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88 Cards in this Set

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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
ACYANOTIC
congenital heart diseases
that cause ↑ Pulmonary
blood flow:
_____
_____
_____
* A/V septal defects
* Patent ductus arteriosus
* Atrioventricular canal
ACYANOTIC
congenital heart diseases
that cause obstructed blood flow from ventricles:
____
____
____
* Coarctation of aorta
* Aortic stenosis
* Pulmonic stenosis
CYANOTIC
congenital heart diseases
that cause ↓ Pulmonary
blood flow:
____
____
* Tetralogy of Fallot
* Tricuspid atresia
CYANOTIC
congenital heart diseases
that cause mixed blood flow:
____
____
____
____
* Transposition of great arteries
* Total anomalous pulmonary venous return
* Truncus arteriosus
* Hypoplastic L heart syndrome
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.
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.
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
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
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.
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
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
Psychosocial Factors
* ____
* ____
* ____
* ____
* Separation
* Bonding
* Feeding
* Care
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
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
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
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.”
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
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
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
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.
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.
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.
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.
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)
Cerebral Perfusion Pressure

- blood pressure gradient
across the brain

CPP = ____–____

Keep above ____
CPP = MAP – ICP

Keep above 60
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
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
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
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
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
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
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
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
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
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)
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
50-70% of Spina Bifida pts have an allergy to _____
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
Most common
causative organisms
of MENINGITIS (80%)

• ____
• ____
• ____
• Haemophilus influenza b
(Hib)

• Strep pneumoniae
(pneumococcal)

• Neisseria menigitidis
(meningococcal)
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
MENINGITIS residual effects

• ____ness, ____ness
• ____
• Subdural ____,
____cephalus
• ____
• ____ palsy
• ____ (Meningococcal)
MENINGITIS residual effects

• Deafness, blindness
• Paralysis
• Subdural effusions,
hydrocephalus
• Seizures
• CP
• Amputation (Meningococcal)
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
Seizure Types
• Partial
– ____
– ____
• Generalized
– ___-___
– A____
– A____
– A____
Seizure Types
• Partial
– Simple
– Complex
• Generalized
– Tonic-Clonic
– Absence
– Atonic
– Akinetic
Status Epilepticus- MED EMERG

• Continuous ____ activity
• Loss of ____
Status Epilepticus- MED EMERG

• Continuous SEIZURE activity
• Loss of CONSCIOUSNESS
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
Med/Nsg Interventions for CP

• ____ training
• ____ assistance
• ____ aids
• ____ Therapy
• ____
• ____
Med/Nsg Interventions for CP

• ADL training
• Mobility assistance
• Communication aids
• Physical Therapy
• Medication
• Surgery
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
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
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
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
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
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
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
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)
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)
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)
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)
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
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
Differences in Adult and Child Cancer

– Origin
– Cause
– Prevention and screening
– Metastasis at diagnosis
– Response to treatment
– Cure rate
Find answers in book
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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%
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
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
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
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
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)
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
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
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
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