cellular regulation
prognosis of leukemia is based on what
WBC count
The nurse is caring for a variety of pediatric clients in the community health clinic. Which client is the nurse most concerned with being at risk for iron-deficiency anemia?
a 16-year-old, pregnant for the first time and lives with her parents
acute febrile illness
a sudden fever or elevation in body temperature
two main types of leukemia
acute lymphocytic leukemia (ALL) and Acute myelocytic leukemia (AML)
the child will become ______ during leukemia
anemic and thrombocytopenic
pancytopenia occurs in what
aplastic anemia
symptoms of acute chest syndrome
atelactesis, chest pain, pulmonary edema, pneumonia, fever, cough
iron supplements cause what
black and tarry stools
where is leukemia found
blood and bone marrow, may spread to other sites
splenic sequestration
blood pooling in the spleen causing enlargement and possibly infarction
where are lymphoblasts located
bone marrow
most common test for lukemia
bone marrow aspiration
key tst for leukemia
bone marrow biopsy
who is at higher risk for leukemia
boys
leukemia
cancer of the bone marrow
when is iron deficiency likely to occur
during rapid physical growth and low iron intake
lymphadenopathy
enlarged lymph nodes
aplastic anemia
failure of bone marrow to produce cells
RISK FACTORS OF pernicious anemia
family history, autoimmune disorder, chrons disease, intestinal infections, HIV, medications, lack of intrinsic factor
signs and symptoms of aplastic anemia
fatigue, dyspnea, tachy, pallor, bruising, blood in stool, bloody tongue
what fluids do you give in sickle cell
hypertonic fluid because these patients hold on to sodium
lab results for aplastic anemia
low RBC, low H&H, low WBC, low platelet
A child with sickle cell anemia comes to the emergency department for evaluation. The nurse suspects that the child is experiencing a vaso-occlusive crisis based on assessment of which signs and symptoms? Select all that apply.
low back pain fever distended abdomen
pernisious anemia lab results
low hgb&hct, low retic, high MCV, low B12
Thrombocytopenia
low platelet count
nadir
lowest neutrophil count
what do you avoid with iron supp
milk and calcium
general nursing interventions for sickle cell disease
monitor vital signs, assess respiratory status (high RR, increased WOB, low O2), altered LOC, monitor visitors
side effects of leukemia treatment
nadir, anemia, thrombocytopenia, mucositis, stomatitis, nausea and vomiting, constipation, hair loss, hepatotoxicity and nephrotoxicity
neutropenia occurs when
nutrophils are under 1500
CVA symptoms indicate what sickle cell disease
occlusion in the brain
milk of how much per day contributes to IDA
over 24 ounces a day
first nursing intervention for sickle cell
oxygenation, monitor for chest pain, ensure adequate gas exchange
most common reason for hospitalization sickle cell
pain episodes, vaso occlusion
third nursing intervention sickle cell
pain management
signs and symp of splenic enlargement
pallor, fatigue, abdominal pain, enlarged spleen
what happens during leukemia
proliferation of immature white blood cells
monitor for what in acute febrile illness
temp above 101.5, bacteria speticemia
splenic disfunction begins when sickle cell
6 months old
Following bone marrow aspiration of a client, analysis reveals more than 20% immature blast cells. Platelet counts are 9000/mm³. What nursing interventions should the nurse employ for the care of this client? Select all that apply.
Assess for mental state changes. Administer prescribed docusate daily.
treatment for pernicious anemia
B12 shots or pills, diet high in B12
sickle cell disease
Genetic disorder in which red blood cells have abnormal hemoglobin molecules and take on an abnormal shape.
what tests are done in leukemia
LFT and BUN
A nurse is caring for a patient who has a diagnosis of acute leukemia. What assessment most directly addresses the most common cause of death among patients with leukemia?
Monitoring for infection
A pediatric client is being screened for a macrocytic anemia? Which types of diagnosis would be considered? Select all that apply.
Pernicious anemia and anemia of folic acid deficiency
eventually what becomes affected in leukeimia
RBC and platelet function
hand foot syndrome
Swelling in the hands and feet usually is the first symptom of SCD. This swelling, often along with a fever, is caused by the sickle cells getting stuck in the blood vessels and blocking the flow of blood in and out of the hands and feet. Treatment: The most common treatments for swelling in the hands and the feet are pain medicine and an increase in fluids, such as water.
food high in B12
1. shellfish 2. liver(ORGAN MEAT) 3. Green leafy vegetables 4. Yeast 5. Milk 6. Cheese Pt who are vegan will have beefy red tongue
peak incidence of leukemia
2-10 years of age
how long is treatment for leukemia
2-3 years
normal ANC count
2000
hemoglobin levels
6-11
acute chest syndrome
A symptom associated with sickle cell anemia where sickle cells get trapped in the lung and cause infection
The registered nurse (RN) and licensed practical nurse (LPN) are preparing an educational program for clients who may be at risk for the development of iron-deficiency anemia. Which client(s) would receive the greatest benefit from this program? Select all that apply.
An adolescent with bulimia nervosa An older adult client on a fixed income A client with Crohn's disease
The nurse is caring for a child admitted with suspected leukemia. The nurse has taken the child's history and performed an assessment. The nurse will plan to prepare the child for which additional diagnostic test first?
CBC
A 7-year-old girl has been battling leukemia and receiving radiation therapy. She is highly susceptible to infections, and the nurse recognizes that this is because she is experiencing secondary immunodeficiency. What factors cause secondary immunodeficiency? Select all that apply.
Cancer Radiation therapy Severe stress Malnutrition
calcium binds to
IRON
when to give and what to give iron with
calcium and before meals
exposure to what can cause aplastic anemia
chemicals and toxins and pesticides
more tests for leukemia
chest x ray and lumbar puncture
early symptom of sickle cell
dactylitis
signs and symptoms of IDA
fatigue, lethargu, pallor, spoon nails, tachy, decreased oxygen level
second nursing intervention for sickle cell
fluid and electrolyte: assess for dehydration, urine output, fluid requirements
maintenance phase of leukemia
given over 2-3 years to maintain remission
consolodation phase of leukemia
given to prevent the disease from going to other parts of the body
nursing interventions for leukemia
handwashing, preventing infection, PO care, antiemetics
what additional risks should the nurse consider most on leukemia patient after infection
hemorrhage
pernicious anemia
inability of body to produce enough RBC's due to low B12
IDA often occurs as a result of
increased milk intake
three phases of leukemia
induction, consolodation, and maintenence
what is the most common cause of vaso occlusive crisis
infection
A nurse is teaching the parents of a child with sickle cell disease. The nurse determines that the teaching was successful when the parents identify which conditions as factors that predispose the child to a sickle cell crisis? Select all that apply.
infection and cold air temperature
most common nutritional anemia
iron deficiency
labs in order prior to administering chemo
renal function test, liver function test, H&H, platelet count, electrolyte count, WBC count
A nurse is preparing to discharge an adolescent with sickle cell anemia. What client need should the nurse emphasize in the discharge assessment?
the need for an adequate support structure
most common childhood cancer
leukemia
lab results for IDA
low HGB, HCT, MCV, MCH, MCHC, iron and ferritin
hypochronia
low blood volume
symptoms of pernicious anemia
nerve damage, osteoperosis, neuro problems, nausea, smooth thick red tongue, loss of appetite
induction phase of leukemia
patient is hospitalized for one month to immediatley induce remission
what is given for splenic disfunction
penicillin
Which signs and symptoms of leukemia would lead the nurse to suspect the client has thrombocytopenia? Select all that apply.
petechiae and epistaxis
A nurse is teaching the parents of a child with a hematologic disorder about ensuring proper nutrition. The nurse determines that the parents have understood the teaching when they identify which food as high in vitamin B12?
poultry
microcytosis
presence of small red blood cells
nursing management of IDA
promoting safety, ensuring adequate iron intake, education
what to teach parents IDA
proper nutrition and follow up with CBC and reticulocyte count
signs and symptoms of leukemia
purpura, bruising, pallor, fever, fatigue, weight loss, bone pain, enlarged spleen and liver, lymphadenopathy
iron sources in diet
red meat, fish, eggs, tofu, enriched grains, beans, leafy greens, dried fruits
complications of aplastic anemia
severe infection, hemorrhage, and death
what needs to be functioning properly before giving chemo
the kidneys
how long do people take iron supp
three months three times a day
reason for lumbar puncture in children
to see if the cancer has spread to the CSF
what is the purpose for allupurinol
it removes uric acid from the killed cells caused by chemo
treatment for splenic enlargement
iv fluids, RBC transfusion
anemia
lack of a normal number of red blood cells
what is the reason for prednisone in leukemia
prednisone alters the mitosis of the cancer cells
drugs for leukemia
prednisone, allupurinol and IV fluid, chemo agents
low platelet in aplastic amount
under 20,000
labs for leukemia
very low or very high WBC, low HGB, HCT, platelets
