Final Exam Stuff Idk

Question 1

management of clubfoot

Answer 1

Starts with weekly manipulation with serial casting, then casting every 2 weeks. Some infants require corrective shoes or bracing. Surgical release of soft tissue may be necessary in some infants - foot is immobilized in a cast for up to 12 weeks after surgery. Ankle-foot Orthoses (AFOs)/corrective shoes used for several years
Teach parents to look for redness, cool toes, skin integrity, etc

Question 2

duchenne muscular dystrophy

Answer 2

short life expectancy
can live into 30s now
x linked so mostly males affected
First affects hips, thighs, pelvis & shoulders but progresses to cardiac and respiratory muscles (causing short life expectancy)
Late walkers, enlarged calves as toddlers, clumsy in preschool years***. School-age children walk on their toes or the balls of the feet with a waddling gait

Question 3

long term effects of HSTC

Answer 3

impaired growth and fertility related to endocrine dysfunction
developmental delay
cataracts
pulmonary/cardiac disease
avascular necrosis of bone
development of secondary cancers.

Question 4

nursing management of ALL

Answer 4

Focus is on managing complications such as infection, pain, anemia, bleeding, hyperuricemia and other adverse effects of treatment. May require blood transfusions. Reducing pain is also a major focus as child has pain due to both disease and treatment - most commonly experience pain of the head, neck, legs and abdomen

Question 5

AML

Answer 5

more resistant to treatment so they need more intense bone marrow suppression and prolonged hospitalization
toxicity from treatment is more common and serious
prolonged chemo after remission, HSTC often required

Question 6

nursing management of AML

Answer 6

health history, common signs and symptoms such as recurrent infections, fever & fatigue. Note skin pallor and salmon-colored or blue-gray papular lesions. Palpate skin for rubbery nodules, lymphadenopathy. Note headache, visual disturbance, signs of ICP such as vomiting indicating CNS involvement and possible brain metastasis

Question 7

nursing management of AML

Answer 7

similar to child with ALL. Focus is on managing adverse effects of treatment and prevention of infection

Question 8

nursing assessment of hodgkins

Answer 8

Explore symptoms of disease including recent weight loss, fever, drenching night sweats, anorexia, malaise, fatigue, or pruritus. Evaluate respiratory status, as the mediastinal mass can compromise respiration. Palpate lymph nodes, hepatomegaly & splenomegaly

Question 9

remission of non-hodgkins

Answer 9

induced with chemotherapy and followed with a 2 year maintenance phase of chemo. CNS prophylaxis is used as can easily spread to CNS system
autologous HSCT may be used

Question 10

neuroblastoma

Answer 10

a tumor that arises from embryonic neural crest cells and is the most common extracranial tumor in children.
In a very complicated spot, cant remove it, covered by nerve endings or blood vessels/spinal cord, need to do chemo first to shrink it then get rid of it
Most frequently is found in the abdomen, mainly adrenal glands, but can occur anywhere along the paravertebral sympathetic chain in the chest or retroperitoneum
When diagnosed past infancy/early toddlerhood, usually has already metastasized. (past like 1yr)

Question 11

assessment of neuroblastoma

Answer 11

Health history, signs and symptoms will depend on location of primary tumor and metastasis. The parents may notice a swollen or asymmetric abdomen. Note any bowel or bladder dysfunction, especially watery diarrhea, neurologic symptoms (brain metastasis), bone pain (bone metastasis), anorexia, vomiting, or weight loss

Question 12

physical exam of neuroblastoma

Answer 12

Note neck or facial swelling, bruising above eyes, or edema around the eyes (due to metastasis to skull bones). Inspect skin for pallor or bruising (bone marrow metastasis) and document any cough or difficulty breathing. Auscultate lungs for wheezing. Palpate for lymphadenopathy, abdomen for firm and nontender masses. Note if hepatomegaly or splenomegaly present

Question 13

nursing management of neuroblastoma

Answer 13

Postoperative nursing care depends on site of tumor removal, usually abdomen. Provide routine care after abdominal surgery.
Care of chemotherapy and radiation side effects
Provide emotional support to child and families, provide referrals for resources to help with coping - usually, tumor is found after metastasis leading to poor prognosis

Question 14

ewing sarcoma

Answer 14

highly malignant tumor that is more rare and occurs most frequently in the pelvis or femur. 25% of children will show metastasis to the lungs, bone and bone marrow and prognosis is dependent on metastasis. Usually treated with chemotherapy, Radiation, and surgical excision in combination. May receive myeloablative chemo that kills bone marrow so child can get a stem cell transplant

Question 15

nursing assessment of ewing sarcoma

Answer 15

Look into history for intermittent pain that progressively worsens, note history of fever and if pain eventually becomes so severe it interferes with sleep.
Ask “when they ______, does it awaken them from sleep?) could be growing pains but requires further evaluation

Question 16

nursing management of ewing sarcoma

Answer 16

Before treatment, discourage active play or weight bearing on affected extremity to avoid pathologic fracture at the tumor site. Focus is on addressing adverse effects of treatment. Be open and honest with child, long treatment and hospital course - help child work through psychological impact of diagnosis

Question 17

wilms tumor

Answer 17

renal tumor, usually occurs between the ages of 2 to 5 years old. Generally is unilateral but can affect both kidneys. Wilms tumor grows rapidly and is usually very large by time it is diagnosed.
Metastasis most often is to perirenal tissue, liver, diaphragm, lungs, abdominal tissue, and lymph nodes. Prognosis depends on staging, extent of metastasis - survival in stages 1 & 2 is 91%.

Question 18

complications of wilms tumor

Answer 18

metastasis or complications from radiation such as liver or renal damage, female sterility, bowel obstruction, pneumonia, or scoliosis

Question 19

treatment of wilms tumor

Answer 19

surgical removal of affected kidney (nephrectomy) with chemotherapy and radiation before and after surgery

Question 20

nursing assessment of wilms tumor

Answer 20

Health history, parents usually notice abdominal mass and then seek medical attention. Note abdominal pain, usually related to rapid tumor growth. Document history of constipation, vomiting, anorexia, weight loss, or family history of cancer. Often associated with several congenital abnormalities and syndromes