peds final
typhlitis
neutropenia enteroclitis, translocation of gut bacteria. Stomach pain- stupid nurses don't take it seriously then patients die. CT right away
The nurse is caring for an infant with grade II vesicoureteral reflux (VUR). The parent is very fearful that the infant will have progressive renal damage. Which response by the nurse would be appropriate?
"This condition usually resolves spontaneously with no symptoms."
normal life of RBC
120 days, sickle cells have a shorter life
Treatment of tinea capitis
oral griseofulvin, may use selenium sulfide shampoo to decrease contagiousness.
medication for sickle cell common
hydroxyurea- helps to rebuild RBC and stimulates production of FHgb
When assessing a child with hydronephrosis, what would the nurse expect to find? Select all that apply.
Abdominal mass Intermittent hematuria
common treatments for cancer (highlighted from slide)
Biopsy, leukapheresis, blood product transfusion, chemotherapy, hematopoietic stem cell transplant, biologic (monoclonal, chimeric — CART-cells). NOT highlighted on slide is surgery, radiation, clinical trial, PICC or PORT
A group of nursing students are reviewing the variations in the genitourinary system in children as compared with adults. The students demonstrate understanding of this information when they state:
Bladder capacity reaches adult capacity by age 1 year.
diagnostics for cancer
CBC with diff, AFP, CT, X-ray, MRI, bone scan, PET, MIBG (neuroblastoma and soft tissue malignancies), ultrasound, bone marrow aspiration, LP
Methotrexate
Crystallize and get trapped in kidneys, damage to kidneys. Give bicarbonate with fluid and dipstick every urine 7-9PH. Give leucovorin*** to clear and protect renal tubules.
The nurse is reviewing the health history of a client suspected of having vesicoureteral reflux. What findings in the health history are consistent with this disorder? Select all that apply.
Flank pain Urinary frequency History or repeated urinary tract infections. Hematuria
chemo med to stimulate bone marrow to produce more WBC (past nadir)
G-CSF (neupogen/neulasta) for WBC
Different phases meds can kill cancer cells
G0, G1, S phase, G2
The nurse is caring for a child diagnosed with acute post-streptococcal glomerulonephritis. When assessing the child, what findings does the nurse anticipate? Select all that apply.
Generalized edema Headache Weight gain
What immunization is given to reduce the effects of epiglottitis?
Hib vaccine
The parents of an 8-year-old child with nocturnal enuresis bring the child to the clinic for a follow-up. History reveals that the parents have tried numerous behavioral and motivational therapies without success. The nurse anticipates medication therapy. Which agents would the nurse identify as being used? Select all that apply.
Imipramine Desmopressin Oxybutynin
Priority nursing interventions for a child with meningitis
Isolation precautions and abx
medication to keep open and close PDA
Keep open with alprostadil (prostaglandins) , close with indomethacin (specific NSAID)
Cisplatin
Metal, weight post and pre administration. Give diuretic before admin to clear med from system, pt is on strict fluid replacement.
The nurse is triaging clients as they come in to an express care facility. Which assessment finding is clinically significant for early nephrotic syndrome?
Periorbital edema
When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority?
Risk for infection
tumor lysis syndrome electrolyte imbalances and consequences
hyperphosphatemia, hyperkalemia. calcium phosphate imbalance leading to ARF, hyperuricemia causes uric acid crystals in renal tubules, hyperkalemia causes arrhythmia, all leads to neuromuscular irritability.
The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion?
Sudden onset of severe scrotal pain with significant hemorrhagic swelling
The nurse is assessing a hospitalized child diagnosed with nephrotic syndrome. What assessment(s) is most important for the nurse to complete to help identify hypoalbuminemia in this child?
The heart rate and blood pressure
The nurse is caring for a 5-month-old boy with an undescended left testis. What would the nurse identify as indicative of true cryptorchidism?
Testis cannot be "milked" down inguinal canal
Disorders with decreased pulmonary blood flow
Tetralogy of Fallot Tricuspid atresia
The nurse is educating the parents of an infant after a circumcision. The parents demonstrate understanding when they state that they need to report what to the physician?
The infant does not urinate within 6 to 8 hours
Digoxin beneficial effects r/t edema
improves contractility and increasing cardiac output therefore second hand benefit of decreasing edema.
cancer, what do we want to prevent
infection anemia hemorrhage
The home care nurse is conducting an in-home visit for a child who had corrective surgery for hypospadias 3 days prior. What would alert the home care nurse to provide additional teaching?
The parent indicates the child is fussy, but calms down when held on the parent's hip.
sickle cell complications
infections, stroke, URI, leg ulcers Splenomegaly
The nurse is reviewing the blood urea nitrogen (BUN) results of an assigned client. The test is elevated. What factors may be associated with this result? Select all that apply.
The child may be dehydrated. The child's diet contains high levels of protein. There may be an infectious process in the child.
what to monitor in reye syndrome
liver enzymes, ammonia levels, ICP
While assessing a child with end-stage kidney disease, the nurse notes that the child has fallen into a coma. The nurse interprets this finding as resulting from which complication?
Uremia
Disorders with increased pulmonary flow
Ventricular septal defects, Atrial defects, atrioventricular canal (pulmonary artery banding), patent ductus arteriosis.
Vincristine and vinplastine
Vincristine, causes peripheral neuropathy and costipation. NEVER give intrathecal** pharmacy can only give to physician. Strict, doctors bring to the bathroom with them
The nurse is caring for a 2-year-old girl with suspected vulvovaginitis. The nurse suspects the cause as Candida albicans based on which finding?
White cottage cheese-like discharge
tumor lysis syndrome- what is it, process
lymphoma or leukemia is common. Excess production of immature white blood cell causing excess cell death —> intracellular content free floating causes electrolyte imbalances.
mercaptopurine
maintenance phase of chemo, people get casual and lazy and cancer comes back. take at home after discharge, compliance is key
Sickle cell patients high risk for what
major is stroke (ischemic), splenomegaly, blindness, hepatomegaly, priapism (painful erection in boys), avascular necrosis of the hip
number one brain tumor in children
medulla blastoma
Leukemia
abnormal uncontrolled proliferation of WBCs. Rapid production of immature WBC (blasts)
Most common leukemia in children
acute lymphocytic leukemia
symptoms of leukemia
anemia, neutropenia, thrombocytopenia
leading cause of death by disease in children
cancer (2nd overall cause of death in children)
An early subtle sign of hypoxia
change in LOC
biggest difference between child and adult cancer
child cancer mostly embryonal, rarely any prevention. Also mostly tissues (blood, lymph, brain,bone, kidney, muscle) rather than adult cancer mostly organ (breast, lung, prostate, bowel, etc.)
oncology emergencies
highlighted- sepsis, tumor lysis syndrome, typhlitis** others not highlighted- superior vena cava syndrome, spinal cord compression, hyperleukocytosis, increased ICP, massive hepatomegaly (resp distress, coagulopathy)
Cyclophosphamide, ifosfamide
damage to bladder and kidney. urine dipstick every void, always give Mesna ON TIME with this med. Prevent hemorrhagic cystitis, mesna protects the bladder.
S/S of kawasaki disease
petechiae, high fever (5 or more days), strawberry tongue, skin rash, erythematous, desquamation (especially fingers and toes), red swollen hands and feet, **CERVICAL LYMPHADENOPATHY (know the cervical chains)**, joints tenderness.
vaccinations to help prevent meningitis
pneumococcal, Hib, meningococcal
Three processes in HUS
thrombocytopenia, hemolytic anemia, acute renal failure.
Tetrology of Fallow (TOF) consists of
ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, overriding aorta
Absolute Neutrophil Count (ANC)
wbc x total neutrophil x 10 total neutrophil is segmented neutrophil % plus the segmented bands %
parents and nurse consideration for chemo kids
wear chemo gloves to care for diapers and stuff, don't touch meds, dispose in chemo bin, chemo spill kit in the room
nadir
when the drug starts to wipe out the bone marrow, it's the lowest point of immunity (like 5 days after med administration for example) tell pt to avoid crowds and stuff 5 days from now. pt often readmit for sepsis r/t nadir
Doxorubicin and daynomycin
antitumor antibiotic, cardiomyopathy side effect. can cause pt to go into HF later on. pt should be on cardiac monitor and should be on dexrazoxane (zinecard) to protect heart
three types of stem cell transplant
autologous (self, likely for relapse), allogenic (can have GVH disease), HLA match
most common cause of sickle cell crisis in children
dehydration, anything that may cause dehydration in children
medications for von willebrand
desmopressin, stimate(IM), IV of vWF
chemo drugs most likely to attack
bone marrow, digestive tract, reproductive system, hair follicles
ANC level for someone to be eligible for chemotherapy
750, or over 500 for someone who's already started chemo
L-asparaginase
enzymes from e. coli, can cause anaphylactic crisis. keep emergency drugs at bedside and emergency supplies at proximity
tumor lysis syndrome considerations and treatment
give amphogel and allopurinol, no fluids with K, requires hydration, keep urine PH 7.0-7.5 with admin of bicarb. Treat with rasburicase** converts uric acid to soluble compound
treatment of sickle cell
hydration, oxygenation, pain relief**** others are antibiotics, hydration
GVHD (graft versus host disease)
occurs 10 days to several months after transplantation, usually affect the liver, GI tract, skin
brain tumor that's advanced by the time it's found
neuroblastoma