Exam 4 Blueprint Flashcards
What is a macule?
circular, flat discoloration < 1 cm
What is a papule?
superficial, solid, elevated <0.5 cm
What is a plaque/annular?
ring-like with central clearing
What is a vesicle?
circular collection of free fluid < 1 cm
Wha is a pustule?
vesicle containing pus
Why are children at risk for skin injuries?
due to their developmental immaturity, they suffer accidental minor injuries frequently
Approximately one in ____ children experience child abuse or neglect
4
What is a non accidental injury to a child
done with harm intent ; child abuse
What are the types of injuries?
abrasions, lacerations, bites, bruises, burns
Where are common sites of bruises (these are caused by normal play)
-forehead
-eyebrows
-elbows
-shins
-knees
Questionable sites for bruises in children include places such as ?
-thighs
-calves
-neck
-back
-tops of shoulders
-etc
Risk factors for child abuse include
-poverty
-prematurity
-chronic illness
-intellectual ability
-parent w/abuse history
-unrelated partner
-alcohol/substance abuse
-extreme stressors
Why are premature infants, children with intellectual ability, and children with chronic diseases at higher risk of maltreatment?
it is harder to care for them
If a child comes into the ED with injuries in uncommon locations (such as backside) and has multiple in places other than the legs, the nurse should be suspicious of
child abuse
Bruises in an infant <9 months should raise suspicion to?
child abuse
What should the nurse observe for if she is working in the ED and suspects child abuse?
-frequent visits / delay in seeking care
- inconsistent stories
-unusual caregiver-child interaction
Physical cues of abuse include?
-suspicious location
-injuries in various stages of healing
-fear of parents
-lack of emotional responses
Infant <6 months sun safety rules
-keep out of direct sunlight
-use minimal sunscreen
What extra clothing can a child wear to increase sun safety
-hats
-sun shirts
Sun exposure time should be limited between what hours
10am - 4 pm
Why should sunscreen be broad spectrum
-screens out other UVA and UVB rays
Requirements for choosing a good sunscreen:
-fragrance and oxybenzone free
-spf 15 or higher
What can be applied to nose, cheeks, ears, and shoulder areas to provide extra sun protection
zinc oxide products
Sunscreen should be applied 30 minutes before activity, and reapplied how often?
-q 80-90 min if in water
-at LEAST q 2 hours
What is the primary burn assessment the nurse should perform when a child comes to the ED?
- assess if airway is patent
2.determine if airway injury is present
3.evaluate child’s skin color, respiratory effort, pulse ox, ABG, carboxyhemoglobin levels, and breath sounds
4.determine pulse strength, perfusion status, and HR
5.note any edema
IF a client experiences an electrical burn, what do they require?
an EKG
S/s of airway injury from burn or inhalation include?
-burns to face/lips
-nose hairs singed
-black sputum
-stridor, hoarseness, wheezing
The secondary assessment a nurse should perform upon child admission to the ED with burns is?
- determine burn depth
- estimate burn extend by calculating BSA affected
- inspect child for other traumatic injuries (I.E spinal cord injury)
Describe a first degree burn:
damage to epidermis
Appearance of first-degree burn:
-pink to red in color
-no blisters
-blanches
Describe a second degree Superficial Partial Thickness burn
-damage to the entire epidermis
-dermal elements remain intact
Appearance of a second degree Superficial Partial Thickness burn
-moist, red, painful
-blisters
-mild to moderate edema
-blanches
-no eschar
Describe a second degree Deep Partial Thickness burn
-damage to the entire epidermis and some parts of the dermis
-sweat glands and hair follicles remain intact
Describe the appearance of a second degree Deep Partial Thickness burn
-mottled, red to white
-blisters
-moderate edema
-blanches
Describe a third degree burn
-damage to the entire epidermis and dermis
-possible damage to subcutaneous tissue
-nerve endings, hair follicles, and sweat glands are destroyed
What is the appearance of a third degree burn?
-red to tan, black, brown, or waxy white color
-dry, leathery appearance
-no blanching
Describe a fourth degree burn
-damage to all layers of the skin that extends to muscle, fascia, and bone
Describe the appearance of a fourth degree burn
-color variable
-dull and dry
-charring
-possible visible ligaments, bone, and tendons
What type of burn is painful, heals in 3-5 days, and has no scarring
first
What type of burn is painful, heals in < 21 days. Has variable amts of scarring, is sensitive to temperature changes/air/light touch
superficial partial thickness burn (2nd)
What type of burn is painful, is sentive to temp changes/light touch, and scarring is likely
deep partial thickness burn (2nd)
What stage of burn has pain that begins as burn heals, scarring is present, and a skin graft is needed
full thickness burn (3rd)
what stage of burn has no pain, scarring is present, skin graft is needed, amputation is possible
deep-full thickness (4th)
How many minutes before dressing changes or procedures should we administer pain medications to clients with burns
45 minutes
What combination of pharmacologic pain management is used when treating burns
-opioids: morphine and fentanyl
-sedative: midazolam
Nonpharmacologic pain measures should be used in clients with burns. Examples of these include
-music, distraction
Fluid resuscitation for 2nd and 3rd degree burns are based on
TBSA (Lund and Browder formula)
What solution is used for fluid replacement for burns in the first 24 hours
LR
24-48 hours after a burn, when capillary permeability improves, what is added to IV fluids to help resuscitation
colloids such as albumin and FFP (fresh frozen plasma)
Adequacy of fluid replacement when treating burns is determined by
evaluating urine output
A urine output of ___ should be maintained when treating burns
1-2 ml/kg/hr
What should be monitored when administering fluid resuscitation to clients with burns
DW, fluid and electrolyte imbalances, I and O’s
Nursing considerations for wound care
-maintain standard precautions/ PPE
-clean with mild soap and water
-assist with debridement and hydrotherapy
Should nurses pop blisters while performing wound care?
no, leave blisters intact
Loose skin from burns should be removed with
sterile scissors
How to prevent infection when caring for burns?
-use aseptic technique
-use Pt-designated equipment such as BP cuffs and thermometers
If a tetanus vaccine is > 5 years old or if status is unknown, what should happen if they have a burn
administer one to prevent infection
Why should flowers/plants be avoided in clients with burns
avoids exposures to pseudomonas to prevent infection
Complications of burns include:
-carbon monoxide injury
-hypovolemic/septic shock
-wound infections
-inhalation injury
What is a skin abrasion
superficial rub or wearing off of the skin usually due to friction; mainly limited to the epidermis
What is a laceration
injury that penetrates skin and soft tissue
What is atopic dermatitis (eczema)
inflammation/rash/itching caused by antigen response to environmental factors, temp changes, sweating
common sites of atopic dermatitis/eczema include
wrists, antecubital of arm, popliteal space
What does atopic dermatitis/eczema cause?
elevated IgE levels
What medications are used to treat atopic dermatitis/eczema
-topical corticosteroids
-immune modulators - tacrolimus
Nursing considerations for tacrolimus include
- used in children > 2
- must avoid direct sunlight
-can cause itching, flu-like symptoms ,and HA
We should educate parents that children with atopic dermatitis should avoid soaps containing
perfumes, dyes, or fragrances
How to promote moisture in children with atopic dermatitis?
-pat skin dry and leave moist while applying moisturizers multiple times daily
Should children with atopic dermatitis bath in warm or hot water
2 x a day in warm water / avoid hot
What type of clothes should children with atopic dermatitis wear?
-100% cotton clothing AND bed linens
-avoid synthetics and wool
-keep fingernails short
What drugs may be given at bedtime for children with atopic dermatitis
antihistamines
What is diaper dermatitis
inflammatory reaction caused from urine, feces, harsh soaps, wipes
T or F: diaper dermatitis can be either non-candida or candida
yes
Non-candida diaper dermatitis assessment finding s
red, shiny, NOT IN CREASES OR FOLDS
-occurs on buttocks, thighs, abdomen and waist
Candida diaper dermatitis assessment findings
deep red lesions, scaly with satellite lesions (outside of diaper area)
-OCCURS IN CREASES OR FOLDS
Children with candida diaper dermatitis may also have
thrush of the mouth
Does candida dermatitis improve with standard diaper cream
no
tx for non-candida diaper dermatitis
-topical A,D, and E or zinc oxide
Tx for candida diaper dermatitis
nystatin or miconazole anti fungal cream
Diaper dermatitis management include
-change diaper s frequently
-avoid rubber pants, harsh soaps, and baby wipes with fragrance or preservatives
Why should nurses obtain the date of LMP for females with acne during their history assessment
acne is worse 2-7 days prior to start of menses
During the history and physical assessment for acne vulgaris, the nurse should ask
-onset of lesions
-medications that exacerbate
-note oily skin/hair
-hx of endocrine disorder
We should educate clients with acne to avoid
oil - based cosmetics and hair products, headbands, helmets/ hats
We should educate our patients with acne to do what to manage their symptoms
-clean skin with mild soap and water BID
-shampoo hair regularly
-avoid picking/squeezing
-eat a balanced diet
How does tretinion work to treat acne
interrupts abnormal keratinization
How does benzoyl peroxide, an OTC medication help manage acne
-inhibits growth of P. acnes
What topical antibacterial medication can be given to reduce acne
clindamycin
What oral antibiotics can be given to treat acne
-tetracycline and erythromycin
What teratogenic medication can be given for severe cases of acne
isotretinoin
How can oral contraceptives be used to help reduce acne
decreases endogenous androgen production
what is rubeola (measles)
a highly contagious viral respiratory illness spread via droplets
Assessment findings of measles includes
-Fever, Koplik spots, cough, nasal inflammation, malaise, conjunctivitis
How does maculopapular rash spread with rubeola
starts on face –> neck –> trunk > arms > legs > feet
Patients with rubeola need to be placed on what type of precautions
airborne
Nursing management of Rubeola / measles includes
-supportive care
-antipyretics
-bedrest, fluids, humidification
If a client is 6 months - 2 years old and is hospitalized or immunocompromised with rubeola, what is the treatment
Vitamin A
Complications of rubeola / measles includes
diarrhea, OM, PNA, encephalitis
Rubeola is communicable _______ days before rash appears and until ______ after the rash disappears
3-5 ; 4-6 days
Physical findings of pertussis include?
-acute respiratory disorder
-paroxysmal cough
-whooping cough
-copious nasal / oral secretions
Patients with pertussis need to be placed in
droplet/standard precautions
therapeutic management of pertussis
-high humidity environment
-observing airway for obstruction
-push fluids
-abx compliance
What is the medication treatment for pertussis?
-Macrolides “mycins”
-erythromycins, azithromycins
If a client is < 1 month of age, pertussis must be treated with
azithromycin
Pertussis can be prevented with what vaccine? When is it given?
-DTaP
-2,4,6,8, 15-18 months
-booster at 11 years
Clinical manifestations of fever include
-sweating, weakness, lethargy, flushing, s/s of dehydration if severe
A fever in an infant younger than 3 months is
100.4 or higher
A fever in a child 3 months to 3 years is
102.2 or higher
An older child will have more traditional s/s of fever such as
-rash
-appearing sick
-persistent diarrhea or vomiting
-s/s of DHD
How often should temp be assessed if client has a fever
-assess q 4-6 hours
-30 - 60 min after administering antipyretic
- any change of condition
Should the nurse change the site or device used for temperature measurement for a client experiencing a fever
No ; use the same to accurately gage changes in temperature
When should antipyretics be administered
when child is experiencing discomfort or cannot keep up with metabolic demands of the fever
Nursing interventions during fever
-assess fluid intake
-encourage oral intake
-IV fluids per order
-keep linens and clothing dry
What two medications are given to manage fever
-tylenol 10-15 mg/kg/dose q 4-6 h
-ibuprofen 5-10 mg/kg/dose q 6-8 h
-ibuprofen only given if > 6 months
Physical findings of Lyme disease include
-onset of rash and erythema migrans
-fever
-HA
-joint/muscle pain that progresses to larger joints
How long after bite from deer tick does onset of rash and erythema migrans occur
usually 7-10 days
Lyme disease treatment for clients > 8 years old
-14-28 day course of Doxycycline
Lyme disease treatment for clients < 8 years old
-Amoxicillin to prevent teeth discoloration
Nursing education for preventing future tick bites includes
-wear protective clothing that fits tightly around wrists, waists, and ankles
-do a full body check after leaving area with ticks
-examine gear, clothes, and pets for ticks
-tumble dry gear on high heat for an hour
-insect repellent is temporary and may be toxic to children
Teaching patients how to remove a tick includes
-using fine-tipped tweezers
-protect fingers with gloves
-do not twist or jerk the tick
-clean site with some and water or alcohol
-save the tick in case child becomes sick
Physical cues of pediculosis captitis
-nits or lice behind ears or on nape of neck
-extreme pruritis
-small red bumps on scalp
-white specks on hair shaft
management of pediculosis capitis
-follow directions exactly on pediculicide
-comb out hair q 2-3 days
-soak combs and hairbrushes in treatment solution, hot water, or shampoo
What should we do to bed sheets or environmental items when our patient has head lice
-use hot water
-use dry cleaning
-seal in plastic bags
What kind of precautions are patients with head lice placed in
contact precautions
What are standard precautions
-applies to all patients
-hand hygiene before and after
-gloves when handling all body fluids
-masks/goggles if splashing of body fluids indicated
What are contact precautions?
-private room or cohort w / like conditions
-gloves and hand hygiene
-gowns donned before entering and doffed before exiting
What are droplet precautions
-respiratory or mucous containing pathogens from nose / mouth
-private room or cohort with like illness
-surgical mask if within 3 feet
what are airborne precautions
-droplets or dust in air
-negative pressure required
-masks or n95 device
-restriction of susceptible visitors or staff
What kind of precautions does rubeola (measles) require
airborne
What kind of precautions does pediculosis capitus need
contact
what kind of precautions does pertussis need
droplet/standard
History cues of immunodeficiency in pediatric patients
-four or more episodes of otitis media in 1 year
-2 or more episodes of severe sinusitis
-tx with abx for 2 months or longer with no effect
-FTT in the infant
-recurrent deep skin or organ abscesses
-persistent oral thrush or skin candidiasis
-hx of infections requiring iv abx
-two or more serious infections such as sepsis
-family hx of primary immunodeficiency
Lab findings for infections include CBC with differential, what does this evaluate?
-proportion of each of the 5 WBC types
Neutrophils increase in the presence of
-bacterial infections or severe stressor
Neutrophils decrease in the presence of
some viruses, exhausted BM (bone marrow), chemo
Eosinophils are associated with
antigen-antibody reactions
Lymphocyte numbers increase in
presence of viral infections, chronic bacterial infections, ALL
Lymphocytes decrease in
HIV/AIDs
Immunoglobulin lab cues of immunodeficiency
IgG
IgA
IgM
IgE
IgD
Lab cues of immunodeficiency that indicate inflammation
ESR and CRP
Lab cues of immunodeficiency that monitor amount of T-helper cells
CD4 Count
What is the Complement C3 lab cue for immunodeficiency
evaluated to determine howe well the immune system is working
Characteristics of IgG
-only immunoglobulin that crosses the placenta and transferred via breastmilk
-protects against viruses, bacteria, and toxins
Lack of IgG causes
severe immunodeficiency
At what age do infants produce their own IgG
6 months - 1 year of age
Characteristics of IgA
-first line of defense against respiratory, gi and gu pathogens
At what age do infants begin producing IgA
3 months of age
Characteristics of IgM
-presence indicates an active infection
Characteristics of IgE
-increases in allergic states
-increases in parasitic infections
-increases in hypersensitivity reactions
what immunoglobulin level is measured during allergy testing
IgE
Pathophysiology of Severe Combined Immune Deficiency (SCID)
-absent B and T cell function
-x - linked autosomal recessive
SCID is a potentially fatal disorder that requires
emergency intervention at time of diagnosis
History and physical cues of SCID
-hx of frequent, severe infections
-chronic diarrhea
-FTT
-persistent thrush
Lab cues of SCID
-very low levels of immunoglobulins IgA and IgM
Main treatment of SCID includes
-preventing infections
What can be administered to reduce the number of bacterial infections in a child
IVIG
What is necessary for a patient with SCID
-a bone marrow transplant with HLA matched sibling or donor
If a transfusion is necessary in a child with SCID, what must we take note of
-only cytomegalovirus (CMV) negative, irradiated blood or platelets can be administered
Diagnostic labs for children with HIV 18 months or older
+ ELISA and +Western blot
Lab criteria for diagnosis of HIV in infants < 18 months and born to an infected mother
+ PCR and viral culture
HIV in children can cause
-progressive HIV encephalopathy
Sx of HIV encephalopathy
-acquired microcephaly
-motor deficits
-loss of previously achieved development milestones
HIV affects what type of cells
CD4 (T-helper cells)
Pathophysiology of juvenile idiopathic arthritis
-autoimmune disease that causes the body to release inflammatory chemicals that attack synovium
-attack joints + eyes or other organs
The first sign of juvenile idiopathic arthritis may be?
-history of irritability or fussiness
Other assessment findings of JIA include
-redness, pain, swelling and stiffness with inactivity or in the AM, eye inflammation, organomegaly, poor weight gain, severe anemia
Lab cues of JIA include
Anemia
+ ANA in young child with pauciartiular type
Increased WBC
+RA Factor in serious cases
Cross reactions to latex - containing products and specific foods such as
pear, peach, passion fruit, plum, pineapple
Latex allergies have a response similar to food allergies. what immunolglobulin mediates this
IgE
Nursing care and interventions for latex allergy???????
-avoid products that contain latex ?
Clinical manifestations of latex allergy????
Symptoms of allergic reactions include
-hives
-flushing
-angioedema
-mouth/throat itching
-swelling of throat/pharnyx/uvula
-runny nose
-gi distress
What allergic reaction symptoms may indicate the airway is compromised
-wheezing
Physical cues of anaphylaxis reactions
-swelling of mucosal tissue, lips
-respiratory compromise
-reduced BP or associated s/s of end organ dysfunction
Management of allergies
-administration of histamine blockers
-If anaphylaxis: epipen should be carried at all times
-written emergency plan for child’s allergy
-dietary consult ot assist family with reading foods labels and recognizing hidden sources of allergens
Nursing assessment for allergic and anaphylactic reactions
-ABC’s
-VS ; auscultate heart and lungs
-assess oropharynx
-assess skin
-note length of time between exposure and reactions
What causes allergic and anaphylaxis reactions
-food or environmental allergens initiate IgE mediated antibodies to form –> mediators and cytokines released
What is amblyopia? aka lazy eye
poor visual acuity in one eye ; can lead to blindness if not corrected ; can be caused by strabismus
all preschoolers should be screened for visual acuity by age
3
the only sign of amblyopia in preverbal child may be
asymmetry of cornea light reflex
Therapeutic management of amblyopia includes:
-wearing patch or administering atropine drops to STRONGER eye
What are the types of hearing loss
conductive and sensorineural
Conductive hearing loss means
transmission of sound through middle ear is disrupted
Causes of conductive hearing loss include
-frequent otitis media with effusion (fluid in middle of ear)
-ruptured tympanic membranes
Sensorineural hearing loss means
caused by damage to hair cells in the cochlea
What are causes of sensorineural hearing loss
-ototoxic meds, meningitis, rubella, excessive noise
Pathophysiology of infantile glaucoma
obstruction of aqueous humor flow, causing high intraocular pressure; vision loss occurs from retinal scarring and optic nerve damage
Assessment findings of infantile glaucoma
spasmodic winking, corneal clouding, enlarged eyeball, excessive tearing, red reflex appears gray or green
Management of infantile glaucoma
-3-4 surgeries (surgical management) is first line treatment
Congenital cataracts pathophysiology
opacity of the optic lens preventing light from entering the eye
-leading cause of visual impairment and blindness
Assessment findings of congenital cataracts
cloudy cornea, absent red reflex
Tx for congenital cataracts
-best outcomes when surgically removed by 3 months of age
-can begin surgery as young as two weeks
Nursing care of children with visual impairment
-use child’s name to get attention
-tell child you are there before touching them
-encourage independency while maintaining safety
-name and describe people/objects to make child more aware of what is happening
-discuss upcoming activities
-use simple and specific directions
-use parts of child’s body as reference
-encourage exploration of objects through touch
What is acute otitis media?
infection of middle ear structures
Bacterial: strep
Viral: RSV , influenza
s/s of acute otitis media
fever, ear pulling, irritability, poor feeding, lymphadenopathy
what does the tympanic membrane look like with acute otitis media
dull, red, bulging, deceased or no movement
management of acute otitis media
-Amoxicillin/Augmentin or azithromycin: PO
-Ceftriaxone: IM x 1 dose
-Tylenol / ibuprofen: manage ear pain and fever
-Benzocain: ear drops for pain if TM intact
If > 3 years old, to assess TM or administering ear drops we pull the pinna
up and back
if < 3 years old, to assess TM or administering ear drops we pull the pinna
down and back
What is otitis media with effusion
collection of fluid in the middle ear with NO infection
-related to allergies or Ig adenoids
S/s of otitis media with effusion
feeling of fullness, transient hearing loss possible
What does the tympanic membrane look like with otitis media with effusion
dull, orange discoloration, air bubbles, decreased movement
Tx of otitis media with effusion
-resolves on own
- if > 3 months no resolution, refer to ENT and assess for hearing or speech loss
What is myringotomy and tympanovstomy
-small incision in TM and placement of PE tubes that can be indicated for a child with recurrent OM
Is post op pain common after PE tube placement
no
is PE tube placement usually done outpatient or inpatient
outpatient under general anesthesia
What is recommended while swimming after ear tube placement
ear plugs
-if water enters ear allow it to drain out
Patient education after PE tube placement
-notify provider if drainage occurs
-ear drop administration
-tubes fall out spontaneously after 8-18 months
S/s of hearing loss in infants
-does not startle to loud noises
-wakes only to touch
-does not turn to sound by 4 months of age
-no babbling at 6 months
-no speech development
S/s of hearing loss in young child
-communicates needs through gestures
-does not speak by 2 years
-prefers solitary play
-does not respond to telephone or door bell ringing
S/s of hearing loss in older child:
-often asks for statements to be repeated
-is inattentive or daydreams
-performs poorly in school
-gives inappropriate answers to questions if not facing speaker
Pathophysiology of ALL
overproduction of immature lymphoblast cells that infiltrate organs and tissues
History cues of ALL
-reports of leg pain
-reports of decreased activity level
-recurrent infections
-persistent fevers
Physical cues of ALL
elevated temp (leukopenia)
pallor in color (anemia)
petechiae, purpura, brusies (thrombocytopenia)
enlarged lymph nodes
hepatomegaly, splenomegaly
Lab cues of ALL
-depleted CBC (WBC may be low, elevated, or high)
-Blood smear for lymphoblasts
-bone marrow aspirate (BMA) for lymphoid cells
Pathophysiology of lymphoma
malignancy of the lymph system
History cues of lymphoma
-adolescent age
-family hx
-reports of night sweats
-weight loss
-hx of frequent infections
Physical sx of lymphoma
-painless enlarged supraclavicular or cervical lymph nodes
the two classifications of lymphoma and their sx
Class A: asymptomatic
Class B: fever, night sweats, > 10 % weight loss, cough, SOB, abdominal discomfort, enlarged liver or spleen, pruritis
Lab cues for lymphoma
Lymph node biopsy + for reed Sternberg cells
Pre - op care for brain tumors
-monitor for increased ICP
-steroids to decrease swelling
-pre-op teaching /emotional support
Post-op management of brain tumor
-monitor for Increased ICP and manage
-frequent VS, pupil checks, and LOC
-monitor I and O’s
-JP drain monitoring and care
How should patients be positioned post operatively of brain tumor removal
-keep head midline
-position on unaffected side at level ordered by provider
Hyperthermia following brain tumor surgery is treated with
antipyretics
Headache following brain tumor surgery is treated with
analgesics
Pathophysiology of Wilm’s tumor (nephroblastoma)
solid tumor that commonly occurs in the abdomen (mainly kidneys)
Assessment/physical cues of nephroblastoma
swollen, asymmetric abdomen, hematuria, HTN, firm nontender abdominal mass
s/s indicative that Wilm’s tumor has metastasized to lungs
cough/SOB/chest pain
Diagnostics for film’s tumor
Abdomen: US, CT, MRI, chest X-ray
UA: gross or microscopic care
24 hr urine
If the 24 H urine protein is negative for homovanillic acid and vanillamandelic acid, this means?
the patient has a wilms tumor
Biggest nursing consideration for Wilm’s tumor
do NOT palpate the abdomen
-place signs outside door and above the bed
What is the most common site for bone marrow aspirate? What about in infants?
-iliac crest
-tibia can be used for infants
Describe the procedure for Bone Marrow Aspiration?
topical anesthetic may be applied over biopsy area 45 min - 1 h prior (fetanyl) ; conscious sedation used (propofol, versed/midazolam)
Post-procedure actions for BMA
-apply pressure to site for 5-10 min
-apply pressure dressing
-assess VS frequently
-monitor for bleeding and infection
Neutropenic precautions
-meticulous hand hygiene
-VS q 4 h
-assess for s/s of infection q 8h
-avoid rectal temps, enemas, suppositories, urinary catheters, and invasive procedures
-restrict visitors
-mask on child when outside room
-soft toothbrush
-private room
-prophylactic ABX
-monitor ANC
-no raw fruits / veggies
-no raw plants
What does chemotherapy do?
target different phase of the cell cycle and affects rapidly growing cells
Common adverse effects of cancer
-mucosal ulceration
-skin breakdown
-neuropathy
-pain
-NV/ Loss of appetite
-hemorrhage cystitis
-cardiomyopathy (late)
-cognitive defects
What is the biggest side effect of chemo
myelosuppression
-anemia, thrombocytopenia, neutropenia
Long term complications of chemotherapy
altered G&D, CV/respiratory changes, reproductive dysfunction, vision/hearing changes, tooth loss, and secondary cances
What is radiation therapy for cancer
-high energy radiation to kill cancer cells
-may also destroy any rapidly dividing cells in proximity to the irradiated area.
Adverse affects of radiation
-similar to chemotherapy
-irritation/ burns to site
Long term complications of radiation therapy
-similar to chemotherapy
-pulmonary fibrosis, osteoporosis, development of secondary cancer at / near the site
Assessment findings of iron deficiency anemia
-pallor in skin, MM, conjunctiva
-SOB
-dizziness
-weakness
-fatigue
-irritability
-spooning of nails (concave shape)
-splenomegaly
Diagnostic labs for iron deficiency anemia
-low RBC, hgb and hematocrit, MCV, MCH, ferritin decreased
-RDW (red blood cell distribution) increased
Tx of iron deficiency anemia
-Fe fortified formula
-4-5 months breast fed infants need Fe+ fortified cereal or Fe gets
-encourage breastfeeding mothers to increase Fe + in their diet
-Limit cow’s milk in children > 1 to 24 oz/day
-SW referral for resources such as WIC
Side effects of Fe+ supplements
-metallic taste in mouth
-nausea
-upset stomach
Client education for Fe+ supplements
-place behind teeth to avoid stains
-cause constipation - increase fluids and may need stool softeners
-cause dark, green stools - this is normal
Foods high in iron include:
-meat
-tuna
-salmon
-eggs
-tofu
-enriched grains
-dried beans and peas
-dried fruits
-leafy green vegetables
-Fe fortified cereals
Physical findings of hemophilia
-swollen or stiff joints
-multiple bruises
-hematuria
-bleeding gums
-bloody sputum or emesis
-black tarry stools
-chest or abdominal pain (internal bleeding)
Lab cues for hemophilia
-PTT prolonged, normal PT and platelets
-low Hgb and Hct
Treatment of bleeding episodes for hemophilia
Factor VIII administration (slow IV push)
-acute and prophylactic regimens
Nursing actions for hemophilia bleeding
-med administration first
-apply direct pressure to external bleeding
-apply ice or cold compress to joint
-elevate extremity
-desmopressin for mild cases
What is a vaso-occlusive crisis?
-when the circulation of blood vessels is obstructed by sickled RBC’s causing ischemia and infarction
Assessment findings of vaso occlusive anemia
-joint pain, increased HR/RR,
-Acute Chest Syndrome, Splenic Sequestration Crisis
-Dactylitis
What does Splenic Sequestration crisis cause
big drops in blood volume
What is dactylitis
symmetric swelling of hands and feet
Labs or vaso-occlusive crisis:
-low Hgb
-Increased platelets, sedimentation rate, LFT, bilirubin, reticulocyte count
Management of vaso-occlusive crisis
-pain control (NSAIDs, opioids)
-Hydration (double maintenance fluid)
-150 ml/kg/day
-Hypoxia (O2 if < 92%)
Risk factors for lead poisoning
-old home (paint/pipes/soils)
-toys
-developmental delays, learning deficits, behavioral problems
-malnutrition
-PICA
Physical cues for lead poisoning
-irritability
-abdominal pain/cramping
-Low IQ/delayed growth and development
-poor appetite
-vomiting
-ataxia
-hematuria
-new onset of seizures
Lab cues for lead poisoning
< 5 mcg: repeat in 6-12 months if high risk
5-14 mcg: repeat test in 1-3 months, educate parents to decrease exposure
15-44 mcg: confirm with repeat test in 1-4 wks, educate parents to decrease lead exposure, repot to local health authorities
>45 mcg: begin chelation therapy
>69 mcg: hospitalized child
When is chelation therapy given?
when blood lead levels are >45
How does chelation therapy work?
-removes lead from soft tissue and bone then excreted via kidneys
What medications are given during chelation therapy
-PO or IV - succimer/Dimercaprol/Adetate calcium disodium
Nursing considerations for Chelation therapy
-ensure adequate fluid intake and monitor I&Os
