NURS 6500 Exam #3

acute lymphoblastic leukemia (ALL)

is the most common form of cancer in children 85% occur in children between 2 and 10 years of age

adverse effects of chemotherapy drugs

Immunosuppression Infection Myelosuppression Nausea Vomiting Constipation Oral mucositis Alopecia Pain

Medical child abuse was historically termed?

Munchausen syndrome by proxy

S/S of abusive head trauma

Seizures Abrupt change in LOC Vomiting without diarrhea Coma Fever Irritability Breathing difficulty Changes in visual gaze When the history involves a sudden onset of symptoms; eg: "I went to check on him and he looked blue."

the normal absolute neutrophil count ranges from?

1.5 to 8.0

overall survival rate of wilms tumor

90%

Nursing process when caring for child with suspected abuse

Step 1) Assessment obtain data Ask caregivers questions, ask child questions R/O medical/physical cause of injury (Henoch-Schönlein Purpura (HSP) Mongolian spots Nevus Simplex Bullous Impetigo, Bilateral black eyes (basilar skull fx, etc.) perform physical exam Step 2) Diagnose (suspect abuse) Step 3) Plan/Implement: Notify supervisor and report suspected abuse to Dept. of Child Services Provide nursing care to child

___ is a type of blood cell that is made in the bone marrow and found in the blood and lymph tissue. Help the body fight infection and other disease.

WBC

prognosis for ALL is based on?

WBC count at diagnosis the higher the WBC count at diagnosis the worse the prognosis

nursing care for AML

is similar to a child with ALL and focus on managing adverse effects of treatment and preventing infection

A nurse is teaching parents of a child with iron-deficiency anemia how to administer ferrous sulfate. The nurse determines that the teaching was successful when they make which statements? Select all that apply.

We'll give him the medicine before he eats his meals." "He has to make sure that he brushes his teeth well." "He might get constipated, so we'll try to get him to eat some more fiber." "We'll have him take the liquid medicine with some orange or pineapple juice."

what about the history would make you suspect abuse?

a delay in seeking medical treatment history that changes over time history of trauma that is inconsistent with the observed injury

in a situation where the child exhibits signs of anemia related to acute hemorrhage, the nurse should anticipate administering?

a transfusion of packed red blood cells to improve oxygenation and circulation

medical abuse is?

a type of child abuse in which the parents creates physical and/or psychological symptoms of illness or impairment in the child the adult meets his/her own psychological needs by having an ill child medical abuse is difficult to detect and may remain hidden for years most cases the biological mother is the perpetrator

how would you interview parents/caregivers who were suspected of abusing their child?

a. Questions for children: i. Are you afraid of anyone at home? ii. Who could you tell if someone hurt you or touched you in a way that made you uncomfortable? iii. Has anyone hurt you or touched you in that way? b. Question for parents: i. Are you afraid of anyone at home? ii. Do you ever feel like you may hit or hurt your child when frustrated?

patho of ALL

abnormal lymphoblasts abound in the blood forming tissues lymphoblasts are fragile and immature, lacking infection fighting capabilities of normal WBC lymphoblasts growth is excessive and abnormal cells replace the normal cells in the bone marrow bone marrow become unable to maintain normal level of WBC, RBCs, and platelets results in anemia, neutropenia, thrombocytopenia

shaken baby syndrome (SBS)

abusive head trauma is a life-threatening injury that occurs when an infant is forcefully shaken back and forth, a motion that ruptures blood vessels in the brain and breaks neural connections causing intracranial hemorrhage

Antiemetics are ordered to control nausea and vomiting in the child undergoing chemotherapy. How can the nurse most effectively use these medications?

administer the antiemetic before starting chemotherapy

retinoblastoma may be hereditary or nonhereditary nonhereditary may be associated with?

advanced paternal age and always present with unilateral involvement

peak incidence of wilms tumor

ages 2 and 3

assess for hypoxia, fatigue, pallor in a child with ____

anemia

what may indicate sexual abuse in a child?

anus and penis or vaginal area has bleeding or discharge

the mouth of a child receiving chemotherapy can become very inflamed and painful. It is important of the nurse to?

assess the oral cavity for redness, lesions, and plaques frequently use soft-bristle toothbrush if gums are inflamed the child may use a saltwater solution or commercial mouthwash to keep the mouth clean

why should you measure BP in a child who has wilms tumor

bc hypertension occurs in 25% of children with wilms tumor

why do you want to avoid palpating the abdomen after the initial assessment preoperatively with a child who has wilms tumor

bc it is highly vascular and soft, so excessive handling the tumor may result in seeding and metastasis

to prevent N/V throughout administration of chemotherapy you can give antiemetics they are most effective when given?

before chemotherapy begins and then on a regular schedule

The nurse is planning care for a school-aged child recovering from being hit by a motor vehicle while riding a bicycle. For what will the nurse assess to determine the onset of disseminated intravascular coagulation in this child?

bleeding from IV sites

in children, warning signs of cancer are most often related to changes in blood cell production or as a result of compression, infiltration or obstruction caused by the tumor. infiltration, obstruction, or compression by a tumor may result in?

bone or abdominal pain pain in other parts of the body swelling unusual discharge

burns located where are highly suspicious for inflicted burns of abuse?

burns that occur in stocking or glove pattern or only to the soles or palms

if a child has a retinoblastoma parents are often first to the notice?

cats eye reflex or whitewash glow to the child's affected eye

Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse?

checking the CSF will reveal whether leukemic cells have entered the central nervous system

A teenage girl asks why chemotherapy causes hair loss. Which response by the nurse is accurate?

chemotherapy affects cancer cells and normal cells that multiply rapidly

bruises located on the ___ are suspicious for abuse.

chest head neck abdomen

A nursing student compares and contrasts childhood and adult cancers. Which statement does so accurately?

children cancers unlike those of adults often are detected accidentally, not through screening

a hallmark of vaso-occulsive crisis, _____, which results from the sickled red cells and increased blood viscosity.

dactylitis

symptoms of brain tumors

depend on the location of the tumor commonly they present with increased intracranial pressure symptoms such as headache, nausea, vomiting

in advanced disease of retinoblastoma or in the case of a massive tumor with retinal detachment ____ is necessary

enucleation (removal of the eye)

the goal of treatment for retinoblastoma

eradicate the tumor preserve vision provide a good cosmetic outcome

in children, warning signs of cancer are most often related to changes in blood cell production or as a result of compression, infiltration or obstruction caused by the tumor. Changes in blood cell production may result in?

fatigue pallor frequent or severe infection easy bruising

common s/s of ALL

fever recurrent infection fatigue, malaise pallor usual bleeding abdominal pain N/V bone pain HA

therapeutic management of children with ALL includes?

focuses on giving chemotherapy to eradicate the leukemic cells and restore normal bone marrow function

The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child?

following guidelines for reverse isolation

an inflamed oropharynx make indicate?

forced oral sex

when the trait is inherited from ___, the child has sickle cell disease, and anemia develops. The trait does not skip generations. The traits occurs most commonly in black clients.

from both parents (homogygous state)

anemia caused by the alteration or destruction of the RBCs is termed?

hemolytic anemia

risk factors for being abusers in parents or caretakers include

history of being abused themselves alch or substance abuse extreme stress

what does it mean that a nurse is a mandated reporter?

in the course of professional responsibilities, the RN must refer suspected cases of neglect or abuse to the local child protection agency

A 12-year-old child is admitted to the hospital with a diagnosis of sickle cell crisis. The nurse has completed an assessment and is creating a plan of care. What aspect of the plan of care is most important to the client's outcome?

increasing the daily fluid intake hydration is paramount to resolving a sickle cell crisis

complications of ALL

infection hemorrhage poor growth CNS, bone, or testicular involvement

retinoblastoma may be hereditary or nonhereditary hereditary may be associated with?

inherited via the autosomal dominant mode

if an infant has shaken baby syndrome what is a clinical manifestation

intracranial hemorrhage

vigorous shaking in the infant leads to?

intracranial hemorrhage and shaken baby syndrome

what is the key intervention for a child with iron deficiency anemia

iron supplementation

s/s of iron deficiency anemia

irritability HA dizziness weakness SOB pallor fatigue spooning of nails

anemia

is a condition in which the level of RBCs is lower than the age appropriate normal value may develop as a result of decreased production of RBCs or loss and destruction of RBCs

retinoblastoma

is a congenital, highly malignant tumor that arises from embryonic retinal cells accounts for 5% of blindness in children most children are diagnosed by age 5 and the 5 year survival rate is 90% when the tumor is confined to the retina

leukemia

is a primary disorder of the bone marrow in which the normal elements are replaced with abnormal WBCs

neglect

is defined as failure to provide a child with appropriate food, clothing, shelter, medical care, and schooling

acute myelogenous leukemia (AML)

is the second most common type of leukemia in children with a peak incidence in the adolescent years affects myeloid cell progenitors or precursors in the bone marrow resulting in malignant invasive and fast growing cells

chemotherapy protocols often call for a combination of drugs because?

it can act on different phases of the cell cycle thus maximizing the destruction of cancer cells

myelosupression

leads to low blood counts in all cell lines, placing the child at risk for infection, hemorrhage and anemia

what are some nonspecific symptoms of emotional abuse

low self confidence sleep disturbances hyper vigilance HA stomachaches

WBC include

lymphocytes monocytes neutrophils eosinophils basophils

nursing care for ALL

manage disease complications such as infection, pain, anemia, bleeding, and hyperuricemia

complications of retinoblastoma

may spread the the brain and the opposite eye as well as metastasis to lymph nodes, bone, bone marrow, and liver

the child with leukemia is susceptible to infection especially during chemotherapy. Infections such as?

meningitis, septicemia, and pneumonia are the most common causes of death

long term complications of chemotherapy is?

microdontia and missing teeth as a result of damage to developing permanent teeth hearing and vision changes hematopoietic and immunologic and gonadal dysfunction endocrine dysfunction altered growth and delayed puberty alterations of cardiorepsiratory, GI, and GU systems development of a secondary cancer as an adolescent or adult

in adults, cancer is influenced to a large extent by environmental factors. Cancer in children is?

most often not attributed to environmental factors, so generally there are not routine screening measures or prevention strategies for childhood cancer

an ANC less than 1.5 in children over age 1 indicates?

neutropenia

s/s of wilms tumor

parent typically observe the abdominal mass with wilms tumor abdominal pain constipation vomiting anorexia weight loss difficulty breathing

wilms tumors commonly metastasizes to the?

perinatal tissues liver diaphragm lungs abdominal muscles lymph nodes

types of child maltreatment

physical abuse sexual abuse emotional abuse neglect

risk factors for abuse in children include

poverty prematurity cerebral palsy chronic illness intellectual disability

bone marrow aspiration

provides samples of bone marrow so the type and quantity of cells being produced can be determined

treatment for retinoblastoma

radiation chemo laser surgery cryotherapy or a combination

common s/s of AML

recurrent infections fever fatigue HA visual disturbances vomiting lymphadenopathy

complications associated with bleeding most often involve joints and muscles. adjunct measures include?

rest ice compression elevation (RICE)

___ may be identified by the presence of leukocoria in one or both eyes. Occurs in early infancy up until early childhood.

retinoblastoma

The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching?

she has been down, but playing in soccer camp will cheer her up

there are several types of hemolytic anemia such as?

sickle cell disease thalassemia

s/s of retinoblastoma

strabismus orbital inflammation vomiting HA leukocoria (cats eye reflex a whiteish appearance of the pupil in the affected eye)

treatment for wilms tumor

surgical removal of the tumor and affect kidney (nephrectomy) radiation or chemo may be administered either before or after surgery

proper assessment technique with suspected abuse

take a thorough and detailed health history of the child's illness or illnesses use quotations to document the parent's responses pay particular attention to statements made by the child's parent or caretaker

The nurse is collecting data from the caregivers of a child brought to the clinic setting. The parents tell the nurse that the child's skin seems to be an unusual color. The nurse notes that the child's skin appears bronze-colored and jaundiced. This observation alerts the nurse to the likelihood that this child has which disorder?

thalassemia

the most common sites for childhood cancer include?

the blood, lymph, brain, bone, kidney and muscle bladder is common site for adult cancer not children

a history of childhood abuse is associated with?

the development of anxiety and depressive disorders, suicidal ideation and attempts, and alcohol and drug use

in children, the bone marrow aspirations sites used are?

the iliac crests or spines

treatment for AML

the induction phase requires intense bone marrow suppression and prolonged hospitalization bc AML is less responsive to treatment than ALL

clinical findings of ALL

the proliferating leukemic cells demonstrate massive metabolic needs, depriving normal body cells of needed nutrients resulting in: -fatigue -weight loss or growth -arrest -muscle wasting as bone marrow expands or the leukemic cells infiltrate the bone result in: -joint and bone pain the leukemic cells infiltrate the lymph nodes causing: -lymphadenopathy -or the liver resulting in hepatosplenomagly with spread to the CNS: -vomiting -HA -seizures -coma -vision alterations -cranial nerve palsies may occur

After the initial assessment is performed on a child with Wilms tumor, further palpation of the abdomen should be avoided because?

the tumor is highly vascular and soft therefore, excessive handling of the tumor may result in tumor seeding and metastasis.

chemotherapy drugs work in two different ways in relation to the cell cycle. Cell cycle specific agents and cell cycle nonspecific drugs. How do cell cycle specific agents exert their actions?

they exert their actions during a specific phase of the cell cycle

chemotherapy drugs work in two different ways in relation to the cell cycle. Cell cycle specific agents and cell cycle nonspecific drugs. How do cell cycle nonspecific drugs exert their effect?

they exert their effect regardless of which phase the cell is in

chemotherapeutic medications disrupt the cell cycle of not only cancer cells but also normal rapidly dividing cells. The cells most likely to be affected by chemotherapy are?

those in bone marrow digestive tract (especially the mouth) reproductive system hair follicles

chemotherapy is cytotoxic to rapidly proliferating cells-malignant or normal. Normal cells that turn over rapidly include?

those of bone marrow, hair, and mucous membranes

complications of AML

treatment resistance infection hemorrhage metasasis

wilms tumor

usually affects only 1 kidney demonstrates rapid growth and is usually large at diagnosis metastasis occurs via direct extension or through the blood stream

at the time of diagnosis some children with AML present with a WBC count above 100,000 termed hyperleukocytosis this results in?

venous stasis and backup of blast cells in small vessels causing hypoxia, hemorrhage, and lung or brain infarction this is a medical emergency these children require leukaphresis to decrease hypervelocity by quickly decreasing the number of circulating blasts

iron deficiency anemia occurs?

when the body does not have enough iron to produce Hgb

___ is the most common renal tumor, the second most common abdominal solid tumor in children and most commonly occurs between the ages of 2 and 5 years.

wilms tumor

avoid abdominal palpation preoperatively in the child with __ tumor; palpation may cause seeding of the tumor and metastasis.

wilms tumor