Pediatrics - Integumentary, Hematology, Oncology Flashcards
Impetigo
Contagious bacterial infection of the skin caused by B-hemolytic streptococci or staphylococci which is common in hot, moist environments.
Presentation of impetigo
Lesions that begins as vesicles or pustules surrounded by redness or edema and progress to exudative and crusting phases.
Interventions for impetigo
- Contact isolation
- Allow lesions to air dry
- Apply warm saline compressions
- Topical and oral antibiotics
Scabies
Parasitic skin disorder where the mite burrows into the epidermis to lay eggs
Interventions for scabies
- Topical application of scabicide to kill mites
- Permethrin use requires full body application left on skin for 8-14 hours and then washed off
- Clean linen daily
Severely burned children are at risk for
- Dehydration
- Infection
- Shock
- Metabolic acidosis
- Cardiovascular problems
- Severe Scarring
- Delayed growth
When administering fluid replacement to a burned child be sure to monitor:
- Urine Output
- Vital Signs
- Capillary refill
- Sensorium status (mental status)
Sickle Cell Anemia
A group of diseases in which hemoglobin A is partly or completely replaced by abnormal sickle cell hemoglobin S.
Hemoglobin S is sensitive to O2 levels in the blood and lowered levels cause these cells to assume a sickle shape, become rigid and clump together obstructing capillary flow.
Sickling is reversible however repeated sickling can cause the RBC to remain permanently sickled.
Risk factors for sickle cell anemia
- Genetics (hereditary)
2. Africa-american
Sickling of RBCs can occur when?
- Fever
- Dehydration
- Emotional/Physical stress
Interventions for Sickle Cell Anemia
- Fluid & electrolyte replacement
- Oxygen
- Transfusion
- 24-hourly analgesics (avoiding demerol which can cause seizures).
- Position for venous return and comfort.
- High calorie/ high protein diet
- Antibiotics
Vaso Occlusive Sickle Cell Crisis
Stasis of blood flow due to clumps in the microcirculation resulting in ischemia and infarction.
Splenic Sequestration (sickle cell anemia)
Pooling and clumping of blood in the spleen.
Hyperhemolytic crisis (sickle cell anemia)
Accelerated rate of red blood cell destruction.
Aplastic Crisis (sickle cell anemia)
Caused by diminished production and increased destruction of RBCs triggered by viral infection or depletion of folic acid.
Iron deficiency anemia
Iron stores are depleted resulting in reduced supply of iron for the manufacture of hemoglobin in RBCs.
Iron deficiency anemia can be caused by
- Blood loss
- Increased metabolic demand
- GI malabsorption
- Dietary inadequacy
Aplastic anemia
Deficiency of circulating erythrocytes and all other formed element of blood resulting rom arrested development of cells within the bone marrow.
Causes of aplastic anemia
- Chronic exposure to toxins
- viruses
- infection
- autoimmune disorders
- allergies
Interventions for aplastic anemia
Restore the function of the bone marrow through immunosuppressive therapy and bone marrow transplantation.
Symptoms of aplastic anemia
- petechiae
- pupura
- bleeding
- pallor
- weakness
- tachycardia
- fatigue
Hemophilia
A group of bleeding disorders resulting from deficiency of specific coagulation proteins. Transmitted as an X-linked chromosome disorder.
Symptoms / Presentation of Hemophilia
- Abnormal bleeding response to trauma
- Epistaxis
- Joint bleeding causing pain, swelling & limited range of motion
- Easy bruising
- Platelet count normal but clotting (aPPT) abnormal
Interventions for hemophilia
- Monitor for bleeding
- Administer factor VIII, DDAVP
- Monitor for joint pain
- Assess neurological status (brain bleed)
- Monitor for hematuria
- Apply pressure and ice to any active bleeding site
von Willibrand’s disease
Hereditary bleeding disorder characterized by a defective protein which causes platelets to adhere to damaged endothelium. Characterized by an increased tendency to bleed from mucous membranes.
Symptoms of von Willibrand’s disease
- Epistaxis
- gum bleeding
- easy bruising
- Excessive menstrual bleeding
β Thalassemia Major
Autosomal recessive disorder in which there is a decreased production of the globin chain. This is common in Italian, Greek and Syrian populations
Symptoms of β Thalassemia Major
- Frontal bossing (prominent forehead)
- Maxillary prominence
- Wide eyes, flat nose
- Green/Yellow skin tone
- Hepatosplenomegaly
- Severe anemia
- Microcytic and hypochromic RBCs
Interventions for β Thalassemia Major
- Administer blood products
2. Monitor for iron overload.
Leukemia
Malignant increase in the number of immature white blood cells in the bone marrow. Immature cells invade the bone marrow causing a decrease in RBCs and a decrease in platelet production. This can cause infection from neutropenia and bleeding due to low platelets.
Signs and symptoms of leukemia
- Fever, fatigue, pallor, anorexia
- hemorrhage due to low platelets
- infection due to neutropenia
- Low Hb, hematocrit and platelet levels
- Inter-cranial problems as CNS becomes involved
- Joint pain as the malignant cells invade bone marrow
Most common infection site for leukemia patients
- skin
- respiratory
- GI
Protective measures for leukemia patients
- Protective isolation
- Aseptic technique
- Wash daily with antimicrobial soap
- Assess frequently for signs of infection
- Avoid invasive procedures
- Bowel plan to prevent trauma
- Avoid live vaccines
Hodgkin’s Disease
A type of lymphoma characterized by a malignancy of lymph node cells
Where does hodgkin’s disease metastasize to?
- Spleen
- Liver
- Bone marrow
- Lungs
- Mediastium
How can you determine a diagnosis of Hodgkin’s disease?
By taking a lymph node biopsy and looking for Reed-Sternberg cells.
Symptoms of Hodgkin’s Disease
- Painless lymph node enlargement
- Non-productive cough
- Systemic reaction (pyrexia, anorexia, weigh loss, night sweats, pruritus)
- Positive Reed-Stenberg Biopsy
Treatment for Hodgkin’s Disease
Radiation - no mets
Radiation + Chemotherapy + Drugs - mets
What to monitor in a child being treated for Hodgkin’s Disease
- Pancytopenia (low RBC, WBC, platelets)
- signs of bleeding and infection
- Side effects of chemotherapy (malaise, n&v)
Nephroblastoma (Wilm’s Tumor)
Type of kidney cancer which occurs in one or both kidneys. Genetically inherited or associated with congenital abnormalities.
Signs and symptoms of Nephroblastoma (Wilm’s Tumor)
- Hematuria
- Swelling/abdo mass
- Urinary retention
- Anemia (due to tumor hemorrhage)
- Pallor, anxiety, lethargy
- Hypertension
- Weight loss
Pre-op Interventions for Nephroblastoma (Wilm’s Tumor)
- Monitor obs
- DO NOT PALPATE ABDOMEN (tumor can rupture)
- measure girth daily
Post-op Interventions for Nephroblastoma (Wilm’s Tumor)
- Monitor obs
- Monitor for hemorrhage and infection
- monitor fluid balance
- Monitor for bowel sounds and abdo distention
Neuroblastoma
Cancer that develops from immature nerve cells usually in the adrenal gland. Can also form in the chest, neck or pelvis.
Presenting signs usually caused by tumor pressing on surrounding tissue or organs. Usually found in children under 10.
Signs and symptoms of neuroblastoma
- Firm, irregular abdominal mass
- Urinary frequency or retention
- Lymphadenopathy
- Pallor, weakness, anorexia, weight loss
- Respiratory impairment (thoracic lesions)
- Neurological impairment (intercranial lesion)
- Elevated vanillylmandelic acid (VMA) urinary levels
Osteocarcinoma
Bone cancer usually found in the long bones of the lower extremities. Peaks between the ages of 10-25. Symptoms often attributed to trauma or growing pains.
Signs and symptoms of osteocarcinoma
- Localized pain
- Palpable mass
- Fractures
- Limited range of motion
Interventions for osteocarcinoma
- Surgical resection
- Limb amputation
- Chemotherapy
Infratenorial brain tumors
Located in the posterior 1/3 of the brain. Symptoms result from intracranial pressure.
Supratenorial brain tumors
Located in the anterior 2/3 of the brain.
Signs and symptoms of brain tumors
- Headache
- Vomiting
- Ataxia (Lack of muscle control during voluntary movements)
- Seizures
- Behavioral changes
Post-op care for brain tumors
- Monitor for signs of ICP
- Monitor for meningitis
- Monitor for pyrexia
- Monitor for hemorrhage
- Neuro obs and pupil response
Signs of ICP
- Headache
- Nausea & forceful vomiting
- Diplopia
- Seizures
- Irritability and restlessness
- Lethargy
Allogeneic bone marrow transplantation
Bone marrow is transplanted from a matching donor into the child.
Autologous bone marrow transplantation
Bone marrow is removed from the child, frozen and reinserted when required.
Syngeneic bone marrow transplantation
Bone marrow removed from the child’s twin and donated to the child.
