Peds unit 3

an immature immune system contributes to an increased risk of respiratory

infection, collapse, and failure

why are Premature babies, infants, and toddlers until the age of 2 years more vulnerable to infection and airway collapse

fragility of pulmonary structures and ease of occlusion from secretions

what can acute respiratory failure lead to?

cardiac arrest

before calcification what airway structures are vulnerable to collapse and occlusion with an acute respiratory infection

soft cartilaginous larynx and trachea

what type of breathers are infants

obligate nose breathers

how long are infants obligate breathers

first five months of life

how long are infant apnea episodes (ones that are considered non life threatening)

10-15 seconds

what do younger children use for respiration until the age of 5-6 years

diaphragm and abdominal muscles

what is an early indication of increased work of breathing

Nasal flaring and accessory muscle movement during an acute illness

lung alveoli are immature in number exponentially increasing from

birth to 3 years

Metabolic processes create a higher demand for

oxygen consumption during infancy

what age do the lungs start to normalize to more adult levels

7-8 years old

the Eustachian tubes of children are smaller and more horizontal until the age of

7-8 years

Arterial Blood Gas (ABG)

ABG's assist the evaluation of acid-base balance measuring the PH, PaO2, PaCO2, HCO3- during symptoms of respiratory distress

Chest (anterior and posterior) Lung Fields Radiography

Views of the airways, lungs provide structural views of the lung fields in order to determine the presence of disease.

Computed Tomography (CT)

Shows a cross section of the lung tissue identifying questionable lesions or alterations, a tumor or mass, also shows specific tissue response to therapies.

bronchoscopy

Scope procedure to assess lesions and foreign body presence in the tracheobronchial tree. Can be curative in the removal of mucoid obstructions as needed.

rast for IgE

Radioimmunoassay test to measure specific IgE antibodies, and systemic response during exposure to a particular trigger allergen.

Pilocarpine Iontophoresis (Sweat Chloride)

Golden standard diagnostic exam to determine the diagnosis of Cystic Fibrosis. Normal findings are <40mEq/L, Suggestive findings: 40 - 60mEq/L, Postive findings: >60mEq/L.
test is not reliable in children younger than 2 weeks related to immaturity of the

Mantoux test

A standard skin test to evaluate for tuberculosis. Testing the cutaneous surface consists of injecting a wheal of recominant purified protein derivative (PPD) medium intradermally and monitoring for a reaction over 48 - 72 hours. Negative results are: <15

End-Tidal CO2 Monitoring

A non-invasive monitor of exhaled breath for the presence of carbon dioxide. Tidal volumes can be used to evaluate response to asthma treatment, indicate impending respiratory failure, and an indication of endotracheal (ET) tube placement.

acute otitis media (AOM): patho

infection involving the eustachian tube

otitis media with effusion (OME): Patho

effusion (fluid behind the tympanic membrane) of the middle ear after an acute infection

what is the most common childhood illness treated by physicians

ear infections

ear infection: symptoms

Ear pain, tugging and pulling at ear
Popping, or tinnitus
Difficulty sleeping, irritability and/or crying
Febrile > 102�F or 38.8�C
Poor feeding
Loss of hearing
Yellow, green and/or foul smelling drainage

ear infection: lab/diagnostic

exam of child's ear using a pneumatic otoscope, the child's tympanic membrane can appear red, swollen or bulging, with limited movement of the eardrum. Injection of air into auditory canal is performed to determine presence of accumulation of fluid behind

T or F Otitis media infections can spontaneously resolve without the need for aggressive therapies

true

acute otitis media (AOM): treatment

generally conservative for the first 48 - 72 hrs administering analgesics and anti-inflammatories for pain/discomfort, especially at bedtime. If spontaneous resolution of symptoms doesn't occur after 72 hrs of close observation, child will be placed on or

what is substituted in children with a penicillin allergy

Cephalosporin, clindamycin, Erythromycin

Priority nursing interventions for AOM or Otitis Media with Effusion (OME)

focuses on treating any worsening infection, acute pain, and fever

Anticipatory guidance provided to parents about otitis media

proper med administration techniques stress the importance of completing the entire antibiotic therapy as prescribed and safe dosing for pain control per 24 hours; Parents can be at risk for administering too much Tylenol or ibuprofen med if not given as

When OME lasts longer than three months and/ or the fluid accumulation in the eustachian tube risks

hearing loss in the child, the surgical procedure tympanostomy is performed

Tympanostomy

placement of a small tube in the child's tympanic membrane to help equalize the pressure in the middle ear and allow fluid drainage. The tube is designed to remain in the tympanic membrane for 6 - 12 months and naturally fall out with the growth of ear ti

Nurses should advise parents that if a tube falls out, it's not a

medical emergency, however, should contact their physician or specialist as soon as possible.

post procedure tube. and ear care

keeping ears dry during bathing include the placement of a cotton ball with petroleum jelly, ear putty or age-appropriate sized earplugs to help keep them dry and reduce the risk of introducing a bacterial infection in the middle ear. Children should neve

Pharyngitis viral or bacterial infections are usually spread by

children exposed to each other in close settings such as daycare or early childhood school settings

pharyngitis and tonsilitis: patho

both viral and bacterial

Pharyngitis

an inflammation of the back of the child's throat, with redness.

tonsillitis

swelling of the adjacent tonsillar tissue in response to the infection as part of the immune system

tonsillitis manifestations

tonsillar tissue is enlarged, red and may have white spots, crypts and/or exudate present; child will breathe with their mouth open exposing foul breath, dry mucous membranes and some difficulty with swallowing

Nurses grade the swelling of tonsils

scale from 0+ (normal presentation) to 4+ (as they approach the uvula)

priority concern with pharyngotonsillitis at 4+

Airway occlusion

the adenoids can also become swollen creating

nasal congestion characteristic to the child's voice and contribute to the development of otitis media, and/or symptoms of sleep apnea.

pharyngitis and tonsilitis: labs/diagnostics

Throat swab for rapid strep and culture obtained at same time depending on presenting symptoms of infection in child; mild symptoms receive a rapid strep test that renders quick results in a ruling out of the bacterial type of the infection. A culture for

pharyngitis and tonsilitis: treatment

Penicillin V is the antibiotic of choice with Group A beta-hemolytic streptococcal pharyngeal infections, Treatment for a 10-day course is standard, with an initial IM injection given in cases when children are likely to be non-compliant with recommended

pharyngitis or tonsillitis infection: prioritized nursing interventions

focused on the ass. and management of a patent airway. Pain is controlled with oral analgesic and anti-inflammatory meds and by encouraging intake of oral fluids to aid in preventing dehydration. Instructions on when to notify the physician with worsening

tonsillectomy: pre operative care

instruction for post-procedure care of tonsillectomy begins when child is diagnosed as an outpatient; children should schedule a tour of surgical center and meet care providers to ask Q's and begin the initial connections of trust. should be taught how to

what builds self-esteem resulting in better surgical outcomes overall

Helping children understand their role and responsibility in recovery; Praise and reward are given to children who demonstrate an interest in their recovery, pre-operatively.

tonsillectomy: postoperative

focused on airway maintenance and close monitoring for any symptoms of bleeding. The nurse must be alerted to any subtle change in the child's condition and notify the physician immediately of any worsening symptoms.

Symptoms of bleeding in children after tonsillectomy (Emergency Condition)

Frequent Swallowing, choking, or signs of fresh bleeding in the back of the throat
Vomiting bright red blood
Anxious behavior
Tachycardia with decreasing blood pressure

how long should parents be monitoring for active bleeding after a tonsillectomy?

7-10 days

what helps maintain adequate hydration and facilitates healing of the postoperative tonsillar membrane after a tonsillectomy

soft foods and plenty of liquids

croup: patho

viral illness that manifests as a narrowing of the upper airway, laryngeal and subglottic area of the throat from inflammation and edema

the three types of croup

acute spasmodic, acute laryngotracheobronchitis (LTB) and acute epiglottitis

the most common cause of croup

parainfluenza, influenza A and B, and respiratory syncytial virus (RSV)

what is a positive sign of viral croup

steeple sign (narrowing in the subglottic area of the throat)

epiglottitis

bacterial infection of subglottic tissue commonly caused by H. Influenzae. rapid onset and quick progression to complete airway obstruction.

A radiologic soft tissue of the neck exam positive for epiglottitis shows

a positive thumb sign (airway occlusion) from severe swelling of the pharyngeal tissues

what is imminent with epiglottitis

complete airway. obstruction

when should an oropharyngeal exam be done

when a secure airway is established

when is intubation done with epiglottitis

mmediately with confirmation of this diagnosis

symptoms of viral croup and epiglottitis

experienced at night when child awakens with sudden-onset of harsh bark-like cough, stridor on inspiration, increased work of breathing, rapid onset fever, anxious, assuming tripod sitting position, drooling, difficulty talking, difficulty swallowing, use

epiglottitis: labs/diagnostics

clinical presentation and radiological evidence of narrowing in the airway. a complete blood count is done to confirm presence of bacterial antigen. a thorough history of childhood vaccines help determine immunity from H. Influenzae.

laryngotracheobronchitis (LTB): treatment

two-fold pharmacologic of corticosteroids and nebulized racemic epinephrine treatment and encouraging oral intake or IV fluids and close monitoring for resolution of symptoms of distress.

epiglottitis treatment

emergency intubation and stabilization of the airway. Admission to the ICU environment for treatment of IV antibiotics until extubation. Resolution of severe symptoms and extubation typically occurs after 48 hrs. The child will receive oral antibiotics fo

Croup and Laryngotracheobronchitis (LTB) nursing interventions

Maintaining patent airway is highest priority a croup infection, stabilize/support adequate O2 with administration of supplemental O2 to maintain saturation levels >95%.
Monitoring for increased accessory muscle use or a change in LOC is crucial for ident

bronchiolitis: patho

respiratory condition resulting in increased inflammation and mucus occlusion of the small airways

what is the significant cause of bronchiolitis infection in children

Respiratory Syncytial Virus (RSV)

who is at an increased risk for hospitalization from the harmful effects of RSV related to complications of hypoxia, dehydration, and atelectasis

children younger than two years

Respiratory Syncytial Virus (RSV): symptoms

Thick, tenacious secretions contribute to hyperinflation of lungs from air becoming trapped due to child's inability to exhale fully. Progressive hyperinflation of the lungs increases risk of atelectasis. Severe hypoxia results as retained CO2 and diminis

RSV: lab/diagnostic

Nasal Pharyngeal Aspirate

Nasal Pharyngeal Aspirate

common way to obtain a respiratory specimen in children under five yrs. Although uncomfortable, is relatively painless and produces more live virus specimen sample than a nasal swab. A nasal wash is generally considered collection method of choice when is

how to perform a Nasal Pharyngeal Aspirate

tilt head back. Instill small amount of sterile saline into nostril (1 ml). Instill saline into small catheter and insert tubing into nostril curving downwards. Aspirate nasopharyngeal secretions into catheter tubing. Remove and flush contents into steril

RSV treatment:

focused on O2 and hydration management during the acute illness. Palivizumab preventative injections are administered to premature babies, immunocompromised or cardiac infants at risk, once a month throughout the cold and flu season. Routine removal of se

Priority nursing care for children with RSV is to

facilitate gas exchange, maintain adequate hydration, prevention through education

how to facilitate gas exchange in children with RSV

cardiopulmonary monitoring of VS and O2. Administration and regulation of supplemental O2 with sat levels <94%. Routine suctioning of secretions to free the airway of mucus is performed before meals and as needed, noting that overuse of suctioning can cre

how to maintain adequate hydration in children with RSV

oral or IV fluid admin. collect I&O data for accurate assess of child's hydration status.

education prevention of RSV

proper handwashing; can live on surfaces for up to 6 hours; avoid infant exposure in crowded buildings during peak cold/flu season and make sure children are up to date on all recommended vaccines.

pneumonia: patho

Accumulation of fluid and cellular debris begin to block the child's air passages. Consolidation of mucous in these areas results in dyspnea, increased respiratory rate and work of breathing.

viral pneumonia (parainfluenza, RSV, Influenza): symptoms

Febrile, low or progressively increasing to higher levels; Adventitious lung sounds, cough, abdominal pain
Infiltrate of perihilar tissue may be noted on chest radiography
Non-elevated white blood cell count (<20,000/mm3)
Duration of illness approximately

Bacterial Pneumonia (Streptococcus pneumonia, Mycoplasma, and Hemophilus Influenza): symptoms

Rapid onset of high fever, usually after an initial upper respiratory illness
Cough, general malaise or anxiety, chest pain
GI symptoms and abdominal pain
White blood cell count elevation ( >20,000/mm3)
Chest radiography shows consolidation

pneumonia: labs and diagnostics

Chest Radiography, Serum studies (CBC), Sputum Cultures, Ultrasound

pneumonia treatment with air

facilitation of airway clearance and correction of impaired gas exchange. Oxygenation is supported with humidified supplemental O2 to keep saturation levels ?91% or according to physician orders.

pneumonia treatment with hydration

Oral/IV fluid interventions are admin in efforts to keep child hydrated and lung secretions thin and liquefied for ease in removal. Accurate I&O data is an essential assess to determine adequate hydration levels in children.

pneumonia treatment with comfort

antipyretics, antibiotics, and analgesics to facilitate child's ability to receive adequate rest and ambulate as directed to facilitate normal respiratory mechanisms and secretion removal. Teaching child to splint their cough using a towel roll, pillow or

pneumonia: priority nursing interventions

support airway clearance, acute pain control, maintain normal breathing patterns, maintain adequate hydration

apnea: patho

immaturity of brainstem's functional capacity to regulate autonomic cardiopulmonary function. The other, apnea as a secondary result of a primary medical condition such as gastrointestinal reflux, seizures, metabolic disorders, childhood obesity and other

central apnea

during sleep when the brain or heart signals for normal respiration are interrupted creating periods of cessation of breathing. Cessation of respirations for >15 seconds is commonly caused by central apnea.

obstructive (OSA) apnea

When soft tissues in the posterior pharyngeal area relax and occlude the airway during sleep.

mixed apnea

a combination of both types when the absence of air movement and obstruction of the airway are present.

obstructive sleep apnea symptoms

periods of cessation of breathing for more than 20 seconds. This type of apnea presents as very loud snoring with pausing for > than 20 seconds multiple times. Restlessness during sleep that results in daytime neurobehavioral complications

what is a known complication of obstructive apnea

Nocturnal enuresis

nocturnal enuresis

bed wetting

sleep apnea labs/diagnostics

polysomnogram (sleep study) is performed on children to monitor their brain wave patterns, oxygenation and heart rate during sleep. Other physical manifestations such as eye and movement of extremities are recorded as well giving clues as to the type of a

traditional pharmacologic interventions for apnea

Methylxanthines (Theophylline) and caffeine

children receiving pharmacologic treatment for sleep apnea show fewer complications with

bradycardia and frequency of periodic breathing until the maturing of systems occurs when the condition spontaneously subsides

Continuous positive airway pressure (CPAP)

machines that force oxygen into the airways when sleeping may be prescribed along with medications

obstructive sleep apnea treatment

children may undergo a surgical adenoidectomy to remove tissue that contributes to airway obstruction

what can help reduce the symptoms of complication associated with OSA.

reducing childhood obesity

sleep apnea nursing interventions

requires management of meds, an adequate breathing pattern and sleep position while hospitalized. Teaching parents about importance of adherence to newly prescribed med regimen and how to perform emergency life-saving steps of CPR before discharge

Exercise-induced bronchoconstriction / Asthma

bronchoconstrictive condition occurring with vigorous exercise in children who have asthma

exercise induced asthma causes

cough, shortness of breath and wheezing

Bronchoconstriction associated with exercise can be managed by

using a short-acting beta-agonists (SABA) or Ipratropium 30 minutes before the activity as directed by the physician in accordance with long-term control medications taken regularly.

asthma diagnostics

peak expiratory flow rate (PEFR) meter

peak expiratory flow rate (PEFR) meter

used to objectively measure airflow of the lungs

asthma action plan

individualized plan helps manage acute exacerbations and becomes an objective historical tool to recall any precipitating symptoms.

meds that give quick relief of acute symptoms in asthma

short acting. beta2-agaonist (SABA's)

long term management of asthma symptoms: meds

long acting beta agonist (LABA's)
inhaled corticosteroids
leukotriene blockers
immunomodulators

prioritized interventions with an acute asthma episode

Teaching the child to use the SABA's before exercise and with acute exacerbation is a priority intervention. Instructing parents and children in how to follow the asthma action plan using the PEFR meter as prescribed, can help reduce emergency room visits

status asthmaticus

a severe, life-threatening asthma attack that is refractory to usual treatment and places the patient at risk for developing respiratory failure.

long term management of asthma is designed to

Minimize impairment in child's life with prevention of severe exacerbation with accurate daily assess. monitor symptoms.
Reduce need to use SABA for relief of symptoms to ?2 days per week using PEFR to regularly monitor lung status and evaluate pharmacolo

cystic fibrosis: patho

genetic autosomal-recessive complication in children when the gene cystic fibrosis transmembrane regulator (CFTR) responsible for movement of fluid across cell membrane is altered and exocrine gland regulation of salt and water removal from the body malfu

what is the overall life expectancy of those with cystic fibrosis

30 - 40 years but growing with the advancement of medical treatment

Parents of children with CF must receive

genetic counseling to understand better the potential risk for other children to be born with the disease.

cystic fibrosis: symptoms

Thickened mucus is a complication affecting the normal function of the digestive, respiratory, reproductive and skin systems.

cystic fibrosis prevents the pancreas from releasing what vitamins that are essential for digestion?

A, D, E, K

cystic fibrosis causes mucous buildup in the intestine and prevents

absorption of fats and proteins resulting in Failure to Thrive and malnutrition

type of stool characteristic prominent in CF children that can also be used as an indication for medication management when symptomatic.

Steatorrhea

Steatorrhea

fat in the feces

Children with CF are at risk of developing frequent serious respiratory infections because

thick, sticky mucous traps harmful germs in the lungs and provides a medium for robust growth.

lung infections are predominantely

bacterial

cystic fibrosis affects the reproductive system

in both girls and boys contributes to delay in development or other complications with sex organs

why are boys with CF sterile

abnormal or no development of the vas deferens

what complications do girls with CF face in the reproductive system

thick cervical mucus that interrupts regular menstrual cycles and/or prevents pregnancy

why are CF children's skin salty

abnormal function of sweat glands releasing high amounts of NaCl. Glands carry salt and water to surface of skin. water evaporates while the cell's inability to reabsorb sodium creates a hyponatremic metabolic condition and abnormally salty skin identifie

what is the gold standard test for diagnosing CF?

sweat chloride test

sweat chloride test

non-invasive, painless test is performed by placing electrodes on the child's skin to produce minimal amounts of sweat for levels of measurable chloride

what level is considered a positive for CF when performing a sweat chloride test

?60 meq/L

why does the sweat chloride test not work on infants less than 2 weeks old

do not produce adequate amounts of sweat for accurate diagnosis using the sweat test.

what is the earliest clinical symptom of CF in newborns

meconium ileum during the first 48 hours of life

CF treatment

multi-specialty individualized care based on their specific conditions. Pancreatic enzyme supplementation to support healthy growth/development and respiratory system maintenance therapies are essential to providing opportunities for the child to live a q

prioritized nursing interventions for CF

facilitate gas exchange
prevent/minimize risk of infection
promote adequate absorption of nutrients

Prioritized Nursing Interventions: facilitate gas exchange in children with CF

removal of secretions rom respiratory tract using chest percussion therapy, mucolytics, bronchodilators, and preventative antibiotics to prevent bacterial growth, high frequency chest wall oscillation

Prioritized Nursing Interventions: Prevent and Minimize Risk of Infection in children with CF

obtain recommended childhood vaccinations, proper hand washing techniques Children encouraged to develop an exercise routine to facilitate lung function.

calorie intake of those with CF

150% of recommended daily intake

how is pancreatic enzyme replacement regulated and when is it given

according to the child's weight and administered with all snacks and meals

what should parents avoid doing with pancreatic enzymes

avoid mixing enzymes with hot or acidic foods for maximum effectiveness.

Persistent murmurs associated with left-to-right shunting lesions may not be detected or diagnosed until

after the first six weeks

Innocuous murmurs detected with auscultation can be

a normal finding and resolve within the first few weeks of extrauterine life

innocent murmurs

transient murmur

turbulent blood flow causes

pathologic murmurs through an opening in the heart

what type of murmur requires referral to a pediatric cardiologist

pathologic murmurs

what is the most effective way to identify cardiac murmurs in children during the physical assessment.

auscultation

Heart lesions in children are the result of a

congenital or acquired complication

Congenital Heart lesions are the result of

genetic alterations (Down Syndrome, Atrial Septal Defect, Patent Ductus Arteriosis, Tetralogy of Fallot)

A congenital heart condition is classified by

he lesion's effect on the body's ability to oxygenate the blood and a shift in the normal direction of blood flow.

Acquired heart disease is the result of

a child contracting a severe illness that attacks the heart muscle itself. Kawasaki disease and Rheumatic fever are two examples of conditions that cause coronary and cardiac tissue injury.

children who have undergone repair of a congenital heart anomalies are also at risk for

contracting infective endocarditis (IE).

Shunting is a cardiac condition when the

blood travels through the heart abnormally related to holes or areas of communication between the heart chambers

Shunting allows for

mixing of oxygenated and unoxygenated or backflow of blood through the heart

Cardiac shunts are identified by

the abnormality in the heart and associated blood flow changes

The most common congenital heart defects in children are

left to right shunting lesions. that reverse the normal pressure gradient from them being higher on the left side of the heart to higher on the right

Electrocardiogram (ECG/EKG)

non-invasive examination of the heart's electrical activity. This test can record arrhythmias, rate irregularities, or damage to the cardiac muscle.

holter (event) monitor

non-invasive continuous monitoring of cardiac activity during activities of daily living for an extended period. capture and record hr, rhythm irregularities, palpitations or other symptoms on demand to thoroughly assess for cardiac irregularities.

Echocardiography (ECHO)

performed by a sonographer using a transducer device to scan the precordium. Ultrasonic beams bounce sound waves through the skin against the heart and become converted into computer images on a monitor Blood flow, valve competence, measurement of chamber

pulse oximetry

screening of newborn babies can help providers monitor for O2 complications during the first 24 - 48 hrs of life. Critical congenital heart disorders are detected using this non-invasive method of assess for early identification

Cardiac Catheterization-based procedure

gold standard for confirmation of congenital heart disorders; invasive procedure performed by inserting a catheter into the brachial or femoral artery leading to the heart, to assess the function of cardiac chambers, measure
CO, diagnose complications wit

heart failure is the result of

two primary physiologic complications of congenital heart disease (CHD), hypoxia and volume overload

who are predominately affected by congenital structural abnormalities creating right-sided HF affecting systemic circulation and oxygenation

Newborns and young infants

who commonly experience heart failure from left-sided complications and pressure overload related to obstruction, damage to the heart muscle or renal disorders causing cardiac hypertrophy and development of inefficient pumping mechanisms

Older children

Characteristics of HF in children are identified during

the child's physical assess as fluid overload in lungs w/adventitious sounds upon auscultation, edema of extremities and dependent sites from the interstitial fluid shift, failure to thrive related to high metabolic demand, dyspnea and exercise intoleranc

Clinical recommendations for feeding the child with HF are focused on

helping the infant to conserve energy and maintain steady growth and weight gain. Caloric recommendations for infants ranges from 140 - 200 kilocalories/day. Breastfed infants unable to meet weight gain goals receive caloric supplement through intermitten

priority intervention for feeding the child with HF are focused on

symptoms of intolerance such as irritability, rapid respiratory rate, vomiting or sweating

polycythemia

secondary condition resulting from hypoxia. primary cause is an absolute increase in RBC mass related to increased production. CHD shunting lesions that alter systemic O2 stimulate the body to increase its O2 carrying capacity to the tissues and over prod

Polycythemia in the ill child with dehydration is at an increased risk for

stroke and pulmonary thrombosis that can lead to cardiac arrest

Hypercyanotic (TET) Spells are associated with

cyanotic heart lesions namely Tetralogy of Fallot (TOF)

Hypercyanotic (TET) Spells occur

randomly with right ventricular outflow obstruction drastically reducing the blood flow to the lungs causing a systemic cyanotic condition that's evident in the child's outward bluish appearance

Teaching parents how to resolve the cyanosis requires putting the infant in the

knee-chest position or having an ambulatory child squat during an acute event to increase peripheral vascular resistance and force more blood through the pulmonary system helps to resolve the cyanosis.

Chest radiography and Echocardiogram help to diagnose

electroconductivity, pulmonary flow, and structural deviations.

Serum studies include

complete blood counts, metabolic panels, cardiac enzymatic and hormonal studies

Pulse oximetry indicates complications with

room air oxygenation

heart failure treatment: Pharmacologic

Pharmacologic therapy is aimed at reducing systemic fluid congestion and edema with diuretics, increasing cardiac contractility with inotropes and reducing increased afterload with vasodilators.

heart failure treatment: conventional therapies

Conventional therapies include the use of a combination of diuretics, inotropic (digoxin), beta-blockers, angiotensin-converting enzymes (ACE) inhibitors and spironolactone medications

digoxin

cardiac glycoside that helps to increase cardiac output and aid in diuresis. requires strict I&O measurements

when do you hold digoxin

apical heart rate of <100 in infants and <70 in older children.

Diuretics and Thiazides

facilitate the removal of excess water and Na+ to prevent fluid volume overload and systemic edema

loop diuretics (lasix)

very potent and potassium wasting

thiazides

have less of the K+ wasting effect than the loop forms of diuretic but are also less potent

Prevention of hyponatremia or hypokalemia is monitored through

serum studies and strict collection of I&O data.

Vasodilators or Angioconverting Enzyme (ACE) Inhibitors

help relax smooth muscle and reduce afterload caused by obstruction affecting left-side cardiac output. The action of the drug prevents the conversion of angiotensin I to angiotensin II in the kidneys reducing the release of aldosterone. Less aldosterone

furosemide

potent loop diuretic

spironolactone

potassium sparing diuretic

thiazide diuretics

acts on distal renal tubules

digoxin description

increases cardiac output has positive inotropic and negative chronotropic effects

vasodilator

relaxes smooth muscle; decreases afterload

nursing care interventions for children with HF

Monitor VS; watch O2 sat levels and report complications of developing hypoxia to the physician.
Support hydration and wt gain by implementing dietary supplementation interventions, performing strict daily wt, I&O assess.
Administer pharmacotherapies as o

ineffective endocarditis (IE)

can be caused by bacterial, fungal or viral antigens that invade the endocardium and heart valves. Exposure to dental procedures, deep cuts, and interventional procedures increases the risk of bacterial invasion by either staphylococcus or streptococcal p

ineffective endocarditis (IE): symptoms

Fever and sweating
Headache, muscle aches, and pain in the joints
Loss of appetite
Erythema
Exacerbation of a preexisting murmur

IE: labs and diagnostics

serum studies including a complete blood count and blood cultures, CRP, ESR and rheumatoid factor. A urinalysis and radiologic studies such as echocardiography and MRI also provide essential data for diagnosis.

IE: Treatment

eliminate all infective bacterial vegetation from the cardiac tissues completely. This intervention is a difficult task that requires long-term antibiotic treatment typically lasting 6 - 8 weeks. In cases of severe persistent vegetation surgical excision

IE: prioritized nursing interventions

Instruct parents to practice daily oral hygiene.
Comply with AHA recommendations for dental prophylaxis
Practice safety by having the child wear a medical alert bracelet or activate other forms of medical alert notification systems in case of an emergency

rheumatic fever: causes

by an untreated or poorly treated infection caused by. streptococcus group A bacteria

rheumatic fever: patho

a complication with strep throat; inflammatory disorder caused by group A streptococcus; causes inflammation throughout the body and can derive from scarlet fever

rheumatic fever: symptoms

occur 2-4 weeks after strep throat; noodles/bums non the. skin, nosebleeds, and fatigue, heart palpations/flutters, joint pain, swelling, fever, shortness of breath, stomach ache, vomiting, rash,

rheumatic fever treatment

antibiotics, pain meds, corticosteroids, anticonvulsants, bed rest

common meds used to treat rheumatic fever

Penicillin G benzathine (PCN-G)
Penicillin VK (Pen VK)
Erythromycin ethylsuccinate (EES) *used with PCN allergy

Kawasaki disease patho

auto-immune complication of unknown etiology primarily affecting children <5 years of age

what is the leading cause of acquired heart disease in children

Kawasaki disease

acute symptoms of Kawasaki disease

high fever >102�F for a period of at least 5 days and lasts up to 14 days. Persistent high fever of >5 days along with 4 of the 5 manifestations confirms diagnosis

Kawasaki: diagnostic manifestations

Oral alterations (strawberry tongue, dry, red and cracked lips) Pharyngeal erythema
Bilateral conjunctivitis
Rash over body surfaces
Redness of upper and lower extremities
Cervical lymphadenopathy and enlarged lymph nodes
Absence of other infectious disea

subacute phase of kawasaki

disease begins when the fevers are no longer present, around the fourth to sixth week of illness. Conjunctivitis and desquamation of the skin on the fingers and toes begin along with increased risk for thrombocytosis and development of coronary aneurysms.

convalescent phase of kawasaki

time when most other manifestations of complication have resolved leaving behind the markers known as Beau's lines in the nail beds.

what stage does Kawasaki disease present itself

acute symptoms/phase

Kawasaki treatment

admitted during acute phase of infection and given a high 2g/kg 1-time dose of IV immunoglobulin or gamma-globulin (IVIG) delivered over 10 - 12 hours and high dose aspirin; o prevent complications of high fever and continued until afebrile for 72 hours.

Kawasaki: nursing interventions

prioritize cardiac assess during acute phase of hospital admission closely monitoring for changes in VS, or LOC that may indicate cardiac compromise, implement and evaluate pain control measures, and maintain adequate hydration

Hypertension (HTN) in children

defined as BP that is greater than the 95th percentile for height and weight

prehypertensive conditions

defined as BP levels between the 90th and 95th percentile

normotensive children

defined as BP readings less than the 90th percentile

what is the main complication associated with Essential HTN

obesity

what is the result of renal complications from underlying physical disorders that create situations of volume overload such as HF

secondary HTN

when does Diagnostic evaluation of blood pressures begin

at 3 years old

how many times must high BP readings be recorded to be considered a diagnostic for HTN

3 separate occassions

HTN prioritized nursing

correcting the underlying condition of obesity in children with essential and secondary HTN. Weight reduction is a primary goal for complete resolution of an essential disorde

hyperlipidemia: patho

(high cholesterol) is the result of a build-up of arterial plaque that creates a significant risk for heart, cerebral and other systemic complications

hyperlipidemia: treatment/nursing interventions

dietary modifications of restricting daily consumption of foods to recommended daily allowances, and balancing proper nutrients fats, proteins and carbs are essential to lowering cholesterol and triglyceride levels in children. Encouraging physical activi

Granulocytes:

Three types of circulating cell formed to help fight infection and inflammation (neutrophil, eosinophil, basophil)

agranulocytes

Five types of cell that together work to prompt immune reaction and inflammatory response. (monocytes, lymphocytes, T cell, B cell)

red blood cells

carry OO2 the tissues in the body concentrated in hemoglobin for transport throughout the systems. Iron stores determine the body's ability to produce an adequate supply of hemoglobin. The lifespan of an RBC is 90 - 120 days.

platelets

regulate the blood's clotting process in order to prevent loss (hemostasis).

Which diagnostic test confirms aplastic anemia

bone marrow aspiration

iron deficiency anemia (IDA): patho

can be attributed to prematurity, low socioeconomic status and limited access to iron-rich food, excessive intake of cow's milk, and insensible blood loss from the GI tract and menstruation in some girls.

recommended amounts of iron for full-term infants from birth to 6 months is

0.27 mg/day

recommended amounts of iron for infants 7 months to 1 year

11 mg/day

Toddler: recommended amounts of daily iron intake

7 mg/day

iron intake for children 4 -8 years of age is

10 mg/day

iron deficiency anemia: symptoms

Pallor of skin, nail beds and gingival tissue
Lightheadedness or vertigo
Irritability
Generalized weakness
Symptoms of Pica: Eating inanimate objects such as paint chips, dirt, or chalk which also correlates with lead poisoning.

iron deficiency anemia: labs/diagnostics

serum study of the complete blood count is the determinate of anemia.

Acceptable levels of hemoglobin should be no less than

11 g/dL

levels of hemoglobin in children with mild anemia is

10-11 g/dL

complications of ID/IDA can be attributed to

prematurity, low birth wt, breastfeeding as only form of nutrition beyond 4 mths w/o Fe supplementation, overfeeding of cow's milk w/o dietary solid food supplement of iron-rich or fortified foods, and exposure to lead.

ID/IDA treatment

modification of dietary intake and supplementation of iron with oral forms of ferrous salts; Oral iron should be taken on empty stomach and admin through a straw to avoid staining the teeth and given with OJ to enhance absorption. Parents should expect ir

Priority nursing goals for the anemic child are to

evaluate child's cognitive baseline for developmental delay and accessing necessary resources for intervention. Teach parents about significance of dietary nutrient, and how to incorporate natural forms of iron in daily diets such as encouraging child to

Sickle cell disease (SCD) is an

autosomal recessive inherited genetic abnormality that alters the shape of an average round red blood cell (HbA

do both parents need to carry the recessive sickle cell gene for the child to have sickle cell anemia

yes

Sickled RBC's are composed of

thick strands that force the abnormal shape of the cell.

vaso-occlusive crisis

overwhelming about of sickled cells begin to block vessel passageways. This complication can happen anywhere in the body but is frequently reported as pain in the chest, joints upper and lower extremities including symptoms of dactylitis.

Acute Splenic Sequestration

complication for children with SCD. The spleen's reticuloendothelial system designed to filter and prevent harmful bacterial infection, cannot function as its intended because of the obstruction created by sickling blood cells

aplastic crisis

related to infection from Parvovirus B19. Parvo completely shuts down hematopoiesis in the bone marrow with acute symptoms lasting up to 10 days. infections such as this create a tremendous deficiency in the amount of available hemoglobin to carry O2 to t

Diagnosis of SCD is now performed with the

newborn screening test done at birth. Serum studies such as the complete blood count assessment are used to determine the significance of the illness and guide treatment when symptomatic.

Standard treatment for SCD children is

prophylactic penicillin 2x daily for the first 5 yrs of life Hydroxyurea is an oral form of fetal hemoglobin (HbF) that prevents adhesions of the sickled RBC to the vessels and stimulates the production of normal RBC's (erythropoiesis) and increases the c

SCD: Prioritized Nursing Interventions

assess VS, adequate hydration, I&O data, IV/oral antibiotics, manage pain, support psychosocial development

hemophilia A

This condition is a result of a lack in clotting factor VIII. 9/10 children have this type of hemophilia.

hemophilia B

lack of clotting factor IX, and is also known as the Christmas disease; symptoms of this complication are similar to Hemophilia A.

hemophilia C:

mild form of the condition where minimal bleeding is noted from a lack of clotting factor XI

hemophilia

lifelong x-linked autosomal recessive disorder that affects male children of women who carry the genetic trait; bleeding out into the tissues and joints

hemarthrosis

bleeding into the knee joint; arthritis and crippling deformities can result from painful, recurrent bleeding episodes. Bleeding under the skin from normal childhood accidents, no matter how small, can cause the development of a hematoma.

recommended triage treatment for hemophiliacs to stabilize an acute bleeding condition.

RICE mnemonic

hemophilia labs/diagnostics

Serum studies include prothrombin (PT) and partial thromboplastin (PTT) clotting time tests, along with specific tests for factors VIII and IX to confirm the diagnosis

hemophilia treatment

recombinant anti-hemophilic factor allow children to receive factor VIII and IX replacement therapies without risks of blood-borne disease.

Desmopressin (DDAVP)

antidiuretic; (hemophilia) helps the tissues in the blood vessels release stored factor VIII. is given as a prophylactic for invasive procedures or minor surgeries and any dental intervention.

hemophilia prioritized interventions

Preventing Bleeding and reducing the risk of Injury

Immune Thrombocytopenic Purpura (ITP): patho

acquired hematologic disorder when the platelet count falls abnormally low <150,000/mm3

petechial

A pinpoint rash commonly seen with mild capillary bleeding under the tissue, or as the result of a low platelet count

purpura

pooling of blood under the skin as a result of low platelet levels in the blood.

symptoms of ITP

petechial, purpura, bleeding gum with brushing or blood in the stool

A purpuric rash is noted with platelet counts

< 45-50,0000/mm3.

Children show symptoms if ITP with a platelet count of

< 100,000/mm3

A normal platelet count is

150,000 to 450,000

ITP treatment

pharmacologic interventions of steroids and IVIG to block the attack of the platelets

Children with chronic complications of ITP will be considered for

splenectomy to stop the destruction of the cells.

ITP nursing interventions

prevent bleeding, safe environment,

full bladder control by the age of

5

Bladder capacity at birth is

20-50 mL

The child's bladder capacity is determined by

age + plus two, totals capacity (i.e., a 3-year-old, plus two would have a 5-ounce capacity)

Urine output averages for children

1-2 ml/kg/hr

Control over emptying the bladder is dependent upon

maturation of the CNS

Children are generally not able to potty train until

18 -36 months of age when myelination of the spinal cord is complete.

Blood Urea Nitrogen (BUN)

assess the amount of urea nitrogen is in the blood. The normal range is from 7 - 20, the BUN level increases with the worsening condition of the kidney.

serum creatinine

Normal creatinine levels for children ? 12 years is 0.0 - 0.7 mg/dL. This level indicates renal function as increased levels suggest the worsening condition of the kidney.

urinalysis

show levels of concentration of urine, the presence of urinary tract infection (UTI), or results of therapeutic management of chronic renal disease or disorder. A culture may also be ordered on the specimen to determine pathogen associated with UTI sympto

urine protein

level of protein in the urine. Chemstrip results of albumin >1+ require further diagnostic testing and comparison ratios with the creatinine.

Glomerular Filtration Rate (GFR)-

indicator of renal function in children and adults. It is the calculation of the clearance of waste from the blood with the child's age and gender.

Kidney, Ureter, Bladder (KUB)

radiograph is used in the first steps of diagnosing a complication with the genitourinary organs. The KUB helps to assess the size, position and any obstructions or stones of the kidneys and bladder abnormalities, or confirmation of ascites.

Voiding Cystourethrogram (VCUG)

uses fluoroscopy to exam the child's urinary tract and bladder assess for structural deviations that contribute to symptoms of obstruction and backflow of urine. The test itself is considered invasive

renal ultrasound

ultrasound is a non-invasive painless intervention that shows the internal structures of the renal system. The ultrasound images help to assess the size, position and any mass or stones of the kidneys and bladder abnormalities.

primary enuresis

wetting from a child who has never experienced a time of urinary control or continence for > 6 months

secondary enuresis

return to wetting after having experienced urinary continence for longer than 6 months

diurnal enuresis

wetting while awake

mono symptomatic enuresis

uncomplicated, no lower tract symptoms or bladder dysfunction

Non-monosymptomatic enuresis

complications of lower abdominal pain and symptoms of urgency, hesitancy, and inability to empty the bladder resulting in post void dribbling.

enuresis: manifestations

Sleep issues, patterns, behaviors during sleep including history of nightmares or night terrors, History of normal patterns of oral fluid intake and typical time of day the most consumption takes place, History of any emotional/ psychosocial complications

enuresis treatment

minimize their feelings of guilt and inferiority

enuresis prioritized nursing interventions

monitor for symptoms of skin breakdown and increased risk of infection
Teaching related to behavioral conditioning and establishing reward programs for compliance in working toward goals of control
Supporting the child's self-esteem and encouraging social

Urinary tract infections occur when

colonization of bacteria manifests in the renal structures whether, urethra, bladder or ureters that can worsen and travel backward infecting the kidneys (pyelonephritis) causing sepsis or bacteremia

most common cause of UTI in children is an

E coli bacterial infection

UTI symptoms: Infants > 2months and Preschool Children up to 2 years

Fever and irritability
Poor feeding
Strong smelling urine
Abdominal pain and vomiting

UTI symptoms: Preschool and Young School Age Children aged 2-6 years

Urinary symptoms of frequency, urgency, and dysuria
Fever and irritability
Strong smelling urine
Abdominal pain and vomiting

UTI symptoms:Older School Age Children > 6 years and Adolescents

Urinary symptoms of frequency, urgency, and dysuria
Fever and irritability
Strong smelling urine
Flank/back pain
Abdominal pain and vomiting
Enuresis and Incontinence

vesicoureteal reflux

urine flows from bladder up to the kidneys

vesicoureteral reflux: symptoms

swelling of kidneys and ureters, febrile UTI

vesicoureteral reflux: treatment

surgery to increase tunnel length of ureter

vesicoureteral reflux: labs/diagnostics

Urinalysis and urine culture, VCUG, bladder catheterization or suprapubic aspiration and ultrasound imaging are performed in severe cases.

Nursing care of the child with a UTI includes

manage/prevent worsen of condition, monitor VS, timely antibiotic administration, adequate hydration, strict I&O, daily WT, avoid bubble baths, change out of wet clothes, routinely relieve bladder

hydronephrosis

dilation of the renal pelvis

pyelonephritis

kidney infection

cystitis

inflammation of the bladder

Hypospadias

Incomplete development of the urethra causes the opening of the urethral meatus to form on the ventral side of the penile shaft

Epispadias

development of the opening of the urethral meatus on the dorsal side of the penile shaft. commonly diagnosed with other structural complications such as bladder exstrophy.

hydrocele

excess of fluid collection in the scrotal sac related to a dysfunction in the drainage of the scrotum.

testicular torsion

emergency condition involving the spermatic cord and scrotum. Sudden onset of severe swelling and pain felt in the scrotum as a result of twisting of the spermatic cord forcing a rotation of the testicle. Blood supply to the testicle is obstructed risking

Treatment for hypospadias repair requires

surgical correction between the ages of 6 - 18 months. Parents are advised to abstain from circumcising their infant as the extra skin can be used for surgical repair if necessary

Acute Post-Streptococcal Glomerulonephritis

kidney disease that develops after infection with certain strains of group A streptococcus bacteria, autoimmune disorder

Acute Post-Streptococcal Glomerulonephritis can cause

inflammation of the glomeruli, causes kidney less able to filter urine

Acute Post-Streptococcal Glomerulonephritis: symptoms

fatigue, blood in urine, fever, headache, nausea, dark urine, edema in face hands and feet, high BP, protein in the urine, less urine frequency,

Acute Post-Streptococcal Glomerulonephritis: diagnosis

based on symptoms, physical exam, and if person has recently had a bacterial infection, ultrasound of kidney, biopsy of kidney, protein analysis

Acute Post-Streptococcal Glomerulonephritis: treatment

treat bacterial infection, treat symptoms, monitor/support kidney function

nephrotic syndrome (MCNS): symptoms

Severe proteinuria +3 - +4
Normotensive
Hypovolemia
Fatigue and weakness

nephrotic syndrome (MCNS): patho

renal injury in which large amounts of protein are lost in the urine

nephrotic syndrome (MCNS): labs/diagnostics

Serum studies of albumin, cholesterol, and triglycerides, complete blood count, hemoglobin, and hematocrit, electrolytes (BUN, Creatinine), - ASO titer, urinalysis, and culture if indicated.

nephrotic syndrome (MCNS): treatment

corticosteroid therapy, oral prednisone (2mg/kg/day)

nephrotic syndrome (MCNS): intterventions

strict sodium intake, diuretics, I&O data, hydration, skin integrity, ascites, no live virus vaccines for 30 days

PET scan (positron emission tomography scan)

views the internal tissues. PET scans involve the injection of radioactive glucose into the veins, assessing for uptake of the sugar by cancer cells throughout the body. Malignancies in the tissue become enhanced in scans showing up as brighter images ove

chemotherapy

implemented using one drug, or a combination of drugs to kill cancer cells. Various types of cells act differently from each other; therefore children may require multiple medications. Unfortunately, chemotherapeutic drugs do not differentiate healthy cel

neoadjuvant chemotherapy

administering medications before surgically debulking a mass

adjuvant therapy

administration of chemotherapy after surgical removal of a mass to eradicate any remaining cells not removed.

radiation

sed to direct energy particle waves into cancer cells to interrupting their DNA and cellular division causing them to die, does not differentiate between healthy and unhealthy cells

neoadjuvant radiation

shrink the size of the tumor prior to surgical removal

adjutant radiation

prevent relapse

side effects of chemotherapy and radiation

low WBC count, anemia, low platelet count, nausea, vomiting, diarrhea, wt gain/loss. mucositis, alopecia

Mucositis (stomatitis)

mouth sores are prevalent during therapy as the tissues are vulnerable to break down. Oral infections can be prevented, and lesions managed with good oral hygiene practices, by keeping the membranes moist and staying well hydrated

surgery (debulking)

performed to remove a tumor, and tumor margins in combination with chemotherapy, or radiation to eradicate any remaining microscopic traces of cancer cells possibly left behind

Hematopoietic Stem Cell Transplant (HSCT):

replace stem cells in the bone marrow that have been depleted by cancer treatment. Radiation and Chemotherapy kill normal stem cells in the bone marrow responsible for cell production.

HSCT can either be

autologous using the child's disease-free stem cells or allogeneic using the stem cells of a family member, or another person who is not related to the family.

what does HSCT help children with

greater tolerance of the higher doses of chemotherapy and suffer less adverse effects of treatment.

Childhood leukemias

cancer arising from the bone marrow that spreads throughout the body as blood delivered to the tissue of organs becomes affected by the disease.

what s a fast-growing cancer that requires immediate treatment upon diagnosis.

Acute Lymphoblastic Leukemia (ALL)

symptoms of ALL

Bone and joint pain, fatigue, fever, weight loss and bleeding, thrombocytopenia, and anemia

ALL labs and diagnostics

Serum studies, bone marrow aspiration, CT, radiography and lumbar puncture

Acute lymphoblastic anemia: cause

blast cells interfere with development and function of healthy WBCs , RBCs, and platelets

induction of remission

first phase of in the cycle of reducing immature blast cells with the goal of inducing a state of remission that should occur in the first 28 days for the best prognosis.

consolidation

Once remission is achieved, therapy is aimed at removing any remaining abnormal cells from sites where chemotherapy cannot cross the blood-brain barrier such as the CNS and gonads (sanctuary sites)

maintenance

phase of chemotherapy is aimed at preventing any regrowth of cells. Cycles during this phase are lower dose and extended over many months to years.

steroid therapy

used throughout these phases of treatment as an adjunct to chemotherapy and to control symptoms of nausea and vomiting. High doses of corticosteroid therapy create conditions of immunosuppression and Cushing syndrome.

children using a steroid therapy need strict monitoring of

temperature and routine serum glucose checks

ALL interventions

monitor neuro fonction, VS, standard precautions, prevent injury, monitor for bleeding, hydration, nutritional status, provide support, involve family members in decisions

brain tumors affecting children begin as

gliomas in the lower parts of the brain stem and cerebellum. Astrocytoma spread throughout brain tissue mixing in with healthy brain tissue making it difficult to remove surgically. This type of cancer also affects the spinal cord.

brain tumor: symptoms

manifest in relation to the location of the tumor

Tumors that obstruct the normal flow of CSF create

visual disturbances, uncoordinated movements, unstable balance, gait, and increased ICP

brani tumor: labs/diagnostics

Radiography exams such as MRI, CT and PET scans are used to evaluate the status of tissue and assess for metastasis. Lumbar puncture is performed to assess for the presence of abnormal cells in the spinal fluid.

brain tumor treatment

surgical craniotomies are performed to eradicate the tumor or reduce its size as an adjunct to chemotherapy treatment. Combinations of treatment are dependent on the type of tumor and location. Not all tumors are operable such as those in the brain stem

Children whose tumors block the flow of CSF in the CNS often receive a

VP shunt or endoscopic third ventriculostomy to restore and maintain proper cranial ventricular pressures

Radiation is also withheld from children with a brain tumor younger than five years related to

potential for damage to developing tissue and cognitive sequelae later in life.

brain tumor: interventions

monitor for infection and ICP post op, LOC, VS, temperature, assess surgical site, treat pain, psychosocial support

Non-Hodgkins Lymphoma (NHL)

malignancy of the lymphatic system; three main types affecting B or T cells lymphocytes, Burkitt and Burkitt-like lymphoma/leukemia, Diffuse large B-cell lymphoma, Primary mediastinal B-cell lymphoma. Children with NHL can experience rapid onset and progr

hodgkin lymphoma (HL)

malignancy of the lymphatic system;commonly occurring in teens and adolescents age 15 - 19 years. Studies show that commonly, the Epstein Barr Virus (EBV) can activate abnormal growth of tissues and colonization of large Reed-Sternberg cells

what is considered the hallmark indication of HL

reed Sternberg cells

HL and NHL symptoms

Painless swelling of axillary, neck and groin lymph nodes
Mediastinal pain, cough, or respiratory distress
Gastrointestinal complications, abdominal pain, weight loss or ascites.
Fever with no cause

HL and NHL labs/diagnostics

Serum blood studies are performed to evaluate complete blood count, metabolic status, and liver function. Tissue biopsy, radiologic exams (MRI, CT, PET scan, x-ray), and bone marrow aspiration.

HL and NHL treatment

Chemotherapy, radiation, HSCT and supportive pharmacologic therapies are all specific to the lymphoma

Nursing care of the child receiving chemotherapy for any tumor, but specifically NHL includes monitoring for

tumor lysis syndrome

tumor lysis syndrome

occurs from the massive amount of large tumor cell destruction releasing considerable amounts of electrolytes into the vascular system overwhelming renal filtration

neuroblastoma

arises from the immature nerve cells (neuroblasts) and rapidly developing cells in children. The condition is isolated to infants and children under five years. These tumors develop in the nerve cells of the adrenal glands that sit atop of both kidneys

neuroblastoma treatment

Surgical removal of the tumor, chemotherapy, radiation, HSCT, immunotherapy and supportive pharmacologic therapies are all specific to the lymphoma.

neuroblastoma symptoms

Symptoms of occur in areas where tumor puts pressure on surrounding tissue and structures.
Tumors of abdomen result in significant distention, pain, and loss of appetite
Bone marrow involvement results in pallor, ecchymosis, and bone pain
Spinal cord comp

neuroblastoma: labs/diagnostics

Diagnostic testing includes radiologic studies (CT, MRI), bone marrow aspiration, tissue biopsy, serum studies and urine testing.

neuroblastoma interventions

Nurses caring for neuroblastoma children is given according to the system specific manifestations and /or type of interventional procedure.
Administer prescribed treatment for pain and assess for resolution of symptoms.

osteosarcoma

mainly found in adolescent to young adult, affects long bones of the axial skeleton; The smaller and more distal the development of the tumor mass, the better the prognosis

the primary sites for osteosarcoma development is

in the metaphysic of the long bones of the knee and the second is near the shoulder on the upper arm

osteosarcoma diagnosis

is a challenge b/c symptoms mimick normal developmental growth pains. Pain and swelling at the tumor site often get overlooked during adolescent growth spurt. In some cases, pathologic fracture follows extended bouts of pain. reports of symptoms lasting f

osteosarcoma: labs/diagnostics

radiologic studies (x-ray, CT, MRI, Bone Scan, PET scan), Needle or Surgical biopsy, serum studies including alkaline phosphatase (ALP) and lactate dehydrogenase (LDH).

osteosarcoma treatment

Chemotherapeutic agents are used during the initial phases of treatment to shrink the tumor in anticipation of surgical removal. After this phase, the tumor is excised, and multi-agent chemotherapy is continued to kill any microscopic cells left in the ti

osteosarcoma interventions

Practice standard precautions prevent /monitor for sign of infection.treat acute pain. Increased levels of pain and anxiety can interfere with healing and acceptance.
Access resources for impaired physical mobility needs and facilitate outpatient services

wilms tumor

cancer that affects small children ages 3 - 5 years of age, also referred to as nephroblastoma

wilms tumor symptoms

most have no symptoms. Parents complain about palpable mass in the abdomen while bathing child

wilms tumor labs/diagnostics

serum including a metabolic panel and complete blood count, clotting studies and urinalysis are analyzed along with genetic marker testing. Radiology and scanning exams (X-ray, CT, MRI, and ultrasound) help determine the extent of disease and staging.

wilms tumor treatment

Surgical nephrectomy followed by chemotherapy and radiation to fully eradicate any remaining cells is the standard treatment.

what should you never do with a wills tumor

never palpate the abdominal mass as rupture can disrupt the protective membrane around the tumor allowing cancer cells to spread throughout the entire abdomen