Nurs 232 Exam 3
What education must be provided for pts receiving either bone marrow of stem cell transplant for cancer?
Can be curative, but has complications of rejection or allergic reaction so must take meds to suppress immune response to foreign body and donor marrow
What is considered the #1 disease related cause of death in children?
Cancer *leukemia is most common type
Sometimes children start off w/ peripheral IV for chemo until a central line can be placed. What is an important nursing role when a pt has peripheral IV? *very rare
Frequently check to make sure it hasn't infiltrated and caused tissue damage *very caustic to veins
A 6 yr old girl has been receiving chemotherapy. She is also receiving TPN via a central line. Which of the following nursing diagnoses is the highest priority? a) Imbalances nutrition: less than body requirements b) risk for deficient fluid volume c) risk for infection d) activity intolerance
c) risk for infection
Why is it important to do thorough diagnostic workup before confirming cancer diagnosis
clinical manifestations are vague and could be signs of other illnesses
The universal 1st reaction of parents to a child's life threatening illness or death is: a) acceptance b) anger c) depression d) shock
d) Shock
What is the universal initial reaction of parent to child having a life-threatening illness/injury? What other reactions may occur? *similar to grieving process
#1) shock and disbelief -anger & guilt -deprivation & loss -anticipatory waiting -readjustment or mourning
What clinical manifestations of leukemia would indicate bone marrow failure
*large joint or bone pain *overt signs of bleeding *petechiae
What are the 2 most common types of leukemia?
-ALL= Acute Lymphoblastic Leukemia *most common* -AML= Acute Myeloid Leukemia
What are physical assessment findings of a dying child?
-Agitation or restlessness -Decreased urine production -Moaning or grunting -Incontinence -Typically unconscious final hours -Tachypnea and dyspnea -Extremely weak, too weak to speak/swallow -Decreased oral intake/anorexia -Deterioration of hearing and vision -Death rattle -Cool, clammy skin -Cyanosis and mottling
What are common side effects of chemo?
-Bone marrow suppression=Neutropenic, Anemic, Thrombocytopenic -Anorexia and weight loss -Constipation -Oral ulcers and rectal irritation/fissures (mucous membranes effected increasing risk of infection) -N/V -Pain
What diagnostic tests might the physician order for pt presenting to hospital w/ symptoms of long bone pain, weakness, decreased appetite, weight loss, bruising and petechiae, confusion for suspected cancer?
-CBC differential (RBC, hgb, hct, platelet, all diff types of WBC) -bone marrow aspiration/biopsy (take cells right from bone marrow to analyze) -lumbar puncture (see if spread to CSF) - MRI,CT, PET, ultrasound, cxr (better picture) -biopsy of tumor -electrolytes or other studies drawn
How does cancer differ in children than adults?
-Children: mostly r/t genetics and embryonic. Cancer is fast growing and the immune system is less responsive b/c not as developed. Less incidence of cancer caused by exposure. -Adults: mostly r/t lifestyle habits and environmental exposure to toxins/carcinogen. Focus on decreasing exposure and changing lifestyle.
Children have vague clinical manifestations of cancer. Which s/s would concern the nurse for possible cancer?
-Pain= leg pain w/ tumor or long bone pain w/ leukemia -Anemia= weakness w/ leukemia -Neuro symptoms= ataxia or confusion -Infection -Cachexia= decreases appetite and weight loss -Bruising and petechiae -Palpable mass
When is there a sharp increase in incidence of ALL and what increases risk ? *most common *5 yr survival rate 92%
-Sharp peak in ages 2-3 yrs, but can occur at any age -risks: down syndrome, genetic factors, and immune deficiency
What clinical manifestations would pt present for suspected leukemia?
-Swollen lymph nodes (lymphadenopathy) -CNS (headache, vomiting, papilledema, inability to move eyes laterally) -Anorexia -Lethargy -Pallor -Enlarged liver (hepatomegaly) and spleen -Large joint or bone pain -Bleeding (overt signs like bruising, petechiae, nose bleeds) -Fever -Malaise -Very high WBC count
What is an adolescent's understanding of death?
-adult understanding -intellectually capable of understanding death -developmental conflicts w/ identity vs inferiority
What guidance can the nurse give for parents of a 7 yr old that are overwhelmed w leukemia diagnosis and don't know what to say to him?
-be honest, factual, and realistic w info -provide images or written material and explain -provide resources to help -utilize child life, social work, or clergy
What are some strategies for communicating w dying child?
-be receptive -ask what they know -talk what's worrying them -ask what's important to them -nonverbal expression of feelings -reassure not abandoned -let them know always be loved and remembered
Since cancer has an increase rate of survival, what physical late effects of cancer and treatment might pt experience?
-cardiotoxicity (baseline ekg and monirot heart function) -pulmonary fibrosis (lung involvement) -ototoxicity -chronic pain -neuropathy -bone loss/osteoporosis -secondary cancers -amputation/scarring/disfigurement -short stature -changes in function, mobility, cognitive ability -infertility -chronic infection
What treatment may be provided for pt w leakumia?
-chemotherapy (ex: intrathecal done w/ lumbar puncture for fluid analysis then administer chemo through spinal column) -radiation for CNS, T-cell leukemia, or testicular involvement
What can influence a child's reaction to loss?
-developmental level -concept of loss and death -relationship w/ deceased -circumstances of loss -caregiver's ability to communicate and provide emotional support -support from peers and others -prior experience w loss -religious and cultural beliefs
What can cause cancer in children?
-embryonic= problems during development in womb -oncogenic= cancer type cells -genetic alterations -environmental exposure (less)
Pt is being treated w/ chemo and presents w very minimal WBC to fight off infection, what s/s might nurse be assessing for infection
-fever -chills or sweats -cough -sore throat or new mouth sore -SOB -nasal congestion -stiff neck -burning or pain w/ urinating -unusual vaginal discharge or irritation -redness, soreness, swelling, or pain in an area like would or port -Diarrhea -vomiting -Abd or rectum pain -new onset pain -changes in skin, urination, or mental status
What complimentary therapies can be taught to pt w cancer to help w/ side effects of treatment?
-herbal meds if approved by physician -music therapy -meditation -peppermint oil
What ages have the highest rates of AML and what increases risk ? *5 yr survival rate 64%
-highest in first 2 yrs of life and adolescence -risks: ionizing radiation or chemicals like chemo exposure in utero, or chromosomal/genetic abnormalities
What are potential complications from treatment of cancer?
-infection>> sepsis >> death -tumor lysis syndrome
What is a preschooler's understanding of death?
-little bit more aware -can see/feel body deteriorate -alter self-concept -describe illness in terms of body mutilation -believes death is temporary and person will return -magical thinking (think caused or punishment) -confuse death w being away or asleep -may have experience of death of pet
What are some neutropenic precautions/protective isolation for pt w/ severe neutropenia as a result of chemo treatment?
-meticulous handwashing -mask if pt leaves or sick caregivers/visitors -no live plants, fresh flowers, fresh raw fruits, veggies, sushi or other items that might transmit infection -positive pressure room w/ HEPA filtration system -monitor closely for s/s infection -limit visitors -up to date w/ immunizations
What important nursing care should be provided for children w cancer?
-monitor for complications of treatment -psychosocial support -development assessment -administer meds -treat side effects (antiemetic for N/V) -pain management -promote optimal nutrition and monitor weight -hydration (2x maintenance) -prevent infection (ex: neupogen stimulate WBC)
What is a toddler's understanding of death?
-no true understanding or concept -know they feel sick or tired -do not associate physical symptoms w illness/death
What is an infant's understanding of death?
-not aware -sense emotions of caregivers -sense separation
Since cancer has an increase rate of survival, what psychosocial late effects of cancer and treatment might pt experience?
-separation -unconnected w peer group -gear of death/second cancer -dealing w/ late effects like infertility -memories -family stress -change in economic status -insurance concerns
Treatment of cancer may be curative, supportive, or end of life care. What are examples of clinical therapy that may be provided for children w cancer?
-surgery (debunk, remove, or stage tumor) -chemotherapy (caustic to veins so use central line) -radiation (shrink tumor) -biotherapy -bone marrow/stem cell transplant (can be curative) -complimentary therapies (helps w/ side effects of treatment)
What is a school age's understanding of death?
-understand death is permanent -death anxiety and fear -knows difference between temp separation and death -not realize death can occur at any age -by 9-10 yrs old has adult understanding
If pt is being discharged and is neurtopenic as a result of chemo treatment, what should the nurse teach the pt to implement neutropenic precautions at home?
-wash hands frequently -avoid crowded places or sick people -do not share food, drinks, utensils, toothbrushes -shower/bathe daily -use unscented lotion to prevent dry cracked skin -cook meat and eggs all the way -thoroughly was raw fruits and veggies -protect skin from direct contact w/ pet urine or feces by wearing gloves to clean up after pet and wash hands immediately afterwards -use gloves for gardening -clean teeth and gums w/ soft toothbush and use mouthwash to prevent sores if ordered -keep all household surfaces clean -get seasonal flu shot as soon as available
The nurse knows that a definitive diagnosis of pyloric stenosis will be made by which of the following tests? a) abd x-ray b) colonoscopy c) CT scan d) abd ultrasound
d) abd ultrasound
How would the nurse assess and provide interventions for the following common side effects of chemo: 1) ___Bone Marrow Suppression (anemia, thrombo, neutro) 2) ___ N/V 3) ___ anorexia and weight loss 4) ___oral ulcers/ stomatasis 5) ___ constipation 6) ___ pain 7) ___anemia 8) ___thrombocytopenia
1) CBC-- signs of bleeding, pain, bleeding precaution, neutropenic/protective isolation 2) ask-- antiemetics, hydration, provide foods that sound good, peppermint oil 3) weight/BMI & how much eat-- high cal, protein, and fat, TPN/tube feed, supplements 4) oral assessment--hydration, special mouth wash/rinse, oral care 5) abd assessment & monitor BM-- fiber, fluids, movement as tolerated, bowel protocol 6) pain scale-- pain med, complimentary therapy, distraction 7) CBC, temp, fatigue--transfusion PRBC, monitor transfusion reaction 8) CBC & bleeding--soft toothbrush/toothette, prevent falls/bumping, try to avoid w/ rectal temps, enema, IM injection
What are the 5 stages of grief? *applies to death, divorce, diagnosis of chronic illness, move
1) Denial and isolation 2) Anger 3) Bargaining 4) Depression 5) Acceptance *is a process, not linear; people go through stages differently in different order *helps adapt to loss
What typically occurs 7-10 days after starting chemo that puts pt at incrased risk of infection, weakness, and bleeding?
Bone marrow suppression causing: -neutropenia (low WBC) -anemia (low RBC) -thrombocytopenia (low platelet) *nadir=lowest point when expect bone marrow suppression to happen
By what age will a child understand death is permanent? and then have an adult understanding of death?
6 yrs= death is permanent 9-10 yrs old= adult understanding
What should the nurse frequently assess for pt going through chemo treatment that measures both mature (segmented) and immature neutrophils (bands)?
Absolute Neutrophil count
What is the typical understanding to death by an adolescent?
Adult understanding *by age 9-10 yrs
What term describes programmed cell death when the cell realizes something is wrong and destroys itself?
Apoptosis
How is leukemia typically diagnosed?
Blood counts (CBC differential) and bone marrow biopsy *watch for bleeding, lot of bruisng, and painful
What should the nurse be concerned about when a child presents to the hospital and parents state: "he has normal activity, growth and development has always been on target, but he has become more clumsy and experiences ataxia"
Cancer such as a brain tumor
What term describes chemicals or processes that, when combined with genetic traits and an interaction with one another, cause cancer
Carcinogen
How would the nurse explain the importance of central line for chemotherapy to a pts family that want to continue to use peripheral IV bc they're concerned w the increased risk of infection?
Chemotherapy is very caustic/damaging to the veins, so it requires central line to minimize tissue injury
Why might a child w/ leukemia experience long bone pain?
Excessive activity of WBC in bone marrow
T or F: it is important for cancer pt that is neutropenic from chemo is up to date w/ all immunizations so if any are missed like MMR they should get the vaccine during hospital visit
False! *no live vaccines for pt or family b/c can shed virus and get infection
T or F: there is a decrease in the incidence of childhood cancer w new education on prevention
False! Theres an increase in incidence, but also an increase in survival *research and protocols conducted by cooperative group called "Children's Oncology Group (COG)" for state of the art treatment
Hospital policy differs for precautions for pts considered neutropenic according to absolute neutrophil count, however what might be implemented?
If neutropenic/ ANC value is very low, pt will be in protective isolation or neutropenic precautions *ex: if severe pt will not leave room but if they have to for a scan, they have to wear mask and everyone must leave the elevator *ex: if pt was not considered neutropenic then they could go into playroom
To decrease risk of infiltration bc chemo is caustic to veins the pt may have an infusaport, PICC line, broviac, etc. What does this increase the pts risk for?
Infection *make sure lines are maintained and dressing changes are sterile
What is the term for a method of med delivery in which the drug is introduced into the spinal canal *ex: lumbar puncture
Intrathecal
What is important to educate to pt and families before starting chemotherapy?
Kills normal and cancerous cells
What is cancer of WBC where they are growing out of control producing lot of immature WBC, so not effective in fighting off infection? The bone marrow will be full of cells causing complaints long bone pain.
Leukemia *2 types=differ based on mutation in lymphoid or myeloid cell
Pts undergoing chemo may not have a noticeable immune response to infection from not having enough WBC to start a response. Because of this, what important nursing interventions might be indicated?
Monitor pt closely, the physician may order a prophylactic ATB to decrease risk of infection
What is described as a decrease production of blood cells in the bone marrow
Myelosuppression
What term describes the lowest point in a lab value or serum blood titer
Nadir
What term describes a gene involved in normal cell growth that was mutated, causing the growth of cancer cells. *can be inherited or caused by exposure to substances in the environment that cause cancer
Oncogenes *Oncogenic is a cancer type cell
Pt w cancer reports increased sensitivity to smell causing lots of nausea? Other than antiemetic, what could the nurse give to decrease nausea
Peppermint oil *place in room on cotton ball to help w changes in smell and increased nausea
What age group is it important to explain that their cancer is not a punishment and not their fault?
Preschool
Parents are concerned that their child has a cognitive issue bc they suddenly started wetting the bed every night after their grandmas funeral. What might be the cause of this?
Regression can occur as a result of loss *normal
What term describes cancers that appear after the primary cancer in treatment but are of a different histologic type *most commonly solid tumors
Secondary cancers
Why is it important to get baseline assessment of development level and continue to monitor? What ages are we going to monitor even closer?
Some treatments and forms of cancer can have an affect on cognition and development. Pts 6 and under will monitor closest
What is the purpose of an infusaport and how does the nurse access it?
Sterile procedure bc accessing central vein to get chemotherapy or lab draws so don't have to poke as much. Use emla cream or numbing spray over site and wait 45 mins to an hr special needle stabilize
Which of the following factors plays a significant role in the nurses ability to provide safe and effective care to terminally ill children a) knowledge of advance psychomotor skills b) understanding of the dying process c) experience with terminally ill adults d) acknowledgment of on feelings about dying and death
d) acknowledgment of on feelings about dying and death
The nurse should be monitoring for tumor lysis syndrome, a complication from cancer treatment. Why/how does this occur for pt w/ tumor? *monitor and report s/s like: N/V, diarrhea, muscle cramps/ twitches, weakness and fatigue, paresthesia, irregular heart rate, confusion, restlessness, irritability, delirium, hallucinations,seizures
Treatment w/ chemo and radiation will break down tumor, which will put out lots of potassium and other electrolytes and substances into bloodstream. Can occur if cancer cells break down too quickly in the body releasing their contents in to the blood faster than the kidneys can remove them.
What should be included in diet to increase absorption of iron to help correct decreased RBC's in anemia?
Vitamin C increases absorption ex: oranges, tomatoes, berries, kiwi
Why are children w/ leukemia at an increased risk for infection?
WBC are reproducing so rapidly in the bone marrow that they aren't effective b/c they are immature *immature WBC= bands
Which of the following observations would be most concerning to a nurse caring for a toddler w diagnosis of idiopathic thrombocytopenia purpura ? a) the child is jumping up and down on bed b) mother of child placing blankets along side of crib c) an order for acetaminophen for discomfort d) petechiae on bilateral legs
a) the child is jumping up and down on bed *petechiae is an expected finding *padding the side of the crib helps prevent injury *can give acetaminophen for discomfort—no aspirin b/c increases risk of bleeding
Nurse is caring for a child receiving chemotherapy. The nurse should be aware that the child may experience which of the following side effects? (select all that apply) a) anemia b) weight gain c) polycythemia d) mucositis e) leukocytosis f) thrombocytopenia
a) anemia d) mucositis f) thrombocytopenia
The parent of a 3 yr old cold asks the nurse for suggestions on how to decrease their child's constipation. Which of the following would be the best response by the nurse? a) be sure to increase the amount of fluid that your child drinks each day b) be sure to add fresh fruits and veggies, such as ba as and grapes to your child's diet c) decrease the amount of whole grains in your child's diet d) increased the amount of milk the cold drinks each day
a) be sure to increase the amount of fluid that your child drinks each day *bananas can bind a child up and cause constipation
Which should be included in discharge teaching of newborn w severe cleft lip and palate? (select all apply) a) burp frequently while eating b) elevate head and chest while feeding c) expect weight gain of 4-5 ounces per week d) ignore occasional vomiting
a) burp frequently while eating b) elevate head and chest while feeding *normal weight gain is 5-7 oz
Which of the following nursing interventions is the most appropriate when working with the school age child who has a terminal illness? a) give factual explanations of the disease, medication, and procedures b) perform all care for the child c) tell the child that everything will be ok d) reinforce that being in the hospital is not a punishment for any thoughts or actions
a) give factual explanations of the disease, medication, and procedures *d is referring to preschool age children
The nurse is teaching the family of a child w sickle cell anemia about triggers that may cause a pain crisis. Which of the following would be included in teaching? (Select al apply) a) infection b) overhydration c) hot humid day d) stress at school e) being outside on a cold winter day
a) infection c) hot humid day d) stress at school e) being outside on a cold winter day
When performing a PA what clinical manifestations would concern the nurse that the pt might have cancer? (Select all apply) a) neuro symptoms like ataxia and confusion b) anemia and weakness c) increased appetite and weight gain d) bruising and petechiae e) increased WBC and immune response f) long bone pain
a) neuro symptoms like ataxia and confusion b) anemia and weakness d) bruising and petechiae f) long bone pain
Which assessment finding is of greatest concern in a child who has sickle cell anemia and of experiencing sickle cell pain crisis a) oxygen saturation of 91% b) hgb 8.2 c) hct 30% d) platelet 205,000
a) oxygen saturation of 91%
A nurse is caring for a 5 yr old who has terminal cancer. Which of the following statements are true? (Select all that apply) a) parents may be at different stages in dealing with child's death b) Child is thinking about future and knows he may not be able to participate c) dying child may become clingy and act like a toddler d) whispering in the room will help the child cope e) death of a child may have long-term disruptive affects on family f) Child doesn't fully understand the concept of death
a) parents may be at different stages in dealing with child's death c) dying child may become clingy and act like a toddler e) death of a child may have long-term disruptive affects on family f) Child doesn't fully understand the concept of death *b is describing adolescent and d is considered scary
Which of the following foods is richest in iron? a) shrimp b) baked potato w skin c) enriched pasta d) grapefruit
a) shrimp *other ex: meats, tofu, green veggies, beans, nuts, grains, dried fruit *iron, folic acid, and vitamin b12 are important for RBC production
An important nursing consideration when caring for a child w sickle cell anemia is which of the following? a) teach the parents and child how to avoid triggers b) refer the parents and child for genetic counseling c) help the family adjust to short term diseas d) observe for complications of multiple blood transfusions
a) teach the parents and child how to avoid triggers *chronic long term disease
Which of the following statements demonstrates by a mother of an 8 mos old child w/ iron-deficiency anemia demonstrates an understanding of this disorder? a) "I will mix the iron sulfate in her morning bottle of formula" b) "I will make sure to include infant cereal in her diet each day" c) "I will give the iron sulfate w/ a meal to improve absorption" d) "My baby may be prone to diarrhea due to the meds"
b) "I will make sure to include infant cereal in her diet each day" *infants should be introduced to solids by 6 mos like cereal, which is usually is fortified w iron *meals do not help w absorption; only take w meals if GI upset *iron may cause constipation
What should the nurse NOT do when performing an abd assessment and palpates a mass? a) assess for other symptoms of cancer b) continue palpating mass to determine size of potential tumor c) report this abnormal finding to physician d) get complete pt hx
b) continue palpating mass to determine size of potential tumor *don't keep palpating mass bc could cause tumor cells to shed off and spread cancer (metastasis)
Which of the following precautions should be taken when pt has bleeding condition? a) apply minimal pressure after injection of venipuncture b) do not take rectal temp c) give injections rather than start IV d) use NSAID for pain relief
b) do not take rectal temp *avoid or minimize invasive procedures and do not give NSAIDs b/c increase risk of bleeding
Morphine 2 mg IV q 2 hrs for pain is ordered for 12 yr old who just had abd surgery. Which is most appropriate nursing action? a) ask physician for an oral pain med b) encourage use of IS every hr during day and when awake at night c) give morphine over 1 hr in syringe pump d) give morphine w Benadryl to prevent itching
b) encourage use of IS every hr during day and when awake at night *to help w lung expansion to prevent pneumonia and atelectasis
Which statement best describes the technique to feed an infant w cleft lip? a) thicken feeding and enlarge nipple opening to allow for easier delivery b) feed upright and slowly, slowing for frequent breaks c) lay the infant on his right side to prevent aspiration d) give small, frequent feedings to prevent aspiration
b) feed upright and slowly, slowing for frequent breaks
You are the nurse caring for following pts. Which pt would you assess 1st a) 12 yr old w sickle cell anemia in vaso-occlusive crisis rating pain 8/10 b) 7 yr old diagnosed w hemophilia A w right knee bleed rating his pain 4/10 on FACES scale c) 2 yr old w sickle cell anemia in vaso-occlusive crisis w RR of 46 bpm d) 3 yr old w ITP w platelet count of 50,000
c) 2 yr old w sickle cell anemia in vaso-occlusive crisis w RR of 46 bpm *Normal RR for 1 yrs: [25-40] and 3 yrs: [20-30] *tachypneic concerned w oxygenation; could be from complication acute chest syndrome
Nurse overhears the parent of a critically injured child who is praying at the child's bedside say "I will stop drinking and smoking". The nurse understands that the parent is in which stage of grieving process a) denial b) acceptance c) bargaining d) anger
c) bargaining
Which of the following would the nurse teach a family indicating that a child is near death? (select all apply) a) warm, pink skin b) bradypnea and dyspnea c) cheyne stokes respiration d) death rattle e) agitation or restlessness f) unconscious
c) cheyne stokes respiration d) death rattle e) agitation or restlessness f) unconscious *will have cool clammy skin, tachypnea and dyspnea, grunting or moaning, loss of sensory functions
Parents of a 10 yr old with in operable brain tumor insist that the child not be informed of his condition. Parents are reluctant to tell a child he's dying due to: a) fear b) anger c) denial d) shock
c) denial *could also be a)fear bc afraid of scaring child
When should nurse contact physician when caring for post op pt who had GI surgery and returned to unit 5 hrs ago? a) has not voided b) has small amount of redness along entire incision c) only has oral pain meds ordered d) oral temp 98.6 F (37 C)
c) only has oral pain meds ordered
The nurse is assigned to a child w/ ALL who has a platelet count of 35,000. The nurse should implement which of the following interventions? a) all visitors should be discouraged from coming to the hospital b) isolation precautions should be started immediately c) provide a soft toothbrush for mouth care d) Monitor child's VS, including BP q 4 hrs
c) provide a soft toothbrush for mouth care *low platelet count (normal 150,000-400,000) so at increased risk for bleeding
If nurse if taking care of severely neutropenic pt w ANC of 50, what new pt assignment would be the least concerning? a) pt w/ MRSA b) pt w/ cdiff c) pt going for orthopedic surgery d) pt w/ rsv
c) pt going for orthopedic surgery *as long as pt does not have an infection
What might concern a nurse for pt who has low WBC count and is in neutropenic precautions? (select all apply) a) pts parents wash hands when entering room b) pts parents don't wear mask when visiting c) pts friends bring flowers d) pts mom thoroughly cleaned, pealed and cooked apples to make applesauce e) pt has delivery for fruit basket from aunt
c) pts friends bring flowers e) pt has delivery for fruit basket from aunt *no live plants, fresh flowers, fresh raw fruits/veggies, sushi or other items that transmit infection *pts family should be performing meticulous handwashing but don't have to wear a mask if not sick
Which of the following interventions by the nurse should have the highest priority for the family following the death of their child? a) verbalizing sorrow and sadness for the loss of their child b) discouraging the family from holding or touching their child c) asking the family to immediately leave the room so that all medical equipment can be removed d) allowing the family to be alone with her child
d) allowing the family to be alone with her child
The nurse should qs which order written by the physician treating a 10yr old boy w sick cell who was just admitted w Vaso-occlusive crisis a) morphine sulfate PCA: 1 mg/hr basal rate and 0.5 mg bolus every 10 mins b) iv fluids of D5 0.45NS at 2x maintanence rate c) oxygen at 1-2 l/min by NC to keep O2 >93% d) ambulate in hall 4x/day
d) ambulate in hall 4x/day *should be bedrest
Which of the following is the priority problem for pt w/ leukemia? a) pain b) nutritional deficit c) bleeding d) infection
d) infection *greatest risk for infection b/c immature WBC
Which is the best description of a neutrophil? a) make antibodies against previously "seen" substances b) secrete histamine c) help clot blood d) line blood vessels in order to defend against infection
d) line blood vessels in order to defend against infection *type of WBC that increases w/ bacterial infection *lymphocytes make antibodies, basophil release histamine, platelet help clot blood
What may be prescribed to prevent infection by stimulating WBC count?
neupogen
What are common sites for infiltration of leukemia?
testicles, spinal cord, and bone marrow
