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NUR331 Exam 3 Flashcards

1
Q

phenylketonuria (PKU)

A
  • inborn genetic error of metabolism where there is an absence of the enzyme phenylalanine hydroxylase (causes inability to metabolize the amino acid, phenylalanine)
  • can build up and cause brain damage
  • will ALWAYS be on a PA+ free formula
  • limited fruits, vegetables, and grains, no meat
  • must keep PA+ in a safe range of 2-6
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2
Q

CM of untreated PKU

A
  • restricted height and weight
  • musty odor to urine and sweat
  • hypopigmentation
  • vomiting
  • irritability
  • seizures
  • hyperactivity
  • mental delay
  • adults have: short attention span, poor short term memory, visual perception problems, poor motor coordination, mood disorders, brain structural changes, etc
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3
Q

NC for PKU

A
  • ensure proper testing as a newborn
  • teaching
  • referral for genetic counseling
  • supportive
  • flexible feeding schedule
  • encourage early treatment
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4
Q

galactosemia

A
  • inborn error of carb metabolism
  • lack of enzyme needed to convert galactose to glucose
  • CM - vomiting, weight loss, jaundice, lethargy, hypotonia, cataracts
  • long term consequences - learning disabilities, lower IQ, short attention span, behavior problems
  • lactose-free diet, soy formula
  • calcium supplements, sensitive to medications
  • don’t allow mom to breastfeed unless she is dairy free
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5
Q

juvenile hypothyroidism

A
  • s/s - hypothermia, large protruding tongue, short and thick neck, delayed detention, hypotonia, poor feeding, prolonged jaundice, constipation, goiter
  • englarged thyroid could obstruct airway
  • levothyroxine for life, prompt treatment needed for brain growth in infants, dose changes with growth
  • teach med administration - avoid heat exposure, do NOT mix with soy formula
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6
Q

hyperthyroidism

A
  • mimics s/s of adults
  • diagnosed based on high T3 and T4
  • given anti thyroid drugs - most likely will receive remission in 1-2 years
  • subtotal thyroidectomy or ablation with radioiodine
  • high cal and nutritious diet, limit activity
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7
Q

agranulocytosis

A

toxic reaction of anti-thyroid drugs that causes sore throat and fever
- should isolate and call HCP

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8
Q

thyrotoxicosis

A
  • thyroid storm
  • can be life threatening
  • can be precipitated by infection, surgery, or discontinuation of antithyroid therapy
  • treated with antithyroid drugs and propanolol
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9
Q

hypopituitarism

A
  • causes - tumors, encephalitis, radiation, head trauma, congenital, and idiopathic
  • absence or regression of secondary sex characteristics
  • normal height and weight at birth but patterns deviate
  • diagnosed by ruling out short stature and Turner’s
  • CM - short, normal to heavy weight, slow bone age, appear younger than chronological age, delayed growth of permanent teeth
  • given growth hormone until reaching adult height, may need thyroid extract, cortisone, testosterone/estrogen (expensive and painful)
  • injections are given at bedtime, requires frequent blood draws
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10
Q

precocious puberty

A
  • sexual development before age 9 in boys or 8 in girls
  • cause - disorder of gonads, adrenal glands, or HPA axis
  • included are premature thelarche, premature pubarche, and premature menarche
  • treat specific cause if known
  • Lupron - monthly IM until puberty that slows growth
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11
Q

congenital adrenal hyperplasia

A
  • decreased enzyme activity that is required for cortisol production in the adrenal cortex
  • overproduction of adrenal androgens results in virilization of female fetus
  • decreased cortisol and aldosterone
  • CM - ambiguous genitalia, decreased stress response, hypoglycemia, increased inflammatory response, hypotension, compromised immune system, dehydration
  • ultrasound to determine organs, chromosome typing for positive sex determination
  • given cortisone to suppress abnormally high secretion of ACTH
  • teach parents of s/s of salt-losing crisis and dehydration
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12
Q

diagnostic criteria of diabetes

A
  • FPG >126
  • PG >200
  • casual >200 with 3 p’s
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13
Q

CM of DM1

A
  • hyperglycemia and acidosis
  • weight loss
  • 3 p’s
  • enuresis
  • irritability
  • unusual fatigue
  • abdominal pain
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14
Q

CM DM2

A
  • overweight
  • fatigue
  • frequent infections
  • acanthosis nigrocans
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15
Q

diabetic medical management

A
  • nutrition
  • medication
  • developmental issues
  • glucose and urine monitoring
  • hypoglycemia management
  • hyperglycemia management
  • sick day management
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16
Q

snack management with DM

A
  • balance of carbs, fats, and proteins
  • extra food during exercise
  • consistent meal times
  • avoid high sugar
  • decrease insulin with exercise
  • eat snacks when drinking alcohol
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17
Q

carb-free sources

A

meat, jello, cheese

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18
Q

onset, peak, duration of insulin lispro

A
  • 15min
  • 1 hr
  • 3-4 hr
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19
Q

onset, peak, duration of insulin glargine

A
  • 4-6 hours
  • 8-20 hrs
  • 24 hours
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20
Q

When should urine ketones be monitored?

A
  • any time glucose is 240+
  • during illness
  • when on an insulin pump and sugar is 240+
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21
Q

What is bolus insulin matched with?

A

carb intake
correction is everything above the desired level

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22
Q

developmental issues with 3-6years DM

A
  • reassure child who thinks it’s punishment
  • encourage child to participate
  • teach child to report lows
  • teach child what to eat when they get low
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23
Q

developmental issues with 6-12 years DM

A
  • educate school personel about DM
  • encourage independence, but all activities must be supervised
  • encourage extra curricular activities
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24
Q

adolescent DM developmental issues

A
  • know which foods fit into meal plan and how to adjust
  • they like to take risks
  • need continued parental support
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25
Q

s/s and management of hypoglycemia

A
  • s/s - low BS, hunger, headache, confusion, shakiness, dizziness, sweating
  • treated when below 60
  • treat with rule of 15
  • follow with meal or snack
  • use glucagon pen if severe (pen has expiration date)
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26
Q

s/s and management of hyperglycemia

A
  • s/s - high BS, glucose in urine, frequent urination
  • check fluids, increase fluids (no caffeine), do not increase activity
  • treat DKA if applicable
  • insulin
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27
Q

ketosis patho

A

cells don’t get glucose needed for energy so your body burns fat for energy
ketones are created from broken down fats
make blood more acidic

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28
Q

DKA s/s

A

kussmaul’s respirations
confusion, lethargy
abdominal pain
vomiting without diarrhea
dehydration symptoms
respiratory distress without lung pathology

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29
Q

What does a high anion gap indicate?

A

metabolic acidosis
usually happens in DM because bicarb is low

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30
Q

causes of mortality from DKA

A

failure to make diagnosis
cerebral edema*
hypo/hyperkalemia
hypoglycemia
hypovolemia

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31
Q

what do electrolytes look like in DKA?

A

high extracellular K
low Na (dilutional)
both are lost in urine

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32
Q

treatment of DKA

A

fluid replacement*
electrolyte replacement
insulin therapy
careful monitoring

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33
Q

goals of DKA treatment

A

correct dehydration
correct acidosis and reverse ketosis
restore normal blood glucose levels
avoid therapy complications

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34
Q

how are insulin drips adminsistered?

A

continuous IV infusion of regular insulin
DO NOT give as a bolus
should be at a rate of 0.1u/kg/hr until acidosis resolves
once glucose reaches 250-300, maintain insulin and begin dextrose infusion
check glucose hourly

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35
Q

when is bicarb administration done?

A

severe acidemia
life threatening hyperkalemia

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36
Q

hourly assessment of DKA patient includes…

A
  • VS
  • neurological status
  • accurate fluid intake/output
  • POC glucose level
  • K level
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37
Q

what should be monitored every 2 hours in DKA?

A
  • urine ketones
  • serum bicarb
  • labs q2-4
  • continuous cardiac monitoring
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38
Q

when to transition off of IV insulin

A

when pH is above 7.3 and bicarb is >15-18
patient is able to eat
able to give SQ insulin

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39
Q

developmental musculoskeletal considerations

A
  • skeletal maturity happens by 17 in boys and after 2 years of menarche in girls
  • they have growth plates
  • porous bone
  • thicker periosteum (allows for faster healing in infants)
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40
Q

managing care of pt with a cast

A
  • handle wet cast with palms of hands
  • turn wet cast every 2 hours until dry
  • avoid ibuprofen, but treat pain
  • ice can help with itching
  • elevate extremity
  • watch skin for breakdown
  • don’t put anything in the cast, can use benadryl for itching
  • exercise non-affected side and do isometric exercises on affected
  • prevent foot drop
  • good diet and lots of fluid
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41
Q

how to assess neurovascular system with cast

A
  • 5 p’s - pain, paresthesia, paralysis, pulse, pallor
  • elevate extremity
  • feel for tightness of cast, should be able to insert a couple of fingers
42
Q

traction care

A
  • maintain correct balance of traction
  • weight care
  • skin inspection
  • pin care
  • assess NV system
43
Q

developmental dysplasia of hip (DDH)

A
  • spectrum of abnormal development of hip
  • RF - twins, breech, and females
  • CM - asymmetry, limited abduction, gallaezzi sign, ortolani test, trandelenburg sign, waddling
  • hip that appears longer is out of socket
  • position hip in abducted position**, can use pavlik harness
  • 6-18mo - treated with surgery or spika cast
  • older child - surgery
  • always put undershirt under the child
  • check skin for redness 2-3 times a day
  • gently massage skin under straps daily to increase circulation (avoid lotion and powder)
  • teach how to hold them with the harness on
44
Q

galleazzi sign

A

short femur

45
Q

ortolani test

A

hip click
also called Barlow

46
Q

trandelenburg sign

A

standing on one leg, patient drops hip on other side (older kids)

47
Q

congenital clubfoot (talipes equinovarus)

A
  • deformity of the ankle and foot that involves bone deformity and malposition with soft tissue contracture (can’t manipulate them straight)
  • also positional clubfoot - crowding that needs stretching and casting and syndromic clubfoot (other diseases)
  • serial casting - new cast every 1-2 weeks for 8-12 weeks
  • surgery
  • wear splint or brace after surgery
  • monitor for potential injury related to the cast
  • altered family process with child physical defect
48
Q

osteogenesis imperfecta

A
  • group of inherited disorders of connective tissue - “brittle bone disease”
  • connective tissue and bone defects due to abnormal precollagen
  • CM - bone fragility and deformity, poor growth, blue sclerae, pre-senile hearing loss, thin skin, excessive diaphoresis and teeth discoloration, mild hyperexia
  • could be confused with child abuse
  • prevent contractures and deformities, prevent muscle weakness and osteoporosis, prevent malalignment
  • treat with braces/splints, surgery to correct deformity
  • panidronate disodium (IV) - aids bone healing and bone resorption (or calcitonin and biphosphonates)
  • careful handling to prevent fractures (BP)
  • teach limitations in activity
49
Q

legg-calve-perthes disease

A
  • idiopathic, self-limiting necrosis of femoral head (unilateral)
  • peaks in school age
  • disturbance in circulation to proximal femoral epiphysis causing 4 stage necrosis
  • CM - insidious onset, most evident when arising and end of day (hip/knee/ thigh pain), intermittent limp pain on affected side, trandelenburg sign, decreased joint ROM, hx of trauma
  • diagnose with radiography
  • goal is to keep head of femur contained with abduction
  • initial NWB period to reduce inflammation and restore motion
  • various types of containment devices
  • surgical reconstruction
  • teach them diversional activities, encourage them to return to school
50
Q

scoliosis

A
  • spinal deformity that includes lateral curve, spinal rotation, or thoracic kyphosis
  • CM - non-painful lateral curve of spine, asymmetry of hips and shoulders, unequal scapula, unequal ribs, asymmetry of abdominal folds
  • if mild, monitor
  • if moderate, bracing (educate importance of adherence)
  • if severe, surgical spinal fusion
  • preop for surgery - may need halo traction, teach them how to log roll and how to work PCA pump
  • post op - monitor for low BP, monitor their back for skin breakdown, keep flat, log roll, many post-op complications
51
Q

superior mesenteric artery syndrome

A

duodenal compression by the aorta and superior mesenteric artery that may result in acute duodenal obstruction
- post op risk of scoliosis
- s/s - vomiting, epigastric pain, nausea, aggravated symptoms when patient is on back, better positioning on left side or belly

52
Q

juvenile idiopathic arthritis

A
  • chronic inflammatory disease of synovium
  • systemic, pauciarticular (less than 5 joints, can lead to blindness), polyarticular (more than 5 joints, spinal and hip involvement)
  • CM - spiking fever, skin rash, pericarditis, morning stiffness, swelling of joint, joint warm to the touch, malaise, anorexia, weight loss, loss of motion, eye problems
  • need to exercise - swim
  • prevent deformity and treat pain
  • exercise and heat to relieve pain
  • prevent obesity
53
Q

osteomyelitis

A
  • infectious process of the bone caused by any organism from endogenous or exogenous cause
  • most often involves femur and tibia
  • patho - bacterial infection carried to bone, excess formation and local bone destruction, dead bone forms, bone becomes honeycombed with sinuses, exacerbations
  • CM - ill appearance, abrupt bone pain, unwilling to move limb or bear weight, fever, irritability, malaise, poor appetite
  • ESR, WBC, cultures
  • IV abx, bedrest is first treatment with pain control
  • surgical draining of abscess
  • complications - factors and chronic condition
  • maintenance of picc, cast care, high cal diet with protein*, prevent heavy activity
54
Q

variations for pediatrics in the hematologic system

A
  • red blood production shifts from the liver to the bone marrow
  • hgb F is predominant for the first 6 months of life
  • fetus receives iron through the placenta from the mother and stores iron for later use
55
Q

what labs help determine the type of anemia?

A

MCV
MCHC
MCH

56
Q

What precautions should a child with low platelets be under?

A
  • > 100,000 - no contact sports and wear protective equipment
  • 50,000-100,000 - padding with activity, protective equipment
  • <50,000 - extreme caution, quiet activities
  • > 20,000 - kids can return to school
57
Q

What do high lymphocytes indicate?

A

viral infection

58
Q

What do high neutrophils indicate?

A

bacterial infection

59
Q

What is ANC?

A

absolute neutrophil count
want 1000+, less than 500 means likely to get an infection
%segs+%bands

60
Q

Nursing Interventions for Neutropenia

A
  • monitor VS, temp >100 is considered a medical emergency
  • inspect skin for breaks and redness
  • inspect mouth for ulcers
  • no flowers or plants in the room
  • low bacteria diet
  • sterility
  • no live virus vaccines
  • avoid contact with people who carry viruses
61
Q

anemia

A
  • individual cannot conduct activity because oxygen carrying capacity in blood is too low
  • caused from hemorrhage, hemolysis, bone marrow suppression, absence of substances needed for production
  • CM - anorexia, pallor, skin breakdown, jaundice, tachycardia, tachypnea, altered LOC, weakness/low exercise tolerance, gum hypertrophy, smooth tongue, blood in urine or stool, infections, cold intolerance
  • effects on circulatory system - hemodilution, decreased peripheral resistance, increased cardiac circulation and turbulance, cyanosis, delayed growth
  • management - treat cause, fluids to replace volume, oxygen, bedrest
  • NC - decrease oxygen demands, prevent complications
62
Q

iron deficiency anemia

A
  • body does not have enough iron to produce hgb
  • CM - irritability, anorexia, pallor of skin, mild growth delay, exercise intolerance, frequent infections, cognitive delays, behavioral changes
  • etiology - inadequate iron stores at birth (premature), deficient intake, impaired iron absorption
  • management - breast milk or commercial formula for first 12 months - limit to 24 ounces a day, start nutritional supplements at 6mo, iron supplements, blood transfusions
  • NC - teach foods rich in iron, teach them to lock up supplements - look like candy
63
Q

how to administer oral iron

A
  • best absorbed in acidic environment, give through straw, increase fluids and fiber in the diet, avoid coffee/tea/dairy/ whole grains one hour after admin
  • SE - GI disturbance, constipation, staining of teeth, tarry stools, overdose is lethal*
64
Q

aplastic anemia

A
  • bone marrow failure
  • treatment - BMT, stem cell transplant, immunosuppressive therapy
65
Q

sickle cell anemia

A
  • usually asymptomatic until 6mo
  • partial or complete replacement of normal hbg with hgbS which is less soluble and abnormally shaped (more rigid, fragile, and rapidly destroyed)
  • complications - acute painful episodes, stroke, sepsis, acute chest syndrome, reduced visual acuity, chronic leg ulcers, delayed growth and development, delayed puberty, priapism, enuresis
  • prognosis - no cure, can get BMT, death can be caused by bacterial infection, stroke, etc
  • dx - hgb electrophoresis
  • treatment - etythropoetin, hydroxyuria, PCN
  • prevent crisis with fluids
66
Q

sickle cell crisis

A
  • acute exacerbations
  • precipitating - increase in need for oxygen, trauma, infection, fever, physical and emotional stress, increased blood viscosity, hypoxia*
  • vaso occlusive crisis - very painful, clumping of cells leading to ischemia and infarction, signs are pain, fever, and tissue engorgement
  • splenic sequestration - life threatening, blood pools in spleen, signs are profound anemia, hypovolemia, and shock
  • aplastic crises - diminished production and increased destruction of RBC, triggered by viral infection, sings are profound anemia and pallor
67
Q

acute chest syndrome

A
  • similar to pneumonia
  • infection that results in sickling of the lungs
  • s/s - chest pain, fever, cough, tachypnea, wheezing, and hypoxia
  • repeated episodes can lead to pulmonary HTN
68
Q

crisis management of SCA

A
  • maintain hydration
  • maintain oxygenation
  • pain management
  • support for child and family
69
Q

thalassemia

A
  • inherited blood disorders of hgb synthesis
  • both parents must be carriers
  • causes RBCs to be rigid and easily hemolyzed, severe hemolytic anemia that leads to hypoxia
  • chronic hypoxia - h/a, irritability, precordial and bone pain, exercise intolerance, anorexia, epistaxis
  • A thalassemia - a chains effected
  • B thalassemia - b chains effected, has four forms (RBC breakdown causes excess iron to be released into blood, give vitamin c to release iron)
  • CM - severe anemia, bronze skin tone, growth delay, cardiac enlargement, bone pan, skeletal deformities, fractures
  • death can be due to heart failure or iron overload
  • diagnosied with hgb electrophoresis
  • management - transfusions, treat hemosiderosis with iron chelating drugs, give vitamin C to bind with iron
  • NC - monitor chelation therapy for too much iron (n/v/d, rash, decreased appetite, neutropenia, excreted through the kidneys so hydration is vital*)
70
Q

idiopathic thrombocytopenia purpura

A
  • autoimmune destruction of platelets in the spleen, could be acute or chronic
  • many children recover spontaneously in 6-12mo
  • CM - sudden onset of easy bruising, purpura, and petechiae, epistaxis
  • platelet count is less than 20,000, prolonged bleeding time
  • cannot give them platelets
  • treatment - anti D antibody (check RBC and make sure you have enough), IVIG, steroids, splenectomy, IV gamma globulin if chronic
  • nursing interventions - assess for bleeding, prevent trauma, avoid unnecessary sticks/procedures, no rectal temps, apply pressure for 5 mins after stick
71
Q

hemophelia

A
  • bleeding disorders that result from deficiencies of specific clotting factors
  • hemophilia A - deficiency for factor 8, most popular
  • hemophilia B - deficiency of factor 9, “christmas disease”
  • CM - symptoms may not occur until 6mo, mobility leads to injuries from falls and accidents, hemarthrosis (bleeding into joint), ecchymosis, epistaxis, bleeding after procedures
  • management - prevent bleeding, replace deficient factor, regular exercise and PT
  • NC - prevent bleeding, recognize bleeding, RICE while preparing factor, be suspicious of h/a, slurred speech, altered LOC, black tarry stools, prevent side effects of bleeding, nutritional counseling (prevent obesity, high iron foods)
72
Q

early signs of hemoarthrosis

A

stiffness, tingling, ache followed by decreased mobility, warmth, redness, swelling, and severe pain

73
Q

HS purpura

A
  • unknown etiology, often follows URI
  • generalized vasculitis of dermal capillaries, extravasation of RBCs, produces petechial skin lesions, inflammation and hemorrhage of GI tract, may lead to ongoing and nephrotic syndrome
  • may resolve without treatment
  • management - steroids, anticoags, symptomatic treatment, maintain hydration, monitor renal function
74
Q

severe combined immunodeficiency disease

A
  • defect of both humeral and cell mediated immunity
  • CM - early frequent infections, FTT, chronic diarrhea, persistent thrush, adventitious sounds, low levels of immunoglobulins, attack grafts
  • management - IVIG, sterile environment, BMT, prevent exposure to infections, support and educate family
75
Q

HIV

A
  • causes wide spectrum of illnesses
  • alterations in T cell function that may effect B cells, killer cells, monocytes
  • rapidly infects CNS, inability to create antibodies
  • kids haven’t been exposed to as many illnesses to be protects and the transmission is different in children
  • commonly from infected mother, blood transfusions, and unprotected sex
  • CM HIV - lymphadenopathy, hepatosplenogegaly, oral candidiasis, chronic diarrhea, development delay, parotits
  • CM aids - serious recurrent bacterial infections, pneumocystitis carnii pneumonia, candidal esophagitis, HSV, encephalopathy, wasting syndrome, cryptosporidiosis
  • dx - PCR*, ELISA, western blot
  • management - antiretroviral therapy, aggressive abx, prophylaxis
  • NC - no breastfeeding, make sure mom is on antiviral for 2/3 trimester, decrease risk for infection, increase protein and cals
  • encourage child to participate in play with other kids
76
Q

cardinal symptoms of cancer in children

A
  • unusual mass or swelling
  • unexplained paleness and energy loss
  • sudden and easy bruising
  • localized pain or limping
  • prolonged fever or illness
  • h/a, vomiting
  • vision loss
  • rapid weight loss
77
Q

CNS tumors

A
  • difficult to treat, poor survival rates
  • CM - h/a, v, clumsiness, unsteady gate, cranial nerve neuropathy, seizures, fine motor abnormality, weakness, behavioral changes, FTT, vital sign change
  • surgery to remove whole or part of tumor, may use radiation to shrink tumor before surgery
  • NC - lay on affected side or supine, reduce ICP, neck flexion, NPO, eye care, comfort measures
78
Q

neuroblastoma

A
  • most common cancer in infancy
  • major tumor develops in adrenal gland or retroperitoneal sympathetic chain
  • s/s depend on location and size
  • dx - radiologic studies, bone marrow eval, IVP to evaluate renal involvement
  • management - surgery, radiation, chemo, BMT
79
Q

hodgkins lymphomas

A
  • reed sternberg cells invaded
  • neoplastic disease originating in lymph system, often metastasizes to spleen, liver, bone marrow, lungs, and other tissues
  • B lymphocytes grow in lymph tissue, cells multiply
  • linked to epstein barr
  • s/s - painless enlargement of lymphnodes, fever, night sweats
  • treatment - radiation, chemo, stem cell transplant
  • complications - liver failure, secondary cancers, delayed puberty
  • significant pain in effected area when drinking alcohol
80
Q

non hodgkins lymphoma

A
  • invaded lymphocytes
  • clinical appearance - usually diffuse rather than nodular, typical to have involvement of meninges
  • complications - metastasis, secondary malignancy
  • managment - chemo
  • s/s - pain, lymph nodes swelling, diarrhea, constipation, cough, dyspnea, orthopnea, facial edema, venous engorgement (may signal mediastinal disease - emergency)
81
Q

how to diagnose bone tumors

A
  • first rule out trauma
  • radiologic studies and bone biopsy*
  • MRI to evaluate neurovascular and soft tissue extension
  • may have elevated alk phos
82
Q

osteogenic sarcoma

A
  • mainly in long bones, especially legs
  • s/s - pain, limp, decreased LOC
  • complications - metastasis
  • may be diagnosed with fx
  • may amputate or resect, salvage limb with prosthetic, chemo accompanying surgery
  • treat pain - may have phantom limb pain
83
Q

ewing sarcoma

A
  • arises in marrow, highly malignant
  • s/s - intermittent pain that progressively worsens to constant and severe, swelling and erythema at site, systemic symptoms
  • treatment - radiation, chemo as adjunct, myeloblative chemo followed by stem cell for severe, surgical resection
  • avoid play time or weight bearing
84
Q

rhabdomyosarcoma

A
  • neoplasm originating from undifferentiated mesenchymal cells in muscle, tendon, bursa, and fascia or in fibrous connective, lymphatic, or vascular tissue
  • s/s depend on site and compression of adjacent tissues, vague symp
  • highly malignant and frequent metastasis, if possible, completely remove tumor, radiation is used, chemo may precede radiation
  • excellent prognosis if stage 1
85
Q

wilms tumor (nephroblastoma)

A
  • malignant neoplasm of the kidney, most often effects young children
  • encapsulated tumor
  • mostly a well child with an abdominal mass, malaise, anorexia, fever, hematuria, and HTN
  • treatment - immediate nephrectomy and removal of regional lymph nodes and chemo
  • handle and bathe carefully, monitor BP and I/O
  • abdominal palpation may rupture the tumor and spill tumor contents into the peritoneal cavity
86
Q

retinoblastoma

A
  • congenital malignant tumor that arises from embryonic retinal cells, many are non hereditary and unilateral
  • dx - cats eye reflex (most common sign), strabismus (eyes do not line up in the same direction), red/painful eye, glaucoma, blindness (late sign)
  • treatment - irradiation, cryotherapy, attempt to preserve vision in least-affected eye, for advanced tumors - enucleation and chemo
  • concern with development of secondary tumors
  • complications - may spread to brain and other eye, metastasis, secondary tumors
  • post op care for enucleation - large pressure dressing with dressing changes
  • educate family on strategies to protect vision in unaffected eye
  • siblings need eye exams every 1-3 weeks for first year of life
87
Q

testicular tumors

A
  • mainly malignant
  • treatment - orchiectomy followed by chemo and or radiation depending on metastasis
  • importance for physical examination
88
Q

leukemia

A
  • patho - stem cells in the bone marrow produce immature WBC which clone and fill marrow
  • consequences - anemia, infection from neutropenia, bleeding tendencies, spleen/liver/lymph nodes show infiltration/enlargement/fibrosis
  • s/s - fever, pallor, bleeding, lethargy, malaise, anorexia, large joint and bone pain
  • cardinal signs of bone marrow failure - petechiae, frank bleeding, joint/bone pain, fatigue
  • dx - bone marrow biopsy
  • management - treat symptoms, combo chemo, cranial irradiation
89
Q

nursing care for child with cancer

A
  • educate family on disease and treatment
  • treat administered drugs on schedule
  • treat complications
  • coping skills
  • growth and development maintained
90
Q

chemo

A
  • rapid induction of complete remission - lasts 3-4 weeks, chemo doesnt cross BBB
  • consolidation strengthens remission
  • intensification - destroys remaining cells
  • maintenance - prevent relapse
91
Q

signs of CNS involvement

A

h/a, persistent n/v, irritability, dizziness, seizures, behavior and personality changes, 6th cranial nerve palsy, lateral eye movement

92
Q

short term AE of chemo

A

immunosuppression, infection, myelosuppression, nausea, vomiting, oral mucositis, alopecia

93
Q

long term AE of chemo

A

microdonita (makes teeth small), missing teeth, hearing and vision changes, hematopoietic, immunologic, gonadal dysfunction, endocrine dysfunction, various alterations of cardiorespiratory and GI systems, second cancer

94
Q

what to do with n/v with chemo

A
  • administer antiemetics like ondansetron
  • avoid strong smells
  • small frequent meals
  • cool rather than hot
  • administer chemo early in day
95
Q

what to do with stomatitis from chemo

A
  • keep oral mucosa and teeth clean
  • use antifungal and antibacterial mouthwash to prevent opportunistic infections
  • rinse mouth with normal saline
  • magic mouthwash
  • avoid local anesthetics
96
Q

examples of oncologic emergencies

A

hemorrhagic cystitis
septic shock
hypercalcemia from large bone destruction
tumor lysis syndrome

97
Q

hemorrhagic cystitis

A

bleeding of bladder
encourage fluid intake
void frequently
administer mesna to protect bladder mucosa

98
Q

tumor lysis syndrome

A
  • tumor cell destruction releases high levels of uric acid, K, and phos into blood, could result in acute renal failure and death
  • RF - large tumor burden, sensitivity to chemo, high proliferative rate, high WBC at diagnosis
  • CM - flank pain, lethargy, nausea/vomiting, oliguria, pruritis, arrhythmias, impaired renal function, tetany, neurological and mental status changes
  • administer fluids, careful IO, DW, urine specific gravity should remain less than 1010, admin electrolytes and allopurinol to reduce conversion of metabolic by products, monitor for tetany and mental status changes
99
Q

AE of radiation

A
  • short term - fatigue, n/v, oral mucositis, myelosuppression, alterations in skin integrity at site or irradiation
  • long term - alterations in growth, hormone dysfunction, hearing and vision alterations, learning problems, cardiac dysfunction, pulmonary fibrosis, hepatic/sexual/renal dysfunction, osteoporosis, development of secondary cancer
100
Q

promoting adequate nutrition for a child with cancer

A

determine body weight for norm
determine child’s food preferences
admin antiemetics
weigh daily or weekly
offer high cal
administer vitamins
administer TPN

101
Q

When are vaccines during chemo considered inactivated?

A

given 2 weeks before or during chemo, should receive live 3 months after chemo has stopped

NSG (12 decks)

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