Ch 46 - Hematologic or Neoplastic Disorder

intravenous immune globulin (IVIG)

* given for Idiopathic thrombocytopenic purpura - IVIG simply provides extra antibodies that your body cannot make on its own. IVIG also provides a wide range of antibodies to help fill in for those your own immune system has not encountered.

Neutropenia

- Neutropenia is when a person has a low level of neutrophils. - Neutrophils are a type of white blood cell. - All white blood cells help the body fight infection. - Neutrophils fight infection by destroying harmful bacteria and fungi (yeast) that invade the body. - Neutrophils are made in the bone marrow.

signs of changes in hematologic system are often subtle and over looked. What are some of the first signs of a problem developing

- color changes in skin such as pallor, bruising and flushing - changes in mental status such as lethargy - decrease oxygenation to the brain

according to the American Academy of Pediatric, what is the recommended action for blood lead level of 20 to 44 mg/dL?

1. confirm the level with a repeat lab within 1 week 2. educate family to decrease lead exposure

three way how childhood cancer differs from adult cancer

1. most common sites of childhood cancer are blood, lymph,brain,bone,kidney,muscle. 2. environmental factors have a strong influence on the cause of adult cancers versus minimal influence on child cancer 3. childhood cancer are typically very responsive

When providing care to a child with aplastic anemia, which nursing diagnosis most likely would be the priority? A) Risk for injury B) Imbalanced nutrition, less than body requirements C) Ineffective tissue perfusion D) Impaired gas exchange

A) Risk for injury

Idiopathic thrombocytopenic purpura

Antiplatelet antibodies

Mean Platelet Volume (MPV)

Assesses platelet volume and size

The nurse is assessing a child with suspected thalassemia. Which of the following would the nurse expect to assess? A) Dactylitis B) Frontal bossing C) Presence of clubbing D) Presence of spooning

B) Frontal bossing (prominent forehead)

A nurse is providing care to a child with idiopathic thrombocytopenic purpura with a platelet count of 18,000/mm3. Which medication would the nurse most likely expect to be ordered? A) Folic acid B) Intravenous immune globulin C) Dimercaprol D) Deferoxamine

B) Intravenous immune globulin * for children with platelet counts bellow 10,000 corticosteroids may be administered for 2 to 3 weeks * In acute or chronic ITP, Intravenous immune globulin may be used as an adjunct and is infused for 1 to 2 days

The nurse is teaching the parents of a child with a hematologic disorder about the functions of the various blood cells. The nurse determines that the teaching was successful when the parents state which blood cell as being primarily responsible for blood clotting? A) Granulocytes B) Erythrocytes C) Thrombocytes D) Leukocytes

C) Thrombocytes (platelets)

chelation therapy

Chelation therapy is a medical procedure that involves the administration of chelating agents to remove heavy metals from the body. can remove iron

Factor VIII

Hemophilia A * an essential blood-clotting protein, also known as anti-hemophilic factor (AHF)

thalassemia

Inherited defect in ability to produce hemoglobin

The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myelogenous leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately? a) Earache, stiff neck, or sore throat b) Blisters, ulcers, or a rash appear c) Temperature of 101° F (38.3° C) or greater d) Difficulty or pain when swallowing

Temperature of 101° F (38.3° C) or greater because many chemotherapy drugs cause bone marrow suppression. Parent must take action at first sign of infection

anemia is the reduction of RBC or hemoglobin in the total blood ______

VOLUME

asplenia

absence of a spleen or of spleen function

Granulocytes

basophils:produce histamine in response to allergic attack eosinophils:produce anti-histamine when the allergic reaction has overcomed. neutrophils: phagocytes which are included in 2nd line defense. They engulf and ingest bacteria rapidly

chelating agents

blood lead levels greater than 45

Clubbing is a sign of

chronic hypoxemia

Hemogram

complete blood count

aplastic anemia

failure of blood cell production in the bone marrow

Thalassemia

inherited defect in ability to produce hemoglobin, leading to hypochromia * to much iron in them

Wilms tumor

malignant tumor of the kidney occurring in childhood

Mean Corpuscular Volume (MCV)

measure of average size of the RBC (Indicates the oxygen-carrying capacity of blood)

Agranulocytes

monocytes:similar to neutrophils. They destroy bacteria lymphocytes: B lymphocytes produce antibodies to attack specific viruses, bacteria, and other foreign invaders. T lymphocytes help to identify cells that require an immune response

penicillin is given for

prophylaxis of infection in asplenia

Deferoxamine

used to treat acute iron toxicity

Hemophilia

A hereditary disease where blood does not coagulate to stop bleeding

When evaluating the hemogram of an 8-month-old infant, the nurse would identify which type of hemoglobin as being the predominant type? A) Hemoglobin A B) Hemoglobin F C) Hemoglobin A2 D) Hemoglobin S

A) Hemoglobin A *after 6 months of age hemoglobin A is the predominant type

The nurse is caring for a 13-year-old girl with von Willebrand disease. After teaching the adolescent and her parents about this disorder and care, which response by the parents indicates a need for additional teaching? A) "We need to administer Stimate prior to dental work." B) "We should be aware that she may suffer from menorrhagia." C) "We should administer desmopressin as often as needed." D) "We understand that she may have frequent nosebleeds."

C) "We should administer desmopressin as often as needed." 24 hours should lapse between doses

A 14-year-old with thalassemia asks for your assistance in choosing her afternoon snack. Which choice is the most appropriate? a. peanut butter with rice cake b. small spinach salad c. apple slices with cheddar cheese d. small burger on wheat bun

C. Children with thalassemia should avoid foods that are high in iron. *Spinach, peanut butter, a burger, and whole-grain bread are high in iron. Apples and cheese are not.

A child with leukemia has the following AM laboratory results: Hgb 8.0, Hct 24.2, WBC 8,000, platelets 150,000. What is the priority nursing assessment? a. Monitor for fever. b. Assess for bruising or bleeding. c. Determine intake and output. D. Assess for pallor, fatigue, and tachycardia.

D. The Hgb and Hct indicate anemia, which results in fatigue, pallor, and tachycardia.

spooning of nails

iron deficiency

the most frequently occurring type of childhood cancer?

leukimia

An adolescent weighing 55 kg is admitted to the hospital experiencing a sickle cell crisis. Intravenous fluid therapy as well as increased oral fluids are ordered as part of his treatment plan. Based on the understanding of the amount of fluids needed to promote hemodilution, the nurse would expect the adolescent to receive how much total fluid in 24 hours? __________ mL

8,250

The nurse is caring for a child with thalassemia who is receiving chelation therapy at home using a battery-operated pump. After teaching the parents about this treatment, which statement by the mother indicates a need for additional teaching? A) "I can have the nurse administer the chelation therapy if I am uncomfortable." B) "I must be very careful to strictly adhere to the chelation regimen." C) "The deferoxamine binds to the iron so it can be removed from the body." D) "The medication can be administered while my child is sleeping."

A) "I can have the nurse administer the chelation therapy if I am uncomfortable." *the nurse wont be leaving with them

The nurse is assessing a child with aplastic anemia. Which of the following would the nurse expect to assess? Select all that apply. A) Ecchymoses B) Tachycardia C) Guaiac-positive stool D) Epistaxis E) Severe pain F) Warm tender joints

A) Ecchymoses B) Tachycardia C) Guaiac-positive stool D) Epistaxis

The nurse is developing a plan of care for a child with thalassemia. Which of the following would the nurse expect to include? Select all that apply. A) Packed RBC transfusions B) Deferoxamine therapy C) Heparin therapy D) Opioid analgesics E) Platelet transfusions F) Intravenous immunoglobulin

A) Packed RBC transfusions B) Deferoxamine therapy

The nurse is conducting a physical examination of a toddler with suspected lead poisoning. Lab results indicate blood lead level 52 mg/dL. Which action would the nurse expect to happen next? A) Repeat testing within 2 days and prepare to begin chelation therapy as ordered B) Repeat testing within 1 week with education to decrease lead exposure C) Confirm with repeat testing in 1 month and referral to local health department D) Prepare to admit child to begin chelation therapy

A) Repeat testing within 2 days and prepare to begin chelation therapy as ordered

The mother of a 5-year-old girl brings the child to the clinic for an evaluation. The mother tells the nurse, "She seems to be so tired and irritable lately. And she looks so pale." Further assessment reveals pale conjunctiva and oral mucous membranes. The nurse suspects iron-deficiency anemia. Which additional finding would help provide additional evidence for this suspicion? A) Spooned nails B) Negative splenomegaly C) Oxygen saturation: 99% D) Bradycardia

A) Spooned nails

The nurse is teaching the parents of a child diagnosed with iron-deficiency anemia about ways to increase their child's intake of iron. The parents demonstrate understanding of the teaching when they identify which foods as good choices for the child? Select all that apply. A) Tuna B) Salmon C) Tofu D) Cow's milk E) Dried fruits

A) Tuna B) Salmon C) Tofu E) Dried fruits

A group of students are reviewing information about glucose-6-phosphate dehydrogenase (G6PD) deficiency. The students demonstrate understanding of the material when they identify this disorder as due to which of the following? A) X-linked recessive inheritance B) Deficiency in clotting factors C) An excess supply of iron D) Autosomal recessive inheritance

A) X-linked recessive inheritance

A child with leukemia received chemotherapy about 10 days ago. She presents today with a temperature of 100.4°F, an absolute neutrophil count of 500, and mild bleeding of the gums. What is the priority nursing intervention? a. Administer IV antibiotics as ordered. b. Provide vigorous oral care frequently with a firm toothbrush. c. Monitor pulse and blood pressure for changes. D. Administer packed red blood cell transfusion.

A. The neutropenic child must have IV antibiotics started as soon as possible in the event of fever to prevent overwhelming infection and sepsis.

The nurse is caring for a child who has just been admitted to the pediatric unit with sickle cell crisis. He is complaining that his right arm and leg hurt. What is the priority nursing intervention? a. Administer pain medication every 3 hours intravenously until pain is controlled. b. Perform passive range of motion of the arm and leg to maintain function. c. Try acetaminophen for pain first, moving up to opioids only if needed. d. Use narcotic analgesics and warm compresses as needed to control the pain.

A. The priority in a sickling crisis is to bring pain under control quickly as this brings the child relief; also, the significant stress resulting from pain can contribute to the further sickling of cells.

A nurse is leading a discussion with a group of new mothers about newborn nutrition and its importance for growth and development. One of the mothers asks, "Doesn't the baby get iron from me before birth?" Which response by the nurse would be most appropriate? A) "You give the baby some iron, but it is not enough to sustain him after birth." B) "Because the baby grows rapidly during the first months, he uses up what you gave him." C) "The iron you give him before birth is different from what he needs once he is born." D) "If the baby didn't use up what you gave him before birth, he excretes it soon after birth."

B) "Because the baby grows rapidly during the first months, he uses up what you gave him."

The nurse is caring for a 12-year-old boy with idiopathic thrombocytopenia. The nurse is providing discharge instructions about home care and safety recommendations to the boy and his parents. Which response indicates a need for further teaching? A) "We should avoid aspirin and drugs like ibuprofen." B) "He can resume participation in football in 2 weeks." C) "Swimming would be a great activity." D) "Our son cannot take any antihistamines."

B) "He can resume participation in football in 2 weeks."

A child with suspected sickle cell disease is scheduled for a hemoglobin electrophoresis. When reviewing the child's history, which of the following would the nurse identify as potentially interfering with the accuracy of the results? A) Use of iron supplementation B) Blood transfusion 1 month ago C) Lack of fasting for 12 hours D) History of recent infection

B) Blood transfusion 1 month ago

A child is prescribed monthly injections of vitamin B12. When developing the teaching plan for the family, the nurse would focus on which type of anemia? A) Aplastic anemia B) Pernicious anemia C) Folic acid anemia D) Sickle cell anemia

B) Pernicious anemia

The nurse is evaluating the laboratory test results of a 7-year-old child with a suspected hematologic disorder. Which finding would cause the nurse to be concerned? A) WBC: 5.6 × 103/mm3 B) RBC: 2.8 × 106/mm3 C) Hemoglobin: 11.4 mg/dL D) Hematocrit: 35%

B) RBC: 2.8 × 106/mm3

A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. The nurse interprets this order as indicating which of the following? A) The child requires a prophylactic dose of iron. B) The child has mild to moderate iron deficiency. C) The child has severe iron deficiency. D) The child is being prepared for packed red blood cell administration.

B) The child has mild to moderate iron deficiency.

A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering the iron supplement, which statement indicates the need for additional teaching? A) "She needs to eat foods that are high in fiber so she doesn't get constipated." B) "We'll try to get her to drink lots of fluids throughout the day." C) "We will place the liquid in the front of her gums, just below her teeth." D) "We need to measure the liquid carefully so that we give her the correct amount."

C) "We will place the liquid in the front of her gums, just below her teeth."

A nurse is conducting a physical examination of a 5-year-old with suspected iron-deficiency anemia. How would the nurse evaluate for changes in neurologic functioning? A) "Open your mouth so I can look inside your cheeks and lips." B) "Do you have any bruises on your feet or shins?" C) "Will you show me how you walk across the room?" D) "Let me see the palms of your hands and soles of your feet."

C) "Will you show me how you walk across the room?"

The nurse is reviewing the white blood cell differential of a 4-year-old girl. Which value would lead the nurse to be concerned? A) Bands: 8% B) Segs: 28% C) Eosinophils: 10% D) Basophils: 0%

C) Eosinophils: 10%

The nurse is reviewing the laboratory test results of a child diagnosed with disseminated intravascular coagulation (DIC). Which of the following would the nurse interpret as indicative of this disorder? A) Shortened prothrombin time B) Increased fibrinogen level C) Positive fibrin split products D) Increased platelets

C) Positive fibrin split products *laboratory testing may reveal: - prolonged PT, PTT, aPTT -Decreased level of fibrinogen increase will be noted in levels of fibrinolysis, fibrinopeptide A, positive fibrin split products and D-dimer

A child with hemophilia fell while riding his bicycle. He was wearing a helmet and did not lose consciousness. He has a mild abrasion on his knee that is not oozing. He is complaining of abdominal pain. What is the priority nursing assessment? a. Perform neurologic checks. b. Assess ability to void frequently. c. Carefully assess his abdomen. d. Examine his knee frequently.

C. The child's complaint of abdominal pain indicates that undetected bleeding may be present in the abdomen. Determining whether internal bleeding is present would take priority over the knee abrasion, which has nearly stopped bleeding.

A 5-year-old has been diagnosed with Wilms tumor. What is the priority nursing intervention for this child? a. Educate the parents about dialysis, as the kidney will be removed. b. Measure abdominal girth every shift. c. Avoid palpating the child's abdomen. D. Monitor BUN and creatinine every 4 hours

C. Excessive palpation of the abdomen in a child with Wilms tumor can cause seeding of the tumor, leading to metastasis.

A child with cancer is receiving chemotherapy, and his mother is concerned that the nausea and vomiting associated with chemotherapy are reducing his ability to eat and gain weight appropriately. What is the most appropriate nursing action? A. Administer an antiemetic at the first hint of nausea. B. Offer the child's favorite foods to encourage him to eat. C. Start antiemetic drugs prior to the chemotherapy infusion. D. Maintain IV fluid infusion to avoid dehydration.

C. Give the antiemetic prior to the chemotherapy drug to prevent nausea and vomiting

A child on the pediatric unit has morning laboratory results of Hgb 10.0, Hct 30.2, WBC 24,000, and platelets 20,000. What is the priority nursing assessment? a. Assess for pallor, fatigue, and tachycardia. b. Monitor for fever. c. Assess for bruising or bleeding. d. Determine intake and output.

C. The extremely low platelet count places the child at significant risk for bleeding, so this takes priority over borderline anemia and possibility of infection.

The nurse is caring for a child recently diagnosed with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The nurse is teaching the parents about triggers that may result in oxidative stress. Which of the following responses indicates a need for further teaching? A) "I doubt he will ever eat fava beans, but they could trigger hemolysis." B) "He must avoid exposure to naphthalene, an agent found in mothballs." C) "He must never take methylene blue for a urinary tract infection." D) "My son can never take penicillin for an infection."

D) "My son can never take penicillin for an infection." *triggers that may result in oxidative stress and hemolysis include bacterial or viral illness * also exposure to certain substances such as medication: sulfonamides, sulfones, malaria-fighting drugs (such as quinine), or methylene blue (for treating urinary tract infections), naphthalene (an agent in mothballs), or fava beans.

The nurse is caring for a 2-year-old boy with hemophilia. His parents are upset by the possibility that he will become infected with hepatitis or HIV from the clotting factor replacement therapy. Which response by the nurse would be most appropriate? A) "Parents commonly fear the worst; however, the factor will help your child lead a normal life." B) "There are risks with any treatment including using blood products, but these are very minor." C) "Although factor replacement is expensive, there's more financial strain from missing work if he has a bleeding episode." D) "Since dry heat treatment of the factor began in 1986, there have been no reports of virus transmission."

D) "Since dry heat treatment of the factor began in 1986, there have been no reports of virus transmission."

The nurse is caring for a child who has been admitted for a sickle cell crisis. Which of the following would the nurse do first to provide adequate pain management? A) Administer a nonsteroidal anti-inflammatory drug as ordered. B) Use guided imagery and therapeutic touch. C) Administer meperidine as ordered. D) Initiate pain assessment with a standardized pain scale.

D) Initiate pain assessment with a standardized pain scale.

bone cancer may be treated with a combination of ______ procedure, radiation, and chemotherapy

limb salvage