Pediatric Hematologic Disorders + leukemia NUR 2310 Flashcards
the parent of a 12 yr notice that their child gets sick often. she looks pale, bleeds easily when brushing her teeth and complains of pain in her legs. what does the nurse say.
she should get diagnosed for leukemia
Consequences of Leukemia
Clinical findings
Decreased erythrocytes: anemia (e.g., pallor, weakness, irritability)
Decreased neutrophils: increased risk for infection (e.g., fever)
Decreased platelets: bleeding tendencies (e.g., ecchymoses, petechiae, bleeding gums and other mucous membranes)
Invasion of bone by leukemic cells: bone pain, fractures
Enlarged spleen, liver, and lymph glands
Intestinal inflammation: anorexia, vague abdominal pain
Later signs: central nervous system (CNS) involvement and frank hemorrhages
Diagnostic Evaluation of Leukemia
Based on the history and physical manifestations
Peripheral blood smear
Immature leukocytes
Frequently, low blood counts
Lumbar puncture to evaluate central nervous system (CNS) involvement
Bone marrow aspiration or biopsy
Therapeutic Management of Leukemia
Chemotherapeutic agents
Cranial irradiation (in some cases)
Hematopoietic stem cell transplantation (HSCT)
limited, visitors that are not sick, no uncooked foods, no fresh fruits and veggies. what are these precautions called
Neutropenic precautions
Normal Hemogram Values 6 to 16 years old
WBC: 4.8- 10.8
RBC: 4.0- 5.2
Hgb: 10.3-14.9
the 8 yr child comes for an assesment. the parent report beeding when brushing teeth, and epistaxis. the child also reports bleeding for no reason. purpuric rash noticed. what is this clotting disorder called
Idiopathic thrombocytopenia purpura (ITP)- Autoimmune disorder
Low platelet
Results in purpura
ITP signs and symptoms
Petechiae
Pinpoint hemorrhages occurring on the body that do not blanch to pressure, Purpura
Larger purplish areas of hemorrhage in which blood collects under the tissues. Preceding viral infection, Epistaxis
Mucosal bleeding
Purpuric rash
Spontaneous bleeding
Chronic
Splenomegaly
how is ITP treated
Platelet level
Acute- self restricting
IV corticosteroids
IV immunoglobulins
Splenectomy
idiopathic[do not know the cause]
the child has swollen knees, and his small cut has been bleeding longer than usual, what blood clotting issue could this be
Hemophilia or ITP
A diagnostic test of Platelet count, Prothrombin time, and
Partial thromboplastin time was ordered. it revealed that the child is missing factor VIII, what is this condition
Hemophilia A: factor VIII deficiency (classic hemophilia)
what is Hemophilia
Genetic disorder caused by a defect in the clotting mechanism
Hemophilia A: factor VIII deficiency (classic hemophilia)
Hemophilia B: factor IX deficiency (Christmas disease)
Both types of hemophilia are sex-linked recessive disorders.
what are other symptoms the child can present
Easy bruising
Ecchymosis[bruise skin]
Hematomas
Prolonged bleeding
GI bleed
Hematuria
Severe nose bleeds
Hemarthrosis[bleeding knee joint]
Desmopressin, a medicine that stimulates factor VIII was prescribed. what other education should be given to parent and child
Avoid contact sports and medications that promote bleeding
Intravenous administration of the specific coagulation factor the client is lacking
the parent is so relieved that their child will be healed and asked how long he will be on this medicine. what is the nurses response
your son will be able to live normally, but the treatment is life long since it is a hereditary disorder
arconym RICE
Raise, Ice, Compress, Elevate
the parent ask how will they deal with swollen joints, what do you recommend
Immobilize and elevate affected joint, ice placed on joint[no direct skin contact, place ice in cloth] to promote vasoconstriction. administer factor VIII
Thing recommended To prevent permanent joint degeneration.
Elevate joint and immobilize during acute bleeding episode.
Encourage active range of motion so child will limit movement based on pain tolerance.
Physical therapy after the acute phase, no weight bearing until swelling has resolved.
Maintain pain relief during physical therapy.
Wilms Tumor things to know
Most common renal tumor
Occurs between the ages of 2 and 5 years old
Can affect 1 or more kidneys
Etiology is unknown
Growth is rapid and it is usually large at diagnosis
Metastasis occurs through the bloodstream
Prognosis depends on staging at diagnosis and extent of metastasis
Wilms Tumor Therapeutic Management
Surgical removal of tumor and affected kidney
Radiation or chemotherapy (before or after surgery)
Obtain thorough health history and exam
what is Hodgkin Disease
Start as malignant B lymphocytes in the lymph tissue
Usually in one general area of the lymph nodes
Presence of Reed-Sternberg cells differentiates Hodgkin disease from other lymphomas
Cells multiply, lymph nodes enlarge, nearby structures are compressed, normal cells are destroyed, and other tissues are invaded
Cause unknown
Risk Factors- family hx of Hodgkin, HIV, prior Ebstein Barr virus, genetic immune disorder
treatment of Hodgkin Disease
Treatment
Chemotherapy treatment choice
Radiation may be necessary
what are the chances of two parents with the Hgb AS trait to get a child with sickle cell disease
25% sickle cell, 50% carrier, 25% normal
