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Pediatrics > Exam 3- Neuro, Onc, Msk, Heme > Flashcards

Exam 3- Neuro, Onc, Msk, Heme Flashcards

1
Q

difference in MSK for children

A

more cartilage, more porous, heal faster, growth plates still growing, stiffness is uncommon, rich vasculature within bones; growth continuous until 18-21

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2
Q

assessment of MSK in children

A

observation: signs of deformity, guarding, signs of distress; touch- tender to touch, may radiate, may not show pain but will avoid using it; neurovascularly intact

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3
Q

5P’s of compartment syndrome

A

Pain, Paralysis, parasthesia, pulses, pallor

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4
Q

compartment syndrome

A

injury that causes an increase in pressure until blood supply is eventually decreased

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5
Q

when treating traumatic injuries in children (MSK related)

A

ABCs. bleeding control, call EMS (they may need to reposition or realign if loss of circulation)

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6
Q

impact of immobility in children on muscle

A

decreased muscle strength, tone, endurance; decreased cardiac output; decreased metabolism and increased O2 need; decreased exercise tolerance; bone demineralization; muscle atrophy

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7
Q

impact of immobilization in children on skeletal

A

bone demineralization: osteoporosis and hypercalcemia

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8
Q

impact of immobilization in children on metabolic system

A

decreased metabolic rate; all systems are slower; decreased appetite (treat with small frequent meals); fatigue

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9
Q

impact of immobilization on cardiovascular

A

redistribution of body fluids (i.e. edema); heart has to work harder (tachycardia and HTN may be present); venous stasis (pooling blood placed at increased risk of clot); decreased ROM; frequent position changes

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10
Q

impact of immobilization on respiratory system

A

decreased chest and lung expansion; decreased respiratory effort (shallow breathing); decreased need for O2, effects of gravity

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11
Q

treating respiratory effects from immobilization

A

cough, deep breathing, incentive spirometer; encourage mobility

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12
Q

impact of immobilization on elimination/GI GU

A

general muscle weakness and atrophy; inactivity slows peristalsis (decreases motility); urinary stasis (increased risk of UTI); constipation d/t decreased peristalsis and potential pain meds

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13
Q

impact of immobilization on integumentary system

A

edema; ulceration of bony prominences; continuous pressure; hard to attend to hygiene; aware of friction moisture and skin tears

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14
Q

impact of immobilization on psychological system

A

increased feelings of frustration, helplessness, anxiety, isolation, seen as punishment; depression, anger, aggression; developmental regression such as enuresis, sucking thumb, baby talk, helplessness

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15
Q

caring for cast in children

A

assess CSMs (circulation, sensation, movement); assess fit of cast, any apparent swelling skin break down, soiling of cast; may cause itching, tightness, moisture, or heat

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16
Q

treatment of MSK injuries

A

traction to realign; external fixation to lengthen and hold still; ambulatory devices such as crutches, walker, walking boot, cane, AFO; surgery

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17
Q

Use of AFO

A

used for pt with cerebal palsy to assist in walking

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18
Q

developmental dysplasia of the hip

A

aka “clicky hips”; instability of hip in neonate; lax ligament that allow hip to dislocate and relocate spontaneously; caucasian and girls at higher risk can be d/t trauma in utero, decreased movement in utero, IUGR, LGA, twin in womb, oligohydramnios

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19
Q

symptoms of developmental dysplasia of hip

A

unequal skin folds; limited abduction; unequal knee height; asymmetrical; ortolani click (if under 4 weeks)

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20
Q

diagnosing development dysplasia of the hip

A

ortolani maneuver, barlow maneuver, ultrasound

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21
Q

treatment of developmental dysplasia of the hip

A

abduction devices, pavlik harness; if pavlik harness doesnt work by 6 months then other methods take place such as surgery or spica; traction followed by a cast; reduction via surgery then cast

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22
Q

nursing considerations of developmental dysplasia of the hip

A

identify, promote normal development, maintain physical mobility, skin care/cast care, proper reducing device use and teaching, family support

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23
Q

clubfoot

A

complex deformity of the foot causing forefoot adduction, midfoot supination, hind foot varus and valgus, ankle equinus; 1/2 cases are bilateral; may occur with other abnormalities like CP or spina bifida; males 2x as likely; may lead to hip problems

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24
Q

valgus vs varus

A

valgus is knees more inward; varus is bowed legs

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25
Q

causes of club foot

A

unknown; strong family tendency; multifactorial

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26
Q

diagnosing club foot

A

apparent at birth; check hips

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27
Q

treatment of club foot

A

goal is to straighten the via casting right after birth; surgery if casting does not work

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28
Q

nursing considerations for club foot

A

cast care, post op care, neurovascular checks, follow-up care, parent education, promote normal development

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29
Q

scoliosis

A

abnormal curvature of the spine; most common spinal deformity consisting of curvature and rotation; classified as congenital, infantile, childhood/juvenile, adolescent (increase in incidence during preadolescent growth spurt)

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30
Q

symptoms of scoliosis

A

uneven hips, one scapula more prominent

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31
Q

diagnosing scoliosis

A

consists of physical exam, X-ray, and screening

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32
Q

treatment of scoliosis

A

depends on the degree of curvature, location of malformation, type of malformation, and age of child; consists of observation, wearing a brace, and surgery if warranted

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33
Q

surgery for scoliosis

A

spinal fusion and insertion of rods

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34
Q

nursing considerations for scoliosis

A

body image alteration (most common complications); skin integrity; surgical pre-op and post-op if needed; pt teaching

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35
Q

osteomyelitis

A

infection of the bone; more common in ages less than 10

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36
Q

pathophysiology of osteomyelitis

A

bacteria adheres to bone and causes inflammatory reaction which can rupture through the bone; typically caused by GBS in infants; could be due to otitis media or a respiratory infection

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37
Q

signs and symptoms of osteomyelitis

A

severe pain, fever, irritability, crying, tenderness to touch, resist movement, guarding

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38
Q

diagnosing osteomyelitis

A

cultures of joint fluids; labs such as CBC to analyze WBCs; imaging- xray, MRI, bone density scan; biopsy; aspiration of synovial fluid

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39
Q

treatment of osteomyelitis

A

IV antibiotics (usually use multiple different antibx); comfort measures; immobilization; physical therapy; teaching

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40
Q

soft tissue injuries

A

consist of contusions, dislocations, sprains, strains; manage with RICE and ICES; seek further medical attention if unable to use limb, pain persists, or 5Ps arise

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41
Q

RICE and ICES

A

rest ice compression elevation; ice compression elevation support

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42
Q

Fractures

A

usually result from birth trauma, injury, or child abuse; true fractures rarely occur in infancy; most common site in childhood is forearm; children heal faster d/t increased blood supply; can be due to trauma, overuse, or disease

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43
Q

healing for children

A

approximately 1 week/year of age until 10 years old

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44
Q

types of fractures

A

complete or incomplete; spiral, oblique, transverse, comminuted, wedge, impacted/compression, displaced, open/compound

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45
Q

symptoms of a fractured bone

A

swelling, pain, decreased ROM; if 5Ps present then it is medical emergency

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46
Q

diagnosing fractures

A

Xray is most useful but can also detect old fractures (signs of child abuse and need to contact CPS); physical exam; history

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47
Q

treatment of fracture

A

reduction/repairing of fracture; immobilization with traction, brace, casting, splinting; surgery if needed

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48
Q

reduction vs traction

A

reduction is repairing of fracture or dislocation where traction is applying manual pulling

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49
Q

complications with fracture

A

circulatory compromise; nerve compression; compartment syndrome

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50
Q

assessing signs of circulatory compromise

A

vital signs, capillary refill, sin color

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51
Q

nerve compression

A

can occur at injury, during, or after; can cause carpal tunnel or sciatic nerve pain

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52
Q

compartment syndrome is

A

increased pressure within compartment of tissue that increases and causes decrease in circulation to muscle and nerves;

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53
Q

treatment of compartment syndrome

A

remove cast, pressure, or dressing to allow free flow of blood to prevent damage tissue, prevent necrosis, and prevent paralysis; DO NOT ELEVATE; require fasciotomy

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54
Q

osteogenesis imperfecta

A

aka brittle bone disease; genetic disorder that causes bones to break easily; main goal is to prevent fractures

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55
Q

signs and symptoms of osteogenesis imperfecta

A

frequent bone fractures (most common); looseness in ligament; bone deformity and pain; bruising easily; curved spine; small stature; blue sclerae

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56
Q

detecting osteogenesis imperfecta

A

genetic testing; blood testing to check for gene mutations; bone density scans

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57
Q

treating osteogenesis imperfecta

A

increase bone strength; occupational therapy for fine motor skills; physical therapy to increase strength and flexibility and ROM; calcium and vitamin D, decrease pain, increase growth, bisphosphonate as ordered

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58
Q

anemia

A

reduction of RBC volume and/or Hgb concentration to levels below normal range for age

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59
Q

causes of anemia

A

excessive RBC loss; increased destruction of RBCs; impaired or decreased rate of RBC production d/t bone marrow failure or deficiency of essential nutrient

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60
Q

clinical manifestations of anemia

A

all symptoms related to decrease in O2 carrying capacity; muscle weakness, fatigue, inability to concentrate, palpitations, tachycardia, dyspnea on exertion, pallor, PICA, dry brittle nails, concave/spoon shaped nails, CNS manifestations, growth retardations

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61
Q

CNS manifestations in anemia

A

headache, dizziness, lightheadedness, irritability, slowed though processes, decreased attention span, apathy, depression

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62
Q

diagnosing anemia

A

screening and checking Hgb/Hct during infancy/early childhood/late childhood/adolescence; history and physical; Labs such as CBC, iron studies, reticulocytes, bone marrow aspiration

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63
Q

normal Hgb by age

A

1-3 days: 14.5-22.5 g/dL; 2 mos: 9-14 g/dL; 6-12 yrs: 11.5-15.5 g/dL; 12-18 male yrs: 13-16 g/dL; 12-18 female yrs: 12-16 g/dL

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64
Q

treatment of anemia

A

prepare child for lab tests; treat underlying causes by replacing blood or nutrient; decrease oxygen tissue needs; prevent complications

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65
Q

iron deficiency anemia

A

caused by inadequate supply of iron essential for normal RBC production; iron is required to produce hemoglobin (decreased iron = decreased hemoglobin); prominent in age groups with rapid growth (9mo-2yrs)

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66
Q

causes of iron deficient anemia

A

low iron stores at birth, maternal iron stores in newborn become depleted, inadequate dietary intake of iron

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67
Q

clinical manifestations of iron deficiency anemia

A

s/s of classic anemia; “milk baby” appearance, glossitis (tongue), angular stomatitis (inflammation and small cracks in one or both corners of mouth), koilonychia (soft concave or “spoon” fingernails), impaired neurocognitive function

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68
Q

managing iron deficient anemia- prevention

A

screening, only breast milk or formula during first 12 mo., iron supps as prescribed, limit milk intake, iron-rich foods

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69
Q

managing iron deficiency anemia- meds

A

ferrous sulfate 2 or 3 divided doses daily; between meals if tolerated

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70
Q

parent education for iron deficiency anemia

A

take with vitamin C to enhance absorption, brush teeth to minimize staining; watch for side effects such as vomiting, constipation, dark green or black stools, tooth discoloration, consult diet

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71
Q

blood transfusions

A

take vitals before admin., take vitals 15 min after admin., then take vitals hourly while infusing, then take final set after infusion; check ID of pt and blood type of pt compared to donor; admin first 50mL or initial 20% (whatever is smaller) slowly and stay with child; admin normal saline PB; admin through filter; use blood within 30 minutes or return to blood bank; infuse unit within 4 hours

72
Q

if blood transfusion reaction is suspected

A

stop transfusion, take vitals, keep vein open with NS and new tubing, notify provider, do not restart until child has been medically evaluated

73
Q

signs of transfusion reaction

A

sudden severe headache, chills, shaking, fever, pain at needle site or along vein, N/V, sensation of tightness in chest, red or black urine, flank pain, hives, wheezing

74
Q

sickle cell anemia

A

hereditatry disorder where presence of abnormal hemoglobin S; autosoma recessive

75
Q

patho of sickle cell

A

states of dehydration, acidosis, hypoxia, or extreme temps cause abnormal hemoglobin to sickle and causes obstruction and increased RBC destruction

76
Q

sickle cell causes…

A

RBCs clump causing thrombosis, arterial obstruction, and increased viscoscity; can lead to entanglement of cells, hemolysis, intermittent vascular occlusion, tissue ischemia causing organ dysfunction)

77
Q

in order for a pt to have sickle cell anemia

A

both parents must carry the trait

78
Q

clinical manifestations of sickle cell anemia

A

possible growth retarrdation, chronic anemia (Hgb 6-9), infection/sepsis susceptibility; spleen enlargement; liver failure and necrosis; kidney impairment leads to hematuria, inability to concentrate urine, enuresis, occasional nephrotic syndrome; retinopathy of eyes; bone changes due to hyperplasia of bone marrow, osteomyelitis susceptibility; stroke or CVA; chronic stress on heart from anemia, cardiomegaly, murmur

79
Q

types of sickle cell disease crises

A

vaso-occlusive (VOC), Acute splenic sequestration, Acute chest syndrome

80
Q

vaso-occlusive crisis (VOC)

A

ischemia causes pain, significant pain in areas involved, dactylitis, severe abdominal pain resembling surgical conditions

81
Q

acute splenic sequestration

A

pooling of blood can cause decreased blood volume and shock, may require splenectomy to avoid splenic sequestration

82
Q

treatment of sickle cell

A

aim to prevent sickling; treat crisis with pain relief, hydration, improve O2 utilization by decreasing activity, transfusions, antibiotics to treat infections, O2 therapy; prevent infections with prophylactic PCN and vaccines

83
Q

causes of sickle cell crises

A

high altitudes, cold weather, swimming in cold water, physical labor

84
Q

hemostasis

A

process required to stop bleeding when blood vessel is injured via vascular influence (vasoconstriction and von willebrand), platelet plug formation, clotting cascade (fibrinogen converted to fibrin to strengthen clot)

85
Q

hemophilia

A

group of inherited bleeding disorders caused by deficiency of certain coagulation factors; X linked recessive; ~60% have family history of disease (rest is spontaneous mutation of gene)

86
Q

hemophilia A

A

aka classic hemophilia; deficiency of factor VIII; occurence is 1:5000; accounts for 80% of hemophilia cases

87
Q

hemophilia B

A

aka christmas disease; deficiency of IX factor; occurrence is 1:20000-30000

88
Q

clinical manifestations of hemophilia

A

prolonged bleeding anywhere, hemoarthrosis (bleeding into joints), ecchymosis, spontaneous hematuria, epistaxis, hemorrhage anywhere in body, severe hemophilia need IV factor VIII

89
Q

diagnostic testing for hemophilia

A

generally dx based on bleeding episode history, X linked inheritance patter, lab findings

90
Q

lab findings for hemophilia

A

platelet, PT, and fibrinogen are normal; low factor VIII or IX levels; prolonged PTT

91
Q

management of hemphilia

A

replacing missing clotting factors via transfusions of XIII or IV; DDAVP for mild hemophilia A; pain management with acetaminophen (aspirin and ibuprofen can limit platelet activity); regular exercise and play; encourage full ROM

92
Q

hemophilia nursing interventions

A

recognize and control bleeding immediately, prevent bleeding, prevent crippling effects of bleeding, family support

93
Q

Neuro assesment

A

compare baseline to current assessment and if no baseline known then compare to normal developmental; assessment includes- LOC, pupil response, cranial nerves, reflexes, motor function, posturing, overall physical exam

94
Q

assessing LOC

A

full consciousness, confusion, disorientation, lethargy, obtundation, stupor, coma, persistent vegetative state

95
Q

GCS

A

assesses visual response, verbal, and motor; scored 3-15; 8 is considered coma

96
Q

eye opening GCS

A

spontaneous, verbal stimuli, pain response, no response; 1-4

97
Q

verbal response GCS

A

coos or babbles, irritable cries, cries to pain, moans to pain, no response; 1-5

98
Q

motor response GCS

A

spontaneous movement/purposefully, withdraws to touch, withdraws to pain, decorticate posturing, decerebrate posturing to pain, no response; 1-6

99
Q

diagnosing increased ICP

A

testing of spinal fluid via LP, EEG to test electrical changes, xray for fx or dislocations, CT for density, MRI for target structures and tissue discrimination

100
Q

nursing role to help kids prepare for neuros testing

A

parent and pt teaching, take fear away via explaining and allowing kid to become familiar, monitor vitals, be truthful

101
Q

manifestations of increased ICP

A

early- irritability, fatigue, personality changes; late- decreased motor response, decreased sensory response to pain, change in pupils (decreased reactivity and size), decreased LOC, decorticate or decerebrate posturing

102
Q

symptoms of increased ICP in infants/young children

A

tense bulging fontanelle, high pitched cry, increased head circumference, “setting-sun” sign, irritability, restlessness, feeding changes

103
Q

symptoms of increased ICP in older children

A

headache, vomiting, cognitive or personality changes, diplopia/blurred vision, anorexia, nausea, weight loss, seizures

104
Q

nursing care/management of increased ICP

A

assess for early changes, admin prescribed meds, keep head and neck at neutral, monitor hydrations status closely, promote normal bowel regimen, prevent weight loss and admin feeds as ordered, prevent skin breakdown, monitor for SIADH or DI caused by hypothalamic dysfunction

105
Q

concussion

A

bruising of brain from bouncing off inside of skull; usually no alteration of mental status; mild

106
Q

skull fracture

A

be aware for potential if child has fall more than 2x their height, signs are battle signs behind the ears and racoon eyes; can be linear fracture, depressed fracture, diastatic fracture, or basilar fracture

107
Q

hydrocephalus

A

increased CSF in ventricles and subarachnoid spaces of brain; caused by impaired absorption, excessive production, obstructed circulation of CSF; communicating (impaired absorption) vs. non-communication (obstruction)

108
Q

manifestations of hydrocepha;us

A

newborn/infant- bulging fontanelle, increased head circumference, sun set eyes, irritability, high pitched cat-like cry, visible scalp veins; chilcusdren- headache, visual disturbance, N/V, pupils are sluggish, decrease in consciousness, seizures, cushings triad

109
Q

cushings tirad

A

HTN (widened pulse pressure), bradycardia, irregular respirations

110
Q

management of hydocephalus

A

ventriculoperitoneal (VP) shunt to drain excess CSF (can cause infection and malfunction)

111
Q

parent education for VP shunt

A

watch for signs of increased CSF at home, changes can be subtle like school performance headache or behavior changes, participate in normal activities, contact sports are prohibited, frequent developmental screenings and medical check ups, may need to revise shunt as child grows

112
Q

epilepsy

A

seizure; uncontrolled electrical activity in brain that may produce convulsion, minor physical signs, though disturbances, or combo of symptoms

113
Q

patho of epilepsy

A

abnormal electrical discharge occurring in cerebral cortex; seizure occurs when sudden imbalance between excitatory and inhibitory forces

114
Q

types of seizures

A

focal (partial)- symptoms confined to one are of brain, EEG localized to one spot; without impaired awareness (simple)- may be motor, sensory, autonomic primarily; with impaired awareness (complex)- impaired consciousness with associated aura and psychomotor manifestations; generalized- involves both hemispheres (usually no aura, tonic clonic; absence seizures- day dreaming’; status epilecticus- longer then 5 minutes without regaining consciousness

115
Q

when seizure occurs, monitor for…

A

when it started, was there aura, characteristics of seizure, how long it lasted; ABCs are priority

116
Q

febrile seizure

A

seizure associated with febrile illness in absence of CNS infection in children older then 1 month without prior seizure activity; simple partial is most common; common ages 6mo-5yrs; treatment to decrease temp with tylenol/motrin, increase fluids, luke warm tub; fever up to 104 is still ok; 105+ is an issue and indicative of bacterial infection

117
Q

risk factors for febrile seizure

A

family hx, temp > 101.8 F, preceded UTI or GI illness

118
Q

treating seizure disorders

A

assess the seizure for time, characteristics, aura, post-ictal; pad crib, stay with child, do not interrupt, promote patent airway, record activity, admin seizure meds, admin diastat as needed; treat with meds, ketogenic diet, vagus nerve stimuli, surgery; as nurse need to educate

119
Q

neural tube defects

A

group of related defects of CNS involving cranium or spinal cord that vary from mild to severely disabling; 50% associated with folic acid deficiency and rest are multifactorial

120
Q

patho of neural tube defects

A

3rd-4th week gestation the neural plat closes to form neural tube that eventually forms brain and spinal cord; inappropriate closure of neural tubes

121
Q

spina bifida

A

part of group of neural tube defects consisting of failure of osseous spine to close; spina bifida occulta, spina bifida cystica

122
Q

spina bifida occulta

A

not visible externally; does not affect spinal cord but may have external signs like dimpling of skin, nevi, or hair tufts; may go undetected d/t most have no neuro effects; if neuro effects then usually motor or sensory deficit of lower extrem and urinary output

123
Q

spina bifida cystica

A

visible defect with external saclike protrusion; can be menigocele or myelomeningocele

124
Q

meningocele spina bifida cystica

A

sac contains meninges and spinal fluid but no neural elements; no neuro deficits

125
Q

myelomeningocele spina bifida cystocele

A

sac contains meninges, spinal fluid, and nerves (more severe); can occur anywhere along spinal column; varying degrees of neuro deficit- usually involves urinary or bladder, can be associated with club feet and congenital dislocation of hips

126
Q

nursing assessment/care of spina bifida

A

assess defect, assess neuro and associated anomalies, monitor for hydrocephalus meningitis and spinal cord dysfunction

127
Q

pre-op and post-op nursing care for spina bifida

A

pre-op: prevent infection and protect sac, position and associated difficulties, early closure within 12-72 hours after birth; post-op: monitor for ongoing complications, monitor bowel and bladder, monitor neuro status; C-section birth to avoid birth canal

128
Q

cerebral palsy

A

non-progressive neuromuscular disorder of varying degrees resulting from damage or developmental defects in part of the brain that controls motor function; manifests differently in each child; most common permanent physical disability in childhood

129
Q

clinical manifestations of cerebral palsy

A

delayed gross motor development, abnormal motor performance, alterations of muscle tone, abnormal postures, reflex abnormalities, associated disabilities

130
Q

spastic cerebral palsy

A

most common type (80%); cortex area of brain is affected; can be hemiplegia, diplegia, quadriplegia, quadriplegia; characterized by stiffness and difficulty moving

131
Q

other signs of spastic cerebral palsy

A

persistence of primitive reflexes, hypertonicity with poor control of posture balance and coordinated, impairment of fine and gross motor skills, tendency to have contractures, weakness of affected limbs

132
Q

therapeutic management of cerebral palsy

A

mobilizing devices, surgical interventions, pharmacologic treatments such as baclofen diazepam (valium) botox AEDs if seizures, technical aids, manage associated problems

133
Q

therapies and education for CP

A

physical therapy, occupational therapy, speech therapy, hearing aids, education, recreation

134
Q

muscular dystrophy

A

group of inherited sidorders with progressive degeneration of symmetric muscle groups causing progressive muscle weakness and wasting; body does not break down protein in muscle; all have increasing disability and deformity with loss of strength

135
Q

duschennes muscular dystrophy (DMD)

A

most severe and ost common type; x-linked recessive (only affects males); mutation in gene that codes of dystrophin; onset between 3-5yrs

136
Q

dystrophin

A

protein that strengthens muscle fibers and prevents them from injury as they contract; found primarily in skeletal muscle or voluntary muscle that controls movement; fat and connective tissue replace degenerated nerve fibers

137
Q

clinical manifestations of DMD

A

normal development early in life; first seen in extremities and trunk; progressive generalized weakness starting around 3-5 yrs; progressive muscular weakness, wasting, and contractures; gowers sign

138
Q

gowers sign

A

child stands up by using hands to walk themselves to standing position

139
Q

complications with DMD

A

contractures and joint deformity, scoliosis, atrophy from disuse, infections, obesity, cardia complications, respiratory complications

140
Q

diagnosing DMD

A

dx based on clinical manifestations, serum levels of dystrophin, muscle biopsy, prenatal diagnosis

141
Q

interventions for DMD

A

no effective cure or treatment; treatment is symptomatic; glucocorticoids can help with muscle strength, multidisciplinary approach; surgery for lengthing muscles for contractures; respiratory devices

142
Q

nursing interventions for DMD

A

immobility, skin breakdown, CSMs with devices, helping prevent complications, coping, decision making, child development

143
Q

meningitis

A

can be bacterial (worse) or viral; invasion of meninges; droplet infection through nasopharyngeal secretions; caused by type B influenzae, neisseria, strep pneumonia

144
Q

symptoms of meningitis

A

nuchal rigidity, headache, high fever, kernigs sign (difficulty extending leg), brudzinski sign (knee and neck), petechiae

145
Q

treatment and management of meningitis

A

LP, labs and cultures, IV antibiotics, isolation, neuro assessment, treat pain, treat fever, vaccine education, family support

146
Q

encephalitis

A

inflammation of CNS that causes altered function of various portions of brain and spinal cord

147
Q

lymphoma

A

malignant solid tumor of the immune systems constitutional cells; these lymphoid cells multiply uncontrollably and form tumors; infiltrate mediastinum, spleen, liver, bone marrow, CNS, skin

148
Q

non-hodgkins lymphoma

A

malignant disease from lymphocytic lineage; typically arise in lymph nodes and spleen; more common in children under 10non-ho

149
Q

non-hodgkin lymphoma clinical manifestations

A

swollen glands, SOB, cough, abdominal pain, changes in bowel patterns

150
Q

treatment of non-hodgkin lymphoma

A

chemotherapy is primary treatment, radiation therapy, targeted therapy with monoclonal antibodies

151
Q

hodgkin lymphoma

A

lymphatic system malignancy characterized by reed-sternberg cells

152
Q

hodgkin lymphoma clinical presentation

A

painless lymphadenopathy, mediastinal mass, pruritis, hepatosmplenomegaly, systemic B symptoms like unexplained fever >38C for 3 days and drenching night sweats and weight loss >10% in 6 months

153
Q

leukemia

A

malignancy of blood-forming cells (bone marrow cells) causing uncontrolled proliferation of blasts, decreased production of normal cells, accumulation of blasts in body organs/tissues

154
Q

manifestation of leukemia

A

fatigue, pallor, anorexia, bruising, bleeding, fever, infection, bone/joint pain, abdominal pain, headache, vomiting, visual disturbances, tachycardia

155
Q

acute lymphoblastic leukemia (ALL)

A

chemotherapy for 2-3 years; goal is to eradicate more than 99% of leukemia cells and restore normal hematopoiesis; CNS directed therapy; intensification/consolidation

156
Q

acute myelogenous leukemia

A

principles of treatment include intensive chemotherapy required to achieve remission and attain cure; lengthy hospitalizations expected throughout treatment; intensive supportive care; challenging to treat

157
Q

osteosarcoma

A

malignant tumor of the bone derived from bone-forming mesenchyme (connective tissues); most common sites are long bones like distal femur, proximal tibia, proximal humerus

158
Q

peak incidence of osteosarcoma

A

2nd decade of life, associated with adolescent growth spurt; male to female ratio 1.5:1

159
Q

manifestation of osteosarcoma

A

pain and tenderness at affected area; may have soft tissue mass

160
Q

treatment for osteosarcoma

A

initial is surgical biopsy, then adjuvant combination chemotherapy, then surgery to amputate or limb salvage or rotationplasty

161
Q

prognosis for osteosarcoma

A

overall survival rate is 65-70%; metastatic is 20-30%

162
Q

wilms tumor

A

most common primary malignant renal tumor; it is rapidly growing and vascular; incidence higher in females (slightly), peak age 2-3yrs,

163
Q

presentation of wilms tumor (nephroblastoma)

A

nontender firm flank mass that does not dross midline in healthy appearing child; may be asymptomatic or have pain, vomiting, gross hematuria, anemia, HTN

164
Q

wilms tumor treatment

A

surgery consisting of unilateral complete nephrectomy, bilateral nephrectomy of more involved kidney and partial nephrectomy of other kidney, chemotherapy, radiation

165
Q

neuroblastoma clinical manifestations

A

often widespread metastatic disease at diagnosis, fevers, irritability, excess sweating, HTN, anemia/fatigue, anorexia, weight loss, diarrhea, limp/refusal to walk, blueberry muffin spots, orbital ecchymosis

166
Q

neuroblastoma treatment

A

based on stage of disease; intense high dose chemotherapy, surgery, radiation therapy, stem cell rescue, antibody therapy

167
Q

central nervous system tumors or brain tumors

A

4500 new tumors diagnosed in children annually (gliomas 25%), most common cause of pediatric cancer and cancer-related deaths, more common in males then females

168
Q

CNS tumor locations

A

2/3 occur in posterior fossa or infratentorial; 1/3 in supratentorial

169
Q

infratentoral tumors

A

located in the brainstem and cerebellum area

170
Q

supratentorial tumors

A

located in areas like the cerebrum or ventricles; the upper part of the brain

171
Q

CNS/brain tumor manifestations

A

headaches, change in mental status, restlessness, anxiety, confusion, increased intracranial pressure, N/V, nerve palsies, ataxia, aphasia, hemiparesis, visual problems

172
Q

treatment for CNS/brain tumors

A

surgery, XRT>3 years, chemotherapy, immune/biotherapy, stem cell therapy

173
Q

side effects of radiation

A

dependent on location, dose, age of pt, adjunctive chemotherapy; N/V, fatigue, cognitive defects, short stature, cataracts, acute pericarditis, dyspnea, pleuritic chest pain, dry cough, increased RR ad effort, diarrhea, cramping, malabsorption

174
Q

side effects of chemotherapy

A

indiscriminately kills rapidly dividing cells; malignant cells can repair themselves when injured; normal cells are more successful at repairing self; the cells that are most affected by chemo are bone marrow, hair follicles, GI tract (oral mucosa in particular)

175
Q

neuroblastoma is…

A

type of cancer that develops in nerve cells called neuroblasts; most common extracranial tumor in children; can start in adrenal glands but can develop in head, neck, chest, abdomen, or spine; most often found in an embryo or fetus

176
Q

enteral iron supplementation

A

Pediatrics (4 decks)

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