peds exam 2

what will increase in the body due to tumors near the adrenal glands?

norepi, epi, & dopamine

what is the most definite diagnostic test for hematologic/oncological malignancies?

biopsy

what is pancytopenia?

anemia, neutropenia, thrombocytopenia

s/s of low RBC count d/t pancytopenia

tachycardia & SOB

what is neuroblastoma?

Adrenal medulla tumor in kids, affecting retroperitoneal area/head/neck/chest, etc.

sxs of adrenal tumor

asymmetrical, firm & non-tender mass, urinary frequency & urgency

do adrenal tumors cross midline?

yes

what is Wilms tumor

a NEPHROblastoma \= tumor/malignancy of the kidneys/abdomen

do nephroblastomas cross midline?

NO

GU sxs of nephroblastoma

frequency & urgency, hematuria

how long will chemo last after a nephroblastoma surgical removal?

6-15 months

biggest nursing consideration for a nephroblastoma

DO NOT PALPATE THE ABDOMEN OR LOCATION OF THE TUMOR, IT WILL METS

effect of leukemia on normal cells in the blood (and resulting sxs)

rapidly dividing leukemia cells take up space -> dec RBC, platelets, & WBC

\
low RBC - (low O2) weakness, fatigue, ==SOB==, pallor

dec PT - bleeding, bruising

dec WBC - inc infections

\
other sxs: weakness, wt loss, bone pain

where is osteosarcoma commonly found?

in the metaphysis of long bones, especially femur

when is osteosarcoma most common in boys?

peak at age 15

tx of osteosarcoma

amputation/limb salvage procedure followed by chemotherapy

what is Ewing's sarcoma?

a CNS tumor occurring in the shafts of long bones and flat bones (pelvis, chest wall, vertebrae)

main age range affected by Ewing's sarcoma

10-20

tx for ewing's sarcoma

radiation & chemo but no amputation

what is rhabdomyosarcoma?

malignancy in skeletal muscle: usually head, neck, orbit of eye

sxs of rhabdomyosarcoma of orbit

(U.S.E.) Unilateral proptosis, Strabismus, Ecchymosis of conjunctiva

what is proptosis?

bulging of the eye(s)

sxs of rhabdomyosarcoma of CNS

HA, diplopia, vomiting

tx of rhabdomyosarcoma

local radiation & chemo

med used for phantom limb pain in adolescents

Elavil/Amitriptyline (TCA)

when is onset of iron-deficiency anemia most common in the pediatric population?

girls at onset of menarche

iron supplements should be given __-\__ hrs after pt has \____/\__________ to prevent decreased absorption

1-2, milk/antacids

s/e of liquid iron supplement

constipation, black tarry stool, can stain teeth (give straw)

what to give as iron supplement to infants not being breastfed

iron-fortified rice cereal

what to give as iron supplement to older children

beans/lentils, peanut butter, green/leafy veggies, breads/flour, poultry, red meat

what can cause iron deficiency in toddlers (nutrition/diet related)

too much milk!

normal H/H for 2 month-old

Hgb: 9-14

Hct: 28-42%

normal H/H for 6-12 yr old

Hgb: 11.5-15.5

Hct: 35-45

normal H/H for 12-17 yr old

Hgb: 13-16 (M) 12-16 (F)

Hct: 37-49 (M) 36-46 (F)

what happens to the spleen in sickle cell anemia?

\-splenomegaly

\-splenic sequestration (sickled cells stay in splenic vasculature instead of cycling through)

\-splenic rupture (risk of infection)

Sickle Cell Crises:

acute vs. chronic sxs of a vaso-occlusive episode

Acute:

severe pain in joints/abd, swelling of hands/feet, vomiting, fever, obstructive jaundice

Chronic:

inc risk of resp infections, retinal detachment/blindness, systolic murmurs, renal/liver failure, seizures, skeletal deformities

downfall results of sequestration

excessive pooling of blood in spleen/liver -\> less circulating blood -\> hypovolemia -\> SHOCK

sxs of hypovolemic shock

TACHYCARDIA, HOTN, irritability, cool extremities, thready pulse, tachypnea

what is aplastic crisis?

Diminished production and increased destruction of RBCs

what is hyperhemolytic crisis?

increased rate of RBC death leading to anemia, but good production

what can result from a splenectomy for splenic sequestration?

decreased immunity

what to apply to skin at site of vaso occlusive episodes

heat packs

sxs of acute coronary syndrome (ACS)

like an MI: resp distress, chest pain, fever

hemophilia: complication of neck swelling/bleeding

airway compromise

hemophilia: complication of bleeding in the joint (hemarthrosis)

loss of mobility -\> ankylosis (bone fusion)

tx for hemarthrosis

like a sprain: ice, analgesics, elevate, immobilize

PT -> ROM

type A "Classic" hemophilia is a deficiency in Factor \______

VIII (8)

type B "Christmas dz" hemophilia is a deficiency in Factor \_____

IX (9)

use of vasopressin for hemophilia

increases factor VIII for mild hemo, or prophylactically for dental/surgical

What is Factor VIII also used for with hemophilia?

tx of active hemorrhage when given IV

what is used to treat swelling and hemarthrosis d/t hemophilia?

corticosteroids

what are used to treat synovitis for hemophilia

NSAIDS

DO NOT take \___________ temps of hemophilia pt

rectal

examples of low-contact sports (to suggest to hemophilia pts

tennis, swimming, golf

tx of nosebleed

put head down, humidify room, moisturize inside of nares w vasoline

what to avoid when treating mouth ulcers r/t chemotherapy and why

avoid viscous lidocaine as it causes risk of aspiration from depressed gag reflex

what diet to put chemotherapy kids on for jaw pain

soft diet

what medication provides protection to the bladder r/t hemorrhage cystitis s/t chemotherapy?

mesna (Mesnex)

what medications to avoid in children with pancytopenia

aspirin/NSAIDS

manifestations of neuropathy (d/t chemotherapy)

constipation, footdrop, weakness/numbness of extremities, jaw pain

main s/e of chemotherapy

skin breakdown, neuropathy, mucosal ulceration, loss of appetite, hemorrhage cystitis, alopecia

likelihood of offspring having SCD if both parents have trait

1 in 4

What test is performed to see if infant has SCD trait or disease?

hemoglobin electrophoresis

what is a normal ICP level?

how to calculate CPP (cerebral perfusion pressure)

MAP - ICP/CVP (whichever is highest)

early signs of increased ICP

HA, vomiting, seizures, diplopia, blurred vision, tent & bulging fontanels, irritability, restless/inconsolability

signs that ICP is increasing past early

decreased LOC, pupils fixed and dilated, decorticate/decerebrate posturing, cushing's triad

pressure on which CN results in fixed and dilated pupils r/t increased ICP?

CN 3 (oculomotor)

what is Cushing's Triad?

-Widened pulse pressure, irregular resps, bradycardia

what diagnostic test is used to rule out meningitis?

lumbar puncture

how long before LP do we apply EMLA cream?

1 hr prior

cerebral hypoxia for more than \__ hrs can cause irreversible brain damage

4

effect of CO2 on blood vessels

vasodilation

what is mannitol used for

osmotic diuretic for cerebral edema

what fluids do we administer to pts with inc ICP

hypertonic saline

paralyzing intervention to keep kid still

rocuronium

common steroids given to reduce inflammation r/t inc ICP

decadron & solumedrol

nursing consideration when giving epileptics r/t their CNS depressant properties

slowly stop, DO NOT ABRUPTLY STOP

description of a ventriculostomy

drain from ventricles of the brain to secrete CSF, tx of inc ICP

where should ventriculostomy drainage be placed?

at level to ear (zero line)

nursing care to minimize straining for pt with a ventriculostomy

stool softeners, avoid coughing, sit up/keep neck midline, MINIMIZE SUCTIONING

reason for hyperventilating pts with prolonged inc ICP

blowing off CO2 will allow vasoconstriction, making more space in skull

where does a VP shunt dump CSF?

into the peritoneal cavity

under which age can a fever cause increased ICP?

under 2 yrs old

how long does tonic phase of generalized seizure last?

10-20 sec

how does clonic phase of generalized seizure last?

1-2 min

position to place pt in after LP

FLAT for 4-6 hrs

simple vs. complex focal seizures

SIMPLE: stays conscious but with UNUSUAL SENSATIONS like seizure activity, HR change, DEJA VU

COMPLEX: altered LOC, behavior, confusion, aura, followed by AMNESIA

infantile spasms are commonly assoc. with some degree of \_________________________

mental retardation

usual cause of transient febrile seizures in childhood

d/t RAPID increase in temperature

when is a seizure an emergency (status epilepticus)?

lasting \>30 mins

med tx for status epilepticus

valium/ativan followed by dilantin/cerebryx

what to avoid when giving dilantin for seizures

avoid CALCIUM (so NO MILK)

main side effect of dilantin admin

gingival hyperplasia

alternative therapy of seizure and how it works

vagus nerve stimulator (magnet placement): stimulates at start of seizure to correct it

alternative diet for seizures and how it helps

keto diet, since breakdown of fats and inc in ketones prevents seizures

immediate nursing actions for status epilepticus

maintain airway, establish IV access

allow child to \_______ in post-ictal phase

REST

what is the main agent of bacterial meningitis?

E. coli

s/s of meningitis in 2mo-2yr olds

poor feeding, hypothermic, NO NUCHAL RIGIDITY, high pitched cry, seizures, bulging fontanel, fever & irritability