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what is neutropenia?
deficiency of neutrophils (less than 1,000 for infants, less than 1,500 for child over 1 year of age)
what are the grades of neutropenia?
1: less than 2,000
2: less than 1,500
3: less than 1,000
what are the signs & symptoms of neutropenia?
fever, lymphadenopathy, organomegaly, pallor, bruising, petechiae
what is some education for neutropenia?
neutropenic precautions
what are neutropenic precautions?
hand washing, check temperature regularly (never rectal), seek medical attention for fever, oral hygiene (soft toothbrush, rinse well), avoid crowds/sick people, no fresh flowers/raw meat/raw honey/fresh produce
what is iron-deficiency anemia?
microcytic, hypochromic anemia caused by inadequate supply of iron, with diminished hemoglobin production
what causes iron-deficiency anemia?
decreased iron supply, increased iron demands, blood loss, inability to form hemoglobin, impaired absorption
what is the recommended dosage of elemental iron?
3 mg/kg per day (donât give with milk, may stain teeth or cause dark stools)
what is reactive attachment disorder?
condition characterized by significant difficulties forming emotional attachments with others, usually related to early life trauma or loss
what are the signs & symptoms of reactive attachment disorder?
marked disturbance in ability to relate socially
emotional withdrawal or inhibition
inability to seek or accept warmth from others
inability to show or respond to affection
marked disinhibition
indiscriminate willingness to seek comfort even from strangers
excessive trust of strangers
what is included in maltreatment of children?
physical abuse, sexual abuse, emotional abuse, & neglect
what is PTSD?
anxiety disorder that occurs in response to real or perceived trauma or threat to oneâs life/safety
what are the signs & symptoms of PTSD?
re-experiencing the trauma through flashbacks/nightmares/sensations, avoiding reminders of anything or any place that triggers memories, physiological symptoms of anxious arousal
how does a nurse implement suicide prevention?
the nurse can discern: does the child have a plan? is that plan possible (is the means accessible)? has the child attempted suicide before?
if any of those factors for suicidal ideation are present, the nurse must refer the child to a mental health professional or for immediate hospitalization
identify school-based programs that target students at risk for dropping out of school & assist children to remain involved
cognitive-behavioral techniques may be used by conducting exercises, activities, & discussions that help the student connect their thoughts & behaviors
what are some healthy sleep habits for children & teens?
only use bed for sleeping, avoid caffeine late in the day, avoid taking naps late in the day, avoid large meals right before bedtime, dim household lights at night, create a healthy sleep environment, turn off screens 30 minutes before bedtime, develop a bedtime routine to help you relax, go to bed at the same time every night, discuss ongoing sleep problems with parent/doctor
what is some information about anxiety?
it is important to distinguish developmentally expected anxiety vs. anxious temperament vs. symptoms of anxiety disorder
anxiety disorders include separation anxiety disorder, panic disorder, agoraphobia, specific phobias, social anxiety disorder, generalized anxiety disorder, substance-induced anxiety disorder, & PTSD
what are the signs & symptoms of anxiety?
anxiety that does not abate or gets worse over time (persistent)
anxiety that pervades more than one aspect of the childâs life, significant distress or avoidance or feared situations, impaired functioning or development in response to the anxiety
what are some nursing interventions for autism spectrum disorder?
be aware of the need for early intervention
early language development, interventions that address social competence, help the family with coping skills, be aware of physical boundaries
what is some education for autism spectrum disorder?
 ALARM acronym as a means of understanding ASD & treatment
autism is prevalent
listen to patients
act early
refer
monitor
what is a neuroblastoma?
third most common pediatric cancer
tumor of nerve tissue, usually developing in the abdomen within the tissues of the adrenal gland (but it can develop elsewhere), that can spread to the lymph nodes, liver, bones, & bone marrow
what are the signs & symptoms of neuroblastoma?
palpable tumor usually crossing the midline (hard, painless mass in neck or abdomen), mass upon radiograph, edema related to vascular compression (if tumor is large enough)
bone pain & swelling/bruising around the eyes can present if the tumor has metastasized
what are some negative effects of chemotherapy?
extravasation, ulceration, cellulitis
what are some medical emergencies for a cancer patient?
hemorrhagic cystitis (bloody or painful urination caused by cyclophosphamide/Cytoxan or ifosfamide/Ifex), tumor lysis syndrome, septic shock
others include superior vena cava syndrome, superior mediastinum syndrome, pericardial effusion, pleural effusion, abdominal emergencies, neurological conditions, shock, & hyperleukocytosis
what are some suggestions for nutrition regarding nausea/vomiting?
offer plain/bland foods, avoid spicy/heavy/fatty foods, serve cold or room-temperature foods to avoid food smells, serve liquids & solids 30 to 60 minutes apart
what are some suggestions for nutrition regarding diarrhea?
offer liquids as well as bananas/rice/applesauce/toast/tea, decrease dietary fiber
what are some suggestions for nutrition regarding constipation?
offer liquids & caffeine, increase dietary fiber, encourage increased activity
what are some suggestions for nutrition regarding poor appetite?
offer small amounts throughout the day, offer liquids between meals, serve âpower-packedâ foods, start with small portions & gradually increase, serve foods/beverages that the child especially likes
what are some suggestions for nutrition regarding sore throat/mouth?
offer soft foods, avoid acidic/spicy/chewy foods, encourage good oral hygiene
what are some suggestions for nutrition regarding heartburn?
avoid high-fat foods/spicy foods/citrus/cinnamon/peppermint/pepper, keep child upright for 1 hour after eating
what are some suggestions for nutrition regarding difficulty chewing/swallowing?
offer soft/moist foods, encourage sips of liquids while eating, avoid hard foods, cut food into small pieces, use butter/sauces/gravies, offer hard candy
what are some suggestions for nutrition regarding belching/intestinal gas/cramps?
avoid gas-forming foods, encourage child to eat slowly, avoid chewing gum
what is a wilmâs tumor?
nephroblastoma (tumor originating in one or both kidneys)
*do not palpate once diagnosed (can cause rupture or further metastasis
what are the signs & symptoms of wilmâs tumor?
palpable abdominal tumor that does not cross the midline
hematuria, hypertension, & pain occur infrequently
other symptoms may include aniridia (absence of iris), hemihypertrophy (increased size of half of the body), & urinary defects such as cryptorchidism & hypospadias
what is leukemia?
normal bone marrow elements are replaced by large amounts of blast cells, causing pancytopenia (low levels of all blood cells)
*ALL is most common type in children
what is a chronic condition?
health situation that persists over time, usually longer than 3 months, or one in which recovery progresses slowly
what is some education for parents & siblings of those with chronic conditions?
IDEA, regular check-ups, including siblings, coping mechanisms
what is some information about grief?
parents often experience renewed & intense grief on occasions that would have been significant benchmarks in the life of the deceased child such as birthdays, holidays, anticipated graduations, etc.
presents as feelings of tightness in throat/chest, SOB, preoccupation with the image of the deceased, inability to focus on anything other than the loved one who died, emotionally distancing self from others, feelings of guilt/responsibility, hostile reactions, inability to complete daily tasks
what are kubler-rossâs stages of grief?
denial/isolation, anger, bargaining, depression, acceptance
what are miles & perryâs stages of grief?
1 = numbness & shock; 2 = intense grief; 3 = reorganization
what is end-of-life care?
meant to provide the best quality of life possible for the child & family by supporting the bereaving child & family, relieving distressing symptoms, & providing respite
what are the effects of a chronic condition on a school-aged child?
separation from peer group is a difficult consequence, possible anger due to interrupted independence & little peer interaction, increased awareness but may not understand the consequences of the condition
what are the effects of a chronic condition on an adolescent?
not fitting in with pediatric unit or adult floor, may be required to accept help from others when previously independent (this also may cause maladaptive coping behaviors), can show regression when overwhelmed, may be affected by concern about burden & strain on parents
what are some nursing interventions for infants with a chronic condition?
rocking/holding/comforting, soothing voice, provide auditory & visual stimulation when one-on-one intervention is not possible, group care measures, designated treatment room, minimize pain & discomfort
what are the effects of a chronic condition on a toddler?
jeopardizes initiation of autonomy, frightening aspects including pain, anxiety, & separation, hinders speech & motor development
most common coping mechanisms is regression (this is expected & will subside in time after returning home)
what chemotherapeutic agents are used for hemorrhagic cystitis?
leucovorin (recovery drug for prevention of HC from medications)
mesna (prevents ifosfamide-induced HC)