EXAM #4 Flashcards
(221 cards)
1
Q
What is the patho/etiology of Attention deficit hyperactivity disorder?
A
Unknown cause but we think dopamine and norepinephrine are involved
2
Q
What clinical manifestations are seen in ADHD?
A
-Inattention
-Hyperactivity
-Impulsivity
3
Q
What screenings are performed to dx ADHD?
A
-Medical and developmental hx
-Physical exam
-Vision and hearing
-Neuro evaluation
-Behavioral checklist
-Presentation that meets the criteria within the last 6 months
4
Q
What medication is used for ADHD?
A
Psychostimulants methylphenidate, dextroamphetamine, amphetamine, lisdexamfetamine
-Based on symptoms not weight
5
Q
What should be monitored when a child is on medication for ADHD?
A
The appetite. Assess weight and nutrition
6
Q
What behavioral therapies will a child with ADHD have?
A
-Parenting skills: prevention of undesired behaviors
-Counseling
-Peer groups
-Family therapy
-Rewards
7
Q
What is included in environmental manipulation for children with ADHD?
A
-Limit stimulation
-Testing
-Organization
-Redirection
8
Q
What is the patho for Autism?
A
Continuum of disorders involving limitations in social relatedness, verbal & nonverbal communication, & range of interest & behaviors
9
Q
What clinical manifestations are seen in children with Autism?
A
-Impairment in social reciprocity
-Inability to maintain eye contact
-Impaired communication
-Restrictive or repetitive behaviors, interest or activities
10
Q
How is Autism diagnosed?
A
First signs program around 18 to 3 months
11
Q
How is autism managed?
A
-Early interventions
-Be aware of child’s physical boundaries & reluctance to by others
-Routine very important
12
Q
What is considered maltreatment of children?
A
Abuse and neglect of a child less than 18 years of age by anyone
-Physical, sexual, emotional
13
Q
What are possible signs and symptoms of abuse or neglect?
A
-Suspicious injuries
-Scared of caregivers
-Fearful of going home
-Acting out
-CNS injury
-Prolonged or recurrent illness that cannot be explained
-Poor relationships
-Sexual knowledge
-Running away
-Decline in school
-Suicide
-Depression
-Hostility
-Poor hygiene
-Hunger
14
Q
What are nursing intereventions used for maltreatment of children?
A
-Identify risk factors
-Teach parents appropriate ways to disipline the child (take away privileges, time out, praise for good behaviors)
-Teach about use of alcohol and drugs during pregnancy
-Educate children about the body and personal boundaires
-Report suspected abuse or follow agency guidelines
15
Q
What is the patho/etiology for down syndrome?
A
Chromosomal abnormality: Trisomy 21
16
Q
What clinical manifestations are seen with Down syndrome?
A
-Poor muscle tone
-Slanting eyes
-Hyper flexibility of the joints
-Flat bridge of the nose
-Short neck with extra folds of skin
-Small stature
-Low-set ears
-Simian crease
-Protruding tongue
17
Q
How is down syndrome diagnosed?
A
Chromosomal blood test
18
Q
Management of down syndrome:
A
-Assist new parents with information and resources
-Early intervention
19
Q
What is the patho/etiology of Type 1 Diabetes?
A
-Not preventable
-Autoimmune disease that causes distruction of the pancreatic cells that produce insulin
20
Q
What clinical manifestations are seen with T1DM?
A
-Polyuria
-Polydipsia
-Polyphagia
-Weight loss
21
Q
How is T1DM diagnosed?
A
-Random glucose levels (>200mg/dL)
-Elevated HgBA1c every 3 months (>7)
-Increased ketones and urine glucose
22
Q
What are s/s of hypoglycemia?
A
-Irritable
-Nervous
-Difficulty concentrating
-Shaky feelings
-Hunger
-Pallor
-Sweating
-HA
-Tachycardia
-Shallow respirations
23
Q
What are s/s of hyperglycemia?
A
-Lethargic
-Confusion
-Double vision
-Thirst
-Weakness
-Flushed dry skin
-Deep rapid Kussmaul respirations
-Fruity acetone breath (from ketones)
-Parethesia
24
Q
What is included in medical management for T1DM?
A
-Monitor BS and A1C
-Nutrition
-Insulin therapy
-Monitoring for complications and ketones
25
Ketones in the urine indicate...
insulin deficiency
26
What type of insulin is Humalog/Novolog? When is it used best?
Rapid acting (10 to 15 min)
-Immediately before meals or after
-Picky eaters or toddlers who do not eat the same amount each time
27
What type of insulin is Regular insulin?
Short acting (30 min)
28
What type of insulin is NPH insulin? When is it best taken?
Intermediate acting (2-4 hrs)
-Varies
-Taken in the morning but does not take effect until the afternoon
29
What type of insulin is Lantus? How long does it last? Can it be mixed?
Long acting (1-2hrs)
-Lasts 24 hours with steady levels
-CANNOT be mixed
30
Education for T1DM:
-How to count carbs
-Exercise monitor sugar before and after
-Ketone monitoring (glucose over 240 and/or child lost weight)
-Monitor blood sugar up to 6 times per day
-Follow up Q3 months
-DKA
-How to administer insulin
-Nutrition
-Sick day rules
31
What is the patho/etiology of hypothyroidism?
Thyroid insufficiency
-Too little thyroid hormone is produced or released
32
Clinical manifestation of hypothyroidism in an infant?
-Prolonged jaundice
-Poor feeder
-Constipation
-Cool/mottled skin
-Hypotonia
-Sleepiness
-Larger fontanelles
-Decreased crying
-Large thick tongue
33
Clinical manifestation of hypothyroidism in a child?
-Short stature
-Delays in developmental milestones
-Weight gain
-Hypotonia
-Puffy facial features
-Mental retardation
-Protruding abdomen
-Sparse, coarse, dry or brittle hair
34
How is hypothyroidism diagnosed?
Newborn screening: TSH levels high and low T4
35
What medication is used to treat hypothyroidism?
Levothyroxine
36
What education/discharge instructions should the nurse provide for hypothyroidism?
-Treatment plan
-Medication administration
-Milestones/development
-Labs for T4 and TSH serum levels Q 4-6mths
37
What is the patho/etiology of Type 2 diabetes?
The body's resistance to recognize and use insulin
38
What are the clinical manifestations of T2DM?
-May have no signs
-Obesity
-Fatigue
-Frequent infections
-3 Ps
39
How is type 2 diabetes diagnosed? (risk factors)
-Overweight >85th percentile
+ 2 of the following risk factors
-Family Hx (1st or 2nd degree relative)
-Native American, AA, Latino, Asian, Pacific islander
-Insulin resistance (acanthosis nigricans) a dark pigment on the neck, armpits, or arms, HTN, dyslipidemia, PCOS, small for gestational age
-Maternal hx of diabetes or gestational
40
How can T2DM be prevented?
Healthy Lifestyle (diet, activity, healthy weight)
41
Nursing care for T2DM:
-Educate on management (monitoring, lifestyle, meds, A1C
-Monitor for complications (-opathys) (DKA)
-Comprehensive care with dietician, school staff, and endocrinologist
42
What medications are used for T2DM?
-Insulin (rapid, short, intermediate, long)
-Metformin
43
What is the patho/etiology of diabetic ketoacidosis?
-Hyperglycemia, ketosis, and acidosis resulting from severly deficient insulin
-Abnormal breakdown of carbs, proteins, and fats leading to high blood sugar
44
What are the clinical manifestations of DKA?
-Fatigue
-Malaise
-N/V
-3 Ps
-Weight loss
-Fever
-Kussmaul respirations
-Acetone odor of breath
-Tachy
45
How is DKA diagnosed?
-Blood glucose greater than 250 mg/dL
-Ketonuria
-Sodium bicarb less than 18 mEq/L
-pH less than 7.34 acidosis
46
How can DKA be prevented?
Consistent monitoring and control of blood sugars
& preventing infection
47
Nursing interventions for DKA:
-Restore fluid volume with Isotonic fluids
-Prevention of lipolysis
-Electrolyte replacement especially K
-Respiratory & neuro assessment
-hourly monitoring of glucose
-K every 2 to 4 hours
48
What is the patho/etiology of precocious puberty?
-Overactivity of the pituitary gland
-Caused by CNS abnormalities, lesions/tumors, or brain injury
-Earlier than 8 YOA
49
What are clinical manifestations of precocious puberty in boys?
-Facial hair
-Penile growth
-Increased masculinity
-Testicular enlargement
-Voice changes
-Axillary & public hair
-Body odor
-Acne
-Emotional lability
-Mood swings
-Growth spurts in height
50
What are clinical manifestations of precocious puberty in girls?
-Breast development
-Onset of menarche
-Ovary enlargement
-Cyst on ovaries
-Axillary & public hair
-Body odor
-Acne
-Emotional lability
-Mood swings
-Growth spurts in height
51
How is precocious puberty dx?
-Blood tests of sex hormones (LH, FSH, testosterone & estrodiol)
-CT or MRI
52
Nursing care for precocious puberty:
-Prevent early exposure to hormones
-Growth charts
-Blood tests
-Collaborative care with endocrinologist
53
Medical care for Precocious puberty:
-CNS tumor removal
54
What medication is given for precocious puberty?
-Gonadotropin-releasing hormone (GnRH) agonist
-Injection daily or every 3/4 weeks, every 3 mths
-Histrelin or Supprelin LA-permanent implant that released inhibitior for a year
55
What education/discharge instructions are given for precocious puberty?
-Psychosocial, body image
-Follow chronological age not developmental age
56
What is the patho/etiology of acne?
Caused by propionibacterium acnes
-Onset of adrenal androgenic hormones
57
What are the Clinical manifestations of acne?
-Increased sebum production
-Inflammation with papules, pustules or nodules
58
How is acne dx?
Skin assessment and history
59
How can we prevent acne?
-Avoid oil based products
-Do not touch, pick or rub acne
-Stress management
60
What education should be provided for acne?
-Clean gently without using oil based products
-Take medication at night
-Side effects
-Birthcontrol
61
What classes of medication is used for acne?
-Antimicrobials
-Retinoids
-Hormones
62
What is the patho/etiology of atopic dermatitis/eczema?
Associated with allergies and asthma
63
IS atopic dermatitis contagious?
No
64
What are the clinical manifestations of atopic dermatitis/eczema?
-Crusty lesion that may weep
-Red, raised, rash that is pruritic that may cause pain
65
How is atopic dermatitis/eczema dx?
H&P, blood test
66
Nursing care for atopic dermatitis/eczema:
-Monitor rash
-Warm water baths
-Avoid excessive scrubbing
-Moisturize immediatley after bathing
67
Education/discharge instructions for atopic dermatitis/eczema:
-Itch avoidance
-Keep nails short
-S/s of infections
-Dress in light,soft non-irritating clothing
-Identify and remove potential irritants
68
What is the patho/etiology of impetigo contagiosa?
-Bacterial infection caused by Staph aureus around the nose or mouth
-Not usually painful
-Highly contagious
69
What are the clinical manifestations of Impetigo?
-Vesicle or pustule with edema and erythema
-Lestions will then erupt leaving sticky, honey-colored exudate than turn to crust
-Itching
70
How is impetigo dx?
Assessment of the skin
71
How can impetigo be prevented?
-Good hand washing
-Keep child home for 24 hours AFTER the start of antibiotics
-Change pillow case nightly
72
What medication is used for impetigo?
Topical antibiotics or oral for widespread infection
-apply with a cotton tip swab
73
What is the patho/etiology of cutaneous candidiasis?
-Fungal infection caused by Candida albicans
-Occurs in infants and children who use corticosteroid inhalers
74
What are the clinical manifestations of oral cutaneous candidiasis?
Whitish gray plaques that can no be removed on the tongue or oral mucosa
75
What are the clinical manifestations of skin cutaneous candidiasis?
Fine, red, or pink papules with scalloped borders
76
How is cutaneous candidiasis dx?
-Hx
-Visualization of the lesions
-Fungal culture
77
How can cutaneous candidiasis be prevented?
-Clean nipples from the bottles with soap and water
-Keep diaper area dry and use barrier creams
-Rinse mouth out after corticosteroid inhalers
78
What medications are used for cutaneous candidiasis?
Nystatin, Clotrimazole, Miconazole
79
Nursing intervetions for cutaneous candidiasis:
-Apply oral medication to the inside of both cheeck with a cotton tip applicator
-Medication education
80
What is Tinea capitus?
Scaly pruritic patches on the scalp. May have hair loss
81
What is Tinea Corporis?
Round oval lesion with a maculopapular border with central clearing ringworm
82
What is Tinea Cruris?
Red, scaly skin that involves the inner thighs, inguinal creases, or perineal area 'jock itch'
83
What is Tinea Pedis?
Red, scaly, pruritic skin that may develop weeping.
-Involves webbed area of the toe and feet, 'athlete's foot'
84
How are the Tinea infections dx?
Visual inspection using a Wood's lamp (will be gold-yellowish color)
85
How can the Tinea infections be prevented?
-Check family pets
-Good handwashing
-Bathe after sports
-Do Not share towel, combs, hats or helmets
86
What medication is used for the Tinea infections?
Antifungals that must be taken at least 6 weeks
87
Nursing interventions for the Tinea infections:
-Whole family must be treated
-Complete meds
-Wear lightweight dry socks
-Clean/disinfect
-Shower/bathe
88
What is patho/etiology for contact dermatitis?
Occurs when allergen or irritant is encountered
-Diaper area, playing outside, jewelry, plants
89
What are clinical manifestations of contact dermatitis?
-Irritated, inflamed, pruritic rash
-Vesticles and bull
-Vesicles may weep serous fluid
90
How is contact dermatitis dx?
-Hx and phyical
-Biopsy of vesicles
-Rule out impetigo and varicella
91
How can contact dermatitis be prevented?
-Wear pants and long sleeves
-Avoid known allergens
-Wash well
92
What medications are used for contact dermatitis?
Antipuritic, oral, or topical steroids
93
Nursing interventions for contact dermatitis:
Cool baths and frequent diaper changes for infants
94
What is the patho/etiology of pediculosis capitis?
-Scalp, body, pubic
-Lice pierce the skin and suck the blood
95
What are the clinical manifestations for pediculosis capitis?
-lice near the nape of the neck and ears
-Louse eggs
-Pearlescent teardrop in shape
-Florescent blue under a Wood's lamp
96
What medication is used to treat pediculosis capitis?
-Permethrin 1%
97
Patient education for pediculosis capitis:
-Wash hair according to shampoo instructions
-Olive oil
-Clean all hats, helmets and toys
-Wash everything is boiling water
-Stay home until lice-free
-Recheck in 7 to10 days
-If item cannot be washed, bag it and leave it for 14 days
98
What does a mosquito bite look like?
-Red, edematous papule
-Pruritic
-Burning pain
99
What does a spider bite look like?
-Red, edematous papule, wheal or pustule often solitary
-Pruritc
-Mild to severe pain
-Local necrosis
100
What does a tick bite look like?
-Small redish area that may be raised
-Sometimes pruritic
101
What does a bee, wasp sting look like?
-Red edematous papule
-Pain
-Allergic reaction: hives, flushing, angioedema or wheezing
102
How bug bites be prevented?
-Wear light-colored clothing with minimal scents
-Cover skin
-Use bug repellant
-Do not play in dead foliage or live, blooming foliage
-Playing in the woods is okay but check for ticks
103
What type of medication is used for bites and stings?
Allergy meds
104
Nursing interventions for bites and stings:
-Clean with soap and water
-monitor for secondary signs of infection
105
Patient education for bites and stings:
-Remove stingers
-Use repellants
-Remove ticks and save them
106
What are clinical manifestations of dog bites?
-Scratches and abrasions
-Deep lacerations or punctures
-Crushing tissue and bone injury including never/tissue/muscle and bone
107
What are clinical manifestations of cat bites?
-Scratches and abrasions
-Puncture like bites
-Complications such as cat scratch disease, osteomyelitis, and septic arthritis
108
Medical management for animal bites:
Antibiotics and suture larger wounds
109
Nursing interventions for animal bites:
-Hx
-Clean with soap and water
-Topical antibiotics and clean dressing
-Tetanus booster
110
What are clinical manifestations of human bites?
-Teeth marks without penetration
-Cutting or piercing of the skin
-Brusing, swelling tenderness
-Erthema, pain, or fever
111
Nursing interventions for human bites:
-Hx
-Irrigate wound
-Topical antibiotics
-Dress wound
-Elevate extremity
-Monitor for infection
112
Patient education for human bites:
Notify family about the risk for blood-borne diseases
-Wound care
-Signs of infections
-Take antibiotics as directed
113
What is the patho/etiology of cat scratch disease?
-From cat scratch or bite. When the saliva penetrates the human skin
-Lasts 6-12 weeks
114
What are the clinical manifestations of cat scratch disease?
-3-10 days
-Papule/vesicle
-Tender lymphadenopathy (head, neck, and or upper limbs)
-HA
-General malaise and low-grade fever
115
How is cat scratch disease dx?
H&P with lab work (biopsy of lymph node)
116
Nursing interventions for cat scratch disease:
-Wound care
-Assess lymph nodes & complications like hepatomegaly
-Hand hygiene
117
What are thermal burn types?
-Flame: fire
-Flash: Explosions
-Scald: Hot liquid or steam
-Contact: touching a hot object
118
What is a radiation burn?
Sunburn, radiation therapy, radioactive material
119
What is a chemical burn?
Corrosive chemical (lye, ammonia, sulfuric acid)
120
What is an electrical burn?
Electricity (chewing, touching power lines, inserting something into an outlet
121
What is a superficial burn?
-Erthema and pain for 2-3 days
-Intact epidermis without blisters
-Peeling of skin
-Heals without scarring
122
What is a superficial partial burn?
-Erthema and blister formation that may weep
-Bleeds easily and is very painful
-Damage to epidermis and the outer portion of the dermis
-Heals within 3 weeks
-Scarring will occur
123
What is a deep partial burn?
-White or pale color to injured tissue
-Huge blisters
-Extremely painful
-Heals in 3-9 weeks
-scarring will occur
-Excision and grafting occur
124
What is a full thickness burn?
-Destroys dermis and epidermis
-Eschar is visible
-May damage nerves, bone and muscle
125
How is the size/extend of a burn measured?
Rule of nines: adolescents
Lund & Browder chart: pedi
126
What are the 3 phases of burns?
-Burn shock/resusciatative: 1st 24-48 hours after injury, characterized by shock
-Recovery/wound healing: Close the wound as quickly as possible
-Rehabilitative: Prevent scar contractures. Enable child to reenter their social environment
127
What is included in a burn assessment?
-Hx
-Remove clothing, jewelry
-Cover with blankets
-Assess depth, surface area and severity
128
Children with about what percent of TBSA will need fluid resuscitation?
10%
129
Chilren who are 15%< of TBSA are at risk for...
hypovolemic shock and cellular shock
130
What is the urine output goal during the resuscitation phase?
0.5 to 1ml/kg/hr
131
How often should dressing changes occur fro burns?
Once or twice daily
132
Pain mangement for burns:
Central lines
-Pain meds 20 to 30 minutes before dressing changes
-Diversion activities
-Child can participate
133
Circulation mangement for burns:
-Assess circulation to extremeties
-Decompression
-Fasciotomy & escharotomy
-Balanced diet and biweekly weigh ins
-TPN for those who cannot handle oral nutrition
134
Pruritis management in burns:
Cool the burn scar
135
What nursing interventions occur during the rehabilitation phase?
-Positioning and splinting
-Start active ROM
-Regular massages
-Pressure garments
136
What is the patho/etiology of inhalation burns:
Burns of the airway
-Causes the lungs to fill up with fluid, causing sudden acute pulmonary edema
137
What are the clinical manifestations of inhalation injuries
-Singed eyebrows, nasal hairs
-Stridor
-Hoarseness
-Burns around the nose or the mouth
-Edematous lips
-Hypoxemia
-HX
138
How are inhalation injuries dx?
-H&P
-Symptoms of sudden acute pulmonary edema
-Sleep obstructive apnea
-Dyspneaworsens when lying down
-Weezing & gasping for air
139
Medication management for inhalation injuries:
Early intubation and ventilation
140
Nursing interventions for inhalation injuries:
-Assess respiratory function
-Minimize development of pneumonia
-Frequent turning
-Chest physiotherapy
141
Clinical manifestations of chemical burns:
Mimick skin conditions (dermatitis)
142
Nursing management for chemical burns:
Priority: Remove the chemical by diluting or brush off
Do NOT use another chemical
-Monitor for renal failure
-Watch blood pressure
143
What is the 6 Cs for burns?
Used for minor burns
-Clothing: remove any clothing that is hot or has chemicals
-Cooling: Use cool saline soaked gauze. NO ice
-Cleaning: Wash with mild soap and water
-Chemoprophylaxis: Bacitracin & Tetanus booster
-Covering: Cover with nonadherent gauze
-Comfort: Give acetaminophen or ibuprofen to decrease pain
144
What is the patho/etiology of Phenylketonuria (PKU)?
Autosomal recessive gene
-Inherited error in metabolism lacks an enzyme
-No prevention
145
What are the s/s of PKU?
No symptoms at birth
-Developmental delays
-Intelectual disabilities
-Seizures
146
How is PKU dx?
Metabolic newborn screening
147
How is PKU treated?
-Phenylalanine-free diet (eliminate proteins)
-No milk for formula
-No meat, dairy, nuts, eggs, dry beans or aspartame
-In moderation: cereal, fruits, veggies
148
What is the pato/etiology of anemia?
Decreased circulating RBCs decrease the oxygen-carrying capacity of the blood
149
What are the clinical manifestations of anemia?
-Fatigue
-SOB
-Lethargy
-Tachycardia
-Pale skin
-Irritability
-Dizziness
150
How is anemia dx?
-H&P
-CBC
-Reticulocyte count (shows how fast the body is making RBCs)
151
Nursing care for anemia:
-Responsible for blood transfusions
-Diet or supplements
152
Education/discharge instructions for anemia:
-Education on s/s of anemia
-Administration of iron
-Quiet play, frequent rest periods
153
What is the patho/etiology of iron deficiency anemia?
-Decreased iron supply
-Increased iron demands
-Blood loss
154
What are the clinical manifestations of iron deficiency anemia?
-Irritability
-Fatigue
-Delayed motor development
-Tachycardia
-Shortness of breath
-Pale skin/conjunctival pallor
155
Management requirements for iron deficiency anemia:
-Iron-rich foods
-Iron supplementation (no milk)
-Lab work Q 3mths
156
Education for iron deficiency anemia: Infant and feedings
-Breast milk or iron-fortified formula until 12 months of age
-Iron-fortified cereal from 6-12 months of age
-No cow’s milk before 12 months.
-After 12 months, limit cow’s milk
-Give supplements inbetween meals
-May stain teeth
157
What is the patho/etiology of sickle cell anemia?
Autosomal recessive
C or S-shaped RBC’s
158
What are the clinical manifestations of sickle cell anemia?
-Pain
-Weakness
-Pallor
-Fatigue
-Tissue hypoxia due to obstruction
159
How is sickle cell anemia dx?
-In utero - chorionic villus biopsy
-Newborn screening
-H & P
-Hemoglobin electrophoresis
160
Nursing interventions for sickle cell anemia: Think HOP
Hydration, oxygentation & pain control (PCA pump)
-Respiratory status
161
Education for sickle cell anemia:
-Chronic illness (get vaccines)
-S/S of sickle cell crisis
-Prevention of complications
-Adequate hydration
162
What are some Precipitating Factors for sickle cell anemia?
Anything that increases the body’s need for oxygen or alters the transport of oxygen
Trauma
Infection, fever
Physical and emotional stress
Dehydration
Hypoxia
Altitude
163
What is a Vaso-occlusive thrombotic crisis?
-Pain crisis
-Ischemia causing mild to severe pain
-Stasis of blood leads to ischemia & then infarction
-Signs: Fever, pain, tissue engorgement
164
What is an Aplastic crisis crisis?
-Diminished production and increased destruction of RBCs (usually after removing spleen)
-Viral infection
-Signs: paleness, lethargy, headache, fever, anemia, fainting, recent illness
165
What is a Splenic sequestration crisis?
-Intrasplenic pooling of large amounts of blood
-5 mo-2yrs
-Life-threatening: death can occur within hours
-Signs: profound anemia, hypovolemia, and shock
166
What is an Acute chest syndrome crisis?
-Lower level of oxygen in the blood
-Similar to pneumonia with the presence of new pulmonary Infiltrates
-Signs: chest pain, tachypnea, fever, wheezing, cough, hypoxia
167
What is the patho/etiology of hemophilia?
The coagulation process cannot be completed, so bleeding is prolonged
Type 1: deficiency of factor VIII
168
What are the clinical manifestations of hemophilia?
-Brusing
-Excessive bleeding
-Swelling and stiffness of the joints with pain
169
How is hemophilia dx?
-PT/PTT
-Direct assay of plasma factor activity level for hemophilia A and B
170
How is hemophilia managed?
-Prompt treatment
-Patient safety, prevention of complications
-Factor Replacement
171
Education for hemophilia:
-Administration of factor via IV
-Prevent bleeding
-Monitor patient for s/s of a cerebral bleed
-Close supervision and a safe environment
-Superficial bleeding: apply pressure for at least 15 minutes +RICE
-If significant bleeding occurs, transfuse for factor replacement
-Avoid contact sports
172
What is the patho/etiology of neutropenia?
Absolute neutrophil count
< 1,000/L in infants
<1,500/L for those older than 1 yr
173
What are the clinical manifestations of neutropenia?
-Fever
-Lymphadenopathy
-Pallor
-Bruising
-Petechiae
-Organomeagaly
174
How is neutropenia dx?
-H & P
-CBC with diff
-Peripheral smear
-Possible bone marrow aspiration
175
What precautions are neutropenia patients under?
Neutropenic
176
Nursing care for neutropenia:
-Monitoring for infection
-Evaluating ANC
-Administration of antibiotics
177
Medical care for neutropenia:
-Colony-stimulating factors
-Bone marrow transplant
178
Education/discharge instructions for neutropenia:
-Handwashing
-Monitor temperature, not rectally
-Oral hygiene using soft toothbrush
179
Pretransfusion, Starting the transfusion, During, After blood transfusions:
-Pretransfusion
Get vitals, verify orders, call for blood, must hang within 30 minutes, can only hang for 4 hours, follow facility policy for checking blood
-Starting the transfusion
Get vitals, start the infusion, and monitor in the room for 15 minutes for adverse reaction
-During
Monitor vitals signs for adverse reaction, DO NOT add anything to the blood
-After
Save the bag for an hour, complete paperwork
180
What should the nurse do when there is a transfusion reaction?
-Stop the transfusion
-Monitor vital signs
-Call the MD
181
Cancer is caused by one or a combination of what 3 factors?
-External or environmental stimuli
-Viruses that can alter the immune system and allow cancer growth
-Chromosomal and gene abnormalities
182
What are some consequences of cancer treatments?
-High-tone hearing loss may be a side effect of cisplatin
-Loss of speech
-Impairment of depth perception
-Increased response time
-Lung problems caused by scarring of lung tissue or reduction in lung elasticity
-Shortness of breath
-Reduced exercise capacity
-Kidney problems: Bleeding, Damage to tubules, Protein wasting
-Musculoskeletal defects involving bones or soft tissue and teeth
-Functional and/or mobility deficits may persist if amputation is performed
-Hormonal abnormalities
183
What is the Etiology/patho of acute lymphocytic leukemia?
-Affects mostly immature, undifferentiated cells
-Leukemia is an overproduction of WBCs
184
What are the clinical manifestations of ALL?
-Vague feelings resembling the flu
-Abnormal blood counts
-Anemia
-Easy bruising
-Petechia
-Fever
-Infection
-“Blueberry muffin” lesions
-Signs & labs consistent with DIC
185
How is ALL dx?
Bone marrow aspiration
186
Education for ALL:
-infection s/s
-Monitor for brusing if counts are low
187
Treatment phases for ALL:
1: Remission-induction: reduce tumor to undetectable size
Multiple Chemo drugs for 4 weeks
CNS prophylaxis
Outpatient once stable
2: Consolidation: destroy any residual leukemic cells
Chemotherapy administered in high doses
Not hospitalized
Radiation may be required
3: Maintenance: control leukemia
Can last for 2–3 years after diagnosis
Usually carried out in an outpatient setting
188
What is the patho/etiology of neuroblastoma?
-Tumor of nerve tissue that forms the sympathetic nervous system
-Most commonly develops in the abdomen
189
What are the clinical manifestations of neuroblastoma?
-Palpation of mass
-Crosses the midline
-Edema in lower extremities if severe
190
How are neuroblastomas dx?
-CT/MRI
-Biopsy of tumor
-Bone marrow aspiration
-Lab studies
191
How are neuroblastomas tx?
-Comfort and pain control
-Surgical resection is performed initially
-In advanced cases, chemo is initiated
-Radiation
192
What is the patho/etiology of Wilm's tumor?
Originates in one or both kidneys
193
What are the clinical manifestations of Wilm's tumor?
-Palpable mass
-Does not cross the midline
-Painless
-Hematuria hypertension occurs infrequently
194
How is a Wilm's tumor dx?
-Lab work
-Renal or abdominal ultrasound
-CT/MRI
-CXR if metastasis is suspected
195
Nursing care for Wilm's tumor:
-Sign stating “No abdominal palpation” above the bed
-Intake and output of urine
196
Medical care for Wilm's tumor:
-Chemotherapy and post-radiation care
-Surgical removal of the mass
197
What are the clinical manifestations of retinoblastoma?
-Strabismus, red painful eyes
Whitish glow in the pupil
-An inward or outward turning of the eye
-Visual impairment/Blindness
-Abnormal appearance of the eye
198
How is a retinoblastoma dx?
-Examination using an ophthalmoscope
-Orbital ultrasound and CT or MRI
199
How is a retinoblastoma managed?
Primary enucleation
200
Education/discharge instructions for retinoblastoma:
-Discharged 3-4 days after surgery
-Teach care of eye socket
-After 3 weeks, child is fitted for a prosthetic eye
201
What is the patho/etiology of osteosarcoma?
-A bone tumor usually occurs in the metaphysis
-More common in long bones
202
What are the clinical manifestations of osteosarcoma?
-Swelling and pain
-Pain increases with activity
-Limp
-Dull, aching pain for several months
-Palpation reveals tenderness, swelling, warmth, and erythema
203
How is osteosarcoma dx?
-X-ray
-Chest x-ray to check for metastasis
-MRI/Nuclear Scan
-Lab tests
-Biopsy
204
How is osteosarcoma managed?
-Pain Management
-Promote function and mobility
-Monitor surgical site for s/s of infection
-Chemotherapy
-Surgical resection of the affected bone or limb-sparing surgery
-Quiet activities
-Body image concerns: issues of adolescents
205
What is the patho/etiology of Ewing's sarcoma?
-Bone and soft tissue
-Middle of bones, most often the femur, pelvis, ribs, and upper arms
-More often seen in males
206
What are the clinical manifestations of Ewing's sarcoma?
-Pain and swelling at the tumor site
-Systemic manifestations: fever or weight loss
207
How is Ewing's sarcoma dx?
-Biopsy
-CT, MRI, bone scan
208
How is Ewing's sarcoma managed?
-Assessment of unusual swelling
-Multiagent chemotherapy
-Radiation therapy
-Surgical resection is preferred if possible
-Quiet activities
209
What is the patho/etiology of Hodgkin's lymphoma?
-Cancer of the lymph system
-Painless, firm, cervical, or supraclavicular lymphadenopathy
210
What are the clinical manifestations of Hodgkin's lymphoma?
-Swollen, firm lymph nodes
-Anterior mediastinal mass is present
-Unexplained fever
-Weight loss
-Night sweats
211
How is Hodgkin's lymphoma dx?
-Biopsy of lymph node
-Reed-Sternburg Cells
-MRI, X-ray, CT scan
212
How is Hodgkin's lymphoma managed?
-Monitor for fever
-Manage pain
-Comfort measures
-Treatment includes radiation and/or chemotherapy
-Quiet activities
213
What is the patho/etiology of Non-hodgkin's lymphoma?
-Cancer of the lymph system
-Different from HL in that there is no single focal origin
-Rapid onset with widespread involvement
214
What is the clinical manifestation of Non-hodgkin's lymphoma?
Pain or swelling
215
How is Non-hodgkin's lymphoma dx?
-Tissue diagnosis and staging
-Elevated serum lactic dehydrogenase
-CT or MRI
216
How is Non-hodgkin's lymphoma managed?
-Assess breathing and chest pain
-Pain management
-Support family
-Aggressive, multiagent chemo as soon as possible
-Intrathecal chemo
-Monitor child for pain, fever, infection, enlarged lymph nodes
-Teach parents to monitor for difficulty breathing
217
How will a toddler react to death?
Based on parent’s reactions
Knows something is wrong
Unable to separate fact from fantasy
Death means separation from the parent and is reversible
218
How will a preschooler react to death?
Understands changes in their body and something is wrong but lacks vocabulary
Fear of death can be present as early as 3 years
219
How will a school aged child react to death?
Realistic understanding but is limited by their ability to understand the concept of time
By age 8-9 years, understands death is permanent
220
How will an adolescent react to death?
Understands at the adult level but lacks the EMOTIONAL MATURITY to face death
Believe death can be defeated
221
What are the signs of impending death?
Decreased heart rate
Decreased appetite
Slurred speech
Lack of thirst despite a dry mouth
