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Wong's Nursing Care of Infants and Children, 11th Ed., Hockenberry, Wilson & Rogers | Registered Nurse (RN) School Study Aid

WBC Differential Lab Value

White Blood Cells (WBC)

5-10 (5,000-10,000)

Neutrophils (50%-70%)

Bands (2%-5%)

Segs (50%-70%)

Lymphocytes (20%-40%)

Monocytes (4%-8%)

Eosinophils (2%-4%)

Basophils (0.5%-1.5%)

2 mins

Whole Blood Composition

Plasma

Electrolytes And Other Solutes

Proteins

Albumin

Fibrinogen

Globulins

Water

Formed Elements

Buffy Coat

White Blood Cells (WBC)

Platelets

Red Blood Cells (RBC)

2 mins

Erythropoietin

Stimulates RBC Production

Chronic Renal Failure

Anemia

Increased Risk of Thrombosis

Pelvic and Limb Pain

Hypertension

Do Not Shake

Monitor Hemoglobin (Hgb) Weekly

May Accelerate Tumor Progression

2 mins

Hemoglobin

Hemoglobin Has Four Iron Hemes

Lots Of Hemoglobin In Red Blood Cells

High O2 Levels Increase O2 Binding

High Temperature Reduces O2 Binding

High CO2 Levels Reduce O2 Binding

Low pH Reduces O2 Binding

Myoglobin Binds Oxygen in Muscle

2 mins

Red Blood Cell Count (RBC) Lab Values

Women: 3.5-5.5 million cells/ MuL

Men: 4.3-5.9 million cells/ MuL

1 min

Hematocrit (Hct) Lab Values

Women: 36% - 46%

Men: 41% - 53%

1 min

Platelet Lab Value

150,000-400,000 Micro L

40 secs

Types of Blood Products

Whole Blood

Packed Red Blood Cells

Fresh Frozen Plasma

Immunoglobulins

Clotting Factors

Albumin

Platelets

Use within 24 Hours

Washing Removes Antibodies

Irradiation Destroys WBCs

2 mins

Blood Transfusion Administration

Proper Patient Identification

Large Bore Needle

Y Tubing

Baseline Vital Signs

Slow IV Infusion

Monitor During First 15 Minutes or 50 mL of Blood

Monitor for Reactions

Do Not Add Anything To Same IV Line

No Dextrose or Lactated Ringers

Jehovah's Witnesses, No Transfusions

3 mins

Transfusion Reactions

Acute Hemolytic

Febrile, Non-Hemolytic

Mild Allergic

Anaphylactic

Circulatory Overload

Sepsis Reaction

Transfusion-Related Acute Lung Injury (TRALI)

Massive Blood Transfusion

2 mins

Warfarin Antidotes

Vitamin K

Fresh Frozen Plasma

59 secs

Iron (Ferrous Sulfate)

Ferrous Salts

Anemia

GI Distress

Nausea and Vomiting

Dark Stools

Take Between Meals

Liquid can Stain Teeth

Keep out of Reach from Children

Caution with GI Disorders

Avoid Antacids

3 mins

Sickle Cell Anemia Assessment

Hemoglobin S (Genetic Defect)

Sickle Shaped RBCs

Jaundice

Vaso Occlusive Crisis

Fever

Priapism

Severe Pain

Prominent in African Americans

May be Asymptomatic

Increased Risk of Infection

2 mins

Sickle Cell Anemia Interventions

Increase Hydration

Analgesics

Oxygen

Warm Compress

Bone Marrow Transplant

Hydroxyurea

Avoid High Altitudes

Prophylactic Antibiotics

Avoid Strenuous Exercise

Vaccines

3 mins

Meperidine (Demerol)

Opioid Receptor Agonist

Moderate to Severe Pain

Post Anesthesia Shivering

Tremors

Constipation

CNS Depression

Sedation

Short Term Administration

Increased Risk Serotonin Syndrome

Does NOT cause Miosis

Renal Failure Increases Toxicity Risk

2 mins

Clotting Overview

Endothelial Cells are Damaged

Platelets Respond to Exposed Collagen and Stick

Platelets Release Recruiting Factors

More Platelets are Attracted

Soluble Fibrinogen Turns to Insoluble Fibrin

Fibrin Seals the Clot

Clot Dissolves

Liver Produces Clotting Factors

2 mins

Hemophilia

Genetic Mutation

Prolonged Bleeding

Pain

Hemarthrosis

Clotting Factor Replacement Therapy

DDAVP (Desmopressin Acetate)

Antifibrinolytic Therapy

Analgesics

Genetic Counseling

Prevent Injury

3 mins

Bleeding Precautions

Hard Foods

Aspirin Products

Blowing Nose Forcefully

Straining During BMs

Enemas or Rectal Suppositories

Pads and Monitor Menstruation

Soft-bristled Toothbrush

Electric Razor

Limit Needle Sticks

Smaller Needle Size

3 mins

Disseminated Intravascular Coagulation (DIC) Assessment

Improper Initiation of Clotting Cascade

Systemic Bleeding

Petechiae, Purpura, Ecchymosis

Change in LOC

Increased PT and PTT

Cyanosis

Increased Fibrin Degradation Products (FDP)

Decreased Platelets and Fibrinogen

2 mins

Disseminated Intravascular Coagulation (DIC) Interventions

Risk for Shock

Renal Failure

Treat Underlying Cause

Manage Bleeding

Maintain Fluid and Hemodynamic Balance

Transfusion

Oxygenation

Heparin Drip

2 mins

Innate Immunity Cellular Response

Natural Killer Lymphocytes Attack Abnormal Cells

Neutrophils in Blood

Infected Cells Release Interferon

Complement Proteins Lyse Pathogens/Infected Cells

Dendritic Cells in Tissue

Macrophages in Tissue

2 mins

Immune System Tissues

Bone Marrow

B Cells and T Cells Formed

B Cells Mature

Thymus

T Cells Tested For Self-Response

T Cells Mature

Lymph Nodes

Mature B Cells and T Cells Monitor Lymph For Pathogens

Spleen

Mature B Cells and T Cells Monitor Blood For Pathogens

1 min

Innate Immunity Barriers

Skin Protects Against Pathogens

Normal Flora Outcompete Pathogens

Lysozyme in Saliva, Tears, and Mucus

Mucous Traps Pathogens

Cilia Remove Mucus

Acid and Digestive Enzymes in the Stomach Kill Pathogens

2 mins

Humoral Adaptive Immunity

B Cell Binds Free Floating Antigen

B Cell Presents Antigen to Helper T Cell

Helper T Cells Help B Cells Develop Antigen Specificity

Plasma B Cells Secrete Antibodies

Memory B Cells Cause Faster Secondary Response

2 mins

Cell-mediated Adaptive Immune Response

Macrophages and Dendritic Cells Present Antigens

T Cell Develops Antigen Specificity

Regulatory T Cells Suppress Response

Memory T Cells Cause Faster Secondary Response

Cytotoxic T Cells Lyse Infected Cells

Infected Cells Present Antigen On Surface

2 mins

Human Immunodeficiency Virus (HIV) Assessment

RNA Retrovirus

CD4+ Helper T Cells

Flu-like Symptoms

Lymphadenopathy

Fatigue

Diarrhea

Unexplained Weight Loss

White Spots on Tongue

Persistent Fever

Night Sweats

2 mins

Human Immunodeficiency Virus (HIV) Stages

Primary Infection

Within 3 Weeks

Flu-like Symptoms

Asymptomatic Stage

Years

Symptomatic Stage

CD4+ < 500

AIDS

Opportunistic Infections

CD4+ < 200

2 mins

Human Immunodeficiency Virus (HIV) Diagnosis

HIV-1/2 Antigen/Antibody Immunoassay

HIV-1/2 Antibody Differentiation Immunoassay

Nucleic Acid Testing (NAT)

Viral Load

Polymerase Chain Reaction (PCR) in Neonates

3 mins

Human Immunodeficiency Virus (HIV) Interventions

Adequate Nutrition

Small Frequent Meals

IV Hydration

Emotional Support

HAART

Transmission Education

Strict Asepsis for Invasive Procedures

Treat Opportunistic Infections

2 mins

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