Week 3 Day 2: Hematologic and Immunologic Alterations

Multiple Choice

Which of the following is NOT typically assessed when evaluating hematologic function in children?

• Complete blood count with differential

• History & assessment findings

• Child’s energy & activity level

• Vision screening

Multiple Choice

Which of the following best describes anemia in childhood?

• A decrease in the number of RBCs and/or hemoglobin concentration below normal

• An increase in white blood cells

• A disorder only affecting adults

• A condition with increased oxygen-carrying capacity of blood

Multiple Choice

What are the two main ways anemia can be classified according to the slides?

• By etiology & physiology and morphology

• By age and gender

• By symptoms and treatment

• By diet and exercise

Open Ended

List three clinical manifestations of anemia mentioned in the slides.

Fill in the Blank

CBC with differential in the diagnostic evaluation of anemia typically shows decreased RBCs, decreased Hgb and Hct, and hemoglobin below ___ to 11g/dl.

Multiple Select

Which of the following are components of supportive care in the therapeutic management of anemia?

• IV fluids to replace intravascular volume

• Oxygen

• Bed rest

• All of the above

Open Ended

Explain the importance of anticipatory guidance and education in nursing considerations for anemia management.

Multiple Choice

Which of the following is NOT a recommended step in blood transfusion therapy?

• Verify identity of recipient & donor’s blood group

• Monitor vital signs

• Use blood within 30 minutes of arrival

• Infuse over 8 hours maximum

Multiple Select

Which of the following are possible transfusion reactions?

• Hemolytic reaction

• Febrile reaction

• Hypothermia

• Hypertension

Multiple Choice

What is the first action a nurse should take if signs or symptoms of a transfusion reaction occur?

• Continue transfusion at a slower rate

• Notify the practitioner after finishing the transfusion

• Stop the transfusion immediately

• Increase the transfusion rate

Open Ended

Explain why iron-deficiency anemia is generally considered preventable and describe at least two strategies for prevention.

Fill in the Blank

The pathophysiology of iron-deficiency anemia is characterized by ___ anemia.

Multiple Choice

Which of the following conditions is associated with increased destruction of red blood cells and may require splenectomy as part of its management?

• Aplastic crisis

• Hereditary Spherocytosis

• Sickle Cell Disease

• Hemolysis

Multiple Select

Which of the following groups are more likely to have sickle cell trait or disease?

• African Americans

• Individuals of Asian Indian descent

• Hispanics

• Native Australians

Multiple Choice

Which of the following statements best describes sickle cell anemia?

• It is a hereditary hemoglobinopathy.

• It is an acquired immune disorder.

• It is a bacterial infection.

• It is a metabolic bone disease.

Open Ended

Explain how sickle cell trait provides a survival advantage in areas where malaria is common.

Multiple Choice

What is the genetic inheritance pattern of sickle cell disease?

• Autosomal dominant

• Autosomal recessive

• X-linked recessive

• Mitochondrial

Multiple Choice

What is the primary cause of tissue and organ damage in sickle cell disease?

• Autoimmune attack on red blood cells

• Obstruction of capillary blood flow by sickled cells

• Bacterial infection

• Vitamin deficiency

Fill in the Blank

The only potential cure for sickle cell disease is ___ transplant.

Open Ended

Describe the differences between splenic sequestration and aplastic crises in sickle cell disease.

Multiple Choice

Which of the following is the most common type of sickle cell crisis and what are its key features?

• Vasoocclusive (VOC) thrombotic crisis; very painful, stasis of blood, ischemia, infarction, fever, pain, tissue engorgement

• Splenic sequestration; blood pools in spleen, profound anemia, hypovolemia, shock

• Aplastic crisis; diminished RBC production, triggered by infection, profound anemia, pallor

• Acute chest syndrome; presents like pneumonia, chest pain, fever, cough

Fill in the Blank

Acute chest syndrome presents like ___ in patients with sickle cell disease.

Multiple Choice

Which of the following are signs and symptoms of acute chest syndrome in sickle cell disease?

• Chest pain, fever, cough, tachypnea, wheezing, hypoxia

• Profound anemia, hypovolemia, shock

• Painful swelling of hands and feet

• Jaundice and dark urine

Open Ended

List and explain at least two medical management strategies for acute chest syndrome in sickle cell disease.

Multiple Select

Which of the following are important aspects of nursing care management for a child with sickle cell disease?

• Monitor child's growth and watch for failure to thrive

• Minimize tissue deoxygenation through multisystem assessment

• Assess pain and hydration status

• All of the above

Multiple Choice

The nurse is caring for a pediatric patient diagnosed with Kawasaki disease. Which of the following medications would the nurse expect to administer?

• Ibuprofen oral suspension

• Vancomycin IV

• Aspirin

• Acetominophen oral tablets

Multiple Choice

What are some key components assessed during the evaluation of hematologic function in children?

• Complete blood count with differential, history & assessment findings, child's energy & activity level, growth patterns

• Blood pressure, heart rate, temperature, respiratory rate

• Vision test, hearing test, dental check-up, skin examination

• Height, weight, BMI, cholesterol levels

Clinical Judgment Measurement Model

Case Study

🧒 Patient Profile

• Age: 6 years

• Gender: Male

• Diagnosis: Sickle Cell Disease (HbSS)

• Chief Complaint: Severe pain in legs and abdomen for 12 hours

​Recognize Cues

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📋 Vital Signs

• Temperature: 101.8°F (38.8°C)

• Heart Rate: 128 bpm (tachycardia)

• Respiratory Rate: 28 breaths/min

• Blood Pressure: 92/58 mmHg

• Oxygen Saturation: 89% on room air

​🩺 Physical Assessment Findings

• General: Appears irritable, crying due to pain

• Skin: Pallor, mild jaundice, cool extremities

• Extremities: Swelling and tenderness in lower legs

• Abdomen: Distended, tender on palpation (possible splenomegaly)

• Respiratory: Mild tachypnea, no adventitious sounds

• Cardiac: Tachycardia, capillary refill >3 seconds

🧪 Laboratory Results

• Hemoglobin (Hgb): 7.8 g/dL (low)

• Hematocrit (Hct): 23% (low)

• Reticulocyte Count: Elevated (12%)

• WBC: 14,000/mm³ (elevated)

• Platelets: 450,000/mm³ (elevated)

• Total Bilirubin: 3.2 mg/dL (elevated)

• LDH: Elevated

• Peripheral Smear: Presence of sickled cells

Analyze Cues

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Prioritize Hypotheses

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​Generate Solutions

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Take Action

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Evaluate Outcomes

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