Unit IV Flashcards
Decreased number of RBCs
Decreases O2-carrying capacity
For most cases, anemia is a symptom of another disease
Anemia
Signs & Symptoms
May be asymptomatic
Fatigue, SOA, HA, difficulty concentrating, dizziness, paleness, tachycardia
Anemia
Nursing Care for Anemia
Encourage iron-rich foods
Iron supplementation
Blood transfusion when severe (hgb <8 and symptomatic)
Iron Rich Foods:
red meat, egg yolk, green leafy vegetables
Most common thrombocytopenia in childhood
Cause unknown – may be autoimmune in nature
Idiopathic Thrombocytopenia Purpura
Transmitted genetically via autosomal recessive gene (both parents must have gene)
cell trait is heterozygous form of disease
Sickle Cell Anemia
Signs & symptoms
All organs may be affected
Vaso-occlusion (PAIN!)
Weakness, pallor, fatigue, tissue hypoxia, jaundice
Sickle Cell Anemia
Diagnosis of Sickle Cell Anemia
newborn screening
Nursing Care for Sickle Cell Anemia
- Treatment of hypoxic episodes
- Good hydration
- Early ID of complications
X-linked deficiency of factor VIII or IX
Males affected, females are carriers
Prolonged Bleeding
Hemophilia
deficient factor VIII (A Hemophilia)
classic hemophilia
deficient factor IX
Christmas disease (B hemophilia)
One of the most common inherited bleeding disorders
Transmitted via autosomal dominant inheritance
Deficiency of vWF
Variable clinical manifestations – prolonged bleeding
Von Willebrand’s Disease
Nursing Care of Von WIllebrand’s Disease
DDAVP – increases plasma vWF and factor VII
Administer FFP
Medical alert bracelet
Increased risk for hemorrhage
(natural)-example-skin, mucous membranes
Innate
(active)-exposure to diseases or immunized
Adaptive
(acquired)-antibodies transferred from mom to baby via breastmilk
passive
Tears, urine, vaginal secretions, mucous, and semen
Flow out from the body and carry out unwanted intruders
Mechanical Barrier
acidic secretions of stomach and digestive enzymes
Neutralize organisms taken into the body through the mouth
Chemical Barrier
First exposure – chicken pox; Second exposure – Shingles; same virus
Varicella Zoster
S&S of Varicella Zoster
- Cutaneous Vesicular lesions
- Follow a nerve pattern
Nursing Care for Varicella Zoster:
- Decrease itching (calamine lotion)
- Decrease pain (Acetaminophen)
- Give Acyclovir (Antiviral medication)
Caused by Epstein-Barr virus
Also known as “the kissing disease” (common among adolescents and young adults)
Infectious Mononucleosis
S&S: Cervical lymphadenopathy, chills, fever, HA, anorexia, malaise, enlarged spleen
Infectious Mononucleosis
Diagnosis of Infectious Mononucleosis:
- monospot
- EBV titer
Nursing Care of Infectious Mononucleosis:
No splenic palpation to avoid rupture
No contact sports for 6 weeks (again, splenic rupture possible)
Rest, fluids, decrease fever, and isolate during acute phase
Eradicated since 1995
Signs and symptoms
Lesions produce pus
Chills, fever, headache, and vomiting
Small POX
Nursing Care for Small Pox:
- Implement isolation
- Give antibiotic to prevent secondary infection
- Give vaccinia Immune Globulin (VIG)
Infants have natural yeast in their mouths – this is an overgrowth d/t immature immune systems
Signs and symptoms
White plaques on the surface of tongue and buccal membranes
Pain – poor feeding
Candida Albicans
Nursing Care for Candida Albicans (oral thrush)
- Maintain nutrition
- Give nystatin (administer with gloved finger using a swab; administer after feedings)
- Educate parents about prevention – pacifiers, bottle nipples
- If breastfeeding, mom will need topical nystatin for her nipples
circular bald spot on scalp
Tinea Capitis
Athletes Foot
Tinea Pedis
Jock Itch
Tinea Cruris
Ringworm
Tinea corporis
What do you use to treat Fungal Infections?
Tinea Capitis - Oral griseofulvin (Fulvicin)
Pedis, Cruris, Corporis - clotrimazole (Lotrimin)
Microbe is dead; however, can still induce antibioties
Microbe is alive but grown under special conditions to decrease virulence
Live Vaccines
Portion of the virus/bacterium for best results
Subunit Vaccines
Viral infection of the nervous system caused by rhabdoviridae lyssavirus
Spread by direct contact with saliva or brain tissue of an infected animal
Fatal if inadequately or untreated in humans
Rabies
Signs and symptoms
Generalized flu symptoms (malaise, fever, sore throat)
Alternations in mental status, Seizures, Hyperexcitability
Respiratory arrest
Rabies
Nursing Care for Rabies
- Clean wound
- Administer Rabies Immune Globulin (HRIG)
- Administer Rabies vaccine series (HDCV)
Spread by mosquitoes – they become infected by biting birds
West Nile Virus
Signs and symptoms
Headache, malaise, anorexia, nausea, vomiting, myalgia, eye pain, lymphadenopathy, and maculopapular rash
Rare – encephalitis, meningitis
West Nile Virus
Multisystem chronic autoimmune disorder of the blood vessels and connective tissue
Cause unknown – genetics vs. triggers?
Systemic Lupus Erythematosus
Signs and symptoms
Variable, fever, malaise, chills, fatigue, weight loss
As disease progresses: butterfly rash, arthritis, photosensitivity, serositis, proteinuria, immune/hematological involvement
Systemic Lupus Erythematosus
Diagnosis of Systemic Lupus Erythematosus
4 or more of the symptoms, labs
Nursing Care for Systemic Lupus Erythematosus
- Manage pain and inflammation – NSAIDS, immunosuppressants
- Treat symptoms
- Prevent complications
Signs and symptoms
Involves few or multiple joints, limping, favoring a particular joint, pain, uneven growth, swelling, loss of motion, and stiffness
Juvenile Idiopathic Arthritis
type of JIA that affects knees, ankles, elbows
Pauciarticular
Type of JIA that involves joints/internal organs, high fever, polyarthritis, rheumatoid rash
Systemic JIA
type of JIA that involves 5 or more joints
Polyarticular
Selectively targets and destroys T cells – leaving patients vulnerable to opportunistic infections
Human Immunodeficiency Virus
Signs and symptoms
Lymphadenopathy, hepatosplenomegaly, chronic diarrhea, FTT, oral thrush, skin infections, fevers, recurrent respiratory infections & neurological involvement
Human Immunodeficiency Virus
Diagnostic Testing for HIV:
ELISA, Western Blot, & PCR
Group of diseases in which there is out-of-control growth and spread of abnormal cells (anaplasia)
Cancer
3 Factors of Cancer
- External stimuli or environment
- Viruses that alter the immune system
- Chromosomal and gene abnormalities
Slow, limited, noninvasive growth
Benign Tumor
- Progressive virulent growth
- Solid tumors
- Systemic cancers
Malignant Tumor
- Arise from primitive embryonic tissue (environmental link)
- Cure rate is better
- Cancers affect stem cells in kids, epithelial cells in adults
- More aggressive and faster growing
- Respond more readily to chemotherapy and radiation
- Treated at major cancer centers in the United States
- More resilient
- Tolerate more aggressive therapy
- Less concurrent physiological problems
- Most common type of cancer in children
- Signs and symptoms
- Fever, fatigue, lethargy, anemia, pale skin, anorexia, and bone or joint pain
- Increased WBC
Acute Lymphocytic Leukemia (ALL)
Nursing Care for ALL
- Remission - induction
- Consolidation
- Maintenance – lasts for 2-3 years after diagnosis
Signs and symptoms
Symptoms resembling the flu, anemia, pallor, fatigue, bone pain, fever, headache or dizziness, petechiae, easy bruising, nosebleeds, or bleeding gums
Increased WBC
Acute Myelogenous Leukemia (AML)
Nursing Care for AML
- Administer multi-agent chemotherapy
- Discuss hematopoietic stem cell transplant
- Matched-sibling bone marrow or stem cell transplantation after remission
Supratentorial Brain Tumor
Supratentorial (anterior 2/3 of brain)
Intratentorial Brain Tumor
Intratentorial (posterior 1/3 of brain)
Signs and Symptoms
Depends on the tumor location, tumor type, and the age of the child
Obstruction of CSF drainage leading to ICP
Neurological changes
Brain Tumor
Originates from neural crest cells
Signs and symptoms
Wide variety depending on site of primary tumor
Upon palpation, tumor crosses midline; hard painless mass in neck or abdomen
Neuroblastoma
Originates in the kidney (nephroblastoma)
Signs and Symptoms
hematuria, hypertension, painless abdominal mass that seldom crosses midline
Wilm’s Tumor
Bone tumor - usually occurs in the metaphysis
Osteosarcoma
most common sites for osteosarcoma
long bones and legs
S&S: pain & swelling, limp
Osteosarcoma
- Bone tumor - highly malignant
- Most common sites are pelvis, arms, legs, and ribs
Signs & symptoms
- Similar to osteosarcoma
Ewing’s sarcoma
Tends to involve the lymph nodes
Non-acute in nature
Signs and symptoms
Painless, firm, cervical, or supraclavicular lymphadenopathy
Hodgkin’s Disease (HD)
Typically a disease of the tissues
No single focal origin
Rapid onset and widespread involvement
Signs and symptoms
Pain or swelling (abdomen, chest, and head/neck)
Non-Hodgkin’s Lymphoma (NHL)
Long-Term Effects of Chemotherapy
High-tone hearing loss
Loss of speech
Impaired depth perception
Increased response time
Lung problems (SOB)
Kidney problems (bleeding)
Musculoskeletal defects
Functional and/or mobility deficits
Hormonal abnormalities
Sterility
Growth retardation, cognitive impairment, and/or learning disabilities
Diabetes insipidus
Peripheral neuropathy
Negative Effects of Chemotherapy
- N&V
- Alopecia
- Extravasation
- Mucositis
- Diarrhea
- Constipation
- Anemia
- Thrombocytopenia
- Neutropenia
condition for three months or longer is
Impact of the Chronic Condition on the Infant
-alters bonding process
(soothe, distract, protect nap time)
Impact of the Chronic Condition on the Toddler:
- Unable to accomplish Autonomy
- Hindered gross and fine motor development
- stress and regression present
(praise for attempts at self-care, bond)
Impact of the Chronic Condition on the Preschooler
- feels punished for wrongdoing
- aggressive, regresses
- Withdraws, sleep problems
(allow expression of fears and frustrations)
Impact of the Chronic Condition on the School-Age Child
- alters autonomy and peer relationships
- interrupts independence
- may refuse to comply, reluctant to answer questions
(unstructured play as outlet)
Impact of Chronic Condition on the Adolescent
- Maladaptive coping behaviors
- Refuses treatments
- Easily overwhelmed and may show regression
- Worries about condition, self-esteem, identity, and family
Impact of the Chronic Condition on the Sibling
- May display a negative attitude toward the ill sibling
- Feelings of jealousy, embarrassment, resentment, loneliness, and isolation
- Thinks that they caused the condition or may acquire the condition too
(keep homelife routined, include sibling in care, provide info about ill child)
follows a medical model, in-hospital care
palliative care
holistic approach; focuses on quality of life, variety of settings
hospice care
end of life is about 6 months away; peaceful death without pain, setting is wherever pt and family desire it to be
end-of-life care
(a waxing and waning of respiration in the depth of breathing with regular periods of apnea)
Cheyne-Stokes respirations (physical sign of impending death)
- Loss of sensation
- Loss of ability of body to maintain thermoregulation: skin may feel cool
- Loss of bowel and bladder function
- Loss of awareness, consciousness, and slurring of speech
- Alteration in respiratory status
Recognition of Physcial SIgns of Impending Death
- Cheyne–Stokes respirations (a waxing and waning of respiration in the depth of breathing with regular periods of apnea)
- Noisy chest or respirations with the accumulation of fluid in the lungs or in the posterior pharynx
- Decreased, weak, or slow pulse rate and drop in blood pressure
Recognition of Physcial Signs of Impending Death
