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Pediatric Nursing Exam 2 > Hematology and Oncology Objective > Flashcards

Hematology and Oncology Objective Flashcards

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1
Q

4 major causes of Anemia

A
  1. Increased demand required for rapid growth in infancy
    Inadequate iron stores at birth
    Mother iron deficient, premature infants
  2. Insufficient iron intake
    Excessive milk intake
    Lack of iron-fortified formula/food
  3. Blood loss
    Acute or chronic
  4. Decreased iron absorption
    IBD, Crohns, Ulcerative Colitis
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2
Q

How to assess for Anemia

Development?
History?

A

Development:
Failure to Thrive

History:
Frequent bleeding
Frequent infections
Energy and activity levels
Food Intake

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3
Q

Laboratory findings Anemia

Routine screening when?
What blood test?
What is Reticulocyte Count?
What is ferratin?

A

Routine screening: 1year

CBC with differential
Hemoglobin electrophoresis
Reticulocyte Count
-Immature RBCs

Ferritin
-Protein that stores iron
Indirectly measures iron

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4
Q

Anemia: Clinical Manifestations

severe and acute
6

TT-PP-WS

A

Tachypnea
Tachycardia
Pallor
Prolonged capillary refill
Weak pulses
Systolic heart murmur

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5
Q

Anemia: Clinical Manifestations

chronic
PJDF

A

Pallor
Jaundice
Delayed growth
Fatigue

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6
Q

Anemia Treatment

What kind of diet and supplement?

A

Treat underlying cause

Iron-rich diet
Oral iron supplements

Transfusions

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7
Q

Steps before giving a blood transfusion

A

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

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8
Q

Blood Transfusion Considerations

A

Client’s religious or cultural background

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9
Q

Monitoring for adverse reaction during or after transfusion

A

Fever
Chills
Change in vital signs from baseline
Pruritus
Dyspnea
Pain
Decreased level of consciousness

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10
Q

Sickle Cell Disease

What kind of disorder?
25% chance of what?
50% chance of what?
characterized by what?

A

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

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11
Q

Diagnosis of sickle cell
2

A

Newborn screening
Hemoglobin electrophoresis

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12
Q

Ethnicity of sickle cell

A

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

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13
Q

RBC Comparison

Normal? lifespan?
Sickle cell? lifespan?

A

Normal
-Soft, biconcave
-Lifespan: 120 days

Sickle cell
-RBC polymerize, forming stiff rods
-Lifespan: 20 days or less

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14
Q

Sickle Cell Disease:
Acute Complications

A

Acute Pain Episodes
Acute Chest Syndrome
Infection
Acute Anemia

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15
Q

Sickle Cell Disease: Acute Pain Episodes

Diagnosis?

A

Most common acute complication

Recurrent vaso-occlusion with ischemia

Diagnosis
Standard criteria: client’s reported pain

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16
Q

sickle cell management for pain

3

A

IV opioids: morphine, hydromorphone

(NSAID): ibuprofen or ketorolac

Warm compress, massage

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17
Q

Sickle Cell Disease:

Acute Chest Syndrome symptoms?

Causes?

A

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

18
Q

Acute Chest Syndrome: Management

A

Frequent assessment
Chest imaging
Oxygenation
IV Fluids
Antibiotics
Analgesia (NSAIDs & Opioids)
Blood transfusion if indicated
Blood cultures
CBCD
Reticulocyte count
Incentive spirometry

19
Q

Sickle Cell Disease: Infection

Risk for what?
Spleen?
Hypoxic environment leads to what?
Bacteria?

A

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

20
Q

Sickle cell disease: Chronic Management

IMMUNIZATIONS 3

A

Pneumococcal
Meningococcal
Haemophilus influenzae type B (Hib)

21
Q

Sickle cell disease: Chronic Management

PENICILLIN PROPHYLAXIS
give to who?

A

All children with SCD from 2 months to 5 years of age

Daily dose

22
Q

Sickle cell disease: Chronic Management

HYDROXYUREA

Increases what?
Decreases risk for what?

A

Increases hemoglobin F

Hemoglobin F reduces Hemoglobin S polymerization

Decrease risk for:
ACS
Acute pain

23
Q

Sickle cell disease: Chronic Management

LIFESTYLE MODIFICATIONS
avoid what? 3

A

Dehydration
Cold temperatures
High altitudes

24
Q

Racism towards Sickle Cell Disease

A

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

25
Q

Hemophilia

X-linked genetic disorder

A

Characterized by a deficiency or absence of clotting factors

Prolonged bleeding

26
Q

Hemophilia A

What deficiency?
Treat with what?

A

Factor VIII (8) deficiency

Treat with recombinant factor 8 and desmopressin

Synthetic vasopressin analog that increases plasma F VIII and von Willebrand factor levels

27
Q

hemophilia B

What deficiency?
Treat with what?

A

Factor IX (9) deficiency

Treat with recombinant factor IX and desmopressin

28
Q

Hemophilia: Clinical Manifestations

A

Bleeding
With or without trauma

Common sites:
*Joint
*Muscle
*Mouth
*GI sites
*Hematuria

29
Q

Hemophilia: Nursing Care

Prevention and Treatment

A

Prophylaxis factor (VIII or IX) administration

Home administration

Hold pressure after all punctures

Avoid contact sports

30
Q

Hemophilia: Nursing Care

Interventions

A

Stop the bleeding

RICE (rest, ice, compress, elevate)

Give early treatment

*Never delay factor administration

31
Q

Absolute Neutrophil count (ANC)

High risk?
Moderate risk?
Low risk?

A

high risk: ANC is less than 500

moderate risk: if ANC is 500-1,000

low risk: ANC is more than 1,000

32
Q

Leukemia

A

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

33
Q

Leukemia: Clinical Presentation

A

Abnormal CBC
Bruising
Petechiae
Fatigue
Pallor
Anemia
Weight loss
Lymphadenopathy
Bone pain
Unexplained fever

34
Q

Acute Lymphoblastic Leukemia (ALL)

A

Most common

Differentiation abnormalities in the lymphoid cell lineage

Peak onset: 2-5 years

35
Q

Acute Myelogenous Leukemia (AML)
Peak onset?

A

Differentiation abnormalities in the myeloid cell lineage

Peak onset: 1st year of life

36
Q

Leukemia diagnosis?

Leukemia treatment?

A

Bone marrow aspirate
Lumbar puncture

Chemotherapy
Stem cell transplant if initial treatment unsuccessful

37
Q

Non-Hodgkin Lymphoma

Common in who?
Diagnosis?
Symptoms?
Treatment?

A

Common in children less than 10 years old

Diagnosis
*Biopsy

Symptoms
*Fever, weight loss, night sweats

Treatment
*Chemotherapy
*Radiation not routine

38
Q

Hodgkin Lymphoma

Common in who?
Diagnosis?
Symptoms?
Treatment?

A

Common in 15-19 years old

Diagnosis
*Biopsy: Reed-Sternberg Cells

Symptoms
*Painless, enlarged lymph node
*Non-specific symptoms

Treatment
*Chemotherapy
*Radiation

39
Q

Wilm’s tumor

Symptoms?
Treatment?
Avoid doing what and why?

A

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.

40
Q

Explain cancer treatment modalities and complications of treatment

most common protozoal infection in immunosuppressed children?

Fever is a what?
Avoid what?
No what?

A

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

41
Q

Complications of cancer treatment

Mucositis/Esophagitis and Treatment?

What kind of diet?

Altered Body Image?

Steroid Effects?

Long-term Effects?

A

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

42
Q

Discuss how the social determinants of health affect pediatric oncology clients

How do Social determinants of health affect pediatric oncology patients? 5

A

Health insurance
Geography
Transportation
Time
Cost

Pediatric Nursing Exam 2 (4 decks)

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