life threatening disorders

HIV/AIDS counts as —-

alterations in cell growth

water, albumin, electrolytes, proteins, Proteins: clotting factors, globulins, antibodies, fibrinogen

plasma

—all of their bones contain myeloid tissue, while adolescents have myeloid tissue in the ribs, sternum, vertebrae, and pelvis primarily

infants/children

s/s: Pain, Fever - can be from cytokine release or infection, Ecchymosis & Petechiae, Bleeding: gums & nose, Pallor, Lethargy & Malaise, Weight loss, Lymphedema, Cranial Nerve Dysfunction (could be from tx as well)

cancer

Bone marrow suppression s/s =

petechiae, ecchymosis

a specialized nuclear medicine imaging test that uses a radioactive tracer to detect or evaluate specific hormone-producing and nerve-related tumors, may be used to detect neuroblastoma

MIBG

interfere with cancer cell DNA/RNA

chemo

Monoclonal antibodies, checkpoint inhibitors, targeted therapy - different from chemo

biotherapy

third line (typically done after every other tx), usually for blood cancers, Allogeneic (donor) & Autologous (own bone marrow) - kill your own immune system almost down to 0 and then start fresh with a whole new immune system

stem cell transplant

absolute neutrophil count (ANC) lower than — = way more susceptible to infection and for the infection to become much more severe

500

platelet count is typically lower in cancer patients because it’s a side effect of treatment so threshold is lower than —-

20,000

for —- in cancer patients: Serotonin Antagonists: ondansetron (Zofran), Dopamine Antagonists: promethazine (Phenergan), metoclopramide (Reglan), Antihistamines: diphenhydramine (Benadryl), Corticosteroids: dexamethasone (Decadron), Cannabinoids: dronabinol (Marinol)

N/V

Myelo suppression s/s =

low ANC, hemorrhage, anemia

meats are well cooked, vegetables/fruits clean, if things don’t have outer skin (bananas are okay because they have peel), Goal is to avoid food infection 

neutropenic diet

childhood cancer complications include:

mucosal ulceration, neuro deficits, hemorrhagic cystitis, alopecia, hormonal effects

sores throughout entire GI tract (mouth to anus) that can be a complication of chemo and childhood cancer

mucositis

a cytoprotective medication used to protect the bladder from irritation and severe bleeding (hemorrhagic cystitis) caused by chemotherapy drugs like ifosfamide and high-dose cyclophosphamide

mesna

a medical condition characterized by inflammation of the urinary bladder lining (urothelium) paired with bleeding into the bladder - can have from chemo or pelvic radiation - give mesna to prevent

hemorrhagic cystitis

hormonal effects can happen from cancer treatment, specifically with the steroids prescribed - can have cushingnoid which appears as —-

swollen face

a serious, potentially life-threatening medical emergency that happens when a large number of cancer cells break down and die quickly, spilling their internal contents into the bloodstream, (certain cancers/treatments are more susceptible)

tumor lysis syndrome

need frequent —- to avoid tumor lysis syndrome progression - will show high K, phosphorus, uric acid, and BUN/creatinine but low calcium

CMP

Diagnosis: CBC with differential & peripheral blood smear, Definitive: bone marrow aspiration/biopsy, Lumbar Puncture: determine CNS involvement, Assessment: impaired healing, pallor, fever, anorexia, petechiae, bone/join pain, hepatosplenomegaly, lymphadenopathy

leukemia

Diagnosis: CBC, total-body imaging (CT, PET, MRI), lymph node biopsy, lumbar puncture, bone marrow aspiration (see how far its gotten), Assessment: lymphadenopathy (enlarged, nontender, firm - will not move with palpation), abdominal pain, fatigue, night sweats, fever, weight loss, persistent cough

lymphoma

Starts in the bone marrow and spreads through the bloodstream, Overproduction of abnormal white blood cells that crowd out healthy cells, types: acute or chronic, s/s: Fatigue, frequent infections, pale skin, bleeding/bruising, bone pain

leukemia

Starts in the lymphatic system (e.g., lymph nodes, spleen), Spreads through the lymphatic vessels, Abnormal lymphocytes form tumors in lymphatic tissues, either Hodgkins or non Hodgkins, s/s: Swollen lymph nodes, night sweats, weight loss, itchy skin, coughing

lymphoma

Diagnosis: MRI, biopsy, brain mapping, avoid LP when increased ICP, Assessment: increased ICP: bulging fontanelles, increased head circumference, headache, vomiting, cerebral dysfunction: nystagmus, impaired mobility/ataxia, slurred speech, seizures, hemiparesis

brain tumors

embryonic cells that differentiate to adrenal gland and sympathetic nervous system

neuroblast

Diagnosis: CBC, neuro exam, CT/MRI, BMA/biopsy, MIBG, Assessment: “silent tumor” - symptoms occur after metastasis, Abdomen: firm, nontender irregular abdominal mass across midline; abdominal pain, vomiting, anorexia, respiratory compromise, urinary dysfunction (compression), Neck/Chest: dyspnea, stridor, dysphagia, Metastasis: lymph nodes, bone marrow, skeletal system, liver, Most common extracranial solid tumor NOT BRAIN CANCER

neuroblastoma

a molecular test that directly detects the genetic material (RNA or DNA) of the Human Immunodeficiency Virus (HIV) in the blood rather than looking for the body's antibody response - done for infants, stands for polymerase chain reaction

PCR

path of transmission for HIV: unprotected sexual contact & IV drug use - adolescents

horizontal

path of transmission for HIV: infant born to HIV-infected mother

vertical

Assessment: lymphadenopathy, hepatosplenomegaly, oral candidiasis, chronic/recurrent diarrhea, failure to thrive, infections

HIV

Opportunistic infection prophylaxis, Trimethoprim-sulfamethoxazole given to people who have HIV to prevent infection - if they present with a low CD4

bactrim

Diagnosis: family history (X-linked recessive), prenatal DNA testing, specific clotting factor assays, increased partial thromboplastin time (PTT), Assessment: site of injury, headache, slurred speech, loss of consciousness, excessive bruising, hematuria, hematomas, Treatment: replace deficient factor, injury prevention

hemophilia

for hemophilia will depend on what factor they are specifically deficient in, Family taught how to infuse clotting factor

primary prophylaxis

Antifibrinolytic drugs: tranexamic acid (TXA), aminocaproic acid (Amicar), Avoid Aspirin & NSAIDs- inhibit platelet function

hemophilia

likely no concept of “death”, perception based on parents’ reaction: anxiety, fear, sadness

infants/toddlers

see death as a type of “sleep”; temporary/reversible, self-power & magical thinking, guilt, shame, punishment related to illness/death

preschoolers

death perception: concrete thinking; guilt, responsibility, logical explanations, anticipatory preparation; encourage control over own body

school age

abstract thinking; rejection of death, invincible, physical changes greater concern than prognosis

adolescents

top 3 causes of death in children in Louisiana:

homicide, MVC, drowning

top 3 causes of death in children in the U.S.:

fire arm related, MVC, drug poisoning