Transcript Hematologic-Oncology

Hematologic-Oncology
Common Hematologic Disorders in
Children
• Iron-Deficiency Anemia
• Sickle Cell Anemia
• Beta-Thalasemia
Major (Cooley’s anemia)
• Hemophilia A
• Von Willebrand’s Disease
• ITP (Immune Thrombocytopenic
Pupura)
Common Heme-Oncology Diseases
in Children
• Acute Lymphocytic Leukemia
• Hodgkin’s Disease
• Non-Hodgkin’s Lymphoma
• Retinoblastoma
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Neuroblastoma
Nephroblastoma
Osteogenic Sarcoma
Ewing’s Sarcoma
Complete Blood Count
• WBC
• RBC
• Hgb
• Hct
• Platelet
CBC with Differential
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WBC
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RBC
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Neutrophils- phagocytosis
Lymphocytes – T and B cell
Monoocytes – phagocytosis, antigen
Eosophils- allergen
Basophils-inflammatory
MCV- volume
MCH
MCHC
RCW- width
Hgb
Hct
Platelet
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MPV
PT, PTT
• The prothrombin time (PT) test measures how long it takes
for a clot to form in a sample of blood.
• Prothrombin is one of several clotting factors that are
produced by the liver.
• The PT test evaluates the integrated function of these
factors and the body’s ability to produce a clot in a
reasonable amount of time.
• Because the reagents used to perform the PT test vary
from one laboratory to another and even within the same
laboratory over time, the normal values also will fluctuate.
Other Labs
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Sed Rate (ESR)
Iron
TIBC (Transferrin)
Ferritin
Bilirubin
Pediatric Laboratory Normal Values:
Children age 2-12 Years
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RBC: 3.89-4.96
HgB: 10.2-13.4
Hct: 31.7-39.3%
Sed: 1-8
WBC: 5,400-11,000
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Platelets: 206,000-403,000
Fe: 20-105
Ferritin: 47-110
TIBC: 240-508
PT: 10-11 sec
PTT: 42-54 sec
Bilirubin- less than 11.7
Anemia’s
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Types in Children:
• Reduction of:
– number of red blood
cells
– the quantity of
hemoglobin
– the volume of packed
red
• Iron-Deficiency Anemia
• Sickle Cell Anemia
• Beta-Thalasemia
Major (Cooley’s anemia
Iron-Deficiency Anemia
The most common hematologic disorder of
infancy and childhood
• 9 months- 2 years, adolescence
• A nutrient deficiency of inadequate
dietary iron
Prevention: iron fortified products
Children at Risk
• low birth weight infants
• infants born to mothers with iron
deficiency anemia
• infants born with GI defects
• chronic blood loss in older children
Pathophysiology
• Dietary Fe is bloodstream binds to
transferrin (TIBC) and is delivered to RBC
in bone marrow, combines with other cells
to make Hgb
• Unused dietary Fe is stored in intestinal
epithelial cells as ferritin
Diagnosis
• Low RBC’s
• Low HGB
– Mild ( < 10.2), Moderate (8-9), Severe (< 7)
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Low HCT
Low Iron
High Transferrin (TIBC)
Low Ferritin
Symptoms
Low Hgb=low O2 tissue perfusion
Hgb of 10.2 or less
• May seem asymptomatic, not noticed by caregiver
• Pallor/Pale mucous membranes (low hgb, not enough red color to
skin)
• Poor muscle tone, decreased activity
• Fatigue
• Increased HR, RR
Hgb < 9
• Above plus irritability, lack of interest in play
History
• Dietary history usually shows abnormally
high milk intake > 32 oz day in toddler
• Ask parents specific questions
• Begin the dietary history at the time the
child awoke yesterday; include all activities
and exactly what the child ate
Management
• Iron-fortified formula
• Limit cow’s milk to 24-32 oz/day for
children >12 months
• Increase age-appropriate iron-rich foods and
Vit C
• Fe supplements- Ferrous Sulfate
Nursing Considerations
Iron-Rich Foods
Vitamin C Rich Foods
Meats, fish, poultry
Orange juice
Vegetables
Citrus fruits
Dried fruits
Strawberries
Legumes
Tomatoes
Enriched grain products
Broccoli
Whole grain cereal
Leafy Green vegetables
Iron-Fortified Cereal
Potatoes
Nursing Considerations
• Manage side effects of Ferrous Sulfate
– Nausea,
– Anorexia
– Constipation
– Abdominal distress
– Black stools.
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Give on an empty stomach if possible
• Monitor bowel movements and suggest increased fluid and
fiber.
Nursing Considerations
• Monitor development, sleep, and activity/fatigue
patterns.
• Monitor hemoglobin to measure effectiveness of
therapy.
• Instruct families to keep Ferrous Sulfate locked
and out of reach of children; poisoning is a serious
risk.
Sickle Cell Anemia
 Autosomal recessive disorder, African Americans
 Characterized by abnormal hemoglobin (HbS)
 Clinical manifestations caused by obstructions due
to the sickled RBC’s and destruction of sickled
and normal RBC’s
Sickle Cell Anemia
Symptoms may not appear until 6 months of
age
Mortality rate children < 3 yo is 15-35%
Diagnosis:
Amniocentesis, CVS, Newborn Screen
Signs & Symptoms:
Initially: fever & anemia at 6 mos
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Pallor
Fatigue
SOB
Irritability
Jaundice
Diagnosis
• Moderately low Hcb and Hct
• Normal Iron, TIBC, Ferritin
• Elevated Billirubin
3 Sequalea of SCA
1. Vaso-Occlusive Crisis
2. Acute Chest Syndrome
3. Splenic Sequestration
Vaso-occlusive crisis
• Severe, sudden onset of sickling where many new
sickled cells pool in a vessel and cause pain and
tissue hypoxia
• Caused by: infection, dehydration, anxiety, cold
• Most common from hypoxia secondary to rapidly
destroyed RBC
• Lasts for hours to weeks
Vaso-occlusive Crisis
Early Signs: pallor,
tachycardia, fever
Late Signs: acute
abdominal, back,
extremity pain
First Crisis in infants:
– Dactylitis (hand &
foot syndrome)
• swelling of hands and
feet
• joints may be warm &
swollen
Management
• Pain relief
• Adequate hydration
• Adequate oxygenation
Pain
• Assess pain every 1-2h or more
frequently
• Use pain scale appropriate for age
• Non-pharmacological pain methods
• AROUND THE CLOCK PAIN MEDS
• Tylenol for mild pain
• Narcotics for mod-severe pain
Prevent Occlusion
• Push PO fluids
• IV hydration: 1.5 to 2 times normal
rate
• Risk for fluid overload
Altered Tissue Perfusion and
Prevent Further Sickling
• Administer oxygen to maintain saturation
of 95% or higher
• Pulse oximetry
• Semi-fowler’s position
• Administer PRBC’s
Acute Chest Syndrome
• Sickle
contents
break off
• Bilateral
pulmonary
involvement
• Causes chest
infection,
embolism
Nursing Considerations
• Know the
symptoms:
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Chest pain
Fever
Cough
Wheeze
Tachypnea
• Analgesics
• Oxygen
• Hydration
Incentive
spirometry,
• Antibiotics
• PRBC
Splenic Sequestration
• Sickled cells block the spleen
• pooled blood in spleen and/or liver
and enlarges
• Pooled blood leads to a decrease in
circulating volume= hypovolemic
shock
• CVA => coma
Nursing Considerations
• Know the
Symptoms:
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Irritability
Pale
Tachycardia
Pain to LUQ
Enlarged Spleen
• Life Threateningget child to ED
a.s.a.p.!
• PRBC
• Remove spleen
Risk for Infection r/t Chronic
Immunosuppression
• Administer PCN everyday
• Up-to-date vaccines
Educate parents:
s/s infection & respiratory distress
possible triggers
treat pain immediately
adequate fluids
Beta-Thalasemia
Major (Cooley’s anemia)
• Hereditary anemia due to abnormal
synthesis of hemoglobin
• Life long disorder
• Mediterranean descent
• Life threatening symptoms
Diagnosis
• Low RBC’s
• Extremely low Hgb < 5
• Increased serum iron
Symptoms
• Facial anomalies
– Frontal bossing (prominent
and protruding forehead)
– Maxillary prominence
– Wide-set eyes with a
flattened nose
• Bronze skin color
(Greenish yellow skin
tone)
• Growth and maturation
retardation
Management:
• RBC transfusions q2-4 weeks to get Hgb to 1012
• Iron Chelation therapy
– Desferal (deferoxamine) SQ
• Splenectomy
• Cure: bone marrow stem cell transplant
– Estimated 70% do not find a suitable donor
Nursing Considerations
– Observe for complications of transfusion- iron
overload
– Supporting the child and family in dealing with
a chronic life-threatening illness
– Monitor Growth and Development
– Refer the family for genetic counseling.
Compare and Contrast
Iron Deficiency Sickle Cell
Thalasemia
•Low RBC’s
•Low HCT
•Low Hgb
•Low iron
•Low ferritin
•High TIBC
•Low RBC’s
•Low HCT
•Very low Hgb
•Increased iron
•Normal
ferritin
•Normal TIBC
•Low RBC’s
•Low HCT
•Mod low Hgb
•Normal iron
•Normal
ferritin
•Normal TIBC
•Inc Billirubin
Bleeding Disorders
• Hemophilia A
• Von Willebrand’s Disease
• ITP (Immune Thrombocytopenic
Pupura)
Clotting
• Host of factors
• Platelets aggregation at site of injury
• Tested by coagulation time (PT/PTT)
Hemophilia A
• Hereditary blood coagulation deficiency
(factor 8)
• Ability to clot is slower
• X-linked recessive (white, males)
Symptoms
• Vary according to
concentration of
factor 8
• Soft tissue bleeding
and painful
hemorrhage into
joints
• Severe bleeding may
occur in GI tract,
peritoneum or CNS
Interviewing the Child
with Hemophilia–Subjective Data
• Recent traumas and measures used to stop
bleeding
• Length of time pressure was applied before
bleeding subsided
• Whether swelling increased after surface
bleeding subsided
• Whether swelling and stiffness occurred
without apparent trauma
Diagnosis
• Above History
• Suspected by Labs:
– Platelet level: Normal
– PTT: Prolonged (elevated number) > 60
• Confirmed by genetic testing for missing
factor
Management of Bleeding
Acute therapy:
• Bleeding must be controlled by IV administration of
factor 8
– After trauma, surgery
• Pressure to laceration
Prophylactic therapy:
• Children age 1-2 receive PO factor 8 replacement on a
regular schedule if frequently symptomatic
• prior to surgery, dental work
Parental Education
• Primary Goal: Injury Prevention
• Promote oral hygiene, up to date
immunizations
• No aspirin
• Avoid activities that induce bleeding
• Provide activities for normal G&D
• Administration of factor replacement prn
Von Willebrand’s Disease
• Most commonly inherited bleeding disorder,
autosomal dominant (Males and Females)
• Lacks production of VWF
• Platelets are normal in number
• Inability of platelets to aggregate
• Varying degrees of disease
– VWF is deficient to defective
Diagnosis
• Platelets is normal
• PT/PTT is normal
• Confirmed by genetic testing for VWF
Signs & Symptoms
Can be so mild that disease
is undiagnosed
Epitaxis
Prolonged
bleeding from cuts
Excessive bleeding
following surgery
• Bleeding from gums
Management
• Prophylactic therapy -Replace
dysfunctional factor in blood
– Treatment of Choice: DDAVP
• Injury Prevention
ITP (Immune
Thrombocytopenic Pupura)
• Autoimmune disorder (antiplatelet
antibody) or cause is unknown
(idiopathic)
• Occurs most commonly at age 2-4 years
• Reduction in and destruction of platelets
• Typically seen 2 weeks after a febrile,
viral illness
Signs & Symptoms
• Excessive bruising and
petechiae
• Epitaxis
• Bleeding into joints
• Tourniquet test: shows
many petechiae after
inflation of BP cuff
Diagnosis
Labs:
• Platelets < 150 (Marked thrombocytopenia)
• PT and PTT: Normal
Management
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Prednisone
IVIG (IV immunoglobulin)
PLT transfusion (only a temporary solution)
Most cases are self-limiting
Avoid when possible:
– administering intramuscular injections
– aspirin, aspirin-containing products, and nonsteroidal
antiinflammatory medications (e.g., ibuprofen)
– taking temperatures rectally
– perform invasive procedures with extreme caution
Compare and Contrast
Hemophilia A
VWF
ITP
Normal Platelets Normal Platelets Very Low
Platelets
Elevated
PT/PTT
Normal PT/PTT Normal PT/PTT
Oncology
• Cancer in adults
– abnormal cell is transformed by genetic mutation of its
DNA
– usually as a result from exposure to a tetragon
• Cancer in children
– usually arises from chromosomal abnormalities, genetic
mutations and proliferation of embryonic cells
Oncology Treatments
• Chemotherapy
– antineoplastic agents
– attempt to destroy tumor cells by interfering with
cellular functions and reproduction
– cytotoxic drugs that are designed to cause cell death.
• Normal cells that have rapid growth are also
affected, such as hair growth.
• Toxic side effects
Oncology Treatments
• Surgical intervention
– removing the entire cancerous tumor (most
ideal and frequently used treatment method)
• Radiation therapy
– interrupt cellular growth by breaking the DNA
stands, leading to cell death.
Types of Cancer in Children
• Small percentage Carcinoma (opposed to
large percentage in adults)
• Mostly Leukemia
• Followed by Lymphoma
• The rest is solid or soft tissue tumors
Clinical Manifestations
• Differ based on type of cancer
• Many symptoms are similar to common
childhood illnesses
• Symptoms may be in site other than the
cancer
• =delay in diagnosis
• Often diagnosis made when cancer is
advanced
Common Clinical Manifestations
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Pain
Anemia
Anorexia, weight loss
Infections
Bruising
Neurological symptoms
Palpable mass
Psychosocial Concerns
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Parents in disbelief
Health child suddenly becomes ill
Potentially life-threatening
Treatment decisions, can last months-years
Travel for treatment, heavy financial
responsibilities
• Effects of siblings
Effects on Child
• Infants- unaware of diagnosis
• Toddlers- aware they do not feel well
• Preschoolers-beginning understanding of
illness, not cancer
• School-age-understand cancer, benefit from
talking about it
• Adolescents-mature understanding, benefits
from other adolescents with cancer
General Nursing Considerations
• Provide optimal nutrition- high metabolic
rate of cancer depletes stores
• Ensure adequate hydration-ice pops, jello
• Manage pain
• Promote growth and development
• Prevent Infection (next slide)
Risk for infection r/t
Immunosuppressed state.
• Monitor vital signs q4h
• Instruct parents how to measure temp at
home
• Proper handwashing
• Inspect child’s skin for breakdown
• Inspect child’s mouth for ulcers
• Teach child and parents meticulous oral
hygiene
• No live virus administration
Leukemia
Leukemia
• Broad term describing a group of malignant
diseases
• Normal Bone Marrow is replaced by abnormal
immature cells
• Etiology: variety of agents thought to increase risk
(virus, toxins, drugs) combined with genetics
• Two forms of leukemia
– ALL: Acute Lymphocytic Leukemia
– AML: Acute Myelogenous Leukemia
Acute Lymphocytic
Leukemia
• Most frequently occurring type of
cancer in children < 15yo (peak 2-6)
• Distorted and uncontrolled
proliferation of immature WBC’s
(lymphoblasts)
• Causes decreased RBC’s, platelets, and
mature WBC’s production and
invasion of body organs by rapidly
increasing lymphoblasts
Signs & Symptoms:
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Fever
Bone or joint pain
Bruising
Decreased RBC’s
Decreased PLT’s
Abnormal high WBC counts
Lymphadenopathy
Hepatosplenomegaly
CNS invasion
Diagnosis:
Based on:
• Signs & symptoms
• CBC changes
• Bone marrow aspiration (> 25% of
lymphoblast cells present)
Management
Chemotherapy in 3 stages
For 2-3 years
1. Induction
2. Sanctuary
3. Maintenance
Induction
• 1st month; aim is to induce remission
(blast cells to < 5%, normal Physical
Findings)
• Approximately 95% of children
achieve remission within 1 month
Sanctuary or Consolidation
Begins after remission, 4 weeks
Goal:
• to maintain remission
• prevent disease from invading
sanctuary sites
Maintenance
• goal to maintain remission
• eliminate residual leukemic cells
• combination of drugs, outpatient
basis
• girls treated for 2 years, boys for 3
Cure: free of disease for 4-5 years
High Doses of Chemotherapy
Can Lead to:
• Tumor Lysis Syndrome
– Metabolic emergency
• results from the lysis (dissolving or
decomposing) of tumor cells and rapid
release of their contents into the blood
Tumor lysis syndrome
• Rapid cell destruction releases high levels of
– uric acid
– potassium
– phosphates
• Uric acid overloads the kidneys
• Leads to cardiac arrhythmias and renal failure
Nursing Considerations
• Children receiving chemotherapy;
• Monitor for:
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Hyperuricemia
Hyperkalemia
Hyperphosphatemia
Hypocalcemia
Nursing Considerations
• Administer vigorous hydration (2–4 times
rate for maintenance fluid)
• Administer allopurinol or urate oxidase
(rasburicase) to reduce conversion of
metabolic by-products to uric acid
Soft Tissue Tumors
Hodgkin's
Non Hodgkin's
Retinoblastoma
Lymphomas
• A malignancy that arises from the lymphoid
system
• Two types:
– Hodgkins
– Non Hodgkins
Hodgkin’s Disease
• Neoplasm of cervical lymphatic
tissue
• Starts in a single or group of lymph
nodes then spreads predictably to
nonnodal sites such as: spleen, liver,
bone, marrow, lungs, mediastinum
• Affects adolescents to late 20’s
• Males > females
• Etiology unknown- infectious agent
likely
Signs & Symptoms:
• Painless enlarged
cervical node
• Unexplained
weight loss,
unexplained
fevers, night
sweats
Diagnosis and Treatment
Diagnosis
• Biopsy of enlarged lymph node
• Staged 1-4
Treatment
• Chemotherapy
• Radiation-low doses, higher is physiologically
mature
• Good Prognosis-single origin
Non-Hodgkin’s Lymphoma
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No single origin
Males > females
Cause unknown
Aggressive proliferation of B or T lymphocytes in
lymph nodes
• Rapid in onset (ages 5-15)
• Usually found with wide-spread involvement via
bloodstream (multiple enlarged nodes)
• Responds quickly to therapy
Signs & Symptoms:
• Acute abdominal and chest pain, constipation,
cramping
• Anorexia, weight loss
• Painless enlarged lymph nodes found in cervical
or axillary region
• Ascites and obstruction with vomiting a late sign
• Advanced disease: CNS symptoms, HA n/v,
mediastinal mass, petichaie, bruising, bone pain
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Diagnosis
Biopsy from bone marrow or lymph node
Staging 1-4
Treatment:
Aggressive multi-agent chemo for 6 mos to 2
years
Risk for tumor lysis syndrome
Intrathecal chemo and crainal radiation
Compare and Contrast
Hodgkins
Non Hodgkins
Males>Females
Late adolescent-20’s
Single origin of cervical
gland
Good Prognosis
Males > females
ages 5-15
No single origin-widespread involvement
Aggressive treatment
Retinoblastoma
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Malignant tumor of retina
Inherited autosomal dominant
Immature retinal cells become malignant
6 weeks of age to preschool age
Unilateral or bilateral
Signs & Symptoms
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Absent red reflex
Whitish glow to pupil
Strabismus develops
Eye pain
Metastases to optic
nerve, subarachnoid
space, brain, 2nd eye
Retinoblastoma
Treatment:
• If small: cryosurgery, partial vision
• If mets: chemo & radiation
• If large: enucleation, eye prosthesis 3
weeks post-op
• Survival rate 90%
Solid Tumors
Neuroblastoma
Nephroblastoma
Osteoscaroma
Ewing’s Sarcoma
Neuroblastoma
• Solid tumor of infants and pre-school
children (peak 22mos)
• Cancer cells arise from sympathetic
nervous system called crest cells
– Embryologic cells of adrenal glands
Etiology: unknown
Signs & Symptoms
• Depend on:
– extent of disease
– location of tumor
• 65% present with protuberant, firm,
irregular abdominal mass that crosses
midline
Neuroblastoma
Other manifestations:
• impaired ROM & mobility
• pain & limping
• large abdominal mass
• respiratory symptoms if chest tumor
Neuroblastoma
Diagnosis:
• Chest x-ray
• CT scan of abdomen, pelvis, spine
• Bone marrow aspiration
Management:
• depends on the presence and extent of
metastasis
Wilm’s Tumor
(Nephroblastoma)
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Malignant tumor of the kidneys
Peak age 3-4 years
Girls > boys
Cause is unknown
Other GU problems
• Occurs in asymptomatic child
– May have genetic predisposition
– Is associated with congenital
anomalies
Nephroblastoma
• Parents usually notice a large, mobile
abdominal mass while bathing or the diaper
doesn’t fit anymore
• Grows extremely quickly, in a matter of
days
• DO NOT PALPATE ABDOMEN
– can rupture the tumor and cause spreading of
cancerous cells
Other Signs & Symptoms
• microscopic to gross hematuria
• hypertension
• abdominal pain
• fatigue, anemia, fever
Diagnosis
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Suspected from a good history
CT scan
Definitive dx made at time of surgery
Staged 1-5
Staging 1 through 5
1. tumor confined to the kidney and completely
removed surgically
2. tumor extending beyond the kidney but
completely removed surgically
3. regional spread of disease beyond the kidney
with residual abdominal disease postoperatively
4. metastases to lung (primary site), liver, bone,
distant lymph nodes
5. bilateral disease
Treatment
• State 1 and 2
– Nephrectomy
– Chemotherapy
• Stage 3-5
– Nephrectomy
– Radiation
– Chemotherapy
• Survival rates are good (up to 90%)
Bone Cancers
Osteogenic Sarcoma
(Osteosarcoma)
• Most common bone malignancy in
children (teenage years)
• Occurs in distal long bones
• Attributed to extremity injury or
growth spurt
• Originates from bone producing cells
• 40-50% occur at distal femur and knee
Signs & symptoms
• Progressive, insidious or intermittent pain
at site of tumor
• Palpable mass & swelling
• Limping, progressive limited range of
motion
• Pathological fractures
Diagnosis
• X-ray, CT, MRI
• Tumor biopsy
• Look for chest metastases
Management
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Remove tumor, prevent spread of disease
Combination of surgery & chemo
Amputation my be necessary
Limb salvage operation
Cure rate: 60-65% without overt metastases
Nursing care
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Comfort
Infection
Potential hemorrhage
Phantom limb pain
Prosthesis
Changes in body image and
functioning
Ewing’s Sarcoma
• Highly malignant tumor
in bone marrow of long
bones
• Can present in any bone
• Spreads longitudinally
through bone
• Affects young
adolescents and older
children
• Metastases is usually
present at time of dx
(lungs, bone, CNS,
lymph nodes)
Signs & Symptoms
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Intermittent pain attributed to injury
Swelling at tumor site
Pain becomes constant
Progresses into
– Weight loss
– Fever
– Increased sed rate
Diagnosis:
• Bone scan
• Bone marrow aspiration & biopsy
• CT of lungs
• Definitive dx: biopsy of tumor site
Treatment:
• Surgery
• Multi agent chemo
• Radiation
Compare and Contrast
Osteogenic scaroma
Ewing’s Sarcoma
Affects long bones
Older adolescents
Intermittent pain Palpable
mass & swelling
Limping, progressive
limited range of motion
Pathological fractures
Metastases not as likely
Surgery and chemo
Affects any bone
School-age and adolescents
Intermittent pain becomes
constant
Swelling at tumor site
Progresses into systemic
symptoms
Metastases likely
Aggressive treatment
Chronically Ill Child
Nursing Diagnosis
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Fear
Death Anxiety
Anticipatory Grieving
Hopelessness
Goals for Care of the Chronically
Ill Child
• Goals for the child
– Achieve and maintain normalization
– Obtain the highest level of health and function
possible
• Goals for the family
– Remain intact
– Achieve and maintain normalization
– Maximize function throughout
the illness
Nursing Care for Children
with Chronic Conditions
and Their Families
• Attend to the needs of the family system
• Revise goals frequently to meet the child’s
changing developmental needs
• Listen carefully to the child's perception of
the condition
Nursing Care for the Dying Child
and the Child’s Family
• Be available to assist both child and family
• Avoid imposing personal beliefs and expectations
• Provide time and attention to the dying child
• Recognize the need to talk about illness
and death
• Provide adequate pain control, oral care, privacy,
and information about the signs of imminent death
• After death, allow family members as much time
as they desire with the child
Practice Questions!
A child is being admitted to the unit with thalassemia
major (Cooley’s anemia). In preparing client
assignments, the charge nurse wants to assign a
nurse to this child who can:
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2.
3.
4.
Teach dietary sources of iron
Administer blood infusions
Work with a dying child
Monitor the child for bleeding tendencies
A 14-year-old boy with sickle cell anemia is
admitted with severe pain in his abdomen and
legs. He asks why the doctor ordered oxygen
when he is not having any breathing problems.
The nurse states the therapeutic action of O2 is:
1.
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4.
Prevent further sickling
Prevent respiratory complications
Increase O2 capacity of RBCs
Decrease the potential for infection
A 10-year old in the ER has a CBC results that
include a Hgb of 8, and Hct of 24. The nurse
determines that based on the lab results which
nursing action has a high priority?
1.
2.
3.
4.
Promotion of skin integrity
Promotion of hydration
Promotion of nutrition
Conserving energy
A 4-year-old is diagnosed with ALL. Following
teaching about the staging and therapy, the nurse
evaluates the family’s understanding of the
problem. The statement by the family that
indicates appropriate knowledge is “Staging
will:
1. Determine the extent of the tumor process and
need for palliation
2. Help determine if treatment is needed
3. Determine if surgery is needed
4. Determine the extent of malignant process and
stage the leukemia
• A 17-year old is being admitted for an
amputation related to a bone tumor. The
nurse is developing a nursing care plan and
determines the most appropriate age related
diagnosis is:
1.Risk for disuse syndrome
2.Disturbed body image
3.Self-care deficit
4.Activity related intolerance
The nurse is reviewing the lab
work on a child admitted for
fatigue
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–
WBC 7,200
RBC3.01
Hgb 9.1
Hct 29.3
Platelets 371,000
• Iron 64
• Ferritin 70
• Transferrin 250
• Bilirubin 18.2
• PTT 45 seconds
• After analyzing the results, the nurse
suspects the child may have:
•
•
•
•
1. Fe Deficiency Anemia
2. Cooley’s Anemia
3. Sickle Cell Anemia
4. Aplastic Anemia
• The nurse is admitting a child for a swollen
elbow. The history indicated multiple
bruising. Which of the following laboratory
results heightens the nurses suspicion for
Hemophilia?
• 1. Hbg 12,000
• 2. WBC 9,000
• 3. Platelets 356,000
• 4. PTT 73 seconds