Hematologic, Immunologic, and Neoplastic Disorders

Pediatric Differences (RBCs)​

- At birth hematopoiesis (blood cell production) occurs in bone marrow​ - At birth the newborn has ↑ RBCs Once the newborn starts breathing air & O2 level in blood increases, - RBC levels ↓ til 2-3 months of age (to 9-11 g/dL) & then begin increasing​ - Adult levels are reached during adolescence (male teens slightly higher than females) start high go down then back up

Splenic sequestration crisis s/s (sickle cell)

- Blood is trapped or pooled in the spleen​ - Mimics blood loss/ shock​ - Ultimately can cause death from profound anemia & cardiovascular collapse​ - Life-threatening​ - Splenectomy - treatment

​​​​​​​​Common Organs Affected in Sickle Cell Disease

- Brain​: Cerebrovascular accident​ - Eyes​: Retinopathy​, Retinal detachment​, Diminished vision​ - Bones:​ Chronic bone ischemia leading to infection and bone degeneration​ - Chest​: Acute Chest Syndrome - Liver:​ Hepatomegaly, Scarring​, Cirrhosis​ - Spleen​: Infarcts leading to fibrosis and increased risk of infection - Kidneys​: Enuresis, Hematuria​, Inability to concentrate urine​ - Penis​: Microcirculatory obstruction possibly causing priapism (prolonged, painful erection) - Emergency bc can cause tissue damage​ - Extremities​: Weakness, Peripheral neuropathy, Arthralgias​ - Skin: Ulcerations

Ewing Sarcoma s/s

- Can occur in any bone; usually femur (sometimes soft tissue behind the bone) - Pain & swelling, palpable lump, fever, pathologic fracture

Treatment of Iron Anemia

- Encourage iron-rich foods - dec milk intake - Supplements (Fe, folic acid, ferrous sulfate 3-6 mg/kg/day) - take with vit c to inc absorption - Blood transfusions

​​Tests for Anemia​

- Hgb (dec) - Hct ​(dec) - Mean corpuscular volume (dec) - RBC count (dec) - Reticulocyte count (inc)

Pediatric Differences (PLTs)​

- Platelet levels in newborns are lower than in older children & adults​ - Levels of many clotting factors are lower in infants​ - Vitamin K is required for synthesis of clotting factors II, VII, IX, & X​ - Gut sterile @ birth: vitamin K administration

​​​​​Chronic Diseases Causing Anemia​

- Sickle cell disease​ - Thalassemia major​ - Cancer​ - Aplastic anemia ​ - Folate deficiency​ - Inflammatory bowel disease​ - Infection​ - Chronic renal disease​ - Liver disease

​Symptoms of Anemia​

- Tachycardia, tachypnea​ - Pallor, pale mucous membranes​ - Poor appetite, pica​ - Poor muscle tone​ - Fatigue, exercise intolerance - Irritability​ - Hepatomegaly ​ - Splenomegaly ​ - Sensitivity to cold​ - Weight loss ​- Prolonged Anemia​: * Nailbed deformities​ * Systolic heart murmur &/or heart failure​ * Growth retardation​ * Developmental delay

Aplastic crisis s/s (sickle cell)

- Triggered by viral infection (Parvovirus B19=5th disease) or depletion of folic acid​ - Profound anemia; life-threatening​

Pediatric Differences (WBCs)​

- WBC count is highest at birth​ - Levels decline after 12 hours and cont. to due so for the 1st week​ - By 1 week levels stabilize & remain so til ~ 1 yr.​ - At 1 yr. WBC ct. slowly decreases til adult value is reached in adolescence​

normal PT time

11-15 sec

normal thrombin time (TT)

14-16 sec

normal fibrinogen

175-700

The mother of a 4-year-old client reports that the client's abdomen seems to be swollen. The client is eating well and the activity level remains unchanged. Based on the information above, what diagnosis is suspected?

Wilms tumor (nephroblastoma)

The nurse is caring for an adolescent with a head injury and suspects increased intracranial pressure (ICP). What findings support that belief? Select all that apply. a. Headache b. Vomiting that can increase to projectile c. Papilledema and blurred or double vision d. Petechial hemorrhages e. Sunsetting eyes

a,b,c,e

The nurse is reviewing the client's history of present illness. Which findings that are consistent with presenting signs of leukemia. Select all that apply. a. Client's mother reported that he has been more tired lately, and she noticed him getting more pale. b. He has had a few episodes of diarrhea during the past week. c. He has been complaining of leg pain for about one week. d. She is also worried because he has more bruises than he normally does. e. Both he and his sister have had a runny nose that the mother describes as clear in color.

a,c,d

A pt with leukemia is scheduled to receive IV chemotherapy after the PRBC transfusion. The nurse should anticipate which of the following actions related to chemotherapy? Select all that apply. a. Administering antiemetic medication prior to starting the chemotherapy. b. Confirming the correct dose is being administered by calculating the dosage using the client's BMI. c. Ensuring a chemotherapy spill kit is available on the hospital unit. d. Educating the family on cytotoxic precautions. e. Assessing the client's mouth for stomatitis and offering lemon glycerin swabs if stomatitis is noted. f. Performing a sterile dressing change on the central line site prior to administering chemotherapy. g. Reviewing possible adverse effects of the chemotherapy being administered. h. Double-checking the chemotherapy order, actual medication, and client's identification bracelet with another nurse.

a,c,d,g,h not b bc you use a pts. body surface area

The nurse is preparing to administer the packed red blood cell (PRBC) transfusion. For each item below, please indicate whether the action is indicated action when giving a PRBC transfusion. Select all that apply. a. Ensure a consent form has been signed prior to starting the blood transfusion. b. Monitor the client for blood infusion reactions for the first 10 minutes of the infusion. c. Check the unit of blood with another nurse prior to starting the transfusion. d. The client should be premedicated with morphine prior to the transfusion. e. Administer the blood transfusion over 3-4 hours. f. Assess for hypotension and fever after the transfusion has started.

a,c,e,f

Which of the following symptoms would you expect the mother to report in a child with a suspected cancer diagnosis? Select all that apply. a. Anorexia b. Unusual weight gain c. Muscle rigidity d. General weakness e. Hematuria

a,d,e

Several tests and procedures are needed to confirm a diagnosis of leukemia. The nurse anticipates including which of the following items when caring for this client during the diagnostic process? select all that apply. a. Explaining to the child that his mother can stay with him and that he can bring a favorite toy or blanket with him b. discussing the 3-year treatment plan with the family prior to any testing or chemotherapy c. telling the child that "a needle will be inserted into your back to obtain cerebrospinal fluid" d. educating the child and family about the test being done that day e. obtaining blood for a CBC f. obtaining blood for a factor VIII level g. preparing the client for a bone marrow aspiration h. placing the client NPO

a,d,e,g c would likly cause the child to be scared

You are caring for a 10-year-old client who has Hemophilia A. This client was playing football and reports to the ED stating "I think I have a concussion." After doing your history, you have discovered the client has not received any factor for the past year. ​ ​ Based on the information above, what is the priority nursing care?​ ​ a. Administer Factor​ b. Allow patient to rest​ c. Ice the affected area​ d. Elevate Head of the Bed​

a. Administer Factor​

You are caring for a 10-year-old client who has Hemophilia A. This client was playing football and reports to the ED stating "I think I have a concussion." After doing your history, you have discovered the client has not received any factor for the past year. ​ ​ Based on the information above, what is the client most at risk for?​ ​ a. Intracranial Hemorrhage​ b. Hemarthrosis​ c. Infection​ d. Epistaxis​

a. Intracranial Hemorrhage​

Doug is 12 years old and all his friends play contact sports. Doug's parents encourage him to join the swim team instead due to his condition. Doug often suffers from nosebleeds, bruising, and blood in the urine. What disorder does Doug have? a. hemophilia b. lymphoma c. leukemia d. neoplasm e. sickle cell f. aplastic anemia g. acquired thrombocytopenia h. lead poisoning i. iron deficiency anemia j. acquired immunodeficiency syndrome

a. hemophilia this was deducted bc contact sports seem to play a role in these s/s

A nurse is planning care for a child with hemophilia. Which statement is true in the care of the child with hemophilia? Select all that apply. a. Hemophilia is commonly a deficiency of factor X. b. Hemarthrosis into the joint cavities of a child with hemophilia is a clinical manifestation. c. Hemophilia A and B are inherited as X-linked recessive traits. d. Spontaneous hematuria in children with hemophilia is a clinical manifestation. e. Males are carriers and do not have the disease.

b,c,d

The mother of a 4-year-old client reports that the client's abdomen seems to be swollen. The client is eating well and the activity level remains unchanged. Based on the suspected diagnosis, what should the nurse assess next? Select all that apply. A. Palpation of the abdomen for the mass size B. Assessing the urine for the presence of hematuria C. Monitor the temperature for the presence of fever D. Monitor the blood pressure for the presence of hypertension

b,c,d

A nurse is planning care for a child with sickle cell disease. Which interventions are utilized in the care of the child? Select all that apply. a. Metabolic alkalosis treatment with IV replacement b. Administration of Hydroxyurea c. Positive self-talk d. Activity and rest cycling for periods of activity intolerance e. Liver resection as a life saving measure

b,c,d not a bc metabolic acidosis is a problem. not e splenectomy is a lifesaving procedure

A nurse is teaching a caregiver of a child with iron deficiency anemia. Caregiver education relating to iron deficiency anemia includes: a. Avoid consumption of cow's milk in infants until age 10 months. b. For breastfed infants, provide an iron supplement. c. Teach parents to add iron-rich foods to child's diet. d. Iron supplementation is required if the child is bottle fed. e. Whole milk is recommended from 12 months to two years.

b,c,e not a bc avoid cows milk until 1 year of age

A child diagnosed with iron deficiency anemia will likely present with which of the following assessment findings? Select all that apply. a. Increased muscle tone b. Delayed learning c. Systolic murmur d. Increased serum concentration of albumin or proteins e. Edematous

b,c,e not a bc will see poor muscle tone not d bc will see dec concentration of albumin or proteins

The nurse is planning the care of a client with leukemia for the upcoming shift. The nurse anticipates including which of the following in the care of this client? Select all that apply. a. Administering ibuprofen as needed for fever or pain. b. Notifying the provider of any temperature >100.4° F (38°C). c. Administering ondansetron as needed. d. Obtaining a rectal temp with vital signs every 4 hours. e. Using a stethoscope and equipment dedicated to only this client. f. Using a 5-mL syringe when flushing the client's CVL. g. Discouraging fresh flowers in the child's room. h. Obtaining a basic metabolic panel (BMP) to evaluate for myelosuppression. i. Placing a mask on the client when he goes outside his hospital room. j. Allowing the client to be involved in daily care as much as possible.

b,d,e,g,i,j do not administer ibuprofen (this is risky), fo not do things rectally, use a 10 mL syringe to flush CVL. BMP does not evaluate for myelosuppression rather CBC (need WBC count w/ differential). Ondansetron is used for nausea

Which of the following statements is true regarding absolute neutrophil count (ANC)? a. ANC is diagnostic to diagnose leukemia. b. An ANC less than 500 indicates a high risk for infection. c. Patients with aplastic anemia will show high ANC level. d. Chemotherapy selection is based on the ANC.

b. An ANC less than 500 indicates a high risk for infection.

The therapeutic management of children with sickle cell disease consists primarily of which of the following?​ ​ a. Oxygen therapy​ b. Prevention and treatment of pain​ c. Adequate hydration​ d. Frequent blood transfusions

b. Prevention and treatment of pain​

A nurse is caring for a client with sickle cell anemia who has a sickle cell crisis. Which of the following is identified as a precipitating factor for a sickle cell crisis?​ a. Fluid overload​ b. Stress​ c. Insomnia​ d. Adherence to antibiotic treatment

b. Stress​

When caring for a child with hemophilia, which of the following clinical manifestations do you expect to find in the patient's history? Select all that apply. a. Lymphadenopathy b. Acute chest syndrome c. Hematuria d. Nosebleeds e. Weight loss

c,d

You are caring for a 10-year-old client who has Hemophilia A. This client was playing football and reports to the ED stating "I think I have a concussion." After doing your history, you have discovered the client has not received any factor for the past year. ​ ​ The client is now stable and is about to be discharged. What sports should the nurse educate the client on to participate safely in? Select all that apply.​ ​ a. Soccer​ b. Basketball​ c. Swimming​ d. Field Hockey​ e. Disc Golf

c,e

A nurse is instructing the parents of your client on administration of liquid oral iron supplementation. The nurse should instruct the mother to:​ a. Administer iron with breastmilk in a bottle​ b. Mix iron with cereal to administer​ c. Administer iron through a straw​ d. Mix iron with formula to administer

c. Administer iron through a straw​

During patient rounds on the pediatric hematology/oncology unit, the nurse is told to prepare her patient for a bone marrow test. Laboratory values show a low reticulocyte count and thrombocytopenia. These findings are consistent with what diagnosis? a. hemophilia b. lymphoma c. leukemia d. neoplasm e. sickle cell f. aplastic anemia g. acquired thrombocytopenia h. lead poisoning i. iron deficiency anemia j. acquired immunodeficiency syndrome

c. leukemia thrombocytopenia is the main thing that lead me to this choice

Tonya is a 16-year-old African American girl in the hospital with complaints of pain in both hands, chest pain, fever, and moderate respiratory distress. The nurse is providing IV therapy for hydration and encouraging oral fluid intake. Medications include hydroxyurea and pain medication. What disorder does Tonya have? a. hemophilia b. lymphoma c. leukemia d. neoplasm e. sickle cell f. aplastic anemia g. acquired thrombocytopenia h. lead poisoning i. iron deficiency anemia j. acquired immunodeficiency syndrome

e. sickle cell the fact that the pt is AA and has s/s of Acute chest syndrome

The nurse on the pediatric floor is reviewing her 4-year-old female patient's chart. Laboratory results show decreased leukocytes, platelets, and erythrocytes. The history states the patient was admitted for a complaint of "chicken pox that will not go away." What diagnosis are these findings consistent with? a. hemophilia b. lymphoma c. leukemia d. neoplasm e. sickle cell f. aplastic anemia g. acquired thrombocytopenia h. lead poisoning i. iron deficiency anemia j. acquired immunodeficiency syndrome

f. aplastic anemia

Five-year-old Roxy is in the hospital with failure to thrive. She was adopted as a baby from a mother who had a positive drug history. Current assessment reveals lymphadenopathy, oral candidiasis, and swelling between the ear and jaw. Her foster mother reports diarrhea for the past 7 days. What diagnosis are these findings consistent with? a. hemophilia b. lymphoma c. leukemia d. neoplasm e. sickle cell f. aplastic anemia g. acquired immunodeficiency syndrome h. lead poisoning i. iron deficiency anemia j. acquired immunodeficiency syndrome

g. acquired immunodeficiency syndrome what lead me to this was the oral candidiasis

Immune Thrombocytopenia (ITP) Manifestations

- presents 1-4 wks after a viral illness - bruising/bleeding - plt <20,00 - Petechiae​ ​ - Ecchymoses​ ​ - Epistaxis​ ​ - Bleeding gums​ ​ - Hematuria, hematemesis​ ​ - Melena

Definition of Anemia​

- ↓ number of red blood cells (RBCs)​ - ↓ quantity of hemoglobin (HgB)​ - ↓ volume of packed red blood cells (PRBC)​ - Lowered ability of the blood to carry oxygen

Hemoglobin normal count

10.2-13.4 g/dl​

Platelets normal count

203-367 X 10/L

normal aPTT

24-34 sec

Red Blood Cells normal count

3.8-5.03 10/L​

Hematocrit normal count

31.7-39.8%​

White Blood Cells normal count

4.86-11.4 X 10/L​

A nurse is planning care for a patient with thrombocytopenia. Which nursing intervention will be included? Select all that apply. a. Monitoring stools for blood b. Avoiding injections c. Avoiding use of salicylates (aspirin) d. Avoiding steroids e. Monitoring activities

a,b,c,e

Iron Deficiency Anemia​ s/s

- asymptomatic or pallor, - fatigue, - irritability, - poor feeding, - tachypnea & cardiomegaly, - pica, - spoon-shaped nails​

You are caring for a 10-year-old client who has Hemophilia A. This client was playing football and reports to the ED stating "I think I have a concussion." After doing your history, you have discovered the client has not received any factor for the past year. ​ ​ what puts the client at risk for injury

- playing football - has not received any factor for the past year

Osteosarcoma post-op edu and care

- Amputation care (usually done at joint above the tumor - Do not elevate the stump or hyperflex - Control bleeding - Phantom-limb pain - SE's of chemo: N/V, hair loss

CBC with differential WBC 1.5 (5.0-10.0 103/mm3) RBC 2.8 (4.6-4.8 106/mm3) Platelets 50,000 (150,000-400,000/mm3) Hemoglobin 7.0 g/dL (13.6-17.5 g/dL) Hematocrit 22% (39%-49%) Segmented neutrophils 29% (31%-57%) Band neutrophils 3% (8%-11%) Lymphocytes 15% (20%-40%) Monocytes 2% (2%-10%) Eosinophils 2% (1%-6%) Basophils 1% (1%-2%) Complete the sentences. The nurse calculates the client's absolute neutrophil count (ANC) to be _______. Based on the calculated ANC, the client has _____ .

480; severe neutropenia ANC is (Band % + Seg %) x total WBC count

A nurse is caring for a 10-year-old with leukemia who is receiving chemotherapy. The child is on neutropenic precautions. Friends of the child come to the desk and ask for a vase for flowers they have picked from their garden. Which of the following is the best response? A. "I will get you a special vase that we use on the unit." B. "The flowers from your garden are beautiful but should not be placed in the room at this time." C. "As soon as I can wash a vase, I will put the flowers in it and bring it to the room." D. "Get rid of the flowers immediately. You could harm the child."

B. "The flowers from your garden are beautiful but should not be placed in the room at this time."

A nurse is caring for a child with sickle cell anemia who has a vaso-occlusive crisis. Which of the following interventions should improve tissue perfusion?​ ​ A. Limiting oral fluids​ B. Administering oxygen​ C. Administering antibiotics​ D. Administering analgesics

B. Administering oxygen​

Which of the following clinical manifestations is common in iron deficiency anemia? Select all that apply. a. Poor muscle tone b. Irritability c. Convex nailbeds d. Ashen color skin e. Nosebleeds

a,b not c bc concave nailbeds

A 13-year-old client is seen in the clinic and is suspected of having Hodgkin's Lymphoma. Which assessment findings would be expected? A. Fever and pain B. Anorexia and nausea C. Enlarged inguinal lymph nodes that are painful at the touch D. Painless, firm, movable adenopathy in the cervical area

D. Painless, firm, movable adenopathy in the cervical area

Which of the following will be abnormal in a child with a diagnosis of hemophilia?​ ​ A. The platelet count ​ B. The hemoglobin level​ C. The white blood cell count​ D. The partial thromboplastin time (PTT)

D. The partial thromboplastin time (PTT) - it will be inc or prolonged

Which of the following therapies would you include for a child with sickle cell disease? Select all that apply. a. Increased hydration b. Hydroxyurea c. Morphine to help with pain crises d. Acyclovir to prevent viral infection e. IV therapy

a,b,c,e

A nurse is monitoring a child with suspected thrombocytopenia. The nurse will observe for which clinical manifestations: a. History of epistaxis b. Petechiae, often over bony prominences c. History of sickle cell d. Recent exposure to bacterial pneumonia

b. Petechiae, often over bony prominences

Jenai was recently bit by a tick while on a hike. She is now exhibiting signs and symptoms of petechiae, blood in her stools, and frequent and spontaneous nosebleeds. Her blood work reveals a decrease in platelet counts. What disorder does Jenai have? a. hemophilia b. lymphoma c. leukemia d. neoplasm e. sickle cell f. aplastic anemia g. acquired thrombocytopenia h. lead poisoning i. iron deficiency anemia j. acquired immunodeficiency syndrome

g. acquired thrombocytopenia petechiae is the main s/s that lead me to this choice as well as the fact she was bitten by a tick

During a well-child examination of a 3-year-old girl with known hearing loss and developmental delays, the mother reports that the family lives in a house built 50 years ago that has copper pipes and chipped paint. The nurse then asks the mother if the child ever has abdominal pain, vomiting, constipation, headache, or fever. What condition does the nurse suspect the child to have? a. hemophilia b. lymphoma c. leukemia d. neoplasm e. sickle cell f. aplastic anemia g. acquired thrombocytopenia h. lead poisoning i. iron deficiency anemia j. acquired immunodeficiency syndrome

h. lead poisoning what lead me to this the most was the old house that has copper pipes and chipped paint.

12-month-old Brian is seen at the local pediatrician's office. The nurse documents the following findings during her assessment: poor muscle tone, irritability, concave nailbeds, and edematous. These findings are consistent with what disorder? a. hemophilia b. lymphoma c. leukemia d. neoplasm e. sickle cell f. aplastic anemia g. acquired thrombocytopenia h. lead poisoning i. iron deficiency anemia j. acquired immunodeficiency syndrome

i. iron deficiency anemia concave nailbeds, and edematous lead me to this choice the most