effects: gastric irritation and constipation)
  • Dietary Iron sources
  • Iron Dextran – IM Z-track
• Types of Hemophilia

  • Hemophilia A (classic) – factor VIII deficiency
  • Hemophilia B (Christmas) – factor IX deficiency
  • Hemophilia C – factor XI deficiency
  • Von Willebrand’s disease – factor VII deficiency and poor platelet aggregation
• Iron Deficiency Anemia occurs when the body doesn’t have enough iron. The body needs iron to make hemoglobin. Hemoglobin carries oxygen from the lungs to the cells throughout the body. Without enough iron, the body produces fewer and smaller red blood cells, resulting in less available hemoglobin and insufficient oxygen for the body's cells
• People with hemophilia are deficient in clotting factors VIII or IX, preventing a stable fibrin clot from forming
• Etiology of Iron Deficiency Anemia

  • Insufficient dietary intake of iron
  • Acute or chronic blood loss
  • Impaired absorption