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Peds Exam III > HemeOnc > Flashcards

HemeOnc Flashcards

1
Q

Cancer Stats

A

Uncommon in general

Most common types:
1) Leukemia - 29%
2) Brain & CNS - 26%
3) Neuroblastoma - 6%

Survival - under 1 yr & over 10 yrs, lower chances, male lower chances
Of the ones we are talking about, ALL has the highest survival rate (same order as above)

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2
Q

What is leukemia?

A

Cancer of the blood - WBCs made in the bone
Bone is hollow in the center & filled with red spongy tissue
Red blood cells being mades, platelets and WBCs
In leukemia, one of these cells (wBCs, RBCs or platelets) starts dividing really rapidly - it’s a leukemia cell, doesn’t carry oxygen, fight off infection or help make bloot clots, it’s just a waste of space, it also leaves little food and room for healthy cells to grow. If it can’t make them, then it can’t supply them. Eventually it leaks out of bones

s/s
decr RBC - fatigue, SOB, pale
decr platelets - prolonged bleeding, easy bruising
decr WBC - freq infections,
weakness, weight loss
leukemia cells grow into wall of bone - bone pain in all bones of the body

Confirm by looking inside the bone marrow w/long needle - bone marrow aspiration

https://www.youtube.com/watch?v=IB3iJUuxt1c

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3
Q

Leukemia tx

A

Chemotherapy

Induction - approx 4 weeks & aim is to kill all leukemia cells, check w/bone marrow aspiration. If it does show only normal cells, we say the pt is in remission. (Remission is NOT a cure)
Consolidation - 2 goals - kill any remaining leukemia cells from induction & second goal is to prevent spread of leukemia into brain. Do this by injecting chemotherapy into CSF (fluid around the brain). And the way we normally give chemo, doesn’t usually penetrate BBB
Maintenance - 2-3 years & same chemo agents as induction but administered as low dose. Goal is prevention of leukemia coming back.

If we know there’s a high risk of leukemia to brain or already has CNS involvement, then we use radiation to the brain (external beam radiation) to kill off leukemia in the brain. We NEVER give this to kids under 5yo bc brain is still growing (think = cognitive & psychological impairment).

Resistant - bone marrow transplant as a last ditch effort. Bone marrow from a donor and we use that to replace pt’s bone marrow.

https://www.youtube.com/watch?v=hH9AETxy6QI

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4
Q

S/s Leukemia

A
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5
Q

Leukemia Workup

A

CBC will give high level of suspicion about leukemia diagnosis

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6
Q

Further Testing for diagnosis and treatment of leukemia

A

Bone marrow biopsy = Definitive dx - because looking for lymphoblasts (immature WBCs)
Lumbar puncture - decide if it has infiltrated CNS - type of chemotherapy (intrathecal chemo if w/CNS involvement)

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7
Q

Leukemia Prognosis

A
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8
Q

What happens when you give chemo to a leukemia patient with a high WBC count?

A

Tumor lysis syndrome _
*
* * Hyperkalemia - heart issues
* Hyperphosphatemia - causes low calcium - tetany, muscle weakness
* Hyperuricemia (uric acid) - kidney & GI issues N/v
* Hypocalcemia -muscle issues

HYDRATE!!!!! - can end up w/acute kidney injury
Allopurinol

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9
Q

Wilm’s Tumor

A
  • grows on or around the kidney -
    removing tumor, chemo or radition
    1. commonly detected by parents @ 2-3 years of age - bathing & feel mass around kidney and liver area
    2. never palplate the abdomen - encapsulated - don’t want them to rupture
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10
Q

Malignant Bone Tumors

A

2 major malignant: osteosarcoma & ewing’s sarcoma
in adolescents - end of long bones close to growth plates
Ewing - femur & pelvis
osteosarcoma - femur & tibia

metastasize into lungs
- coughing
- SOB
- respiratory issues

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11
Q

Symptoms of bone tumors

A

Triad: swelling, (Bone) pain & bone fractures

Chronic inflammatory response: triggers fatigue, fever, weight loss & night sweats
- imflammatory markers SED rate & CRP

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12
Q

Brain tumors

A

most common: IICP
more spec. depending on type/location of tumor

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13
Q

Neuroblastoma

A

Solid tumor anywhere along the sympathetic nervous system chain.
adrenal glands (most common), abdomen, chest but can also pop up in other places.

  1. not brain tumors. solid masses formed from neural cells in embryonic stage. don’t form into full nerve cells
  2. s/s depend on where tumor is. vary widely. tx depends on staging. stages 1-4, stage 4 most advanced.

peak age of dx 18-24 months, most before 5yo. takes a while to find masses (deep). often don’t show up until later stages. difficult to treat bc metastasize and difficult to diagnose

more advanced stages = more advanced tx than lower stages.

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14
Q

Cancer SE management & prevention

A

Neutropenia
Thrombocytopenia
Mucositis

*learn about other SE

https://curesearch.org/Treatment-Side-Effects
https://www.youtube.com/watch?v=oZb9x_06CD0&t=3s

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15
Q

Neutropenic precautions

A

7-14 days after chemo, they will become neutropenic. Immune system very low.

  • Avoid crowds or exposure to sick people
  • No fresh fruit, fresh flowers, raw vegetables, pepper - can harbor germs
  • Strict hand washing
  • Aseptic technique with procedures – BE METICULOUS
  • Immediate attention if signs of infection!
  • DO NOT give antipyretics for fevers or start antibiotics until blood cx drawn
  • Monitor for septic shock – progresses quickly
  • NO live vaccines!
  • VZIG within 72 hours of exposure to chickenpox (immunoglobulin)
  • Immunizations 3-12 months after therapy
  • Prophylactic antibiotics Bactrim
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16
Q

Calculating Absolute Neutrophil Count (ANC)

A

ANC refers to the total number of neutrophils/granulocytes present in the blood. Indicates the body’s ability to fight infection.
* Normal value: ≥ 1500 cells/mm3.
* Mild neutropenia: ≥1000 - <1500/mxm3.
* Moderate neutropenia: ≥500 - <1000/mm3.
Severe neutropenia: < 500/mm3.

Chemo usually HELD if < 1000/mm3.

Segs (polys) and bands reported as decimal point.
* WBC times [(segs / 100) + (bands / 100)]
*
1. Multiply WBC times 1000 for TRUE WBC
2. Convert your Neutrophils (Segs and Bands) to decimal points
3. Add your Segs and Bands together
4. Multiply WBC times your Segs/Bands total

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17
Q

Bleeding Precautions

A
  • Nothing per rectum
  • Avoid activities prone to injury
  • Avoid aspirin
  • Avoid injections
  • Avoid constipation
  • Dental consult BEFORE starting chemo
  • Avoid dental work, appliances, flossing
  • May need to remove braces
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18
Q

Mucositis

A

Common side effect of chemo - can occur ANYWHERE along GI tract, not just mouth

  • Offer a soft, bland non-acidic diet, child preferences
  • Brush teeth with small, soft toothbrush
  • Use gauze or toothettes when thrombocytopenic
  • Frequent water or saline or baking soda mouth rinses (no peroxide, alcohol, glycerin - dry out mucous membranes)
  • Dental consult BEFORE chemo starts
  • Pain management - aggressive
  • Drink with straw - can HELP - good
  • Antifungals
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19
Q

Hematology

A
  • Sickle Cell Disease
  • Iron Deficiency Anemia
  • Thalassemia
  • Bleeding disorder - hemophilia & von wildebrand’s
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20
Q

Sickle Cell Anemia

A

**autosomal recessive **

Sick cell trait - don’t have disorder underless under extreme conditions
parts of world w/high malaria burden
Sickle Cell Mutation -** sickle hemoglobin** can carry oxygen, but when deoxygenated, sticks to other hbs proteins and form polymers that distort red blood cells into a sickle shape in certain “favorable conditions” such as acidosis, - decrease affinity for oxygen
low-flow vessels where hb can dump oxygen
repeated sickling damages cell membrane & causes premature destruction
intravascular hemolysis (low haptoglobin - sign of intravascular hemolysis) - causes unconjugated bilirubin
incr reticulocytes - bone formation - expansion of cheecks etc
vaso-occlusion - stick in bones of hands and fed
- other bones - avascular necrosis
- speen - can lead to problems w/spleen
- howell-jolly bodies
- moya moya
- acute chest syndrome
- renal papillae
- priapism

dx. blood smear, newborn blood spot screen

avoid hypoxia, dehydration, acidosis

opiods for pain
abx for underlying bactreial infections

occassionally blood transfusion

prophylaxis - pcn
tx hydroxyurea

21
Q

Sickle Cell Complications

A
  • Vaso-occlusive crisis
  • Hydration is the #1 tx bc blood is very viscous. trying to flush oxygen, pain management
  • Splenic sequestration - cells die inside spleen and sit there.** Spleen stops functioning and primary fn of spleen is fighting infection, immunity. usually spleens are removed early in life. will take penicillin prophylactically up until about age 5.**
  • Aplastic Crisis
  • Acute Chest Syndrome
  • Stroke - implementation of trans-cranial dopplers to assess risk of stroke. frequent blood transfusion, can have too much iron in system. Have to give chelation therapy - deferoxamine to eliminate excess iron
  • Priapism
22
Q

Thalassemia (Cooley’s anemia or Beta-Thalassemia)

A

worst one of a group, blood disorder of hemoglobin synthesis

Severe type of anemia treated w/regular blood transfusions. Like we talked about w/sickle cell and the need to prevent stroke, this can result in too much iron in the system.

These children also need iron chelation therapy w/deferoxamine

even w/ transfusions can still lead to:
* delayed growth
* lung problems
* cancer
* endocrine abnormalities

23
Q

Iron deficiency anemia symptoms

A
  • occurs in young infants who are inclusively breastfed
  • tiredness, weakness, fatigue, no energy
  • Exclusively breast fed infants should get iron supplements at 4 months, preemies @ 1 month
  • Whole milk should not begin until 1 year
  • Administer iron supplements on an empty stomach if possible and……
    –> Give with Vitamin C to enhance absorption
    –> Do not administer with milk
    –> If stomach upset, give with small amount of food
    –> Stool should turn black or green
    –> Increase dietary fiber
    –> Give with dropper in back of mouth or straw to avoid staining teeth. Rinse mouth with water.
24
Q

Hemophilia

A

X-linked disorder, very rare in women

  • joint bleeds (esp knee, ankles, elbows) – joints are eventually damaged and can eventually be crippled
  • won’t stop bleeding w/o medicine or pressure
  • bruises look bad
  • no contact sports
  • can be tested in utero
  • 2 diff types, and mild, moderate, severe

Factor 8 injections to give what they need to help their blood clot

25
Q

genetics of hemophilia

A

x linked recessive

Green = no hemophilia Red = hemophilia Half = carrier of gene**

26
Q

Hemophilia Management and Teaching

A

“RICE mnemonic”

Compression for 15 MINUTES NO PEEKING.

Nothing Per Rectum
Avoid
* BP’s
* IM or SQ injections
* venipunctures except for Factor infusions
* Heparin
* Aspirin
Use finger sticks for blood samples OR saline lock for specimens

  • Avoid contact sports
  • Helmet use
  • Head injury symptoms – IMMEDIATE attention
  • Management of bleeding**
  • Range of motion exercises for joint circulation
  • Genetic counseling

Swimming is a great activity bc not weight bearing

27
Q

von Willebrand disorder

A

bleeding disorder that lacks plasma protein needed to carry protein 8. Not lacking factor, just can’t distribute it through the body.

Same result – bruising, bleeding, manage bleeding the same way. RICE.

Not treated w/ factor b/c they have that
severe menstruation - menorrhagia

desmopressin (antidiuretic & clotting promotor)
ddAVP
von willebrand protein

28
Q

Leukemia
(ALL)
p. 645

A

Bone marrow produces immature blast cells
WBC that cannot function normally.

ALL peaks 2-3 years

S/S
↓ RBC: anemia - pallor, lethargy
↓ WBC: infection
↓ Platelet: bruising, nose bleeds
bone pain, CNS involvement: headache

Dx
WBC ↑
Platelet ↓
Hemoglobin ↓

Confirmed diagnosis with:
BM biopsy

Tx/Nursing:
Phases of chemo:
1. Induction
2. Consolidation
3. Maintenance

If CNS involvement: Intrathecal chemo

29
Q

Bone Tumors
(Osteosarcoma/Ewing’s)
p. 643

A

Tumors in the long bones (femur, tibia)

Osteosarcoma: metaphysis; growth spurts (13 yrs girls; 14 yrs boys)
Ewing’s: diaphysis; 5-20 yrs

S/s
Bone pain
Swelling
Fracture
Fever
Night sweats
Weight loss

Dx
Sed rate ↑
C-reactive protein ↑

x-ray

Metastasis to:
lungs

Tx/ Nursing
Chemo, radiation, surgery (limb salvage)

30
Q

Brain Tumors
p. 639

A

Solid tumors of the brain and central nervous system.

S/s
Manifests with signs of increased ICP
Table 24-6

Vary with area of the brain and type of tumor (headache, N/V, seizure visual changes, IICP)

Dx:
CT scan
MRI

Tx/ Nursing
Chemo
Surgery
Radiation
surgery (limb salvage)

31
Q

Neuroblastoma
p. 640

A

Smooth, hard, nontender solid tumor occurring along the sympathetic nervous system chain.
Peak: 17-22 months

s/s
Location determines symptoms

Dx
Blood counts, biopsy
Staging 1-4 (4 is most advanced): treatment depends on stage; often not diagnosed until later stages

Tx/ Nursing:
Chemo, radiation, surgery
Treatment based on staging

32
Q

Wilm’s Tumor
p. 643

A

Rapidly growing kidney tumor.
Peak age 2-3 years

S/s: Firm mass located to one side of the midline of the abdomen.

Dx: Most often discovered by parents when bathing child.

Tx/nursing: Safety Alert p. 643:
NEVER palpate the abdomen

33
Q

Iron Deficiency Anemia
p. 589

A

Anemia (not enough RBC and hemoglobin) as a result of low iron levels from blood loss or nutritional issues

S/s
Pallor
Fatigue
Irritability
Tachycardia
Tachypnea
Pica (eating nonfood items

Tx:
Iron sulfate supplement

Nursing Implications:
Implications/
side effects of administering iron:
Take on empty stomach
Liquid should be squirted in back of mouth (blackens teeth; rinse or brush after)
Black-tarry stools
Constipation

34
Q

Sickle Cell Anemia
p. 593

A

Autosomal recessive disorder of abnormal hemoglobin when RBCs change shape (sickle) and blood becomes viscous and occludes vessels leading to ischemia.

S/s:
Triggers/
Precipitating Factors:
Dehydration, illness (fever, surgery), temperature changes, stress, hypoxia (change in altitude)

Tx:
Hydration
Oxygen
Pain management
Hydroxyurea

Nursing Implications:
Know the different types of crises (cause, symptoms, treatment): Table 23-5, p. 595
Vaso-occlusive Crisis
Splenic sequestration
Aplastic crisis
Acute Chest Syndrome
Priapism, p. 593
Stroke, p. 593, 596

35
Q

Hemophilia
p. 602

A

x-linked recessive bleeding disorder resulting in deficiency of clotting factor
Hemophilia A: Factor VIII
Hemophilia B (Christmas Disease): Factor IX

s/s
Bruising, bleeding, (bleeding into joints, nosebleeds)

Tx
Replace missing Factor

Nursing implicatoins:
Implications of bleeding into joints:
limited movement
bone changes &/or deformities
What to do when a bleed occurs:
Rest
Ice
Compression for at least 15 minutes
Elevation

36
Q

von Willebrand Disease
p. 604

A

Autosomal dominant bleeding disorder lacking the plasma protein that carries Factor VIII.

S/s
Bruising
Nosebleeds
Prolonged bleeding with procedures

Tx
DDAVP &/or vWF protein

Nursing implications:
Manage bleeds as with hemophilia

37
Q

Thalassemia
p. 601

A

Thalassemias are inherited blood disorders of hemoglobin synthesis characterized by anemia. Can be minor to major. B-thalassemia major (Cooley’s anemia) is focus here.

S/s
Pallor
Jaundice
Irritability
Stunted growth
Hepatosplenomegaly

Tx
Standard treatment is blood transfusions (can be done intrauterine)
Stem cell transplant is the only cure

Nursing implications:
Deferoxamine is given to decrease iron build up associated with multiple blood transfusions

38
Q

Thrombocytopenia - leukemia side effect

A

Low platelet count –
S/s

Bruising or petechiae (small, red, pinpoint spots on the skin)
Bleeding from the nose, gums or central venous access device that doesn’t stop after applying pressure for 5 – 10 minutes
Black stools or vomit (this may mean blood is in the stomach or bowel)

  • Any child with a low platelet count should not play contact sports (football, rugby)
  • use a soft toothbrush when brushing teeth to prevent bleeding of the gums
  • nose bleed: sit your child upright as you apply pressure to the outsides of each nostril, just below the bridge. Pinch the area with your thumb and finger and hold the pressure for 10 minutes. If the bleeding does not stop, call your healthcare provider.
  • be cautious of anything that might cause bleeding in your child.
  • No enemas or suppositories (medicine put into the rectum), and do not check a rectal temperature.
  • do not give your child aspirin (salicylate) or ibuprofen (Motrin®, Advil®, or Pediaprofen) unless you are told to do so by your healthcare team. These medicines cause the platelets to be unable to form clots, which stop bleeding. Some over-the-counter medicines like cold and flu medicines contain aspirin or ibuprofen.
39
Q

Anemia - - leukemia side effect

A

Low red blood cell count

Red blood cells carry oxygen throughout the body. Oxygen enters the lungs with each breath and binds (attaches) to hemoglobin in the red blood cells. Hemoglobin carries the oxygen to all the organs and tissues in the body. Two laboratory tests are done to measure the number and function of red blood cells:

A Hemoglobin test shows how much oxygen the red blood cells are able to carry. A normal hemoglobin level is between 12 and 16.

A Hematocrit shows the percentage of red blood cells in the blood. A normal hematocrit is between 36 and 50.

S/s

When the hemoglobin count is low, the body is not able to get as much oxygen to go throughout the body.

A person with low hemoglobin may have the following symptoms:

  • Tiredness
  • Shortness of breath
  • Headache
  • Fast heart rate
  • Pale skin and/or pale gums
  • Dizziness

A blood transfusion may be given if your child’s hemoglobin is too low.

If your child needs a blood transfusion, the blood given will match your child’s blood type. The blood will be given over several hours into a vein, through an IV in the arm. Your child will be checked during the transfusion for signs of a reaction.

40
Q

Neutropenia/Fever

A

White blood cells fight infection. A normal white blood cell count is between 5,000 and 10,000 cells. A white blood cell count below 1,000 cells increases the risk of infection. In some cases, your child may be given a medicine, such as “G-CSF (granulocyte-colony stimulating factor),” to help increase the number of white blood cells in the bone marrow.

Different types of white blood cells have different jobs. The “differential” is part of the blood count report that shows the breakdown of the various types of white blood cells in your child’s blood count.

Neutrophils help to fight bacterial infections.

Lymphocytes make antibodies to fight infections.

Monocytes help to fight infection by killing and removing bacteria.

Basophils and eosinophils respond during an allergic reaction.

The term “ANC,” which stands for “Absolute Neutrophil Count,” is the total number of neutrophils in your child’s white blood cell count. We often refer to the ANC as the “infection-fighting” count. The lower the ANC drops, the higher the risk of infection. When the ANC drops below 500, the risk of infection is high.

While there are no outward signs of a low white blood cell count, it’s important to be aware of the timing of low blood counts following chemotherapy. Whenever your child receives chemotherapy, you’ll want to speak with the nurse about the timing of low counts.

Call your health care provider right away if you notice any signs of infection, including:

  • Fever
  • Chills
  • Cough
  • Trouble breathing
  • Diarrhea
  • Pain

If your child has a central venous access device (central line or port), check for redness, swelling, pain or pus at the site. A child with a low ANC may not have redness or pus, but could still have an infection.

41
Q

Calculating ANC

A

ANC value & risk for infection

<500 – high
500-1,000 – moderate
>1,000 – lower

On most blood count reports, you will see the ANC already calculated for you. You can also ask your health care provider to tell you the ANC. To calculate the ANC yourself, use this formula:

ANC = (% segs + % bands) x WBC

Look at your child’s differential. Add the percentage of segs (sometimes called polys or PMNs) and bands together (combined, these make up the neutrophil count). Multiply the neutrophil count by the white blood cell count (WBC).

Example: WBC = 1,000, % segs = 20%, % bands = 1%

ANC = (% segs + % bands) x WBC

ANC = (20% + 1%) x 1,000

ANC = (0.21 x 1,000)

ANC = 210 (high risk for infection)

42
Q

Mouth Sores/(Mucositis)

A

Can happen in all mucous membranes of GI tract. Oral mucositis or stomatitis is most common.

Have your child brush their teeth with a soft toothbrush after each meal and before bed.

Rinse the mouth with water after brushing. Do not use mouthwashes that contain alcohol. Alcohol dries out the mouth.

If a dry mouth is a problem, have your child suck on sugar-free hard candies or ask your health care provider about mouthwashes or other products for dry mouth.

ome chemotherapy medicines and radiation therapy to the head and neck can cause mouth sores. The inside of the mouth may be red or may have sores that can be painful. You may also see white plaques (small raised areas) in the mouth that may be from a fungal infection.
If mouth sores are a problem:
* Give your child plenty of fluids.
* Have your child drink fluids with a straw.
* Avoid spicy or acidic foods.
* Give your child foods that are cold or at room temperature.
* Try soft, tender, or pureed (beaten or blended) foods.
* Avoid dry or coarse foods.
* Cut food into small pieces.
* Rinse the mouth with water or a mouthwash recommended by your healthcare provider several times a day.
* Avoid mouthwash that contains alcohol.

Your healthcare provider may give your child a medication to treat a fungal infection in the mouth (thrush), and/or a pain medication if the sores are painful. Call your healthcare provider if your child cannot drink fluids, swallow, or if your child’s medicine does not help take away the pain.
Suggestions:
* Avoid food and drinks with extreme temperatures that can hurt the mouth and throat. Lukewarm or room-temperature foods and beverages may be better tolerated.
* Avoid acidic foods and beverages like citrus and tomato juices that can burn the mouth and throat. Fruit nectar, especially pear nectar, may be well tolerated.
* Avoid salty or spicy foods that can burn or sting. Offer blander foods instead.
* Try soft foods that are easy to chew, or consider mixing food in a blender with fluid (water, broth, gravy) to make it easier to eat.
* Experiment with liquid nutritional formulas. A registered dietitian can provide suggestions and samples of products to try.
* Encourage using a straw to drink fluids and thinned pureed food instead of a spoon.
* Ask your child’s doctor or nurse about medicine you can give before meals to numb the mouth or throat
* * Avoid commercial mouthwash containing alcohol, which can burn.
DEALING WITH A DRY MOUTH
Radiation therapy to the head or neck area can reduce the flow of saliva and cause a dry mouth, making it harder to chew and swallow foods. Dry mouth can also change the way foods taste.
Suggestions:
* Try very sweet or tart foods and beverages (but avoid tart foods if the child has a sore mouth or throat).
* Sucking on hard candy, popsicles, or chewing gum can help produce more saliva. Sugar-free candies and gum are better to avoid tooth decay.
* Serve foods with sauces, gravies, or butter to help make them moist and easier to swallow.
* Prepare soft and pureed foods.
* Use lip balm to keep your child’s lips moist.
* Sipping on liquids throughout the day may help keep the mouth moist.
* Ask the doctor about products that can help with a dry mouth.

43
Q

Nausea/Vomiting

A

Chemotherapy and radiation therapy can cause nausea, vomiting and diarrhea. Any of these symptoms can place your child at risk for dehydration (loss of fluids in the body).
Medications to help decrease nausea and vomiting are usually given before chemotherapy or radiation. The type and amount of anti-nausea medicine will be based on your child’s treatment plan and reaction to the treatment. It is important to let your healthcare provider know if your child has nausea or vomiting at home after chemotherapy, so additional medicine or other types of treatment can be used.
Some ways to help decrease nausea and vomiting include:
* Eat small meals or snacks.
* Eat foods that are easy to digest (crackers, rice, gelatin).
* Sip cool clear liquids.
* Do not eat fried, spicy or very rich foods.
* Eat in a room that is free from cooking or other smells.
* Rinse your child’s mouth after vomiting.
Nutrition’s Role:
* Avoid offering overly sweet or greasy foods, hot and spicy foods, and foods with strong odors.
* Offer small amounts of food; it can help to use smaller plates and bowls to avoid overwhelming the child.
* Discourage drinking with meals. Instead, offer liquids 20-30 minutes before or after meals.
* Encourage your child to eat and drink slowly. Avoid forcing past his or her point of tolerance.
* Do not offer favorite foods when your child is feeling nauseous. This can “turn off” the child to those foods if they become associated with a feeling of nausea.
* Avoid giving food for one to two hours before treatment if nausea occurs during radiation therapy or chemotherapy.
* Offer dry crackers, cereal, or toast.
* Clear, cool liquids are refreshing.
* Serve meals and snacks in well-ventilated rooms, since the cooking smells can cause nausea. Cold foods are less aromatic than hot foods and may be better tolerated. Use an exhaust fan in the kitchen when cooking to eliminate odors.
* Avoid taking the lid off of hospital trays in front of the child, as even these odors can be nauseating. Remove the lid outside of the room, and take only the items into the room that the child wants.
* Breakfast foods are often tolerated best, and can be eaten at any time of the day.
* Dress the child in (or encourage him or her to wear) loose-fitting clothes.
* If nausea and vomiting is severe, try to encourage the child to drink at least some fluids so he or she does not become dehydrated. If the problem continues, call the child’s physician.
Ask your physician about medications that can be used to help control these symptoms, called antiemetics

44
Q

Instructions for families: When to notify the healthcare provider/seek medical attention while receiving treatment (Families want to know p. 633)

A

Temp > 38
Any bleeding (nosebleeds, bloody stools or urine, petechiae, bruising)
Pain or discomfort with urination or stool
Sores in mouth
Vomiting or diarrhea
Persistent pain anywhere
Signs of infection (cough, fever, runny nose, tugging at ears)
Signs of infection at central line (redness, drainage, tenderness)
Exposure to communicable disease, especially chickenpox

45
Q

Tumor Lysis Syndrome
(Table 24-3, p. 623)

A

Breakdown of malignant cells release intracellular components into blood

Manifestations

Hyperuricemia
Hyperkalemia
Hyperphosphatemia
Hypocalcemia

Treatment

Hydration 2-4 x maintenance

Correct electrolyte imbalance

Allopurinol (to prevent production of uric acid)

Nursing Implications
1.Administer fluids before chemo

2.Strict I&O

3.Daily weight

  1. Monitor urine specific gravity (< 1.010)

5.Monitor for medication side effects

46
Q

VASO-OCCLUSIVE CRISIS

A

s/s: pain, swelling, painful hands & feet, prolonged cap refill, impaired tissue perfusion
Causes: sickled cells get stuck, exertion, extreme temp, recent illness, dehydration, elevation, stress
Interventions: hydration, oxygen, pain management (opioids or other narcotics)
Priority: hydration

47
Q

Splenic sequestration

A

causes: pooling of blood in the spleen
s/s: anemia, hypovolemic shock, belly pain LS, fatigue
interventions: fluid replacement, maybe blood transfusion, splenectomy (when they are old enough)
priority: pcn until 5yo bc spleen doesn’t function dt damage to spleen, splenectomy when old enough

48
Q

Acute chest syndrome

A

s/s: Infection, opacity on chest x ray, decr perfusion, decr O2 sats, cloudy lungs w/infiltrates, SOB, chest pain, fever, tachypnea, coughing
Causes: occlusion of vasculature in lungs - infiltrates
Tx: oxygen, pain control, respiratory support, hydration, checking lungs, incentive spirometer
Priority intervention: abx for potential infection

49
Q

Stroke (sickle cell)

A

S/s: numbness, weakness in face, facial droop, assymetry, slurred speech (just like adults). sm kids hard to tell orientation
Causes: vasooclussion in brain, CANT use TPA, ischemic stroke (oxygenated blood cut off)
Tx: transcranial dopplers to assess for stroke risk, hydration, oxygen, blood transfusion
primary intervention: blood transfusion (exchange transfusion)
with a lot of blood transfusions – iron built up in the blood -deferoxamine - chelation therapy

Peds Exam III (10 decks)

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