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Peds > Hem/Onc > Flashcards

Hem/Onc Flashcards

1
Q

Types of hemoglobin

A

Hgb F- until 6 months
Hgb A- adult
Hgb A2- subtype of hgb a

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2
Q

How does hematopoiesis differ from infants and adults

A

Infants: all bones involved
Adulthood: only flat bones

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3
Q

3 types of cells found in blood

A

Erythrocyte (RBCs)- transport nutrients/oxygen to the tissue and carry waste away from tissue
Thrombocytes (platelets)- clotting
Leukocytes (WBCs)- fight infection

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4
Q

Iron sources

A

Newborn: maternal stores
Infants: milk or iron fortified formula
Adolescence: physiologic anemia

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5
Q

Who is at increased risk of anemia

A

Pre-term infants
2-6 months of age=physiologic anemia
(increased growth + increased blood volume + decrease in maternal iron stores = anemia)
Adolescence: increased time of growth

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6
Q

Role of the spleen

A

Production and destruction of RBCs
Stores platelets

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7
Q

Clinical manifestations of iron-deficiency anemia

A

Fatigue, lethargy
Pallor of oral mucosa
Nail spooning
Tachycardia
Splenomegaly
Decrease hgb, hct, serum Fe, ferritin levels

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8
Q

Nursing management of iron-deficiency anemia

A

Dietary intervention
Promote safety
Iron supplementation
Education

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9
Q

Sickle Cell Anemia

A

Autosomal recessive dz where hemoglobin SS partially or completely replaces normal hemoglobin
Found predominantly in AA

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10
Q

Vaso-occlusive Crisis

A

Acute pain crisis
Occurs when stasis of blood causes tissue hypoxia leading to ischemia and possible infarction
Severity dependent on the site of the occlusion
Symptoms of VOC include: pain, fever, tissue engorgement, joint swelling, and tachycardia
Pain in joints, hands, feet, abdomen
Enuresis common

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11
Q

Sickle cell dz progression

A

Decreased oxygen –> Hemoglobin S sickles –>
cells become rigid –> obstruct capillary blood flow –>
congestion of blood –> tissue hypoxia –>
additional sickling –> extensive infarctions –>
vaso-occlusion

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12
Q

What is splenic sequestration in sickle cell crises

A

When blood pools in the spleen
Profound anemia, hypovolemia, and shock, splenomegaly

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13
Q

What is acute chest syndrome in sickle cell crises

A

Clumping of the sickle cells in the lungs
Leads to hypoxia
Hypoxia = further sickling

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14
Q

What is aplastic crisis in sickle cell crisis

A

Increased destruction of fragile RBCs
Leads to temporary cessation of RBC production

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15
Q

Treatment of sickle cell anemia

A

Bone marrow transplant (only cure- not done very often)
Blood transfusion
Hydroxyurea
New biologics

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16
Q

Nursing management of sickle cell anemia

A

Full physical assessment
Lab tests include: hgb/hct, platelet count, ESR
Education
Pain management:
-analgesics (NSAIDS, acetaminophen, narcotics)
-distraction, relaxation
-oxygen, if hypoxia present
-fluids (po, IV)
-heat packs, ice packs

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17
Q

What is B-thalassemia Major

A

Disorder of hemoglobin synthesis
Autosomal recessive
Most common in mediterranean, African, Asian, and Middle Eastern descent
Increased bone marrow with thinning of bony cortex

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18
Q

Manifestations of B-thalassemia

A

Failure to thrive
Pallor and/or jaundice
Severe anemia
Hemosiderosis
Hepatosplenomegaly
Bone deformities- frontal and maxillary bone bossing

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19
Q

B-thalassemia treatment

A

Chronic transfusion tx
Chelation therapy
Splenectomy
Education

20
Q

What is disseminated intravascular coagulopathy (DIC)

A

Acquired process involving abnormal activation of body’s thrombin mechanism and fibrinolytic system
Secondary illness
Severe and life-threatening

21
Q

DIC dz process

A

increased uncontrolled bleeding –>
anemia from excess bleeding –>
organ damage –>
tissue hypoxia and necrosis

22
Q

Precipitating factors of DIC

A

Cancer
Hypoxia
Burns
Traums
Sepsis
Shock
Liver dz
NEC

23
Q

Assessment for DIC

A

Excessive bruising
Petechiae
Hematuria
Oozing injection sites
Mild GI bleeding

24
Q

DIC management

A

Constant assessment especially circulation and neurologic status
Administer clotting factors, platelets
Administer anti-coagulation therapy
Apply pressure and elevate if possible areas of acute bleeding

25
Q

What is idiopathic thrombocytopenia purpura (ITP)

A

Immune response- produces anti-platelet antibodies
Typically secondary to viral infection
Neonatal d/t maternal platelet issues, placental insufficiency & fetal hypoxia
Symptoms: petechiae, ecchymoses, purpura
Platelets less than 50,000
Typically acute but can become chronic

26
Q

ITP management

A

Observe and document
Reassurance
Education: avoid trauma; avoid aspirin, NSAIDs, and antihistamines
Severe cases: corticosteroids IVIG
Chronic cases: splenectomy

27
Q

What is hemophillia

A

Group of chronic hereditary bleeding disorders
Deficiency of a specific blood clotting factors

28
Q

Symptoms of hemophillia

A

Easy bruising
Prolonged bleeding from wounds
Epistaxis
Hemarthrosis

29
Q

3 main types of hemophillia

A

A (classic- 80%)- Factor VIII
B (Christmas dz)- Factor IX
von Willebrand dz- factor vWF

30
Q

Complications of hemophilia

A

Intracranial bleeding
GI hemorrhage
Shock
Death

31
Q

Hemophilia management

A

Prevent bleeding
NO contact sports
Avoid aspirin & NSAID’s
Education
Factor replacement: VIII or IX concentrate
Desmopressin
Support

32
Q

What is a neuroblastoma

A

Abnormal proliferation of neuroblast in the sympathetic nervous system
Most common outside of cranium
Solid tumor
Usual onset ~22 months of age
Unknown cause
Typically a late diagnosis
Prognosis based on staging of tumor, location of tumor and location of metastasis

33
Q

Neuroblastoma symptoms

A

Abdominal fullness
Fatigue and fever
Weight loss
Bowel and bladder dysfunction
Neurological symptoms
Dyspnea
Limp
Malaise

34
Q

Neuroblastoma management

A

Biopsy & surgical resection
Chemotherapy
Emotional support family and child
Radiation
Palliation

35
Q

What is leukemia

A

Cancer of blood-forming tissue
Issue is with the immature and/or abnormal WBCs
Most common malignancy of childhood
ALL (acute lymphoblastic) & AML (acute myelogenous)
Majority of cases are now curable

36
Q

Leukemia dz process

A

Bone marrow infiltration of immature WBCs –>
Crowds out stem cells –>
Anemia, thrombocytopenia, immature ineffective WBCs/neutropenia

37
Q

What is ALL

A

Unrestrictive proliferation of immature lymphocytes (WBCs)
Classification is based on type of WBC that becomes neoplastic and immaturity of neoplastic cell
Cure rate = greater than 70%
Peak age of 4 years
Exact cause unknown

38
Q

What is AML

A

Arrest of bone marrow cells resulting in the proliferation of immature granulocytes (WBCs)
Classification: french-american-british classification
Cure rate = about 50%
Peak age is adolescence
Exact cause is unknown

39
Q

ALL symptoms

A

Fatigue
Pallor
Petechiae
Bleeding (bruising)
Fever
Lymphadenopathy
Hepatosplenomegaly
Weight loss
Bone pain/ abd pain
HA
N/V
Papilledema

40
Q

AML Symptoms

A

Fatigue
Pallor
Petechiae
Bleeding (bruising)
Fever
Lymphadenopathy
Hepatosplenomegaly

41
Q

Leukemia management

A

Corticosteroids
Chemotherapy
Platelet transfusions
Prevent & manage complications
Pain management
Emotional support of family and child

42
Q

WILMS tumor

A

Nephroblastoma-intrarenal cancer
Usually unilateral
Peak incidence 2-4 yrs of age
Cause unknown
Survival = about 90%
Prognosis dependent on staging and metastasis
Usually asyptomatic
May have: abd pain, hematuria, hypertension, fever

43
Q

WILMS tumor management

A

Nephrectomy
Chemotherapy
Radiation
Emotional support

44
Q

Osteosarcoma

A

Most common bone cancer
Arises from osteoblasts
Peak incidence = puberty
Metastasis to lungs
Main symptoms is pain/swelling
Metaphysic of long bone

45
Q

Osteosarcoma management

A

Surgical removal of tumor
Chemotherapy
Limb sparing surgery
Emotional support

46
Q

Rhabdomyosarcoma

A

Soft tissue tumor
Very fast growing
Peak incidecne = 2-5 yrs of age
Prognosis based on staging
Metastasis is common to lung, bone, and CNS
Survival rate = 39% if metastasized
Symptoms if present based on tumor location

47
Q

Rhabdomyosarcoma managment

A

Radiation
Surgery & biopsy
Chemotherapy
Emotional support

Peds (14 decks)

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