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64 Cards in this Set
- Front
- Back
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Most ppl who relapse after qutting smoking do so within?
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the first 3 months of quitting
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Children most often initiate smoking between what ages?
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ages 11 and 15
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Which of the following was shown by research to be a reason kids start using tobacco?
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Genetics, tv viewing & sensation seeking
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Your 12-y.o pt Frankie, tells you he smokes bc it makes him feel tough and look cool. What intervention is most likely to be effective?
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point out that stained teeth & bad breath are not attractive
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Exposure to second hand smoke is assoc w/ incr short term risk of the following health probs in kids except?
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Lung cancer. (It does incr the risk for SIDS, lower respiratory tract infs, & otitis media)
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Which of the following is generally true for preteen smokers?
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A majority of preteen smokers have attempted to quit in the past yr
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The % of women who smoke during pregnancy is closest to?
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12.9% according to birth certificate data but 22% according to a national survey
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Risk for which of the following complications of pregnancy is increased in smokers?
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ectopic pregnancy
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Smoking during pregnancy is assoc w/ a decrease in the size of the fetus relative to gestational age, especially in what trimester?
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3rd trimester
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Which of the following describes the best recommendation regarding smoking cessation pharmacotherapy during pregnancy?
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1st attempt to quit w/o pharmacotherapy
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What is the recommended # & length of counseling for intensive tobacco interventions?
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at least 4 sessions, 10 minutes each
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What racial or ethnic group has a relatively high use of menthol cigarettes?
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African-American
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What is true about the Advise step of the 5 A's of tobacco intervention counseling?
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a few brief tobacco interventions by a health professional can be effective
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In the US, which of the following groups has a relatively high rate of smoking, compared to the national average?
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Native Americans
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4 types of preventive health care?
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-physical
-illness & accident prevention (anticipatory guidance) -immunizations -developmental screening |
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Frequency of periodic health exams for each age group?
Newborn - 6 months? 6-12 mo? 12-24 mo? After 24 mo? |
Newborn - 6 mo: every 2 mo
6-12 mo: every 3 mo 12-24 mo: Q 6 mo After 24 mo: annually |
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BMI classifications for normal, overweight, etc?
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Normal: 3-84%
At risk of overweight: 85-94% Overweight: > 95% Nomenclature changing bc many kids overweight now |
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About anemia in children?
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-most common hematologic disorder of childhood
-decr in # of RBCs and/or hemoglobin conc below normal -decr O2 carrying capacity -decr O2 gets to the cells -if anemia develops slowly, kids are very adaptable to it -tx is based on the underlying cx |
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About Iron Deficiency Anemia (IDA)?
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-Iron stored in fetal erythrocytes & liver, spleen & bone marrow
*iron stores adequate until 5-6 mo of age *anemia results if iron is not added to diet at that age |
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Prevention of iron deficiency anemia (IDA)?
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*iron-fortified infant formula
*iron-fortified infant cereal is recommended starting @ 4-6 mo *exclusively breast-fed infants require iron supplements |
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What age group is at greatest risk of anemia? (IDA)
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Toddlers. bc want to drink juice or milk all the time & don't want to eat
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Cow's milk in relation to iron deficiency anemia?
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-Cow's milk to the exclusion of iron rich foods.
*poor source of iron *limit milk to 24 oz/day age 12-24 mo olds, otherwise whole milk until 24 mo |
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Tx of iron deficiency anemia (IDA)?
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-Iron rich foods not enough once anemic
-Iron supplements for 3 mo or more *Better absorption -ferrous iron in 2 div. doses bw meals -w/ citrus fruit or juice |
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Administration considerations for ferrous iron?
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-med dropper or straw to prevent teeth staining: give to back of throat
-expect tarry,dark green,blackish stools:from the iron -dose dependent on degree of anemia |
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Ethnicity r/t to Sickle Cell Anemia?
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-occurs primarily in Afr. Amer.
-Mediterranean, Caribbean,Indian pops can have it as well -Dx w/ infant newborn screening -autosomal recessive |
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What is a vaso-occlusive crisis r/t sickle cell anemia?
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-In times of low O2, low pH or low temp
*HbS cells become elongated,rigid,sickle shaped, & cz hemolysis *circulation is impaired by clogged capillaries, czing pain,infarctions & swelling |
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What is a splenic sequestration r/t sickle cell anemia?
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-incr breakdown of RBCs by the spleen & liver:sickle cells only last 10-20 days instead of normal 2 mo
-shorter lifespan of the spleen due to autoinfarction |
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Incr inf due to sickle cell anemia?
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S. pneumococcus-need for Pneumovax every 5 yrs
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When do symptoms of sickle cell anemia begin?
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Symptoms begin in 2nd 6 mo of life: will start on PCN prophylaxis at about 2 mo of age. This is to prevent meningitis & inf in general.
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S/S of Sickle Cell Anemia?
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-HbF (fetal Hgb) decreases, HbS (abnormal sickle Hgb) increases
-Pale,slightly jaundiced w/ splenomegaly *Hgb 5 to 9 g/dl *Incr WBC, platelets & reticulocyte counts -Fever -Abdominal pain or chest pain: pain is signature about this -Painful swelling of hands or feet due to infarction |
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Sickle cell anemia mgmt?
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PAIN: must be aggressively managed & believed, PCA pumps: only use for 5-7 days to decr chance of addiction. PCA pump only used in crisis.
-Prophylactic PCN V, bid, 2-mo to 5-yrs -Prevnar,Pneumovax,Meningococcal, & flu vaccines -Prompt tx of infs & maintenance of hydration & body temp *to prevent hypoxia *folic acid if diet is low in green, leafy veggies: to help make hemoglobin |
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Hemophilia manifestations in an injury?
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Mild to severe bleeding, dependent on:
-Severity of the injury *symptoms consistent w/ involved area of injury -Amt of clotting factor -symptoms may not occur until later infancy: bc carrying them around so won't get injured. Will see bruising 1st -Hemarthrosis -Ecchymosis (bruising), epistaxis) -Bleeding after procedures |
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What is hemarthrosis?
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Hemophilia Manifestation
-Bleeding into joint spaces: common w/ kids with hemophilia -Repeat bleeds cx joint immobility |
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Hemophilia Interventions?
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-safe environment w/ careful supervison
-electric razor, care w/ dental procedures -Avoidance of obesity -Bleeding: *Superficial: pressure for 15 min + ice *Significant: transfuse w/ antihemophilic factor *DDAVP -Hemarthrosis *elevation, immobilization of affected joint *Ice, analgesics, ROM |
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What is DDAVP?
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a synthetic form of vasopressin that incrs plasma factor VIII & vWF levels & is the tx of choice in mild hemophilia
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X-Linked Recessive Inheritance of Hemophilia?
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-males are affected almost exclusively
-transmission occurs thru carrier females to their sons -male to male transmission does not occur -affected males are at risk of transmitting the disorder to their grandsons thru their carrier daughters |
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General clinical manifestations of pediatric cancer?
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Presentation can be vague
-Kids are normally sick a lot in the 1st few yrs, so symptoms are dismissed *symptoms often similar to those of common illnesses *can delay dx -Sometimes, few symptoms at all *can mean advanced stage at dx *can mean metastasis has already occurred -kids present w/ metastases much more frequently than do adults |
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Common presenting symptoms of pediatric cancer?
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-Anemia, pallor
-bruising, petechiae or frank blding -cachexia: weight loss, anorexia, weakness, anemia -infection -Neurologic symptoms: *headaches, muscle weakness, incontinence *visual changes -visible or palpable mass |
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Initial nursing assessment of pediatric cancer?
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-family hx of cancer experience
-personal history of incr risk disorders -symptoms -development & immunization status -live vaccines due? *growth & nutrition,hydration,pain -how sick is the child at dx? *emotional state |
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General diagnostic tests for pediatric cancer (labs)?
Red Blood Cells |
-Complete bld count w/ differential
-RBC's *Hgb, Hct *RBC indices-detects size, helps determine type of anemia -Platelets |
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General diagnostic tests for pediatric cancer (labs)?
White Blood Cells |
White Blood Cells
-% of all 5 types of WBC -Absolute neutrophil count *segmented (mature) + bands (immature) *(neuts) + (bands) x (wbc x 10) -Neutrophils are also called polys or segs - < 500 is very low & incrs inf risk |
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General diagnostic tests for pediatric cancer (labs)?
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-complete metabolic panel
-renal function tests (BUN,creatinine) -LFTs -urinalysis -special tests: *Alpha-fetoprotein: liver tumors *VMA or HVA: adrenal tumors,neuroblastoma *elevated catecholamines: neuroblastoma |
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General diagnostic tests for pediatric cancer?
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Use is dependent on type of cancer the pt is thought to have.
-ultrasound,CT,MRI,radiographs -nuclear medicine scans,IVP -bone marrow aspiration,biopsy or scan -lumbar puncture -PFTs, EKG |
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Specific diagnosis and Tx of pediatric cancer?
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-Biopsy: identifies,classifies,stages
-T = tumor characteristic -N= lymph node involvement -M= metastasis -S = extent of disease -Bone marrow aspiration *iliac crest, sternum *dx & monitoring of effectiveness of therapy |
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Nursing considerations for pediatric cancer?
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-Explain everything
*what,how,discomfort level *mgmt of side effects *importance of adherence to regimen -Play therapy *expressions of feelings & fears *clarify misconceptions *practice dolls -Emotional support |
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Chemotherapy tx for pediatric cancer?
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-Unique protocol dependent on:
*type of cancer *stage & cellular char. -Cells that divide rapidly most sensitive to chemo *GI,hair,reproductive tissue,bone marrow -diarrhea,mouth sores,hair loss -depletion of RC,WBC, & platelets -Central or PICC line *drugs are caustic,wear gloves,watch lines closely |
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Adverse effects of chemo for pediatric cancer?
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-Bone marrow suppression 7-10 days after chemo
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Tx of adverse effects of chemo for pediatric cancer?
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Colony-stimulating factors-glycoproteins (cytokines) that stimulate bone marrow to incr prod of various cell types.
-G-CSF: stimulates neutrophil prod (granulocytes) *Neupogen: SC or IV, daily for up to 14 days, until ANC is > 10,000. -Not given w/in 48 hrs of chemo -CBC done twice a wk,just b4 dose *Erythropoietin: stimulates erythrocyte prod. -Epogen & Procrit: SC or IV, hypertension is a serious side effect, dose adjusted based on labs |
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Tumor lysis syndrome as an adverse effect of chemotherapy?
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-Breakdown of cancer cells,rapid release of:
*Potassium: hyperkalemia *Purines: hyperuricemia -allopurinol used to prevent uric acid prod. *Phosphorous: hyperphosphatemia hypocalcemia -can quickly result in acute renal failure |
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Interventions for Tumor Lysis Syndrome?
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-incr IV fluids 48 hrs before chemo w/ much higher than maintenance rates during chemo
-baseline & daily weights -strict I/O & BP monitoring -urinary alkalinization to incr pH to 7.0 |
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Nursing care during chemotherapy?
(N/V) |
-Assess fluid/electrolytes
-prophylactic,scheduled, individualized antiemetics -Zofran,Reglan,Compazine |
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Nursing care during chemo?
(Malnutrition) |
-high protein, high calorie foods
-may need NG or G-tube feedings -constipation, diarrhea -susceptibility to infection |
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Nursing care during chemo?
(Stomatitis, change in taste) |
-soft sponge toothbrush
-mouth care before/after meals -no viscous lidocaine in small kids *can anesthetize throat & impair gag reflex -normal saline or plain water mouth rinse |
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Nursing care during chemo?
(Rectal ulcers) |
-no rectal temps or meds
-may have ulcers along entire GI tract -warm, sitz bath for rectal ulceration -meticulous cleaning of area |
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Nursing care during chemo?
(hemorrhagic cystitis & alopecia) |
-Hemorrhagic cystitis
*czed by chemo or radiation *incr fluid > 1.5 times normal maintenance rate *encourage frequent voiding *mesna - drug urotoxicity -Alopecia *ice cap during chemo *may decr uptake of drug by hair follicle |
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Effectiveness of Radiation therapy?
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-not effective on cells w/ low O2 content
-not effective during cell division -scheduled over 1-6 weeks to capture all cells that they possibly can. |
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Immediate side effects of radiation therapy?
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-fatigue
-anorexia, N/V -schedule antiemetics -ok to use in young kids for this indication |
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Radiation therapy side effects on Bone?
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-asymmetrical bone growth
-incr risk of fractures 4m normal activities -scoliosis,kyphosis,spinal shortening |
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Radiation therapy side effects on Hormones?
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-hypothyroidism,hypopituitarism,growth
-assess growth & thyroid function every 6 months for 3 yrs -infertility -delayed secondary sexual changes in girls |
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Radiation side effects on nervous system?
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-lethargy,drowsiness,seizures,learning disorders
-headaches,cataracts,change/loss of taste |
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other general side effects of radiation?
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-pneumonitis,pericardial fibrosis, GI malabsorption,salivation,tooth growth
-nephritis,chronic cystitis,alopecia,anorexia,mucositis, diarrhea |
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Symptoms of neuroblastoma?
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-pain often results 4m compression of organs
-Abdominal mass *firm,non-tender,irregular,crosses midline *urinary frequency,retention *ecchymosis *periorbital edema,exophthalmos (skull) *pain (bone) -pallor,weakness,anorexia,weight loss -dx based on tumor or bone marrow & catecholamines in the urine or bld |
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Manifestations of Hodgkin lymphoma?
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-painless lymph node enlargement
*cervical or supraclavicular most common *inguinal,axillary or chest -fever -weight loss -night sweats (if have then def think Hodgkin) |
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S/S of Non-Hodgkin lymphoma?
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-Solid tumors of lymph system
*diffuse,rather than nodular -B-cell & T-cell lymphomas *earlier,more rapid dissemination *mediastinum & meninges involvement common |
