Try the all-new QuickBooks Online for FREE.  No credit card required.

Pediatric Hematologic Disorders and Cancer (PowerPoint)

Document Sample
Pediatric Hematologic Disorders and Cancer (PowerPoint) Powered By Docstoc
					                 Presented by
Marlene Meador RN, MSN, CNE
Hematologic System
Adult                            Pedi
 Life cycle of RBC- 120 days     Life cycle of RBC- 100 days
 Cell production- marrow and        (neonate)
  spleen                            Cell production- red bone
 RBC’s= 4.1 to 4.9 million/ml       marrow (infant)
 Hemoglobin=                       #RBC’s= 5million/ml at birth
 Hematocrit=                       Hemoglobin= 17-18 g
                                    Hematocrit= 45-50%
Iron Deficiency Anemia
 Cause
 Signs and symptoms
 Diagnostic tests
 Nursing interventions
   Oral supplements- What significant side
    effects does the nurse need to remember?
   Dietary teaching- what specific foods?
What Parents Want to Know:                                    (p 1281)

 Specific foods: (based on age of child)
    Cream of wheat or iron fortified cereal
    Apricots, prunes, raisins and other dried fruits
    Egg yolks
    Dark green leafy vegetables
 Administration of Iron Supplements:
    Give with vitamin C –rich fluids
    Prevent staining from liquid iron supplements
    Changes in stool patterns
    Avoid mixing supplement with food/drink containing calcium
Sickle Cell disease
 Sickle cell trait- genetic disorders characterized
 by production of elongated, crescent shaped
 erythrocyte in the place of normal Hbg p 1282-

   Precipitating factors (p 1284)
   Signs and symptoms
Three Forms of Sickle Cell Crisis
Acute sequestration
Types of Sickle Cell Crisis
 Vaso-occlusive- most common effects
    Pain
    Hand and foot syndrome (dactylitis)
    CVA- hemiplegia, aphasia, seizures, LOC changes, vision
     changes, and headache
    Acute chest syndrome- chest pain, fever cough (leading
     cause of death in SCD)
    Priapism
    Hepatomegaly
    Hematuria
Types of Sickle Cell Crisis
 Aplastic 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)
Quick Review:
 What is most common reason for admission to
  the ED for a child with SCD?
 What precipitates a sickle cell crisis?
 How does sickling effect the life span of an
 what organs experience complications as a
  result of chronic sickling crisis?
Diagnosis & Treatment
Cord blood testing if one parent is
 known to carry trait
Blood transfusions
  Complications
  Nursing interventions before/during/after
Patient/family teaching
Immunizations- why
Clinical Judgment:
 Why are blood transfusions ordered for
  the patient in sickle cell crisis?
 Can a neonate have a diagnosis of sickle
  cell disease?
 What ethical issues relate to this
Hemophilia (p 1291)
 X-linked trait
What factor is missing or defective?
                   Factor VIII
 Who is the carrier, and who is effected by
 this disorder?
Diagnosis & Treatment
When does diagnosis most
 commonly occur?
  What specific laboratory tests and
What are signs & symptoms?
Nursing Care:
 Factor VIII- when should the patient
  receive this medication?
 What does the family need to know
  about factor VIII?
 Human plasma
 Vasopressin (DDAVP)
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
    Administer Factor VIII
    Apply local pressure for 10-15 minutes
    Elevate the joint and immobilize
    Apply cold compresses
Complications of hemophilia
 Hemarthrosis- assess child for joint pain,
 edema, or permanent deformity. Where
 most common?

 At risk for hemorrhage
Childhood Cancers
promotes understanding
and clarity;
with understanding, fear
in the absence of fear,
hope emerges; and in the
presence of hope, anything
is possible” (Stovall, 1995)
Childhood Cancer
 C- continual unexplained weight loss, fatigue malaise
 H- 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
What signs and symptoms would lead to the
diagnosis of leukemia?
 Fever
 Pallor
 Overt signs of bleeding
 Lethargy or malaise
 Anrexia
 Large joint or bone pain
 Petechiae, frank bleeding
 Enlarged liver or spleen, changes in lymph nodes
 Neurologic changes
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
Further diagnostic findings:
 Bone marrow aspiration- iliac crest (why this
   How does the nurse prepare the child/family
    for this procedure?
   What are the nurse responsibilities for this
Treatment and Plan of Care: (p 1313/1321)
  Chemotherapy: three phases
    Induction phase
      Delayed   intensification
    Remission and maintenance
Nursing Plan of Care for a Child
Undergoing Chemotherapy:
 Myelosupression- protect from injury
 Infection/sepsis (neutropenia)- protect
  from infection
 Renal damage
 GI disturbances
 Metabolic emergencies
Intrathecal Medication
 Chemotherapy instilled
 into spinal canal
Assess and monitor for
 placement of
 intrathecal catheter
 and assess neuro
Cranial Radiation
Head and neck tumors are more
 sensitive to radiation than
When would chemotherapy become
 an adjunct to radiation therapy?
Tumor Lysis Syndrome:
What causes tumor lysis syndrome?
What are signs and symptoms of this
What nursing interventions apply to
Bone marrow and Stem Cell
 Used to treat leukemia, neuroblastomas and
  some noncancerous conditions-aplastic
 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
Develop a plan of care for the child undergoing
treatment for leukemia:
  Risk for injury:
   Soft tissue/mucous membranes
   Generalized trauma
 Risk for infection:
 Risk for alteration in bowel elimination
 Risk for GI distress
 Fluid volume delicate
Nephroblastoma- Wilm’s Tumor
 Soft renal tumor - one or both kidneys
 (p 1332) Metastasis or seeding spread by
 Nephrectomy treatment of Wilm’s tumor
Nursing treatment of Wilms’ tumor:
 Pain management
    Frequent reposition
    Noninvasive and pharmacologic pain interventions
 Prevent circulatory overload
    Weigh daily
    I&O, urine for specific gravity
 Prevent infection
    Hand washing
    Protective isolation
    Homecare needs
Clinical manifestations of
Neuroblastoma (p 1327)
 Smooth, hard, non-tender along sympathetic
  nervous system
 Frequent location is abdomen
 Neck and facial edema from vena cava
 Increased ICP
 Limp if metastasis to bone
 Pancytopenia
Nursing Management
 Assess by observation and inspection   (not
 Document bowel and bladder function
 Record height & weight, observe gait
 Chemotherapy, radiation, surgery
 Teach parents S&S of infection. Why?
Osteosarcoma- most common
primary bone malignancy in
 Goal of treatment- remove tumor and prevent spread of
    Biopsy     Chemo       Surgery      Chemo
     (radiation=palliative pain control)
 Promote self esteem
    Side effects of chemotherapy
    Amputation of extremity
    Separation from friends and family
Ewing Sarcoma- second most common bone
tumor associated with children
 Pain, soft tissue swelling
 Anorexia, fever, malaise with metastasis
 Diagnosis same as osteosarcoma
 Management
   Chemo
   Surgery (decrease tumor bulk)
   Radiation
Pathophysiology and Manifestations
 Most common soft tissue malignancy
 Divided by young (<10 yrs) and older
  (adolescents) in location
 60% have positive prognosis
 Soft to hard, nontender mass (depends
  on location)
 In pelvic tumors, may disrupt organ
Diagnosis and Treatment
 CT, BM aspiration and biopsy
 Renal function and liver function tests
 Treated with chemo, surgery and
Retinoblastoma (p1333)
Retinoblastoma- rare malignant tumor
of the neural retina
 “cat’s eye” reflex seen as a white light in the
  pupil is the most common “leukocoria”
 May have strabismus of involved eye
 Red painful eye is late symptom
 Staging based on extent of disease
Nursing care of the child/family
with a malignant disease:
 Initial focus on support of family members
 Nurses facilitate the educational process to allay fears
  of unknown
 Encourage family members to verbalize fears and
 Postoperative care if indicated
 Community resources (through the discharge planner,
  case worker)
Death and Dying:
Understanding of death according to developmental age:
 < 3 years- no understanding/concept of death
 3-5 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
Nursing Care and Grief
 Child- encourage child to express feelings,
 allow choices, help maintain

 Family- listen, answer questions, provide
 information, encourage expression of
 feelings and fears
For questions or concerns please contact
Marlene Meador RN, MSN, CNE
McKinney, James, Murray, & Ashwill.
 Maternal- Child Nursing Third ed (2009).

Shared By: