t4 U10 - hematology/oncology Flashcards
normal RBC level for 1-6 yr?
4.5-5
normal RBC level for 6-18Y?
4.5-5
normal Hmg for 1-6?
9.5-14
normal Hmg for 6-18?
10-15.5
normal Hmt for 1-6?
30-40%
normal Hmt for 6-18?
32-44%
s/sx of Anemia?
Fatigue/Lethargy
SOB
Tachycardia
Pale skin
Dizzy
what would a CBC show for a suspected anemic patient?
Low RBC
Low hmg
Low hmt
Low reticulocyte count
iron supplement considerations?
Give with Vit C rich foods
Brush teeth after (can stain)
DONT give with milk
common age for children to develop anemia & why?
2-3Y
Food lags
who is at highest risk for iron deficient anemia?
pre mature infants & btwn 6-12mth
what would be good to include in a childs diet to increase Iron?
Beans
Red meat
Fortified cereal
Eggs
Green leafy veggies
what should be monitored with taking iron?
constipation – increase the fiber
what is a common finding when taking iron supplements?
black tarry stools
sickle cell can present with _____?
Pallor
Fatigue Jaundice
Tissue hypoxia
ensuring what for sickle cell patients can increase the good outlook?
being up to date on vaccines
primary to focus on for sickle cell?
Rest
Hydration
Pain control
Oxygenation
what organ can become damaged/overworked from sickle cell?
Spleen
what medication can be given at home for sickle cell pain?
Acetaminophen/Ibuprofen
if in a vaso-occlusive crisis, what medication is given?
Morphine (Duramorph)
Ketorolac (Toradol)
edu about Toradol?
No longer than 5 days due to GI bleeding
what can be observed with a vaso-occlusive crisis?
Tissue engorgement
Pain
with aplastic sickle cell, what should be closer monitored/why?
Fever (101.5+)
Body cant filter out bacteria = sepsis
what symptoms would be present in splenic sickle cell that = life threatening?
profound anemia
hypovolemia
shocl
lack of what factor causes hemophilia A & that does what?
factor 8
can’t form clots = prolonged bleeding
s/sx of hemophilia?
Bruising
Soft tissue bruising
Intracranial hemorrhage (infants)
Excessive bleeding
situations were hemophilia bleeding could be seen?
circumcision
tooth removal/loss
what is hemarthrosis?
Internal bleeding btwn joint spaces
most common sites for Hemarthrosis?
Knees
Elbows
presentation of hemarthosis?
Swelling
Warmth/redness
Loss of redness
what should a child with hemophilia avoid doing?
playing sports
does hemophilia always present immediately?
No
Can present at 6m
steps to take for bleeding with hemophilia?
Pressure for 15 min
Ice application
Factor 8 given at hospital
what medical related things should hemaphilia pt avoid?
Im injections
Aspirin
important education for adolscents with hemophilia?
how to self administer IV factor
level that classifies as Neutropenia in infants?
<1,000/uL
level that classifies as Neutropenia for 1y +?
<1,500u/L
bruising, pale and petechiae can present with Neutropenia, why/what is the cause?
Neutropenia effects RBC & platelets
s/sx of Neutropenia?
Lymphadenopathy
Pallor
Fever
Bruising
Fever
what is important to assess with Neutropenia?
underlying infection
especially around mouth, skin, ears & perianal area
how would a Neutropenia be placed in a hospital?
reverse isolation
how would be Neutropenia room be set up/have to do?
Nurse wear a gown
No roomie
No fresh fruit/flowers
when monitoring for infection with Neutropenia what is given?
broad spectrum ABX (Empiric therapy)
how can colony stimulating factors be given
@ home
SubQ injection once/day
considerations with Neutropenia?
No rectal temps
Avoid hot tubs
Use a soft toothbrush
what is not given to Neutropenia pt with low counts?
NSAIDS/Aspirin
important teaching for Neutropenia?
proper handwashing technique
what is done before giving blood transfusions?
2 PT identifiers
CONSENT
steps for pretransfusion of blood?
V/S
Call for blood
Hang blood w/in 30min but NO LONGER than 4 hr
what do you do when starting a blood transfusion?
V/S Q 15min
CAN’T leave for first 15 min (monitor for reaction)
Post blood transfusion, what does the nurse do?
Keep bag for an hour
Paperwork
what should the nurse wear during blood transfusion?
Gloves & goggles
what to do in case of reaction to blood transfusion?
Stop infusion
Call PCP
Flush line w/saline
Monitor VS
what is HSCT?
Bone marrow transplant
what are the 3 types of HSCT?
Autologous: Own stem cells
Allogeneic: Compatiable donor (usually sibling)
Syngeneic: Twin
indications for HSCT?
Sickle cells
Severe Aplastic anemia
what is characterisitc sign of asplastic anemia?
Pancytopenia: Reduction in all cellular elements of blood
possible hematological complication for PT with chronic illness?
Development of thrombosis
Most often in lung or extremity
what is the goal with chemotherapy?
Decrease size of primary tumor
Good for “broad spread”
what is the goal with radiation?
Break apart bonds within cell & cause to die
Delivers PRECISE targeting
what is the priority nursing intervention for infection prevention in cancer patients?
Neutropenic precautions
things to monitor/teach for infection prevention in cancer patients?
Meticulous skin care
S/sx of infection
Cisplatin can cause what complication?
high tone hearing loss
how can the kidney be affected by cancer treatment?
Bleeding
Protein wasting
Lung consequences of cancer treatment?
reduced elasticity = SOB, reduced exercise ability
if a cancer patient has open oral sores, what is the recommended diet?
bland foods
cancer patients are on what type of precautions?
neutropenic
(no flowers/fruit)
what/where does ALL focus on?
immature/undifferentiated cells
WBC
children who have what are at higher risk for ALL?
downs syndrome
what is a common “overview” of s/sx of ALL?
vague flu feelings
specific s/sx of ALL?
blueberry muffin lesions on trunk
petechiae
limping/refusal to walk
abdominal distention
where would the swelling be with ALL?
enlarged supraclavicular lymph nodes
why would a pt with ALL have abdominal distention? & why does it happen
enlarged spleen
can’t filter
what WBC counts would be best & worst to see in ALL?
Best: Under 5,000
Worst: 50,000
in worst case WBC how do we treat ALL patients?
Doxorubicin (abx)
what are the 3 phases of chemo?
remission-induction
consolidation
maintaince
what is the primary goals in remission induction?
reduce tumor to undetectable size
protect brain
consolidation stage consists of what?
destroy residual tumor
where is neuroblastoma most common?
the ABDOMEN
what s/sx would neuroblastoma present with?
palpation of mass
edema in LE
bruising/swelling around eyes
what would a neuroblastoma mass feel like?
crossess midline
hard & painless
what is a priority management in neuroblastoma
comfort
most important thing to know about wilm’s tumor patients?
NO ABDOMINAL PALPATION
s/sx of wilms tumor?
unilateral mass/abdominal swelling
Hematuria
what/where does Wilm’s tumor affect?
kidneys
what will happen if Wilm’s tumor is palpated?
Spread over body
important management for Wilm’s?
Monitor I&O’s & bowel output
Monitor BP
what should a Wilm’s PT diet consist of?
foods high in protein & calories
(offer options to encourage eating)
examples of medication used in Wilm’s
Actinomycin D (dactinomycin)
Vincristine (Oncovorin)
what should be assess in a Wilms PT urine?
presence of clots
odor
color
amount
protein in urine
s/sx of retinoblastoma?
strabismus: red painful eye
whitish glow in pupil (Leukocoria)
Inward/outward turning of eye
nursing care/management for retinoblastoma?
showing families photographs of children undergoing this procedure
post op edu for rentinoblastoma
eyelid is closed & will wear a patch over eye
discharge 3-4 days
some clear drainage is ok
no straining/blowing nose
no rubbing eye for 2 wk
how to clean/care for retinoblastoma post op
gentle irrigation w/ prescribed solution
thin coating of ABX
where does osteosarcoma occur?
LONG BONES IN METAPHYSIS
what can damage to the metaphysis cause?
stunted/delayed growth
s/sx of osteosarcoma?
pain increased with activity/weight bearing
limp
dull ache several months prior
what would palpation of osteosarcoma reveal?
tenderness
swelling
warmth!
redness!
how/what would diagnose osteosarcoma/
Sunburst pattern on bone
XRAY
primary management for osteosarcoma?
promote function & mobility post op
what cancer treatment is used for osteosarcoma?
chemo before surgery to shrink tumor size
what/where does Ewings Sarcoma effect?
Bones & soft tissue
Middle of bones
Most often femur/pelvis
how can Ewings Sarcoma cause respiratory distress?
if in chest wall
s/sx of Ewings Sarcoma
systemic (fever/weight loss)
pain/swelling at site
primary nursing diagnosis for Ewings Sarcoma?
Impaired mobility
how do you assess Ewings Sarcoma
palpate any firm or non tender enlargements
when wouldnt surgery be an option of Ewings Sarcoma
if the lesions are in pelvic or sacral area
why is chemo preferred over radiation for Ewings Sarcoma?
radiation could increase risk of induced secondary infection
what/where does Hodgkins’s Lymphoma taken place?
Lymph system
SINGLE POINT
presentation of Hodgkins’s Lymphoma?
- Swollen, firm supraclavicular lymph nodes!
- non-moveable !
- anterior mediastinal mass
- night sweats
what would be seen on a biopsy that would confirm HODGKINS
Reed-Sternberg cells
Important assessment for HODGKINS?
- Resp assessment: Coughing/difficulty breathing
- Chest pain
- Chronic fatigue
management for HODGKINS?
radiation & chemo
what is NON-Hodgkins lymphoma?
NO single focal origin
Rapid onset with widespread involvement
which tissues are most often affected with NON-Hodgkins lymphoma?
bowel
appendix
upper midsection of chest
s/sx of NON-Hodgkins lymphoma?
pain/swelling @ abdomen, chest, head/neck
possible facial muscle weakness
diagnosis for NON-Hodgkins lymphoma?
elevated serum lactic dehydrogenase (500+)
management of NON-Hodgkins lymphoma?
aggressive multiagent chemo ASAP
(intrathecal chemo given for CNS prophlaxis)
what are characteristic s/sx of ITP?
Thrombocytopenia (decrease in platelets)
Purpura (hemorrhage under skin)
how is newly diagnosed ITP characterized?
normal platelet count w/in 6m of diagnosis with no evidence of relapse
what child may present with ITP symptoms?
healthy child who recently had viral infection
measles/mumps/rubella/chkn pox
s/sx that may present with ITP?
epistaxis: Nosebleeds
Intracranial hemorrhage
petechiae
how is ITP diagnosed?
no definitive
often self limiting
what would a CBC show for ITP?
platelet count less than 20,000
usual platelet count?
150-400,000
when is platelet transfusion recommended for ITP?
ONLY!! if severe life threatening bleeding
medical care for ITP?
steroids
IVIG admin
anti-D antibody
side effects of anti-D antibodies?
temporary anemia that resolved when IgD disperses
fever/chills
HA post infusion
considerations for igD?
monitor VS
what are the qualifications are a splenectomy in ITP?
episodes of life threatening bleeding
older than 5
low platelets affect ADL
edu on how parents should handle nosebleeds?
child lean down and forward & pitch nose bridge
what should ITP patients be instructed to avoid?
Aspirin
straight edge razors
tampons
rectal
