Hematology and Oncology Objective Flashcards
4 major causes of Anemia
- Increased demand required for rapid growth in infancy
Inadequate iron stores at birth
Mother iron deficient, premature infants - Insufficient iron intake
Excessive milk intake
Lack of iron-fortified formula/food - Blood loss
Acute or chronic - Decreased iron absorption
IBD, Crohns, Ulcerative Colitis
How to assess for Anemia
Development?
History?
Development:
Failure to Thrive
History:
Frequent bleeding
Frequent infections
Energy and activity levels
Food Intake
Laboratory findings Anemia
Routine screening when?
What blood test?
What is Reticulocyte Count?
What is ferratin?
Routine screening: 1year
CBC with differential
Hemoglobin electrophoresis
Reticulocyte Count
-Immature RBCs
Ferritin
-Protein that stores iron
Indirectly measures iron
Anemia: Clinical Manifestations
severe and acute
6
TT-PP-WS
Tachypnea
Tachycardia
Pallor
Prolonged capillary refill
Weak pulses
Systolic heart murmur
Anemia: Clinical Manifestations
chronic
PJDF
Pallor
Jaundice
Delayed growth
Fatigue
Anemia Treatment
What kind of diet and supplement?
Treat underlying cause
Iron-rich diet
Oral iron supplements
Transfusions
Steps before giving a blood transfusion
Informed consent
two RNs verify blood product prior to administration
Administer within 30 minutes of delivery
Filter tubing
Slower infusion rate the first 15 minutes
Max infusion time over 4 hours
Vitals at baseline, at 15 minutes, then per institution policy
Blood Transfusion Considerations
Client’s religious or cultural background
Monitoring for adverse reaction during or after transfusion
Fever
Chills
Change in vital signs from baseline
Pruritus
Dyspnea
Pain
Decreased level of consciousness
Sickle Cell Disease
What kind of disorder?
25% chance of what?
50% chance of what?
characterized by what?
Autosomal recessive inherited blood disorder
25% chance will inherit two genes for sickle cell or two genes for Hemoglobin A
50% chance will inherit one gene for sickle cell and one normal gene, carrier state
Sickle Cell Trait
Characterized by the formation of long chains of hemoglobin when deoxygenated
Diagnosis of sickle cell
2
Newborn screening
Hemoglobin electrophoresis
Ethnicity of sickle cell
Affects approximately 100,000 Americans
*1 in 365 Black or African-American births
*1 in 16,300 Hispanic-American births
*1 in 13 Black or African-American births are BORN with Sickle Cell Trait
RBC Comparison
Normal? lifespan?
Sickle cell? lifespan?
Normal
-Soft, biconcave
-Lifespan: 120 days
Sickle cell
-RBC polymerize, forming stiff rods
-Lifespan: 20 days or less
Sickle Cell Disease:
Acute Complications
Acute Pain Episodes
Acute Chest Syndrome
Infection
Acute Anemia
Sickle Cell Disease: Acute Pain Episodes
Diagnosis?
Most common acute complication
Recurrent vaso-occlusion with ischemia
Diagnosis
Standard criteria: client’s reported pain
sickle cell management for pain
3
IV opioids: morphine, hydromorphone
(NSAID): ibuprofen or ketorolac
Warm compress, massage
Sickle Cell Disease:
Acute Chest Syndrome symptoms?
Causes?
Pulmonary vascular vaso-occlusion
New infiltrate on chest imaging
Plus 2 of the following
*Chest pain
*Decreased oxygen saturation
*Tachypnea
*Fever
Infection
Acute pain episode
Acute Chest Syndrome: Management
Frequent assessment
Chest imaging
Oxygenation
IV Fluids
Antibiotics
Analgesia (NSAIDs & Opioids)
Blood transfusion if indicated
Blood cultures
CBCD
Reticulocyte count
Incentive spirometry
Sickle Cell Disease: Infection
Risk for what?
Spleen?
Hypoxic environment leads to what?
Bacteria?
Risk for pneumonia, sepsis, and osteomyelitis!!!
*Spleen infarction
(Spleen plays a role in preventing infection)
*Hypoxic environment leads to spleen infarction during the first 6-12 months of life
*Unable to produce specific immunoglobulin antibodies to certain bacteria
*Streptococcus pneumoniae
Sickle cell disease: Chronic Management
IMMUNIZATIONS 3
Pneumococcal
Meningococcal
Haemophilus influenzae type B (Hib)
Sickle cell disease: Chronic Management
PENICILLIN PROPHYLAXIS
give to who?
All children with SCD from 2 months to 5 years of age
Daily dose
Sickle cell disease: Chronic Management
HYDROXYUREA
Increases what?
Decreases risk for what?
Increases hemoglobin F
Hemoglobin F reduces Hemoglobin S polymerization
Decrease risk for:
ACS
Acute pain
Sickle cell disease: Chronic Management
LIFESTYLE MODIFICATIONS
avoid what? 3
Dehydration
Cold temperatures
High altitudes
Racism towards Sickle Cell Disease
Marginalized and dismissed while seeking medical care for life threatening complications
Stigmatized as drug-seeking and exaggerating their pain
Inadequate treatment and increased suffering
Often avoid medical care because of the perceived racial stigma
Hemophilia
X-linked genetic disorder
Characterized by a deficiency or absence of clotting factors
Prolonged bleeding
Hemophilia A
What deficiency?
Treat with what?
Factor VIII (8) deficiency
Treat with recombinant factor 8 and desmopressin
Synthetic vasopressin analog that increases plasma F VIII and von Willebrand factor levels
hemophilia B
What deficiency?
Treat with what?
Factor IX (9) deficiency
Treat with recombinant factor IX and desmopressin
Hemophilia: Clinical Manifestations
Bleeding
With or without trauma
Common sites:
*Joint
*Muscle
*Mouth
*GI sites
*Hematuria
Hemophilia: Nursing Care
Prevention and Treatment
Prophylaxis factor (VIII or IX) administration
Home administration
Hold pressure after all punctures
Avoid contact sports
Hemophilia: Nursing Care
Interventions
Stop the bleeding
RICE (rest, ice, compress, elevate)
Give early treatment
*Never delay factor administration
Absolute Neutrophil count (ANC)
High risk?
Moderate risk?
Low risk?
high risk: ANC is less than 500
moderate risk: if ANC is 500-1,000
low risk: ANC is more than 1,000
Leukemia
Normal production of other blood cells is then blocked due to lack of space and nutrients
*Results in anemia, thrombocytopenia
*Reduced mature WBC: Infection
*Reduced Platelets: Bruising, bleeding
*Reduced RBC: low oxygen
saturation, fatigue, anemia
Leukemia: Clinical Presentation
Abnormal CBC
Bruising
Petechiae
Fatigue
Pallor
Anemia
Weight loss
Lymphadenopathy
Bone pain
Unexplained fever
Acute Lymphoblastic Leukemia (ALL)
Most common
Differentiation abnormalities in the lymphoid cell lineage
Peak onset: 2-5 years
Acute Myelogenous Leukemia (AML)
Peak onset?
Differentiation abnormalities in the myeloid cell lineage
Peak onset: 1st year of life
Leukemia diagnosis?
Leukemia treatment?
Bone marrow aspirate
Lumbar puncture
Chemotherapy
Stem cell transplant if initial treatment unsuccessful
Non-Hodgkin Lymphoma
Common in who?
Diagnosis?
Symptoms?
Treatment?
Common in children less than 10 years old
Diagnosis
*Biopsy
Symptoms
*Fever, weight loss, night sweats
Treatment
*Chemotherapy
*Radiation not routine
Hodgkin Lymphoma
Common in who?
Diagnosis?
Symptoms?
Treatment?
Common in 15-19 years old
Diagnosis
*Biopsy: Reed-Sternberg Cells
Symptoms
*Painless, enlarged lymph node
*Non-specific symptoms
Treatment
*Chemotherapy
*Radiation
Wilm’s tumor
Symptoms?
Treatment?
Avoid doing what and why?
Clinical Manifestations
*Asymptomatic abdominal mass
*Malaise, hematuria, and hypertension
Treatment
*Surgery
*Chemotherapy
*Radiation
*Avoid palpating the abdomen. Wilm’s tumor is often encapsulated and palpating the abdomen could cause the tumor to rupture and spread cancer cells.
Explain cancer treatment modalities and complications of treatment
most common protozoal infection in immunosuppressed children?
Fever is a what?
Avoid what?
No what?
Definition: ANC < 500/mm3
Severe infection risk
Pneumocystis jiroveci pneumonia (PCP): most common protozoal infection in immunosuppressed children
*Prophylaxis: trimethoprim-sulfamethoxazole (Bactrim):
*Fever is a medical emergency
*Avoid large crowds
*Hand hygiene
*No fresh flowers
Complications of cancer treatment
Mucositis/Esophagitis and Treatment?
What kind of diet?
Altered Body Image?
Steroid Effects?
Long-term Effects?
Mucositis/Esophagitis
*Inflammation/ulceration of mucous membranes of oral cavity/esophagus
Treatment:
*Oral hygiene
*Avoid acidic food/drinks
Nausea/Vomiting
*Poor control leads to dehydration, electrolyte imbalance, weight loss, psychological stress
*Anti-emetics scheduled or as needed
*Ondansetron (Zofran)
*Promethazine (Phenergan)
*Lorazepam (Ativan)
*Altered Nutrition
*High calorie diet
*TPN/IL
Altered Body Image
*Alopecia
*Altered growth
*Delayed sexual maturation
Steroid Effects
*Cushingoid appearance, facial swelling
*Behavioral changes
Long-term Effects
*Family dynamics
*Risk for relapse
Discuss how the social determinants of health affect pediatric oncology clients
How do Social determinants of health affect pediatric oncology patients? 5
Health insurance
Geography
Transportation
Time
Cost
