Peds Exam 1 Flashcards
(145 cards)
1
Q
Adults w Cancer
A
-usually not metastasized at diagnosis
-involves organs
-the primary cause is environmental exposures
-usually, a long latent period, could be up to 20 years
2
Q
Kids with Cancer
A
-about 92% of cancer develops from primitive embroyal tissue
-involves tissues
-the cancer is usually metastasised at diagnosis
-short latent period
3
Q
Early s/s of pediatric cancer
A
-unexplained pallor
-loss of energy
-unusual mass, lump, or swelling
-sudden unexplained weight loss
-unexplained fever that doesn’t go away
-easy bruising/ bleeding
-prolonged/ongoing pain in one or more areas of the body
-limping, refusal to bear weight
-frequent headaches, especially in the morning ( the headaches are associated with vomiting)
-vision changes
4
Q
What is the most common type of cancer in children
A
leukemia
5
Q
Leukemia s/s
A
-petechiae
-MSK pain
-fatigue
-weight loss
-pt may present with hyperleukocytosis
-50% of pt present w/ lymphadenopathy
-50% of patients have a fever
-50% of patients present with hepatomegaly/splenomegaly
6
Q
children with trisomy 21 are at an increased risk for
A
leukemia
7
Q
leukemia description
A
immature lymphoblasts replace normal cells in the bone marrow which leads to pancytopenia ( anemia, neutropenia, thrombocytopenia)
8
Q
Hodgkin Lymphoma ( HL ) is most common in which age group
A
teens, young adults
9
Q
what is the hallmark sign of Hodgkin lymphoma
A
presence of Reed-Sternberg B cells
10
Q
Hodgkin lymphoma description
A
malignant cells proliferate in lymph tissues which lead to lymphadenopathy which then leads to compression of nearby structures which kills healthy cells and invades surrounding lymph tissue
11
Q
Epstein-Barr virus infection is usually associated with
A
Hodgin Lymphoma
12
Q
Hodgin Lymphoma s/s
A
-this pt usually have non-specific symptoms
-weight loss
-fever
-night sweats
-anorexia
-fatigue
-enlarged and matted lymph nodes (supraclavicular and cervical are the most common)
-REED STERNBERG CELLS
13
Q
Non-Hodgkin Lymphoma description
A
-all lymphomas except Hodgkin’s ( common in 48% of patients with primary immunodeficiencies)
-B and T lymphocytes mutate and increase rapidly in the DEEP tissues
-progression of symptoms occurs quickly
14
Q
non-hodgkin lymphoma s/s
A
-pain
-lymphadenopathy
-abdominal mass
-mediastinal mass present may lead to superior vena cava syndrome since the mass is pressing into the vena cava
15
Q
osteosarcoma description
A
most common malignancy of bone in children and adolescents
often occurs in long bones: distal femur, proximal tibia, proximal humerus
16
Q
osteosarcoma s/s
A
-intermittent pain localized to tumor size
-tends to develop following an injury
-limping
-changes in gait
-soft tissue mass on exam that is tender to palpation
-usually metastasises in the lungs and other bones
17
Q
Ewing Sarcoma description
A
most often in the long bones of the extremities ( predominantly the femur, tibia, fibula, and humerus) and bones of the pelvis
18
Q
Ewing Sarcoma
A
-the trauma may incite symptoms
-intermittent pain that transitions to constant over weeks to months ( pain worsens overnight)
-there is usually edema and erythema over mass
19
Q
Retinoblastoma
A
most common primary intraocular malignancy in children
-10% to 15% of cancers occur <1 year of age
-there are heritable and non-heritable types
-can metastasize into CNS through the optic nerve
20
Q
retinoblastoma s/s
A
-Leukocoria
-strabismus
-nystagmus
-if you take a picture with flash, you will be able to see the difference between the pupils
21
Q
Neuroblastoma description
A
-tumor originates from the neural crest during fetal development
-can arise anywhere throughout the SNS, the adrenal gland is the most common location and then the abdomen follows
22
Q
Neuroblastoma s/s
A
-non-tender abdominal mass and or asymmetry
-abdominal pain
-constipation
-back pain/ weakness from spinal cord compression
-fever
-weight loss
-anemia
-bone pain
-bowel and bladder dysfunction
-ecchymoses above the eyes
-facial edema if it reaches the skull
23
Q
Kids with cancer considerations
A
-encourage vaccines ( NOT LIVE ONES)
-do not take rectal temperatures
-notify oncologist/bring child to ER if kid becomes febrile
24
Q
Neutropenic precautions
A
-if ANC is less than 1000, the patient is neutropenic
-pt needs a private room and to close the door
-frequent hand hygiene
-no rectal temps
-avoid invasive procedures
-no fresh fruits, veggies
-should be no plants in the room
25
Hematopoietic Stem Cell Transplant
-bone marrow transplant
autologous: child's own stem cells are removed so the patient can undergo chemo and then the cells are restored after treatment
allogeneic: donor's stem cells
26
Pre-transplant (HSCT)
-prophylactic ABX, antifungals, antivirals
-regular CHG bath
-give blood products PRN
-give G-CSF if ordered
27
Post-transplant (HSCT)
-prophylactics
-maculopapular rash
-the patient may need systemic steroids if GVHD occurs
-manage GI s/s
-bleeding and pancytopenia may occur
-give G-CSF PRN for autologous HSCT recipients
(filgrastim may be given IV or injection)
28
Superior Vena Cava Syndrome description
-a mediastinal mass ( NHL or neuroblastoma) compresses on the superior vena cava
-
29
s/s of Superior Vena Cava Syndrome
-dyspnea
-cyanosis
-wheezing
-diminished breath sounds
30
Management of Superior Vena Cava Syndrome
-intubation
-ventilation
-surgery
-comfort measures
31
Neutropenic Enterocolitis (Typhlitis)
-life-threatening
-necrotizing enterocolitis
-occurs mainly in patients with blood cancers following the induction of chemo
-there is a disruption of intestinal mucosa which allows for opportunities pathogens to cause an infection and necrosis of the intestinal wall
32
s/s of neutropenic entercolitis
-abdominal pain
-nausea and vomiting
-anorexia
-blood emesis
-diarrhea
33
Oncologic Emergencies: increased ICP
-brain tumor or brain mets that compress the brain and can lead to herniation
34
s/s of increased ICP
-HA
-vomiting
-altered LOC
-irritability
-seizures
-Cushing's triad
35
Spinal Cord Compression description
-tumor or mets compresses the cord
36
s/s of spinal cord compression
-autonomic or sensory dysfunction
-back, leg, neck pain
-paralysis
-weakness
37
Tumor Lysis Syndrome description
therapy which causes rapid lysis of tumor cells ( like chemo and radiation) which leads to intracellular contents releasing into systemic circulation
38
complications of tumor lysis syndrome
-hyperkalemia
-hyperphosphatemia
-secondary hypocalcemia
-hyperuricemia
-AKI
39
s/s of tumor lysis syndrome
-diarrhea
-anorexia
-lethargy
-muscle cramps
-dysrhythmias
-HF
-seizures
-tetany
-syncope
-hematuria
40
Prevention of TLS
-give hypouricemic agents prophylactically and during chemo/radiation treatment
-IVFs at 2x maintenance
-frequent F and E monitoring
-limit Potassium intake, give glucose with insulin or calcium gluconate to decrease the risk of dysrhythmias
-aggressive hydration
41
When does the production of RBC begin?
8 weeks in utero
42
where is erythropoietin derived from
the liver in the fetus, but the kidneys take over after birth
43
what are the three types of hemoglobin present at birth
Adult ( Hgb A and A2)-- present in utero and predominate around 2 months after birth
HbF: predominate at 8 weeks gestation ( decreases to 70% by birth and disappears by 6-12 months old)
44
Iron-deficiency anemia
-Fe deficiency is the most common nutritional disorder in the world, with increased prevalence in developing countries
-occurs when the body does not have enough iron to produce Hgb
45
risk factors for iron-deficiency anemia
-prematurity or LBW
-exposure to lead
-breast-feeding beyond 4 months without iron supplementation
-cow's milk without adequate Iron intake
-low socioeconomic status
-recent immigration from a developing country
-use of meds that interfere with iron absorption ( like antacids)
46
assessment for iron-deficiency anemia
-inspect mucous membranes and skin pallor
-assess for spooning of nails
-auscultate for flow murmur
-assess for splenomegaly
47
Diagnosing iron-deficiency anemia (children 6 months to 5 years)
ferrtin is less than 15 mg/L
hemoglobin is less than 11g/dL ( 0.5 -5 YEARS)
48
diagnosing iron-deficiency anemia ( children 5 to 12 years)
ferritin is les than 15 mg/L
hemoglobin is less than 11.5 g/dL
49
s/s for iron-deficiency anemia
-growth retardation in chronic cases
-irritability
-HA
-weakness
-pallar
-fatigue
severe s/s:
-SOB
-dizziness
less common s/s:
-pica
-muscle weakness
-unsteady gait
-difficulty feeding
50
Nursing Interventions for Fe-deficiency anemia
-encourage breastfeeding moms to increase Fe+ intake
-if baby is formula fed, encourage Fe-fortified formula
-for kids under a year, limit cow's milk to less than 24oz a day ( an excess amount can cause cow's milk colitis)
-no NSAIDS, give them Tylenol
-begin iron supplementation beginning @ 4 months
51
Considerations for Iron supplementation
-inform parents that stool may be black
-constipation may occur but give laxatives and stool softners PRN
-it is recommended to give 3-6mg/kd/daily an hour before a meal to increase absorption
-iron drops can stain the teeth brown/orange so give older children a straw and put the drops behind the teeth of younger children
52
Heme sources
-beef
-chicken
-turkey
-tuna
-crab
-halibut
-pork, shrimp
53
Non-heme sources
-iron-fortified cereal/oatmeal
-soybeans
-lentils
-kidney beans
-lima beans
-spinach
54
Sickle Cell Disease description
an autosomal recessive disorder
three most common types: HbSS ( most severe), HbSC, HBS beta thalassemia
55
hallmark s/s of sickle cell disease
-vaso-occlusive phenomena
-hemolytic anemia
56
how long do sickle cells last versus normal RBCS
20 days vs 120 days
57
things that can lead to a sickle cell crisis
-dehydration
-infection
-cold
-respiratory distress
-pain
58
Why are infants usually asymptomatic if they have sickle cell
Because the fetal hemoglobin is protecting them. When it wears off at 3-4 months, they may start to show symptoms
59
Sickle Cell Assessment findings
Skin: pallor, breakdown, lesions, ulcerations, jaundice
oral mucosa: pallor, dry/cracked
auscultation: murmur, adventitious breath sounds
palpation: warmth, tenderness, ROM joints, organomegaly
Vitals: fever, tachycardia, tachypnea, hypotension
60
Dactylitis
-occlusive crisis in fingers and toes
-super inflamed and swollen hands/feet
-ulcerations
-extreme pain
-typically happens in infants ( 45% of infants with sickle cell will experience this by 2 years old)
-strickly a sickle cell complication
61
Acute Chest Syndrome
-unique to sickle cell patients
-these pt will experience-- chest pain, wheezing, hypoxemia, respiratory distress when there is pulmonary infiltrates
62
Splenic Sequestration
-unique to sickle cell patients
-this is when RBCs get trapped in the spleen and there is pooling RBC in the spleen
s/s: splenomegaly, hypotension, pallor, SOB
-BIG mortality rates
-if a patient gets this once, they are likely to get it again
- if patient gets a splenectomy, make sure they are vaccinated
63
Sickle Cell Nursing Considerations
-administer hydroxyurea ( this medicine increases the amount of fetal hbg in the body so the patient has less number of sickle cells)
-NO ICE PACKS
-increase fluid
-genetic testing
-if patient is noncompliant with their med regimen, they are likely to have a crisis
64
Hemophilia description
a defect in Factor VII or IX which causes fibrin to become jelly-like and unstable
65
Hemophilia A description
X-linked disorder
-deficiency in factor 8
- VIII deficiency
-most common hereditary disease associated with life-threatening bleeding
-affects mostly males
-usually occurs between 20-30 yrs
-
66
Hemophilia B description
X linked disorder
factor 9 deficiency
IX deficiency
" Christmas disease"
Affects more males
67
children with hemophilia may have
hemarthrosis ( a boggy feeling around the joints)
68
Sickle Cell Considerations
-avoid contact sports
-good oral hygiene to prevent gum disease
-educate pt on how to give factor
-avoid NSAIDs since they can cause bleeding (give Tylenol instead)
-give desmopressin as ordered ( slow push)
69
IgG is acquired through_____ . It reaches adult levels at what age?
Through the placenta & at age 7 years
70
Warning signs of a primary immunodeficiency
-family history of primary immunodeficiency
-2+ serious infections ( like sepsis)
-history of infections that require IV antibiotics to clear
-persistent oral thrush or skin candidiasis after 1 year
-recurrent deep skin/organ abscesses
-failure to thrive
-2+ episodes of pneumonia in 1 year
-treatment with antibiotics for 2+ months and there is little effect
-2+ severe sinusitis epidoses in 1 year
-4+ acute otitis media episodes in 1 year
71
HIV is spread through:
-sexual contact
-IV drug use
-infected blood products
-vertical transmission (mother to child, usually in embryo)
72
Diagnosing HIV for kids under 18 months
-virologic testing
-cannot do the Western blot since it will show the mother's information
73
Diagnosing HIV for kids 18 months and older
Western blot
74
HIV manifestations
in the acute/ early phase:
-fever
-lymphadenopathy
-sore throat
-HA
-rash
-myalgia/arthralgia
-diarrhea
Chronic Infection ( without AIDS)
-fatigue
-night sweats
-generalized lymphadenopathy
-HSV, HPV, Varicella
-persistent oropharyngeal/vulvovaginal candidiasis
75
pauciarticular arthritis
-involvement of four or fewer joints
-knee is the most common joint
non-joint s/s:
-eye inflammation
-malaise
-poor appetite
-poor weight gain
76
Polyarthricular arthritis
-involvement of 5+ joints
-usually involved smaller joints and often affects the body systemically
non-joint s/s:
-malaise
-lymphadenopathy
-organomegaly
-poor growth
77
systemic arthritis
-in addition to join involvement, fever and rash can occur
non-joint s/s:
-enlarged spleen
-liver
-lymph nodes
-myalgia
-severe anemia
78
Manifestation of JIA
Onset before 16 years old-- has to be persistent for at least 6 weeks
-unknown etiology
infant/nonverbal child s/s:
-irritability/fussiness
-withdrawal from play
-difficulty getting up in the morning
-prolonged high fever
-red,macular rash
-limping
-guarding of extremities
-joints are warm, red, tender, stiff
-looks similar to hemarthrosis but isn't not the same thing
79
Nursing Considerations for JIA
-NSAIDS
-glucocorticoids
-antirhetumatic durgs
-children can start taking ibuprofen at 6 months
80
Kawasaki Disease description
-boys are more affects than females
-usually more Asains
81
complications of Kawasaki disease
-coronary artery abnormalities
-long term: HF, MI, arrthymias
82
for a child to have this disease, they MUST present with
-fever
-inflammation of the mucous membrane
-strawberry tongue
-dry, cracked lips
-rashes on palms and feet
-vasculitis
-polymorphous rash
83
Nursing Care Kawasaki disease
-administer IVIG (most effective first 7-10 days, single infusion over 8 to 12 hours)
-give aspirin
-monitor for arrthymias
-NO LIVE VACCINES until at least 11 months after IVIG, flu vaccine ( d/t risk for reye from aspirin) -- keep lips moisturized, give them popsicles, or other cool liquids
84
infant vitals
HR: 80-150
RR: 25-55
85
toddler vitals
HR: 70-120
RR: 20-30
86
pre-school vitals
HR: 65-110
RR: 20-25
87
School-age vitals
HR: 60-100
RR: 14-22
88
adolescent vitals
HR: 55-95
RR: 12-18
89
infant age
one month- twelve months
90
toddler age
one to three years
91
preschool age
three to six years
92
school age
six to twelve years
93
adolescent
12 to 20 years
94
infant experiences (Erikson)
trust vs mistrust
95
toddler experiences (Erikson)
autonomy vs shame/doubt
96
preschoolers' experience (Erikson)
initiative vs guilt
97
school-age experiences (Erikson)
Industry vs inferiority
98
adolescent experiences ( Erikson)
Identity vs role confusion
99
what is the most common cause of illnesses in children and why
respiratory and because they have smaller airways
100
airway differences between children and adults
-babies are nose breathers until about 4 weeks old (the reflex to open your mouth when your nares are obstructed are not there until about 3-4 months)
-proportionally, their tongues,tonsils, and adenoids are larger
-children under 10 years old have laryngeal narrowing
-they have fewer alveoli
-infant chest walls are flexible and soft
101
oxygen moves from ______ to ______
from the alveolar air to the blood
102
CO2 moves from _____ to _____
blood to the alveolar air
103
what is the first sign of respiratory distress
tachypnea
104
where does cyanosis usually start
around the mouth and then as it progresses, it becomes more central
105
what type of population ( outside of respiratory will you see cyanosis)
anemic kids; kids with cardiac conditions
106
where is a suprasternal retraction located
above the sternum
107
where is a clavicular retaction located
by the clavicle
108
where is a intercoastal retraction located
between the ribs
109
where is a substernal retracton location
below the sternum
110
how do you keep children's nose clean and how after do you clean
saline and suction to keep their nose clear. only saline every diaper change. saline and suction before feeds
111
wheezing occurs because of
obstruction of lower trachea or bronchioles
112
rales occur because of
alveoli are fluid-filled like in pneumonia
113
Early, MIddle, and Late signs of hypoxia
tachypnea, nasal flaring, cyanosis
114
What does deterioration in kids look like?
-increased WOB
-fatigue
-change in mental status
-new onset of not eating or drinking
115
Acute nasopharyngitis --- " the common cold"
causes: RSV, rhinovirus, adenovirus, enterovirus, flu
s/s: more severe in infants and children than in adults; abundance amount of nasal mucus which causes the child to mouth breathe; irritability; fever;
116
Acute Otitis Media --- MIDDLE EAR INFECTION
-common childhood illness due to infection of fluid in the middle ear
-
117
s/s of acute otitis media
-fever
-pain
118
How to help decrease the risk of acute otitis media
-breastfeed infants if possible
-avoid 2nd hand smoke
-routine childhood immunizations
119
cause of the flu
-the spread of inhalation of droplets or contact with fine-article aerosols
120
s/s of the flu
-fever
-chills
-body aches
-runny nose
-cough
-diarrhea
-fatigue
121
acute infectious pharyngitis
cause: multiple viruses
s/s: pharyngitis, HA, fever, abdominal pain
122
painless hematuria is a hallmark sign of which disease
Group A strep
123
Group A strep s/s
-inflamed tonsils with exudate
-sandpaper rash ( scarlatina): cervical lymphadenopathy with tenderness and pain
124
Mononucleosis cause
Epstein-Barr virus, oral secretions
125
s/s of Mononucleosis
-fever
-VERY TIRED
-malaise
-sore throat
-lymphadenopathy
126
complications of mononucleosis
-splenic rupture
(no contact sports for 3 weeks)
-aseptic meningitis
-viral hepatitis
-rash if the patient is on antibiotics
127
Croup description
primarily affects 3 months to 3 years old
causes: parainfluenza but also other viruses
128
croup s/s
-usually occur at night
-lasts about 3 to 5 days
129
management of croup
-cool mist vaporizer
-saline to nose if there is congestion
-can give pt steroids
130
Epiglottitis
MEDICAL EMERGENCY
caused by H influenza
more common now that vaccination rates are decreasing
131
epiglottitis s/s
-abrupt onset that usually starts with fever and sore throat
-progresses to drooling, anxiety, irritability, and respiratory distress
132
if child presents with tripod breathing and drooling, make sure to ask them about their vaccination history because you can suspect
epiglottitis
133
Epiglottitis Considerations
-always have intubation ready
-positioning is important
-oxygen at the least invasive manner
-prevention is the Hib vaccine
134
Pertussis -- "Whopping Cough"
-highly contagious acute respiratory disorder
s/s: copious secretions
children under 1 year are most susceptible since they have small airways and they have not gotten all their vaccines
"100 day cough"
they may need intubation from 6-21 days
135
Bronchiolitis
cause: viral
most often occurs in winter and spring
s/s:
-rhinorhea
-pharngitis
-coughing
-wheezing
-LOTS OF MUCUS
-low grade fever
-retractions
-NIGHT SWEATS AND UNEXPLAINED WEIGHT LOSS
136
diagnosing Bronchiolitis
-ELISA assay
-IFA staining
-chest x ray that shows hyperinflammation on lungs
137
with what condition would you give palzumab
bronchiolitis
138
complications of pertussis
-hypoxia
-apnea
-pneumonia
-seizures
-death
-encephalopathy
139
whooping cough considerations
-droplet precautions
-monitor oxygenation
140
tuberculosis
cause: contagious, inhalation of droplets of mycobacterium
incubation period of 2 to 10 weeks
141
tuberculosis s/s
-fever
-malaise
-anorexia
-weight loss
-cough
-diminished breath sounds
-pallor
-night sweats
142
what are the three A's for asthma
atopic dermatitis, allergies, asthma
143
what can cause aggression in children
Montelukast for asthma management
144
Cystic Fibrosis S/S
-salty taste of skin
-alterations in electrolyte imbalance
-meconium ileus
-bulky, greasy stools
-pancreatic enzyme activity is lost which leads to malabsorption of nutrients
-failure to thrive ( many of them need feeding tubes)
-mucus plus in small airways
-decreased fertility
-chronic/recurrent respiratory infections
145
what is the diagnostic test for cystic fibrosis
sweat chloride test
