Heme part 1 Flashcards
An x-linked recessive disorder transmitted by females and predominantly found in male offsprings
Haemophilia, in this disease, a group of bleeding disorders characterized by a deficiency in a blood clotting factor
Cara just delivered a baby that has excessive bleeding from the umbilical cord after it is cut. What disease do you think this newborn has?
Haemophilia. The nurse should also assess for bruising, nose bleeds, deep internal bleeding, and joint damage.
Haemophilia mangement includes:
meds (Factor VIII, Advate for Factor XI), DDAVP (increases the level of factor VIII), medic-alert bracelet, injury prevention, reg. dental diet, and no aspirin or aspiring like meds
Scotty, a 6 year old was recently diagnosed with Hemophilia. As his nurse, what are you going to educate mom about?
ANY head trauma= factor infusion, bleeding episodes need immediate attention, limitation in sports but encourage reg. exercise, make sure child wears medic-alert bracelet, and no aspirin or aspirin-like meds
Peety Pablo comes into the ED complaining of a headache when he work up, blurry vision and vomiting. He denies nausea though. What could he possible have?
Brain tumor. Patients with brain tumors typically will have a headache when awakening, vomiting without nausea, loss of concentration, change in behavior and vision problems
1 disease related death in children
Cancer
Most common childhood cancer
leukemia
Most common solid tumor
brai
What is the most common presenting symptom of brain tumors
headache on awakening
Pain, fever, weakness, cachexia, anemia, persisten vomiting, headache, infection, and bruising are all what?
Clinical presentations of brain tumors
In an assessment of a infant with a brain tumor, what might you find?
widening sutures, increasing frontal occipital circumference, and tense/buldging fontanel
Post op care for brain tumor includes:
observing for increased ICP and seizures, monitor I and O, and appropriate post-op positioning
While monitoring I and O, what are you specifically looking out for?
SIADH and DI
Upon assessment, your patinet has voided a large amount of dilute urine. Since he is post-op brain tumor removal, what might this patient be exhibiting?
Diabetes insipidus caused by a deficiency in antidiuretic hormon. When ADH is inadequate, the renal tubules do not absorb water, leading to polyuria
Most postop clients with infratentorial (lower portion of back of the head) tumors are prescribed to:
lie flat or turn to either side
T or F, a large tumor may require that the child not be turned to the operative side
TRUE
Suctioning, coughing, and straining can all cause :
increased ICP
Malignant, encapsulated renal tumor
Wilm’s Tumor- usually affects young, preschoolers
Clinical manifestations of Wilm’s tumor include:
abdominal mass in flank area, confided to midline (usually discovered by parents), fever, pallor, lethargy, ^ BP (excess renin secretion)
You are the nursing caring for 5 year old Billie who has a Wilm’s Tumor. What should you make sure you NEVER do to this patient?
NO abdominal palpation
Most kids with Wilm’s Tumor undergo a nephrectomy, what is included in their post-op care?
Watch for ^ BP, monitor kidney function (I & O, urine specific gravity), maintain NG tube, check for bowel sounds, and support family during chemo and radiation
This form of childhood cancer attacks the developing nerve cells in the adrenal gland
Neuroblastoma also called the “Silent Tumor”
Onset of Neurblastoma
22 months of age
Clinical manifestations of Neuroblastoma
May have weight loss, irritability, and fever.
What is the INSS?
Internation Neuroblastoma Staging System
Stage 1
localized tumor with COMPLETE gross excision (lymph noded may be positive)
Stage 2A
localized tumor with INCOMPLETE gross excision (lymph nodes negative)
Stage 2B
localized tumor WITH OR WITHOUT complete gross excision, with ipsilateral nonadherent lymph noded positive for tumor
Stage 3
unresectable unilateral tumor infiltrating across the midline, with or without regional lymph node involvement; or localized unilateral tumor with contralateral regional lymph node involvement; or midline tumor with bilateral extension by infiltration (unresectable) or by lymph node involvement
Stage 4
any primary tumor with dissemination to distant lymph nodes, bone, bone marrow, liver, skin, and/or other organ (except as defined by 4S)
Stage 4S
localized primary tumor (as defined for stage 1, 2A, or 2B) in infants aged less than one year with dissemination limited to skin, liver, or bone marrow (marrow involvement should be minimal)
Unrestricted proliferation of immature WBCs
Leukemia
Consequences of Leukemia
Anemia ( v RBCS, infection (neutropenia), and bleeding (from thrombocytopenia)
Nursing considerations for Leukemia
prepare pt/family for tests, relieve pain, prevent infection, prevention bleeding, protect the kidneys from uric acid (allopurinol), manage nause and vomiting, and soothe mucosal ulceration
Why are we worried about uric acid in a leukemia patient?
Rapid cell destruction from chemo resutls in a high level of uric acid being excreted during treatment. This can plug the glomeruli and renal tubules, causing loss of kidney function
What do you want to look out for in a patient with neutropenia?
Febrile Neutropenia- watch for temp > 38.3 C (101F). Nurse should be concerned about possible infection.
What are common sites of infection?
Central lines, orla mucosa, and surgical sits. Infections can be bacterial, viral, and fungal
Timmy has leukemia. His parents noticed a he just has not been acting “right”. They bring him into the ED. He has an eleveated temp. What labs might the MD order STAT?
CBC with differentials, blood cultures from all lumens of CVAD and obtain a peripheral specimen
Culture pos. in lumen, but negative in the periphery. What might the course of action be?
Kill bacteria in CVAD with antibiotics, but keep it indwelling.
Culture pos. in both lumen and periphery, what might be the course of action?
Take the CVAD out, because now we are dealing with a systemic infection.
