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88 Cards in this Set
- Front
- Back
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CV Changes at Birth
* Ductus arteriosis ____ * Pulmonary vascular bed ____ * Pulmonary vascular resistance ____ * Systemic vascular resistance ____ * Foramen ovale __ d/t ___ |
*Ductus arteriosis CONSTRICTS
*Pulmonary vascular bed OPENS *Pulmonary vascular resistance DECREASES *Systemic vascular resistance INCREASES *Foramen ovale CLOSES d/t BLOOD FLOW FROM LEFT TO RIGHT |
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ACYANOTIC
congenital heart diseases that cause ↑ Pulmonary blood flow: _____ _____ _____ |
* A/V septal defects
* Patent ductus arteriosus * Atrioventricular canal |
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ACYANOTIC
congenital heart diseases that cause obstructed blood flow from ventricles: ____ ____ ____ |
* Coarctation of aorta
* Aortic stenosis * Pulmonic stenosis |
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CYANOTIC
congenital heart diseases that cause ↓ Pulmonary blood flow: ____ ____ |
* Tetralogy of Fallot
* Tricuspid atresia |
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CYANOTIC
congenital heart diseases that cause mixed blood flow: ____ ____ ____ ____ |
* Transposition of great arteries
* Total anomalous pulmonary venous return * Truncus arteriosus * Hypoplastic L heart syndrome |
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NCLEX
After a pediatric client has a cardiac cath, which intervention would the nurse consider to be of highest priority during the immediate post procedure period? 1. Encourage intake of small amounts of fluid. 2. Teach the parents signs of CHF. 3. Monitor the site for signs of infection. 4. Apply direct pressure to entry site of 15 minutes. |
4. Apply direct pressure to
entry site of 15 minutes. |
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NCLEX
Which of the following home care instructions in included for a child postcatheterization? 1. Encourage fluids and regular diet. 2. Encourage physical activities. 3. The child can routinely bathe after returning home. 4. The child may return to school the next day. |
1. Encourage fluids and regular diet.
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Patent Ductus Arteriosus
* Diagnosis - Continuous ____ below left ____ - Dx with ____, cardiac ___ * Treatment - ____ for preterm only - ____ |
Patent Ductus Arteriosus
* Diagnosis - Continuous MURMUR below left CLAVICLE - Dx with X-RAY, cardiac ECHO * Treatment - INDOMETHACIN for preterm only - SURGERY |
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Transposition of the Great Arteries
* Pathophysiology - ____ blood enters ____ and ____ - ____ circulation * Clinical manifestations - Initially appears ____ - ____ develops within a few hours of life |
Transposition of the Great Arteries
* Pathophysiology - UNOXYGENATED blood enters RA and RV - PARALLEL circulation * Clinical manifestations - Initially appears NORMAL - CYANOSIS develops within a few hours of life |
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NCLEX
Which of the following statements is correct for a child with tetralogy of Fallot? 1. The condition is commonly referred to as “blue tets.” 2. They experience hypercyanotic, or “tet” spells. 3. They experience frequent respiratory infections. 4. They experience decreased or absent pulses in the lower extremities. |
2. They experience hypercyanotic, or “tet” spells.
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NCLEX
Administration of which of the following drugs would be the most important in treating transposition of the great arteries? 1. Digoxin 2. Diuretics 3. Antibiotics 4. Prostaglandin E1 |
4. Prostaglandin E1
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NCLEX
Which of the following cardiovascular disorders is considered acyanotic? 1. Patent ductus arteriosus 2. Tetralogy of Fallot 3. Tricuspid atresia 4. Truncus arteriosus |
1. Patent ductus arteriosus
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Psychosocial Factors
* ____ * ____ * ____ * ____ |
* Separation
* Bonding * Feeding * Care |
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NCLEX
A 2-year-old child has a known cardiac defect and is in congestive heart failure. Which assessment finding indicates to the nurse a toxic dose of digoxin? 1. Tachycardia and dysrhythmia 2. Headache and diarrhea 3. Bradycardia, nausea, and vomiting 4. Tinnitus and nuchal rigidity |
3. Bradycardia, nausea, and vomiting
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Kawasaki Disease
* Pathophysiology - ____itis - ____itis - ____ on echocardiogram |
Kawasaki Disease
* Pathophysiology - VASCULitis (BV inflamm) - PANCARDitis (inflamm of ALL structures of heart) - ECTASIA (dilation of tubular vessel) on echocardiogram |
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NCLEX
When assessing a child with suspected Kawasaki disease, which of the following symptoms is common? 1. Low-grade fever 2. “Strawberry” tongue 3. Pink moist mucous membranes 4. Bilateral conjunctival infection with yellow exudate |
2. “Strawberry” tongue
1st sign - HIGH (not low) fever |
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NCLEX
A nurse is giving discharge instructions to the parents of a child with Kawasaki disease. Which of the following statements shows an understanding of the treatment plan? 1. “A regular diet can be resumed at home.” 2. “Black, tarry stools are considered normal.” 3. “My child should use a soft-bristled toothbrush.” 4. “My child can return to playing football next week." |
3. “My child should use a soft-bristled toothbrush.”
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NCLEX
Which of the following statements best defines the term cardiogenic shock? 1. Decreased cardiac output 2. A reduction in circulating blood volume 3. Overwhelming sepsis and circulating bacterial toxins 4. Inflow or outflow obstruction of the main bloodstream. |
1. Decreased cardiac output
CAUSES 2. A reduction in circulating blood volume RESULTING IN GLOBAL HYPOPERFUSION |
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NCLEX
Which of the following signs is considered a late sign of shock in children? 1. Tachycardia 2. Hypotension 3. Delayed capillary refill 4. Pale, cool, mottled skin |
2. Hypotension
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NCLEX
A child with suspected bacterial endocarditis arrives at the emergency department. Which of the following findings is expected during assessment? 1. Weight gain 2. Bradycardia 3. Low-grade fever 4. Increased hemoglobin level |
3. Low-grade fever
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NCLEX
A nurse is teaching wound care to parents after cardiac surgery. Which of the following statements is most appropriate? 1. Lotions and powders are acceptable. 2. Your child can take a complete bath tomorrow. 3. Tingling, itching, and numbness are normal sensations at the wound site. 4. If the sterile adhesive strips over the incision fall off, call the physician. |
4. If the sterile adhesive strips over the incision
fall off, call the physician. |
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NCLEX
A child with an atrial septal repair is entering postoperative day 3. Which of the following interventions would be most appropriate? 1. Give the child nothing by mouth. 2. Maintain strict bed rest. 3. Take vital signs every 8 hours. 4. Administer an analgesic as needed. |
4. Administer an analgesic as needed.
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NCLEX
A chld with a cyanotic heart defect is being discharged home to await surgical repair. In the discharge teaching, the nurse instructs the parents: 1. To prevent the child from crying at all. 2. To observe the child for signs of increased intracranial pressure. 3. In cardiopulmonary resuscitation. 4. To identify growth and development milestones. |
2. To observe the child for signs of increased intracranial pressure.
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Monro - Kellie Hypothesis
• Once sutures have fused, the skull is a rigid compartment filled to capacity with non-compressible contents: – brain ____% – blood ____% – CSF ____% • If one component increases in volume, another component must ____ or ICP will ____. |
Monro - Kellie Hypothesis
– brain 80% – blood 10% – CSF 10% • If one component increases in volume, another component must DECREASE or ICP will INCREASE. |
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Normal ICP
Adult ___-___ mm Hg Child ___-___ mm Hg (Accept values < ___ mm Hg) |
Normal ICP
Adult 3 - 15 mm Hg Child 0 - 10 mm Hg (Accept values < 20 mm Hg) |
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Cerebral Perfusion Pressure
- blood pressure gradient across the brain CPP = ____–____ Keep above ____ |
CPP = MAP – ICP
Keep above 60 |
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Causes of Increased ICP
• ____ lesions (__,__,__) • ____ injury (__,__) • ____ problems (__natremia,__failure, __failure,__acidosis) • Subarachnoid/intracerebral ____ • ____ Malfunction |
Increased ICP
• MASS lesions (TUMORS, ABSCESSES, HEMATOMAS) • ISCHEMIC injury (STROKE, HYPOXIA) • METABOLIC problems (HYPOnatremia, LIVER failure, RENAL failure, Diabetic Ketoacidosis) • Subarachnoid/intracerebral HEMORRHAGE • SHUNT Malfunction |
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S/S of Increased ICP
• ____ dysfunction • ____ weakness • ____ deficits • ____ nerve palsies • ____ pain • Deterioration in level of ____ • ____ |
• PUPILLARY dysfunction
• MOTOR weakness • SENSORY deficits • CRANIAL nerve palsies • HEADACHE pain • Deterioration in level of CONSCIOUSNESS • SEIZURE |
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LATE S/S of Increased ICP
• Severe deterioration of ___ • ____ • ____edema • ____ing • Change in ____ signs • Impaired brain stem ____ |
• Severe deterioration of LOC
• VOMITING • PAPILLedema • POSTURing • Change in VITAL signs • Impaired brain stem REFLEXES |
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S/S of Increased ICP
in an INFANT • ____ feeding • ____ity • ____-pitched cry • ____, ____ fontanel • ____ing • ____ scalp veins • ____ head circumference |
S/S of Increased ICP
in an INFANT • POOR feeding • IRRITABILity • HIGH-pitched cry • TENSE, BULGING fontanel • VOMITing • DISTENDED scalp veins • INCREASED head circ |
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TX for Elevated ICP (slide#1)
• 1st: ___'s! – Stabilize ____ - ____-____ CO2 – ____active drugs – ____ drugs (Osmotic/Loop) – ____osmolar therapy with ____% saline – Positioning: ____, HOB ___, ____/____ alignment |
TX for Elevated ICP (slide#1)
• 1st: ABC’s! – Stabilize AIRWAY - LOW-NORMAL CO2 – VASOactive drugs – DIURETICS (Osmotic/Loop) – HYPERosmolar therapy with 3% saline – Positioning: SUPINE, HOB UP, HEAD/NECK alignment |
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TX for Elevated ICP (slide#2)
• ____tion • Maintain ____ temp • ____ • ____ Drainage • ____ control • ____ regimen • Avoid clustering ____ • Avoid ____ exercises • Provide a ____ environment |
TX for Elevated ICP (slide#2)
• SEDAtion • Maintain NORMAL temp • SURGERY • CSF Drainage • SEIZURE control • BOWEL regimen • Avoid clustering ACTIVITIES • Avoid ISOMETRIC exercises • Provide a CALM environment |
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Syndrome of Inappropriate
ADH Secretion - ____ H2O reabsorption – ____ serum osmolality – ____ serum Na (<110mEq/L) – ____ urine osmolality – Irritability, anorexia, nausea, cramps, lethargy, stupor, convulsions |
- INC. H2O reabsorption
– DEC. serum osmolality – DEC. serum Na (<110mEq/L) – DEC. urine osmolality – Irritability, anorexia, nausea, cramps, lethargy, stupor, convulsions |
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SIADH Tx/NSG interventions
• ____ fluids • ____tonic saline • Monitor ____ • Accurate __&__ • Urine ____ • Daily ____ • ____ checks • ____ precautions |
SIADH Tx/NSG interventions
• RESTRICT fluids • HYPERtonic saline • Monitor ELECTROLYTES • Accurate I&O • Urine SPECIFIC GRAVITY • Daily WEIGHT • NEURO checks • SEIZURE precautions |
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S/S Diabetes Insipidus
• Insufficient ___ Hormone • ____ diuresis • ____ osmolality • ____ urine specific gravity • ____ thirst • ____hydration |
S/S Diabetes Insipidus
• Insufficient ADH • UNCONTROLLED diuresis • DEC. osmolality • DEC. urine specific gravity • INSATIABLE thirst • DEhydration |
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DI Tx/NSG Interventions
• Fluid ____ • Strict __&__ • Daily ____ • Urine ____ • Monitor ____ • Med: ____ |
DI Tx/NSG Interventions
• Fluid REPLACEMENT • Strict I&O • Daily WEIGHT • Urine SPECIFIC GRAVITY • Monitor ELECTROLYTES • Med: DDAVP (Desmopressin) |
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Nursing Dx for pts with
Neural Tube defects • Potential for ____ • Potential for ____ • Potential for ____ • Potential for ___ skin ___ • Altered ____ • Alteration in ___ processes |
Nursing Dx for pts with
Neural Tube defects • Potential for infection • Potential for trauma • Potential for injury • Potential for impaired skin integrity • Altered body image • Alteration in family processes |
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50-70% of Spina Bifida pts have an allergy to _____
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50-70% of SB pts have an allergy to LATEX
Treat ALL SB pts as if they have this allergy Found in: catheters, gloves, tubing, tape, tourniquets, glue, toys, handles, tires, balloons, elastic |
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Most common
causative organisms of MENINGITIS (80%) • ____ • ____ • ____ |
• Haemophilus influenza b
(Hib) • Strep pneumoniae (pneumococcal) • Neisseria menigitidis (meningococcal) |
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MENINGITIS Tx/NSG Intervent.
• Meds: ____ • ____ precautions • ____tion • Fluid ____ (how much?) • Monitor for increased ___ • ____ measures • ____ tests |
MENINGITIS Tx/NSG Intervent.
• Meds: ABX • Isolation precautions • Ventilation • Fluid restriction (how much? 1/2 to 2/3) • Monitor for increased ICP • Comfort measures • Hearing tests |
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MENINGITIS residual effects
• ____ness, ____ness • ____ • Subdural ____, ____cephalus • ____ • ____ palsy • ____ (Meningococcal) |
MENINGITIS residual effects
• Deafness, blindness • Paralysis • Subdural effusions, hydrocephalus • Seizures • CP • Amputation (Meningococcal) |
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Etiology of Seizures
• ____pathic • ____ Process • ____ Imbalance • ____ (temp) • ____ Injury or ____ Tumor • ____ Intoxication • ____therapeutic Drug Levels |
Etiology of Seizures
• Idiopathic • Infectious Process • Metabolic Imbalance • Fever • Brain Injury or Brain Tumor • Drug Intoxication • Subtherapeutic Drug Levels |
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Seizure Types
• Partial – ____ – ____ • Generalized – ___-___ – A____ – A____ – A____ |
Seizure Types
• Partial – Simple – Complex • Generalized – Tonic-Clonic – Absence – Atonic – Akinetic |
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Status Epilepticus- MED EMERG
• Continuous ____ activity • Loss of ____ |
Status Epilepticus- MED EMERG
• Continuous SEIZURE activity • Loss of CONSCIOUSNESS |
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Causes of Cerebral Palsy
• ____ birth • Perinatal ____ • ____ • Intrauterine ____ • Congenital ____ Anomalies • ____ Disorders |
Causes of Cerebral Palsy
• PREMATURE birth • Perinatal ASPHYXIA • INFECTION • Intrauterine ISCHEMIA • Congenital BRAIN Anomalies • METABOLIC Disorders |
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Med/Nsg Interventions for CP
• ____ training • ____ assistance • ____ aids • ____ Therapy • ____ • ____ |
Med/Nsg Interventions for CP
• ADL training • Mobility assistance • Communication aids • Physical Therapy • Medication • Surgery |
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Hypopituitarism: GHD
Clinical manifestations * ____ stature * ____ or ____ rate of growth * Higher ____-to-____ ratio * ____ bone age |
Hypopituitarism: GHD
Clinical manifestations * Short stature * Deteriorating or absent rate of growth * Higher weight-to-height ratio * Delayed bone age |
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Congenital Hypothyroidism
* Clinical manifestations - Large ____ fontanel - Umbilical ____ - ____ (bowels) - Prolonged ____ * Treatment: Early Tx prevents ____ |
Congenital Hypothyroidism
* Clinical manifestations - Large posterior fontanel - Umbilical hernia - Constipation - Prolonged jaundice * Treatment: Early Tx prevents Cretinism |
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Definitions:
Virilization = Development of male secondary sexual characteristics Adrenarche = the increase in activity of the adrenal glands just before puberty |
Pseudohermaphroditism = an individual having internal reproductive organs of one sex and external sexual characteristics resembling those of the other sex or being ambiguous in nature
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NORMAL HGB VALUES
Infant: __-__ g/dl 6-12 yr: __-__ g/dl 12-18 yr: __-__ g/dl |
NORMAL HGB VALUES
Infant: 9 – 14 g/dl 6-12 yr: 11.5 – 15.5 g/dl 12-18 yr: 12 – 16 g/dl |
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Anemia (Hgb levels)
– Mild: __ g/dl – Moderate: __–__ g/dl – Severe: < __ g/dl |
Anemia (Hgb levels)
– Mild: 11 g/dl – Moderate: 3 – 7 g/dl – Severe: < 3 g/dl |
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SICKLE CELL complication
STROKE (or high-risk for it) Tx: * ____ transfusion q ____ wks * Desferoxamine (____ therapy) binds ____, allows excretion to occur (b/c RBC destruction from SCD -> ____ overload -> ____ deposited in tissues unless excreted - __ infusion __ nts/week |
SICKLE CELL complication
STROKE (or high-risk for it) Tx: * Blood transfusion q 3-4 wks * Desferoxamine (Chelation therapy) binds iron, allows excretion to occur (b/c RBC destruction from SCD -> iron overload -> iron deposited in tissues unless excreted - SC infusion 5 nts/week |
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Beta-thalassemia
Medical/Nursing Management • Medical Tx: – Chronic ____ – Sometimes ____ectomy – ____ transplant • Nursing Issues: – Blood Transfusions – ____ therapy – Risk of infection, post- splenectomy – Patient/Family Education |
Beta-thalassemia
Medical/Nursing Management • Medical Tx: – Chronic transfusions – Sometimes splenectomy – Bone marrow transplant • Nursing Issues: – Blood Transfusions – Chelation therapy – Risk of infection, post- splenectomy – Patient/Family Education |
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Aplastic Anemia
• Pancytopenia – Neutrophils < ____ – Platelets < ____ – Hemoglobin (RBCS) ____ – Reticulocytes < ____% • Etiology – Primary (congenital): ____ – Secondary (acquired): ____ (viral, toxic, pharmacologic) |
Aplastic Anemia
• Pancytopenia – Neutrophils < 500 – Platelets < 20,000 – Hemoglobin (RBCS) DEC. – Reticulocytes < 1% • Etiology – Primary (congenital): Fanconi’s anemia – Secondary (acquired): Injury (viral, toxic, pharmacologic) |
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Coagulation Disorders
• ____ A (factor VIII) – aka classic hemophilia • ____ B (factor IX) – aka Christmas Disease • ____ C (factor XI) • ____ disease (vWF) |
Coagulation Disorders
• Hemophilia A (factor VIII) – aka classic hemophilia • Hemophilia B (factor IX) – aka Christmas Disease • Hemophilia C (factor XI) • Von Willebrand’s disease (vWF) |
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Hemophilia A & B
Lab Findings • Platelets: ____ • Bleeding time: ____ (clot formation) • PT (or INR): ____ (extrinsic pathway) • PTT: ____ (intrinsic pathway) |
Hemophilia A & B
Lab Findings • Platelets: normal • Bleeding time: normal (clot formation) • PT (or INR): normal (extrinsic pathway) • PTT: prolonged (intrinsic pathway) |
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Hemophilia A & B
Medical/Nursing Management • Monitor for ____ episodes/complications • “First aid” for bleeding: – ____ – Administer ____- containing product • ____ infusions – ____-derived or recombinant – DDAVP (Mild Hemophilia A) |
Hemophilia A & B
Medical/Nursing Management • Monitor for bleeding episodes/complications • “First aid” for bleeding: – RICE – Administer factor- containing product • Factor infusions – Plasma-derived or recombinant – DDAVP (Mild Hemophilia A) |
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Hemophilia
Patient/Family Education • Emergency treatment of bleeding • IV ____ administration • Anticipatory guidance: – ____ precautions – Physical activity – Monitoring for complications |
Hemophilia
Patient/Family Education • Emergency treatment of bleeding • IV factor administration • Anticipatory guidance: – Safety precautions – Physical activity – Monitoring for complications |
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von Willebrand’s Disease
• vWf “transports” Factor ____ • Types: decreased, abnormal or near absence of vWF • Results in : mucosal bleeding, epistaxis, easy bruising, menorrhagia • Treat with ____, and vWF replacement |
von Willebrand’s Disease
• vWf “transports” Factor VIII • Types: decreased, abnormal or near absence of vWF • Results in : mucosal bleeding, epistaxis, easy bruising, menorrhagia • Treat with DDAVP, and vWF replacement |
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Differences in Adult and Child Cancer
– Origin – Cause – Prevention and screening – Metastasis at diagnosis – Response to treatment – Cure rate |
Find answers in book
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Childhood Cancer
Treatment Modalities • ____ (biopsy, resect, debulk) • ____ (rapidly dividing cells) • ____ therapy (shrink, residual) • ____ transplant • ____ response modifiers |
Childhood Cancer
Treatment Modalities • Surgery (biopsy, resect, debulk) • Chemotherapy (rapidly dividing cells) • Radiation therapy (shrink, residual) • Bone marrow transplant • Biologic response modifiers |
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LYMPHOMA
• From lymphoid and hematopoietic systems HODGKINs Disease – Older children/adolescents – Focal, painless enlarged ____ tissue Dx: Node biopsy and staging Tx: Chemotherapy & radiation |
LYMPHOMA
• From lymphoid and hematopoietic systems HODGKINs Disease – Older children/adolescents – Focal, painless enlarged lymph tissue Dx: Node biopsy and staging Tx: Chemotherapy & radiation |
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Atrial Septal Defect
* Pathophysiology - Blood flow ____ to ____ - ____ congestion * Clinical manifestations - Symptomatic? ____ - ____ ____ failure * Treatment - ____ for ___ ___ failure - ____ repair |
Atrial Septal Defect
* Pathophysiology - Blood flow LEFT to RIGHT - PULMONARY congestion * Clinical manifestations - Symptomatic? SOMETIMES ASYMPTOMATIC - CONGESTIVE HEART failure * Treatment - DIURETICS for CHF - SURGICAL repair |
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Ventricular Septal Defect
* Pathophysiology - Blood flow ____ to ____ - Heart ____ - ____ congestion * Clinical manifestations - Symptoms? ____ - ____ ____ failure * Treatment - May ____ by age ___ |
Ventricular Septal Defect
* Pathophysiology - Blood flow LEFT to RIGHT - Heart ENLARGEMENT - PULMONARY congestion * Clinical manifestations - Symptomatic? SOMETIMES ASYMPTOMATIC - CONGESTIVE HEART failure * Treatment - May CLOSE by age TWO |
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Patent Ductus Arteriosus
* Pathophysiology - ____ to ____ shunt - Fibers don’t respond to ____ ____ at birth * Clinical manifestations - Symptomatic? ____ - Sounds? ____ - ____ pulses, ____ pulse pressure - ____ ____ failure |
Patent Ductus Arteriosus
* Pathophysiology - LEFT to RIGHT shunt - Fibers don’t respond to INCREASED O2 at birth * Clinical manifestations - Symptomatic? SOMETIMES ASYMPTOMATIC - Sounds? MURMUR - BOUNDING pulses, WIDER pulse pressure - CONGESTIVE HEART failure |
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FACTORS KNOWN TO
ELEVATE INTRACRANIAL PRESSURE |
Elevate ICP
• Hypercapnia • Hypoxemia • Respiratory Procedures • Vasodilating Drugs • Positioning • Valsalva Maneuver • Coughing • Emotional Upset • REM sleep • Arousal from sleep • Hyperthermia • Seizures • Clustering of Activities |
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SICKLE CELL Life-threatening complications
• ____ Sequestration: – Trapping of blood in ____, can result in shock/rupture • Infection/____: – Fever, S&S infection – Leading cause of death in SCD pts < __ (#) yrs • Hemolytic/Aplastic: – ____ failure |
SICKLE CELL Life-threatening complications
• Splenic Sequestration: – Trapping of blood in spleen, can result in shock/rupture • Infection/Sepsis: – Fever, S&S infection – Leading cause of death in SCD pts < 5 yrs • Hemolytic/Aplastic: – Bone marrow failure |
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SCD
Medical/Nursing Management • ____ transfusion • PT teaching: Living with chronic illness • Pain Management - Opioids: ATC, PCA, __->__ transition (avoid ____) - NSAIDS (motrin) • Adequate ____ • Adequate ____ • Support coping • Observe for complications |
SCD
Medical/Nursing Management • Blood transfusion • PT teaching: Living with chronic illness • Pain Management - Opioids: ATC, PCA, IV -> oral transition (avoid meperidine) - NSAIDS (motrin) • Adequate oxygenation • Adequate hydration • Support coping • Observe for complications |
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Acute Lymphocytic Leukemia
• Proliferation of abnormal lymphoblasts, causes pancytopenia • Presenting symptoms: ____, ____ pain, ____ (color), ____ing • TX: 3 Treatment phases (chemo) – Induction (4 weeks) – Consolidation (6 months) – Maintenance (2 - 3years) • For relapse, further ____ and ____ transplant |
Acute Lymphocytic Leukemia
• Presenting symptoms: Fever, bone pain, pallor, bruising • 3 Treatment phases (chemo) – Induction (4 weeks) – Consolidation (6 months) – Maintenance (2 - 3years) • For relapse, further chemo and bone marrow transplant |
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Acute Myelogenous Leukemia
• ____ proliferation of ____ cells in ____ • Presenting symptoms: ____-like, ____ing, or as in ALL • TX: – Induction phase – Intensive ____ • Increased incidence of ____ |
Acute Myelogenous Leukemia
• Malignant proliferation of myeloid cells n bone marrow • Presenting symptoms: Flu-like, bleeding, or as in ALL • TX: – Induction phase – Intensive chemotherapy • Increased incidence of DIC |
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S/S of Hydrocephalus
• Assess: ____ circ, ____ fontanel, ____ sutures • Same S/S as ICP – ____ache, ____ing, ____edema, ____ (musc), ____ity, ____argy, ____-pitched “neuro” cry, ____sion, ____s, ____ nerve dysfunction • ____ ventricles on CT/MRI |
Hydrocephalus
• Assess: HEAD circ, BULGING fontanel, SEPARATED sutures • Same S/S as ICP – HEADache, VOMITing, PAPILLedema, ATAXIA (musc), IRRITABILity, LETHargy, HIGH-pitched “neuro” cry, CONFUsion, SEIZUREs, CRANIAL nerve dysfunction • ENLARGED ventricles on CT/MRI |
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Status Epilepticus
Nursing Tx/Interventions 1. ____ 2. ____ 3. ____ ALSO: • ____ diet • ____ |
Status Epilepticus
Nursing Tx/Interventions 1. Stabilize airway! 2. Safety precautions 3. Medications – Ativan or Valium – Dilantin (Phenytoin); Fosphenytoin – Tegretol – Depakote – Phenobarbital ALSO: • Ketogenic diet • Education |
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NSG Management of GHD
> Assessment > Nursing diagnoses - ____ growth/developmt r/t inadeq ____ secretion - Disturbed ____ image r/t ____ stature - Deficient ____ r/t tx > Outcome identification > Planning/implementation - ____ injections of ____ > Evaluation > ____ teaching re: ____ |
NSG Management of GHD
> Assessment > Nursing diagnoses - Delayed growth/developmt r/t inadeq GH secretion - Disturbed body image r/t short stature - Deficient knowledge r/t tx > Outcome identification > Planning/implementation - SQ injections of GH > Evaluation > Pt/Family teaching re:tx |
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Acquired Hypothyroidism
Clinical manifestations * ____ rate of growth * Weight ____ * ____ (bowels) * ____ skin * ____ or ____ hair * ____ (energy) * ____ intolerance * ____ of face, eyes, hands * ____ deep tendon reflexes * ____ puberty Tx = Med: ____ |
Acquired Hypothyroidism
Clinical manifestations * Decreased rate of growth * Weight gain * Constipation * Dry skin * Thinning or coarse hair * Fatigue * Cold intolerance * Edema of face, eyes, hands * Delayed deep tendon reflexes * Delayed puberty Tx = Med: Levothyroxine |
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Hyperthyroidism
Clinical manifestations * ____ rate of growth * Weight ____ despite ____ appetite * ____, ____ skin * ____cardia * ____ changes * Heat ____ * Emotional ____ * _____somnia, ____ tremors Tx: * ____ medication * ____ therapy * Subtotal ____ectomy |
Hyperthyroidism
Clinical manifestations * Increased rate of growth * Weight loss despite excellent appetite * Warm, moist skin * Tachycardia * Ophthalmic changes * Heat intolerance * Emotional lability * Insomnia, fine tremors Tx: * Antithyroid medication * Radioactive iodine therapy * Subtotal thyroidectomy |
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Congen. Adrenal Hyperplasia
Clinical manifestations * Male fetus: ____ * Female fetus: virilized _____ • Enlarged ____ • Fusion of ____ • ____ appearance to labia • ____ism (genitals) * Children (often toddlers) present with: adrenarche, ____ growth velocity, ____ bone age, acne, ____ism (hair) |
Congen. Adrenal Hyperplasia
Clinical manifestations * Male fetus: no phys changes * Female fetus: virilized external genitalia • Enlarged clitoris • Fusion of labial folds • Rugae appearance to labia • Pseudohermaphroditism * Children (often toddlers) present with: adrenarche, accelerated growth velocity, advanced bone age, acne, hirsutism |
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HEMATOLOGY
• Red Blood Cells – Life span: ____ days, removed by ____ – Types of hgb: ____ and ____ – Hgb molecule has __(#) heme, __(#) globin chains • White Blood Cells – Early inflammatory response: neutrophils – Immunity: lymphocytes – Inflammatory/phagocytic: monocytes, macrophages • Platelets – Life span: ____ days – ____ # in inflamm. states |
HEMATOLOGY
• Red Blood Cells – Life span: 120 days, removed by SPLEEN – Types of hgb: A (adult) and F (fetal) – Hgb molecule has 4 heme, 4 globin chains • White Blood Cells – Early inflammatory response: neutrophils – Immunity: lymphocytes – Inflammatory/phagocytic: monocytes, macrophages • Platelets – Life span: 10 days – INC. # in inflamm. states |
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SICKLE-CELL pathophysiology
• RBC sickling caused by: ___emia(O2), ___osis(pH), ____hydration, stress, infection, ____ extremes • Sickled RBC destruction -> ____ • Accumulated RBCs in spleen -> ____ damage & fibrosis • Sickled RBCs obstruct capillaries/____, impair ____ -> pain, ____ dysfunction |
SICKLE-CELL pathophysiology
• RBC sickling caused by: hypoxemia, acidosis, dehydration, stress, infection, temp extremes • Sickled RBC destruction -> anemia • Accumulated RBCs in spleen -> spleen damage & fibrosis • Sickled RBCs obstruct capillaries/vessels, impair circulation -> pain, organ dysfunction |
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Hemophilia (A & B)
• Clinical Manifestations: – Hemat____, Hem____, Hemat____, Epistaxis (nose ____),Intracranial ____, Other ____ (neck, abdomen, mouth) • Dx – History, Thromboplastin Generation test • Severity (based on % of factor) – Mild: __-__% of normal – Moderate: __-__% – Severe: < __% |
Hemophilia (A & B)
• Clinical Manifestations: – Hematomas, Hemarthroses, Hematuria, Epistaxis, Intracranial bleed, Other bleeding (neck, abdomen, mouth) • Dx – History, Thromboplastin Generation test • Severity (based on % of factor) – Mild: 5-35% of normal – Moderate: 1-5% – Severe: < 1% |
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TYPES of Cerebral Palsy
* ____- tense, contracted muscles (most common) * ____- poor sense of balance, falls/stumbles * ____- constant, uncontrolled motion of limbs, head, and eyes * ____- tight muscles that resist effort to make them move * ____- uncontrollable shaking, interfering with coordination |
TYPES of Cerebral Palsy
* SPASTIC- tense, contracted muscles (most common) * ATAXIC- poor sense of balance, falls/stumbles * ATHETOID- constant, uncontrolled motion of limbs, head, and eyes * RIGIDITY- tight muscles that resist effort to make them move * TREMOR- uncontrollable shaking, interfering with coordination |
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SICKLE CELL Life-threatening complications
•____-occlusive episode: -PAIN due to ____ (acute, chronic) –____ *S/S= severe ____ache, ____ signs *Evaluate c transcranial ____ *Tx: ____ transfusion q 3-4 wks Tx: ____ therapy: Desferoxamine SC infusion __ nts/week –Acute ____ Syndrome *S/S= pneumonia-like picture, ____emia, pain *Tx= Transfusion or ____ transfusion, ____ support |
SICKLE CELL Life-threatening complications
•Vaso-occlusive episode: -Pain due to ischemia (acute, chronic) –Stroke *S/S= severe headache, neuro signs *Evaluate c transcranial doppler *Tx: blood transfusion q 3-4 wks Tx: Chelation therapy: Desferoxamine SC infusion 5 nts/week –Acute Chest Syndrome *S/S= pneumonia-like picture, hypoxemia, pain *Tx= Transfusion or exchange transfusion, Respiratory support |
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Beta-thalassemia
• Mediterranean, Middle East, Africa, South China, Southeast Asia • Synthesis beta ____ chain impaired • RBCs w/ less ____ • ____ in marrow destroyed • Increased erythropoietin, but ineffective ____ production • Bone marrow ____ (abnormal multiplication of cells) • Sequelae (a secondary condition resulting from a disease): – Severe ____ – ____ growth/ development – Without treatment: ____ by 5 – 6 years |
Beta-thalassemia
• Mediterranean, Middle East, Africa, South China, Southeast Asia • Synthesis beta Hgb chain impaired • RBCs w/ less Hgb • RBCs in marrow destroyed • Increased erythropoietin, but ineffective RBC production • Bone marrow hyperplasia • Sequelae: – Severe anemia – Impaired growth/ development – Without treatment: death by 5 – 6 years |
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Aplastic Anemia
• Dx'd with: ____ aspirate, ____ studies • Tx: • ____ therapy may induce remission (ATG, cyclosporin, steroids) • Only cure is ____ • Nursing Management: – Potential for infection – Potential for injury – Inadequate tissue perfusion |
Aplastic Anemia
• Dx's with: bone marrow aspirate, chromosome studies Tx: • Immunosuppressive therapy may induce remission (ATG, cyclosporin, steroids) • Only cure is bone marrow transplant • Nursing Management: – Potential for infection – Potential for injury – Inadequate tissue perfusion |
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14 yo with sickle cell disease, admitted from ER for fever and pain. 3 day hx increasing chest pain, fever to 38.5. Wt = 45 kg
Admit VS: T= 38.4ax, HR= 140, RR= 32, BP= 142/88, 02 sat 90% on room air. Rates pain as 9/10 on 0-10 scale. Points to upper right chest as pain location, also back and abdomen. Has an implanted port in rt chest, accessed in ER, now with D5%/0.45NS at 25 ml/hr. CBC, retic count, and blood cultures drawn, chest xray done. * What are your nursing priorities? * What else do you need to assess? * What other information would be useful in planning care? |
* What are your initial nursing actions?
* When will you reassess? * What kinds of medical orders do you expect? * Which, if any, of these results is concerning? And, why? •CXR results show a right upper lobe opacity. ? Infiltrate. •CBC results: H/H = 7.0 / 20 (norm =13-16/37-49) •Retic count = 1.5 (norm = 0.5-1.5) •WBC = 15,000 (norm = 4.5 – 11.0) •segs:80%, bands:10% (norm segs = 54 - 62, bands = 3 - 5) |
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Lymphoma
• From lymphoid and hematopoietic systems NON-HODGKINs Lymphoma – Peak 7-11 years S/S: Depend on location (mediastinal mass, pleural effusion, lymphadenopathy) – Pain, edema, generalized – Often advanced at dx • With mediastinal mass, risk of ____ distress and superior vena cava syndrome • Treatment with multi-agent ____ • High risk of ____ lysis syndrome |
Lymphoma
• From lymphoid and hematopoietic systems NON-HODGKINs Lymphoma – Peak 7-11 years S/S: Depend on location (mediastinal mass, pleural effusion, lymphadenopathy) – Pain, edema, generalized – Often advanced at dx • With mediastinal mass, risk of respiratory distress and superior vena cava syndrome • Treatment with multi-agent chemotherapy • High risk of tumor lysis syndrome |
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Wilms Tumor
• Arises in ____, primordial cells • S/S: ____ swelling, pain, ____uria, ____ BP, malaise • Dx: CT/MRI • Surgery to remove ____ or ____, ____therapy • Pre-op: monitoring, no ____ palpation (fragile outer capsule of tumor) • Postop: – Care as for major abd surgery, large abd incision – Fluids, BP, pain |
Wilms Tumor
• Arises in kidney, primordial cells • S/S: abdominal swelling, pain, hematuria, INC. BP, malaise • Dx: CT/MRI • Surgery to remove tumor/kidney, chemo • Pre-op: monitoring, no abdominal palpation (fragile outer capsule of tumor) • Postop: – Care as for major abd surgery, large abd incision – Fluids, BP, pain |
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Neuroblastoma
• From neural crest cells: – brain, adrenal medulla, pelvis, mediastinum, sympathetic ganglia • S/S: caused by ____ on adjacent structures, ____ • Dx: scans, lab tests (depending on location), biopsy • Staging: based on age, markers present, histology, extent of spread (62% have ____) • Treatment: surgical removal, intensive ____, radiation (stage III), BMT |
Neuroblastoma
• From neural crest cells: – brain, adrenal medulla, pelvis, mediastinum, sympathetic ganglia • S/S: caused by compression on adjacent structures, metastases • Dx: scans, lab tests (depending on location), biopsy • Staging: based on age, markers present, histology, extent of spread (62% have mets) • Treatment: surgical removal, intensive chemo, radiation (stage III), BMT |
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CHF
* Treatment: - ____ - Meds: ____ - Positive ____ - ____ support * Nursing management - 1st: ____ ~ ____ assessment ~ ____ support, ____ c child - Nursing diagnoses ~ ____ Cardiac output ~ Fluid volume ____ ~ Imbalanced nutrition: ____ than body reqs - ____ identification and planning - Evaluation and family ____ |
CHF
* Treatment: - SURGERY - Meds: DIURETICS - Positive INOTROPES (↑CO) - NUTRITIONAL support * Nursing management - 1st: ASSESSMENT ~ PHYSICAL assessment ~ FAMILY support, INTERACTION c child - Nursing diagnoses ~ DECREASED cardiac output ~ Fluid volume EXCESS ~ Imbalanced nutrition: LESS than body reqs - OUTCOME identification and planning - Evaluation and family TEACHING |
