Presented by Marlene Meador RN, MSN, CNE. Hematologic System Adult Pedi Life cycle of RBC- 120 days...
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Transcript of Presented by Marlene Meador RN, MSN, CNE. Hematologic System Adult Pedi Life cycle of RBC- 120 days...
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Pediatric Hematologic Disorders
and Cancer
Presented by Marlene Meador RN, MSN, CNE
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Hematologic SystemAdult PediLife cycle of RBC- 120
daysCell production- marrow
and spleenRBC’s= 4.1 to 4.9
million/mlHemoglobin=Hematocrit=
Life cycle of RBC- 100 days (neonate)
Cell production- red bone marrow (infant)
#RBC’s= 5million/ml at birth
Hemoglobin= 17-18 gHematocrit= 45-50%
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Iron Deficiency AnemiaCauseSigns and symptoms Diagnostic testsNursing interventions
Oral supplements- What significant side effects does the nurse need to remember?
Dietary teaching- what specific foods?
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Sickle Cell diseaseSickle cell trait- genetic disorders
characterized by production of elongated, crescent shaped erythrocyte in the place of normal Hbg. p. 1494-1503 Precipitating factors (p. 1496)Signs and symptoms
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Types of Sickle Cell CrisisVaso-occlusive- most common effects
PainHand and foot syndrome (dactylitis)CVA- hemiplegia, aphasia, seizures, LOC
changes, vision changes, and headacheAcute chest syndrome- chest pain, fever cough
(leading cause of death in SCD) PriapismHepatomegalyHematuria
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Types of Sickle Cell CrisisAplastic Crisis:
Decreased RBC production- S&S malaise, headache, pallor, lethargy, and fainting (precipitated by infection)
Splenic sequestration- life threatening S&S pallor, irritability, tachycardia, hypovolemic shock
Hyperhemolytic crisis- (not in text)- RBC’s destroyed more rapidly than usual (immature cells)
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Quick Review:What is most common reason for
admission for a child with SCD?What precipitates a sickle cell
crisis?How does sickling effect the life
span of an RBC?what organs experience
complications as a result of chronic sickling crisis?
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Diagnosis & Treatment
Cord blood testing if one parent is known to carry trait
Blood transfusions-
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TreatmentPatient/family teaching-MedicationsImmunizations- why important?
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HemophiliaX-linked trait
What factor is missing or defective? Factor VIII
Who is the carrier, and who is effected by this disorder?
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Diagnosis & TreatmentWhen does diagnosis most commonly occur?
What are signs & symptoms?
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Nursing Care:Factor VIII- when should the patient receive this medication?
What does the family need to know about factor VIII?
Human plasmaVasopressin (DDAVP)
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Nursing Care cont…What is the primary nursing goal for a patient
with hemophilia?Prevent or stop bleeding
What are specific interventions to achieve this goal?Administer Factor VIIIApply local pressure for 10-15 minutesElevate the joint and immobilizeApply cold compresses
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Complications of hemophilia
Hemarthrosis- assess child for joint pain, edema, or permanent deformity. Where most common?
Death- at risk for hemorrhage
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Childhood CancerC- continual unexplained weight loss, fatigue
malaiseH- headaches with vomiting (early morning)
I- increased edema or pain in joints
L- lump or mass, persistent lymphadenopathy
D- development of whitish appearance in pupil of the eye
R- recurrent or persistent fevers, night sweats
E- excessive bruising or bleeding
N- noticeable pallor
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What signs and symptoms would lead to the diagnosis of leukemia?FeverPallorOvert signs of bleedingLethargy or malaiseAnrexiaLarge joint or bone painPetechiae, frank bleedingEnlarged liver or spleen, changes in lymph
nodesNeurologic changes
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Lab values for a diagnosis of leukemia: examination of CBC with at least 25% blasts confirm the diagnosis Normal Leukemia
Leukocytes < 10,000
Leukocytes> 10,000
Platelets 20-100,000
Hemoglobin 7-11
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Further diagnostic findings:Bone marrow aspiration- iliac crest
(why this site?)
How does the nurse prepare the child/family for this procedure?
What are the nurse responsibilities for this procedure?
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Treatment and Plan of Care:Chemotherapy: four phases
Induction phaseConsolidationDelayed intensificationRemission and maintenance
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Nursing Plan of Care:Myelosupression- protect from injury
Infection/sepsis (neutropenia)- protect from infection
Renal damageGI disturbancesMetabolic emergencies
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Intrathecal MedicationChemotherapy instilled into spinal canal
Assess and monitor for placement of intrathecal catheter and assess neuro checks
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Cranial RadiationHead and neck tumors are more
sensitive to radiation than chemotherapy.
When would chemotherapy become an adjunct to radiation therapy?
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Tumor Lysis Syndrome:What causes tumor lysis syndrome?
What are signs and symptoms of this complications
What nursing interventions apply to treatment?
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Bone marrow and Stem Cell TransplantationUsed to treat leukemia, neuroblastomas
and some noncancerous conditions-aplastic anemia
Goal to administer a lethal dose to kill the cancer, and resupply the body with stem cells from the child’s own bone marrow, or a compatible donor
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Develop a plan of care for the child undergoing treatment for leukemia:Risk for injury:
Soft tissue/mucous membranesGeneralized trauma
Risk for infection:Risk for alteration in bowel eliminationRisk for GI distressFluid volume delicate
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Wilm’s TumorSoft tumor frequently along
sympathetic nervous system(p.1552-3) Metastasis or seeding
spread by palpation Nephrectomy treatment of Wilm’s
tumor
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Nursing treatment of Wilms’ tumor:Pain management
Frequent repositionNoninvasive and pharmacologic pain interventions
Prevent circulatory overloadWeigh dailyI&O, urine for specific gravity
Prevent infectionHand washingProtective isolationHomecare needs
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Clinical manifestations of neuroblastoma:P. 1549-1552Smooth, hard, non-tender along sympathetic
nervous systemFrequent location is abdomenNeck and facial edema from vena cava
syndromeIncreased ICPLimp if mets to bonePancytopenia
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Nursing Management Assess by observation and inspection
(not palpation)Document bowel and bladder functionRecord height & weight, observe gaitChemotherapy, radiation, surgeryTeach parents S&S of infection. Why?
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Death and Dying:Understanding of death according to
developmental age:< 3 years- no understanding/concept of death3-5 years- afraid of separation from parents 5-9 years- understand death is permanent,
irreversible and sad. Concerns for fear of pain, being left alone and leaving parents and friends.
Age 10> have adult’s concept of death
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Nursing and GriefChild- encourage child to express feelings, allow choices, help maintain independence
Family- listen, answer questions, provide information, encourage expression of feelings and fears