Peds - Hematology/ Oncology

The parent of a child with Down syndrome calls the nurse and reports 3 weeks of a lack of energy, limping, and weight loss in the young child. What is the most appropriate response by the nurse?

"Bring your child to the primary health care provider to be examined"

Parents tell the nurse who is admitting their infant for a well-child exam that they recently saw a "white glow" in their child's left pupil. What is the nurse's best response?

"I will report this to the pediatrician"

The nurse is reinforcing teaching with a group of caregivers of children diagnosed with iron-deficiency anemia. One of the caregivers tells the group "I give my child ferrous sulfate." Which statement made by the caregivers is correct regarding giving ferrous sulfate?

"My husband gives our daughter orange juice whne she takes her ferrous sulfate, so she gets vitamin C"

A nurse is conducting a class to the group of parents on sickle cell anemia. Which statement by a parent indicate teaching has been effective?

"The sickle shape of red blood cells decreases oxygen to tissues"

The nurse is caring for a 13 year old girl with von Willebrands disease. After teaching the adolescent and her parents about this disorder and care, which response by the parents indicates a need for additional teaching?

"We should administer desmopressin as often as needed"

The nurse is preparing to post a sign about the crib of an infant with Wilms tumor. Which statement shoudl the nurse post?

"do not palpate the abdomen"

What is the volume of average blood transfusion?

10 mL/kg

What is the average range for Hgb?

11-12.5 g/dL

How long should you initially monitor a child for when giving a blood transfusion?

15-20 minutes

What is the average platelet count?

150,000-450,000

What are leukemia diagnostics looking for?

3 cell lines down (pancytopenia)

What is the average range for RBCs?

3.2-5.3

What is the average range for Hct?

35-45%

What is the average ratio of Hct to Hgb?

3:1

Infants get how much iron daily from their mother before birth that they store in their hemoglobin that should last them 4-6 months?

4 mg/day

What is the rate of blood transfusion?

5 mL/ kg/ hour

What is the average WBC count?

5,000-13,000

Which initial volume of blood transfusion should you administer slowly?

50 mL

What is the avergae WBC count for newborns?

900-30,000 mm3

Which ANC is indicative of neutropenia and severe neutropenia?

<1000, <500

The nurse is assessing children in an ambulatory clinic. Which child would be the most likely to have iron-deficiency anemia?

A 15 year old adolescent who has a heavy menstrual period

_____ is a medication given via central venous line to stimulate bone marrow to produce RBC/ WBCs.

ATG

______ is a medication given to treat tumor lysis syndrome that blocks uric acid formation

Allopurinol

_____ is given for aplastic anemia to stimulate erythropoiesis. It may cause early puberty in boys.

Androgen Steroid Therapy

What is the BSA hydration requirement formula?

BSA x 1600 = mL/day

What type of cells become mast cells in tissues, releases histamine during healing, and allows WBCs to exit vessel at point of injury?

Basophils

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 jaundice. This observation alerts the nurse to the likelihood that this child has which disorder?

Beta Thalassemia

_____ is an autosomal recessive disease of Mediterranean descent in which abnormal beta chains produce hemoglobin that is unstable and RBCs that are easily destroyed.

Beta Thalassemia

______ is best if done early before multiple transfusions which increase WBC + HLA antigens when donor is available

Bone marrow transplants

_______ is the leading cause of death with Beta Thal.

Cardiomegaly

_____ is a medication given to oncologic patients in which you should monitor their urine d/t possibility of hemorrhagic cystitis.

Cytoxan

______ is an anti-diuretic hormone given to decrease urianry output. You should monitor the urine of these patients.

DDAVP

_____ is a medication used along with iron supplements given SQ by pump overnight to prevent free-iron release with RBC destruction from building up in tissues. You should give folic acid with this medication.

Desferal

What type of cells increase with parasitic infections, allergic reactions, and help to dissolve clots?

Eosinophils

What is the gold standard for diagnosis of sickle cell anemia?

Hemoglobin electrophoresis

____ is a bleeding disorder where there is a deficiency in coagulation factors that mostly affects males

Hemophilia

During a physical exam of a 13 year old boy, the nurse observes a single, enlarged rubbery feeling cervical lymph node in the armpit. The boy reports unexplained loss of weight and malaise. Which condition should the nurse most suspect in this client?

Hodgkins lymphoma

______ is a lymphatic cancer that is common in teenagers.

Hodgkins lymphoma

What medication may be given midway through a blood transfusion in order to prevent fluid overload?

Lasix

What is the antidote to methotrexate?

Leucovorin

_______ is the most common childhood cancer that is characterized by low WBC at diagnosis.

Leukemia

What type of cells increase with viral infections and are vital to cell-mediated immunity?

Lymphocytes

_____ is a medication given to oncologic patients that when given in high doses may be dangerous.

Methotrexate

What type of cells are phagocytes that increase with chronic inflammation?

Monocytes

What should patients with hemophilia avoid?

NSAIDS, IM injections, contact sports

____ is an oncologic medication that is a bone marrow stimulant

Neupogen

Which cancer is known as the silent cancer and is characterized by supraorbital ecchymosis aka raccoon eyes?

Neuroblastoma

What is treatment for hemophili?

RICE + factor replacement

Which cancer is characterized by the cat's eye reflex aka leukocoria?

Retinoblastoma

When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a splenectomy, which would the nurse identify as a priority?

Risk for infection

_____ could occur 7-14 days after transfusion similar to anaphylactic reaction. You should give steroids to prevent this.

Serum sickness

______ is an autosomal recessive disorder where Hgb A is replaced by Hgb S and the Hgb crystallizes into a cresent shape leading to obstruction and severe pain and hypoxia.

Sickle Cell Anemia

The nurse is talking with a 9 year old child diagnosed with acute leukemia who will soon begin chemo. The child expresses worry taht when her hair falls out friends won't like her or want to play with her anymore. Which response by the nurse would be best?

Talk with her and her family about wearing a wig, cap, or scarf

______ is the term used for low platelet count, usually characterized by petechiae in the mouth or around the eyes.

Thrombocytopenia

Which crisis is the most common type of sickle cell crisis?

Vaso-occlusive

_____ is an oncologic medication that may cause foot drop or constipation

Vincristine

______ is an inherited bleeding disorder where there is a deficiency in the Von Willebrand factor protein that is characterized by prolonged bleeding time.

Von Willebrands

_____ should be given before chemotherapy treatments

Zofran/ antiemetics

Wilms tumor is suspected in a 5 year old child. Which action should be avoided?

abdominal palpation

Which nursing interventions are appropriate for the plan of care designed for a child diagnosed with hemophilia who is experiencing an episode of active bleeding?

administering acetaminophen as prescribed for pain, applying splints to extremities, scheduling physical therapy for 48 hours after bleeding stops, encouraging self performance of active range of motion exercises

When are babies allowed cows milk?

after 1 year old

What is the treatment for TLS?

allopurinol

A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to manage a bleeding episode?

apply heat to the site of bleeding

A child being treated for leukemia is diagnosed with neutropenia. What nursing instructions directly prevent client infections?

avoid large crowds, inspect skin daily for scratches and scrapes, remove house plants, flowers, and goldfish from the home, stay away from people who are sick

What is the function of Hgb?

binds to and carries oxygen to tissues

If iron supplements are working, what will result?

black tarry stools

What are symptoms of hemophilia?

bleeding, hemarthritis, occult blood in stools, hematuria, epistaxis

The nurse is examining a child who was diagnosed with acute lymphoblastic leukemia (ALL) 6 months ago. The child exhibits pallor, ecchymosis, and petechiae. The nurse interprets these findings as indicating that the cancer has invaded which part of the body?

bone marrow

What is the most common type of solid tumor in children?

brain tumors

What are the symptoms of Beta Thalassemia?

bronze skin, freckling, organomegaly, pain, fever, bone hypertrophy, enlarged maxilla, osteoporosis

How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old?

call it a tumor of muscle tissue

What is the function of red blood cells?

carries hemoglobin which carries oxygen to tissues, CO2 to lungs, and help maintain pH

Which levels are elevated in neuroblastoma patients?

catecholamines, and vanillymandelid acid and homovanillic acid

Intratentorial tumors occur where?

cerebellum

Supratentorial tumors occur where?

cerebrum

Which sxs may indicate an MI in sickle cell patients?

chest pain, does not alleviate with movement

What should be given for neutropenia?

colony stimulating factors

What does cerebrospinal fluid look like?

colorless drainage

A nurse is providing care to a child with hemophilia who is experiencing muscle and joint involvement related to the bleeding. Which intervention will the nurse include as an adjunctive measure to control bleeding?

compression

If a patient has milk baby syndrome, what instructions will we give the parents?

cut milk down to 1 liter per day

What are interventions for Beta Thal?

desferal, transfusion to maintain Hgb, vitamin C, protect spleen from injury, prophylactic abx after splenectomy

What is the most important teaching about Wilms tumors?

do not palpate the abdomen, post signage about bed that states this

What are brain tumor symptoms?

early morning headache, vomiting that leads to projectile vomiting, neurologic changes, seizures, increased ICP, cranial nerve malfunction, vision changes

The nurse is instructing the parents of a child with sickle cell anemia on safety precautions. What should the nurse emphasize during teaching?

ensure a consistent and daily intake of adequate fluids to prevent dehydration

What are symptoms of leukemia?

fever, URIs, fatigue, palor, irritability, anorexia, bruising, petechiae, bleeding, bone pain, vague abdominal pain

What are some things that may trigger a sickle cell crisis?

fever, metabolic acidosis, hypoxia, dehydration

What are extreme symptoms of iron defiency anemia?

glossitis, angular stomatitis, koilonychia, impaired cognitive function

Which sxs may indicate a stroke in sickle cell patients?

headache, impaired speech, visual disturbances, seizures, weakness, cannot function on one side

In a patient with Beta Thalassemia, once ______ has occurred, it is irriversible.

hemachromatosis

What is the number one priority for sickle cell patients?

hydration

Which fluids should be given to brain tumor patients?

hypertonic fluids, like Mannitol

What can cause low iron?

inadequate intake, poor absorption, increased loss/ demand

The nurse is doing a health history for a 14 year old pregnant girl during a health supervision visit. For which condition should she be screened?

iron-deficiency anemia

Why is demerol not given to sickle cell patients for pain?

it may cause seizures

What are symptoms of tumor lysis syndrome?

low specific gravity, low calcium, high phosphorus, high potassium

Which sxs may indicate acute chest syndrome in sickle cell patients?

lung pain, SOB, dyspnea, congestion, cough

A school-aged child is admitted to the hospital with vaso-occlusive sickle cell crisis. Which measure in the child's plan of care should be given priority?

maintaining fluids through IV

What is important patient teaching for patients receiving radiation therapy?

major skin changes may occur so hygiene is crucial, no harsh chemicals like certain soaps and use sunscreen

Which type of cells increase with acute inflammation?

nuetrophils

What would a child with Milk Baby syndrome look like?

pale, wheezy

A 5 year old boy is diagnosed with congenital aplastic anemia. Which symptoms should be considered when developing the plan of care?

pallor, fatigue, easy bruising, cyanosis

The nurse is assessing a child and notices pinpoint hemorrhages appearing on several different areas of the body. The hemorrhages do not blanch on pressure. The nurse documents the finding as:

petechiae

Why do adolescents have a higher incidence of iron-deficiency anemia?

poor diet, menstruation, rapid growth

What are symptoms of Von Willenbrands?

prolonged bleeding time, nosebleeds, gingival bleeding, easy bruising, excessive menstrual flow

The nurse develops a meal plan for a child with iron-deficiency anemia. Which meal would the nurse teach the parent has the highest amount of iron?

red meat, eggs, oatmeal, dried fruit

Which foods are Fe rich?

red meat, green leafy vegetables

A nurse is caring for a 12 year old girl who is recovering from surgery for removal of a brain tumor. Which intervention should the nurse implement to avoid increasing intracranial pressure?

regulate the rate of IV fluid infusion carefully

Why is a follow-up so important in patients with Hodgkins?

secondary malignancy rate is high

The nurse is administering meperidine as ordered for pain management for a 10 year old boy in sickle cell crisis. The nurse would be alert for:

seizures

Which hematologic diseases may require splenectomy?

sickle cell, beta thalassemia, aplastic anemia

What are interventions for nosebleeds?

sit upright, lean forwards, pressure on nose for 10 minutes, pack with cotton, apply ice

What should you do if a reaction occurs when giving a blood transfusion?

stop the transfusion, maintain airway, nolus 500 mL NS, call doctor

What is important education for taking iron supplements?

take between meals, if it causes GI upset may take with meals, take with Vitamin C, avoid tanins

What are symptoms of iron-deficiency anemia?

underweight, palor, fatigue, muscle weakness

What are symptoms of Hodgkins?

weight loss, fever, night sweats

Which type of cells are also called leukocytes and are necessary for immunity?

white blood cells

What diagnostic result would you expect in a patient with aplastic anemia?

yellow, fatty bone marrow aspiration

The nurse is preparing to send a child with cancer for a radiation treatment. Which medication should the nurse provide to premedicate the child for this procedure?

zofran (antiemetic)