Pediatric Hematologic Disorders + leukemia NUR 2310

Question 1

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.

Answer 1

she should get diagnosed for leukemia

Question 2

Consequences of Leukemia

Answer 2

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

Question 3

Diagnostic Evaluation of Leukemia

Answer 3

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

Question 4

Therapeutic Management of Leukemia

Answer 4

Chemotherapeutic agents
Cranial irradiation (in some cases)
Hematopoietic stem cell transplantation (HSCT)

Question 5

limited, visitors that are not sick, no uncooked foods, no fresh fruits and veggies. what are these precautions called

Answer 5

Neutropenic precautions

Question 6

Normal Hemogram Values 6 to 16 years old

Answer 6

WBC: 4.8- 10.8
RBC: 4.0- 5.2
Hgb: 10.3-14.9

Question 7

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

Answer 7

Idiopathic thrombocytopenia purpura (ITP)- Autoimmune disorder
Low platelet
Results in purpura

Question 8

ITP signs and symptoms

Answer 8

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

Question 9

how is ITP treated

Answer 9

Platelet level
Acute- self restricting
IV corticosteroids
IV immunoglobulins
Splenectomy
idiopathic[do not know the cause]

Question 10

the child has swollen knees, and his small cut has been bleeding longer than usual, what blood clotting issue could this be

Answer 10

Hemophilia or ITP

Question 11

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

Answer 11

Hemophilia A: factor VIII deficiency (classic hemophilia)

Question 12

what is Hemophilia

Answer 12

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.

Question 13

what are other symptoms the child can present

Answer 13

Easy bruising
Ecchymosis[bruise skin]
Hematomas
Prolonged bleeding
GI bleed
Hematuria
Severe nose bleeds
Hemarthrosis[bleeding knee joint]

Question 14

Desmopressin, a medicine that stimulates factor VIII was prescribed. what other education should be given to parent and child

Answer 14

Avoid contact sports and medications that promote bleeding
Intravenous administration of the specific coagulation factor the client is lacking

Question 15

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

Answer 15

your son will be able to live normally, but the treatment is life long since it is a hereditary disorder

Question 16

arconym RICE

Answer 16

Raise, Ice, Compress, Elevate

Question 17

the parent ask how will they deal with swollen joints, what do you recommend

Answer 17

Immobilize and elevate affected joint, ice placed on joint[no direct skin contact, place ice in cloth] to promote vasoconstriction. administer factor VIII

Question 18

Thing recommended To prevent permanent joint degeneration.

Answer 18

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.

Question 19

Wilms Tumor things to know

Answer 19

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

Question 20

Wilms Tumor Therapeutic Management

Answer 20

Surgical removal of tumor and affected kidney
Radiation or chemotherapy (before or after surgery)
Obtain thorough health history and exam

Question 21

what is Hodgkin Disease

Answer 21

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

Question 22

treatment of Hodgkin Disease

Answer 22

Treatment
Chemotherapy treatment choice
Radiation may be necessary

Question 23

what are the chances of two parents with the Hgb AS trait to get a child with sickle cell disease

Answer 23

25% sickle cell, 50% carrier, 25% normal

Question 24

the child presents with swollen hands and feet, and complains of pain. what is occuring

Answer 24

a Vaso-occlusive crisis. Vaso-occlusive crisis: blood flow is impaired by sickled cells, causing ischemia and pain to affected area.

Question 25

Sequestration crisis

Answer 25

pooling of the blood in the liver and spleen with decreased blood volume.