Peds Final 3

Front 1

What is Leukemia?

Back 1

Cancer of the blood-forming tissues of the bone marrow

Front 2

What is the most common form of childhood cancer?

Back 2

Leukemia

Front 3

Leukemia occurs when the stem cells in the ______ _______ produce ________ _____ which cannot function normally because the cells are distorted and uncontrolled in their proliferation.

Back 3

bone marrow
immature WBC’s

Front 4

What is a lymphoblast?

Back 4

an immature lymphocyte- which cannot function normally

Front 5

How do the immature WBCs grow in children with Leukemia?

Back 5

They proliferate rapidly by cloning instead of normal mitosis causing the bone marrow to fill with abnormal (immature) WBC’s.

Front 6

Leukemia and apoptosis:

Back 6

The cancerous- rapidly growing, immature WBCs in Leukemia pts have NO programmed cell death

Front 7

Leukemia and angiogenesis

Back 7

The cancerous immature WBCs have their own blood supply- to supply a steady stream of nutrients allowing for continued out of control growth.

Front 8

Do the immature cancerous WBCs stay in the bone marrow?

Back 8

No, they spill out into the circulatory system where they steadily replace the normally functioning WBC’s.

Front 9

What happens to immunity when the immature WBCs start replacing the mature WBCs in circulation?

Back 9

As this occurs the protective lymphocytic functions such as cellular and humeral immunity are reduced, leaving the body vulnerable to infections.

Front 10

Not only does Leukemia cause a decrease in mature WBCs but other blood cells are decreased as well. Which other cells are decreased?

Back 10

RBCs and platelets

Front 11

Why do leukemia pts have bleeding, black stool, petechiae, GI bleed, nose bleeds?

Back 11

Because of their low platelet levels- thrombocytopenia

Front 12

What are the three big results of leukemia that children will present with?

Back 12

Anemia
Infection (fever w/out associated symptoms)
Bleeding

Front 13

What RBC level indicates anemia?

Back 13

HgB <11

Front 14

What WBC level indicates infection?

Back 14

WBC <100,000

Front 15

What is a normal platelet count?

Back 15

250,000 - 400,000

Front 16

Should normal child ever have blasts in circulation?

Back 16

No! THEY SHOULD BE IN BLOOD MARROW. IF YOU HAVE BLASTS IN A CBC WITH DIFF, THAT IS BAD!

Front 17

What are the two types of leukemia?

Back 17

ALL- Acute Lymphocytic Leukemia and
AML- Acute Mylocytic Leukemia

Front 18

Which of the two types of leukemia is less life threatening/more curable?

Back 18

ALL= Acute Lymphocytic Leukemia

Front 19

What is the survival rate with ALL?

Back 19

90% survival

Front 20

What is the survival rate with AML?

Back 20

20-50% survival rate with a bone marrow transplant

Front 21

What are the most common first symptoms of leukemia?

Back 21

PETECHIAE
FEVER
FATIGUE

Front 22

What is petechiae?

Back 22

rash- pinpiont red spots, non blanchable. Shows signs of bleeding.

Front 23

With neutropenia, body’s normal bacterial flora can become...

Back 23

aggressive pathogens

Front 24

What happens to bones when child had leukemia?

Back 24

Invasion of the bone marrow with leukemic cells gradually causes a weakening of the bone and a tendency toward fractures.

Front 25

What type of pain will child with leukemia present with?

Back 25

leukemic cells invade the periosteum, increasing pressure in bones causing SEVERE PAIN

Front 26

Is weight loss ever normal in a child?

Back 26

No, Weight Loss is a big sign for pediatric cancer and is never normal in a healthy child.

Front 27

What happens if platelet count drops below 20,000?

Back 27

emergency platelet transfusion!

Front 28

What tests are done to detect leukemia?

Back 28

bone marrow aspiration or biopsy
CBC with Differential
Imaging- ultrasound, radiograph, MSI and CT can also be used for DX

Front 29

What is the test for Definitive diagnosis of leukemia?

Back 29

Bone marrow aspiration or biopsy to differentiate between ALL and AML

Front 30

What are treatments for leukemia?

Back 30

Chemotherapy
Radiatino
Bone Marrow Transplant

Front 31

How is chemo given for leukemia?

Back 31

In 4 phases

Front 32

What are the 4 phases chemo for leukemia is given?

Back 32

Induction
Consolidation
Delayed Intensification
Maintenance

Front 33

What happens during the induction phase for chemo?

Back 33

Rapidly killing off all cells especially the immature WBCs (4-6 weeks of chemo) the goal is to have less than 5% blast cell population left- forcing into remission

Front 34

What happens during the Consolidation phase for chemo?

Back 34

second phase that goes after any possible lingering blast cells

Front 35

What happens during the Maintenance phase for chemo?

Back 35

IM chemo injections for 2-3 years to avoid a relapse

Front 36

Why does chemo need to attack cells at various time intervals?

Back 36

Need to attack cell in different phases (metaphase, telophase, etc…). Need to hit cells at different division stages

Front 37

What are the complications of checmo?

Back 37

myelosuppression= reduction of bone marrow function resulting in neutropenia, anemia, and thrombocytopenia

Front 38

What are s/e of chemo that patient may experience?

Back 38

Fatigue
Alopecia(temporary)
Mucositis (oral inflammation that can allow for infections such as thrush)
N/V/D
Constipation
Perianal abscess
Anorexia and cachexia

Front 39

Why does it sometimes take along time to have a bone marrow transplant?

Back 39

Because, - donation has to be from a prefect or as close to perfect (not too common- important to become a donor through BE THE MATCH)

Front 40

Absolute Neutrophil Count (ANC) tells us what information?

Back 40

tells how sick the patient is and the level of isolation precautions they require

Front 41

How to calculate ANC?

Back 41

#WBCs( #Neurtophils + # Bands)= ANC

Front 42

ANC: The lower the number the _________ the level of isolation

Back 42

higher

Front 43

ANC count of 900-1500 indicates

Back 43

mild moderate

Front 44

ANC count of 500-900 indicates

Back 44

moderate severe

Front 45

ANC count of <500 indicates

Back 45

severe severe

Front 46

What type of isolation are pts undergoing chemo on?

Back 46

Reverse isolation- d/t decreases WBC

Front 47

What protection for pts on reverse isolation?

Back 47

All visitors gown, glove and mask up, no flowers, no outside stuffed animals, no visitors with any possible sickness, no balloons, nothing can come into the room from the outside without proper sterilization and cleaning

Front 48

Tumor lysis syndrome

Back 48

Accumulation of waste products (uric acid and potassium) can cause a metabolic emergency (metabolic acidosis) and renal damage

Front 49

THE LEADING CAUSE OF DEATH FOR CANCER PATIENTS IS?

Back 49

INFECTION

Front 50

Nursing goals during chemo?

Back 50

prevent fever
promote rest
prevent bleeding

Front 51

How do we hydrate child during induction phase of chemo?

Back 51

IV fluids at 2-4x the child’s maintenance (over hydrate)

Must check daily weights

Front 52

What type of transfusion will child have curing chemo therapy?

Back 52

transfuse packed RBCs and platelets

Front 53

What type of labs will nurse obtain and monitor for child undergoing chemotherapy?

Back 53

blood cultures
spec grav of urine q4h and strict I&Os

Front 54

What medications will nurse administer during chemotherapy (other than chemotherapy meds)

Back 54

antibiotics to prevent sepsis
allopurinol to decrease uric acid accumulation r/t rapid cell breakdown caused by the chemo

Front 55

What causes Thrombocytopenia, leukopenia, anemia when child had leukemia?

Back 55

Low platelet, Low RBC, and Low WBC count d/t the suppression of bone marrow- Because of the proliferation of immature WBCs other cells cannot compete for space and nutrients.

Front 56

Thrombocytopenia

Back 56

Low platelet counts

Front 57

Thrombocytopenia causes increased risk for _____

Back 57

bleeding

Front 58

S/S of Thrombocytopenia:

Back 58

Ecchymosis
Petechiae
black stools

Front 59

Petechiae

Back 59

non blanchable pinpoint red spots- this is secondary to bleeding

Front 60

Normal platelet level

Back 60

150,000-400,000

Front 61

If platelet level below 20,000...

Back 61

will have an emergency platelet transfusion

Front 62

Patient teaching for Thrombocytopenia

Back 62

No contact sports
Be careful to prevent injuries that can cause bleeding
Be careful when brushing teeth
Teach s/s of bleeding

Front 63

Leukopenia

Back 63

Decrease in number of WBC (caused by immune or bone marrow disease)

Front 64

Leukopenia causes a decrease in the ability of the body to...

Back 64

fight infection and disease

Front 65

S/S Leukopenia

Back 65

Most common manifestation Neutropenia (listed below)
Infection
Low grade fever

Front 66

What to teach about Leukopenia?

Back 66

Teach how to prevent infection- handwashing, keep away from crouds, ask friends/family not to visit if they are sick

Front 67

Neutropenia

Back 67

An abnormally small number of neutrophils in the blood- happens with leukemia

Front 68

What does it mean if pt has > 50,000 WBCs?

Back 68

Bad sign- most are immature WBCs or leukemia cells. Worse prognosis. Have no properties to fight against infection

Front 69

What is the single most important predictor of prognosis for leukemia?

Back 69

The initial WBC count

Front 70

Anemia

Back 70

Low RBC- erythrocyte- Count

Front 71

What Hgb level indicates anemia?

Back 71

Hgb < 10 shows anemia

Front 72

What is a normal Hgb range?

Back 72

12-16

Front 73

What are S/S of anemia?

Back 73

Malaise
Fatigua
Anorexia
Pallor

Front 74

What are things to monitor for with anemia?

Back 74

Diet
Monitor H & H
Monitor growth

Front 75

Intussusception

Back 75

When the intestine telescopes into itself

Front 76

Where does Intussusception usually occur?

Back 76

at the iliocecal valve

Front 77

What is the result of Intussusception?

Back 77

obstruction of stool, and the resulting inflammation also causes decreased blood flow

Front 78

Intussusception manifests in a triad:

Back 78

Pain
Bloody jellylike stool
and a palpable mass in the upper right or mid abdomen

Front 79

What are the treatments for Intussusception?

Back 79

barium or air enemas (They will usually try enemas three times, and then go to surgery)

Front 80

What are nursing considerations for Intussusception?

Back 80

1) Maintain fluid and electrolye balance. (You will need to start an IV and monitor electrolyte levels.)
2) Post –Op involves observing for signs of infection.
3) As diet is advanced, look for decreased appetite or pain.

Front 81

Pyloric Stenosis

Back 81

A swelling of the pyloric muscle at the sphincter at the base of the stomach which inhibits gastric contents from making their way into the intestine

Front 82

How does Pyloric Stenosis manifest?

Back 82

Initially, the baby will be a good eater with some spit up. Then, after 2-8 weeks after birth, the baby will start projectile vomiting as the stenosis becomes more pronounced. The infant will become dehydrated, and will have electrolyte imbalances and will be very hungry.

Front 83

What are th key S/S of Pyloric Stenosis?

Back 83

projectile vomiting
dehydration
electrolyte imbalances
Will be very hungry.

Front 84

What requirements to dx pyloric stenosis?

Back 84

An abdominal ultrasound displaying a thickened pyloris of more than 4 mm, or longer than 14 mm supports a dx of pyloric stenosis.

Front 85

What treatment for pyloric stenosis?

Back 85

Surgery is performed ASAP (Open pylormyotomy)
Patient will need TPN, and fluid and electrolytes parenterally until the obstruction is relieved.

Front 86

Nursing considerations for pyloric stenosis?

Back 86

Promote comfort
Minimize weight loss
Post- op, look for signs of infection.

Front 87

celiac disease

Back 87

Also known as gluten intolerance, It is an immunologic disorder in which chronic malabsorption of glutenin and glaiden results in a accumulation of glutamine, which is toxic to the intestinal mucosa, damaging the villi.

Front 88

People with celiac disease cannot eat what foods?

Back 88

wheat, barley, rye, or oats

Front 89

What are S/S of celiac disease?

Back 89

Fatty stools (steatorrea)
Chronic diarrhea, and abdominal distension
Growth impairment. They may also have iron deficiency, defects in tooth enamel, and abnormal liver function tests.

Front 90

How is celiac disease treated?

Back 90

Diet management, Lifetime commitment

Front 91

Hirschsprungs Disease

Back 91

(AKA congenital aganglionic megacolon) It is when inadequate motility causes obstruction of the intestine, causing it to enlarge.It is due to missing ganglionic cells in a segment of the rectum or colon which prevents peristalsis in that part of the intestine.

Front 92

How does Hirschsprungs Disease manifest in newborns?

Back 92

Newborn= failure to pass meconium and abdominal distension.

Front 93

How does Hirschsprungs Disease manifest in Infant and Older child ?

Back 93

Constipation, ribbon stools, vomiting, failure to gain weight and delayed growth. Failure to thrive

Front 94

What is treatment for Hirschsprungs Disease?

Back 94

Prior to surgery = Low residual diet, stool softeners, diet supplements

Front 95

What type of surgery is performed for Hirschsprungs Disease, and what is the possible complication?

Back 95

removal of a portion of the intestine. This may mean that there is a potential for short gut syndrome and that there may need to be colostomy bag temporarily.

Front 96

What are nursing considerations for Hirschsprungs Disease?

Back 96

Assess for passage of meconium. Tell parents to notify us if childs abdomen becomes distended. Monitor for infection, manage pain, hydration, measuring abdominal circumference, possible stoma care.

Front 97

Omphalacele

Back 97

Abdominal contents herniate into the umbilical cord. Large defects may include intestines, stomach, liver, and spleen

Front 98

What other diseases are associated with Omphalacele?

Back 98

additional chromosomal defects and congenital heart defects.

Front 99

How does an Omphalacele manifest?

Back 99

Swollen umbilical cord, filled with abdominal contents.

Front 100

What is the treatment for omphalacele?

Back 100

Initially, guard the omphalocele from injury by placing the child in a bag that goes over his feet up to his chest. Then the defect can be surgically repaired using one or two surgeries.

Front 101

What to be on the lookout for if child has an omphalacele?

Back 101

Be alert for signs of other congenital anomalies. (Tracheoesophageal fistula, heart defects, genitourinary)

Front 102

What are nursing interventions for omphalacele?

Back 102

Keep omphalocele moist and covered. Monitor vitals hourly, assess temperature (Infant can lose heat through the sac)

Front 103

If child has omphalacele, what is their diet?

Back 103

NPO

Front 104

Because child with omphalacele is NPO, what are important nursing considerations?

Back 104

maintain fluids and electrolytes via IV route.

Front 105

What psychosocial aspect can be affected for child with omphalacele?

Back 105

Bonding

Front 106

Gastroschisis

Back 106

Abdominal contents located outside of the abdominal wall.

Front 107

How is Gastroschisis different from omphalacele?

Back 107

Unlike omphalocele, Gastroschisis is not indicative of other congenital defects.

Front 108

How is more at risk to have a baby with Gastroschisis?

Back 108

More common in young moms who smoke.

Front 109

How does Gastroschisis manifest?

Back 109

Abdominal contents outside the abdominal wall.

Front 110

What are treatments for Gastroschisis?

Back 110

Keep the abdominal contents moist and covered (Gauze and normal saline).
May use a silo procedure in which a bag is placed over the contents and gravity is used to pull contents back into the abdomen.
Surgery is also needed.