T3 - Blueprint 3 (Josh) Flashcards
— is NOT associated w/ a neurological deficit b/c there are no nerves in the sac.
Meningocele
Leukemia is more common with who?
- whites
- boys
- family history
- Down’s Syndrome
Normal HCT
Male: 38.8 - 50.0%
Female: 34.9 - 44.5%
How is Wilm’s Tumor treated?
Surgery to remove kidney/tumor
Chemo (dactinomycin or vincristine)
Postop Radiation
Meds for ICP
Mannitol and steroids
Midazolam
Antibiotics
Antiepeleptics
Barbituates
Phenobarbital
Signs of ICP
headaches
irritability
HIGH PITCHED CRY (Cat Cry)
Vomiting
Visual Changes
Ataxia
Seizures
After amputation w/ Osteosarcoma, what drugs help treat phantom limb pain?
TCA Antidepressants
Unilateral dilated pupils indicate —
Fixed dilated pupils indicate —
Bilateral fixed and dilated pupils indicate —
intracranial mass
brainstem herniation
brainstem herniation from ICP
— is a very serious form of Lymphoma and is treated aggressively.
NHL
- radiation
- chemo
— is a malignancy that occurs in the adrenal gland, sympathetic chain of the retroperitoneal area, head, neck, pelvis, or chest.
Neuroblastoma
What is Hemorrhage Cystitis and how is it treated?
S/E of Chemo where a sudden onset of hematuria combined with bladder pain and irritative bladder symptoms.
treat w/
- encourage fluids
- encourage frequent voiding
- mesna to protect bladder
Oftentimes, with osteosarcoma, there can be temporary relief of pain when —
extremity is flexed
What is the purpose of chemo for Retinoblastoma?
to reduce tumor size so that other treatments can be used
Leukemia can lead to…
- Deficient RBCs = —-
- Deficient WBCs = —
- Deficient Platelets = —
Anemia
Neutropenia
Thrombocytopenia
Which stage of NHL?
single tumor w/ regional involvement on SAME SIDE of diaphragm
Stage 2
Which stage of NHL?
Any of stages 1-3 plus CNS or bone marrow involvement
Stage 4
The following are LATE SIGNS of which type of cancer?
- Pain
- Hematuria
- Ulcerations in mouth
- Enlarged kidneys and TESTICLES
- ICP
Leukemia
Positive signs for meningitis:
Brudinski Sign
flex the child’s head while supine
if this makes knees or hips flex involuntarily, it is a positive sign
B for brain (lift head)
Which Stage of NHL?
single tumor at single site
Stage 1
— seizures are drop attacks.
Atonic or Akinetic
- can cause injuries to face and head b/c they are unable to break their fall
We want our Hgb to be above —
11 gm/dL
What is Intrathecal Chemotherapy?
chemo administerd via lumbar puncture to treat cancers that have reached the CNS
Positive signs for meningitis:
Kernig Sign
raise leg w/ knee flexed then extend leg at knee
if resistance or pain, it is positive sign
K for knee (flex the knee)
Foods rich in Folic Acid are —
Foods rich in Vit C are —
Folic Acid
- leafy green veggies
- beans
- citrus fruits
- breads
- cereals
- rice
- pastas
Vit C
- bell peppers
- dark leafy greens
- kiwi
- broccoli
- berries
- tomatoes
- peas
- papayas
- citrus fruits
Which type of Lymphoma is more diffuse through the body, Hodgkins or Non-Hodgkins?
Non-Hodgkins
- also cell type is undifferentiated
- dissemination is earlier and faster
- mediastinal involvement and invasion of meninges also is typical
– is toxic encephalopathy that can be caused by ASA use in kids?
Reye’s Syndrome
- also pepto bismol
What is reduced and elevated w/ VIRAL Meningitis?
Protein slightly elevated
WBC elevated (500 or more)
Treatment for Rhabodmyosarcoma?
surgical biopsy, local radiation and chemo, rather than radical surgical procedures
What will be reduced and elevated with BACTERIAL Meningitis?
Glucose reduced
Protein elevated
WBC elevated (1000 or more)
Why is Intrathecal Chemo necessary?
typically, BBB prevents chemo drugs from crossing into brain to treat cancer there
so it must be administered into the spinal column
Surgery for spina bifida is usually done when?
24-48 hrs after birth
Setting sun eyes are a sign of —
hydrocephalus
Ways to manage seizures w/out meds?
Ketogenic Diet
VNS
Which vaccine helps prevent Viral Meningitis?
H flu
— clients always end up in ICU
Encephalitis
The Tonic phase lasts —
The Clonic phase lasts —
10-20 secs (stiffening)
30 secs (clonic muscle activity)
Which posture is associated w/ an injury above the brainstem?
Decorticate
- corting is a HIGHER FORM of dating
What is Cushing’s Triad?
Bradycardia
Bradypnea
High BP
- all LATE signs of ICP
Normal Leukocyte values?
4,500 - 11,000
Which positiion is associated w/ meningitis?
opisthotinic position
- head and neck hyperextened to relieve discomfort
— seizures last 5-10 seconds and is more common in girls.
Absence (petit mal)
— is the use of freezing to destroy bloodflow to teh tumor w/ Retinoblastoma.
Cryotherapy
— is a cancer that originates in the lymphoid system.
Hodgkins
Management of Meningitis?
ELEVATE HEAD
reduce stimulation (dark room, limit visits)
— is the most common cause of childhood cancer.
Leukemia
What is the third most common cancer in Peds?
Non-Hodgkins Lymphoma
LOC levels
Lethargy
Obtunded
Stupor
Coma
Persistent Vegetative State
Meds for Seizures
Diazepam
Phenytoin
Carbamazepine
Valproic Acid
Fosphenytoin Sodium
Ethosuximide
The following are S/S of which type of cancer?
- Pallor, eays bruising, lethargy, malaise
- Enlarged liver, lymph nodes, joints
- Abdominal, leg, and joint pain
- Constipation, headache, vomiting/anorexia, unsteady gait
Leukemia
Spina Bifida is closely associated w/ —
hydrocephalus
Which seizure if often mistaken for daydreaming in class?
Petit Mal (Absence)
Why should bed be flat postop for shunt placement?
to avoid overdrainage
Glasgow Coma Scale measures…
Eye opening
Verbal Response
Motor Response
Normal Platelet values?
150-450 billion
How effective is chemo with advanced Retinoblastoma?
not effective
no evidence it increases survival rates
The following are s/s of which type of cancer?
- leukocoria
- strabismus
- blindness
Retinoblastoma
Which stage of NHL?
tumor on both sides of abdomen; also, all primary thoracic, intraabdominal and paraspinal or erpidural tumors.
Stage 3
What is the most common finding w/ Hodgkins Lymphoma?
firm, nontender, enlarged movable nodes in supraclavicular or cervical area
When we typically think of seizures, we think of which kind?
Tonic Clonic (Grand Mal)
What are the four phases of Tonic Clonic (Grand Mal)?
Aura phase
Tonic Phase
Clonic Phase
Postlictal Phase (altered LOC after seizure is over)
– is premature closure of the sutures (or absence of sutures) leading to cone-head type appearance.
Craniosynostosis
How will CSF appear w/ Meningitis?
cloudy (should be clear)
The following are s/s of which type of childhood cancer?
- Firm, nontender, abdominal swelling/mass
- Fatigue, malaise, weight loss
- Fever
- Hematuria
- HTN
Wilm’s Tumor (Nephroblastoma)
Which chemo is good for Wilm’s Tumor?
Dactinomycin
Vincristine
Inflammation of brain usually caused by viral infection like meningitis.
Encephalitis
What is Polycythemia and what are the complications?
increased concentration of Hgb in blood
This can be associated with higher risk of thrombus or clot formation leading to strokes, heart attacks, pulmonary embolism, and possibly death.
Another complication of polycythemia vera is the potential transformation into a blood cancer (leukemia), excessive bleeding (hemorrhage), or clotting problems.
Half of children w/ — have few symptoms.
neuroblatoma
With encephalitis, — impairment is common.
neurological
Reflex:
Infant swings to the side that is stroked
galant reflex
What is Agranulocytosis and what are the complications?
deficiency in granulocyts in blood
increased vulnerability to infection
Nephroblastoma is another term for which type of cancer?
Wilm’s Tumor
What is SVC Syndrome?
obstruction of Superior Vena Cava which leads to swelling of upper arm, face and neck
happens w/ NHL
Some general S/E of Chemo include:
Mucosal Alteration
Skin breakdown
Neuropathy
Loss of appetite
Hemorrhage Cystitis
Alopecia
Which Stage of Hodgkins?
lesions in one lymph node area or only one extralymphatic site
Stage 1
—- is seizure that lasts more than 30 mins, or a series of seizures which are so rapid that they don’t allow child to regain consciousness before next one.
Status Epilepticus
When is Rhabodmyosarcoma painful?
when tumor starts pressing against vital structures
sometimes there is no pain with Rhabdomyosarcoma
Leukemia causes an increase in what?
immature WBCs (bands) which then infiltrate into organs and tissues
Diagnosis of Encephalitis.
History
- recent immunizations
- recent travel (to areas w/ vectors)
- recent insect bites
How should we approach hydration w/ ICP client?
2/3 maintenance
we don’t want to increase ICP even more w/ too much fluid
Which Stage of Hodgkins?
lymph node regions on both sides of diaphragm, or one extralymphatic site, spleen, or both are involved
Stage 3
Which odd allergy is associated w/ spina bifida?
latex allergy
Is Cushing’s Triad an early sign or late sign of Brain injury?
LATE
Treatment for Bacterial Meningitis
IV antibiotics
Isolatoin for 24 hrs
Hydration
Antiseizure Meds
Mannitol
Glasgow coma scale scoring?
15 best
8 or less is bad
3 is worst
Which Stage of Hodgkins?
two or more node regions on same side of diaphragm or one additional extralymphatic site or organ on same side as diaphragm
Stage 2
What type of foods to prevent spina bifida?
Folic Acid and Vit C
Reflex:
Infant extends arm when head is turned toward that side
Tonic Neck
Which Stage of Hodgkins?
ancer has metastasized diffusely throughout body to one or more extralymphatic sites
Stage 4
Leukemia is classified how?
type of WBCs that are effected
- Acute Lymphoid Lukemia (ALL)
- Acute Myelogenous or Nonlymphoid Leukemia (AML/ANLL)
Where are we most likely to first see enlarged lymph nodes in Hodgkins Lymphoma?
Painful?
supraclaviular or cervical area
Not painful
— is a cancer that effects the ends of long bones.
Osteosarcoma
- distal femur
- proximal tibia
- proximal humerus
Which syndrome is a primary cause of Hydrocephalus?
Arnold Chiari Syndrome
– is the use of laserbeams to destroy retinal blood flow to the tumor w/ Retinoblastoma.
Photocoagulation
Seizure manifestation can be caused by —
Hyponatremia
Hypernatremia
Late: hypoglycemia
– is a type of cancer that effects skeletal muscle.
Rhabdomyosarcoma
- typically in head/neck and orbit of eye
Meds for Infantile Spasms
ACTH (gel form)
What concerns might the nurse have about sedation in the acute head injury patient?
interferes w/ the need to perform periodic LOC exams
Complications from Meningitis
DIC
Subdural Effusion
Sepsis
Septic Arthritis
Seizures
Hearing Loss (w/ gentamycin)
What is a Ketogenic Diet?
What?
- high fat
- low carb
- adequate protein
why?
- body can shift from using glucose as fuel, allowing brain to use it
An — hemorrhage is between skull and Dura Mater
A — hemorrhage is between Dura and Arachnoid.
Epidural
Subdural
What are Leukemic (Blasts)?
immature WBCs
affects the normal production or mature WBCs
Implantable device that reduces seizures?
Vagus Nerve Stimulation (VNS)
