F HEM-ONC Flashcards
Iron deficiency anemia
What is it?
RF (5)
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)
Iron deficiency anemia
Diagnostics/labs
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
Iron deficiency anemia
S/s
Tachycardia
Pallor
Brittle, spoon shaped fingernails
Fatigue/irritability/muscle weakness
Cravings (non-nutritive substances/PICA/ICE)
Iron deficiency anemia
Nursing management (screen)
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
Iron deficiency anemia
Tx
Premature
Full term
Greater than 1y/o
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
Iron deficiency anemia
Iron supplements (instructions)
How to treat severe anemia
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
Lead poisoning
Where does it come from
Who retains lead more
Screening done when
What it does (labs?)
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
Lead poisoning
S/s not critical
Cognitive impairement
Hyperactivity and inattention/behavioral problems
HA
Fatigue/agitation
Abd pain
Lead poisoning
Critical level s/s
Vomiting
Stupor
Sz
Encephalopathy
Renal damage
Lead poisoning
Consult who?
Tx
Med
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
Sickle cell anemia
Hereditary or acquired
What type
Hereditary, autosomal recessive disorder
if both parents have trait ach kid had 1-4 likelihood of having disease
Patho of sickle cell anemia
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
Prognosis for sickle cell anemia
Is there a cure
Care?
Leading cause of death in young children w/ sickle disease
No cure
Supportive care (prevent sickling episodes)
Bacteria infection (leading cause)
Sickle cell anemia crisis (vasoocclusive crisis)
Precipitating factors
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
Sickle cell anemia crisis (vasoocclusive crisis)
S/s
Severe pain (bones and joints)
Swollen joints, hands, feet
Abd pain
Hematuria
Jaundice (destroys RBCs)
Sickle cell anemia crisis (vasoocclusive crisis)
Complications
Splenic sequestration:
-Excessive pooling of blood within the spleen reducing the circulating volume
-results in HYPOVOLEMIA and SHOCK
Sickle cell anemia crisis (vasoocclusive crisis)
S/s of hypovolemic shock cause by splenic sequestration
Tachycardia
HOTN
Weak/thready pulses
Cold extremities
Pallor
Decreased UOP
Sickle cell anemia crisis (vasoocclusive crisis)
Tx (6)
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
Sickle cell anemia crisis (vasoocclusive crisis)
Goals of tx (how we do that 3)
Prevent vaso-occlusive episodes and infection
Childhood vaccines
Aggressive tx of infection
Adequate hydration/nutrition
Hemophilia
Hereditary or acquired (type)
What is it
Symptoms occure at what age
Hereditary (x-linked recessive)
-mother to son transmitted
Symtpoms may not occure until 6 mo old
(not moving around much to show signs)
Types of hemophilia and their deficiency
Hemophilia A:
Classic hemophilia (deficiency of factor VIII)
B: deficiency of factor IX
C: deficiency of vWF
Hemophilia s/s 5
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)
Hemophilia tx
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
Hemophilia contraindication tx
Passive ROM (may cause more bleeding)
Hemophilia client education
Prevent bleeding at home:
-low contact sports (bowling, swimming, golf)
-soft toothbrushes
UTD immunizations
Control bleeding w/ RICE method
Childhood cancer
Difficult to diagnose why
Most symptoms can be attributed to other common childhood illnesses
Ped cancer tx goals
Remove cancer (sx)
Inhibit growth of rapidly growing cells
(Chemo/rediation)
Replace cancerous bone marrow
(Hematopoietic stem cell transplant/BMT)
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
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
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
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
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
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
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)
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
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)
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
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
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)
Wbcs and plt labs to know
Wbcs (5000-1000) (5-10)
Plts (150,000 - 400,000) (150-400)
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
Wilms tumor - nephroblastoma
S/s
Painless (firm, abdominal swelling/mass)
Fever, fatigue, malaise, wt loss
Heamturia
HTN
Wilms tumor - nephroblastoma
Labs/diagnostics
-BUN, Creatinine
-Urinalysis
-CBC
Usually:
-Abdomina US
-Abdominal & Chest CT
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)
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
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
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
Neuroblastoma
Diagnostics
Tx
Skeletal survey
CT of skull, neck, chest, abd
Bone marrow aspiration
Tumor biopsy
Tx:
-sx removal
-chemo/radiation
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)
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)
Osteosarcoma
Originates from?
Common in who
Bone producing cells which invade the metaphysis (long bone)
-form solid tumor
Common in:
-caucasian adolescent males
What 2 things like eachother
Lungs & bones
Osteosarcoma
S/s
Bone pain
Limb, decreased ROM
Swelling
Osteosarcoma
Diagnostic
-Bone marrow biopsy
-Surgical biopsy
-Xray/CT/MRI
-CT of chest and skeletal survey to observe for metastasis
Osteosarcoma
Tx
Chemo
Sx excision (limb salvage goal)
Limb amputation necessary in some cases:
(Need prostheses, PT/OT, childlife therapy)
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
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
Rhabdomyosarcoma
Most common what
Age
Most common in who
Most common soft tissue cancer
(head, neck, GU, extremities)
Age: <5y/o
Caucasians
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
Rhabdomyosarcoma
Diagnostics
Tx
-Tumor biopsy
-CT/MRI
-CT of chest/skeletal survey, LP, bone marrow biopsy (determine metastasis)
Tx:
-sx removal
-radiation/chemo before
Radiation and chem is used to do what before sx?
Shrink tumors
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
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
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
Childhood leukemia
Late s/s
Pain
Hematuria
Ulcerations in mouth
Enlarged kidneys/testicles
S/s of increased ICP
-(⬆️HC, bulging font, dilated scalp veins)
Childhood leukemia
Labs/diagnostics
Labs:
-CBC
—low RBC, h&h, PLT, neutrophils
—WBCs (low, normal, high)
Diagnostics:
-bone marrow aspiration/biopsy
-cerebrospinal fluid analysis
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
