Pediatric Hematologic Disorders and Cancer
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Transcript Pediatric Hematologic Disorders and Cancer
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
spleen
RBC’s= 4.1 to 4.9 million/ml
Hemoglobin=
Hematocrit=
(neonate)
Cell production- red bone
marrow (infant)
#RBC’s= 5million/ml at birth
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 12821283
Precipitating factors (p 1284)
Signs and symptoms
Three Forms of Sickle Cell Crisis
Vaso-occlusive
Acute sequestration
Aplastic
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
RBC?
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
Treatment
Patient/family teaching
Medications
Immunizations- why
important?
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
diagnosis?
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
values?
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
goal?
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
Death
Childhood Cancers
“…communication
promotes understanding
and clarity;
with understanding, fear
diminishes;
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
Leukocytes < 10,000
Leukemia
Leukocytes> 10,000
Platelets 20-100,000
Hemoglobin 7-11
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?
Treatment and Plan of Care: (p 1313/1321)
Chemotherapy: three phases
Induction phase
Consolidation
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
checks
Cranial Radiation
Head and neck tumors are more
sensitive to radiation than
chemotherapy.
When would chemotherapy become
an adjunct to radiation therapy?
Tumor Lysis Syndrome:
What causes tumor lysis syndrome?
What are signs and symptoms of this
complications
What nursing interventions apply to
treatment?
Bone marrow and Stem Cell
Transplantation
Used 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
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
palpation
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
syndrome
Increased ICP
Limp if metastasis to bone
Pancytopenia
Nursing Management
Assess by observation and inspection
palpation)
Document bowel and bladder function
Record height & weight, observe gait
Chemotherapy, radiation, surgery
Teach parents S&S of infection. Why?
(not
Osteosarcoma- most common
primary bone malignancy in
children
Goal of treatment- remove tumor and prevent spread of
disease
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
Rhabdomyosarcoma
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
function
Diagnosis and Treatment
CT, BM aspiration and biopsy
Renal function and liver function tests
Treated with chemo, surgery and
radiation
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
questions
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
independence
Family- listen, answer questions, provide
information, encourage expression of
feelings and fears
For questions or concerns please contact
Marlene Meador RN, MSN, CNE
Email [email protected]
References:
McKinney, James, Murray, & Ashwill.
Maternal- Child Nursing Third ed (2009).
Saunders.