2 Nursing Assessment in Peds Heme Onc

Question 1

Differences and similarities between purpura and petechiae?

Answer 1

Petechiae are lass than 5 mm, Purpura is more. They are both nonblanching purple-pink lesions

Question 2

Where is the mediastinum? What vital structures are contained there?

Answer 2

Between the:

1) suprasternal notch and diaphragm
2) sternum and spine
3) between the parietal pleura (pleura that lines the inner chest well and covers the diaphragm)

Contains thymus, thyroid, esophagus, lymph nodes, tracheo, bronchi, heart, major vessels and nerves

Question 3

Cough, wheezing, orthopnea and respiratory distress could be signs of?

Answer 3

mediastinal mass. get CXR

Question 4

Precautions in a child with a mediastinal mass?

Answer 4

never force to lie down because it could shirt and cause respiratory arrest. Sedation should never be given unless proper personnel and equipment. When sedates, chest muscles relax and the mass could compromise the airway

Question 5

Face swelling, upper arms, and engorged vessels could be?

Answer 5

Superior Vena Cava Syndrome due to compressing the SVC and vital structures. Sometimes misdiagnosed as an allergic reaction

Question 6

What is a ‘matted’ lymph node?

Answer 6

When a group of nodes feels connected and seem to move as one unit. This is often related to cancer.

Question 7

What is an abnormally enlarged lymph node?

Answer 7

greater than 1 cm, (matted is not great, nor is a large node in the hollow above the elbow)

Question 8

Possible signs of increased intraabdominal pressure?

Answer 8

Dyspnea, pain, n/v, constipation, diarrhea, urinary retention or hematuria, appetite decrease

Question 9

Classical presentation for CNS tumors - headache timing

Answer 9

morning or postnap, n/v, palsies. morning n/v. seizures are only in about 15%

Question 10

Workup for suspected CNS tumors?

Answer 10

Immediate CT or MRI, immediate neurosurgical consult. LPs should be avoided in children with headaches (without fevers) until a CT shows normal ventricular size to prevent herniation

Question 11

Head tilt, macrocephaly, short stature, bulging fontanel, irritability and lethargy, torticollis, precocious puberty may be

Answer 11

CNS tumor related. Sometimes short stature, FTT and precocious puberty due to hypothalamix-pituitary

Question 12

What is the ‘setting sun sign’

Answer 12

impaired upward gaze, sign of possible CNS tumor

Question 13

What is the buffy coat?

Answer 13

WBCs and platelets, middle layer between plasma and RBCs after spin down

Question 14

On a CBC, what is MCH, MCHC, and RDW?

Answer 14

MCH indicates amount of hemoglobin in each RBC.
MCHC indicates the concentration of hemoglobin per RBC (related to the hydration status of the RBC).
MCH and MCHC are both indicative of RBC color (pale versus normal). Pale is associated with anemia.
RDW indicates variations in the size of RBCs.

Question 15

What could an elevated MCV mean?

Answer 15

immature cells, fetal hemoglobin, vitamin B12 or folic acid deficiency, methotrexate chemotherapy. Dr Camilo says it is also related to taking 6mp and can be a measure of compliance

Question 16

Normal WBC

Answer 16

4,000-11,000

Question 17

Different types of WBCs:
Infection fighters?
immunity?
phagocytes?
allergy/parasites?
hypersensitivity?

Answer 17

• neutrophils (infection)
• lymphocytes (immunity)
• monocytes (phagocytosis)
• eosinophils (allergy, parasites)
• basophils (hypersensitivity)

Question 18

What is a ‘left shift’ with neutrophils

Answer 18

and increase in immature forms due to bacterial infection

Question 19

These things could cause an increase in neutrophils

Answer 19

bacterial infections, glucocorticoid therapy, stress, epinephrine

Question 20

These meds could cause what symptom: viral infections, bactrim, chloramphenicol, gantrisin, tegretol, dilantin, bone marrow disease

Answer 20

Neutropenia

Question 21

ANC calculation

Answer 21

segs % (polys) + bands% (stabs) X total WBC

Question 22

Two ways to evaluate creatinine clearance?

Answer 22

12-24 hr urine collection or a GFR (radiographic glomerular filtration rate, a nuc med test). Some chemo is based on creat clearance.

Question 23

When a GFR is scheduled, what should you check that could make it falsely low?

Answer 23

recent radiographic study like MIBG scan

Question 24

Difference between indirect and direct bili?

Answer 24

indirect is water insoluble, direct is after it has travelled through the bloodstream to the liver where it is changed into water soluble form (direct)

Question 25

Children with APL or sepsis may present with

Answer 25

coagulopathies. get PT/PTT, d dimer and fibrinogen

Question 26

Asplenic or functionaly asplenic patients with a fever

Answer 26

EMERGENCY just like neutropenic patients

Question 27

In all patients with shaking chills, you should check

Answer 27

a cap refill and report if delayed >2 secs

Question 28

Shaking chills with amphotericin, IVIG, monoclonal antibodies or blood products may be treated by administering:

Answer 28

meperidine, hydrocortisone and benadryl