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Alterations in Oxygenation (Transport) Cheat Sheet by

Nursing care of children with alterations in health status of oxygen transport.

Thalas­semia

Autosomal recessive genetic disorder of inadequate production of normal hemogl­obin. found in meditt­eranean ethnic groups.
Clinical Manife­station
Asympt­omatic | Major retard­ation | Life threat­ening
Spleno­megaly, Heptom­egaly
Pathop­hys­iology
Genetic defect, synthesis of one of a or b globin chains, production of abnormal Hgb and RBC, Hemolysis, Anemia
Collab­orative Care
• No specific drug or diet are effective for treatment
• Minor (heter­o-beta) : body adapts to low Hgb
• Major (Homo-­beta) : Blood transf­usions with IV defero­xamine (used to remove excess iron from the body)
 

Polycy­themia

A net increase in the total number of Red blood cells. Overpr­odu­ction may be due to:
- myelop­rol­ife­rative syndrome in bone marrow
- reaction to chroni­cally low oxy lvls or malignancy
Pathop­hys­iology
Myelop­rol­ife­rative due to hypoxia, the stem cell grow uncont­rol­lably, BM becomes Hyperc­ell­ular, Blood becomes thick to sluggish circul­ation, BM becomes fibrotic.
Compli­cations
- Increased viscosity of blood
- Hemorrhage and thrombosis
Treatment
- Phlebotomy
- Myelos­upp­ressive agents : Intron A, Agrylin, Aspirin
 

Idiopathic Thromb­ocy­topenia Purpura (ITP)

Disorder of decreased platelets (below 150,000)
Causes
•Low production of platelets
•Increased breakdown of platelets
Symptoms
• Bruising, Nosebl­eeds, Petechiae
Immune Thromb­ocy­topenic Purpura
• Abnormal destru­ction of circul­ating platelets
• Autoimmune disorder
• Destroyed in hosts' spleen by macrop­hages
Thrombotic Thromb­ocy­topenic Purpura
• Increase agglut­ination of platelets, form microt­hrombi
Diagnostic Studies
•Platelet count, Hgb/Hct, prothr­ombin time (PT)
•Activated partial thromb­opl­astin time (aPTT)
Treatments
•Corti­cos­teroids (Betha­met­hasone, predni­sone, prelone)
• Plasma­phe­resis, Splene­ctomy, platelet transf­usion
                       
 

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