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Sophomore 1 Test 4 > Hematology, Immunology, and Oncology > Flashcards

Hematology, Immunology, and Oncology Flashcards

1
Q

Hematological Disorders

A
  1. Hemophilia A
  2. Sickle Cell Disease
  3. Iron Deficiency Anemia
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2
Q

Common Medical Treatments for Hematological Disorders

A
  1. Blood Product Transfusion
    • IV PRBCs, platelets, or plasma
    • Requires 2 RN signatures
    • Monitor VS frequently
  2. Supplemental O2
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3
Q

Iron Deficiency Anemia

A

The body does not have enough iron to produce hemoglobin

** Common in 6-20 month year olds, and in adolescents

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4
Q

S/Sx of Iron Deficiency Anemia

A
  1. Irritability
  2. Pica
  3. Spoon-shaped nails
  4. Headache
  5. Weakness
  6. Dizziness
  7. SOB
  8. Pallor
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5
Q

What is a major contributing factor of iron deficiency anemia in young children?

A

Cow’s milk consumption contributes to iron-deficiency anemia in older infants and young children due to its poor iron availability

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6
Q

Iron Deficiency Anemia Treatment

A

Iron Supplements

  1. Vitamin C can increase absorption
  2. Do not administer with cow’s milk
  3. May color stools/urine black
  4. May stain teeth, provide straw
  5. Increase fiber intake
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7
Q

Iron Deficiency Anemia Nursing Management

A
  1. Protect child from injury
  2. Dietary Education
    - Iron fortified infant cereal
    - Avoid fast foods
    - Increase amount of iron rich foods
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8
Q

Sickle Cell Disease

A
  1. Severe chronic blood disorder
  2. Affects 1 in 400 African Americans
  3. Recessive pattern of inheritance
  4. Elongated RBCs with a shorter life span
  5. Sickling triggered by any stress or traumatic event
  6. Sickled cells clump together and prevent normal blood flow to tissues
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9
Q

Sickle Cell Disease Nursing Management

A
  1. First = pulse ox
  2. Prevent infection
  3. Scheduled pain medication
  4. Supplemental oxygen during sickle cell crisis (during a pain crisis these patients are shallow breathers)
  5. IVF
  6. Closely monitor Hgb, Hct, and electrolytes (potassium)
  7. Educate family on early recognition of vaso-occlusive events
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10
Q

Prevention or Early Recognition of Vaso-Occlusive Events

A
  1. Seek immediate attention for ANY febrile illness
  2. Obtain vaccinations and penicillin prophylaxis
  3. Encourage adequate fluid intake daily
  4. Avoid temperatures that are too hot or too cold
  5. Avoid overexertion or stress
  6. Have 24-hour access to physician, nurse practitioner, or facility familiar with sickle cell care
  7. Contact MCP if you suspect pain crisis
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11
Q

For a child with sickle cell disease, seek medical attention immediately if…

A
  1. Child is pale and listless
  2. Abdominal pain
  3. Limp or swollen joints
  4. Cough, shortness of breath, chest pain
  5. Increasing fatigue
  6. Unusual headache, loss of feeling, or sudden weakness
  7. Sudden vision change
  8. Painful erection that won’t go down (priapism)
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12
Q

Hemophilia A

A
  1. X-linked disorder (passed from mother to sons; daughters are carriers)
  2. Factor 8 deficiency leads to inability to activate Factor 10 which means they can’t convert prothrombin to thrombin which leads to the inability of platelets to be used in clot formation
  3. Ranges from mild to severe
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13
Q

Hemophilia Nursing Management

A
  1. Preventing bleeding
  2. Managing a bleeding episode
    - Factor 8 replacement IVP
    - Cold compress
  3. Education
  4. Risk for vitamin D deficiency (because they stay inside so much)
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14
Q

Preventing Bleeding in the Child with Hemophilia

A
  1. Protect toddlers with soft helmets, padding on the knees, carpets in the home, and softened or covered corners
  2. Children should stay active: swimming, baseball, basketball, and bicycling (wearing a helmet) are good physical activities
  3. Avoid intense contact sports
  4. Avoid trampoline use and ATVs
  5. Arrange premedication with Amicar is oral surgery is indicated
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15
Q

Immunological Disorders

A
  1. HIV
  2. Juvenile Idiopathic Arthritis
  3. Allergies/Anaphylaxis
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16
Q

Causes of Infant HIV

A
  1. Perinatal transmission

2. Breastmilk

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17
Q

Causes of Adolescent HIV

A

Nonsterile needles or sexual contact

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18
Q

Infant HIV Diagnostics

A

Polymerase chain reaction (PCR) test to diagnose

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19
Q

Adolescent HIV Diagnostics

A

Platelets and CD4 to diagnose

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20
Q

Is there a cure for HIV

A

No, but survival rates improved with highly active antiretroviral therapy (HAART)
** COMPLIANCE very important

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21
Q

S/Sx of Infant HIV

A
  1. Failure to thrive
  2. Recurrent bacterial infections
  3. Chronic or recurrent diarrhea
  4. Fever
  5. Developmental delay
  6. Prolonged candidiasis
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22
Q

HIV Nursing Management

A
  1. Early recognition and prevention
  2. Promote HAART compliance
  3. Promote nutrition
  4. Provide family education and support
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23
Q

Juvenile Idiopathic Arthritis

A
  1. Autoimmune disorder mainly affecting the joints (pain, redness, warmth, stiffness, and swelling)
  2. Chronic disease (healthy periods with flare ups)
  3. Three types
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24
Q

Three Types of Juvenile Idiopathic Arthritis

A
  1. Pauciarticular (least severe)
  2. Polyarticular
  3. Systemic (severe)
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25
Q

S/Sx of Juvenile Idiopathic Arthritis

A
  1. Fussiness
  2. Withdrawal from play
  3. Limping or guarding
  4. Joint swelling
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26
Q

Juvenile Idiopathic Arthritis Pharmacological Treatment

A
  1. NSAIDs
  2. Corticosteroids
  3. DMARDs
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27
Q

NSAIDs for Juvenile Idiopathic Arthritis

A
  1. With food to decrease GI upset
  2. Monitor liver enzymes and renal function
  3. GI bleeding risk
  4. Do not crush or chew extended release
    * * NSAIDs are helpful with pain relief, but antirheumatic drugs are necessary to prevent disease progression
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28
Q

Corticosteroids for Juvenile Idiopathic Arthritis

A
  1. With food to decrease GI upset
  2. May mask s/sx of infection
  3. Do not stop abruptly, taper over time
  4. Monitor BP
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29
Q

DMARDs for Juvenile Idiopathic Arthritis

A
    • Methotrexate
      1. Do NOT give PO with dairy products
      2. 3-6 weeks to benefit from treatment
      3. IV is photosensitive
      4. Monitor CBC, renal, and liver function
30
Q

Juvenile Idiopathic Arthritis Nursing Management

A
  1. Maintain joint ROM and muscle strength
  2. Adequate pain relief and promoting med compliance
  3. Regular eye exams and vision screenings
  4. Promote sleep (warm bath at bedtime, warm compresses)
  5. Encourage joining local support groups
31
Q

Most Common Food Allergens

A
  1. Milk
  2. Eggs
  3. Peanuts
  4. Tree nuts
  5. Fish and shellfish
  6. Wheat and soy
32
Q

S/Sx of allergic reactions/anaphylaxis

A
  1. Hives, flushing, facial swelling, mouth and throat itching
  2. Vomiting, abdominal pain, and diarrhea
  3. Extreme cases: swelling of the tongue, uvula, pharynx, and upper airway
  4. Wheezing = ominous sign
33
Q

Allergy/Anaphylaxis Education

A
  1. True allergy versus intolerance
  2. Teach child and family to recognize s/sx of allergic reaction
  3. Teach how to avoid allergens hidden in food
34
Q

Allergy/Anaphylaxis Treatment

A
  1. Diphenhydramine

2. Epinephrine for anaphylaxis

35
Q

Nursing Interventions for Anaphylaxis

A
  1. Provide oxygen
  2. Give albuterol if bronchospasms present
  3. Give epi, diphenhydramine and/or corticosteroids as ordered
  4. Give fluids as ordered (increases plasma volume because they are vasodilated)
  5. Educate family on preventing and managing future episodes
  6. Teach family how to use epi pen (warn child if may feel like their heart is racing)
36
Q

Childhood Cancers

A
  1. Leukemia and Lymphoma
  2. Brain tumors
  3. Wilms tumor
37
Q

Origin of Childhood Cancers

A

Usually comes from primitive embryonal and neuroectodermal tissues (leukemia, lymphoma, sarcoma, CNS tumors)

38
Q

Common Medical Treatments for Cancer

A
  1. Biopsy
  2. Surgical removal of tumor
  3. Blood product transfusion - irradiated, leukodepleted, CMV-neg products
  4. Stem cell transplantation (PC is graft vs host disease)
  5. Radiation therapy
  6. Chemotherapy
39
Q

Radiation Therapy

A
  1. Ionizing radiation (high energy x-ray) delivered to cancerous area
  2. Usually given several times a week for several weeks
40
Q

Radiation Therapy Nursing Considerations

A
  1. Do not wash off radiation marking
  2. Keep skin clean and dry
  3. Fatigue is common side effect
  4. Red, dry, peeling skin at site
  5. Adverse effects on organ irradiated
  6. Area will be photosensitive
  7. Can also cause diarrhea
  8. Mucositis, dry mouth, and loss of taste may occur if head or neck radiated
  9. Do not apply deodorants or perfumed lotions on the radiation treatment site
  10. Avoid the use of heat or ice packs at the site
  11. Instruct the child and family that clothing should fit loosely so as not to irritate the site
41
Q

Adverse Effects of Radiation Therapy

A
  1. Fatigue
  2. Nausea
  3. Vomiting
  4. Oral mucositis
  5. Myelosuppression
  6. Alterations in skin integrity
42
Q

Chemotherapy

A
  1. Disrupts the cell cycle of cancer cells and normal rapidly dividing cells
    - Affects bones marrow, GI tract (especially mouth), reproductive system, and hair follicles
43
Q

Chemotherapy Route

A

PO, IV, IM, or IT (intrathecal)

** Must be chemo certified to administer

44
Q

Adverse Effects of Chemotherapy

A
  1. Immunosuppression
  2. Nadir
  3. Infection
45
Q

Nadir

A

Point after chemo when neutrophil count is at its lowest

  • Absolute neutrophil count = 500
  • Neutrophils are important WBC for fighting bacteria
46
Q

Preventing Infection in Children Receiving Chemotherapy for Cancer

A
  1. Practice meticulous hygiene
  2. Avoid known ill contacts, especially persons with chicken pox
  3. Avoid crowded areas
  4. Do not let the child receive live vaccines
  5. Do not take the child’s temperature rectally or give medications by the rectal route
  6. Administer twice-daily trimethoprim-sulfamethoxazole for 3 consecutive days each week as ordered for prevention of pneumonia
47
Q

Myelosuppression

A

Bone marrow suppression

  • Risk for infection (neutropenia)
  • Hemorrhage and anemia (thrombocytopenia)
  • Platelet count less than 20,000 cmm needs transfusion
48
Q

Nursing Management of N/V during Chemotherapy

A
  1. Ondansetron prior to chemo and around the clock for 1-2 days
  2. Strict I/O
  3. Small, frequent meals
  4. Daily weights
49
Q

Nursing Management of Oral Mucositis During Chemotherapy

A
  1. Bland, soft diet
  2. Soft toothette for oral care
  3. Mouth rinses
50
Q

Nursing Management of Pain During Chemotherapy

A
  1. Distraction
  2. EMLA cream for procedures
  3. Narcotics for acute, severe pain or chronic pain
  4. IV, PO, patches, epidural or PCA pumps
51
Q

Neutropenic Precautions

A
  1. VS Q4h
  2. No raw fruits and vegetables
  3. No fresh flowers or live plants
  4. Place mask on child when he/she is leaving room
  5. Do not take rectal temperatures or give medications rectal route
  6. No urinary catheters
  7. No live vaccines (MMR and varicella)
52
Q

Family Education for Children with Cancer

A
  1. Keep a calendar of all appt. times, lab draw days, important phone numbers
  2. Seek medical care immediately for temp 38.3 (101) or higher
  3. Call oncologist or seek medical care for
    • Rapid breathing
    • Increased bruising
    • Earache, sore throat, nuchal rigidity
    • Carefully monitor central venous catheter site
53
Q

Leukemia

A
  • The growth of lymphoblasts is excessive and the abnormal cells replace the normal cells in the bone marrow
  • The bone marrow becomes unable to maintain normal levels of RBCs, WBCs, and platelets, so anemia, neutropenia, and thrombocytopenia result
54
Q

Leukemia Diagnostics

A
  1. WBC
  2. Peripheral smear
  3. Bone marrow aspiration
55
Q

Leukemia Prognosis

A

Curable BUT can relapse and hard to cure advanced stages

56
Q

Leukemia Treatment

A

Chemotherapy

57
Q

S/Sx of Leukemia

A
  1. Fever
  2. Fatigue
  3. Weight loss
  4. Pallor
  5. Bruising
    IF IT SPREADS…
  6. Bone pain
  7. Lymphedema
  8. Hepatosplenomegaly
58
Q

Lymphoma

A

Tumors of the lymph tissue

- Lymph nodes, spleen, tonsils, and thymus are affected

59
Q

Lymphoma Prognosis

A

Prognosis depends on stage and class of the disease

60
Q

Lymphoma Diagnostics

A

Biopsy or tissue sampling

61
Q

Lymphoma Treatment

A
  1. Chemotherapy

2. Possible stem cell transplant and radiation

62
Q

S/Sx of Lymphoma

A
  1. Weight loss
  2. Fever
  3. Night sweats
  4. Fatigue
  5. Enlarged lymph nodes
63
Q

Brain Tumor Prognosis

A

Depends on location, size, and invasiveness

64
Q

Brain Tumor Diagnostics

A
  1. CT
  2. MRI
  3. PET
65
Q

Brain Tumor Treatment

A
  1. Surgical removal
  2. Chemotherapy
  3. VP shunt for fluid buildup (hydrocephalus)
66
Q

S/Sx of Brain Tumors

A
  1. N/V
  2. Morning headache
  3. Unsteady gait
  4. Changes in vision
  5. Seizures
  6. Changes in behavior/personality
67
Q

Brain Tumor Nursing Considerations

A
  1. Goat is to treat increased ICP and prevent increased ICP
  2. Give dexamethasone for inflammation
  3. Give stool softener
  4. Regulate fluid intake
  5. Minimize environmental stimuli
  6. Shave head prior to surgery
  7. Post op keep child on NON operative side
  8. HOB elevation promotes drainage
68
Q

Wilms Tumor/Nephroblastoma

A

Solid tumor of the kidney

  • Rapid growth, usually large at diagnosis
  • Spreads to liver, diaphragm, lungs, abdominal muscles, and lymph nodes
69
Q

Wilms Tumor Diagnostics

A
  1. Renal/abdominal US
  2. CT
  3. MRI
70
Q

Wilms Tumor Treatment

A
  1. Surgery (nephrectomy)
  2. Chemo
  3. Radiation
71
Q

S/Sx of Wilms Tumor

A
  1. Abdominal mass to one side
  2. Abdominal pain
  3. Constipation
  4. Vomiting
  5. Anorexia
  6. HTN
72
Q

Wilms Tumor Nursing Considerations

A

Avoid palpating the abdomen after the initial assessment preoperatively. Wilms tumor is highly vascular and soft, so excessive handling of the tumor may result in tumor seeding and metastasis.

Sophomore 1 Test 4 (4 decks)

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