Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CPN Exam > CPN Exam Hematologic/Oncologic/Cardiovascular > Flashcards

CPN Exam Hematologic/Oncologic/Cardiovascular Flashcards

1
Q

Anemia

A

A decrease in the serum hemoglobin– Acute or chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Anemia Manifestations

A

Acute anemia (acute tissue hypoxia) – muscle weakness, fatigue, pallor, headache, lightheadedness, increased HR

– Chronic anemia (compensated) – growth retardation, delayed sexual maturation, increased HR, heart murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Anemia Management Acute

A

Iron deficiency = give iron supplementation
– Blood transfusion is generally required with a hemoglobin
< 7.0-8.0

– Iron supplementation is generally used with a hemoglobin > 7.0-8.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Anemia Management Chronic

A

Blood transfusion is generally not considered until hemoglobin is ≤ 6.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Iron Deficiency Anemia

A

Most prevalent nutritional disorder in U.S.

Lack of iron leads to small RBC, that breaks apart and does not carry oxygen well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Kids at risk for Iron Deficiency Anemia

A

Premature infants and multiple birth infants
- Fetal transfer of Iron = Highest rate in last trimester
-Full term infant has 6 months iron stores

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Iron Deficiency Anemia Assessment

A

Assessment of nutritional status/eating habits
– Identification of excessive milk intake or early introduction of whole milk
- Whole milk is a poor iron source

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Iron Supplementation Instructions

A

Temporarily stains teeth – give with medicine dropper, brush teeth afterwards
– Absorption is best between meals and given with a citrus fruit or juice (i.e. orange juice)
– Stool should be a tarry green or black when iron levels are adequate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Sickle Cell Disease

A

Group of genetic disorders of hemoglobin production characterized by a predominance of the abnormal Hgb S

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Sickle Cell Disease Pathophysiology

A

– RBCs sickle and get trapped/stuck in vasculature
-Caused by dehydration and hypoxia
– RBC Lifespan = 20 days (reduced from 90-120)o Chronic hemolytic anemia
Caused by vaso-occlusive crisis (VOC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Sickle Cell Disease Assessment

A

Developmentally appropriate pain scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Sickle Cell Disease Interventions

A

RBCs Un-sickle with adequate oxygen and hydration
-Hydration (IV/PO)
-Oxygenation

Pain Management
-Pharmacologic
-Non-Pharmacologic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sickle Cell Disease Prevention

A

Promote hydration
Monitor for dehydration
Avoid/minimize risk factors
– Extreme heat/cold
– Hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Fever in Sickle Cell Disease

A

Fever is the first sign of bacteremia in the child with SCD (child must be medically evaluated)

Caused by splenic failure (↓ ability to fight infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Fever in SCD Management

A

History, physical, vital signs, blood cx, CBC
Prompt IV Antibiotics
Monitoring for s/s of sepsis
Patient and family education– temperature taking– when to call health care provider

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Fever prevention in SCD

A

Penicillin prophylaxis - PCN PO BID
Pneumococcal Vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Immune/Idiopathic Thrombocytopenic Purpura (ITP)

A

Definition: An acquired hemorrhagic disorder that results in the autoimmune destruction of platelets in the spleen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ITP Diagnosis

A

CBC, other lab work, bone marrow aspiration
-80% of children:
– are between 2 and 10 years of age
– recover completely within 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ITP Assessment

A

Platelet count typically < 20,000
Assess for petechiae
Note bruises and other bleeding (urine and gums)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ITP Management

A

Steroids (to reduce platelet destruction; 2-3 week response) Intravenous Immunoglobulins (IVIG)– 3-6 hour IV administration; 10-12 hour response; very expensive Splenectomy for chronic, unresponsive ITP
Bleeding Precautions
– Avoid: trauma, injections, ibuprofen– Provide safety measures (no contact sports)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hemophilia

A

A group of bleeding disorders in which there is a deficiency in one of the factors necessary for coagulation of blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Hemophilia Pathophysiology

A

Severe: spontaneous bleeding
Moderate: bleeding with trauma
Mild: bleeding with severe trauma or surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Hemophilia Management

A

Assess for signs of bleeding
Give Factor VIII or IX
Immobilize and elevate joint/affected area
Monitoring for bleeding complications
Range of motion exercises after acute injury/bleeding subsides
Prevent bleeding/injury based on developmental risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

PRBC’s Administration

A

Take VS prior to starting
Check right patient, right blood type, and same type and cross match between patient and donor
IV NS to piggyback tubing
Administer 20% transfusion slowly
Use appropriate filters
Stay with patient
Assess for reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Transfusion Reactions

A

– Hemolytic - Flank pain, severe headache, dyspnea, shock and renal failure, fever/chills
– Allergic - Hives and itching– Febrile - Fevers and chills

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Transfusion Reaction Interventions

A

Stop the transfusion
– Maintain the patent IV using normal saline
– Monitor vital signs
– Contact MD/PNP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Leukemia

A

1 type of cancer in children

Is an abnormal proliferation of white bloods cells invading the bone marrow causing:
– Bone pain (from bone marrow hypertrophy)
– Anemia
– Bleeding Disorders (Petechiae and Ecchymosis)
– Lymphadenopathy
– Immunosuppression

28
Q

Acute Lymphoid Leukemia

A

Acute Lymphoid Leukemia (ALL)
– Most common type of leukemia and cancer in children
– Peak age is 2-5 years
– > 85% cure rate
– Death usually follows overwhelming infection

29
Q

Acute Myelogenous Leukemia

A

More common than ALL in adolescents
– 60-70% cure rate
– Death usually follows overwhelming infection

30
Q

Brain Tumor

A

Most common childhood solid tumor and 2nd most common childhood cancer
Most commonly seen in kids 5 to 10 years old

31
Q

Brain Tumor Symptoms

A

Cause increased intracranial pressure (ICP) and CNS side effects including
– Most common symptoms
Headache upon awakening
Seizures
– Other Symptoms
Vomiting
Abnormalities in coordination, gait, reflexes, speech

32
Q

Brain Tumor Management

A

Prepare child for CT or MRI
Prepare for radiotherapy prior to tumor removal
Prepare for chemotherapy
Prepare for surgery
Post-surgical care
– Monitor neurologic status, ICP, and seizure activity
– Provide skin care and prevent infection
– Administer chemotherapy

33
Q

Hodgkin’s Lymphoma

A

Begins in lymph node(s)o Characterized by giant, multi-nucleated Reed-Sternberg Cells

34
Q

Non-Hodgkin’s Lymphoma

A

Proliferation of B or T Lymphocytes

35
Q

Hodgkin’s Management

A

Painless enlargement of lymph nodes (most commonly in supraclavicular region)
– Systemic symptoms = weight loss, fever, night sweats

36
Q

Non-Hodgkin’s Management

A

Depend on site and extent of involvement
– Swelling in abdomen or neck
– Congestion/URI Symptoms
– Systemic symptoms = same as for Hodgkin’s

37
Q

Wilm’s Tumor (Nephroblastoma)

A

Embryonal cancer of the kidney originating during fetal life
Average age at diagnosis is 2-4 years
Tumor is usually unilateral
Prognosis is good if there is no metastasis

38
Q

Wilm’s Tumor Assessment

A

Assess for nontender mass, usually midline near liver
Note abdominal pain, hypertension, hematuria, anemia, or constipation

39
Q

Wilm’s Tumor Management

A

Cautious palpation of the abdomen as to avoid mass rupture and bleeding
Prepare child and family for a nephrectomy within 24-48 hours of diagnosis followed by chemotherapy

40
Q

Tumor Lysis Syndrome

A

Serious metabolic disorder occurring within 72 hours following starting of chemotherapy (occasionally prior to) resulting in elevated uric acid, potassium, and phosphorous and decreased calcium

41
Q

Tumor Lysis Syndrome Assessment

A

CV: dysrhythmias (due to hyperkalemia); can cause sudden death
GU: renal impairment/failure (b/c of ↑ uric acid); may need dialysis
Neuro: lethargy, muscle spasms, cramps, seizures
GI: nausea and vomiting

42
Q

Tumor Lysis Syndrome Management

A

Electrolyte/Fluid Management
Restrict potassium intake, fluid administration
Diuretic
Strict I & O and Daily Weight

43
Q

Cyanotic Heart Defect S/S

A

Cyanosis of lips and digits and/or a “dusky look” with abnormal oxygen saturations
Breathlessness, tachypnea
Feeding difficulties
Failure to thrive

44
Q

Acyanotic Heart Defect S/S

A

Pink baby with normal oxygen saturations
– May have oxygen desaturations with exertion
-May be asymptomatic; symptoms may emerge
-Activity intolerance/fatigue
-Feeding difficulties
-Recurrent respiratory infections
-Respiratory distress (nasal flaring, retractions, tachypnea, grunting)

45
Q

Tetralogy of Fallot

A

Cyanotic
involves the mixing of oxygenated and deoxygenated blood for transport to the systemic circulation

46
Q

Tetralogy of Fallot Disorders

A

Pulmonary artery stenosis, ventricular septal defect (VSD), hypertrophy of the right ventricle, and an overriding aorta (dextraposition of the aorta)

47
Q

Tetralogy of Fallot Pathophysiology

A

The increased pressure in the right ventricle causes blood to shunt from the right to left ventricle forcing deoxygenated blood into the aorta and then to the systemic circulation

48
Q

Tetralogy of Fallot Assessment

A

Acute episodes of cyanosis and hypoxia called “tet spells” or “blue spells”
– Polycythemia
– Signs of chronic hypoxia
Dyspnea, clubbing of digits, failure to thrive, exercise
intolerance

49
Q

Tetralogy of Fallot Management

A

Decrease oxygen demands - time limited activities
Knee to chest positioning during tet spells
Oxygen
Surgical repair around 12 months

50
Q

Ventricular Septal Defect

A

Acyanotic
The most common congenital cardiac anomaly
Occurs when the septum between the ventricles fails to completely form, resulting in left-to-right shunting of blood.

51
Q

VSD Assessment

A

Signs of congestive heart failure (CHF) with right ventricular hypertrophy
– Tachycardia
– Diaphoresis
– Tachypnea
– Fatigue
Failure to thrive
Exercise/activity intolerance
Recurrent respiratory infections

52
Q

VSD Management

A

Digoxin - decrease pulse, strengthen cardiac contractions
-Monitor for bradycardia, dysrhythmias, anorexia, nausea, vomiting
Monitor fluid status
-Strict I&O
Administer diuretic as ordered
-Monitor potassium loss
High Calorie food

53
Q

Coarctation of the Aorta

A

Obstructive Defect
Narrowing of aortic arch = decrease blood flow to trunk and lower extremities, increase to head and arms
Risk for stroke

54
Q

CoA Assessment

A

Full, bounding pulses in the arms with weak or absent pulses in the legs
Increased blood pressure on the arms and decreased blood pressure in the legs
Warm upper body and cool lower body

55
Q

Rheumatic Fever

A

Acquired autoimmune inflammatory disorder
Occurs 1-6 weeks after a group A betahemolytic infection– Related to inadequate treatment
Antibodies are produced against the toxin of streptococci and attack and destroy the heart valves

56
Q

Rheumatic Fever Assessment

A

Fever
- Fatigue
- Joint pain with swelling, redness, and warmth
– Chorea (sudden involuntary movement of the extremities)
– Erythema marginatum (temporary, disk-shaped red macules that are non-pruritic and faded in the center

57
Q

Rheumatic Fever Management

A

Prevention is KEY
– Administer penicillin with strep throat infections
Treatmen
– Promote bed rest until ESR normalizes (about 5 weeks)
– Medicationso Anti-inflammatoryo Penicillin prophylaxis to prevent future attacks

58
Q

Kawasaki Disease

A

Acute systemic vasculitis of unknown origin lasting 6-8 weeks; coronary arteries most at risk
Leading cause of acquired heart disease in kids
– Untreated, 25% develop permanent cardiac damage– With treatment, permanent cardiac damage is rare

59
Q

Kawasaki Disease Complications

A

Myocardial infarction caused by occlusion of a coronary artery as a result of
-Thrombosis
-Stenosis
Fluid overload and CHF

60
Q

Acute Phase Kawasaki Disease

A

High, persistent fever unresponsive to antipyretics
– Swelling of the conjunctiva without drainage
– Inflammation of the mouth, lips, tongue
Strawberry tongue
-Rash – varies from child to child
– Swollen, red hands and feet
– Cervical lymphadenopathy

61
Q

Subacute Phase Kawasaki Disease

A

Begins with resolution of fever and ends when all outward symptoms are gone.
– Hands and feet peel during this phase.
– Irritability persists

62
Q

Convalescent Phase Kawasaki Disease

A

Begins when all clinical signs of KD have resolved and ends when all blood values (ESR, C-Reactive protein) return to normal.
– ESR and C-Reactive protein = remain elevated
Thrombocytosis still present
Arthritis still present

63
Q

IV Immune Globulin

A

Reduces incidence of coronary artery abnormalities when given within 10 days of infection/symptoms

64
Q

Salicylate Therapy (aspirin)

A

Anti-inflammatory dose (80-100 mg/kg/day divided Q 6 hours)

65
Q

Maintenance Treatment Aspirin

A

Low, Anti-platelet dose (3 – 5 mg/kg/day)* In kids with normal echocardiograms – continued 6-8 weeks until PLT count has returned to normal* In kids with abnormal echocardiograms – continued indefinitely

66
Q

Kawasaki Disease Treatment

A

Cardiac Monitoring
– Assessment for S/S fluid overload and CHF
– Administer fluids judiciously
Symptom Relief
– Minimize skin discomfort
- Mouth care
- Cool cloths and lukewarm baths
Medication Administration
– IVIG– Complications: anaphylaxis, headache
* Patient/Family Education– Support family particularly regarding child’s Irritability
Offer support
Offer time away/breaks

67
Q

Fluid Maintenance

A

Kg 1-10 X 4ml/hour +
Kg 11-20 X 2ml/hour +
Kg >20 X 1 ml/hour

CPN Exam (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions