Ped's priorities...low h&h or high temp?

[yooper13]

Anyone have idea with rationale which ped's onc patient would be the priority? I believe the exact numbers were H&H; 8.5 and 13 for blood transfusion, Temp 39.9 C for IV abx

I chose temp before h&h (even though it is really low), because in a pediatric patient the temp can spike within minutes, and can cause seizures and even brain damage, so I think it is important to give the abx, and of course assess and try to lower temp with whatever is ordered (or non-pharm interventions)

Then again, the blood transfusion is also important; however, on a ped's oncology floor the h&h is expected to be low in general because of lymphoma, leukemia, anemia, etc...

Anyone have a different take?

Thanks

[nurseprnRN, BSN, RN]

Homework? Exam question?

It depends. If homework, you get to choose; it is very likely that your faculty wants to hear your understanding of the issues and physiology and see how you process them as much as what the "right" answer is. So gather your facts and write them both up, and make your choice.

If there is a good pedi onc nurse around here, however, I would certainly bow to his/her expertise if there is a more definitive answer than "it depends."

[turnforthenurse, MSN, NP]

Now of course a Hgb of 8.5 is low, but normal values vary depending on the age of the child, and that piece of data is missing. Now I know for adults, docs are choosing not to transfuse until the Hgb is

[KelRN215, BSN, RN]

H&H of 8.5 and 13 seems wrong. If a patient has a Hgb of 8.5, you'd expect their Hct to be in the 24-25 range. When I worked in the hospital, most recently, we transfused based on Hgb not Hct and they didn't get transfused until their Hgb was less than 7. If the Hct really was 13 then you'd expect their hemoglobin to be in the 5 range and they'd definitely get transfused.

A temp of 39.9 in an oncology patient definitely takes preference in this case, IMO. Oncology patients can go septic at the drop of a hat if they're neutropenic. Sepsis is your main concern here, not febrile seizures. Febrile seizures are a concern primarily in patients between 9 months and 5 years of age with high fever regardless of their oncological history. They very rarely cause brain damage.

The reason you expect the H&H to be low in peds oncology has more to do with bone marrow suppression from chemotherapy (as most patients who are admitted to oncology are undergoing treatment) than it does with the underlying diagnosis.

[yooper13]

Thanks for the responses! Yes, it was a homework question; scenario-type. I was not given the age of the child, since it was more about the unit, and how would I prioritize based on knowledge of that patient population (basically 2 months to 18/21 years...kind of a wide range). There was a third which I ranked as #1 (dropping O2 sats), I was just curious if I had put 2 and 3 in the right order of priority, and why or why not.

Thanks for the good info, all!

[Esme12, ASN, BSN, RN]

I am not sure I agree with placing the temp over volume....

Volume depletion is fatal in anyone...... but especially children ages