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NURS 373 > Hematological & Immunological Dysfunction > Flashcards

Hematological & Immunological Dysfunction Flashcards

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1
Q

History for child with suspected hemotological/
immunological issue

A

what’s normal for them vs new onset

child’s energy

family history

pale, fatigued, easily bruised (low platelets)

bleeding

diet (iron sources)

infections

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2
Q

Complete Blood Count components

A

WBCs

RBCs

Hemoglobin

Hematocrit

Platelets

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3
Q

WBCs indicate…

A

infection, leukaemia, immunodeficiency, viral illness

bone marrow or immune dysfunction

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4
Q

Hemoglobin indicates…

A

also in bone marrow

can be low in anemia?

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5
Q

Hematocrit

A

% of RBC in the blood

will be low with anemia

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6
Q

Most common RBC/hematological disorder for childhood

A

anemia

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7
Q

Anemia

A

decrease in the # of RBCs AND/OR hemoglobin concentration below normal

decreased oxygen-carrying capacity 
of blood

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8
Q

T or F: Anemia is usually a manifestation of something else.

A

TRUE

leukemia or lymphoma

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9
Q

T or F: It is normal for newborns to experience anemia.

A

TRUE

why - premature - not getting all the iron rich blood from mom

delayed cord clamping can help to increase iron

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10
Q

Sign of SEVERE anemia

A

murmur

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11
Q

Classification of anemias (2)

A

1) Etiology and physiology

2) Morphology

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12
Q

1) Etiology and physiology classification

A

RBC and/or Hgb depletion

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13
Q

2) Morphology classification

A

characteristic changes in RBC size, shape, and/or color

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14
Q

Management of anemia

A

physical exam & diagnostics

treat underlying cause
-transfusion
-nutrition

supportive care
-IV fluids
-O2
-bed rest - decrease the demand

prep for lab tests

prevent complications

support/educate family

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15
Q

Things you can do to help kids during lab tests

A

play with equipment beforehand

educate, explain

bring stuffed animal

distraction**

freezing cream or spray

sucrose in infants

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16
Q

Safety thing to look out for with anemia patients

A

dizziness

falls risk

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17
Q

Anemia signs and symptoms

A

tired

pallor

sometimes jaundice

splenomagoly

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18
Q

Iron deficiency anemia

A

inadequate supply of dietary iron

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19
Q

Who is at a higher risk of iron deficiency anemia?
a) bottled fed babies
b) breast fed babies

A

b) breast fed babies

supplementation in the formula

may need to supplement iron at 4 months

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20
Q

Populations at an increased risk of iron deficiency anemia

A

Indigenous populations

babies

adolescence

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21
Q

Ways to prevent iron deficiency anemia

A

iron-fortified cereals and formulas for infants

breastfed babies: supplement at 4 months

premature: supplement at 2 weeks

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22
Q

T or F: Cow’s milk contains iron.

A

FALSE

avoid until 12 months

limit to 600 mL daily

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23
Q

Amount of iron to give

A

3-6 mg per kg

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24
Q

Sickle cell anemia

A

normal adult hemoglovin is partly or completely replaced by abnormal sickle hemoglobin

most common in black population

doesn’t necessarily present in infants

changes over time - crisis starting in toddlerhood

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25
Sickle cell anemia patho
obstruction of the sickled RBCs vascular inflammation increased RBC destruction abnormal adhesion + inflammatory process = vasoconstriction
26
Sickle cell anemia can result in...
local hypoxia tissue ischemia infarction
27
Clinical manifestations of sickle cell anemia
vaso-occlusive crisis stroke (cells block vessels) Chest Syndrome Acute Splenic Sequestration Hyperhemolytic Infection
28
vaso-occlusive crisis
pain crisis episode characterized by ischemia pain can be very very severe minutes to days
29
Chest Syndrome
similar to pneumonia fever, cough, hypoxia, wheezing
30
Acute Splenic Sequestration
pooling of blood, usually in the spleen may have to have spleen removed or not working properly increased risk of infection
31
Hyperhemolytic
anemia jaundice
32
Management of a sickle cell crisis
prevent and treat rest  hydration oxygen - above 95% electrolyte replacement pain management!** -morphine or hydromorphone blood tranfusions antibiotics education/support
33
What is an important focus of education for parents of a child with sickle cell?
education surrounding addiction medication important for a child in pain
34
Leading cause of death from disease in children past infancy
neoplastic disorders most common childhood cancer: leukemia
35
T or F: Leukemia has a good prognosis.
TRUE survival rate: 95%
36
Between what ages does leukemia peak?
2 and 5 years
37
Leukemia
broad group of malignant diseases of bone marrow and lymphatic system
38
Types of leukemias (3)
1) Acute lymphoid leukemia (ALL) -most common** 2) Acute nonlymphoid (myelogenous) leukemia (ANLL or AML) 3) Stem cell or blast cell leukemia
39
Pathophysiology of leukemia
overproduction of WBC, but immature can have high WBC count acute - super low leukocytes bone marrow most affected organs: liver and spleen cellular destruction takes place by infiltration and subsequent competition for metabolic elements
40
Symptoms of leukemia
presents like a viral illness, then more frequent illnesses fever, fatigue (anemic) aching bones or joints (bone marrow full of cells) headaches rashes swollen glands (lymph nodes) frequent infections unexplained weight loss bleeding or swollen gums enlarged spleen or liver, or a feeling of abdominal fullness slow-healing cuts, nosebleeds, or frequent bruises
41
Leukemia rashes (2)
1) purpleish rash -blood pooling caused by a lack of platelets 2) petichia -broken capillaries from low platelets
42
Term for low platelets
thrombocytopenia
43
Term for low hemoglobin
anemia
44
Term for low WBC/leukocytes
leukopenia
45
Term for when everything is low
pancytopenia
46
Diagnostic evaluation for leukemia (4)
1) history, physical manifestations**** 2) Peripheral blood smear -immature leukocytes -frequently low blood counts 3) Bone marrow aspiration or biopsy -taken at the iliac crest -to see if there are blasts in the bone marrow 4) Lumbar puncture to evaluate CNS involvement/disease -test for blasts or leukaemia cells as well
47
What does chemo help prevent?
CNS involvement
48
High risk WBC count
over 50,000
49
High risk age of diagnosis
over 10 -high risk: ALL want adolescents to have AML under want, want to have ALL
50
Low risk cell involvement
B cells
51
High risk phenotype
Philadelphia chromosome
52
Higher risk gender
boys girls have more favourable outcome
53
When should patients ideally be in remission?
end of induction therapy (1 month)
54
Relapse after transplant prognosis
dismal stem cell or bone marrow transplant
55
Therapeutic management of leukemia
Chemotherapeutic agents Cranial irradiaiton Transfusion
56
When are transfusions needed?
hemoglobin < 70, OR symptomatic e.g. fatigue, pallor platelets < 10
57
4 phases of leukemia therapy
1) Induction therapy: 4 to 6 weeks 2) CNS prophylactic therapy -intrathecal chemotherapy 3) Intensification (consolidation/post remission) therapy -to eradicate residual leukemic cells and prevent resistant leukemic clones 4) Maintenance therapy -to preserve remission
58
Mneumonic for 4 phases
I care, I monitor
59
Length of leukemia treatment
2 years
60
Febrile Neutropenia criteria (2)
1) absolute neutrophil count <0.5 2) fever
61
T or F: Feb neut is a medical emergency.
TRUE go to ER asap****
62
Feb neut management
admitted to hospital IV antibiotics -Pip/Tazo min. 48H in hospital
63
When can a child with feb neut be discharged?
no fever within 48h --> can be discharged once 48h period is up, must go 24h without a fever to be discharged
64
What happens if cultural are positive?
10 - 14 days of IV antibiotics
65
What happens if the child continues to have a fever?
will think fungal infection kidneys, brain, lungs, heart
66
Chemo precautions
nitrile gloves -and while changing diapers flush toilet 2x with lid down beware of bodily fluids letting others know cytotoxic status of child when transferring
67
How long is a child cytotoxic for after chemo?
7 days
68
What to do if you are exposed/contaminated to chemo meds?
spill kits eye wash
69
Main types of lymphomas (2)
1) Hodgkin’s disease 2) Non-Hodgkin’s lymphoma (NHL)
70
Which lymphoma is more common? a) Hodgkin's b) non-Hodgkin's
b) non-Hodgkin's
71
Which lymphoma is worse? a) Hodgkin's b) non-Hodgkin's
b) non-Hodgkin's
72
Hodgkin’s disease most prevalent in.....
15 to 19 years usually diagnosed at earlier stage of disease
73
Non-Hodgkin’s lymphoma (NHL) most prevalent in....
<14 years of age
74
Hodgkin’s lymphoma
cancer of lymph tissue found in the lymph nodes, spleen, liver, bone marrow, and other sites RF: past EBV
75
Hodgkin’s lymphoma - Classification A symptoms
PAINLESS swelling of the LYMPH NODES in the neck, armpits, or groin (swollen glands)
76
Hodgkin’s lymphoma - Classification B symptoms
PAINLESS swelling of the LYMPH NODES in the neck, armpits, or groin (swollen glands) fatigue fever and chills that come and go unexplained itching soaking night sweat unexplained weight loss chest pain - depending on where tumour is big spleen, liver, abdominal fullness
77
What is one of the first signs of Hodgkin's lymphoma type B
pruritis itching
78
Hodgkin's lymphoma diagnostics (4)
1) lymph node biopsy 2) chest x-ray 3) bone marrow biopsy 4) Presence of Reed-Sternberg cells -owl looking cells -double nucleus
79
Hodgkin's lymphoma management
radiation and/or chemo infection prevention
80
Non-Hodgkin’s Lymphoma
cancer of the lymphoid tissue
81
Non-Hodgkin’s Lymphoma symptoms
depend on area affecting, how fast its growing new onset wheeze facial swelling respiratory distress asymmetrical tonsils acute abdominal pain
82
Non-Hodgkin’s Lymphoma treatment
depends on age, stage, symptoms etc. CHEMO** radiation --> not often surgery Rituximab (Rituxan) (B-cell)
83
Care priorities for the child with cancer
Family Centred Care -health care team  -support -education -cultural considerations

NURS 373 (12 decks)

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