Lecture 3 - Life Threatening Disorders

The plasma consists of water, albumin, ____, and protein. Examples of proteins includes ____ factors, globulins, antibodies, and fibrinogen.

Hematopoiesis occurs in the ____ tissue (bone marrow) and the _____ system. In infants and children ____ bone contains myeloid tissue. In adolescents only the ___, sternum, vertebrae, and pelvis contain it.

Generalized S/S of childhood cancers include:

1. Pain that is considered more ____ and achy especially with no _____. An exception would be bone cancer in which the pain is more _____.

2. A ____ is due to overactivation of cytokine release due to a tumor

3. Ecchmyosis and ____ due to bone marrow suppression

4. Bleeding from the ___ and nose associated with thrombocytopenia

5. Pallor occurs due to _____

6. Lethargy and _____ due to inc metabolic demands

7. Weight loss due to both inc in metabolic demands and loss of ____ due to not feeling well

8. ____ or swollen lymph nodes.

9. Cranial nerve dysfunction due to brain tumor but also bc of ____ or radiation.

A red flag is always unexplained symptoms that involve ____ systems.

DX tests usually start with a ____ test to get the CBC and CMP. A ____ is used to determine kidney function. A ____ is done to see if anything is CNS related and is collected via LP. A ____ of a tumor and molecular genetic testing can be used to select the best TXT. For bone cancer, this is a bone _____.

Imaging will probably begin with ____ and then move on to higher imaging. MIBG is similar to MRI and PET but uses ____ tracing to highlight certain cancer cells

TXT includes:

1. ____ for excision of a solid tumor.

2. Chemo interferes with the cancer cell ____ and RNA. This helps inhibit the cancer cells ability to ____ from the immune system.

3. Biotherapy includes monoclonal ___, ____ inhibitors, and targeted therapy.

4. Stem cell ____. This includes allogenic which are ____ stem cells and autologous in which you kill your ___ immune system and start fresh from your own bone marrow.

5. Radiation is used to ____ solid tumors. Total body radiation is prepping somebody for a ____ cell transplant.

6. Supportive care involves managing side ____ of DX and TXT

electrolytes; clotting; myeloid; lymphatic; all; ribs; generalized; injury; localized; fever; petechiae; gums; anemia; malaise; appetite; lymphadenopathy; chemo; multiple; blood; urinalysis; CSF; biopsy; aspiration; xray; radioactive; surgery; DNA; hide; antibodies; checkpoint; transplant; donor; own; shrink; stem; effects

Complications w childhood cancers include:

1. The greatest and main one being ____. An absolute neutrophil count of below ____/mm3 is considered neutropenia. This is called the ANC number which is obtained via ____ w differential. For example something as simple as a cold can turn into _____.

2. A ____ due to platelet count being below 20,000 mm3

3. ____ which presents as pallor and malaise

4. N/V which can be treated w following meds:

   1. A serotonin antagonist like _____

   2. ____ antagonists like promethazine and metoclopramide

   3. Antihistamines include high dose ____ benadryl or diphenhydramine

   4. ______ like dexamethasone

   5. Dronbinol with is medical _____

5. Altered nutriion and FTT bc ____ and ability to tolerate certain foods is imapired. Provide a high ____ and calorie diet. The diet should consist of ____, moist, and soft foods. You want to protect the oral mucosa by avoiding acidic and ____ foods. A ____ diet eliminates food-borne pathogens. These ensure that meats are well-cooked and that fruits and veggies are thoroughly _____. Avoid things that do not have an outer ___ to proect the flesh. Contraindications include _____, grapes, lettuce, tomatoes, etc.

6. Due to oral pain w eating, lack of energy to eat, or nausea they may need ____ feeds or TPN.

7. Imapired nutrition leads to impaired ____ integrity.

8. Mucosal _____. Avoid harsh foods that are ____ and crumbly. Provide barrier creams, ____ softeners and sitz bath to protect rectum from irritation.

9. Neurological deficits like ____, aeakness, pain, ataxia

10. Hemorrhagic cystitis in which ____ will be aded to inhibit urotoxicity

11. Hair loss called ____ which when it regrows may be different leading to body image concerns.

12. Hormonal effects like ____ syndrome which is due to steroidal effects of TXT. Patients will have red cheeks and a round/____ face. Mood changes include rage, ____, and irritability.

infection; 500; CBC; sepsis; hemorrhage; anemia; ondansetron; dopamine; IV; corticosteroids; marijuana; taste; protein; bland; crunchy; neutropenic; cleaned; rind; strawberries; enteral; skin; ulcers; crunchy; stool; constipation; mesna; alopecia; cushing; puffy; depression

Childhood cancer emergencies include:

1. ____and shock that occurs from infection and neutropenia. The cardinal sign is ____ and this is an emergency in which they need to go to ER. You want to obtain a blood or urine ____ first and get them on _____ right away before imaging.

2. Tumor ____ syndrome in which the cancer cells are destroyed and release intracellular contents into blood leading to _____ abnormalities. You want to montior the ____ frequently like q4-6h. These usually occur w the initiation of _____. If these do occur, you want to start _____ and electrolyte supplementation. If we do not do these fast enough it can lead to ____, seizures, muscle cramps, adn _____ failure.

3. _____ is excessive microthrombi

sepsis; fever; culture; antibiotics; lysis; metabolic; CMP; chemo; hydration; arrhythmias; renal; DIC

Cancer in the blood forming tissues particularly the bone marrow is called _____. This leads to overproduction of _____ cells which overcrrowds and prevents ____ cells from forming AKA myeloid _____. DX evaluation includes a ____ w differential and a peripheral blood ____ to visualize those cells. A DEFINITIVE DX is made via bone marrow ____ or biopsy. A LP is used to determine ___ involvement.

Upon assessment you may see:

1. Impaired ____ due to low WBC. This means frequent infections or ____ times taken to get over infections.

2. _____ due to anemia

3. ____ due to thrombocytopenia.

4. Hepatosplenomegaly and lymphadenopathy which is associated with ____

5. Bone and ____ pain related to crowding

6. Fever, anorexia

Cancer spreads via the ____.

TXT includes ____, radiation, targeted therapy, and HSCT

leukemia; immature; healthy; suppression; CBC; smear; aspiration; CNS; healing; prolonged; pallor; petechiae; metastasis; joint; blood; chemo

Malignancy that arises in the lymphatic system is called ____.A definitive DX includes a lymph node _____. A LP and bone marrow aspiration is used to check for ____. Other DX evals include CBC< imaging, etc.

Upon assessment you will see:

1. Lymphadenopathy in which the lymph nodes are enlarged, nontender, ____, and fixed.

2. ____ pain due to enlarged lymph nodes in that area

3. Fatigue, night ___, and fever

4. Weight ____ due to inc metabolic demands of cancer cells

5. A persistent ____ due to enlarged lymph nodes in mediastinum.

Cancer spreads via the ____ vessels.

TXT is usually successful if identified ____. This includes ___, radiation, targeted therapy, and HSCT

lymphoma; biopsy; metastasis; firm; abdominal; sweats; loss; cough; lymphatic; early; chemo

The most common pediatric solid tumor is a ____ tumor. A DX is via a ____, biopsy, and brain mapping. You want to avoid LP when there is inc _____.

A big sign of brain tumor is neuro _____. Examples include one-sided ____, seizures, impaired ____, and cranial nerve dysfunction. Other assessment findings include:

1. Inc ICP due to the tumor taking up space which will look like ____ fontanellles, inc head _____, headache, vomiting

2. Cerebtal dysfunction can appear as _____ speech, hemiparesis, ____(eyes), imapired mobility/_____, etc.

3. TXT includes a _____ (SX) to remove the tumor if possible. ____ therapy can be used to laser off the cells. Radiation is ____ due to long-term neuro consequences..

brain; MRI; ICP; impairment; weakness; speech; bulging; circumference; slurred; nystagmus; ataxia; craniotomy; laser; delayed

Cancer that develops in immature cells nerve cells that usually develop into adrenal gland and SNS is called _____. This tumor does not occur in the ____.

A DX includes MIBG, CBC, neuro exam, CT, BMA,/_____, etc.

This is known as a _____ tumor. This is bc symptoms occur after ____. Assessment findings include:

1. The abdomen is ___ and non tender. There is an irregular abdominal ___ that crosses the ____. Abdominal pain, vomiting anorexia, resp compromise, and ____ dysfyunction due to compression

2. Neck/chest symptoms like dyapnea, ______, and dysphagia

3. It commonly metastasizes to ____ nodes, bone marrow, _____ system, and liver.

TXT includes ____, chemo, HSCT, and radiation

neuroblastoma; brain; biopsy; silent; metastasis; firm; mass; midline; urinary; stridor; lymph; skeletal; surgery

HIV/AIDS is diagnosed in inhants via ____ or rapid HIV tests.

Horizontal transmission is due to unprotected _____ contact and ___ drug use especialy for adolescents.

Vertical transmission is when an infant is born to HIV-infected ____.

Assessment findings include:

1. Lymphadenopathy and _____

2. Oral ______ due to overgrowth of the fungu

3. Recurrent or chronic ____ due to microorganisms in GI tract

4. FTT and inc risk for _____.

TXT includes:

1. Comibation _____ therapy regiment (ART). This is not a cure but suppresses viral ____ instead.

2. Opportunistic infections prophylaxis includes trimetrhropim-sulfamethoxazole AKA _____.

BF guidance includes a ___ decision made by mother and provider. BF is still considered _____ nutrition even if mom HIV+

PCR; sexual; IV; mother; hepatosplenomegaly; candidiasis; diarrhea; infections; antiretroviral; replication; bactrim; mutual; optimal

Hemophilia is a ____ linked recessive disorder. If a family HX is present, they will usually have ____ testing done. After they are born they will have specific clotting ___ and monitor _____ levels which are usually increased.

Assess site of injury, headaches, _____ speech, loss of conciousness, excessive _____, hematuria, and hematomas.

TXT includes ____ the deficient factor and prevent further injuries.

1. The primary prophylaxis is ____ infusion therapy so provide family education

2. Treat injuries via RICE

   1. R = ____

   2. I = ____

   3. C= _____

   4. E = _____

3. Adminster _______ drugs like TXA and aminocaproic acid. You want to avoid ____ and NSAIDs as they inhibit platelet function. You want to avoid ____ injections when possible.

Encourage low risk spots/ activities like chess, art, _____, reading, golf, running, ettc.

X; prenatal; assays; PTT; slurred; bruising; replacing; home; rest; ice; compression; elevate; antifibrinolytic; aspirin; IM; swimming

For infants and toddlers they likely have no ___ of death. Their perception of death is based on their _____ reactions like anxierty, fear, sadness.

Preschoolers think of death like ____, in which it is temporary or reversible. They have self-power and believe in ____ thinking. They may feel ____ or shame and think that _____ is rleated to death/illness.

School-aged children have more ____ thinking but still think they may be at fault. You want to provide ____ explanations. They are usually receptive to _____ preparation like talking abt it, encouraging ____, and expression of feelings. Let them make as many ____ as they can.

Adolescents have more ____ thinking in that they may ____ death. They may believe they are ____ and are more worried abt ___ changes than prognosis.

You want to provide physical comfort by doing ____ care and maintaining hygiene. Manage ___ and symptoms via PCA pump.

Child-life specialist will help w coping and ____ building activities. These can include collecting ____, jewelry, and handprints.

The top 3 causes of childhood death in LA includes ____, motor vehicle ____, and drowning.

The top 3 in the US include _____ related, motor vehicle crashes, and ____ poisoning.

concept; parents; sleeping; magical; guilt; punishment; concrete; logical; anticipatory; questions; decisions; abstract; reject; invicible; physical; oral; pain; legacy; hair; homicide; crashes; firearm; drug