PEDS Exam 2

CU NSG 3030

Environmental factors for kids getting cancer

• Radiation (xrays, mri)

• turf that is cancer causing chemicals

• foods

Genetic conditions that predispose kids to cancer

• down syndrome

• family history

Is there a genetic link?

—

Childhood cancers: _________ embryonic origin, no strong _____________ link, routine screening ____ recommended, few _______________ strategies, metastatic disease at __________, more responsive to treatment, .70% ______ rate

primitive, environmental, not, preventive, diagnosis, cure

Cancers demonstrating the greatest improvement in survival rates:

• acute leukemia

• CNS tumors

• non-Hodgkin’s lymphoma

• bone tumors

• Wilms tumor

What’s behind the improved outcomes?

COG, POG, clinical trials w/ cancer treatment, transition to multi-modal therapy, provide data to:

• improve therapy

• decreased morbidity

• increase survival of children w/ cancer

Cancers of blood and lymph system

• leukemia (all-acute lymphoid leukemia, AML-acute myelogenous leukemia)

• lymphomas

• Hodgkin’s disease

• non-Hodgkin’s lymphoma

Nervous system tumors

• neuroblastoma

• brain tumors

  • astrocytoma

  • medulloblastoma

  • brainstem glioma

  • ependyoma

Bone tumors

• osteogenic sarcoma

• Ewing sarcoma

  • (PNET) primitive neuroectodermal tumor

Solid tumors

• Wilm’s tumor

• Rhabdomyosarcoma

• Retinoblastoma

• Testicular tumors

Warning signs of cancer in children: C.H.I.L.D.R.E.N.

—

Lab/Diagnostic test

• CBC (complete blood count)

• CMP/BMP

• LP (lumbar puncture)

What might a LP test be looking for?

testing cerebral spinal fluid for cancer cell findings —> CSF: finding wbc

• child should be under anesthesia

• dr might push chemotherapy into their csf space

  • profolacitally

CBC might look like _____ for a cancer pt.

very low ______ count

Skin findings:

• bulging Fontenelle

• bruising/petechia

• pallor/pale

• rash

Heart findings:

• increased HR (lump adding pressure)

• increased BP (pump harder)

HEENT findings:

• swollen lymph nodes

• depends on where cancer is…

• trouble swallowing

  • anorexia

  • dehydration

lungs findings:

Neuro findings:

• balance difficulty

• difficulty focusing

• seizures

• double/poor vision

modes of therapy:

• surgery

• chemotherapy

• radiation

• biologic response modifiers

• bone marrow transplant

Two specific goals of surgery:

1) obtain a biopsy

2) remove all traces of tumor

Surgery may be ________ when cancer has metastasized or advanced. Most used in ______ tumors. Most successful in ____________ tumors.

palliative, solid, encapsulated

Encapsulated tumor has what around it?

cells, they contain it

Chemotherapy can be classified according to the:

primary mechanism of action

Alkylating chemotherapy: 3 types

• cyclophosphamide

• ifosfamide

• cisplatin

Antimetabolites chemotherapy: 2 types

• methotrexate

• mercaptopurine

plant alkaloids chemotherapy: 2 types

• vincristine

• vinblastine

Antitumor antibioticsvchemotherapy: 2 types

• doxorubicin

• daunomycin

Adrenal/gonadal hormones chemotherapy: 2 types

• prednisone

• dexamethasone

others chemotherapies: 1 type listed

• L-asparaginase

many chemotherapeutic agents are ________

vesicants

extravasation can occur if chemotherapeutic agent _______ into surrounding tissue

infiltrates

infusion should be stopped ____________ with any sign of infiltration (pain, stinging, swelling, redness)

immediately

What is a potentially fatal complication of administering chemotherapeutic agents?

anaphylaxis

Anaphylaxis is characterized by:

• urticaria

• angioedema

• flushing

• rashes

• difficulty breathing

• hypotension

• n/v

L-asparaginas, bleomycin, cisplatin, etoposide have known ____________ potential

anaphylactic

If a pt is receiving chemo and begins to have these symptoms, what would you do first?

• STOP IMMEDIATELY MED/remove IV/PORT

• inform physician

When giving meds with known anaphylactic potential

• Observe VS closely (q15 minutes for at least an hour)

• Emergency equipment at the bedside

• Emergency drugs readily available

If a reaction is suspected

• Discontinue medication immediately

• Flush/aspirate IV line

• Ongoing monitoring of VS

• Notify MD

Who has published comprehensive guidelines for safe practice issues related to administration of chemotherapy?

The Oncology Nursing Society

Nurses must use safeguards to protect themselves

• Prepare drugs in properly ventilated room

• Wear disposable gloves and protective clothing

• Use precaution to prevent any physical contact with the chemotherapeutic agents

Nurses must know how to care for and maintain central venous access devices

• Central line

• Port-a-cath

Children might become _______ to port. (think: “Mr. Tubey”)

attached

Radiotherapy

• can be used in conjunction w/ chemotherapy and surgery

• can be used for curative purpose and for palliative

radiotherapy is _________. Acute side effects are caused by the damage to _________________ cells.

cytotoxic, proliferating

Biologic theerapy:

• some may stimulate the body’s immune system (immunotherapy or biological response modifiers therapy)

• may use antibodies to target cancer cells directly

• may interfere with specific molecules related to tumor growth (targeted therapies)

Goals of treatment

• cure or free from disease

• developmentally appropriate care

• maintain normalcy as much as possible

Complications of treatment

• acute adverse effects

• pediatric oncologic emergencies

• long term effects

managing adverse effects of treatment

• head

  • alopecia

  • mucositis: ulcerations/sloughing of mucosa anywhere along the GI tract

  • Pain

  • local anesthetic w/out alcohol (Benadryl/Maalox) rinse

  • do not use viscous lidocaine which may depress gag reflex and increase risk of aspiration

  • morphine PCA may be required

managing adverse effects of treatment

risk of infection:

• must maintain excellent oral care

• use toothette/soft sponge toothbrush

• peridex is effective against candidal and bacterial infections

• rectal temperatures and suppositories are avoided for pts with rectal ulcers

alopecia

baldness, fingernails, skin regeneration lost

cancer pts will enjoy sucking on candy, why?

dry mouth

note: chocking hazard. give appropriate to age

Nausea/vomiting can occur after chemotherapy administration or after radiation. What med would you give?

Intervention:  Zofran (antiemetic) 30 min-1 hour prior to chemo and every 2, 4, or 6 hours for 24 hours after chemo

GI tract adverse effects of chemotherapy treatment:

• N/V/D

• constipation-lack of motility or neuropathy

• anorexia

anorexia is a ________ effect related to cancer that is nonspecific, aversion to ____from n/v during treatment, response to stress in the __________, depression

physical, food, environment

depression

• Intervention:  Ongoing assessment of nutritional status

• Supplement with high-protein and high-calorie foods

• Hyperalimentation as needed to maintain optimal nutritional status

Pediatric oncological emergencies

• acute tumor lysis syndrome

• hyperleukocytosis

• obstruction

• overwhelming infection

Direct result of rapid release of _________ contents during death of malignant cells as a result of ________

• Usually occurs during ______ ________

• Causes ______ abnormalities

• Hyperuricemia

• Hypocalcemia

• Hyperphosphatemia

• Hyperkalemia

intracellular, treatment, initial treatment, metabolic

Crystallization of ___ ____ in renal tubules can lead to ___ _____failure and _____

uric acid, acute renal, death

hyperkalemia = ?

high K (potassium)

potassium affects the heart

Medication to reduce uric acid formation and promote excretion of by-products of purine metabolism

Allopurinol

______ Anatomy and Physiology of ____________ system

Bone, Hematological

Coagulation Cascade

Three steps of the coagulation cascade

• blood vessel constriction

• primary hemostasis

• secondary hemostasis

More detailed order of coagulation cascade (hemostatic cascade) DO NOT NEED TO MEMORIZE :)

• injury site

• blood vessels constrict

• platelets adhere

• platelets activate and aggregate

• clotting factors are triggered

• prothrombin converts to thrombin

• fibrin converts to fibrinogen (weak plug - primary hemostasis)

• fibrinogen stabilized (clot stabilized bleeding controlled - secondary hemostasis)

Three dif anemias

• iron deficiency anemia

• sickle cell anemia

• beta-thalassemia (Cooley Anemia)

Iron deficiency anemia

Iron Deficiency Anemia

Cause:

• Insufficient iron intake (dietary deficiency)

• Increased iron needs (pregnancy, growth spurts)

• Blood loss (menstruation, gastrointestinal bleeding)

• Malabsorption (celiac disease, gastric surgery)

Symptoms:

• Fatigue and weakness

• Pale skin

• Shortness of breath

• Dizziness or lightheadedness

• Cold hands and feet

• Brittle nails

• Headaches

For diagnosis and treatment, consult a healthcare professional.

sickle cell anemia

Sickle Cell Anemia

Cause: Sickle cell anemia is caused by a mutation in the HBB gene, which encodes the beta-globin subunit of hemoglobin. This mutation leads to the production of abnormal hemoglobin known as hemoglobin S (HbS).

Symptoms:

• Anemia (fatigue, weakness)

• Episodes of pain (sickle cell crises)

• Swelling in hands and feet

• Frequent infections

• Delayed growth in children

• Vision problems

For management, regular medical care and treatments are essential.

beta-thalassemia (cooley anemia)

Causes of Beta-Thalassemia (Cooley Anemia)

• Genetic mutations in the HBB gene affect hemoglobin production.

• Inherited in an autosomal recessive pattern.

Symptoms of Beta-Thalassemia

• Fatigue and weakness.

• Pale or yellowish skin (jaundice).

• Shortness of breath.

• Enlarged spleen and liver.

• Bone deformities, especially in the face and skull.

• Delayed growth and development in children.

Iron Deficiency Anemia: pathophysiology

RBCs w/ hemoglobin and iron

Etiology of IDA

• infants 9-24 mths

• older children

Risk factors of IDA

• prenatal

• infancy

• childhood

• adolescents

epidemiology of iron decicient anemia

Epidemiology of Iron Deficiency Anemia

• Prevalence: Affects approximately 1.62 billion people globally, particularly in developing countries.

• Risk Groups:

  • Pregnant women

  • Infants and young children

  • Adolescents

  • Vegetarians and vegans

• Causes:

  • Inadequate dietary intake

  • Malabsorption disorders

  • Chronic blood loss (e.g., menstruation, gastrointestinal bleeding)

• Geographic Variation: Higher rates in regions with poor nutrition and limited access to healthcare.

Key Statistics

• Most common nutritional deficiency worldwide.

• Significant impact on cognitive and physical development in children.

Clinical presentation of IDA

• common manifestations

• additional manifestations

common manifestations of iron decicient anemia

Common manifestations of iron deficiency anemia include:

• Fatigue and weakness

• Pale skin and mucous membranes

• Shortness of breath

• Dizziness or lightheadedness

• Cold hands and feet

• Brittle nails

• Headaches

• Restless legs syndrome

• Increased heart rate

If you suspect iron deficiency anemia, consult a healthcare professional for diagnosis and treatment.

Lab testing and diagnostic testing of IDA

• complete blood count

• additional testing

expected CBC findings for iron decicient anemia

Expected CBC Findings for Iron Deficiency Anemia

• Hemoglobin (Hb): Decreased

• Hematocrit (Hct): Decreased

• Mean Corpuscular Volume (MCV): Decreased (microcytic)

• Mean Corpuscular Hemoglobin (MCH): Decreased

• Mean Corpuscular Hemoglobin Concentration (MCHC): Decreased

• Red Cell Distribution Width (RDW): Increased

• Reticulocyte Count: Often decreased or normal

These findings indicate a reduction in red blood cell production and size due to insufficient iron.

additional testing for iron decifient animia (besides cbc)

Additional Testing for Iron Deficiency Anemia

1. Serum Ferritin: Measures stored iron in the body.

2. Serum Iron: Assesses the amount of circulating iron.

3. Total Iron-Binding Capacity (TIBC): Evaluates the blood's capacity to bind iron with transferrin.

4. Transferrin Saturation: Percentage of transferrin that is saturated with iron.

5. Reticulocyte Count: Indicates bone marrow response to anemia.

6. Peripheral Blood Smear: Examines the shape and size of red blood cells.

treatment and therapies for iron deficiency anemia

Treatment and Therapies for Iron Deficiency Anemia

1. Iron Supplements: Oral iron supplements (ferrous sulfate, ferrous gluconate) are commonly prescribed.

2. Dietary Changes: Increase intake of iron-rich foods (red meat, poultry, fish, lentils, beans, spinach).

3. Vitamin C: Consuming vitamin C-rich foods (citrus fruits, tomatoes) can enhance iron absorption.

4. Intravenous Iron: For severe cases or when oral supplements are ineffective.

5. Address Underlying Causes: Treat any underlying conditions causing the deficiency (e.g., gastrointestinal bleeding).

6. Regular Monitoring: Follow-up blood tests to monitor hemoglobin and iron levels.

iron deficiency anemia effect on overal health

Iron Deficiency Anemia and Overall Health

Iron deficiency anemia can lead to:

• Fatigue: Reduced oxygen transport causes tiredness.

• Weakness: Decreased energy levels affect daily activities.

• Cognitive Impairment: Impacts concentration and memory.

• Immune Function: Increased susceptibility to infections.

• Heart Problems: Can lead to rapid heartbeat or heart failure in severe cases.

Addressing iron deficiency is crucial for maintaining overall health.

considerations for the pediatric population (concerning iron deficiency anemia)

Considerations for Pediatric Population Regarding Iron Deficiency Anemia

1. Age-Specific Needs: Infants and toddlers require higher iron intake due to rapid growth.

2. Dietary Sources: Encourage iron-rich foods (e.g., meat, beans, fortified cereals).

3. Absorption Factors: Vitamin C enhances iron absorption; avoid calcium-rich foods during iron intake.

4. Screening: Regular screening for at-risk populations (e.g., premature infants, low-income families).

5. Supplementation: Consider iron supplements if dietary intake is insufficient, under medical guidance.)

Dietary recommendation of iron (when iron deficient)

Causes of Iron Deficiency Anemia

• Inadequate dietary intake of iron

• Blood loss (e.g., menstruation, gastrointestinal bleeding)

• Increased iron requirements (e.g., pregnancy, growth spurts)

• Malabsorption disorders (e.g., celiac disease)

Symptoms

• Fatigue and weakness

• Pale skin

• Shortness of breath

• Dizziness or lightheadedness

• Cold hands and feet

Additional Testing

• Serum ferritin

• Serum iron

• Total iron-binding capacity (TIBC)

• Transferrin saturation

Dietary Recommendations

• Consume iron-rich foods: red meat, poultry, fish, lentils, beans, tofu, and fortified cereals.

• Pair with vitamin C sources (e.g., citrus fruits) to enhance absorption.

self-care skills for iron deficiency anemia

Self-Care Skills for Iron Deficiency Anemia

1. Dietary Changes: Increase intake of iron-rich foods (e.g., red meat, beans, lentils, spinach).

2. Vitamin C: Consume vitamin C-rich foods (e.g., citrus fruits) to enhance iron absorption.

3. Avoid Inhibitors: Limit intake of calcium and tannins (found in tea and coffee) during iron-rich meals.

4. Supplements: Consider iron supplements as advised by a healthcare provider.

5. Regular Check-ups: Monitor iron levels through blood tests as recommended.

Sports concern for anemia

bruising/bleeding

Promoting social and personal development for IDA

• play

• socialization

effected by limiations

social limitaions of iron deficient anemia

Social Limitations of Iron Deficient Anemia:

1. Fatigue and Weakness: Affected individuals may struggle with daily activities, impacting work and social interactions.

2. Stigma: There may be misconceptions about the condition, leading to social isolation.

3. Economic Impact: Increased healthcare costs and potential loss of income due to illness.

4. Educational Challenges: Students may face difficulties in concentration and performance in school.

5. Mental Health: Increased risk of anxiety and depression due to chronic health issues.

Client education for iron deficiency anemia

Causes of Iron Deficiency Anemia

• Inadequate dietary intake of iron

• Blood loss (e.g., menstruation, gastrointestinal bleeding)

• Increased iron requirements (e.g., pregnancy, growth spurts)

• Malabsorption disorders (e.g., celiac disease)

Symptoms

• Fatigue and weakness

• Pale skin

• Shortness of breath

• Dizziness or lightheadedness

• Cold hands and feet

• Brittle nails

Additional Testing

• Serum ferritin

• Serum iron

• Total iron-binding capacity (TIBC)

• Transferrin saturation

Dietary Recommendations

• Increase intake of iron-rich foods: red meat, poultry, fish, beans, lentils, tofu, spinach, and fortified cereals.

• Pair iron sources with vitamin C-rich foods (e.g., citrus fruits) to enhance absorption.

Client Education

• Importance of adhering to dietary recommendations.

• Understanding symptoms and when to seek medical help.

• Discussing potential side effects of iron supplements.

• Importance of follow-up testing to monitor iron levels.

What foods are rich in iron?

Foods Rich in Iron

1. Red Meat: Beef, lamb, and pork

2. Poultry: Chicken and turkey

3. Seafood: Oysters, clams, and sardines

4. Legumes: Lentils, beans, and chickpeas

5. Nuts and Seeds: Pumpkin seeds, cashews, and almonds

6. Leafy Greens: Spinach, kale, and Swiss chard

7. Fortified Foods: Cereals and bread

8. Dried Fruits: Apricots, prunes, and raisins

These foods can help increase iron intake, essential for blood health.

How would you explain the importance of eating iron rich foods to a parent/guardian of a child who has begun eating solid foods?

Eating iron-rich foods is crucial for a child's growth and development, especially as they transition to solid foods. Iron supports healthy brain development, boosts the immune system, and helps prevent iron-deficiency anemia, which can lead to fatigue and developmental delays. Foods like lean meats, beans, spinach, and fortified cereals can provide essential iron. Pairing these with vitamin C-rich foods enhances iron absorption. Ensuring a balanced diet will promote overall health and well-being for your child.

Pathophysiology of sickle cell anemia

Pathophysiology of Sickle Cell Anemia

Sickle cell anemia is a genetic disorder caused by a mutation in the HBB gene, leading to the production of abnormal hemoglobin (HbS).

1. Red Blood Cell Deformation: Under low oxygen conditions, HbS polymerizes, causing red blood cells to become rigid and sickle-shaped.

2. Vaso-occlusion: Sickle-shaped cells can obstruct blood flow in small vessels, leading to ischemia and pain.

3. Hemolysis: The abnormal cells have a shorter lifespan (10-20 days), resulting in chronic hemolytic anemia.

4. Complications: Increased risk of infections, acute chest syndrome, and organ damage due to reduced blood flow.

Management includes pain relief, hydration, and blood transfusions.

sickle cell anemia causes _________ molecules to stick to one another and clump ________.

hemoglobin, clump

Airplane concerns for anemia

• dehydration

• sitting for hours

• pain

• decreased O2

• high altitude

treatment of anemia

• fluid

• IV/meds

• AVOID NSAIDs

• give analgesics

• threat O2

• compression stockings

• antibiotics

• NEVER GIVE BLOOD THINNERS

function of platelets

clot

function of WBCs

protect

function of RBCs

carries oxygen/nutrients

Lab values given in exam

don’t need to memorize pg. 784 :)

Hemoglobin

iron needs to “hem” oglobin

Greatest reason for iron deficiencies

• malnutrition

• solution: supplement/proper nutrition

Microcytic/hypochromic

fuller on outside, not on inside