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Pediatrics > Neoplastic, hematologic, endocrine > Flashcards

Neoplastic, hematologic, endocrine Flashcards

1
Q

Nearly half of all childhood cancers involve _____

A

Blood or blood forming agents

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2
Q

How does childhood cancer differ from adult cancer?

A

Children grow faster and therefor their cancer does as well

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3
Q

What are the negative implications of the fast growing nature of cancer in children?

A

Very high rates of metastatic cancers. Rapid spread throughout the body

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4
Q

How do children respond to cancer treatment compared to adults?

A

They respond much better and have a much higher cure rate

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5
Q

What is the patho of a brain tumor?

A
  • Caused of them is unknown

- Usually a solid tumor below the roof of the cranium

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6
Q

How do brain tumors manifest in children?

A

They cause behavioral and neurological changes.

These can be from tissue loss or damage or increased ICP

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7
Q

What are some common s/s of brain tumors in children?

A
  • Headache
  • Vomiting
  • Ataxia
  • Seizures
  • Visual disturbances
  • Increased ICP
  • Nystagmus
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8
Q

What is a neuroblastoma? (patho)

A
  • A solid tumor outside of the cranium
  • Often diagnosed after it metastasizes
  • Unknown causes
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9
Q

What determines the clinical manifestations of a neuroblastoma?

A

The location of the mass

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10
Q

What are the s/s of a retro-peritoneal neuroblastoma?

A
  • Bowel and bladder alterations
  • Weight loss
  • Abdominal fullness
  • Fatigue
  • fever
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11
Q

What are the s/s of a Mediastinal neuroblastoma?

A
  • Dyspnea
  • infection
  • neck or facial edema
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12
Q

What are the s/s of a intracranial neuroblastoma?

A

Periorbital ecchymosis

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13
Q

What is the patho of Osteosarcoma

A
  • Cancer of the soft bone tissue
  • Affected bone tissue never matures into compact bone
  • peaks during puberty
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14
Q

What is the most common location for osteosarcoma?

A

The metaphysis of the distal femur, prox tibia or prob humerus

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15
Q

What are the clinical manifestations of osteoscarcoma?

A
  • Pain and swelling of the affected limb (sometimes the pain moves to hip/back
  • Causes a limp
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16
Q

What is a major risk of osteoscarcoma?

A

The chance of it metastasizing to the lungs

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17
Q

What is the ESR test? What does it measure?

A

Erythrocyte Sedimentation rate

-Meansures the rate at wich RBC’s precipitate in 1 hour

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18
Q

What does the ESR test determine? What does it indicate?

A
  • It is a nonspecific measure of inflammation
  • Sed rate is affected by an alteration in blood proteins by inflammation and necrosis
  • Indicates infection or autoimmune disorder
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19
Q

What is the CRP test? what is it not?

A

It is the C-reactive protein test.

It is not a liver function test

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20
Q

What does CRP measure?

A

The livers response to inflammation and infection

-also the risk for atherosclerosis

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21
Q

What is the benefit to a CRP test?

A

Changes faster than ESR

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22
Q

What is a unique treatment for osteoscarcoma?

A

Rotationplasty

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23
Q

What is the most common congenital malignant intraocular tumor of childhood?

A

Retinoblastoma

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24
Q

What are some characeristics of retinoblastoma?

A
  • Uni or bilateral

- May have a genetic proponent

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25
Q

What are the main s/s of retinoblastoma?

A
  • Cat eye reflex
  • Strabismus
  • Pain
  • Dec. vision
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26
Q

What is retinoblastoma usually diagnosed?

A

1-2 years old

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27
Q

What family gene should alert the the chance of retinoblastoma? What other cancer is this gene associated with?

A

RB1

Osteogenic sarcoma

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28
Q

What is Nephroblastoma (aka Wilms tumor)

A

A malignant renal and/or intra-abdominal tumor

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29
Q

When is the peak growth for nephroblastoma?

A

3 years

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30
Q

What s/s lead to the diagnosis of nephroblastoma?

A
  • Abdominal swelling or mass with no other symptoms
  • Hx of congen. anomalies
  • Signs of malignancy
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31
Q

How is a nephroblastoma treated?

A
  • Surgery/chemo

- Removal of affected kidney

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32
Q

What is the biggest nursing con. when treating a child with nephroblastoma?

A

DO NOT PALPATE TUMOR PRe-OP

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33
Q

What are some other nursing cons for a child after treatment for a nephroblastoma?

A
  • Post op treatment/care
  • Family support
  • Education on living with one kidney
  • High risk for F and E imbalance
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34
Q

What is the function of surgery in the treatment of cancer?

A
  • To remove all malignant cells
  • Reconstruction
  • Palliative care
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35
Q

What is the function/considerations for chemotherapy?

A
  • Many body systems are negativley affected by the treatment (Hematopoietic, GI, Hep., renal, integ, reproductive)
  • Venous access sites need to be maintained
  • Hair will grow back different
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36
Q

What are some considerations for a patient going through radiation treatment?

A
  • Xerostomia (dry mouth)
  • Skin breakdown
  • Pneumonia
  • reduced growth rate and bone integrity
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37
Q

Bone marrow transplants are now called what?

HSCT

A

Hematopoietic stem cell transplantation

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38
Q

What is the function of Biological response modifiers?

A

To stimulate the bodies immune system to destroy cancer cells

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39
Q

What are some examples of Biological response modifiers?

A
  • Colony stimulation factors (CFS)
  • interleukins
  • monoclonal antibodies
  • interferons
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40
Q

What is the patho. of iron deficiency anemia?

A

-inadequate supply of iron leads to smaller RBC’s, less RBC’s, lower oxygen carrying capacity of blood.

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41
Q

What are the s/s of acute iron def. anemia?

A

Pallor, fatigue, irritability

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42
Q

What are the two main assessments for iron def. anemia?

A
  • Nutritional intake

- Low ferritin levels

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43
Q

Chronic iron def. anemia can cause…..

A

Nail changes. growth and development delays, PICA

44
Q

What is a side effect of iron supplements?

A

Black or green stick poop

45
Q

What is a consideration when taking liquid iron supplments?

A

they can stain teeth

46
Q

What are the main teaching points when a pt is taking iron suppliments?

A
  • Take with protein, vit c, and folic acid and NOT calcium. better on an empty stomach
  • Begin iron fortification at 4-6 months
  • Brest milk does not have a good supply of iron
  • High iron diet, limit dairy
  • the fetus will begin to store iron in the third trimester and will use those stores for the first few months of life
47
Q

What are some caused of iron deficiency anemia?

A
  • Bleeding
  • Poor diet
  • Heavy Flo
  • Growth spurts
48
Q

What is the patho of sickle cell anemia?

A
  • Autosomal recessive blood disorder
  • One amino acid replaces another causing a change in the shape of RBC’s r/t a change in hgb
  • these RBC’s are short lived and unable to pass through micro circulation and can clump together
49
Q

What are the three ways that sickle RBC’s affect the body?

A
  • Distruction of RBC’s
  • Clumping of RBC’s causing clogs in micro circulation
  • Pooling of RBC’s in spleen
50
Q

Explain how sickle cell anemia presents in a patient.

A

It goes through periods of exacerbation and dormancy.

The patient will experience a crisis when their cells begin to sickle

51
Q

Along with the individual aspect of the crisis, what are some general s/s of sickle cell anemia during an exhaserbation

A
  • Pallor
  • Fatigue
  • SOB
  • Irritable
52
Q

When a pt is in a sickle cell anemia crisis they will always be in ____

A

Pain

53
Q

What are the three types of sickle cell anemia crisis?

A
  • Vaso-occlusive (hand and foot)
  • Sequestration (spleen and liver pooling)
  • Aplastic (fifth’s disease)
54
Q

What is an aplastic crisis?

A

A massive RBC death

55
Q

What are the interventions for a sickle cell anemia crisis?

A
  • PCA (morphine)(control pain)
  • PROM (promote circulation)
  • Hydration (to dilute) via IV or oral
  • Heat (open capillaries)
  • O2
  • Infection prevention
56
Q

What is the number 1 intervention for a sickle cell anemia crisis?

A

O2 (helps reverse some of the sickling)

57
Q

Why is Demerol not given to children?

A

It causes seizures

58
Q

What is one treatment for sickle cell anemia (not for the crisis)

A

-Stem cell or bone marrow transplant

59
Q

What are some common triggers for a sickle cell anemia crisis?

A
  • Fever
  • Infection
  • Acidosis
  • Dehydration
  • Constricting clothing
  • Exposure to cold
60
Q

What is B-Thalassemia (cooley anemia)

A
  • Often inherited in Mediterranean families
  • Anemia that is caused by defective Hgb.
  • Causes fragile RBC’s and leads to anemia and hypoxia
  • Iron from broken RBC’s accumulates in the body and may need to be treated
61
Q

What are the s/s of B-Thalassemia?

A
  • Darkening or bronzing of the skin
  • Skeletal changes
  • CHF
  • Hepatomegly
  • Splenomegaly
62
Q

How is B Thalassemia treated?

A

Blood transfusion and chelating agents

63
Q

What is Hemophilia?

A

-Several Hereditary bleeding disorders

64
Q

What is the patho of Hemophilia?

A

Bleeding disorder causes excessive bleeding after minor falls, loss of teeth, circumcision, and immunizations.

65
Q

How is Hemophilia treated?

A

When bleeding is active, the PT will use DDAVP is the form of a nasal spray. This will constrict blood vessels and help control the bleedin
-Long term, treated with clotting factors

66
Q

What are some nursing considerations for children with hemophilia?

A
  • Help them to be kids
  • Maintain a safe environment
  • Encourage activity
  • Non-contact sports
  • Home care administration of factors
67
Q

When are most children diagnosed with Type 1 DM

A

after a hospital visit for DKA

68
Q

What is the main goal in childhood DM management?

A

To empower the child to perform self care

69
Q

By ____ years old, a child with DM should be able to ____ under heavy supervision

A

9

administer their own insulin

70
Q

A ___ year old with DM can be empowered to assist in car by ____

A

Being allowed to retrieve glucometer and other supplies

71
Q

SIADH is AKA ___

A

water intoxication

72
Q

What is SIADH?

A

A condition when ADH is secreted in the presence of low serum osmolarity

73
Q

What caused SIADH?

A
  • Brain tumor
  • Trauma
  • CF
  • pneumonia
  • Ventilator
74
Q

What is the main symptom of SIADH? How does that symptom present?

A

Water retention

  • Decreased output
  • Weight gain
  • Decreased Na
  • increased ECF causing Neuro and GI symptoms
75
Q

How is SIADH treated?

A
  • Fluid restriction
  • IV NaCl
  • Treating the underlying disorder
76
Q

What is hypopituitarism?

A

a growth hormone deficiency that causes stunted growth and a proportionate skeleton

77
Q

What causes hypopituitarism?

A

The body fails to produce growth hormone because of injury, tumor or it can be idiopathic
-can be genetic

78
Q

How is hypopituitarism diagnosed?

A

a deteriorating rate of growth over one year

79
Q

How is hypopituitarism treated?

A

Growth hormone injections

80
Q

What is a major nursing consideration for a child with hypopituitarism?

A
  • This condition requires a large about of family and financial support
  • The treatment is long term
  • Development can be affected
81
Q

What is hyperpituitarism?

A

Accessive growth hormone

82
Q

How is the body affected if it develops hyperpituitarism before the closure of the epiphyseal plates?

A

An average height of over 8 feet

83
Q

How is the body affected if it develops hyperpituitarism after the closure of the epiphyseal plates?

A

Acromegaly

84
Q

What is one of the major negative effects of Acromegaly?

A

The internal organs don’t match the growth of the body and eventually fail to maintain homeostasis

85
Q

How is hyperpituitarism treated?

A
  • Surgery
  • Irradiation
  • Radioactive implants
86
Q

Why is hyperpituitarism often misdiagnosed?

A

Because we place a high value on height

87
Q

How is precocious puberty?

A
  • The appearance of secondary sex characteristics before 8-9 years old
  • Also caused advanced bone growth and maturation
88
Q

What can cause precocious puberty?

A

-Disorders of the gonads, adrenal, tumor, or unknown causes

89
Q

In terms of growth, what is the biggest concern with precocious puberty

A

Growth stops early and can cause stunted height

90
Q

What are the social and developmental implications of precocious puberty

A
  • High sex drive at a very young age

- Social isolation

91
Q

How is precocious puberty treated?

A

LHRH analogs are given to slow down but not stop the precocious puberty

92
Q

What is congenital hypothyroidism?

A

-Deficiency in thyroid hormone

93
Q

An infant with congenital hypothyroidism will present as____

A

Sleepy, easy, and quiet

94
Q

What are the s/s of congenital hypothyroidism

A
  • Decline in growth
  • Dry skin
  • Puffy eyes
  • sparse hair
  • constipation
  • Mental decline
  • Decreased appetite
  • Bradycardia
  • Goiter
95
Q

How do the s/s of congenital hypothyroidism differ from adults with hypothyroidism?

A

-s/s are the same but occur along side a change in past growth patterns with increased weight and decline in height

96
Q

How is congenital hypothyroidism treated?

A

Thyroxine therapy

97
Q

What are the 2 big nursing considerations for a child with congenital hypothyroidism?

A
  • Keep them warm

- treat constipation

98
Q

How does the outward appearance of a child with hypo]erthyroidism present?

A
  • possible goiter
  • Exophthalmos
  • may be underweight
99
Q

children with hyperthyroidism often have a concurrent _____disorder

A

auto-immune

100
Q

What are the s/s of a child with hyperthyroidism

A

Emotional Lability, restless, decline in school work, tachycardia, accelerated linear growth, behavioral problems, trouble concentrating

101
Q

hyperthyroidism is aka ___

A

graves disease

102
Q

What are the key nursing interventions for a child with hyperthyroidism

A
  • increase caloric intake
  • Keep quiet
  • rest
  • monitor for thyroid storm (fever, sweating, tachycardia, palpations, tremors) this is an emergent situation
103
Q

What is the treatment for hyperthyroidism?

A
  • Antithyroid drugs
  • Subtotal thyroidectomy
  • ablation with radioiodine
104
Q

What is Addison disease?

A

A chroninc adrenocortical insufficiency.
The body cant make stress hormones!
This is an auto-immune disease that caused destruction of the adrenal glands
-Can be caused by trauma or infection

105
Q

What are the s/s of addison’s disease?

A

Gradual
-Muscle weakness, mental fatigue, irratable, pigment changes at pressure points, general bronzing, dehydration, weight loss, hypotension, syncope, hypoglycemia, GI distress

106
Q

What is the Tx for Addison’s disease?

A

monthly injections of Cortisol and aldosterone

107
Q

What is the main nursing consideration for Addison’s disease?

A

Monitor for a crisis that comes from dehydration. can lead to coma, shock, and circulatory collapse

Pediatrics (20 decks)

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