N-Trivia

Iron-deficiency Anemia
Comparison of Pediatric Cancers and Adult Cancers
From Fetal Circulation to Pulmonary Circulation

Posted: 08 Oct 2010 10:00 PM PDT

Definition: Iron deficiency anemia (IDA) is an ailment when there is not enough hemoglobin produced by the body to meet its requirement.

The benchmark for its diagnosis is marked by below-normal total body iron

Etiology:

It is caused by inadequate intake of iron-rich foods or inadequate absorption of iron.
Some of the known could be due to:
a.) chronic diarrhea
b.) malabsorption syndromes
c.) high cereal intake with low animal protein ingestion partial or complete gastrectomy

Prevalence: It is more common in developing countries and tropical zones. According to the Food and Nutrition Research Institute (FNRI) as of 2003, in the Philippines iron deficiency anemia is common among children 6 months to one year old, pregnant and lactating women. Government efforts are still being implemented since it poses a public concern. Women between 15 – 45 years old are the ones being mostly affected.

Pathophysiology: In IDA, when iron levels in the body decreases, transferrin which binds with and transport iron is also depleted. As a result, red blood cells (RBCs) the oxygen carrying component of the blood is likewise depleted leading to decreased levels of hemoglobin in the body.

Physical Findings:

Asymptomatic if in mild cases
palpitations, dizziness and cold sensitivity
brittleness of hair, nails and pallor
dysphagia, stomatis, atrophic glossitis
dyspnea and weakness

Diagnosttic Examinations:

Complete Blood count – first test to check the levels of the parts of the blood (red blood cells, white blood cells, platelets)
Reticulocyte count - The test shows whether your bone marrow is making red blood cells at the correct rate.
Peripheral smear – To check whether the red blood cells look (microcytic) smaller and (hypochromic) paler than normal
Serum iron markedly decreased
Serum ferritin decreased
*Ferritin – a protein that binds with iron in the body making it easier to be transported.

Medical Management:

Oral supplements of iron (Ferrous Sulphate)
Parenteral Iron – for children with iron malabsorption or chronic hemoglobinuria
Transfusion – indicated for severe anemia cases of severe infection, cardiac dysfunction

Nursing Management:

Asses for fatigue, activity intolerance, and other sings of impaired tissue oxygenation
Promote an adequate intake of iron-rich foods (iron fortified formula and cereals, liver, egg yolk, and organ meats
Emphasize to family members or care givers proper administration of oral iron supplements. Give supplements in two or three divided doses in small amount of Vitamin C-containing liquid. (This enhances absorption)
Explain the potential adverse effects of iron which includes nausea and vomiting, diarrhea or constipation or black stools and tooth discoloration.
Instruct care givers to keep iron supplements out of reach of children since it is toxic when overdosed.

Nursing Care Plan – Anemia

image courtesy: catea.gatech.edu

Comparison of Pediatric Cancers and Adult Cancers

Posted: 08 Oct 2010 06:31 PM PDT

Pediatric Cancers:

Incidence: Pediatric cancers are rare, covers less than one percent of all cancers.
Sites : t involves tissues such as mononuclear phagocyte system, Central Nervous System , muscles and bones.
Histology : Most common type could be found are nonepithelial, sarcomas, embryonal, leukemia, lymphoma.
Latency (from iniationa to diagnosis): It occurs relatively in shorter periods of time.
Environmental factors: Most pediatric cancers occur as a combination of environmental factors and hereditary factors called ecogenetics.
Prevention: As of the present, there minimal strategies known.
Early Detection: These are generally accidental findings.
State of diagnosis: 80% of the cases are metastasized when found out.
Response to treatment: Pediatric cancers are very responsive to chemotherapy and tolerance to higher doses could be noted.
Treatment of side effects: There is less difficulty in treating the side effects, however there are long term consequences.
Prognosis: Greater than 60% are cured.

Adult Cancers

Incidence: Adults cancers are common which covers more then 99% of all cancers.
Sites : It involves organs such as the lungs, breast, colon prostate.
Histology : Most common types are epithelial and carcinomas.
Latency (from initiation to diagnosis): It occurs in a long period of time like a patient could be well over 20 years
Environmental factors: It has a strong relationship to environmental and lifestyle factors
Prevention: Adult cancers today are 80% preventable.
Early Detection: It is possible to detect early when early detection and screening practices are done such as Breast Self Examination.
State of diagnosis: It could either be local or regional.
Response to treatment: It is less responsive to chemotherapy.
Treatment of side effects:More difficulty with acute toxicity but fewer long-term consequences.
Prognosis: Less than 60% could be cured.

Photo credits: http://www.bluejacketsfoundation.org

From Fetal Circulation to Pulmonary Circulation

Posted: 08 Oct 2010 05:38 PM PDT

The development of the cardiovascular system begins to develop toward the end of the third week of pregnancy. On the Fetal Circulation ,shunts for the blood in the developing heart serve a very practical need. Initially all of the blood returns to the right atrium. However, because the lungs develop very late, the pulmonary vessels are limited in their capacity and the resulting resistance is high. Thus, the pulmonary circulation system cannot deal with all the blood. For the circulation system to remain balanced nonetheless, there are two shunts that provide shortcuts for most pulmonary circulation system.

The Fetal Circulation:

Oxygen from the placenta travels to the umbilical vein bringing oxygen and nutrients.
Some of the blood flows to the hepatic circulation, others bypass the liver and pass through the ductus venosus.
The blood from the lower parts of the lower parts of the body together with the blood in the ductus venosus flows toward the inferior vena cava.
Some of the blood goes from the right atrium goes to the right ventricle via the tricuspid valve while others pass the foramen ovale leading to the left atrium.
From the left atrium, it goes towards the left ventricle, mixing with the poorly oxygenated blood from the lungs and then pumped towards the ascending aorta.
From th ascending aorta, the blood is pumped to the upper parts of the body like the heart, neck, head and upper limbs.
Then perfuse to the placenta via the two umbilical arteries.
Meanwhile the blood that enters the right ventricle together with the poorly oxygenated blood from the head and upper extremities returns to the right side of the heart by the way of the superior vena cave then, passes through the pulmonary artery wherein 10% enters the lungs, most of the blood bypasses the lungs which is then pumped to the ductus arteriosus going to the descending aorta.
The blood is the pumped and perfused to other parts of the fetus.
The blood then returns to the placenta via the two umbilical arteries.

Transition after Birth

The infant takes his first breath causing the mechanical expansion of the lungs. In this way the ductus venosus and ductus arteriosus constrict as large amount of oxygen enters the young lungs. With lung inflation, the alveolar oxygen tension increases, causing reversal of the hypoxemia-induced pulmonary vasoconstriction of the fetal circulation. Clamping of the umbilical cord also increases systemic vasucalr resistance and left ventricle pressure, which further closes the ductus venosus. A decrease in pulmonary vascular resistance and an increase in systemic vasuclar resistance causes a left to right shunting and increasing PO2 which further closes the ductus arteriosus.

Pulmonary Circulation

Oxygen-depleted blood from the body leaves the systemic circulation when it enters the right heart, more specifically the right atrium through the superior (upper) vena cava and inferior (lower) vena cava.
The blood is then pumped through the tricuspid valve (or right atrioventricular valve) into the right ventricle
Blood is then pumped through the semilunar valve and i nto the left and right pulmonary arteries (one for each lung) and travels through the lungs.
The pulmonary arteries carry out deoxgenated blood to the lungs while the pulmonary veins carry oxygenated blood to the red blood cells where they release carbon dioxide and pick up oxygen during respiration.
The oxygenated blood then leaves the lungs through pulmonary veins, which return it to the left heart, completing the pulmonary cycle.
This blood then enters the left atrium, which pumps it through the bicuspid valve, also called the mitral or left atrioventricular valve, into the left ventricle.
The blood is then distributed to the body through the systemic circulation before returning to the pulmonary circulation.

As changes in the cardiovascualr system at birth happens, there are some structure of the system do not function as it used to be and there are adult structures are derived from these:

Foramen Ovale turns into Foramen Ovalis
Umbilical Vein turns into Ligamentum teres
Ductus Venosus turns into medial umbilical ligaments
Umbilical arteries and abdominal ligaments turns into superior vesicular artery (which supplies the bladder)
Ductus Arteriosum turns into Ligamentum arteriosum

Photo Credits from: Blogspot and Biosbcc.net