Nursing Care of Pediatric Patients: Key Concepts and Review

Comprehensive flashcards covering key topics from provided lecture notes.

Malignancies

Cells that are growing and proliferating in a disorderly fashion

Leukemia

Immature white blood cells (WBC) overgrowth

Neoplasm

Abnormal growth, either benign (growth is limited) or malignant (cancerous or with unlimited growth)

Biopsy

Surgical removal of cells for laboratory analysis

Tumor Staging

Malignant tumor's extent and progress are documented

Sarcomas

Tumors derived from connective tissue, such as bone & cartilage, muscle, blood vessels, or lymphoid tissue

TNM System

Tumor's size, any presence in the lymph nodes, cancer cells metastasized or spread to other organs

Leukemias

Distorted & uncontrolled proliferation of WBC's (leukocytes)

Acute Lymphocytic Leukemia (ALL)

Immature lymphocytes, limits production of RBC's and platelets

Acute Myeloid Leukemia (AML)

Over proliferation of granulocytes, risk for infection

Hodgkin Disease

Reed-Sternberg Cells develop (non-functioning cells)

Non-Hodgkin Disease

Malignant disorders of the lymphocytes (either B or T cells)

Osteogenic Sarcoma

Malignant tumor of long bone

Ewing Sarcoma

Bone marrow

Neuroblastoma

Tumors of the sympathetic nervous system, common in the abdomen or spinal ganglia

Rhabdomyosarcoma

Tumor of striated muscle

Nephroblastoma (Wilm's Tumor)

Malignant tumor of the kidney

Retinoblastoma

Malignant tumor of the retina of the eye

Basal Cell Carcinoma

Epithelial growth that appears as a small ulcer that does not heal

Squamous Cell Carcinoma

A tumor of the epidermis that appears as a white scaly lesion

Malignant Melanoma

A tumor originating in melanocytes or nevi that appears as a mole changing in appearance

Chief Concerns (Assessing Children with Cancer)

Weight loss, loss of appetite, easy bruising, swelling in a body part, headache, eye deviations

Physical Examination (Assessing Children with Cancer)

Swollen lymph glands, pain and swelling in a large joint, eye deviations, palpable mass in abdomen

General Signs and Symptoms of Cancer

Nausea and vomiting, weight loss, ecchymotic marks, headache, unexplained fever, bleeding/bruising, morning headaches and neurologic changes

Assessing Acute Lymphocytic Leukemia

Pallor, low-grade fever, lethargy, low thrombocyte count, petechiae, bleeding from oral mucous membranes, easy bruising on arms and legs, abdominal pain, vomiting, anorexia, bone and joint pain, headache or unsteady gait, painless, generalized swelling of lymph nodes, elevated leukocyte count, lesions on long bones, blast cells in csf

Acute Lymphocytic Leukemia Bone Marrow Aspiration

Bone marrow aspiration identifies type of wbc involved

Assessing Hodgkin Disease

One painless, enlarged, rubbery-feeling cervical lymph node followed by enlargement of other nodes and liver, spleen, bone marrow, cns, anorexia, elevated chest, sweats, sedimentation rate, anemia malaise, night

Hodgkin Disease Diagnostic Assessment

Biopsy of lymph nodes, abdominal ct, lymphangiogram

Assessing Non-Hodgkin Lymphoma

Enlarged lymph glands of neck and chest, possibly of axillary, if mediastinal lymph glands involved, cough or chest tightness, edema of face

Non-Hodgkin Lymphoma Diagnostic Assessment

Biopsy of affected lymph nodes and bone marrow

Burkitt Lymphoma

Enlarged, painless lymph node of neck or abdomen blocking a body system, growth so rapid cell mass may double in size in as few as 24 hours

Cerebellar Astrocytomas

Slow-growing, cystic tumors that arise from glial or support tissue surrounding neural cells

Medulloblastomas

Fast-growing tumors found most commonly in cerebellum

Brainstem Gliomas

Often cause paralysis of the fifth, sixth, seventh, ninth, and tenth cranial nerves

Symptoms of Increased Intracranial Pressure

Headache occurs on arising, may be intermittent throughout day, intense on straining, vomiting occurs on arising, not nauseated, will eat immediately after, diplopia, ptosis, or strabismus, papilledema

Neoplasms of the Brain Diagnostic Testing

Skull films, bone scan, ultrasound or mri, cerebral angiography, or a ct scan, possibly myelography, lumbar puncture

Assessing Osteogenic Sarcoma

Taller than average, painful, swollen site, possibly inflamed, feels warm, report of recent trauma to site

Osteogenic Sarcoma Diagnostic Testing

Elevated serum alkaline phosphatase, biopsy of site

Assessing Ewing Sarcoma

Intermittent pain at site, becomes constant and severe, onion Skin reaction on x-ray

Ewing Sarcoma Diagnostic Testing

Bone scan, bone marrow aspiration, biopsy, CT scan of lungs, and iv pyelogram or kidney MRI

Assessing Neuroblastoma

Palpable abdominal mass after possibly excessive sweating, flushed face, hypertension, possibly abdominal pain, constipation, possibly loss of motor function in lower extremities weight loss, anorexia

Neuroblastoma Diagnostic Testing

Arteriogram, ultrasound, CT, or MRI scan of chest, abdomen, pelvis, gallium bone scan, bone marrow aspiration and biopsy

Assessing Nephroblastoma (Wilms Tumor)

Palpable firm, nontender abdominal mass, possibly hematuria, Low-grade fever, anemia

Nephroblastoma (Wilms Tumor) Diagnostic Testing

CT scan or ultrasound, glomerular filtration rate or blood urea nitrogen assays

Assessing Retinoblastoma

Pupil appears white, strabismus

Retinoblastoma Diagnostic Testing

CT scan, MRI, and ultrasound

Nursing Diagnoses Regarding Cancer

Pain, imbalanced nutrition, risk for infection, disturbed body image, compromised family coping

Radiation Therapy

Changes the DNA component of a cell's nucleus and prevents replication

Chemotherapy

A chemotherapeutic agent is a drug that is capable of destroying malignant cells, ensures maximal tumor cell death with side effects like alopecia, fever, vomiting, diarrhea that can lead to dehydration

Surgery (Cancer Treatment)

An operation/procedure done for the removal of tumors

Stem Cell Transplantation

Transplantation of stem cells from the bone marrow of a well person to a child with cancer

Alopecia

Hair Loss

Cushingoid Appearance

Facial puffiness and weight gain

Gastroesophageal Reflux Assessment

Appears effortless Vomiting

Gastroesophageal Reflux Assessment

Irritable and may experience period of apnea

Gastroesophageal Reflux Assessment

Presence of gastric secretions in the esophagus

Gastroesophageal Reflux Treatment

Medication, like proton pump inhibitor omeprazole (prilosec), ranitidine (zantac)

Gastroesophageal Reflux Treatment

Laparoscopic or surgical procedure to tighten/suture esophageal sphincter

Physical Assessment of Gastrointestinal Illness in Children

Vomiting, diarrhea, poor skin turgor, dry mucous membrane, weight loss

Diagnostic Tests for Gastrointestinal Illness in Children

X-ray with contrast medium Endoscopic exam, Abdominal ultrasound MRI-magnetic resonance imaging Serum analysis Fluid concentration thru urine test

Gastroesophageal reflux (Achalasia)

Neuromuscular disturbance in which the gastroesophageal (cardiac) sphincter and the lower portion of the esophagus are lax and thus allow easy regurgitation of the gastric content into the esophagus

Pyloric stenosis

Constriction of the outlet of the stomach

Pyloric stenosis

Hypertrophy (increase in the size) or hyperplasia (overgrowth of a tissue) of the muscle surrounding the pyloric sphincter

Pyloric Stenosis Assessment

Vomiting - spitting and progress to projectile vomiting soon after the end of feeding, changes in stool, failure to gain weight, lethargy

Pyloric Stenosis Diagnostic Evaluation

Palpation of pyloric mass in conjunction with persistent, projectile vomiting is pathognomonic sign

Initial Treatment for Pyloric Stenosis

Rehydrate to correct electrolytes Correct alkalosis

Pyloric Stenosis Treatment

Surgery- Ramstedt pyloromyotomy

Hiatal Hernia

Is the intermittent protrusion of the stomach up through the esophageal opening

Hiatal Hernia Assessment

Periodic vomiting similar to esophageal reflux, pain accompanies vomiting, shortness of breath

Hiatal Hernia Diagnostic Testing

Ultrasound and Barium swallow

Hiatal Hernia Management

Baby kept in upright position to prevent condition from recurring

Hiatal Hernia Laparoscopic Surgery

Surgery - to reduce stomach ability to protrude through the diaphragm

Intussusception

Is the invagination of one portion of the intestine into another

Intussusception Assessment

Jelly like stool with blood and mucous Acute episodic abdominal pain A sausage shaped mass palpated in the right upper quadrant Vomiting up bile Lethargy

Intussusception Management

Abdominal x-ray- show obstruction and Barium or air enema (pneumatic insufflation)

Intussusception Surgical Management

Straighten the invaginated portion through surgery

Volvulus

Twisting of the intestine

Volvulus Assessment

Intense crying, pain, pulling up the legs, abdominal distention, and vomiting

Volvulus Diagnostic Testing

Abdominal x-ray and barium enema

Volvulus Medical Management

Correction of fluids and electrolytes and treatment of shock if present

Volvulus Medical Management

Rectal tube to decompress an area via intestinal intubation

Volvulus Surgical Management

Incision made in the abdominal wall via Laparotomy

Volvulus Surgical Management- Anastomosis

Joining together of two or more hollow organs

Hirschsprung's Disease

Disease of the large intestine; Absence of ganglionic innervation to the muscles of a section of the bowel

Hirschsprung's Disease Assessment

Infant do not pass meconium Development of abdominal distention

Hirschsprung's Disease Surgical Treatment

Pull through operation

Endocrine System

Ductless glands that work together with the neurologic system to regulate and coordinate a body's systems

Growth Hormones (Somatotropin)

Increases bone and cartilage growth and increase gastrointestinal absorption of calcium

Pituitary Gland

Directed by the hypothalamus, organ located in the center of the brain

Growth Hormone Deficiency

Production of the human growth hormone (somatotropin) is deficient, children cannot grow to full size

Assessment of Growth Hormone Deficiency

Normal in size and weight at birth but First few years of life, the child begins to fall below the 3rd percentile of height and weight on growth chart

Management of Growth Hormone Deficiency

To rule out kidney disease via Administration of vasopressin (pitressin); Surgery if tumor is present

Management of Growth Hormone Deficiency

IDIOPATHIC: Desmopressin an arginin vasopressin intranasally. For emergency cases it can be given IV

Diabetes Insipidus

A disease in which there is decreased release of antidiuretic hormones (ADH) by the pituitary gland

Assessment of Diabetes Insipidus

Excessive thirst (polydipsia), Polyuria, first as bedwetting in a toilet trained child

Thyroid Gland

Controlling the rate of metabolism in the body through production of thyroxine (t4) and triiodothyroxine (t3) by its follicular cells

Assessment of Thyroid Function

Radioimmunoassay of t3 and t4

Congenital hypothyroidism

Causes reduced production of t3 and t4

Congenital hypothyroidism Assessment

Child sleep excessively; the Tongue becomes enlarged; Extremities usually feels cold

Congenital hypothyroidism Management

Administration of thyroid hormones (sodium levothyroxine); Treatment may start within the 1st 1-2 weeks of life