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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
Hemophilia client education
Prevent bleeding at home: -low contact sports (bowling, swimming, golf) -soft toothbrushes UTD immunizations Control bleeding w/ RICE method
26
Childhood cancer Difficult to diagnose why
Most symptoms can be attributed to other common childhood illnesses
27
Ped cancer tx goals
Remove cancer (sx) Inhibit growth of rapidly growing cells (Chemo/rediation) Replace cancerous bone marrow (Hematopoietic stem cell transplant/BMT)
28
Chemo therapy Chemo safety? What presents many challenges to caregivers? Metabolized where and excreted where? Type of access needed?
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
Chemo therapy side effects Bone marrow suppression (when greatest) 3 things it causes
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
Chemo side effects (how to combat) N/V, anorexia Alteration in bowl elimination
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
Chemo side effects Mucositis and dry mouth What to do to help this
Painful sores, vulnerable to yeast infection Use straw Bland soft diet Mouth runses, peridex, magic mouth wash Lip lubrication Soft toothbrush/swaps
32
Chemo side effects Alopecia Anaphylactic reaction
Alopecia: -use gentle shampoos -use cotton hat or scarf -avoid blow dryers/curling irons Anaphylactic reaction: to chemo -have emergency drugs available
33
Chemo side effects All of them in one flash card (8 groups)
Bone marrow suppression: -anemia, neutropenia, thrombocytopenia N/V, anorexia Alteration in bowel elimination (constipation/diarrh) Mucositis and dry mouth Alopecia Anaphylactic reactions
34
Radiation therapy Ways we use it for Can be palliative how How it works and can cause
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
Radiation therapy Nursing care/client education Things to do 4 Avoid (3) Seek med care if (3)
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
Hematopoietic stem cell transplant/ BMT What needed before stem cell transplant? Autogolous vs allogenic How is it administered (migrates where)
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
Hematopoietic stem cell transplant/ BMT Protectivr isolation? Prevent infection until when (how long) Monitor for what (give what)
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
Calculation of the absolute neutrophil count (ANC) ANC under what is at risk for overwhelming infection
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
Supportive care for ped oncology emergency infection When to give blood Also meds for infection
Replace blood when: RBCs Hgb <8 Plt <20,000 or bleeding Abx, antiviral, antifungals (to prevent opportunistic infections)
40
Wbcs and plt labs to know
Wbcs (5000-1000) (5-10) Plts (150,000 - 400,000) (150-400)
41
Wilms tumor - nephroblastoma What is it Arises from what Usually only what Age
Solid tumor of the renal parenchyma of kidney Arises from immature kidney cells Usually only 1 kidney 2-5y/o
42
Wilms tumor - nephroblastoma S/s
Painless (firm, abdominal swelling/mass) Fever, fatigue, malaise, wt loss Heamturia HTN
43
Wilms tumor - nephroblastoma Labs/diagnostics
-BUN, Creatinine -Urinalysis -CBC Usually: -Abdomina US -Abdominal & Chest CT
44
Wilms tumor - nephroblastoma Avoid Tx Post op considerations
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
Neuroblastoma Found exclusively in who When usually diagnosed Tumor is often what? Leading to what
Found exclusively in infants and children -diagnosed before age 5 Tumor often silent: -diagnosed late
46
Patho of Neuroblastoma Tumor location Parents notice what
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
Neuroblastoma S/s
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
Neuroblastoma Diagnostics Tx
Skeletal survey CT of skull, neck, chest, abd Bone marrow aspiration Tumor biopsy Tx: -sx removal -chemo/radiation
49
Retinoblastoma Congential. Highly malignant tumor -Tumor develops where -S/s
Develops on retina S/s: VISION -strabismus, vision loss -white reflection in childs eye instead of red color (leukoria)
50
Retinoblastoma Diagnostic Goal Tx
-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
Osteosarcoma Originates from? Common in who
Bone producing cells which invade the metaphysis (long bone) -form solid tumor Common in: -caucasian adolescent males
52
What 2 things like eachother
Lungs & bones
53
Osteosarcoma S/s
Bone pain Limb, decreased ROM Swelling
54
Osteosarcoma Diagnostic
-Bone marrow biopsy -Surgical biopsy -Xray/CT/MRI -CT of chest and skeletal survey to observe for metastasis
55
Osteosarcoma Tx
Chemo Sx excision (limb salvage goal) Limb amputation necessary in some cases: (Need prostheses, PT/OT, childlife therapy)
56
Ewing sarcoma Develops where (highly malignant) S/s
Pelvis/femur -Intermittent pain (progressively worsens) -Pain (constanct, severe, interrupts sleep) -Swelling at site -Fever, fatigue, wt loss
57
Ewing sarcoma Diagnostics Tx
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
Rhabdomyosarcoma Most common what Age Most common in who
Most common soft tissue cancer (head, neck, GU, extremities) Age: <5y/o Caucasians
59
Rhabdomyosarcoma S/s
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
Rhabdomyosarcoma Diagnostics Tx
-Tumor biopsy -CT/MRI -CT of chest/skeletal survey, LP, bone marrow biopsy (determine metastasis) Tx: -sx removal -radiation/chemo before
61
Radiation and chem is used to do what before sx?
Shrink tumors
62
Childhood leukemia Affects what Peak onset at what age Affects who most
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
Childhood leukemia 2 groups Leukemia causes what leading to what Have alot of s/s when
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
Childhood leukemia Early s/s *Look like their from other causes*
Low-grade fever Pallor, bruising, petechiae Abd, leg, joint pain Listlessness, HA Vomiting, constipation, wt loss
65
Childhood leukemia Late s/s
Pain Hematuria Ulcerations in mouth Enlarged kidneys/testicles S/s of increased ICP -(⬆️HC, bulging font, dilated scalp veins)
66
Childhood leukemia Labs/diagnostics
Labs: -CBC —low RBC, h&h, PLT, neutrophils —WBCs (low, normal, high) Diagnostics: -bone marrow aspiration/biopsy -cerebrospinal fluid analysis
67
Childhood leukemia Tx
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

N305 (17 decks)

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