Week 8-11 Flashcards
Leukaemia is diagnosed based on:
• Blood counts and bone marrow aspiration.
Most important prognostic indicator for leukaemia:
• Initial leukocyte count
Child abuse risk factors
- Social & environmental factors
- Poverty
- Homelessness
Legislation covering child abuse
In 2009 the legislation that governs mandatory report of child sexual abuse became part of the Children and Community Services Act 2004.
Leukaemia is characterised by:
• Leukocytes filling the red bone marrow and immature WBCs flood into the bloodstream. Thus crowding out other blood cell lines causing severe anaemia and bleeding problems.
Symptoms of leukaemia:
• fever • weight loss • bone pain
The most common causes of death from Leukaemia are:
• internal haemorrhage • overwhelming infections
Which nursing diagnosis is highest-priority for a child undergoing chemotherapy who is experiencing N&V?
- Fluid and Electrolyte Imbalance
- Body Image Disturbances
- Alterations in Skin Integrity
- Alterations in Nutrition
- Fluid and Electrolyte Imbalance
The nurse is assessing an adolescent. The nurse notes that the teen has bloodshot eyes and dilated pupils, and has lost weight. Based on her assessment, the nurse should suspect that the teen:
- Is abusing drugs.
- Is considering suicide.
- Has started smoking.
- Is intoxicated.
- Is abusing drugs.
A child has been seen 6 times in the clinic in the last month because of “severe vomiting”. The child’s physical exam is normal, electrolytes are within normal limits, and the child is gaining weight appropriately. The mother tells the nurse that she is very concerned about her child’s health. Based on this info, the child should be further eval. for which of the following conditions?
- Munchausen’s syndrome by Proxy.
- Sexual abuse.
- Physical neglect.
- Physical abuse.
- Munchausen’s syndrome by Proxy.
An adolescent experiencing status asthmatics was rushed to the Emergency Department by ambulance. The parents arrive and ask to see their child. The triage nurse at the reception desk knows that the adolescent was pronounced dead on arrival. At this moment, the triage nurse’s best intervention is:
- Ask the parents to please take a seat in the waiting room.
- Remain behind the desk, and tell the parents, “I’m sorry, but your child didn’t make it.”
- Immediately escort the parents to a quiet, private room.
- Tell the parents that they must wait because only the doctor can talk with them.
- Immediately escort the parents to a quiet, private room.
A hospice nurse makes an initial vista to the home of a terminally ill child to meet the family members and explore the parents’ wishes. Which question should the nurse ask first?
- How do you feel about interventions that will prolong your child’s life?
- Do you want life-saving interventions withheld?
- Will you consider a do not resuscitate (DNR) or allow natural death (AND) order?
- What can I do for you and your family?
- What can I do for you and your family?
Common clinical manifestations of cancer
(Vary by type and location):
- Pain • Cachexia • Anaemia
- Infections • Bruising
- Neurologic • Palpable mass
Known etiologies of cancer (variable):
• Single or combination of factors
- External stimuli
- Innate immune system and gene abnormalities
- Chromosomal abnormalities
- Alterations in cellular growth
Provide brief information about diagnostic tests for cancer:
- CBC and differential
- Bone marrow aspiration
- Bone marrow biopsy
- Lumbar puncture
- Radiographic examination
Nursing Care Plan for Cancer (based on type of cancer & therapy):
- Infection control • Pain
- Nutrition • Growth and development
- Emotional needs • Spiritual needs
Child abuse and mandatory reporting
It is a legal requirement in Western Australia for doctors, nurses, midwives, teachers and police officers to report all reasonable beliefs of child sexual abuse to the Department for Child Protection.
Summarise the effects of a life-threatening illness or injury on children
Infant: • Sleep-wake cycle and feeding routine are disrupted
• Excessive irritability
Toddler: • Frightened by immobilisers • Associates pain with punishment
Preschooler: • Fears mutilation
• Easily regresses to earlier stages
School-age: • Fears body injury & death • Fears loss of control
Adolescent: • Displays anger, rebellion, and withdrawal
Differences between the adult and paediatric airway
Upper Airway
- The child’s airway is shorter and narrower.
- Infant’s airway 4mm diameter; adults 20.
- Bronchial division of trachea is higher and R bronchus angle is more acute.
- Newborns are obligate nose breathers (only breathing through mouth when crying). Infants up to 2-3 months don’t automatically open mouth to breathe so nasal patency is critical.
Differences between the adult and paediatric airway
Lower Airway
- Newborns have 25 million alveoli but not fully developed. Adults have 300 million.
- Bronchi and bronchioles smooth muscle is undeveloped in newborns. Can’t react to irritants by bronchospasm and muscle contraction till 5 mths.
- <6 yrs use diaphragm to breathe as intercostal muscles are immature.
- Chest wall retractions due to ribcage being mostly cartilage & flexible.
- Children consume more O2 because of higher metabolic rate.
- Fewer glycogen reserves leading to more rapid muscle fatigue when using accessory muscles.
Reasons why children may be anaemic
• Diet (most common cause especially during puberty) • Body not able to absorb iron adequately • Slow blood loss over a period of time • Lead poisoning
Children most at risk of anaemia
- Premature babies • adolescent girls (menstruation) • Babies who drink’s cows milk before 1yr • Breastfed but not given complementary food containing iron after 6 mths • Formula fed not fortified with iron
- Children (1-5 yrs) who drink more than 710 mls of milk a day without other supplements • chronic infections or restricted diets • children (1-5) exposed to lead
Manifestations of anaemia
• Pallor • Tired, Weak • Sore tongue • Headache or dizziness • Behavioural problems • Repeat infections • Loss of appetite • Increased sweating • Funny food cravings (pica) • Failure to grow as expected
Treatment of children with anaemia
• Diet (most important) • Supplements • Treatment for infection
Children need 8-10 mg of iron per day
Sources of iron:
Apricots, chicken, turkey, fish & other meats, dried beans, lentils and soyabeans, eggs. Liver, molasses, oatmeal, peanut butter, prune juice, raisins and prunes.
The types of foods that supply normal electrolytes:
• Calcium • Potassium • Magnesium
Blood volume of a child formula
Weight x 80 or 85 mL = blood volume
(Weight = Twice the age + 9 according to Jan)
So a 5 yr old = 10 + 9 = 19
19 kg x 80 = 1.520 Litres of blood
Adult = more than 5 Litres of blood
Text says 5 yr old weighs 25 kg (maybe an American kid!)
Iron deficiency anaemia is the most common form of anaemia. What screening is done to identify it?
• Haematocrit or haemoglobin
(Children 2-12 yrs)
Haematocrit: 31.7-39.8%
Haemoglobin 10.2-13.4 g/dL
(divide by 18 to get mmol/l cos we’re not stupid Americans)
Haematocrit is typically 3x the haemoglobin concentration
Infections cause an increase in
• Neutrophils (p1371 text)
