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AN305 > F HEM-ONC > Flashcards

F HEM-ONC Flashcards

1
Q

Iron deficiency anemia

What is it?

RF (5)

A

Inadequate supply of iron results in decreased Hgb

RF:
-premature birth (decreased iron stores from mom)
-excessive intake of cows milk in toddlers
(Not good source of iron, need iron rich foods too)
-malabsorption disorder
-poor dietary intake of iron
-increased iron requirements (blood loss)

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2
Q

Iron deficiency anemia

Diagnostics/labs

A

CBC (RBC, H&H)

Retic count (immature RBC-want less than 3%)
-body producing too much RBC to try and fix issue

Serum iron, ferritin, transferrin/total iron binding capacity

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3
Q

Iron deficiency anemia

S/s

A

Tachycardia
Pallor
Brittle, spoon shaped fingernails
Fatigue/irritability/muscle weakness
Cravings (non-nutritive substances/PICA/ICE)

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4
Q

Iron deficiency anemia

Nursing management (screen)

A

Nutritional screening:
-Fe fortified formula
-breast milk (if mom doesnt get enough iron)

Blood Screening:
-12mo (dont do before bc still have moms iron store
-15-18 mo
-screen if symptoms are present

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5
Q

Iron deficiency anemia

Tx
Premature
Full term
Greater than 1y/o

A

Supplement: iron drops, MV(multi vitamin) w/ iron

Diet:
Premature infants, LBW (need iron supplement)

Full term infant: breast milk, iron fortified formula, iron fortified rice cereal

Greater than 1 y/o:
-limit milk 2-3 severings daily
-red meats, eggs , iron fortified breakfast cereal, dried fruits, leafy green vegatables, vit C foods

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6
Q

Iron deficiency anemia

Iron supplements (instructions)

How to treat severe anemia

A

Supplements:
-give on empty stomach (1hr before meals)
-give w/ vit C
-GI upset common
-if liquid (drink thru straw)

Severe anemia:
-bed rest/cluster care
-ferrous sulfate IV
-PRBC transfusion
-supplemental O2

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7
Q

Lead poisoning

Where does it come from
Who retains lead more
Screening done when
What it does (labs?)

A

Paint/pipes

Children retain and absorb lead better than adults

Screening: 1y/o and 2y/o

Intereferes w/ normal cell function:
-inhibits body ability to make Hgb
-low H&H, elevated serum lead

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8
Q

Lead poisoning

S/s not critical

A

Cognitive impairement
Hyperactivity and inattention/behavioral problems
HA
Fatigue/agitation
Abd pain

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9
Q

Lead poisoning

Critical level s/s

A

Vomiting
Stupor
Sz
Encephalopathy
Renal damage

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10
Q

Lead poisoning

Consult who?
Tx
Med

A

Consult : social services, dietician

Tx:
-ferrous sulfate supp
-diet high in iron and calcium
-encourage oral fluid intake (lead excreted in kidney)

Med:
-chelating agent: succimer for lead level >45
—capsule (if unable to swallow can sprinkle on food)
—recheck lead level monthly

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11
Q

Sickle cell anemia

Hereditary or acquired
What type

A

Hereditary, autosomal recessive disorder

if both parents have trait ach kid had 1-4 likelihood of having disease

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12
Q

Patho of sickle cell anemia

A

Hgb in the RBCs take on elongated sickle shape
-rigid and obstruct capillary blood flow
-increased blood viscosity (thickened)

-obstruction lead to engorgement and tissue ischemia d/t tissue hypoxia resulting in PAIN

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13
Q

Prognosis for sickle cell anemia

Is there a cure
Care?
Leading cause of death in young children w/ sickle disease

A

No cure

Supportive care (prevent sickling episodes)

Bacteria infection (leading cause)

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14
Q

Sickle cell anemia crisis (vasoocclusive crisis)

Precipitating factors

A

Anything that increases the bodys need for oxygen
Or
Alters the transport of oxygen

Events triggered by stress or trauma:
-infection, fever, hypoxia, extreme cold exposure, high altitudes

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15
Q

Sickle cell anemia crisis (vasoocclusive crisis)

S/s

A

Severe pain (bones and joints)
Swollen joints, hands, feet
Abd pain
Hematuria
Jaundice (destroys RBCs)

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16
Q

Sickle cell anemia crisis (vasoocclusive crisis)

Complications

A

Splenic sequestration:

-Excessive pooling of blood within the spleen reducing the circulating volume
-results in HYPOVOLEMIA and SHOCK

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17
Q

Sickle cell anemia crisis (vasoocclusive crisis)

S/s of hypovolemic shock cause by splenic sequestration

A

Tachycardia
HOTN
Weak/thready pulses
Cold extremities
Pallor
Decreased UOP

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18
Q

Sickle cell anemia crisis (vasoocclusive crisis)

Tx (6)

A

Pain management: narcotics/opioids, PCA pumps, NSAIDS, Acetaminophen

IV fluids (decrease viscosity of blood)

Monitor heart/lungs (spo2 >92%)

Abx (if bacterial infection)

Blood transfusion or exchange transfusion

Possible splenectomy

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19
Q

Sickle cell anemia crisis (vasoocclusive crisis)

Goals of tx (how we do that 3)

A

Prevent vaso-occlusive episodes and infection

Childhood vaccines

Aggressive tx of infection

Adequate hydration/nutrition

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20
Q

Hemophilia

Hereditary or acquired (type)
What is it
Symptoms occure at what age

A

Hereditary (x-linked recessive)
-mother to son transmitted

Symtpoms may not occure until 6 mo old
(not moving around much to show signs)

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21
Q

Types of hemophilia and their deficiency

A

Hemophilia A:
Classic hemophilia (deficiency of factor VIII)

B: deficiency of factor IX

C: deficiency of vWF

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22
Q

Hemophilia s/s 5

A

Active bleeding: epistaxis, bleeding gums, hematuria

Hematomas/bruising even w/ minor injuries

Bleeding in GI tract (black tarry stools/hematemesis)

Hemarthrosis (bleeding into joints spaces
-warmth, pain, bruising, decreased movement

Bleeding after procedure:
Can bleed from mouth (compromise airway)

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23
Q

Hemophilia tx

A

Replacement of missing clotting factors: maintenance and episodic

Desmopressin (DDABP):
-increases factor VIII activity by 2-4 times
(for mild hemophilia)

Transfusion

Corticosteroids, NSAIDS (helps w/ hemarthrosis)
-ice packs, elevate extremity

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24
Q

Hemophilia contraindication tx

A

Passive ROM (may cause more bleeding)

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25
Q

Hemophilia client education

A

Prevent bleeding at home:
-low contact sports (bowling, swimming, golf)
-soft toothbrushes

UTD immunizations

Control bleeding w/ RICE method

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26
Q

Childhood cancer

Difficult to diagnose why

A

Most symptoms can be attributed to other common childhood illnesses

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27
Q

Ped cancer tx goals

A

Remove cancer (sx)

Inhibit growth of rapidly growing cells
(Chemo/rediation)

Replace cancerous bone marrow
(Hematopoietic stem cell transplant/BMT)

28
Q

Chemo therapy

Chemo safety?
What presents many challenges to caregivers?
Metabolized where and excreted where?
Type of access needed?

A

Chemo safety: chemo gloves, flush twice, dispose in proper bin)

Side effects present many challenges

Metabolized in liver, excreted in kidneys

Central venous access: CVC, port

29
Q

Chemo therapy side effects

Bone marrow suppression (when greatest)
3 things it causes

A

7-10 days after chemo greatest suppression

—Anemia: monitor BP/HR/RR/O2
-cluster care, rest periods
—Neutropenia, life threatening:
-aseptic technique, visitor screening
-avoid crowds, public places, daycares
-no live vaccines
—Thrombocytropenia:
-no rectal temps, needle sticks, NSAIDS
-soft tooth brush

30
Q

Chemo side effects (how to combat)

N/V, anorexia
Alteration in bowl elimination

A

N/V, anorexia
-give anti-emetic prior to chemo
-dont offer fav foods during chemo/radiation
-monitor fluids/electrolyte
-aggressive nutrition support (high protien/calorie)
-smaller more freq meals/snacks

Alteration in bowel elimination:
(constimation more likely than diarrhea)
-push PO fluids, IVF if needed
-monitor I/O, DW

31
Q

Chemo side effects

Mucositis and dry mouth
What to do to help this

A

Painful sores, vulnerable to yeast infection

Use straw
Bland soft diet
Mouth runses, peridex, magic mouth wash
Lip lubrication
Soft toothbrush/swaps

32
Q

Chemo side effects

Alopecia

Anaphylactic reaction

A

Alopecia:
-use gentle shampoos
-use cotton hat or scarf
-avoid blow dryers/curling irons

Anaphylactic reaction: to chemo
-have emergency drugs available

33
Q

Chemo side effects

All of them in one flash card (8 groups)

A

Bone marrow suppression:
-anemia, neutropenia, thrombocytopenia

N/V, anorexia

Alteration in bowel elimination (constipation/diarrh)

Mucositis and dry mouth

Alopecia

Anaphylactic reactions

34
Q

Radiation therapy

Ways we use it for
Can be palliative how
How it works and can cause

A

Curative, adjunct, shrink before surgery

Palliative to prevent further growth/decrease pain

Non, selective, kills rapid dividing cells:
-bone growth can be altered
-secondary cancers later (risk)

35
Q

Radiation therapy

Nursing care/client education
Things to do 4
Avoid (3)
Seek med care if (3)

A

Wear lead aprons
Wash markd areas w/ hands and lukewarm water (pat dry)
Wear loose cotton clothing
Keep area protected from sun exposure

Avoid use of soaps, lotions and powders

Seek medical care:
-If blisters, weeping, redness/tenderness

36
Q

Hematopoietic stem cell transplant/ BMT

What needed before stem cell transplant?
Autogolous vs allogenic
How is it administered (migrates where)

A

High does chemo and total body irradiation prior to stem cell transplant

Autogolous: self
Allogenic: someone else

Stem cells given IV (migrates to bone marrow)

37
Q

Hematopoietic stem cell transplant/ BMT

Protectivr isolation?
Prevent infection until when (how long)
Monitor for what (give what)

A

Protextive iso:
-positive pressure room
-limit visitors
-HEPA filters
-PPE
No flowers/potted plants

Prevent infection until marrow engrafts (2-6wks)

Monitor for GVHD (graft vs host disease)
(maculopapular rash, desquamation)
-administer immunosuppressive med

38
Q

Calculation of the absolute neutrophil count (ANC)
ANC under what is at risk for overwhelming infection

A

WBC’s x (segs + bands)

WBC 1.0 (1000) x (7% segs + 7% bands)
1000x14% (0.14) = 140 ANC

ANC lower than 500 is at risk for overwhelming infection

39
Q

Supportive care for ped oncology emergency infection
When to give blood
Also meds for infection

A

Replace blood when:
RBCs Hgb <8
Plt <20,000 or bleeding

Abx, antiviral, antifungals
(to prevent opportunistic infections)

40
Q

Wbcs and plt labs to know

A

Wbcs (5000-1000) (5-10)

Plts (150,000 - 400,000) (150-400)

41
Q

Wilms tumor - nephroblastoma

What is it
Arises from what
Usually only what
Age

A

Solid tumor of the renal parenchyma of kidney

Arises from immature kidney cells

Usually only 1 kidney

2-5y/o

42
Q

Wilms tumor - nephroblastoma

S/s

A

Painless (firm, abdominal swelling/mass)

Fever, fatigue, malaise, wt loss
Heamturia
HTN

43
Q

Wilms tumor - nephroblastoma

Labs/diagnostics

A

-BUN, Creatinine
-Urinalysis
-CBC

Usually:
-Abdomina US
-Abdominal & Chest CT

44
Q

Wilms tumor - nephroblastoma

Avoid
Tx
Post op considerations

A

Avoid palpating abd (cause tumor seeding)

Sx removal of tumor/kidney
-radiation/chemo before and after sx

Avoid contact sports (only have 1 kidney)

1 kidney priotires:
-foley (strict I/O), UOP
-BP (tells us if kidney being perfused)

45
Q

Neuroblastoma

Found exclusively in who
When usually diagnosed

Tumor is often what? Leading to what

A

Found exclusively in infants and children
-diagnosed before age 5

Tumor often silent:
-diagnosed late

46
Q

Patho of Neuroblastoma

Tumor location

Parents notice what

A

Arise from Neural crest cells (usually in SNS)
Cells perliferate and begin to form a tumor/mass

Tumor loacted in adrenal gland of kidney

Parents notice:
-swollen abd/asymmetrical or palpable mass

47
Q

Neuroblastoma

S/s

A

Lump/mass in abd, chest, neck or pelvis
Loss of appetite, vomiting, wt loss, stomach pain
Lymphadenopathy
Pallor, bruising
Facial swelling, orbital edema/bruising

48
Q

Neuroblastoma

Diagnostics

Tx

A

Skeletal survey
CT of skull, neck, chest, abd
Bone marrow aspiration
Tumor biopsy

Tx:
-sx removal
-chemo/radiation

49
Q

Retinoblastoma

Congential. Highly malignant tumor
-Tumor develops where
-S/s

A

Develops on retina

S/s: VISION
-strabismus, vision loss
-white reflection in childs eye instead of red color (leukoria)

50
Q

Retinoblastoma

Diagnostic
Goal
Tx

A

-Physical exam
-Fundoscopic exam under general anesthesia
-CT/MRI
-Lumbar puncture/bone marrow biopsy to determin metastasis

Goal: preserve vision

Tx:
-radiation/chemo/ laser sx/ cryotherapy (combo)
-if advanced (removal of eye)

51
Q

Osteosarcoma

Originates from?
Common in who

A

Bone producing cells which invade the metaphysis (long bone)
-form solid tumor

Common in:
-caucasian adolescent males

52
Q

What 2 things like eachother

A

Lungs & bones

53
Q

Osteosarcoma

S/s

A

Bone pain
Limb, decreased ROM
Swelling

54
Q

Osteosarcoma

Diagnostic

A

-Bone marrow biopsy
-Surgical biopsy
-Xray/CT/MRI
-CT of chest and skeletal survey to observe for metastasis

55
Q

Osteosarcoma

Tx

A

Chemo
Sx excision (limb salvage goal)

Limb amputation necessary in some cases:
(Need prostheses, PT/OT, childlife therapy)

56
Q

Ewing sarcoma

Develops where (highly malignant)

S/s

A

Pelvis/femur

-Intermittent pain (progressively worsens)
-Pain (constanct, severe, interrupts sleep)
-Swelling at site
-Fever, fatigue, wt loss

57
Q

Ewing sarcoma

Diagnostics

Tx

A

Same as osteosarcoma:
-Xray/CT/MRI
-CT chest/skeletal survey for metastasis
-Bone marrow biopsy
-Surgical biopsy

Tx:
-Intense radiation/chemo/surgical excision
-Myeloblative chemo then stem cell transplant

58
Q

Rhabdomyosarcoma

Most common what
Age
Most common in who

A

Most common soft tissue cancer
(head, neck, GU, extremities)

Age: <5y/o

Caucasians

59
Q

Rhabdomyosarcoma

S/s

A

Pain in local areas related to compression by tumor
(Possible absence of pain in some parts of body)(retroperitoneal)

Based on affected area:
CNS
Orbit
Nasopharynx, sinus
Middle ear
Retroperitoneal area
Perineum
Extremity

60
Q

Rhabdomyosarcoma

Diagnostics
Tx

A

-Tumor biopsy
-CT/MRI
-CT of chest/skeletal survey, LP, bone marrow biopsy (determine metastasis)

Tx:
-sx removal
-radiation/chemo before

61
Q

Radiation and chem is used to do what before sx?

A

Shrink tumors

62
Q

Childhood leukemia

Affects what
Peak onset at what age
Affects who most

A

Affect the bone marrow/lymphatic system

Peak onset 2-5y/o

Most common in:
-males
-caucasians/hispanics
-children with trisomy 21
-family hx of leukemia

63
Q

Childhood leukemia

2 groups

Leukemia causes what leading to what
Have alot of s/s when

A

ALL(acute lymphoblastic leukemia)
AML(acute myelogenous leukemia)

Cause increased production of IMMATURE WBCs w/ neoplastic features leading to infilitration of organs and tissues

Alot of s/s when it infiltrates the bone marrow

64
Q

Childhood leukemia

Early s/s

Look like their from other causes

A

Low-grade fever
Pallor, bruising, petechiae
Abd, leg, joint pain
Listlessness, HA
Vomiting, constipation, wt loss

65
Q

Childhood leukemia

Late s/s

A

Pain
Hematuria
Ulcerations in mouth
Enlarged kidneys/testicles
S/s of increased ICP
-(⬆️HC, bulging font, dilated scalp veins)

66
Q

Childhood leukemia

Labs/diagnostics

A

Labs:
-CBC
—low RBC, h&h, PLT, neutrophils
—WBCs (low, normal, high)

Diagnostics:
-bone marrow aspiration/biopsy
-cerebrospinal fluid analysis

67
Q

Childhood leukemia

Tx

A

Chemo (eradicate leukemic cells/restore bone marrow function)

hematopoietic stem cell transplant/BMT (after chemo)

Sanctuary sites: get to sites chemo didnt
-intrathecal chemo (given prophylactically)
-radiation done for CNS, testes involvement

AN305 (17 decks)

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