Term
______________ is an inborn error of metabolism (IEM). There is an absence of phenylalanine hydroxylase needed to metabolize the essential amine acid phenylalanine to TYROSINE. |
|
Definition
|
|
Term
Where does PKU come from? Does it last a lifetime? |
|
Definition
| PKU is an inborn trait, in other words.... it's congenital. PKU is a LIFE LONG DISEASE. |
|
|
Term
| Why do we need Tyrosine... what does it form? |
|
Definition
| Tyrosine is needed to form melanin, epinephrine, and thyroxine. So there is a malfunction in the metabolism of these with PKU. |
|
|
Term
| So, without tyrosine there is a decreased production of melanin. What does this result in? |
|
Definition
| Blond Hair, blue eyes, and fair skinned childred. |
|
|
Term
| If phenylalanine is not metabolized in the blood stream and causes damage to the developing brain and CNS. What will occur if this is not corrected? |
|
Definition
|
|
Term
| PKU is an autosomal ________ disease that happens rarely (1 in 4000-12000 births) - controllable by diet when diagnosed. The highest incidence is in US and Northern Europe. It primarily effects _________ children. |
|
Definition
| PKU is autosomal RECESSIVE. It mostly effects CAUCASIAN CHILDREN. |
|
|
Term
| What are some clinical s/s of PKU? |
|
Definition
| FTT (failure to thrive), vomiting, irritable, developmental delays, unpredictable & erratic behaviors, mental retardation, mousy or musty smelling urine (the urine smells abnormal with PKU). |
|
|
Term
| The _______ blood test is used for PKU. The Normal amount is 0.5-1 mg/dl. A diagnosis of PKU is when there is more than ____ mg/dL. Is Screening optional for parents? |
|
Definition
| Guthrie Blood Test. PKU > 4 mg/dL. Screening for PKU is MANDATORY in all 50 states. Usually done just before discharge - after child has ingested proteins. |
|
|
Term
| Managing PKU involves meeting the child's nutritional needs for growth & maintaining phenylalanine levels within a safe range. It is necessary to restrict ________ from the diet. However, some is allowed - small amount. |
|
Definition
|
|
Term
| How much protein (phenylalanine) is allowed in a child's diet? |
|
Definition
| The diet is allowed 20-30 mg/kg/day of phenylalanine. A level of 2-10 mg/dL is recommended for children. |
|
|
Term
| Management includes giving what kind of milk to kids? |
|
Definition
| NO COWS MILK. PKU needs Specially Prepared Milk Sustitutes/Special Formulas. (Some names - don't memorize tho - are Phenyl Free 1, Phenyl Free 2, Phenex, Phenex, Phenyl Free). |
|
|
Term
| Is breast feeding allowed for PKU children? |
|
Definition
| Yes, breastfeeding is allowed with careful monitoring as it has low phenylalanine content. |
|
|
Term
| Children with PKU should not be given any artificial _________ . why? |
|
Definition
| Sweeteners (like Aspartame) b/c it is converted to penylalanine in the GI tract. NO ARTIFICAL SWEETENERS. |
|
|
Term
| Children with PKU really need assistance by a registered dietician... it's essential. They will show child & family how important ____________ size is. |
|
Definition
| portion. They need to stay on their diets for life! |
|
|
Term
| It is very imp for PKU kids to monitor their _________ levels. |
|
Definition
|
|
Term
| Women who have PKU need what? |
|
Definition
| genetic counseling for pregnancy. It's really important to know potential to pass PKU on b/c it is autosomal recessive. |
|
|
Term
| The inability to synthesize adequate amounts of Thyroid hormone (which does a lot of metabolism) is ____________ _____________. |
|
Definition
| congenital hypothyroidism. |
|
|
Term
| Is congenital hypothyroidism usually seen alone or with other abnormalities? |
|
Definition
| Often associated with other abnormalities & genetic defects. (Like PKU and others...) |
|
|
Term
| Congenital Hypothyroidism is an autosomal _________ trait. |
|
Definition
|
|
Term
| S/S of Congenital Hypothyroidism are: |
|
Definition
| poor feeding, lethargy, prolonged neonatal jaundice, poor breathing & bradycardia, constipation, hoarse cry, large fontanels (do not close by the time we expect). Essentially, everything is massively slowed down. |
|
|
Term
| Other S/S of Congenital Hypothyroidism that occur after 6 WEEKS OF AGE are: |
|
Definition
| Depressed nasal bridge, Short forehead, puffy eyelids, large tongue, coarse dry lusterless hair, large fontanels and wide cranial sutures, umbilical hernia, abdominal distention, hypothermia. DEPRESSED NASAL BRIDGE, LARGE TONGUE, LARGE FONTANELS, PUFFY EYELIDS |
|
|
Term
| Why is early dx of Congenital Hypothyroidism so imp? |
|
Definition
| Early Dx helps prevent progressive deterioration of the nervous system and mental handicaps. |
|
|
Term
| Is screening for congenital hypothyroidism mandatory? |
|
Definition
| Yes, mandatory in all 50 states. |
|
|
Term
| What screen is done for Congenital Hypothyroidism? |
|
Definition
| Simple Blood Test - measures T4 blood levels. Ok to take in first 24-48 hours, prior to discharge. |
|
|
Term
| What is the prognosis of Congenital Hypothyroidism like? |
|
Definition
| Normal physical growth & intelligence is possible if medication is started shortly after birth. |
|
|
Term
| What is the treatment given after Congenital Hypothyroidism is diagnosed? |
|
Definition
| Lifelong Hormone Replacement of SYNTHROID (synthetic levothyroxine sodium). The med is "LIFE LONG" and will stop/prevent any mental or physical problems. |
|
|
Term
| Parents must be taught about S/S of overdosing on thyroid medication... what are they? |
|
Definition
| Child is IRRITABLE, NERVOUS, TREMORS, INSOMNIA, LOOSE STOOLS, OR WEIGHT LOSS, INCREASE IN APPETITE, FEVER, SWEATING, TACHYCARDIA, PALPITATIONS. The infant is often "very high strung & inconsolable. It's very important to know everything is essentially ramped up. Imp to be able to check the child's pulse. |
|
|
Term
| What are the S/S the child is receiving an UNDER dosage of Synthroid (thyroid supplement)? |
|
Definition
| Under dosage = return to early manifestations. SLEEPY BABY, FATIGUE, DECREASED APPETITE, CONSTIPATED. |
|
|
Term
|
Definition
| Med is crushed & placed in formula or food. |
|
|
Term
| Blood levels & Thyroid function tests are done as recommended. Imp to know later to get what kind of counseling? |
|
Definition
| genetic counseling d/t autosomal recessive. Be aware they could possibly pass this on. |
|
|
Term
| Growth Hormone Deficiency is controversial & can have many causes. What is "hypopituitarism" cause? What about "panhypopituitarism?" |
|
Definition
| Hypopituitarism = dysfunction of the pituitary causes decreased/absent hormone production, normally the cause. Panhypopituitarism = a total lack of ALL hormones. There is usually many other abnormalities with this. |
|
|
Term
| Is Growth Hormone Deficiency congenital or acquired? |
|
Definition
| BOTH. Can be acquired d/t damage at birth or after, as a result of a serious infection, head injury or tumor. A head injury can effect growth plates. We will see it at growth spurt (11-12) if not obvious at birth. |
|
|
Term
| What are other causes of short stature? |
|
Definition
| Constitutional delay of growth, familial or genetic short stature, nutritional issues, renal disease, chromosomal abnormalities, syndromes, small for gestational age, idiopathic short stature |
|
|
Term
| There are psychosocial aspects of having short stature... |
|
Definition
| THE MOST IMPORTANT PROBLEM IS LOWER SELF-ESTEEM R/T HEIGHT DISCREPANCY, social skills and anxiety, academic issues, appearing younger than chronological age, parental guilt |
|
|
Term
| What's the diagnosis for GH deficiency? |
|
Definition
| Child who is only as tall as kids 2 or more years younger (ex/ a 6 yr old shorter than avg. 4 yr old) OR who falls away from a previously normal growth curve. They should both be evaluated by a ped endocrinologist. |
|
|
Term
| What is the purpose of evaluating for GH deficiency? |
|
Definition
| to verify whether or not there is an absence of GH and/or other organic causes. |
|
|
Term
| When evaluating GH deficiency, what else needs to be evaluated? |
|
Definition
| A detailed fam history r/t heights of relatives, siblings & parents. Info on child's general health and nutritional state, past illness and injuries. Growth patterns since birth are evaluated. Radiographic surveys including EPIPHYSEAL MATURATION & bone age. (epiphyseal - is growth plates... once they close - you can't add any height at the end of therapy) |
|
|
Term
| Drugs used to stimulate GH production are: |
|
Definition
| insulin, arginine, glucagon, & levodopa. |
|
|
Term
| When are blood samples taken for GH deficiency? |
|
Definition
| overnight during sleep. They will also monitor for 24 hrs & see if they are getting the hormone release amy when they're supposed to. |
|
|
Term
| Replacement of GH is effective in __% of children. |
|
Definition
|
|
Term
| How much synthetic hormone is given for treatment of GH deficiency? What are the results in 1st year? following years? |
|
Definition
| 25-50 mcg/kg daily injections (subq or IM). Growth is 4-4.8 inches in the first year & 2.7-3.5 in following year. |
|
|
Term
| What is the criterion to stop giving synthetic growth hormone? |
|
Definition
| If the plates are closed (Epiphyseal Closure) means the end of height increase. |
|
|
Term
| The FDA has approved using GH in children who have what conditions? |
|
Definition
| GH deficiency, Chronic Renal Failure, Turner Syndrome, Prader-Willi Syndrome, SGA, Idiopathic short stature. |
|
|
Term
| GH treatments are very costly - $20-$30,000 per year! Why is GH treatment so controversial? |
|
Definition
| some think GH should not be given to otherwise healthy children. Others feel that short stature (below the 3rd percentile) should be treated. |
|
|
Term
| Precocious puberty used to be sexual development before 9 in boys & 8 in girls. What are the current ages? |
|
Definition
| Same for boys - before age 9. Puberty in girls is occuring earlier though. For caucasians, it's puberty before 7 yrs old. For African Americans, it's puberty before 6 years old. oh my GOSH! |
|
|
Term
| What is the cause of precocious puberty? |
|
Definition
| THE MAJORITY OF CASES, IT IS UNKNOWN. Pituitary gland may signal the ovaries and testicles to make hormones at an earlier time than usual. Or an abnormality may exist in the ovary, testicles, or adrenal glands causing the change. |
|
|
Term
| Signs of precocious puberty are -- Puberty is developing earlier.. what for females & males? |
|
Definition
| girls: breast development, pubic hair or underarm hair, a "growth spurt" in height, onset of menstruation, acne, body odor. boys: enlargement of testicles or penis, pubic, underarm & facial hair, deepening of voice, rapid height growth, acne |
|
|
Term
| What will the medications do for precocious puberty pt's? |
|
Definition
| The meds will cause females to decrease in breast size/allow for NO more development. meds in males will cause penis & testicles to shrink back to age appropriate development. Height will also slow down to the expected rate before puberty begins. The meds will halt development at that point until kids really should be going through these changes. Treatment is discontinued at a chronological appropriate time allowing puberty changes to resume. |
|
|
Term
| What psychological support is necessary for a precocious puberty pt? |
|
Definition
| Dress & activities should be age appropriate for child (a 6 yo child is a 6 yo even with breasts... follow correct age, not just b/c body is ahead). |
|
|
Term
| Is sexual interest usually advanced before the child's chronological age? |
|
Definition
| No, usually sexual interest is not advanced |
|
|
Term
| Are precocious puberty children fertile? should they be on contraception? |
|
Definition
| Yes, they are fertile, but no contraception is recommended unless the child is sexually active. |
|
|
Term
| What are the most difficult years for precocious puberty kids? |
|
Definition
| school age years before puberty. After puberty begins for the other kids, the physical differences are not apparent. |
|
|
Term
| What is the definition of Congenital Adrenal Hyperplasia (CAH)? |
|
Definition
| It is deficiency of an ENZYMES used by ADRENAL CORTEX to produce CORTISOL from CHOLESTEROL. |
|
|
Term
|
Definition
| Is the decrease in production of cortisol from cholesterol. Lack of enzyme needed to produce the cortisol from the cortex. |
|
|
Term
|
Definition
| CAH is an INHERITED DEFECT. It is an AUTOSOMAL RECESSIVE DISORDER. CAH occurs in 6 different enzymes - 90% of cases involve the ENZYME 21-HYDROXYLASE. |
|
|
Term
| The adrenal glands normally make steroids from cholesterol to secrete 3 hormones: |
|
Definition
| 1. Mineralcorticoids to produce Aldosterone. 2. Glucocorticoids to produce Cortisol 3. Androgens to produce Testosterone |
|
|
Term
| In utero the developing fetus' pituitary senses a lack of cortisol. It therefore attempts to FORCE THE ADRENAL TO PRODUCE CORTISOL by stimulating the gland. Since there is no cortisol being made by the adrenal gland - what happens? |
|
Definition
| Androgens are produced in excess (they produce Testosterone). EXCESSIVE PRODUCTION OF ANDROGENS. |
|
|
Term
| CAH leads to in utero virilization of the uterus. In other words... CAH causes - |
|
Definition
| Females to be born with AMBIGUOUS GENITALIA. (the clitoris is hypertrophied & resembles a penis with hypospadius, labia is fused to a variable degree and appears as a scrotum, urogenital sinus opens behind the clitoris, but the INTERNAL ORGANS ARE THOSE OF A FEMALE). If a male has CAH - their external genitalia looks normal. The genitalia & skin creases may be SLIGHTLY DARKER d/t increased ACTH. Immediate diagnosis with male is not as likely as with a female. |
|
|
Term
|
Definition
| very rare, 1 in 12,000-15,000 births. |
|
|
Term
| There are 3 kinds of CAH. What is the classic kind? |
|
Definition
| Classic salt wasting form. These kids are the most severely effected. Females present with ambiguous genitalia at birth. Both males & females will present with a salt-losing adrenal crisis in the 1st few weeks of life d/t the absence of both the mineralcorticoids and cortisol. ABNORMAL ALDOSTERONE & CORTISOL in SALT WASTING FORM of CAH. |
|
|
Term
| What other symptoms happen to kids who have the classic salt wasting form of CAH? |
|
Definition
| Symptoms of Hypovolemic Shock d/t excessive Sodium losses in urine, dehydration, and elevated Potassium will occur. |
|
|
Term
| The 2nd kind of CAH is the Classical NON-salt wasting. What is this? |
|
Definition
| Females present with a varying degree of genital virilization. Both males and females do not manifest the salt-losing problems as they have normal aldosterone. |
|
|
Term
| The NONCLASSICAL form of CAH is |
|
Definition
| the less severely affected. There are variable manifestations. Girls do not have ambiguous genitalia. |
|
|
Term
| How are children with CAH diagnosed? |
|
Definition
| The females at birth may be misdiagnosed as a male with undescended testicles and hypospadius or a small penis. All cases of ambiguous genitalia need to be followed up early to prevent problems with mistaken gender. (they need FOLLOW-UP!) Need an ultrasound or x-ray to see internal organs present b/c they will tell immediately. The chromosomes will be that of a normal female - it is not a chromosomal genetic disorder. |
|
|
Term
| Children suspected of CAH need a 24 hour urine to test presence of what? |
|
Definition
| 17-ketosteroid levels (testosterone) |
|
|
Term
| When is the appearance of acute adrenal insufficiency apparent? |
|
Definition
| 2nd through the 7th week of life |
|
|
Term
| Children who have type 2 or 3 may go undiagnosed for years though. When might they be diagnosed? What triggers adrenal insufficiency episodes for them? |
|
Definition
| They can't adjust to stressful situations. STRESS triggers adrenal insufficiency episodes. |
|
|
Term
| What replacement is necessary for CAH & how long? |
|
Definition
| Hydrocortisone (Cortisol) replacement tablets. Just replace what's missing - pretty easy, but it is FOR LIFE. All of these are for life, except GH. |
|
|
Term
| What does replacement of hydrocortisone (Cortisol) do? |
|
Definition
| causes suppression of ACTH by the pituitary, Androgen production is decreased, virilization is halted. |
|
|
Term
| We know that lifelong replacement of hydrocortisone (Cortisol) is necessary for CAH, but do they need to increase their dose sometimes? when? |
|
Definition
| Yes, increase dose during periods of stress, surgery, infection or injury. |
|
|
Term
| Salt wasting type of CAH needs __________ replaced also. what is the med? Also needs an injectable form of cortisone (ie Solu-Cortef) on hand if child is vomiting and can't keep med down or when experiencing severe stress. |
|
Definition
| aldosterone. Florinef Acetate - orally once a day. |
|
|
Term
| Children with salt wasting CAH.... do they need their salt restricted, increased, what? |
|
Definition
| INCREASE in dietary salt (b/c they are wasting it away). Also recommend a MEDIC ALERT BRACELET. |
|
|
Term
| If no replacement medications are given then _____________ of the female will continue. |
|
Definition
| masculinization (like pubic hair, deeper voice, enlarging clitoris, facial hair, temporal baldness, no breasts, no menstruation, no fertility.) BOTH males & females have PREMATURE EPIPHYSEAL CLOSURE - DWARFED ADULTS ABOUT 3'6 in height. |
|
|
Term
| What happens to males if they are not treated for CAH? |
|
Definition
| Penis hypertrophies between 18 months & 5 years and secondary sex characteristics will appear. Rapid growth, voice deepening, acne, pubic & auxilliary hair and muscle development will occur. Gonads will fail to develop and child will be STERILE as an adult if no treatment. |
|
|
Term
| One nursing intervention is gender assignment. What sex is usually chosen? |
|
Definition
| usually raised as females d/t the fact their internal structures are intact. The parents should be fully advised of situation if there is a question of gender at birth. Nurses can help them understand the diagnosis & explain to family members. They will need continued support & guidance, as you would expect... |
|
|
Term
| Surgical treatment involves --> |
|
Definition
| recession (size reduction) of the clitoris, separation of the labia, creation of vaginal orifice - plastic surgery pretty much to make girls more classic in genitalia. Surgery is best done before 17 months of age. Often done in stages & will need several surgeries to correct & revise. |
|
|
Term
| The parents of a CAH child need... |
|
Definition
| genetic counseling. The affected child is going to need counseling too. |
|
|
Term
| What is the most common endocrine disorder in children? |
|
Definition
|
|
Term
| When is the peak incidence of diabetes discovery in children? |
|
Definition
| 10-15 years old, but can occur at any age usually before 20 years old. |
|
|
Term
| Diabetes is most common to what ethnicity? |
|
Definition
|
|
Term
| How is diabetes Type 1 characterized from Type 2? |
|
Definition
| Type 1 diabetes has an absolute insulin deficiency |
|
|
Term
| Type 1 diabetes is an AUTOIMMUNE disorder that causes beta cell ___________. |
|
Definition
|
|
Term
| What are the 2 main factors behind Type 1 diabetes? |
|
Definition
| 1. Genetic predisposition 2. Environmental factors such as viral illness, toxin, cows milk can trigger the autoimmune response |
|
|
Term
| Type 1 diabetes is associated with ___ antigens. |
|
Definition
|
|
Term
| Is Type 2 increasing in children? |
|
Definition
| Yes it increasing in children - especially adolescents |
|
|
Term
| The majority of children who have type 2 diabetes have a ________ with the disease. |
|
Definition
| 1st or 2nd degree RELATIVE. It is GENETIC |
|
|
Term
| What ethnicities are presdisposed to Type 2 diabetes? |
|
Definition
| African Americans #1, American Indians, Eskimos |
|
|
Term
| What environmental factors contribute to Type 2 obesity? |
|
Definition
| inactivity and diets high in fat and refined carbohydrates contribute to the problem |
|
|
Term
| What are the clinical S/S of Type 1 diabetes? |
|
Definition
| Polyuria (excessive urination), Polydipsia (excessive thirst), Polyphagia (excessive hunger). For children, big signs are: ENURESIS (BED WETTING) & NOCTURIA (WAKING IN THE NIGHT TO PASS URINE) |
|
|
Term
| What are other s/s of type 1 diabetes? |
|
Definition
| weight loss, ketonuria (there is not enough carbs to break down so fat is broken down to get glucose), hyperglycemia, fatigue, irritability |
|
|
Term
| What are the s/s of Type 2 diabetes? |
|
Definition
| insidious (SLOW) onset, overweight, may have 3 P's, Weakness, Fatigue, May have FREQUENT INFECTIONS d/t yeast (VAGINAL and UTI). |
|
|
Term
| Type 2 diabetes is characterized by Insulin ___________. |
|
Definition
|
|
Term
| Type 2 diabetes is insulin resistant and often occurs with: |
|
Definition
| Hypertension, Elevated LDL & triglycerides, acanthosis Nigricans (darkening at the folds like back of knees & arms only happens w/ Type 2), Polycystic Ovary Syndrome (PCOS) is very common with Type 2. |
|
|
Term
| Treatment for Type 2 diabetes focuses on: |
|
Definition
| nutrition & increased physical activity. Treatment plan should address the life style and risk factors of the ENTIRE family to be effective, blood sugar monitoring. |
|
|
Term
| _________ is the only oral diabetic agent approved for youths. Insulin may also be used, but are phased off once lose wt & diet control happens. |
|
Definition
|
|
Term
| To diagnose both Type 1 & 2, a BG greater than or equal to ____ mg/dl on 2 occasions indicates DM. |
|
Definition
| 126. (This is the preferred method to diagnose) |
|
|
Term
| Other methods to diagnose both types of diabetes are: |
|
Definition
| 1. casual (random) plasma glucose 200 mg/dl+ w/ symptoms (3 P's & weight loss). 2. Oral Glucose Tolerance Test (OGTT). Remember, preferred method is a BG of 126 mg/dl+ on 2 occasions indicates DM |
|
|
Term
| If you lower your BG, you lower your risk of _____________. |
|
Definition
|
|
Term
| What health professionals should be involved with a Diabetic peds pt? (recommended by Amer Diabetes Assoc) |
|
Definition
| MULTIDISCIPLINARY TEAM APPROACH: Ped endocrinologist, diabetic nurse educator, dietitian, mental health professional, exercise physiologist, client & family who are an integral part of the team. |
|
|
Term
| Infants desired BG levels: |
|
Definition
| 100-200 levels are allowed |
|
|
Term
| What should a toddlers BG be before meals? at bedtime? |
|
Definition
| 100-180 before meals. 110-200 at bedtime. |
|
|
Term
| HgBA1c of a toddler/preschooler should be between: |
|
Definition
| 7.5%-8.5% (it's checked every 3 months & tells average of BG over last 90 days) |
|
|
Term
| School age child should have what BG before meals? Bedtime? |
|
Definition
| before meal=90-180. Bedtime=100-180. A1c less than 7.5%. |
|
|
Term
| Adolescents & young adults should have a BG of what before meals? at bedtime? what about A1c? |
|
Definition
| before=90-130. Bedtime=90-150. A1c=less than 7.5% |
|
|
Term
| Why do children have higher rates for BG levels? |
|
Definition
| Kids have HIGHER BG RATES D/T THEIR VULNERABILITY TO HYPOGLYCEMIA. |
|
|
Term
| How often should kids be checking BG? |
|
Definition
| at least 4 times a day & often more frequently. |
|
|
Term
| What is the Honeymoon Period experienced often by Type 1 diabetics after the initiation of insulin therapy? |
|
Definition
| 80-90% of beta cells are destroyed & the other 10% go on hiatus. When given insulin, the remaining cells work HARD. Honeymoon lasts 2 weeks to 2 years. This is VERY confusing for patients. Nurses must educate!!! Unfortunately it does NOT mean their diabetes is going away. Just getting a little extra help & eventually they'll be back to 4-5 injections/day probably. |
|
|
Term
| During the honeymoon period, how much insulin is given? Is beta cell destruction continuing? |
|
Definition
| Continue to give low doses of insulin. The remaining beta cells are releasing insulin for a variable period of time, but the Beta cell destruction is continuing. |
|
|
Term
| Rapid acting Insulins used for children (lispro, aspart, glulisine) - are the most common insulins. Tell about these.. |
|
Definition
| BOLUS or MEALTIME INSULINS. Onset of action is 5-15 mins. Peak is 30-90 mins & the duration is 4-5 hours. Don't have to wait to eat. Brand names are: Humalog, Novolog, Apidra. |
|
|
Term
| What are the short acting insulins given to children? |
|
Definition
| REGULAR insulin. Onset 30-90 minutes. Peak 2-4 hours. Duration 5-7 hours. Brand names = Humulin R & Novolin R. (This one you take the shot & wait 30 mins to eat - why we've gotten away from using it as much..) |
|
|
Term
| Intermediate acting (basal insulin) is: |
|
Definition
| NPH. (not used as much d/t night time drop). Onset 1-2 hours. Peak action: 6-14 hours. Duration: 16-20 hours. Brand name= Humulin N |
|
|
Term
| Long Action (basal insulin) is |
|
Definition
| Insulin glargine, determir. Onset 90 mins, Peakless, Duration 24 hours. Brand name: Lantus and Levemir (bedtime injection). we DO NOT MIX this with other insulins!!! |
|
|
Term
| insulin may be given in many methods. One is: |
|
Definition
| Subq at least 2x/day w/ 2 types of insulin Regular and NPH. |
|
|
Term
| Having tight control involves MULTIPLE DOSE INJECTIONS of 3 or more a day to cover food intake. Often it is: |
|
Definition
| Lispro to cover meals and Lantus at bedtime for basal control for 24 hours. |
|
|
Term
| To decrease the number of injections, an ________ _______ is available |
|
Definition
|
|
Term
| How does an insulin pump work? |
|
Definition
| allows for more physiologic insulin delivery than injections. It releases small amount of insulin 24 hrs/day. When eat? Bolus in/calculate the amount of insulin necessary for a meal. |
|
|
Term
| What are some advantages of the insulin pump? |
|
Definition
| More flexible meal & snack times, decreased amount of injections required, improved A1c levels. |
|
|
Term
| Insulin pumps allow for a continuous baseline infusion with intermittent boluses as determined by the user. Boluses are determined by: |
|
Definition
| blood sugar, activity and diet. Blood sugar must be monitored 5-6 times a day still. Insulin pump is the size of a pager and worn on a belt. Medication is delivered by a small catheter in subcutaneous tissue. |
|
|
Term
| How often should the insulin pump insertion sites be changed? It can't be removed for how long? how much does an insulin pump cost? |
|
Definition
| change site every 48-72 hours, It can't be removed for more than 1 hour a day, expensive =$6000/yr or $120/month. Luckily, most insurance companies will cover now. |
|
|
Term
| A complication that occurs with a persons weight when starting on an insulin pump is: |
|
Definition
| can see a huge weight gain b/c all of a sudden they can eat... something HC worries about. Generally, though, therapy is managed much better for most who are in control. |
|
|
Term
| What is a key component to educate parents about diabetes? |
|
Definition
| There must be a coordination of food intake with insulin action. <-- key component |
|
|
Term
| There should be a consistent number of calories to meet exogenous ______ requirements. |
|
Definition
| insulin - (to not become hypoglycemic) |
|
|
Term
| ___________ counting is necessary for diabetics bc they are the main foods that raise blood sugar no matter what the source is. |
|
Definition
|
|
Term
| So is 15 Grams of carbs from one source (fruits) the same as 15 Grams of carbs from another (potatoes)? |
|
Definition
| Yes - a dietician will help establish total grams of carbs to eat at meal's and snacks. |
|
|
Term
| One serving of starch, fruit or milk is equal to __-__ grams of carbs. Are veggies counted? |
|
Definition
| 12-15. No, vegetables are not counted (except potatoes, corn & peas are counted) |
|
|
Term
| Are fats & proteins recommended in a diabetic diet? |
|
Definition
| Yes, a reasonable amount of both are recommended. No foods are off limits anymore for Type 1. |
|
|
Term
| What is recommended about concentrated sweets for diabetics? |
|
Definition
| They are discouraged, but not prohibited. |
|
|
Term
| 15 grams of carbohydrates = __ carb. |
|
Definition
| ONE. (some diabetics use carbs and some use grams of carbohydrates). Calculating the insulin/carb ratio to figure out the insulin needed is done next. |
|
|
Term
| what does exercise do for diabetics? |
|
Definition
| exercise & being physically active helps the cells utilize BG more effectively. |
|
|
Term
| Exercise _______ blood sugar & helps insulin to enter the cell more readily. Therefore the insulin requirement is _________. |
|
Definition
|
|
Term
| Someone who is going to exercise, should do what? |
|
Definition
| they should always cary a carb source to treat hypoglycemia or take before exercise to prevent it from happening. MUST HAVE A RAPID ACTING GLUCOSE ON BODY AT ALL TIMES! |
|
|
Term
| When is exercise NOT recommended for a diabetic? |
|
Definition
| When BG is greater than 240 & ketones are present. When diabetes is that poorly controlled - do not exercise until control is achieved. |
|
|
Term
| Where should insulin injection go if you are going running? what about lifting weights? |
|
Definition
| The injection should not be put in the limb that is being exercised. For example, do not give in leg if going for a run b/c it will metabolize much faster. |
|
|
Term
| After activity has taken place, when might delayed hypoglycemia happen? what should be done? |
|
Definition
| Glucose may drop 6-12 hours after exercise. So check blood glucose at bedtime and/or during the night. Need to check these kids in the middle of the night b/c of DELAYED HYPOGLYCEMIA... it might not really drop for awhile after the activity. |
|
|
Term
| What are the causes of hypoglycemia? |
|
Definition
| Overdose of insulin, omitting or eating less food,overexertion without food on board, nutritional and fluid imbalance (N/V), alcohol intake. <-- recommend to eat whenever drinking alcohol b/c hypoglycemia occurs. |
|
|
Term
| Some mild s/s of hypoglycemia? |
|
Definition
| sweating, pallor, nervous, palpitations, tremulousness, hunger, cold, clammy |
|
|
Term
| some moderate s/s of hypoglyemia... |
|
Definition
| weakness, dizziness, headache, drowsiness, irritable, loss of coordination, disorientation, slurring words (classic signs of a drunk person - wear a med alert bracelet b/c cops have thought they were drunk!) |
|
|
Term
| severe s/s of hypoglycemia... |
|
Definition
| seizures, semi comatose or coma, slurred speech, staggering gait, combative, confused. An EMERGENCY INJECTION OF GLUCAGON is necessary! They need an IM INJECTION by someone else! |
|
|
Term
| How should mild to moderate symptoms of hypoglycemia be treated? |
|
Definition
| 1. 10-15 grams of simple carbohydrates (Give them orange juice, soda, milk, gummi bears. not chocolate b/c it takes too long.) 2. Follow with a complex carbohydrate (give more fat & protein to maintain BG until a meal. 3. retest blood sugar in 15-30 minutes. |
|
|
Term
| How should a severe hypoglycemic rxn be treated? |
|
Definition
| Administer Glucagon asap & call 911. 911 must be called so person can get 50% IV glucose to keep their BG up. |
|
|
Term
| Why might HYPERglycemia occur? |
|
Definition
| Too little insulin given or dose missed, too much food eaten, stress and stressful events (an illness/surgery, emotional upsets**), increase in growth hormone with puberty. (Natural increase of insulin dosage with puberty). |
|
|
Term
| Emotional stress causes ____glycemia. |
|
Definition
|
|
Term
| long term diabetes will cause the s/s of hyperglycemia to... |
|
Definition
| be decreased. Having diabetes long term will mask the s/s of hyperglycemia. |
|
|
Term
| Classic signs of Hyperglycemia with diagnosis are: |
|
Definition
| gradual onset of: lethargy,weakness, the 3 P's, N/V, abd pain, dehydration, warm & flushed |
|
|
Term
| When might children need a major readjustment of insulin dosages? |
|
Definition
| puberty d/t all the hormones being released and causing insulin resistance. |
|
|
Term
| What is diabetic ketoacidosis? |
|
Definition
| blood sugars above 240, pH less than 7.3. Can be fatal & is very serious. Often the first indication of diabetes is when this occurs & child ends up at hospital in full blown ketoacidosis. A person can go back into Diabetic Ketoacidosis at anytime. |
|
|
Term
| What are s/s of diabetic ketoacidosis? |
|
Definition
| ketosis, ketonuria, impaired consciousness, fruity odor to breath, kussmaul's respirations (rapid & shallow), dehydration, electrolyte imbalances |
|
|
Term
| Stress influences blood sugar!!! what should a parent do if diabetic child is sick? |
|
Definition
| monitor BG every 2-4 hours, do NOT STOP taking insulin doses during sickness, monitor urine for ketones (with strip) every 2-4 hours, Maintain hydration: if able to tolerate have them take soft bland foods and 8 oz of fluid per hour. Notify HC practitioner if vomiting and BS is above 240. |
|
|
Term
| Infancy (0-12 months) is a very difficult time for diabetes diagnosis. |
|
Definition
| The s/s of hypoglycemia can't be picked up easily & the parents need a ton of emotional support b/c giving 5-7 injections per day to your infant is really hard. Child needs support from parents. leads to TRUST ISSUES. |
|
|
Term
| Toddlerhood (12-36 months) is also a tough time for a diabetes diagnosis. |
|
Definition
| Period of AUTONOMY vs. SHAME & DOUBT. Diagnosis is very elusive in this age group too (might not notice any increase in urinary out put). The child will fear the pain of injections. They already have finicky eating patterns & appetites. Toilet training issues & early symptoms can be confused. It is really hard to correctly identify and treat hypoglycemic episodes. Child will have tantrums and discipline is hard. Recommend that parents have normal rules/discipline. |
|
|
Term
| Preschoolers (3-6 years) diagnosed with diabetes: |
|
Definition
| INITIATIVE vs. GUILT - may think they're guilty. Say, "what'd I do wrong mommy?" Child may interpret diagnosis as punishment for real or imagined offenses. May suffer a set-back in self-esteem that needs positive reinforcement. They fear injections (which are usually after meals), parents will need support, they have unpredictable appetites & food intake and hypoglyemic episodes. It's hard to find child care willing to control BG, but it is necessary the babysitter knows how to effectively manage when parent is unable to. |
|
|
Term
| During preschool they are gaining confidence in their ability to master tasks but still do not have the coordination and cognitive development to perform most diabetic tasks. Parents should: |
|
Definition
| involve diabetic child in activities as much as possible... give the young child the power/control! |
|
|
Term
|
Definition
| INDUSTRY VS. INFERIORITY. The school age group is capable of taking an active role in his own care with adult supervision. They still need the parental support, but should share responsibilities. This age group still has dietary issues. The diabetes regiment needs to be FLEXIBLE to allow participation in school, sport, and peer activities. |
|
|
Term
| School age kids need to know they are kids first & diabetics second. Term used is: |
|
Definition
| Person with Diabetes. (we don't say "diabetic". should not be defined by the disease.) |
|
|
Term
|
Definition
| IDENTITY VS. IDENTITY DIFFUSION. There are rapid biological changes (that change insulin needs). They have body image concerns & do not want to wear an insulin pump. Behavioral experimentation happens in adolescence, loss of control & coping skills. |
|
|
Term
| The cornerstone with diabetes is ____________. |
|
Definition
| EDUCATION. It is most important! we must turn the power & control to child & family... to manage themselves. |
|
|
Term
|
Definition
| Begin to Integrate diabetes into new lifestyle... need help transitioning into adult world, assure insurance. Need family support to transition to independence. Learn coping skills to enhance his ability for self-management. (Want to help avoid risky behaviors... alcohol, drug use, pregnancy - really need to control d/t many being born early or still birth.) |
|
|
Term
| What is a protrusion of the bowel into the groin region that causes an OBESRVABLE & PALPABLE bulge in that area? |
|
Definition
|
|
Term
| Inguinal hernias make up ___ of hernias & are more common in ____. |
|
Definition
|
|
Term
| How are inguinal hernias managed? |
|
Definition
| prompt elective surgery to avoid incarceration (intestinal obstruction, strangulation, GANGRENE). Usually there is bilateral involvement. This is an outpatient surgery usually. |
|
|
Term
| Before surgery, nursing care for inguinal hernias involves... |
|
Definition
| Encourage the parents to watch the child for reddness, swelling, inability to reduce the hernia (going to basically be pushing it back in until surgery can happen). Want to monitor the infant & reduce crying or straining. |
|
|
Term
| Monitor the older child and reduce: |
|
Definition
| straining, coughing, standing for a long time. Want to keep all kids with inguinal hernias as calm as possible. No straining during BM's. Want to decrease pressure on the abdominal area. |
|
|
Term
| After operation on inguinal hernia, the goal is to... |
|
Definition
| PREVENT INFECTION. Going to sponge bathe for 2-5 days, do frequent diaper changes on infants, and promote comfort (give Acetaminophen (Tylenol). |
|
|
Term
| What are post op activity restrictions for inguinal hernia surgery? |
|
Definition
| INFANTS & TODDLERS = no restrictions. OLDER CHILDREN = restrict heavy lifting, pushing, wrestling, fighting, bike riding and athletics for 3 weeks. SCHOOL CHILDREN = go to school when can, but NO PE for 3 weeks. |
|
|
Term
| what is a fluctuant mass of fluid within the processus vaginalis that presents as scrotal swelling? |
|
Definition
| Hydrocele (if you back light it: can see fluid through & it's clear fluid, not a mass) |
|
|
Term
| What is a NONCOMMUNICATING hydrocele? |
|
Definition
| peritoneal fluid is trapped in the testicular tunica vaginalis during closure of the processus vaginalis. The fluid is gradually reabsorbed. Usually NO treatment is necessary. |
|
|
Term
| What is a COMMUNICATING hydrocele? |
|
Definition
| The processus vaginalis remains OPEN! So you're getting different amt's of fluid at diff times... very variable amt of fluid down there. because it did NOT close. |
|
|
Term
| A _____________ hydrocele is going to have changes in intra-abdominal pressure & gravity. There will be force of peritoneal fluid into processus vaginalis & scrotal swelling of variable size. |
|
Definition
|
|
Term
| A hydrocele will have transillumination. whats that? |
|
Definition
| shows the fluid if back lit. lights up like a light bulb. |
|
|
Term
| Communicating hydroceles predispose the child to a _____. |
|
Definition
|
|
Term
| Surgical repair of the hydrocele is necessary if the following present: |
|
Definition
| a large, symptomatic hydrocele. remains after 3 months of age. hernia. |
|
|
Term
| Surgery for a hydrocele is best done by what age? |
|
Definition
| best done by 1 year of age (sooner if hernia is present). Surgery is usually an outpatient basis. |
|
|
Term
| What is normal to expect after surgery for hydrocele? |
|
Definition
| normal to have swelling & discoloration, will resolve spontaneously within 10 days. |
|
|
Term
| What is failure of one or both testes to descend into the scrotal sac? |
|
Definition
|
|
Term
| Who has much higher rates of cryptochidism? |
|
Definition
| Premature infants. Because the tests normally descend during the 8th month of gestation. |
|
|
Term
| What is Retractile Testes? |
|
Definition
| They have normally descended testes, but a hyperactive "cremasteric" reflex pulls the testes back into the inguinal canal. If you stroke the inside of thigh it is sensitive to stimulation/touch & cold, usually bilaterally. The testes normally retract, but this should go away at about 6 months. They can be "milked and brought back down into scrotum. |
|
|
Term
| What is done first for Cryptorchidism? |
|
Definition
| hormone therapy - to stimulate testicular descent |
|
|
Term
| What other methods are done for Cryptorchidism? |
|
Definition
| Luteneizing Hormone (LH) Nasal Spray or Human Chorionic Gonadotropin (hCG) Injection |
|
|
Term
| What is done if hormone therapy does not work for Cryptorchidism? |
|
Definition
|
|
Term
| What is the surgery for Cryptorchidism called? |
|
Definition
| Orchiopexy. It surgically places testes in scrotum. Should be done if testes have not descended by one year of age. It is usually an outpatient surgery. |
|
|
Term
| When is the best time for Orchiopexy (surgery for Cryptorchidism) ? |
|
Definition
| best time psychologically is between 1-2 years of age. Earlier if hernia is present. |
|
|
Term
| There are physical risks if the surgery is not done early... like what? |
|
Definition
| 1. REDUCED FERTILITY (higher degree of body heat in abd damages the testes) 2. TESTICULAR MALIGNANCY (increased 20-40%, usually occurs at 30-40 years old. If untreated by 2 yrs of age? risks increase the longer the testes are in that area. Greatest risk if untreated or surgery is not done during or after puberty. |
|
|
Term
| After a pt has surgery to descend the testicles (orchiopexy), what nursing care is necessary? |
|
Definition
| 1. PREVENT INFECTION - keep operative site free of stool & urine 2. PROMOTE COMFORT - pain med as needed 3. TEACH SELF EXAM OF TESTES to older child 4. TEACH IMPORTANCE OF LONG TERM FOLLOW UPS - for tumors & infertility. |
|
|
Term
| What is the congenital anomaly in which the urethral opening is located along the ventral surface (underside) of the penile shaft? |
|
Definition
|
|
Term
| There is an increased risk for hypospadius if... |
|
Definition
| father or sibling has hypospadius (it's congenital) |
|
|
Term
| should boys born with hypospadius be circumcised as usual? |
|
Definition
| NO, they are NOT circumcised b/c the foreskin may be used in surgical reconstruction. |
|
|
Term
| When is the best time for surgery on hypospadius? It may be a single or a multi stage surgery, just depends. |
|
Definition
|
|
Term
| What are potential areas of repair for hypospadius? |
|
Definition
| correction of chordee, straightening of penis, construction of new urethra. |
|
|
Term
| What is done for urination while hypospadius surgery heals? |
|
Definition
| urinary diversion - allows healing of the urethra. may have a suprapubic catheter. |
|
|
Term
| The goals of surgery for hypospadius are: |
|
Definition
| to make urinary & sexual function as normal as possible. To improve the cosmetic appearance of the genitalia. |
|
|
Term
| After surg for hypospadius nursing care involves caring for the drainage system... what's this mean? |
|
Definition
| Nurse may need to prevent disruption (use restraints possibly), tape catheter to prevent any tension, assure no clamping or kinking of the catheter tube & maintain patency. |
|
|
Term
| A UTI can change to sepsis in an infant. Nursing care to reduce the risk of infection after hypospadius surg is very imp. what must be done? |
|
Definition
| Give PROPHYLACTIC ORAL ANTIBIOTICS prior to the surgery, going to give urine acidifying agent (like ascorbic acid) b/c increasing acidity will decrease infection (want a low pH). Finally, put antibiotic ointment on the urethral meatus. |
|
|
Term
| Nursing care after hypospadius involves using a COMPRESSION DRESSING TO THE PENIS. What for? |
|
Definition
| The compression dressing will Reduce Edema & Reduce Bruising. |
|
|
Term
| It is very important to CONTROL BLADDER SPASMS following hypospadius surgery. what does nurse give for this? |
|
Definition
| Ditropan & Belladonna - an opium suppository. |
|
|
Term
| Older children who have hypospadius surgery need to have ... |
|
Definition
| their activity restricted post-op. |
|
|
Term
| What discharge planning is taught after hypospadius surgery? |
|
Definition
| care of the urinary drainage system. teach the parents how to maintain & allow child to be at home. ENCOURAGE FLUIDS. avoid activities like: rough play, swimming, contact sports, straddle type toys, sandboxes.... until the area is healed. Need to ensure the tubing doesn't get dirty or infected too. |
|
|
Term
| What is a congenital anomaly in which the urethra is located on the dorsal surface (topside) of the penile shaft? |
|
Definition
| EPISPADIAS (This is much more significant & doesn't happen in normal child... there is usually other issues happening) |
|
|
Term
| What is a MILD vs a SEVERE Epispadias? |
|
Definition
| Mild: meatus located in front of the glans penis. Severe: extends to exstrophy of the bladder. Surgical intervention depends on the degree of the involvement. |
|
|
Term
| What is bladder exstrophy? (occurs in severe epispadias) |
|
Definition
| a CONGENITAL anomaly characterized by the extrusion of the urinary bladder to the outside of the body through a defect in the lower abd wall. (there is a higher incidence of this in males) |
|
|
Term
| How is bladder exstrophy managed? |
|
Definition
| a series of staged reconstructions. Initially they close the abd defect within the first few hours/days of life (surg asap!). Subsequently, they will do an epispadias repair, bladder neck reconstruction, creation of urethral sphincter meachanism (usually there is not a sphincter), genitalia reconstruction. URINARY DIVERSION MAY BE PERMANENT. |
|
|
Term
| Parents who have a child with bladder exstrophy need help to promote their bonding. What can a nurse do? |
|
Definition
| assist the parent to bathe, feed, diaper, etc... support the parents b/c they are grieving the loss of a "perfect child" |
|
|
Term
| What should a nurse do prior to surgery for a bladder exstrophy? |
|
Definition
| PREVENT INFECTION by covering the defect with a sterile nonadherent dressing. Need to protect the exposed bladder tissue. Practically covering the area with clear plastic wrap or thin film dressing without adhesive. Do NOT USE PETROLEUM JELLY!!! Keep the surrounding area clean & protect from dribbling urine. |
|
|
Term
| What does a nurse do after surgery? |
|
Definition
| routine post-surg repair, wound care, monitor urine output & appearance, comfort measures |
|
|
Term
| __________ Syndrome is a clinical state characterized by abnormal increase in the permeability of the glomerulus to plasma protein. |
|
Definition
|
|
Term
| In nephrotic syndrome, the glomeruli is more permeable to plasma _________. |
|
Definition
|
|
Term
| The primary group of Nephrotic Syndrome includes the most common type in children (80%). It is Idiopathic - no known cause. What is it called? |
|
Definition
| Minimal Change Nephrotic Syndrome (MCNS) |
|
|
Term
|
Definition
| It is idiopathic - no known cause - know that! Know it is Primary too! |
|
|
Term
| Secondary reasons for Nephrotic Syndrome: |
|
Definition
| Systemic Disease, Drugs, Toxins (3 causes) |
|
|
Term
| Nephrotic Syndrome can be congenital, but it is very RARE for it to be congenital. |
|
Definition
| It is autosomal recessive, managed by dialysis & transplants, but death is common in the first 2 years of age. |
|
|
Term
| The glomerular membrane is normally impermeable to large proteins, but in Nephrotic Syndrome the glomerulus becomes permeable to protein, especially _________. |
|
Definition
|
|
Term
| Where are all the proteins found in Nephrotic Syndrome? |
|
Definition
| In the URINE (hyperalbuminuria!!!), but the serum albumin is really low (hypoalbuminemia). There are fluid shifts from plasma to interstitial spaces (causing HYPOVOLEMIA & ASCITES - fluid settles in the intraabdominal area). |
|
|
Term
| UA of nephrotic syndrome would show: |
|
Definition
| an increase in albumin in urine, but a decrease in serum albumin. also causes fluid shifts = ascites in abdomen. |
|
|
Term
| What are the clinical s/s of nephrotic syndrome? |
|
Definition
| Massive proteinuria, Hypoalbuminemia (low serum albumin), Edema (periorbital, ascites, labial or scrotal, lower extremities). swelling in groing & feet/ankles. There is HYPERLIPIDEMIA, weight gain, diarrhea, anorexia, difficulty breathing, skin breakdown on feet/ankles (wherever fluid sits), skin pallor, malnutrition, lethargy, irritability, depression, DARK/FROTHY URINE. |
|
|
Term
| There is often a recent history of an ______ with nephrotic syndrome. |
|
Definition
| Upper Respiratory Infection. (d/t increased fluid volume in lungs) |
|
|
Term
| Other common infections with nephrotic syndrome are: |
|
Definition
| cellulitis, pneumonia, peritonitis, sepsis. Pneumonia happens b/c there is a decease in kidney functioning, but an increase of fluid in lungs = pneumonia cycle. |
|
|
Term
| Causes of infection in nephrotic syndrome? |
|
Definition
| Edema, steroids, immunosuppressive therapy, loss of immunoglobulins, poor nutrition. |
|
|
Term
| What is the URINE like in Nephrotic Syndrome? |
|
Definition
| Decreased urine volume (amount), but the concentration of the urine is really increased (why it's dark & frothy). There is MASSIVE proteinuria. and MICROSCOPIC HEMATURIA (blood in urine is very common). The specific gravity is increased. |
|
|
Term
| The objectives of treatment for nephrotic syndrome are: |
|
Definition
| to decrease the urinary protein loss, balance nutrition, restore normal metabolic function, prevent or treat any function. |
|
|
Term
| What nursing care is important in Nephrotic Syndrome? |
|
Definition
| MEDICATIONS are #1. Rest is what is done in hosp anyway: monitor I & O, nutrition/fluid management, skin care, prevention of infection, activity, respiratory care, socialization/emotional support. |
|
|
Term
| What is the PRIMARY THERAPEUTIC AGENT used for Nephrotic Syndrome? |
|
Definition
|
|
Term
| The goals of prednisone use: |
|
Definition
| to reduce excretion of urinary proteins and promote excretion of edema fluid. |
|
|
Term
| Diuresis usually occurs between days __ & ___. |
|
Definition
|
|
Term
| Continue diuresis until urine is free of protein & remains so - this takes.... |
|
Definition
|
|
Term
| Should Prednisone be stopped right when diuresis is over? |
|
Definition
| No, The dosage needs to be TAPERED for weeks to months. |
|
|
Term
| What are the side effects of using Prednisone? |
|
Definition
| moon face, buffalo hump, hirsutism, increased appetite, gastric ulcer/bleeding, HTN, susceptible to infection, growth retardation. |
|
|
Term
| Relapse of Nephrotic Syndrome happens to 85% of kids with MCNS. Though the tendency for relapse decreases with time (good news)... How can parents prevent this? |
|
Definition
| Teach parent to monitor with urine dipstick (just do normal UA's, can get a target). If the child is having Proteinuria of 2+ or more, for 3 consecutive days = concern for relapse. Other s/s to watch are: increased edema, weight gain, fever. |
|
|
Term
| Nephrotic Syndrome kids need to be watched for FLUID MANAGEMENT! how is this done? |
|
Definition
| REPORT LESS THAN 1 ml/kg/hr!!! monitor for edema, measure ABD GIRTH and WEIGH DAILY (same time & scale). A 'dry diaper' is a big sign if they are infants. |
|
|
Term
| BLOOD PRESSURE also needs to be monitored at least once per shift. What is it usually? |
|
Definition
| NORMAL to SLIGHTLY DECREASED. |
|
|
Term
| Factors that promote HYPERTENSION in nephrotic syndrome kids are: |
|
Definition
| increased total body fluid volume & concurrent steroid therapy. |
|
|
Term
| What is the diet for nephrotic syndrome? |
|
Definition
| no added salt in diet & avoid high sodium foods (we are trying to get the fluids out) - no ramen noodles, no mcdonalds french fries... can go back to regular diet after awhile. Just NO SALT DURING RELAPSE or STEROID THERAPY. If they have severe edema? Will have further sodium restriction. They can go back to regular diet during remission. |
|
|
Term
| What is done to protect from skin breakdown in nephrotic syndrome? |
|
Definition
| change position every 1-2 hours, keep skin clean & dry, support edematous body parts. |
|
|
Term
| how is infection prevented for nephrotic syndrome? |
|
Definition
| meticulous handwashing, avoiding infectious persons, monitoring & reporting: fever, cough, sore throat, abd pain. Taking ANTIBIOTICS during the EDEMATOUS PHASE, Immunizations, reporting illness |
|
|
Term
| When does the Edematous stage happen? What activity is allowed? |
|
Definition
| 3-4 weeks after initial treatment. BEDREST |
|
|
Term
| What activity during remission is allowed? |
|
Definition
|
|
Term
| What is the prognosis for nephrotic syndrome? |
|
Definition
| it depends on response to steroid therapy, histology of the renal lesion. There is a VERY GOOD PROGNOSIS for most if MCNS. If the histologic pattern is not MCNS, there is a greater chance of progressive renal failure. |
|
|
Term
| What is acute glomerulonephritis? |
|
Definition
| an inflammation of the glomeruli which most commonly follows a GROUP A BETA HEMOLYTIC STREP INFECTION of the throat or skin. |
|
|
Term
| Acute Glomerulonephritis is typically due to: |
|
Definition
|
|
Term
| What are the clinical manifestations of acute glomerulonephritis? |
|
Definition
| they are variable, but GROSS HEMATURIA, HYPERTENSION, periorbital edema, anorexia, weight gain, decreased urine out. |
|
|
Term
| The S/S of acute glomerulonephritis are similar to nephrotic, but what is #1 with acute glomerulonephritis? |
|
Definition
| GROSS HEMATURIA & HYPERTENSION |
|
|
Term
| What complications happen with acute glomerulonephritis? |
|
Definition
| Hypertensive Encephalopathy is the primary one avoiding! (also there is acute cardiac decompensation & acute renal failure) |
|
|
Term
| what are the s/s that Hypertensive Encephalopathy is happening? |
|
Definition
| headache, vomiting, blurred vision, dizziness, restlessness, lethargy, disorientation, tachycardia, convulsions |
|
|
Term
| How long does the Edematous Phase in Acute Glomerulonephritis last? |
|
Definition
|
|
Term
| What are the manifestations of the edematous phase? |
|
Definition
| listless, apathetic, anorexic, increased blood pressure, URINE IS CLOUDY, SMOKY BROWN, URINE OUTPUT IS DECREASED. |
|
|
Term
| The first signs of improvement in acute glomerulonephritis: |
|
Definition
| small increase in urine output& decrease in body weight. |
|
|
Term
| The ___________ phase usually starts 1-2 days after the first signs of improvement. |
|
Definition
| Diuretic - causing copious diuresis |
|
|
Term
| Blood pressure management is #1 with acute glomerulonephritis. What will happen to it during resolution ~2-3 weeks? What else will decrease? |
|
Definition
| BP will decrease. Gross hematuria will disappear in a few weeks, but microscopic hematuria may persist for several months. |
|
|
Term
| Nursing care for acute glomerulonephritis involves: |
|
Definition
| fluid balance monitoring, monitoring for complications, preventing infection, medications, diet, activity. |
|
|
Term
| Meds given for acute glomerulonephritis are: |
|
Definition
| Diuretics, Antihypertensives, Antibiotics |
|
|
Term
| What is the diet for acute glomerulonephritis? |
|
Definition
| they have a POOR APPETITE affecting their intake. If child is uncomplicated: regular diet w/ no salt. If HTN or edema is starting to develop: moderate sodium restriction. Oliguria (when can't urinate? the cardiac compensation is increasing) it is necessary to RESTRICT POTASSIUM when no urine output. If severe Azotemia (nitrogen containing compounds like urea, creatinine) - then restrict protein. |
|
|
Term
| Uncomplicated child with acute glomerulonephritis' diet: |
|
Definition
| regular diet with no added salt |
|
|
Term
| Child with HTN or Edema's diet: |
|
Definition
| Moderate sodium restriction |
|
|
Term
| Child with Oliguria (when can't urinate, increase in cardiac decompensation): |
|
Definition
|
|
Term
| Child with severe Azotemia (increased nitrogen compounds like urea or creatinine): |
|
Definition
|
|
Term
| What is the prognosis of APSGN (Acute poststreptococcal glomerulonephritis)? reoccurence? |
|
Definition
| Usually runs its course in about one month. Reoccurence is unusual after the first 3 months. Most people completely recover & death is rare b/c it is easily treated. Give diuretics-> Antihypertensives-> increase fluids when in diuretic phase. |
|
|
Term
| What is a Urinary Tract Infection? |
|
Definition
| infection w/in the urinary tract affecting the bladder, urethra, ureters or collecting system of the kidneys. |
|
|
Term
| UTI's most commonly affect the _________. |
|
Definition
|
|
Term
| A UTI affecting the: urethritis, cystitis, or prostatitis. is considered the _______ tract. |
|
Definition
|
|
Term
| UTI affecting the: pyelonephitis or the VUR (vesicoureter reflex) is the ______ tract. |
|
Definition
|
|
Term
| Common UTI's under 5 years old in girls? is often due to the.. |
|
Definition
| VUR (vesicoureter reflex) so an UPPER tract infection |
|
|
Term
| Who is most at risk for UTI's? |
|
Definition
| Neonate/young infant boys, older infant to young adult (more common in females at this age) - peaks 2-6 yo if no anomaly. Also common in postmenopausal women & elderly. |
|
|
Term
| What is the most common cause of UTIs? |
|
Definition
| Gram Negative Bacilli -> E COLI!!! others are klebsiella pneumonia & proteus mirabilis. Also, Gram Positive cocci-> Staph. |
|
|
Term
| Hematogenous spread UTI's: |
|
Definition
| 1. usually occur below 4 months of age. 2. Older-must have prior injury to urinary tract (obstruction of ureter, damage from stones, renal scars) |
|
|
Term
| Ascending Infection of UTI: |
|
Definition
| Usually only to those who are OVER 4 MONTHS OF AGE |
|
|
Term
| What are potential anatomic abnormalities that may cause UTI's? |
|
Definition
| anatomic or neurologic obstruction, nephrolithiasis (kidney stones), vesicouretral reflux (urine reflexes), noretractable foreskin, labial fusion |
|
|
Term
| What are S/S of a LOWER tract infection? |
|
Definition
| no fever, frequent urination (more than every 2 hours), suprapubic discomfort or pressure, uregency, dysuria (painful urination at the end of voiding often) |
|
|
Term
What are S/S of a UPPER tract infection?
|
|
Definition
| chills, FEVER, flank pain (even tap on area & you get pain |
|
|
Term
| What are the signs of a UTI in an infant/neonate? |
|
Definition
| VAGUE, NONSPECIFIC SYMPTOMS - (like FTT, difficulty feeding, irritability, diarrhea, persistent diaper rash). Fever without focus of infection? Suggests UTI. Need to get a urinary tract evaulation as part of sepsis work up. |
|
|
Term
| How do we screen for UTIs? what would it show? |
|
Definition
| Simple UA. Urine dipstick would show positive leukocyte esterase, positive nitrite. Urine pH is alkaline (more than 7) |
|
|
Term
| a urine ________ is the GOLD STANDARD OF DIAGNOSIS FOR UTIs. |
|
Definition
| Culture (C&S is done to assure treating the correct bacteria as well) |
|
|
Term
| What is the most accurate way to get the urine for culture? |
|
Definition
| Catheterization or Suprapubic Aspiration. Small infants are catheteried often. |
|
|
Term
|
Definition
| eliminate the current infection, identify contributing factors to reduce the risk of recurrence, prevent systemic spread of infection, preserve renal function |
|
|
Term
| what is the purpose of treating UTIs? |
|
Definition
| to eliminate the current infection. To identify contributing factors to reduce the risk of recurrence (esp in young children b/c it's not real common), prevent systemic spread of infection, preserve renal function |
|
|
Term
| How do we treat complicated UTI's in children? |
|
Definition
| IV or IM antibiotics followed by oral |
|
|
Term
| How do we treat 'uncomplicated' UTI's in children? |
|
Definition
| TMP-SMX, (trimethaprim-sulfamethoxazole), Septra, Bactrim, nitrofurantoin, amoxicillin. These are OTC & effective in all age ranges. It elps pain asap & antibiotic will decrease ain in the next few days. |
|
|
Term
| What med relieves the pain of UTI? |
|
Definition
|
|
Term
| What follow-up is needed after meds? |
|
Definition
| need to get a monthly culture for 3 months, then --> every 3 months for 6 months. |
|
|
Term
| A 4 yo girl is seen in the outpt center w/ a UTI. She is started on Bactrim. What teaching is important to discuss w/ the mom? |
|
Definition
| reporting the infection early is imp, proper hygiene (wipe front to back), avoid chemical irritants, decrease irritation from clothing (swimmers/divers need to watch), increase fluids & frequently void, if sexually active be sure to void after sex, avoid constipation. |
|
|
Term
| What is adequate fluid intake for a child? what about an adult? |
|
Definition
| 100 mL/kg for child. 2-3 L/day for an adult. |
|
|
Term
| What helps to acidify urine? |
|
Definition
| Vit C helps. A urine pH of 5 will decrease bacterial multiplication |
|
|
Term
| How does cranberry/blueberry juice help? |
|
Definition
| prevents bacteria from adhering to the bladder wall. Should have 2-3 glasses of juice per day. Need 4-6 weeks to work as a prevention strategy. |
|
|
Term
| Who is enuresis (bed wetting) more common in? |
|
Definition
|
|
Term
| A mom comes to you & is very upset her 6 yo is still wetting the bed. what do you say? |
|
Definition
| Night time bed wetting until 6 years old is NOT a concern. (15% of five year olds do & 3% of 10 year olds) |
|
|
Term
| How can bed wetting be managed? |
|
Definition
| Enuresis alarm, Motivational Therapy, Bladder Stretching Techniques (increase fluids & teach to hold. Will expand the bladder & train child). Drug therapy is used if bad enough. |
|
|
Term
| What are some of the drugs given if enuresis gets bad enough? A spasmodic bladder will cause it sometimes... |
|
Definition
| Imipramine, DDAVP, Ditropan |
|
|
Term
| What education is done for parents of a child struggling w/ bed wetting? |
|
Definition
| Limit Fluids, Discourage punitive approach (limit response to accidents and teach the child to participate). Observe for side effects of medications, Counseling if needed. esp if child is 10-12 years old, there are sleepover & they're not going type of thing. |
|
|
Term
| Iron Deficiency Anemia is a _________ __________ anemia. It is brought about primarily by inadequate diet intake of iron necessary for normal RBC production. |
|
Definition
| HYPOCHROMIC, MICROCYTIC ANEMIA |
|
|
Term
| Children who are 6 mo's - 2 years old are diagnosed when their hemoglobin is less than ___ g/dL and hematocrit is less than ___%. |
|
Definition
|
|
Term
| Children with Iron Deficiency anemia are diagnosed according to their labs ... |
|
Definition
| just know there are 3 levels of severity (mild, moderate & severe) of Iron Deficiency Anemia |
|
|
Term
| How does iron def anemia happen? |
|
Definition
| inadequate diet intake of iron (most common), iron malabsorption, low iron stores at birth, significant blood loss. |
|
|
Term
| What are the risk factors for iron def anemia in infants who are premature/low birth weight? |
|
Definition
| They have poor iron stores at birth. The maternal iron stores last approx 4 months, 50% of iron in maternal milk is absorbed, 10% of iron in cow's milk is absorbed (why we don't give milk until 1 year). |
|
|
Term
| What are the risk factors for iron def anemia in infants/children? |
|
Definition
| Rapid increase that is happening in their body size & blood volume has an effect. Usually insufficient iron rich formula & foods, they're having excessive intake of whole cow's milk which has less iron absorption. They may be breastfed without dietary iron. They're often very PICKY EATERS at this age. Eating a VEGETARIAN/VEGAN nonmeat diet in 2-5 year olds puts them at risk. Malnutrition. |
|
|
Term
|
Definition
| eating disorder d/t anemia where they crave dirt, metal, nails d/t decreased iron intake. |
|
|
Term
| Why are adolescents at risk for iron def anemia? |
|
Definition
| rapid growth rate during puberty, increased muscle mass and circulating blood volume, unbalanced diet and poor eating habits, having menarche- esp if it is early and/or heavy menses. |
|
|
Term
| What factors put an adult at risk for iron def anemia? |
|
Definition
| premenopausal women, pregnant women, chronic blood loss, low socioeconomic background, older adult |
|
|
Term
| What are the S/S of Iron Deficiency Anemia? |
|
Definition
| Lethargy/fatigue, irritability, pallor, frequent infections, inability to concentrate, heavy menses |
|
|
Term
| Other iron def anemia findings: |
|
Definition
| conjunctiva in eyes may be pale, mucous membranes are pale, there are cardiac problems, devlopmental delays, weight is variable. |
|
|
Term
| Iron Def Anemia is ALWAYs checked between 9-12 mo's. What else is checked if there is any concerns? |
|
Definition
| between 1-5 yo. Between 5-12 yo. Between 14-20 yo. |
|
|
Term
| Breast milk is highly recommended, but what should be done at 4-6 months? |
|
Definition
| Need to ADD iron supplement to breast milk. B/c breast milk has a low concentration of iron, the bioavailability is greater, and there is a progressive decline in iron content. |
|
|
Term
| Preterm infants need iron supplementation at __ months. |
|
Definition
|
|
Term
| Who needs iron supplementation by 6 months? |
|
Definition
| Infants that are EXCLUSIVELY BREASTFED |
|
|
Term
| Who else should receive iron supplements? |
|
Definition
| Infants getting formula that is not fortified with iron (it always should be!). and children with hemoglobin's below 11. |
|
|
Term
| MILK INTAKE RECOMMENDATIONS - Have formula + iron until 12 months. WHOLE cow's milk after 12 mo's. How many oz of milk should be given per day for 1-5 year olds. This is sufficient to meet Ca++ needs... |
|
Definition
|
|
Term
| Encouraging iron rich foods is always good... what is high & mod in iron? |
|
Definition
| high=red meat, oily fish. mod=beans, peas, fortified cereals, dark green vegetables, nuts. |
|
|
Term
| What foods decrease iron intake? |
|
Definition
| excess cows milk (more than 24 oz/day) and Tea |
|
|
Term
| All iron supplements are not the same. Which ones are better absorbed? |
|
Definition
|
|
Term
| What should NOT be taken with the iron supplement? |
|
Definition
| Do NOT consume with milk, antacids or tea |
|
|
Term
| What helps the absorption of Iron? |
|
Definition
| Ascorbic Acid (ORANGE JUICE HELPS!) |
|
|
Term
| What's recommended for taking liquid ferrous sulfate? When should it be taken? |
|
Definition
| Use a dropper or straw to avoid staining your teeth. Brush your teeth. Give between meals. |
|
|
Term
| When you start iron supplements, stools may normally be: |
|
Definition
| dark (greenish black) - warn families |
|
|
Term
| what are some sd effects of iron supplements? |
|
Definition
| n/v, diarrhea, constipation, anorexia. Can give iron with snack or small meal. ONLY give iron with meals if they have side effects. |
|
|
Term
| Iron therapy should return hemoglobin to normal within... |
|
Definition
| 4-6 weeks. It's entirely possible to bring Hemoglobin up 1.0 g/dl or more in a month. |
|
|
Term
| Continue iron therapy for at least ___ months after Hgb levels return to normal |
|
Definition
|
|
Term
| However, iron therapy treatment should not exceed ___ months |
|
Definition
| five (except for older adults who may require life long supplementation of iron) |
|
|
Term
| What other ways can Iron be given? |
|
Definition
| parenteral iron. packed red blood cells. |
|
|
Term
| How does somebody get Sickle Cell Anemia? |
|
Definition
| Autosomal Recessive Inheritance |
|
|
Term
| With sickle cell anemia - there is an abnormal form of hemoglobin within the erythrocyte (RBC). There is Hemoglobin ___ present when normally there is normal adult hemoglobin (Hgb A). |
|
Definition
|
|
Term
| Sickle cell causes - Chronic Hemolytic Anemia: RBC's only have a life span of __-__ days. They normally live 90 days (3 months). There is a chronic turnover of sickle Hgb & it is not lasting nearly as long as it should. |
|
Definition
|
|
Term
| The genetic transmission of Sickle Cell Anemia is: |
|
Definition
| autosomal RECESSIVE. We know that both parents have a heterozygous trait. There is a 25% chance of having the disease, a 50% chance of being a carrier & a 25% change of having normal Hgb with each pregnancy. |
|
|
Term
| What nationality most commonly has sickle cell? |
|
Definition
| african american. (also in caribbean/mediterranean, arabian, india) |
|
|
Term
| In the American Black Population the disease is in 1 in 400 or 500 births. The trait is in: |
|
Definition
| 1 in 12 is a carrier. VERY HIGH! |
|
|
Term
| What is the basic defect of sickle cell anemia? |
|
Definition
| Normal hemoglobin: GLUTAMIC ACID in the 6th position of the beta chain Hgb A. Instead, VALINE replaces it -> Hgb S. |
|
|
Term
| what are sickle cell disease stressors? |
|
Definition
| Situations that promote Oxygen Deprivation. Like: hypoxia and acidosis. Vasooclusive crisis are the biggest problems with sickle cell. having frequent URI's (more likely to get hypoxic), there is an increased risk in winter. Environmental: low oxygen concentrations, weather. Stress: emotional & physical. It can be purely emotionally driven to have a crisis. STRESS AVOIDANCE is important for sickle cell. Although it can happen b/c of unknown causes too. |
|
|
Term
| What is the sickling process? |
|
Definition
| Hgb S + situations that cause oxygen deprivation (ie stressors). The sickled cells CLUMP TOGETHER (hard, sticky & can't flow through vessels). Small blood vessels become occluded -> Ischemia -> Necrosis -> Pain. |
|
|
Term
| Is Sickle Cell Anemia checked & apparent at birth? |
|
Definition
| No, sickle cell does not appear until 4-6 months of age b/c of the presence of FETAL HEMOGLOBIN. No problems until 6 mo's of age. |
|
|
Term
| One type of sickle crisis is: VASO-OCCLUSIVE crisis... |
|
Definition
| it is the MOST COMMON. There is a painful episode d/t clumping of RBC's, ischemia, infarction, pain. The biggest worry is CVA's... seen with repetitive crises. |
|
|
Term
| One type of sickle crisis is: SPLENIC SEQUESTRATION crisis... |
|
Definition
| The blood pools in the spleen. it's LIFE THREATENING. There is decreased intravascular blood volume --> resulting in shock. Going to need a Splenectomy if it's recurrent. |
|
|
Term
| One type of sickle crisis is: APLASTIC CRISIS... |
|
Definition
| a VIRAL INFECTION triggers it. RBC production stops -> profound anemia. This is usually self-limiting. |
|
|
Term
|
Definition
| pooling of sickle cells & inflammation in the fingers or toes. It is very painful. |
|
|
Term
| You are the nurse in an adult ER department. A 24 year-old client with sickle cell disease comes in at least every 2 weeks c/o pain & requesting pain meds. What do you think? |
|
Definition
| Look at their hx... they're going to NEED a TON OF PAIN MEDS. Probably developed quite a bit of resistance. This is a situation where you need to trust your patient. Increase their dose of pain meds. Should talk to them about stress, dehydration (not taking drugs or excessively drinking). |
|
|
Term
| What are other s/s of sickle cell crisis? |
|
Definition
| Acute Chest Syndrome: sickling of small blood vessels of lungs, pain, temp is higher than 38.3 (101), cough, dyspnea, tachypnea, respiratory distress |
|
|
Term
| __________ is a major worry with sickle cell! It can happen to an 8 yo w/ frequent crisis. |
|
Definition
| Stroke (sickle cells block major cerebral blood vessels) |
|
|
Term
| What are S/S of Stroke to pay attn to in sickle cell child? |
|
Definition
| Severe headache, Slurred Speech, Unsteady Walk |
|
|
Term
| What is the leading cause of death for sickle cell kids (under 10 yrs old)? |
|
Definition
| INFECTION (Sepsis or Meningitis) |
|
|
Term
| Sickle cell disease causes an impairment of the spleen. The spleen is replaced by fibrotic tissue. This is /t infarcts in spleen (autosplenectomy). There is a loss of the filtering system & this increases susceptibility of _________. The spleen can even become nonfunctional by 5 years of age in kids. |
|
Definition
|
|
Term
| What organisms cause infections under 5 yrs old? what about over 5 yrs old? |
|
Definition
| <5=pneumococcal. >5=gram negative (E. COLI, Salmonella) are very dangerous. Remember, e. coli is the #1 cause of UTI's. Something as seemingly simple as a UTI in a menstruating female can cause a massive crisis. must be very careful! |
|
|
Term
| What are nursing interventions for sickle cell? |
|
Definition
| PAIN MGMT! Get it under control quick. Prevent/manage infection (need to start antibiotics asap), promote hydration, minimize tissue deoxygenation, minimize crises, drug therapy, patient/family education |
|
|
Term
| Sickle Cell Disease can cause SEVERE PAIN. (will give opioids parenterally, may be on PCA or continuous infusion). However pain is very subjective & these pt's are used to pain. What should the nurse get? |
|
Definition
| Their pain scales may be lower b/c of constant pain. a 4 may be high! It is important to get their tolerable level & achieve this before they go home. |
|
|
Term
| What is given for moderate & mild pain? |
|
Definition
| Acetaminophen & Ibuprofen for both (whatever works better for them) |
|
|
Term
| How else is pain managed? |
|
Definition
| assess pain Q 2-4 hrs (location, intensity, duration, character), Use pain intensity rating tool (monitor efectiveness of pain mgmt), use HEAT (not cold), REST (minimize O2 consumption), Hydration!!! |
|
|
Term
| What is done to prevent/manage infection in sickle cell pt's? |
|
Definition
| Need PROPHYLACTIC PENICILLIN (Pen VK) for pretty much any procedure. 3 mo's - 12 yrs of age. HANDWASHING is key. ISOLATION as appropriate. very imp to stay up to date on IMMUNIZATIONS (routine meningococcal, influenza, penumococcal (Prevnar, Pneumovax) |
|
|
Term
Imp to teach the s/s of infection & to have them REPORT THEM EARLY. What are the signs?
|
|
Definition
| fever of 101 (38.3), lethargy, irritability, vomiting, diarrhea |
|
|
Term
| Sickle Cell Pt's need PROMPT TREATMENT with ... |
|
Definition
| parenteral antibiotics (e.g. ceftriaxone) |
|
|
Term
| It is SO important to teach & PROMOTE HYDRATION!! Why? |
|
Definition
| Hemodilution is very imp to reduce blood viscosity & prevent sickling. |
|
|
Term
| IV + PO intake needs to be: |
|
Definition
|
|
Term
|
Definition
| Signs of Dehydration & to treat it promptly. Child unable to concentrate urine-low specific gravity leads to dehydration. Enuresis is common-do NOT decrease fluids for sickle cells kids!!! |
|
|
Term
| Teachers need to understand the child w/ sickle cell is going to need: |
|
Definition
| to be allowed to have water in class & permission to frequently use restroom. |
|
|
Term
| It is important to also MINIMIZE TISSUE DEOXYGENATION. how? |
|
Definition
| Bed rest (very imp during acute crisis), avoiding stressors, monitor oxygen saturation (often go home with oxygen sats... if are hypoxic, <92%, give oxygen! Adminstering oxygen does not reverse sickling, but it may prevent more sickling from occuring. |
|
|
Term
| Need to MINIMIZE CRISES. teach to: |
|
Definition
| avoid stressors, report s/s of crises immediately, frequent medical supervision, adequate nutrition, administer blood transfusion (real common especially with spleen problems). An acute spleen sequestration (corrects hypovolemia). In Aplastic crisis the packed RBCs will increase Hgb. Blood transfusions are also given Post CVa to reduce blood viscosity. |
|
|
Term
| Sickle Cell Disease kids must take prophylactic antibiotics, pain medications, like talked about. Why are they also taking Folic Acid? |
|
Definition
| Increased Folate is required b/c of hemolysis. This prevents 'megaloblastic anemia'. |
|
|
Term
| A normal supplement that many sickle cell pt's take is ______________. It is used with frequent pain episodes. Elevates Hemoglobin F by decreasing sickling. |
|
Definition
|
|
Term
| Finally, people with sickle cell take ____________ to stimulate RBC production. |
|
Definition
|
|
Term
| What education is necessary for pt w/ sickle cell? |
|
Definition
| EDUCATE EARLY (12-13 yo) about getting pg & having child w/ sickle cell, encourage genetic counseling, educate about all aspects of the disease, encourage family to promote normal G & D, allow expression of feelings about the disease, Identify community and national resources. |
|
|
Term
| What is the prognosis for Sickle Cell pt's? |
|
Definition
| It's variable & depends on the severity. Men live until about 42 on average. Women live until about 48 on average. Improved survival is d/t: screening, follow-up & early intervention. |
|
|
Term
| What are the most common hereditary bleeding disorders? |
|
Definition
| Hemophilia, vonWillebrands's Disease |
|
|
Term
| Hemophilia & VonWillebrands's disease results from deficiencies abnormalities in specific _________ ___________. |
|
Definition
|
|
Term
| The coagulation cascade can be ridiculously confusing. we just need to know... |
|
Definition
| there can be deficiencies through out that cause problems |
|
|
Term
| Hemophilia A is a deficiency in Factor ____. |
|
Definition
|
|
Term
| Hemophilia B is a deficiency in Factor ___ |
|
Definition
|
|
Term
| VonWillbrands Disease is a deficiency of: |
|
Definition
|
|
Term
| Hemophilia is genetically transmitted. What chromosome is it on? |
|
Definition
|
|
Term
| If the woman is a carrier & her partner does not have the disorder: what are the chances for children? |
|
Definition
| 50% chance son will have the disorder. 50% chance daughter will be a carrier. |
|
|
Term
| The MILD form of hemophilia is the most common (5-40%).. what happens here & what needs to be restricted? |
|
Definition
| Have some restricted activities, still restricted, no contact sports. There is bleeding with severe trauma or surgery in mild. |
|
|
Term
The MODERATE form of hemophilia affects 2-4.9%... what happens here & what needs to be restricted?
|
|
Definition
| No Contact Sports (factors into activity), there is BLEEDING WITH TRAUMA |
|
|
Term
The SEVERE form of hemophilia... what happens here & what needs to be restricted?
|
|
Definition
| have very restricted activities. They get spontaneous bleeding without trauma. Just sit at home & get a nosebleed with nothing. |
|
|
Term
| Hemophilia pt's have the potential for bleeding: |
|
Definition
|
|
Term
| __________ is oozing of blood into the joint cavity. The joints become sweollen, tender & painful. Repeated hemorrhages can cause damage to synovial membrane, degeneration of cartilage & cysts, contractures, severe crippling is possible even. |
|
Definition
|
|
Term
| How can nurses help hemophilia? |
|
Definition
| administering the missing clotting factor, injury prevention, control bleeding, teaching |
|
|
Term
| If a person with Hemophilia ( no factor 8) gets an injury, what should be done asap? |
|
Definition
| administer the missing clotting factor asap w/ injury. There is a new recombinant factor that has no human product in it at all. The family should be taught how to admnister. The child should be taught to self adminster. An implanted venous access device may be necessary. |
|
|
Term
| What kind of injury prevention is done for infants w/ hemophilia? |
|
Definition
| pad the crib, use nonbreakable feeding utensils, wall-to-wall carpeting, pad edges of furniture, give safe toys, use approved car seat, wear a HELMET when learning to talk. |
|
|
Term
| What activities are OK for a child/adolescent with hemophilia? What is NOT ok? |
|
Definition
| Mild cases need to use knee pads, elbow pads, helmets. If Mod/Severe no sports requiring padding. Swimming is OK for a young child. Swimming, bike riding, golfing, bowling (w/ protective equip) is all OK. NO Contact Sports, No sports that cause too much strain on the knees & ankles, |
|
|
Term
| Control bleeding for hemophiliacs w/ the RICE method. What's that? |
|
Definition
| Rest, Ice, Compression, Elevation of joint |
|
|
Term
| Should pt's with hemophilia do active or passive exercises? |
|
Definition
| Do gentle ACTIVE ROM to their comfort. Do only after bleeding has stopped & within 24-48 hours. Allow client to control with own pain tolerance level. Do NOT do PASSIVE exercise, don't force b/c it could cause damage. Could stretch the joint capsule, could cause more bleeding. |
|
|
Term
| Home Infusion Therapy is something that families should be taught for hemophilia. What are signs of major bleeding to know? |
|
Definition
| headache, blurred vision, vomiting, lethargy |
|
|
Term
| What are some family teaching done to prevent bleeding? |
|
Definition
| use a soft toothbrush, NO RECTAL TEMP, activity restrictions, environmental safety. Teach to control bleeding w/ RICE. |
|
|
Term
| What med should be taken for pain in hemophiliac? |
|
Definition
| Acetaminophen (Tylenol) - just NO aspirin b/c it's an antiplatelet |
|
|
Term
| Should a hemophiliac be taught basically that exercise is dangerous & not for them? |
|
Definition
| NO, regular exercise & physical therapy is good & strengthens muscles around joints. Support the family too. |
|
|
Term
| What is the prognosis/life expectancy of a hemophiliac? |
|
Definition
| approaches that of the general population |
|
|
Term
| What is the major cause of death for hemophiliacs? |
|
Definition
|
|
Term
|
Definition
| Idiopathic (Immune) Thrombocytopenic Purpura |
|
|
Term
| Does ITP happen since birth? |
|
Definition
| NO, ITP is an ACQUIRED hemorrhagic disorder. |
|
|
Term
|
Definition
| autoimmune response to disease-related antigens. autoantibodies produced & attach to platelets. Phagocytosis of antibody coated platelets. Increased destruction of platelets (thrombocytopenia) in the spleen. |
|
|
Term
| The ACUTE form of ITP happens during what time frame? |
|
Definition
| lasts less than 6 months. |
|
|
Term
| The ACUTE form of ITP usually happens 1-4 weeks after... |
|
Definition
| 1-4 weeks after a viral infection (e.g. URI, measles, mumps, rubella, chk pox, human parovirus) |
|
|
Term
| Who is the ACUTE form of ITP most common in? |
|
Definition
|
|
Term
| The CHRONIC form of ITP lasts.. |
|
Definition
|
|
Term
| The CHRONIC form of ITP needs to rule out... what? |
|
Definition
| immunodeficiency disorder, autoimmune disease, neoplasms. |
|
|
Term
| The CHRONIC form of ITP is most common in who? |
|
Definition
| older children. women between 20-40 years old. |
|
|
Term
|
Definition
| bleeding of the integument: usually a combination of petechiae, purpura, ecchymoses (getting bruising with no known cause). Mucous membranes are bleeding. There is potential internal blood loss. Intracranial hemorrhage risk, but less than 1%. |
|
|
Term
| ITP is characterized by a decreased ___________ count. |
|
Definition
| platelet - there is less than 150,000 platelets |
|
|
Term
| What happens in platelets are less than 50,000? |
|
Definition
| There is prolonged bleeding from trauma or injury |
|
|
Term
| What happens if platelets are less than 20,000? |
|
Definition
| can cause spontaneous life threatening hemorrhage |
|
|
Term
| what are the nursing interventions for ITP? |
|
Definition
| primarily supportive, prevent and/or minimize bleeding, administer medications. |
|
|
Term
| What should be done to prevent/minimize bleeding in ITP pt? |
|
Definition
| avoid Aspirin or aspirin containing products, avoid injections, use a soft toothbrush, Activity should be: no contact sports (football, ice hockey, wrestling, etc), no carnival rides, swimming all right, but NO diving. |
|
|
Term
| What meds are given for ITP? |
|
Definition
| PREDNISONE (most common, inexpensive, increased platelet survival-decrease production of antiplatelet antibodies), IVIG (2nd most common, expensive, blecks antibody that results in destruction of platelets), not as common -> ANTI-D ANTIBODY (WinRhoD)- (lessens phagocytosis of platelets), IMMUNOSUPPRESSIVE THERAPY (lessens antibody production). |
|
|
Term
| The prognosis of ITP is usually self-limited. What are the indications of a splenectomy? |
|
Definition
| Unresponsive to Prednisone, High doses of Prensione are needed to maintain adequate platelet count, manifestations for 1 year or longer, can decrease the risk of hemorrhage w/ chronic form |
|
|
Term
| Lead Poisoning sources of lead are: |
|
Definition
| lead-based paint (most common), soil, dust, air with lead particles (if live in industrial areas), water can contain lead, occupation & hobbies, dinnerware, cosmetics, folk remedies |
|
|
Term
| What are the effects of LEAD on body systems? |
|
Definition
| HEMATOPOIETIC (anemia), NEUROLOGIC (mental retardation, serizures, coma, death), RENAL (acute renal failure chronic renal failure |
|
|
Term
| Lead poisoning is defined as blood lead level (BLL) greater than or equal to ___ mcg/dl |
|
Definition
|
|
Term
| Children with BLL of greater than __ mcg/dl are considered lead exposed and worthy of intervention. |
|
Definition
|
|
Term
| Who is at high risk for lead poisoning? |
|
Definition
| child/sibling with elevated BLL, lives in/regularly visits home built before 1959, lives in/regularly visits house built before 1978 with rennovation or remodeling in the last 6 months. Lives in a building where other kids are being followed or treated for elevated lead levels, parents have occupational exposure, child lives near an active lead smelter, or other industry likely to release lead into the environment. |
|
|
Term
| What are red flags of lead poisoning? |
|
Definition
| foreign body ingestion/pica, unexplained seizures, neurologic symptoms, abd pain, growth failure, developmental delay, hyperactivity |
|
|
Term
| Children who have a BLL of 10 mcg/dl or above should have.. |
|
Definition
| an environmental evaluation done... need to find the source: home, school, etc... |
|
|
Term
| What are strategies to reduce environmental lead hazards: |
|
Definition
| keep child away from chipping, peeling, flaking paint. temporarily cover above with contact paper, duct tape. want to WET MOP floors, windows. do NOT vacuum hard surfaced floors, window sills, it spreads the dust. Wash toys & pacifiers often. |
|
|
Term
| Should you vacuum or wet mop to prevent lead hazards? |
|
Definition
| WET MOP... vacuuming spreads dust in air more. |
|
|
Term
| Other ways to reduce lead hazards are: need to wash the child's face & hands often (esp before eating), hose down places where kids play (porch, driveway, sidewalk). Should hot or cold water be used?? Food should not be stored in what? |
|
Definition
| Need to use only COLD water for drinking, cooking & food prep. No food storage in ceramic ware & lead crystal for food storage. |
|
|
Term
| Why are regular meals important to decrease lead? |
|
Definition
| more lead is absorbed on an empty stomach... so eating regularly decreases this |
|
|
Term
|
Definition
| high iron, high calcium (to counteract loss of these minerals through lead exposure.) |
|
|
Term
| Calcium EDTA is given IM or IV... |
|
Definition
| it binds to lead & removes from system. giving it IM is very painful. need to give deep, mix with procaine, use warm compress. Monitor labs (e.g. BLL, electrolytes, liver function tests) |
|
|
Term
| Other meds given with Calcium EDTA for lead poisoning are... |
|
Definition
| British antilewisite (BAL) given IM. monitor labs & ECG. SUCCIMER (DMSO) given orally. May give as outpatient. Hydration is very important b/c it's excreted by the kidneys. These both have significant sd effects. Usually give Ca++ EDTA if it's going to be done. If they are over 25 mcg/dl it has to be done tho! |
|
|
Term
| Adequate _________ is VERY IMPORTANT since Chelates are excreted by the _________. |
|
Definition
|
|
Term
| The prognosis for lead poisoning is variable. most of the major problems are r/t encephalopathy. What can happen with an elevated lead level over time? |
|
Definition
| academic problems, delinquency, mental retardation, behavior changes, paralysis, seizures |
|
|
Term
| The bone growth in children is more porous & flexible. When is bone growth activity high in children? |
|
Definition
| 2-4 wks infant, 8-10 wks adolescent, 10-16 wks in adult. The poristeum is thicker & more active. The bone Remodeling is great. The Epiphyseal plate is present (growth plate) it is an area of weakness. |
|
|
Term
| _________ are the leading cause of death in 1-4 year olds. |
|
Definition
|
|
Term
| Playground deaths happen 15-17x/year. How? |
|
Definition
| Usually strangulated somehow by clothes |
|
|
Term
| Parent tells you they are too scared to allow their child to participate in recreational sports... what do you know? |
|
Definition
| recreational injuries (playing in the yard) has more injuries than organized sports. |
|
|
Term
| Other big causes of injury are: |
|
Definition
| motor vehicle injuries. other: lawn mower, trampoline, fireworks, sledding & farm injuries. |
|
|
Term
| What is the #1 injury sport? |
|
Definition
| Basketball is #1 (not football!). 2) playground activities 3) biking 4) football |
|
|
Term
| Children spend more time & energy in sports than any other age group. Every sport is going to have potential for injury. There is an increased # of children involved in sports. Why do injuries often occur? |
|
Definition
| often a physical mismatch, they don't realize their limitations |
|
|
Term
| Why should kids participate in sports? |
|
Definition
| contributes to GROWTH & DEVELOPMENT, education process and better health. Provides exercise, provides interaction with peers. Socially acceptable means enjoy stimulation and conflict. Helps process of self-appraisal, development of self-respect and concern for others. |
|
|
Term
| Some acute overload injuries from sports: |
|
Definition
| Dislocations (easier when loose, gymnastics, dancing, football is more tight), Sprains, Muscle Pulls are acute injuries. |
|
|
Term
| What are Chronic Overload sport injuries? |
|
Definition
| Stress Fractures, Tendonitis, bursitis, and fasciculitis (pain in arch or heel of foot) |
|
|
Term
| What is the #1 sports injury? |
|
Definition
| contusion (damage to soft tissue/bruising) |
|
|
Term
| If you're a first responder to a sports injury what should you do? |
|
Definition
| #1 first thing is to IMMOBILIZE until treated. RICE for injury in extremity. Have someone else call 911 to get them there. |
|
|
Term
| When are extra calories & carbs needed? increased fluids? |
|
Definition
| always increase fluids, don't need extra calories/carbs unless over one hour of continuous exercise. |
|
|
Term
| Fractures happen at high activity level with limited coordination. What do you suspect if the story doesn't match the injury? |
|
Definition
|
|
Term
| Where are the common locations for kids to fracture (break) bones? |
|
Definition
| forearm (distal, radius, ulna), Epiphyses (growth plate), elbow, leg, clavicle. |
|
|
Term
| If a child has a fracture in their Epiphyses (growth plate), ribs or skull fracturs... must rule out: |
|
Definition
| Abuse. Know red flags, suspicious fracture type or location, other injuries present. |
|
|
Term
| Common Types of Fractures in Children |
|
Definition
| BENDS (can bend 45 degrees until it breaks), BUCKLE (compression & bone looks like a bump. ex/ something falls on this to make a bump), GREENSTICK (snap.. leaves fragments, like a "tree snapping branch does this") |
|
|
Term
| What are the clinical s/s of fractures? |
|
Definition
| Swelling, Bruising/Redness, Pain/Tenderness, Diminished functional use of affected part, muscular rigidity, crepitus, vascular injury. The 5 S/S of vascular injury: pain pallor, pulselessness, paresthesia (tingling), paralysis. have wiggle fingers & toes b/c kids may not feel. |
|
|
Term
| What are some complications that may happen b/c of fractures? |
|
Definition
| Circulatory impairment (don't put cast on immediately b/c of swelling), Nerve Compression Syndromes (so much pressure from swelling it compresses the nerves), Epiphyseal Damage (if broken at growth plate could affect length of limb later), Nonunion/Malunion (movement after alignment in kids), Infection, Pulmonary Emboli (tho kids do have longer PTT than adults & it will take them longer to clot d/t longer bleeding studies) |
|
|
Term
| How are Fractures managed? |
|
Definition
| Diagnostic Studies (get x-ray, MRI-prob need sedation) Lab studies (don't really need to know, but some destruction of RBC's happens, Hgb & Hct may go down slightly), Closed/Open Reduction (open reduction means surgically put in screw, rods, while closed reduction means they do not break skin to realign), Plaster Immobilization, Traction, External/Internal Fixation (internal fixation is metal plates, rods, pins, screw. external is a cast) |
|
|
Term
| The orders for pin care will vary between doctors, but generally it's: |
|
Definition
| use HALF STRENGTH hydrogen peroxide on cutip around each pin. Press on tissue so it doesn't grow on. Use cutip with sterile water to wipe off. No ointment unless ordered. |
|
|
Term
| Types of casts for fracture: |
|
Definition
| plaster (better on upper ext), light weight, Spica (body cast that immobilizes hips, thighs. Going to do plaster 1st & then last layer is light weight. |
|
|
Term
| Nursing interventions for a cast: |
|
Definition
| Observe N/V status close, Turn every 2 hours, support wet cast with pillow & palm hand, elevate extremity, petal rough cast edges, no objects under cast, R.O.M. to extremity distal to cast. USE PALMS (or pillow) not fingers to move wet cast. |
|
|
Term
|
Definition
| Cut several strips of petaling tape to about 4 inches, tuck one end of the tape under the edge of the cast and apply the tape to the cotton lining. Place the free end of the tape onto the cast's outside surface, continue to overlap the strips until a complete edge is formed, cover all edges of the cast, paying special attention to the diaper area of opening. Use the "cold" setting only with hairdryer. |
|
|
Term
| Is it ok to place stuff down in cast?? |
|
Definition
| No, don't place anything into the cast |
|
|
Term
|
Definition
| Restrict strenuous activity for just a few days, report foul odor & observe for drainage, clean soiled areas, prepare for cast removal (noise is frightening), provide positive diversion & therapeutic play |
|
|
Term
| What should a nurse do if she smells a foul odor coming from the cast? what about drainage? |
|
Definition
| Foul odor is a sign of INFECTION & needs to be reported. Drainage should be marked & dated. |
|
|
Term
| Nursing interventions for a SPICA cast: |
|
Definition
| Takes 24-48 hours to dry, instruct movement of patient, protect from urine/stool, petal cast. (change diapers q hour. if holding stool? they may need a softener) |
|
|
Term
| Effects of immobilization: |
|
Definition
| circulatory/respiratory, muscle atrophy, joint contracture, metabolic, integument, GI/GU, Psychological, family maladaption. |
|
|
Term
| When immobilized it will be important to: |
|
Definition
| Promote as much normalcy as you can. If they are in traction for a long time they are going to need some diversional/distracting activities b/c they will go crazy after awhile. |
|
|
Term
| Why are children often placed in traction (instead of just having the extremity pinned)? |
|
Definition
| Pinning can disrupt growth. TRACTION is preferable to pinning in children. |
|
|
Term
| Traction might be intermittent or continuous. They may just have skin traction. Or may require skeletal traction. Where is skeletal traction placed? |
|
Definition
| distal to bone to put pressure on. |
|
|
Term
| Bryant's traction is used for fractures of the femur or congenital anomalies of hip. patient's limbs are suspended in the airvertically at a ninety degree angle from the hips and knees slightly flexed. Over a period of days, the legs hips are gradually moved outward from the body using a pulley system. The patient's body provides the countertraction. This is used ONLY IF: |
|
Definition
| less than 2 yrs old & Less than 30 lbs. Otherwise tape will come off. The danger is pressure on the hip can cause necrosis. So it is not advised as much. The child should not be totally flat & you should be able to put hand under their bottom. |
|
|
Term
| You walk into a child who has tractions room. They are conscious, breathing. what do you always check first? |
|
Definition
| CHECK CIRCULATION. Assess 5 p's: pain, pallor, pulses, paresthesia (tingling), paralysis... wiggle/fingers & toes. |
|
|
Term
| What do you do if the pt does not have a pulse in extremity? |
|
Definition
| Call the Dr or have a friend call the Dr. Not going to cut off without the Dr there. |
|
|
Term
| What are the #2 & #3 things to assess in traction pt? |
|
Definition
| #2) get some pain medicine #3) assess if the weights are freestanding... get at the foot of the bed, look at the kid & get a clear straight angle with the traction. The foot of the bed & check if the weights are hanging freely. |
|
|
Term
| Can a child who is in traction be rolled? how will you change the bed? |
|
Definition
| No. You will change bed head to bottom. scoot sheet & press mattress... get it under them. |
|
|
Term
| For a pt on bedrest in traction the nurse should: |
|
Definition
| observe their N/V status close, maintain traction apparatus, encourage diet of increased roughage & fluids, maintain skin integrity- should have special mattress like egg crate, sheep skin), ROM of unaffected parts, do Pin care, provide diversional activities & therapeutic play. |
|
|
Term
| What interaction/toys to promote fine motor development for child in traction? |
|
Definition
| Fine motor development? Puzzle, Play-doh. gross motor develoment? ball |
|
|
Term
| Developmental Dysplasia of the Hip has 3 different types. what are they? |
|
Definition
| 1. Preluxation (Dysplasia): is unstable hip that is "capable of" dislocation. 2. Subluxation: is "incomplete" dislocation. 3. Luxation (Dislocation): the hip IS dislocated |
|
|
Term
| Why does Dev Dysplasia of the Hip (DDH) happen? risk factors for it? |
|
Definition
| ETIOLOGY IS UNKNOWN. 60% of the time there are no risk factors known. Potential risk factors are: caucasian, girls, positive family history, maternal hormone secretion, & intrauterine posture |
|
|
Term
| What are the clinical s/s of DDH? |
|
Definition
| Positive Ortolani & Barlow Tests (pt on back, bring hips to abd & open out to sides, hear clunk? positive), child has UNEQUAL SKIN FOLDS, Limitation of abduction on affected side, have unequal knee height, positive Trendelenburg sign (abnormal gait). X-RAYS are NOT helpful until 4 months of age. |
|
|
Term
| Explain the Ortolani Maneuver? |
|
Definition
| 1. abduct each knee until the lateral aspects of knees touch the exam table 2. click or clunk is heard on abduction (confirms dislocated hip) 3. most reliable from birth to 2-3 months - only used then 4. confirms a dislocated hip (b/c an x-ray can't at this point) |
|
|
Term
| What is the Barlow Maneuver? |
|
Definition
| 1. Flex & slightly adduct both hips while lifting the femur & applying pressure to the trochanter 2. Causes an unstable hip to dislocate 3. Confirms joint instability until 6 weeks |
|
|
Term
|
Definition
| Barlow & Ortolani tests, limited hip abduction, as seen in flexion at 6-10 weeks, apparent shortening of femur, as indicated by level of knees in flexion, Asymmetry of gluteal and thigh folds. Positive Trendelenburg (hopefully it's caught before chid is walking though. This is opposite what you would think: the lesion is on the contralateral side of the sagging hip. So, the healthy side is the downward side. The hurt side is upward. |
|
|
Term
| How is DDH managed in a newborn-6 months? |
|
Definition
| 1. Cast (after aligned) 2. Abduction splint (pic holds babies hips out to side) 3. Pavlik Harness (allows for more movement, keeps in alignment they want. Successful about 89% of the time if done early though. Average is 2-3 months long for 24 hours. |
|
|
Term
| How is DDH handled in a 6-18 months? |
|
Definition
| 1. gradual reduction by traction followed by a cast & then a brace 2. Closed reduction followed by cast & then a brace 3. If not successful an open reduction is required |
|
|
Term
| How is an OLDER Child managed for DDH? |
|
Definition
| Open Reduction then cast followed by rehabilitation |
|
|
Term
| Nurses need to put childs undershirt & diaper ________ harness or cast. assure it's in proper position & it's not too flexed. |
|
Definition
|
|
Term
| How does a nurse maintain a reduction device? |
|
Definition
| they may or may not remove it for bathing, should wear undershirt & knee socks-place diaper UNDER The straps, assess skn beneath harness 2-3 times per day, do not powder or lotion baby, keep in proper positioning, prevent soiling, provide relief from boredom. |
|
|
Term
| What is Talipes? who is it more common in? |
|
Definition
| Clubfoot. More common in males (2:1). Positive family history in 1/2 of cases. |
|
|
Term
| What are the 3 types of clubfoot? |
|
Definition
| 1. POSITIONAL (able to get) 2. SYNDROMIC (unable to tun to normal position. Syndromic is the true congenital clubfoot (most common). 3. CONGENITAL (associated with another defect) |
|
|
Term
| What are the clinical manifestations of clubfoot? |
|
Definition
| The deformity of the limb is characterized by: Smaller calf muscles & tightening or lax of foot, Adductus of the forefoot, increased longitudinal arch, heel turned in (Varus), heel turned out (valgus), plantar flexion, dorsiflexion. The most common type=Talipes Equinovarus |
|
|
Term
| If the pt has a 'Positional' clubfoot they need to do stretches & exercises to foot. But if they have 'Syndromic' - True Clubfoot - they need: |
|
Definition
| serial casting... it is the treatment of choice. Position as much as can and cast. Remove cast & postition foot more. done every few days. Then every few weeks. Takes about 8 wks until to the position they want. |
|
|
Term
| The goal of managing clubfoot is: |
|
Definition
| a pain-free foot with good mobility, without calluses, and without the need to wear modified shoes & inserts. Functional abnormality? Passive Stretching exercises. |
|
|
Term
| Nursing Interventions & care of club foot involves: |
|
Definition
| assessment, teaching parents cast care, reinforce orthopedic surgeon's explanations & instructions, emotional support, support normal G & D |
|
|
Term
| What is Legg Calve Perthes Disease? |
|
Definition
| Aseptic necrosis of the femoral head. There is rubbing & a lot of pain! 2-12 yrs old: 20% bilateral. Mostly happens to caucasian males. The cause is UNKNOWN: there is trauma, inflammation, coagulation defects. |
|
|
Term
| What are the clinical manifestations of Legg Calve Perthes Disease? |
|
Definition
| The onset is insidious (slow), it's achy, stiff, referred pain, joint dysfunction, limited ROM. Diagnosis: radiographic examination. |
|
|
Term
| How is Legg-Calve-Perthes disease managed? |
|
Definition
| REST: non weight bearing, Nonsurgical containment: non-weight bearing devices help reduce pain. They are on bed rest for about 6 weeks. The Bucks traction will bring ball from hip joint. The parents are give the option of surgery or a non-surg treatment (wear brace). Surgery will go in, clean necrotic & transplant bone form somewhere else. takes 6 wks, cast, wheelchair, crutches, shorter length of time. 6 months vs. 2 years. Higher increased risk for developing arthritis as an adult. |
|
|
Term
| Nursing interventions for Legg Calve Perthes Disease? |
|
Definition
| Assessment, Education of corrective device (emphasize importance of compliance), post op cast care, promotion of normal G & D. They need to wear it to bed, but may take it off to bathe. |
|
|
Term
| How would you respond to a mom that says she needs to be ready for a gymnastic meet in 3 months? |
|
Definition
| Explain the process and the importance for the rest of her life. Even with surgical intervention, it is going to take 6 months. Very invasive & painful (transplanting bone)... cast, wheelchair, crutches.... she's not doing the meet! |
|
|
Term
| What is the disorder of the proximal femoral physis that results in malalignment of the femoral head relative to the femoral neck? (the femoral head pulls out of the socket->displacing the hip) |
|
Definition
| SLIPPED FEMORAL CAPITAL EPIPHYSIS (SFCE) |
|
|
Term
| When does SLIPPED FEMORAL CAPITAL EPIPHYSIS usually occur? |
|
Definition
| during growth spurts. There are HORMONAL & MECHANICAL factors that cause it. Endocrine disorders, GH therapy, radiation therapy & chemo agents. |
|
|
Term
| With SLIPPED FEMORAL CAPITAL EPIPHYSIS the toe is out & keeps the affected leg kind of out. Results in an "antalgic limp" Who is it common in? |
|
Definition
| more common in polynesians, african americans, males, can be bilateral |
|
|
Term
| The child with SLIPPED FEMORAL CAPITAL EPIPHYSIS often has a History of: |
|
Definition
| thigh or knee pain or maybe no pain. some limp, out-toeing or gait abnormality. less often, they're easily fatigued. May or may not related symptoms to an injury. |
|
|
Term
| What does the physical exam & diagnosis of SLIPPED FEMORAL CAPITAL EPIPHYSIS? |
|
Definition
| Antalgic Limp, Out-toeing, decreased internal rotation hips, hip flexion is limited & produces pain. Diagnosed by: radiography (x-ray), MRI or bone scan. |
|
|
Term
| How is SLIPPED FEMORAL CAPITAL EPIPHYSIS managed? |
|
Definition
| EARLY DIAGNOSIS IS CRUCIAL, a screw is placed to keep ball in hip spot, want NON-weight bearing, Internal Fixation, post surgery: non-weight bearing & crutch use until there is painless ROM achieved. |
|
|
Term
| Nurses can help SFCE management by: |
|
Definition
| assessment, maintain non-weight bearing status, pain control, teaching before surgery-need to be on BEDREST prior to surgery! This is rough, they're often athletic, adolescent boys. Then after surgery: teach wound care & crutch walking (going to be 2-6 months!), promote normal G & D |
|
|
Term
| When can a child following SFCE surgery expect to play sports again/recover? |
|
Definition
| if surgery during Fall? No Winter sports, but Spring sports will be OK. |
|
|
Term
| Scoliosis is a spinal deformity that usually involves the __________ curve, spinal rotation causing rib asymmetry, and thoracic hypokyphosis. what's the cause? |
|
Definition
| lateral. cause may be unknown or r/t other disorders. It may be congenital or acquired. |
|
|
Term
| Scoliosis is most common beginning in: |
|
Definition
| the preadolescent growth spurt. Though they rarely experience discomfort & there is few outward signs. Why screening is so important |
|
|
Term
| Explain Scoliosis exam... |
|
Definition
| observe using Adam's Position (leaning way forward), use Scoliometer (highest position on back, take 3 different screening, higher than 5 degrees is red flag), radiographic exam, MRI is done if other pathology. Screening for scoliosis is controlversial. A large # get referred from school & it's costly & most turn out minor. |
|
|
Term
| There are exercises to do for scoliosis management & there are braces too. Mild scoliosis is up to ____ degrees (just monitor the progression curve). While moderate is ____-____ degrees (need bracing). |
|
Definition
| mild: up to 15 degrees. moderate: 15-40 degrees. |
|
|
Term
| What are some teaching instructions for scoliosis brace kids & parents? |
|
Definition
| Emphasize the importance of compliance (is a real problem), going to take it off for showers, ok to take brace off for 1 hour per day & it won't be a problem, no contact sports with brace, tennis ok (some sports are) |
|
|
Term
| If child has more than 15 degree curve? Need to consider surgery. why does this benefit child? |
|
Definition
| If it's 15 degrees, they are having a 50% decrease in breathing/pulmonary. Surgery is done to help pulmonary, cosmetic, pain caused in older children, children with neuro difficulties have difficulty sitting & walking b/c of imbalance. |
|
|
Term
| Surgery for scoliosis works by: |
|
Definition
| realigning and straightening the spine with internal fixation and instrumentation combined with spinal fusion. Types: Harrington Rod, Luque segmental instrumentation, Cotrel-Dubousset approach |
|
|
Term
| Tell about the Harrington Rod surgery: |
|
Definition
| It can be put in anterior or posterior or both. have nuts & bolts to keep the rod straight. Will need a back brace. Should ambulate by day 3. Go to side of bed, put feet down & then stand up. |
|
|
Term
| Tell about the Cotrel-Dubousset Approach of surgery: |
|
Definition
| Rod & wire. Often need BLOOD during surgery. Often takes a couple of weeks for family to donate blood. |
|
|
Term
| what do nurses do for scoliosis? |
|
Definition
| assessment of the curve, bracing (teach care of brace, emphasize compliance, encourage normal G & D. Before surgeryL assist with teaching & work up. |
|
|
Term
| Care for pt who just had scoliosis back surgery involves: |
|
Definition
| Child usually doesn't realize what HUGE surgery this is. They will have an incision all the way down their back: ** monitor in ICU for 24-48 hours. ABC's! Careful assessment of N/V status. Place on special mattress or mattress pad. ** LOG ROLL every 2 hours. It is ok to log roll, just keep the back straight. |
|
|
Term
| Other care after scoliosis surgery involves: |
|
Definition
| frequent pain meds (PCA) after surg + FOley Cath, assess their bowel motility, skin integrity (incision), instruction on ambulation, instruct brace or cast care, promote normal G & D. They don't usually have an NG tube. The hospital stay is about 7 days: mostly for pain control. |
|
|
Term
| Osteogenesis Imperfecta is a type of defect in the ______________ gene. The error results in faulty bone mineralization, abnormal bone architecture & increased susceptibility to fractures. |
|
Definition
| precollagen. Essentially, they're missing collagen (the structural component of the bone. It is also called brittle bone disease - their bones are really soft. |
|
|
Term
| Osteogenesis Imperfecta is an autosomal ______________ hereditary disorder. |
|
Definition
| dominant (although she also said it can occasioally be autosomal recessive, but it's rare). It is heterogenous. |
|
|
Term
| There are 4 types of OI, but 2/3 of cases are Type I. What are the symptoms of OI? |
|
Definition
| Mild bone fragility, BLUE SCLERA, normal teeth, joint laxity, have hearing loss or hear ringing in their ears during teen years & leads to deafness. Have vertigo by late 40's - 50's. |
|
|
Term
OI may be confused with _____ _______
|
|
Definition
|
|
Term
|
Definition
| primarily supportive, medications to increase bone density, experimental: bone marrow transplants (they have had positive results, but it's still considered experimental). Lightweight braces & splints, physical therapy, may need surgery to correc the deformities later. |
|
|
Term
|
Definition
| being Supportive - parents need extensive teaching (how to care for the child, assessment of the fracture, 1st aid if fracture, discipline-the child needs to have discipline!). Should carefully support child when turned, positioned, or moved. Parents should stay in hospital to protect the child from HC workers. Parents are the ones who should move the child around. Do NOT do BP on these children! NO tourniquette before blood draws or IV. |
|
|
Term
| When you change a babies diaper with IO what is different? |
|
Definition
| you cannot lift by the ankles like normal, just sort of slide under. |
|
|
Term
| Need to help parents guide suitable activities to promote optimum ___________ , but need to protect the child from harm too. Should refer the family to the OI foundation |
|
Definition
|
|
Term
| What is NOT done on OI kids? |
|
Definition
| no BP! no tourniquette before IV is put in! Parents need to stay in the hospital to protect the child from HC workers. |
|
|
Term
| What is Juvenile Idiopathic Arthritis (JIA)? |
|
Definition
|
|
Term
| What sex & what 2 age groups does juvenile arthritis peak in? |
|
Definition
| Females. 1-3 yrs old. 8-10 yrs old. |
|
|
Term
| Juvenile Idiopathic Arthritis is a CHRONIC inflammation with joint effusion & eventual erosion. Where does it come from? |
|
Definition
| unknown, some theories say it is caused when infectious agents create autoimmune inflammatory processes |
|
|
Term
| Juvenile Idiopathic Arthritis (JIA) clinical manifestations: |
|
Definition
| stiffness (often in morning), swelling, warm to touch, loss of motion, may be tender & painful to touch, growth disturbances (often d/t long term corticosteroids). RF is only in about 10% of cases |
|
|
Term
| 3 major classifications of JIA? |
|
Definition
| systemic onset, pauciarticular, and polyarticular |
|
|
Term
|
Definition
| diagnosed by exclusion: age of onset, # of joints involved & exclusion of other causes. Antinuclear antibodies are common. Leukocytosis is frequently present during exacerbations. (ESR may or may not be present & RF is only present in about 10% of cases) |
|
|
Term
|
Definition
|
|
Term
| What are the major goals of JIA? |
|
Definition
| control pain to a functional level (can't really take away all pain), preserve joint ROM, minimize effects of the inflammation, promote G & D. Use a multidisciplinary approach. Possibly: Surgery. |
|
|
Term
| What are the pharmacological treatments for JIA? |
|
Definition
| NSAIDs, slow acting antirheumatic drugs ,corticosteroids (like to give in bursts or every other day b/c they can stunt growth), etanercept, other cytotoxic agents. |
|
|
Term
|
Definition
| assessment, PAIN RELIEF, diet & exercise, sleep & rest (when increased fatigue -> need more naps), encourage compliance, promote normal growth & development activities (school is encouraged though some have trouble. some maybe just go to afternoon classes), emotional support |
|
|
Term
| Duchenne Muscular Dystrophy (DMD) is caused by what? |
|
Definition
| it's unknown, but it's basically a defect in the muscle enzyme. it's a metabolic disturbance unrelated to the nervous system. |
|
|
Term
| Duchenne (DMD) is the most severe & most common muscular dystrophy. who does it happen to? |
|
Definition
| Males. It's an X-LINKED RECESSIVE PATTERN (1/3 of cases is due to new gene mutations. There is an absence of Dystrophin in muscle. They're missing a protein in the muscle. |
|
|
Term
| Duchenne Muscular Dystrophy has an onset of what age group? They usually have a history of delayed _________ development. |
|
Definition
| 3-5 yrs old w/ a hx of delayed motor development. |
|
|
Term
| What are the 1st symptoms of DMD? What about the later symptoms? |
|
Definition
| 1st signs are often difficulty running, riding bicycle or climbing stairs. Later they have an abnormal gait, lordosis (protruding abdomen b/c of spinal curve), frequent falling and characteristic manner rising from squatting on the floor. |
|
|
Term
|
Definition
| Manner of walking self up when on the floor w/ hands while legs are straight. They can't just stand up. |
|
|
Term
| What are some other manifestations of DMD? |
|
Definition
| calf muscle hypertrophy, loss of independent ambulation by 9-11 years old, mild mental retardation is common (does not occur with ALL, but on average a 20 pt lower IQ), slow progressive general weakness. The average age of death is early 20's. Death is usually due to respiratory or cardiac failure. |
|
|
Term
| What are some complications of Duchenne Musc Dystrophy? |
|
Definition
| Contractures, Scoliosis is VERY COMMON (need surgery just to sit up in chair, it's bad), disuse atrophy, infections (encourage cough & deep breathing), obesity is common (w/o active muscles they don't need as many calories, tend to be overfed), cardiac |
|
|
Term
| DMD kids often will wear ThAIRapy vests like CF pt's to break up secretions. It is very important to teach DMD pt's to get a ________ vaccine. |
|
Definition
|
|
Term
|
Definition
| Genetics (defective dystrophin gene), serum enzymes (if checked 2 yrs prior to s/s, they would be elevated), biopsy (show muscle fibers), EMG (shock muscle & get decreased response with electrical stimulation). |
|
|
Term
| How is DMD therapeutically managed? |
|
Definition
| There is NO EFFECTIVE TREATMENT. Parents face long-term decisions like want a trach? want a vent? |
|
|
Term
| What is the GOAL of Duchenne Musc Dystrophy? |
|
Definition
| maintain ambulation as long as possible & prevent contractures. |
|
|
Term
| Children with DMD need nurses to: |
|
Definition
| promote as much independence as possible, they need a balance between limiting activity and allowing activity. Encourage avoiding respiratory infections. Going to need a lot of emotional support & have depression about their future. Will eventually need paliative care b/c die in early 20's. |
|
|
Term
| What is the DIET for Duchenne Muscular Dystrophy? |
|
Definition
| LOW CALORIE & HIGH VITAMIN C. |
|
|
Term
| a condition where the head is tilted to one side. they have limited ROM in neck is called... |
|
Definition
|
|
Term
| Metatarsus Adductus is a when the foot is turned ________ greater than 20 degrees. |
|
Definition
|
|
Term
| Metatarsus Varus is a condition where the foot is turned ________ greater than 20 degrees. |
|
Definition
|
|
Term
| Pes plantus is ______ feet |
|
Definition
|
|
Term
| Genu Varum is ____ ________. |
|
Definition
|
|
Term
| Genu Valgum is _____ ______. |
|
Definition
|
|
Term
|
Definition
| hyperextension of the knee joint |
|
|
Term
| Osgood-Schlatter disease usually occurs during a growth spell. What is seen? |
|
Definition
| Swelling beneath the knee. This will go away on its own. Parent will be scared by this. If it's painful? Rest. |
|
|
Term
| Cancer risk factors to children: |
|
Definition
| ionizing radiation, electromagnetic fields (not proven), parental exposure to Benzene petroleum agents, alcohol & smoking during pregnancy |
|
|
Term
| who has a genetic predisposition to Epstein-Barr Virus (EPV)? |
|
Definition
| Chromosomal abnormalities (Down Syndrome, Fanconi Syndrome) & Diseases with specific genetic links (Retinoblastoma has the strongest genetic link to cancer, Wilm's Tumor (increased incidence of congenital anomalies), Neuroblastoma) |
|
|
Term
| How prevalent is cancer in children? |
|
Definition
| Cancer is the 2nd leading cause of death in children. There has been improved prognosis in the last 3 decades. The definition of "cure" |
|
|
Term
| __________ has the best prognosis. |
|
Definition
|
|
Term
| Bone Tumors (osteogenic & Ewing Sarcoma) happen more to _________. |
|
Definition
|
|
Term
| Wilms Tumors (kidney, soft tissue) happen more to ___________ _______. |
|
Definition
|
|
Term
| What is the definition of "cure"? |
|
Definition
| 1) complete the therapy 2) continuous freedom of clinical care 3) cancer type & risk of relapse 4) period of time, usually 2-5 years |
|
|
Term
| LEUKEMIAS are the MOST COMMON form of childhood cancer. It is more frequent in males. The peak onset for leukemia what age group? What is affected? |
|
Definition
| 2-6 yrs old. Affects the bone marrow & lymphatic system. |
|
|
Term
| Leukemia is classified by the type of WBC affected by the disease. What kind of leukemia is it if the WBC's being affected are: Lymphatic, Lymphoid, Lymphoblastic, and Lymphoblastoid (synonyms)? |
|
Definition
| It is ALL: Acute Lymphocytic Leukemia |
|
|
Term
| Leukemia is classified by the type of WBC affected by the disease. What kind of leukemia is it if the WBC's being affected are: Myelocytic, Myelogenous, Monoblastic, acute NonLymphoid leukemia (ANLL)? |
|
Definition
| AML: Acute Myelogenous Leukemia. ANL=AML |
|
|
Term
| What is the most common form of leukemia in children? |
|
Definition
| ACUTE LYMPHOCYTIC LEUKEMIA (ALL). Is 80% of leukemias in children. This type rarely occurs in adults over 40. |
|
|
Term
| Within ACUTE LYMPHOCYTIC LEUKEMIA there is FAB subtypes (L1, L2, L3). Which one is most common & has best prognosis? |
|
Definition
|
|
Term
| What are signs of a good prognosis? |
|
Definition
| FAB = L1. Cell surface markers = early Pre B cell & CALLA (common acute lymphocytic antigen). Leukocytes are LESS THAN 50,000. There are more than 50 chromosomes. You're a female. between the ages 2-10 yrs old. Have the FAB morphology L1. |
|
|
Term
| Acute Myelogenous Leukemia is most common leukemia in _________. |
|
Definition
| adults. AML is only 20% of leukemias in kids & is harder to treat. The chronic form is only 2% of childhood leukemias. The cell surface markers are not well defined with AML. |
|
|
Term
| What is the pathophysiology of Leukemia? |
|
Definition
| There is UNRESTRICTIVE PROLIFERATION OF IMMATURE WBCs IN THE BLOOD FORMING TISSUES OF THE BODY. Results in the REPLACEMENT OF NORMAL FUNCTIONING CELLS WITH NONFUNCTIONAL LEUKEMIC CELLS. |
|
|
Term
| The consequences of Leukemia are: |
|
Definition
| Decreased functioning eryhtrocytes (get ANEMIA), Decreased Platelet production (get BLEEDING), Decreased functioning WBCs (Neutropenia) (get Infection). |
|
|
Term
| The big 3 consequences of Leukemia are: |
|
Definition
| Anemia, Bleeding & Infection. |
|
|
Term
|
Definition
| infiltration, enlargement, and fibrosis of spleen, liver, and lymph glands. Insidious (slow) onset with a cold or minor symptoms, fever, pallor, fatigue, anorexia, petechiae, bone & joint pain, spleen, and liver enlargement, excessive bruising, lymphadenopathy, malaise, profound anemia, abnormal WBC, thrombocytopenia. |
|
|
Term
| Children are diagnosed with leukemia when: |
|
Definition
| usually when they're not sick, it's based on history & physical manifestations. Peripheral Blood Smears (show immature leukocytes, frequently low blood counts), Bone Marrow Aspiration is the MOST DEFINITIVE (will be a large number of BLAST cells), Lumbar Puncture shows bad significant positive CNS involvement. |
|
|
Term
| Goal of treating acute leukemia: |
|
Definition
| To achieve a complete remission & restoration of normal bone marrow function. Usually a combo of chemo is used with drugs according to the established protocol of the institution. Radiation is used sparingly in kids... only use radiation in very high risk leukemia situations. Kids normally just get chemo & drugs for leukemia. |
|
|
Term
| When is a bone marrow transplant considered for leukemia children? |
|
Definition
| ALL (most common type in kids) during 2nd remission period. AML (less common) during first remission period. |
|
|
Term
| The goal of acute leukemia treatment is: |
|
Definition
| complete remission and restoration of normal bone function |
|
|
Term
| Chemo treatments begin with Induction phase. It is begun immediately and lasts 4-6 wks. What is the goal? |
|
Definition
| Goal is to achieve a complete remission determined by absence of clinical signs of disease and presence of 5% blast cells in bone marrow. |
|
|
Term
| Induction uses 4-5 drugs combined. There are different drugs used for ALL & AML types. What are the types used in ALL? |
|
Definition
| corticosteroids, vincristine, L-asperaginase, and doxorubicin at various schedules. |
|
|
Term
Induction uses 4-5 drugs combined. There are different drugs used for ALL & AML types. What are the types used in AML?
|
|
Definition
| doxorubicin or daunomycin and cytosine arabinoside, and various other drugs |
|
|
Term
| The 2nd phase of chemo treatment is the 'Intensification' phase. what happens during this phase? how long does it last? |
|
Definition
| Pulses of several meds are given periodically during the first 6 months of treatment. The goal here is to eradicate residual leukemic cells and prevent resistant leukemic clones. |
|
|
Term
| When is CNS prophylactic Therapy used? |
|
Definition
| Continued during all phases with intrathecal METHOTREXATE sometimes in combination w/ other drugs to prevent CNS disease. |
|
|
Term
| The last phase of chemo is 'Maintenance' Therapy. What is the goal here? |
|
Definition
|
|
Term
| What is taken daily during the maintenance phase? |
|
Definition
| Daily 6-mercaptopurine, weekly methotrexate and pulses of steroids and vincristine. Patients will need to continue weekly or monthly blood counts to assess for effects of mylosuppression. Most relapses occur within the first year. A relapse would be the presence of leukemic cells in the bone marrow. |
|
|
Term
| how long does the maintenance phase last? |
|
Definition
|
|
Term
| What are the 3 phases & how long do they last again? |
|
Definition
| Induction (4-6 weeks), Intensification (6 months), Maintenance (2.5-3 yrs) |
|
|
Term
| What is the prognosis of Acute Leukemia? |
|
Definition
| The majority of children who receive multiagent chemo will survive. 80% achieve long term survival without serious health problems from the disease or treatment (ALL). Prognosis with bone marrow transplant varies, but long-term survival is between 25-50%. The prognosis for ALL (more common in kids) is better than prognosis of AML (more common in adults, but does occur in kids). |
|
|
Term
| What is (Lymphoma) Hodgkins Disease? |
|
Definition
| Neoplastic Disease originating in the lymphoid system |
|
|
Term
| What age group does Hodgkins affect in children? |
|
Definition
| It is rare under 5 yrs old. It is common between 15-19 yrs old. |
|
|
Term
| What is the etiology of Hodgkins Disease? |
|
Definition
| Unknown, but there is a possibly an association with the Epstein Barr Virus |
|
|
Term
| There is a systematic spread that occurs with Hodgkins Disease that helps to diagnose (as well as Reed Sternberg Cells). Where is the predictable metastasis to? |
|
Definition
| spleen, liver, bone marrow, lungs & other tissues |
|
|
Term
| Hodgkins has enlarged lymph nodes that are painful or painless? |
|
Definition
| PAINLESS LARGE LYMPH NODES. They are firm, nontender, movable in the clavicular & cervical region. |
|
|
Term
| What lymph node is often involved first in a child? |
|
Definition
| Child usually has the "sentinel node" located near the lef of the clavicle often involved first. (Other S/S are: night sweats, nonproductive cough, wt loss, anorexia, pruritis, mediastinal mass (sentinal node), hepatosplenomegaly <- enlarged spleen) |
|
|
Term
| How is Hodgkins Disease diagnosed? |
|
Definition
| a CT scan of the neck, chest, abd and pelvis. Chest x-ray. bone marrow. Going to do a complete blood work up & urinalysis. In selected cases may do a laparotomy w/ multiple biopsies of organs and lymph nodes and a splenectomy. |
|
|
Term
| Hodgkins Disease diagnosis will do a lymph node biopsy. Presence of ____________ cells is diagnostic. |
|
Definition
|
|
Term
| How is Hodgkins Disease treated? |
|
Definition
| Chemo & irradiation based on the clinical staging of the disease. Responds well to aggressive therapy, but increases chances of complications & serious late effects (risk for other cancer later in breast, thyroid). Follow up care is essential to monitor for relapses. Getting a Splenectomy requires prophylactic antibiotics for an undetermined length of time. |
|
|
Term
| Overall 10 year survival rate for kids with Hodgkins Disease is ___%. |
|
Definition
| 90%. Prognosis is excellent with localized disease (stage 1 & 2). Late reocurences do occur both with the original disease process & 2nd malignancies. Risk for late reoccurences is higher in FEMALES than males. |
|
|
Term
| How many pediatric lymphomas are classified as NON-Hodgkins Lymphomas though? |
|
Definition
|
|
Term
| Who does non-Hodgkins Lymphomas happen to? |
|
Definition
| Occurs most often under 15 yrs of age (peak ages are 7-11) |
|
|
Term
| Who is Non-Hodgkins Lymphoma seen the most in? |
|
Definition
| Patients with immunodeficiency syndromes or those who are immunosuppressed due to having a transplant. |
|
|
Term
| Non-Hodgkin Lymphoma (NHL) us a malignancy in the B & T lymphocytes. Clones of the malignant cells infiltrate the lymph nodes, bone marrow, blood & other organs. NHL includes many subtypes classified by cell size, structure, appearance, grade (how fast or slow they grow), etc... What are the 3 NHL that are very fast, aggressive growing types? |
|
Definition
| Lymphoblastic, Burkitt or non-Burkitt and Large Cell Lymphoma. These 3 are fast growing, but respond well to chemo. |
|
|
Term
| What are the clinical s/s of NHL? |
|
Definition
| depends on the anatomic area involved & the extent of involvement. It can metastasize to bone marrow & resemble leukemia. Might have abd cramps, constipation, pain, anorexia, wt loss, ascites, vomiting. Painless and enlarged lymph nodes in cervical and auxilliary region, fever. Compression of tumor to organs & abd, mediastinum, head & neck cause symptoms of obstruction. |
|
|
Term
| Diagnosing Non-Hodgkins Lymphoma is done by: |
|
Definition
| surgical biopsy of lymph nodes, bone marrow aspiration, x-rays and CT of the chest, abd & pelvis. Lumbar puncture. Staging (how much has spread to other areas of the body). grading (how aggressive the cancer is) |
|
|
Term
| Non-Hodgins Lymphoma: Burkitt's Lymphoma. What is the presentation of Burkitt's Lympomas? |
|
Definition
| Rapid growing tumor, in abdomen, jaw or eye orbit. Rarely seen enlarged lymph nodes or hepatosplenomegaly. NO LARGE LYMPH NODES. Tumor Lysis Syndrome happens b/c very fast growing. The tumor lyses & biproducts are dumped in system. may cause metabolic complications. give allopurinol. |
|
|
Term
| How is Non-Hodgkins Lymphoma treated? |
|
Definition
| aggressive approach w/ chemo. similar treatment for leukemia. Administer for ** 6-24 months ** Aggressive tumors are very responsive to treatment, thankfully. |
|
|
Term
| What are the most common solid tumors in children? |
|
Definition
| brain tumors. They are 20% of childhood CAs. |
|
|
Term
| Where are 60% of brain cancer tumors at? |
|
Definition
| infratentorial or below the tentorium cerebri (below the cerebellum and brain stem) |
|
|
Term
| About 40% brain tumors are: |
|
Definition
| in the anterior 2/3 of the brain (cerebrum) |
|
|
Term
| What's the patho of brain tumors? |
|
Definition
| they originate from abnormal DNA and uncontrolled cell division. There is NO CLEAR ETIOLOGIC FACTOR for them though. |
|
|
Term
| Brain tumors cause DEATH TO SURROUNDING TISSUE b/c infiltration & compression. Cerebral edema leads to increased ICP causing... |
|
Definition
| focal neuro deficits, obstruction of CSF flow, pituitary dysfunction, and eventual herniation of the brain stem. |
|
|
Term
| Where do neoplasms come from? |
|
Definition
| any cell within the cranium. Tumors are named from the tissue of origin. |
|
|
Term
| what does high level vs low level tumor mean? |
|
Definition
| high level means more aggressive |
|
|
Term
| What is the most common pediatric tumor? |
|
Definition
|
|
Term
| _____________ make up 20-25% of ped brain tumors. Is highly malignant. |
|
Definition
|
|
Term
| What are child brain tumors that are difficult to access? |
|
Definition
| Cerebellar Astrocytoma (15% brain tumors), Brainstem Glioma (15% of tumors, hard to remove), Ependymoma (4% tumors, invades ventricles) |
|
|
Term
| Signs of brain tumors are r/t anatomic loc, size & child's age. What are some signs though? |
|
Definition
| headache upon wakening, vomiting that is not r/t food intake, neuromuscular changes (lose balance, clumsy, loss of developmental milestones), behavior changes (irritble, lethargic, acting bizzare) |
|
|
Term
| Clinical signs of cranial nerve neuropathy: |
|
Definition
| head tilt, face weakness, visual defects |
|
|
Term
| What are other VS disturbances & other clinical signs of brain tumors? |
|
Definition
| decreased pulse & respirations, increased BP, hypothermia & hyperthermia, seizures, nuchal rigidity, papilledema, cranial enlargement, bulging fontanel |
|
|
Term
| Diagnosis of brain tumors involves: |
|
Definition
| careful & thorough hx, physical & neuro exam to establish deficits, MRI, CT, skull films, EEG, LP, definitive diagnosis is usually based on TISSUE SPECIMENS taken during surgery. |
|
|
Term
| How are brain tumors treated? |
|
Definition
| surgery, radiotherapy, and chemo are used depending on type of tumor. |
|
|
Term
| Stereostatic surgery involves the use of CT & MRI and special computer techniques. What does Radiotherapy do? |
|
Definition
| used to treat many tumors & to shrink tumors before surgery. |
|
|
Term
| In the last decade, Chemotherapy has come up with more effective drugs (b/c they can cross the ______ and treat tumors) all alone or with radiotherapy (shrinking) and surgery. |
|
Definition
| BBB - blood brain barrier |
|
|
Term
| What are other drugs used for brain tumors? |
|
Definition
| corticosteroids to control cerebral edema, anticonvulsants for seizures, pain meds, antibiotics, antiemetic and histamine blockers |
|
|
Term
| Obviously, dx of brain tumor is a crisis event. Family & child will need a lot of support. What can the nurse do to prepare the family? |
|
Definition
| inform the child & family the head will be shaved, prepare them for the size of the dressing, inform them they will be in an ICU and the child will likely be asleep for a couple of days. |
|
|
Term
| Nursing care after brain tumor surgery. What position should the bed be in? |
|
Definition
| Place the HOB at 30 degree angle (if supratentorial tumor, in the upper 1/2 head) and flat on either side (if infratentorial tumor, lower 1/2 head by brainstem) |
|
|
Term
| What other nursing care post op? |
|
Definition
| monitor VS (potential for hypothermia/hyperthermia so do TEMP!), monitor for increased ICP and hemorrhage (neuro signs like decreased LOC & dressing), may need Restraints, Fluids |
|
|
Term
| __________________ are primarily found in the abdomen. They are silent killers that usually metastasize before they are found. have an overall poor prognosis. 50% cases occur in kids under 2 yrs old. |
|
Definition
|
|
Term
| What are the S/S of a neuroblastoma? |
|
Definition
| a firm not tender mass that CROSSES THE MIDLINE OF ABD, causes compression of adjacent structure creating symptoms, compression of ureter, kidney, bladder causing urinary problems, compression of spinal cord: bowel & bladder problems, paralysis. Chest problems are cough, breathing problems. Lymphadenopathy. Intracranial lesion-neuro impairment. May cause BLACK EYES and edema around the eye b/c of metastasis from original tumor. |
|
|
Term
| Diagnosis of Neuroblastoma tries to locate the primary site of metastasis. Does the usual x-ray, CT scan, bone marrow aspirate & biopsies. What else is analyzed? |
|
Definition
| 24 hour urine for breakdown products of catecholamines (VMA & HVA, dopamine and norepinephrine) |
|
|
Term
| Neuroblastomas do have a bad survival rate :( and the treatment is going to be based on clinical staging (how far it has spread). If in stage 1 & 2 ... |
|
Definition
| surgical removal is ideal. Chemo is the main therapy for extensive disease. Recurrent disease in children over 2 yrs old is 10-20% survival rate (low!) with high dose chemo, BMT or peripheral stem cell rescue. |
|
|
Term
| The prognosis for neuroblastoma is better ... |
|
Definition
| the younger you are at diagnosis, the better the prognosis. This one has a genetic component & 15-20% are inheritable. |
|
|
Term
| __________________ is the most common intraabdominal and kidney tumor of children. |
|
Definition
| Wilms Tumor: Nephroblastoma |
|
|
Term
|
Definition
| Most common sign is: swelling or mass w/in abdomen (but this does NOT cross the midline. Firm, nontender, confined to one side. Other s/s are hematuria, anemia, HTN, wt loss & fever, metastasis to lungs (pain, dyspnea, SOB, cough, etc) |
|
|
Term
| Wilms Tumor is diagnosed by: |
|
Definition
| abd ultrasond, CT, MRI, heme studies, kidney fx tests, UA, bone marrow, phys exam, tumors can be quite large & usually remain encapsulated for an extended period of time. Pre-op they should NOT BE PALPATED IN ABDOMEN. Do want to monitor BP frequently. |
|
|
Term
| Surg for Wilms Tumor involves chemo & surgery.... |
|
Definition
| entire kidney & adrenal gland is removed. great care taken to avoid rupturing encapsulated tumor. other kidney & lymph nodes are inspected for disease, any involved structures are removed, if both kidney are involved a partial nephrectomy may be done on the least affected and a total on the most affected kidney. |
|
|
Term
| Radiotherapy is only done on really large Wilm's Tumors, ones that metastasized or reoccured. All children need to receive _____________ after surgical removal of Wilm's Tumor for 6-15 months. |
|
Definition
|
|
Term
| What nursing care is needed for Wilm's Tumor? |
|
Definition
| These kids have no symptoms of disease other than mass, parents feel guilty, have a swift intervention with surgery within 24-48 hours after being diagnosed. Prior to surgery the kid needs a DO NOT PALPATE ABD sign on bed. Carefully handle child. MONITOR BLOOD PRESSURE. Support child & family. |
|
|
Term
| After surgery for wilm's tumor, nursing care is to... |
|
Definition
| accurate I & O, monitor BP, monitor GI activity. Life long considerations with one kidney.... really need to avoid UTI's in girls and avoid contact sports. Protect the one kidney from injury! |
|
|
Term
| Rhabdomyosarcoma is the most common.. |
|
Definition
| soft tissue sarcoma in children. |
|
|
Term
| Sarcomas derive name from tissue of origin too. Where is Rabdo? Where is Myo? Where is Striated? |
|
Definition
| Rabdo=Striated. Myo=muscle. Striated=skeletal... found almost anywhere in the body... |
|
|
Term
| Where do Rhabdomyosarcoma occur? |
|
Definition
| Many sites... the most common are head, neck, and orbit of eye. |
|
|
Term
| Who are Rhabdomyosarcoma most common in? |
|
Definition
| children under 5, but can be seen in children of all age groups. |
|
|
Term
| What are clinical s/s of Rhabdomyosarcoma? |
|
Definition
| s/s depend on tumor location and compression of organs (soft to hard, non tender, immobile, mass). Perioorbital (eye): visual changes. Nasopharynx: stuffy nose, nasal obstruction, pain, sinus discharge, swelling. ear: otitis media, pain, drainage. Extremity: ROM is affected. |
|
|
Term
| What are the s/s of Rhabdomyosarcoma in the retroperitoneal & pelvic area? |
|
Definition
| function of organs affected, abd mass, pain, intestinal & GU obstruction. Tumors here are often widely metastasized before diagnosis. Many of the signs are vague & suggest childhood illness! |
|
|
Term
| ___________ is imp to establish with Rhabdomyosarcoma because it is a tumor that is highly malignant with metastasis at diagnosis. Aggressive multimodal therapy is recommended. |
|
Definition
|
|
Term
| What is the treatment of Rhabdomyosarcoma? |
|
Definition
| Now it's complete removal of primary tumor followed by radiation and chemo for 1-2 years |
|
|
Term
| What is the prognosis of Rhabdomyosarcoma? |
|
Definition
| 5 yr survival rates are about 65%. If child is disease free for 2 years he is probably cured. If a relapse occurs though prognosis is poor. |
|
|
Term
| Osteosarcoma & Ewings Sarcoma account for 85% of primary malignant _________ tumors in children. |
|
Definition
|
|
Term
| Bone Tumors (osteosarcoma & ewings sarcoma) are most common in males. highest incidence growing in adolescents. S/S are similar: |
|
Definition
| LOCALIZED PAIN & SWELLING at tumor site is seen the most, palpable mass, LIMP or decreased ROM. |
|
|
Term
|
Definition
| need to r/o infection. definitive dx is (CT scans, bone scans, bone biopsy), MRI, LABS: ELEVATED ALKALINE PHOSPHATASE with some bone tumors, LUNG TOMORGRAPHY to r/o metastasis |
|
|
Term
| _____________ Sarcoma is the most frequent bone tumor in children. It peaks at age 10-25 yrs old. Where are the primary tumor sites? |
|
Definition
| Osteogenesis Sarcoma. Metaphyses of long bones adjacent to the epiphyseal growth plate. More than 505% occur in the distal femur. Other sites: humerus, tibia, pelvis, jaw. METASTASIS TO LUNG FREQUENTLY BY THE TIME DIAGNOSIS HAPPENS. |
|
|
Term
| _________ Sarcoma is the most common frequent malignant tumor in children & adolescents. Occurs in under 30 yrs old, majority betw 4-25 yrs old. |
|
Definition
|
|
Term
| Ewing Sarcoma arises in the marrow especially in the femur, vertebre, tibia, ulna, umerus, pelvis, scapula, rubs & skull. Is metastasis common? |
|
Definition
| No, metastasis is uncommon at diagnosis time for Ewing |
|
|
Term
| Treatment of Osteogenic Sarcoma is pretty traditional. Going to need a pretty radical surgial resection or amputation of affected area. Usually going to do a resection of bone with prosthetic replacement. MUST get aggressive chemotherapy after surgery ... why? |
|
Definition
| to kill microscopic metastasis to lungs |
|
|
Term
| What is the most common first approach for Ewing Sarcoma? what is not routinely recommended? |
|
Definition
| Radiation. Surgery is not routinely recommended, but considered if radiotherapy renders the extremity useless or if the tumor is resectable. follow radiation by chemo. prognosis is best if no metastasis at time of diagnosis. |
|
|
Term
| Pre-op prep is crucial for bone tumors... |
|
Definition
| need to support on concept of amputation, surgical resection. they def will have body image concerns - its already a major issue in an adolescent. Nurses should use an honest approach. Help them to verbalize their feelings/anticipate grieving, talk with someone who has been through it. |
|
|
Term
| Nurses should let people know about |
|
Definition
| pain management (phantom limb pain, stump care, prosthesis, rehab) Reactions of anger and depression are normal. Assist family in dealing with diagnosis of malignancy. Manage complications of radiation & chemo. |
|
|
Term
| What's a rotationoplasty? |
|
Definition
| remove the diseased area. Then take the lower leg & turn knee so it becomes the hip joint. and ankle joint becomes the knee joint. |
|
|
Term
| ______________ is a CONGENITAL malignant tumor that arises from the retina. may be bilateral or unilateral. |
|
Definition
|
|
Term
| All bilateral cases of retinoblastoma are ___________. |
|
Definition
| Inherited. Unilateral may be inhereited or may not be. |
|
|
Term
| The average age of diagnosis with retinoblastoma is ____ months. |
|
Definition
|
|
Term
| What's the patho of retinoblastoma? |
|
Definition
| tumor grows on the retina and grows inward. may be one or multiple tumor sites. Cells break off of the tumor & cause "seeding" throughout the vitreous. these are "Floaters in the eyes" Most cases are diagnosed before metastasis occurs. It rarely extends to the optic nerve to CNS. |
|
|
Term
| What's the most common sign of retinoblastoma? |
|
Definition
| Cat's reflex (Leukokoria): a whitish glow seen in the pupil. 2) strabismus - uncoordinated eye other s/s: red, pain in eye, often w/ glaucoma, nystagmus, orbital cellulitis, etc... blindness is a late sign. |
|
|
Term
| Diagnosis of retinoblastoma involves: |
|
Definition
| opthalmologist exam under anesthesia (get staging of tumor, tumor size, and location established). Metatastasis is not common at time of diagnosis, it is rare. Retinoblastoma is a disease that can even spontaneously regress.. |
|
|
Term
| What's the goal of treatment with retinoblastoma? |
|
Definition
| to eradicate the tumor & preserve vision in affected eye. Radiotherapy is the standard of care (shrink it down!) Other approaches: surg implant of Iodine 125 applicator on sclera, photocoagulation w/ laser to destroy blood vessels to tumor, Cryotherapy (freezing the tumor) |
|
|
Term
| What if the optic nerve is involved... what is the treatment of choice? |
|
Definition
| Enucleation (eye removal) must be done & is the treatment of choice |
|
|
Term
| Is chemo used for retinoblastoma? |
|
Definition
| Only used if it metastasized & it has not been shown to improve survival |
|
|
Term
| What happens if there is bilateral involvement with retinoblastoma? |
|
Definition
| Q attempt to preserve useful vision in less affected eye with enucleation of the most severely affected eye. |
|
|
Term
| What is the overall survival rate for retinoblastoma? |
|
Definition
|
|
Term
| What is the most common developing secondary tumor to Retinoblastoma? |
|
Definition
| Osteogenic Sarcoma is most common. Children with bilateral form are more likely to develop tumors. |
|
|
Term
| Tell about Enucleation... |
|
Definition
| support parent & child & dispel misconceptions, going to remove inside of eye, all external structures are untouched. After surg, a temporary prosthesis will be placed to retain the shape of the eye, observe for infection, hemorrhage and swelling. Need genetic counseling for parents, siblings & affected child. |
|
|
Term
| What are the CARDINAL SYMPTOMS OF CANCER IN CHILDREN?? |
|
Definition
| Unusual mass or swelling, unexplained PALENESS and LOSS OF ENERGY, Sudden tendency to BRUISE, Persistent, localized pain or limping, prolonged unexplained fever or illness, frequent headaches, often with vomiting, sudden eye or vision changes, excessive, rapid weight loss |
|
|
Term
| How is CA managed in children? |
|
Definition
| surgery, radiation, chemotherapy, biologic response modifiers, bone marrow transplantation |
|
|
Term
|
Definition
| destroys the cell's ability to reproduce by damaging the cell's DNA. rapidly growing & dividing cells are most vulnerable. Normal tissues are most sensitive to radiation: Hematopoietic, Epithelial (skin, mucus membranes, hair), Reproductive |
|
|
Term
| Radiation sd effects on hematopoietic system: |
|
Definition
| anemia & myelosuppression & fatigue |
|
|
Term
| Radiation sd effects on skin & hair |
|
Definition
| erythemia, desquamation, dryness, itching, alopecia. skin markings for radiation fields. |
|
|
Term
| Radiation sd effects on GI tract: |
|
Definition
| N/V, diarrhea, altered taste |
|
|
Term
| Radiation sd effects on Reproductive: |
|
Definition
|
|
Term
|
Definition
| all diff chemo agent cytotoxic actions (how they are classified) are going to effect DNA/RNA synthesis, interfere with cell division, and alter cell metabolism in some way. combining drugs allows for optimum cell destruction with minimum toxic effects and decreased resistance. |
|
|
Term
| Is Chemotherapy selective on killing only malignant cells? |
|
Definition
| no chemo is not selctive to kill only malignant. most harmful to the rapidly growing cells like: hair, skin, mucous membrane of GI tract, cells in the hematopoietic system, reproductive cells. |
|
|
Term
| Chemo agents require extra precaution of handling & administering... |
|
Definition
| they are vesicants (sclerosing agents) that cause severe damage if it infiltrates into the tissue (extravasation). Venous access devices have greatly facilitated safe & effective drug administration. Risk for anaphylaxis. Careful handling of drugs by nurses is necessary to protect themselves. |
|
|
Term
| Chemo drugs are combined for... |
|
Definition
| optimal cell destruction & minimal sd effects. Drugs are cycled for a specific number of times (ie. every 3-4 weeks for 6-12 times according to an established protocol). Use drugs with different NADIRs. Clinical trials are important to investigate new drugs and optimum usage. |
|
|
Term
|
Definition
| the pt when WBCs are platelets are lowest & the pt is most vulnerable. Usually occurs within 7-14 days. Predicts when he client is at greatest risk for infection & bleeding. Recovery of WBCs and platelets is usually within 21-28 days. should monitor with a frequent blood count. |
|
|
Term
| What are Biologic Response Modifiers? |
|
Definition
| They're Colony Stimulating Factors. They help stimulate cell growth of specific cells and help reduce the hematologic toxicity of chemo (G-CSF). Neupogen-Neutrophils. Epogen-Neutrophils. Neumega-Platelets. |
|
|
Term
| an __________ bone marrow transplant is where the recipient donated to themself. This is most common. |
|
Definition
|
|
Term
| an __________ bone marrow transplant is where an identical twin donated. |
|
Definition
|
|
Term
| an __________ bone marrow transplant is where the marrow donor is a sibling or parent with similar HLA type. May even be an unrelated donor through the bone marrow registry. |
|
Definition
|
|
Term
| What do bone marrow transplants allow CA pt's to do? |
|
Definition
| receive lethal and potentially more effective doses of chemo & radiation in order to rid the body of all CA cells. BMT's are standard use for leukemia's. Also used with neuroblastoma, Hodgkin disease, non-Hodgkins, rhabdomyosarcoma, ewing & wills tumors. |
|
|
Term
| what happens during 'conditioning' phase of BMT? |
|
Definition
| eradicate malignant ells to create space in bone marrow for engraftment of new marrow. Total body irradiation and high doses of chemo are used to totally immunosuppress the pt. |
|
|
Term
| They will then harvest the bone marrow. Next is pre-engraftment... |
|
Definition
| lasts 2-4 wks. marrow can't produce any cells. pt is totally immunosuppressed. High risk for bleeding & infection. |
|
|
Term
|
Definition
| Where WBC, CBC & platelet counts start to rise |
|
|
Term
| Finally a Bone Marrow Transplant. Where do they need to be? |
|
Definition
| Protective Isolation for several weeks or more. (Laminar air flow, HEPA filters, Neutropenic diet, limited visitors). Vigilant Assessment & monitoring is needed. They are at HIGH RISK FOR INFECTION, BLEEDING, ANEMIA. Can have GI, cardio, hepatic, and renal complications. Monitor for rejection (graft) failure and GVHD (graft vs host disease). Also monitor for infection. |
|
|
Term
|
Definition
| Absolute Neutrophil count is WBC x % neutrophils = ANC. IF ANC is below 1000 it is defined as neutropenia. ANC is below 500? Child is at GREAT RISK for INFECTION. |
|
|
Term
Calculate ANC. (Bands + Segs) x WBC = ANC.
If there is 7% segs + 7% bands = 14% or 0.14. The neutrophils WBC=1000. try... |
|
Definition
| ANC=1000 x 0.14 = 140 (way lower than 500 even, very high risk for infection) |
|
|
Term
| Child with Fever + ANC below 500 merits ____________. |
|
Definition
| hospitalization. they're at great risk for sepsis, secondary infection, malaise, dehydration, seizures. Should have culture of every orifice and lines child has. Antibiotics, protective isolation, monitor temp & VS closely, monitor any wound site carefully. |
|
|
Term
| What precautions are necessary with neutropenia? |
|
Definition
| Laminar Air Flow Systems, HEPA filtration, Special masks may be used, Avoid using stagnant water in pitchers, no fresh flowers or potted plants in room, Neutropenic diet is: no fresh fruit, vegetables, no raw or uncooked foods. |
|
|
Term
| The administration of _________ to help raise WBCs after chemo more quickly. |
|
Definition
| Colony Stimulating Factors (Neupogen). |
|
|
Term
| When neutropenic should be given ________ or _________ 3 times a week for prophylaxis of Pneumocystitis carinni. |
|
Definition
|
|
Term
| ____________ gel for alpha-strep prophylaxis to teeth & gums. |
|
Definition
|
|
Term
| At home, a neutropenic client needs to.. |
|
Definition
| avoid crowds of people with infection, avoid childre who have been recently vaccinated with live vaccines, If ANC is 500 or below? child should stay home from school. Check temp daily. Continue normal family contact and activities including school as long as ANC is above 500. |
|
|
Term
| Advise parents with neutropenic child that: |
|
Definition
| no antipyretics with a fever until the physician has been notified. No immunizations. Good handwashing for the entire family. Get adequate nutrition, fluids and rest. |
|
|
Term
| What is thrombocytopenia? |
|
Definition
| Platelets. Less than 100,000? avoid high risk activities. Less than 10,000? risk of hemorrhage |
|
|
Term
| With thrombocytopenia the nurse needs to: |
|
Definition
| assess for bleeding. do NOT give any IM injections, no aspirin. Control nose bleeds & blow nose gently. Mouth care (gingival bleeds). administer platelets. |
|
|
Term
| For anemia, blood transfusions are to approach: __ g/dL. |
|
Definition
|
|
Term
| What should be done for anemia? |
|
Definition
| Children are able to tolerate the low heme levels. Allow child to regulate activity with reasonable adult supervision. Inform school teachers of potential limitations to strenuous activity. |
|
|
Term
| What should be done for Nausea & Vomiting? |
|
Definition
| Administer the antiemetic prophylactically (about 30 minutes to an hour before chemo starts). Then regular administration every 2-4-6 hours for at least 24 hours after chemo. Some evidence beginning antimetic therapy up to 24 hours before is helpful. Avoid development of anticipatory symptoms. Give chemo at night w/ a mild sedative is helpful also. |
|
|
Term
| What should be done for altered nutrition? |
|
Definition
| Needs assessment of nutrition status. Should continue evaluating throughout treatment. Get ht, wt & head circumference. Look at labs: albumin, transferrin and albumin. Give Oral Supplements with high-protein and high-calorie foods. Calorie Counts. |
|
|
Term
| what is done for altered nutrition and anorexia? |
|
Definition
| increase calories (substitute crm for milk**, full fat yogurts & ice crms, cook with butter, use real sugar, high cal snacks, enteral feeds may be necessary, pareteral hyperalimentation is some cases) |
|
|
Term
| what is done for altered nutrition & anorexia? |
|
Definition
| bring fave foods from home or take out! Eat small frequent males. avoid any bad odors that would deter eating. Encourage parents to relax pressures placed on eating. Some kids don't want food during chemo... avoid offering their favorite food during this time. Otherwise allow child to eat any food tolerated at any time. |
|
|
Term
| What can be done for mucosal irritation (stomatitis or mucositis)? |
|
Definition
| ulcers are anywhere along the alimentary tract, bland soft moist diet, eat foods COLD or at ROOM TEMP, encourage fluids through a straw, avoid acidic foods, use sponge toothbrush or cotton tipped applicator to brush teeth after eating. |
|
|
Term
| What else can be done to reduce mucosal irritation? |
|
Definition
| rinse mouth with NORMAL SALINE rinses, for infant: swab gums with gauze soaked in saline, clean mouth both before & after eating and at night. Local anesthetics without alcohol. Systemic pain meds. Meticulous toilet hygiene, stool softeners. |
|
|
Term
| Some chemotherapy can cause neurotoxic effects such as constipation due to decreased bowel innervation. We know that opioids given for pain can make this worse. What can make it better? |
|
Definition
| physical activity, ambulation, stool softeners, and laxatives. |
|
|
Term
| After chemo, neuropathy can occur & cause a... |
|
Definition
| foot drop, weakness & numbness in feet so bad... starts with the tingles & can progress to where walking it very difficult. |
|
|
Term
| What is Post irradiation Somnolence (brain tumor)? |
|
Definition
| Sleeping for long period after brain tumor removal |
|
|
Term
| _________ ________ is a side effect of chemical irritation of bladder & chemotherapy or radiation. |
|
Definition
|
|
Term
| Hemorrhagic Cystitis can be prevented by giving... |
|
Definition
| liberal oral or parenteral fluid intake (1.5 times the recommended intake), frequent voiding, administer chemo early in the day, administer Mesna (inhibits urotoxicity) |
|
|
Term
| What skin care should be done? |
|
Definition
| assess skin for erythema, pain and dry or moist desquamation (peeling). keep area clea with tepid water & soft washcloth, use mild soap sparingly. Do not remove markings on skin for treatment purposes. Avoid sun exposure. Do not use powders, ointments, lotions, deodorants, etc... |
|
|
Term
| What should be done for alopecia? |
|
Definition
| warn children and fam that this is a strong possibility w/ chemo & radiation, warn that hair falls out in clumps, often choose to cut hair short or shave head, consider buying a wig, use mild shampoos & soft brushes, protect the scalp (use hat & sunscreen). |
|
|
Term
| what should be done for steroid effects? |
|
Definition
| INCREASE APPETITE, Promote a sense of well-being as much as possible, the will have alterations in body image (d/t the puffy face, wt gain, wide range of mood changes). Need to ASSURE THEM THE EFFECTS ARE TEMPORARY. Encourage them to share their feelings (parent & child). |
|
|
Term
| What is the long term after affects of disease & multimodal therapy are: |
|
Definition
| psychosocial, cognitive, emotional, and phys development may be effected by treatments and disease. G & D issues, reproductive dysfunction, neuro deficits, organ fibrosis, cardiomyophaty, 2nd malignancies. |
|
|
Term
| What needs to be considered before & after treatments? |
|
Definition
| the importance of follow-up after completion of therapy to monitor for long-term and late effects and 2ndary malignancies. Genetic counseling when child reaches adulthood. Reproductive concerns. |
|
|
