Transcript NURS 2410 Unit 6

NURS 2410 Unit 6
Nancy Pares, RN, MSN
Metro Community College
Disorders of Eye
• Visual disorders
– Myopia
– Astigmatism
– Strabismus
– Amblyopia
Disorders of Eye
• Visual disorders
– Cataracts
– Glaucoma
– Retinoblastoma
– Color blindness
– Retinopathy of prematurity (ROP)
Disorders of Ear
• Otitis media
• Otitis externa
• Hearing impairment
Figure 24-2 Of the three anatomic differences in the eustachian tube between adults and small children (shorter, wider, more
horizontal), which do you think could cause more problems for the child and why? Answer: More horizontal. Small children who
are bottle fed in a supine position have a greater probability of developing otitis media because the eustachian tube opens when
the child sucks and the horizontal angle provides easy access to the middle ear. In older children the greater angle helps keep
foreign substances and germs away from the middle ear.
Disorders of Nose and Throat
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Epistaxis
Nasopharyngitis
Sinusitis
Pharyngitis
Tonsillitis
Vision Screening
• 20/20 by age 6 or 7 (visual acuity)
• Screening starts at well-child exams when
cooperative (screening timing and frequency)
Hearing Screening
• Infant in hospital
– Screening timing and frequency
– Many states mandate
• Observation for cues to hearing
• Clinical manifestations
Risk Factors
• Chronic ear infections
• Chronic fluid/effusion
• Follow-up needed for hearing deficit
Abnormalities of Eyes
• Conjunctivitis
– Bacterial
• Antibiotic eye drops
– Viral and allergic
• Supportive care
• Periorbital cellulitis
– Oral or intravenous antibiotics
Abnormalities of Eyes
• Other disorders
– Multiple types of treatments based on etiology
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Occlusion therapy
Compensatory lenses
Surgery
Vision therapy
– Refer to eye specialist
Abnormalities of Ears
• Otitis media
– Antibiotic usage
– Supportive care
Figure 24-7 Acute otitis media is characterized by abrupt onset, pain, middle ear effusion, and inflammation. Note the
injected vessels and altered shape of cone of light. See Chapter 7for a normal tympanic membrane. Source: Courtesy
of Kevin Kavanagh, MD, FACS.
Figure 24-8 Otitis media with effusion is noted on otoscopy by fluid line or air bubbles. Pneumatic otoscopy or tympanometry
shows a nonmobile tympanic membrane. Note that the light reflex is not in the expected position due to a change in tympanic
membrane shape from air bubbles. Where would you expect to see the light reflex? (See Chapter 7 for a description of normal
findings.) Source: Courtesy of Kevin Kavanagh, MD, FACS.
Abnormalities of Ears
• Recurrent otitis media or effusion
– ENT referral for possible tympanostomy tube
placement
• Otitis externa
– Antibiotic ear drops
Abnormalities of Ears
• Hearing loss
– Sensorineural
• Cochlear implant
Box 24-7 (continued) Cochlear Implants
Abnormalities of Nose
and Throat
• Collaborative care includes antibiotics if
bacterial in etiology
– Nasopharyngitis
– Pharyngitis
– Tonsillitis
• Tonsillectomy
• Criteria for surgery
– Sinusitis
Eye Abnormalities
• Primary intervention is prevention
– ROP interventions and prevention strategies
• Protective eyewear
Ear Abnormalities
• Prevention focus
– Decrease otitis media
– Increase access to care
– Increase frequency of hearing screens
– Reduce noise-induced hearing loss
Nose, Throat, and
Mouth Abnormalities
• Prevention measures
• Education to prevent communicable diseases
• Home care for common communicable
diseases
• Injury prevention
• Dental emergencies
– Tooth avulsion
Collaborate with Family of a Child with
Human Immunodeficiency Virus (HIV)
• Plan care
– Age and developmentally appropriate
• Medication regimen
– Education on importance of regimen
– Education on side effects
• Promotion of general health
– Avoid infectious individuals
Collaborate with Family of a Child with
Human Immunodeficiency Virus (HIV)
• Promotion of growth and development
– Proper food
– Proper atmosphere, toys, friends
• Emotional support
– Caregiver
– Child
• Support groups
Nursing Management of Systemic
Lupus Erythematosus
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Avoid triggers
Long-term planning for chronic illness
Maintain fluid balance
Promote adequate and appropriate nutrition
Nursing Management of Systemic
Lupus Erythematosus
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Promote skin integrity
Promote rest and comfort
Emotional support
Community activities and support groups
Nursing Management of
Juvenile Arthritis
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Pain relief
Maintain joint mobility
Prevent deformities
Promote self-care
Well-balanced diet
Hydration
Medication management
Latex Allergy
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Increasingly common
Children at risk for allergy
Testing for latex allergy
Latex allergy questionnaire
Nursing Care for Child with
Latex Allergy
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Alternative products
Medical-alert ID bracelet
Epinephrine kit at home and school
Education of caregivers related to
hypersensitivity reactions
– Preparation to provide care
Hypersensitivity Reactions
in Children
• Type I
– Definition
• Type II
– Definition
• Type III
– Definition
• Type IV
– Definition
Nursing Management
• History
• Assessment
– Type I and Type II carry EpiPen
LEARNING OUTCOME 3
• Integrate information about oncologic
emergencies into plans for monitoring all
children with cancer.
Clinical Therapy
• Therapy may be singular or combination of
treatments
– Surgery
– Chemotherapy
– Radiation
– Biotherapy
– HSCT
– Complementary therapies
– Palliative care
Nursing Care Plan
• Based on type of cancer and therapy
– Infection control
– Pain
– Nutrition
– Growth and development
– Emotional needs
– Spiritual needs
Three Types of
Oncological Emergencies
• Metabolic
– Tumor lysis syndrome
– Septic shock
– Hypercalcemia
• Hematologic
– Caused by bone marrow suppression
– Require transfusion and careful RBC and WBC
assessment
Three Types of
Oncological Emergencies
• Space-occupying lesions: tumors with
extensive growth
– Spinal cord compression
– Increased ICP
– Brain herniation
– Seizures
Three Types of
Oncological Emergencies
• Space-occupying lesions: tumors with
extensive growth
– Hepatomegaly
– Gastrointestinal obstruction
– Cardiac and respiratory complications
– SVC syndrome
Solid Tumors
• Brain and central nervous system
– Most common malignancy in children, next to
leukemia
– Treatment depends on type and location of tumor
– Surgery
– Radiation
– Chemotherapy
Figure 29-13 Approximately 1,700 children under the age of 14 years are diagnosed annually as having tumors of the
brain and central nervous system. The four most common brain tumors in children are medulloblastoma, cerebral
astrocytoma, ependymoma, and brainstem glioma.
Solid Tumors
• Neuroblastoma
– Definition
– Treatment based on protocol
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Surgical
Chemotherapy
Radiation
HSCT
Solid Tumors
• Wilms’ tumor
– Define
– Treatment based on stage
• Requires surgical removal
• Radiation
• Chemotherapy
Table 29-8 (continued) National Wilms Tumor Study Staging System
Solid Tumors
• Bone tumors (osteosarcomas)
– Definition
– Treatment
• Surgery required
• Chemotherapy
• Radiation
• Ewing’s sarcoma
– Similar to osteosarcoma
Leukemia
• Most commonly diagnosed malignancy in
children under 14
• Definition
Nursing Management
• Difficult due to multisystem effect
• Long period of treatment required
• Assessment complete and thorough
– Observe for signs of bleeding
– Observe for signs of infection
Nursing Management
• Monitor for toxic side effects of chemotherapy
or tumor cell lysis
– Renal function
– Special attention for children on
cyclophosphamide
Nursing Management
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Nutrition
CNS infiltration
Pain
Bone marrow suppression
– Isolation and transmission precautions
Nursing Management
• Education of family and child
– Careful handwashing
– Prevention of spread of infection
– Oral care
Soft Tissue Tumors
• Hodgkin’s disease
– Definition
– Treatment based on staging
• Outpatient setting
• Chemotherapy
Figure 29-16 Lymph nodes and organs affected in Hodgkin disease in children.
Soft Tissue Tumors
• Non-Hodgkin lymphoma
– Definition
– Three types
– Treatment tailored to stage
• Stages I and II treat with drugs
• Stages III and IV treat with additional drugs and longer
period
Soft Tissue Tumors
• Rhabdomyosarcoma
– Definition
– Locations
– Treatment
• Surgical when possible
• Widefield radiation
• Chemotherapy
Figure 29-17 Rhabdomyosarcoma is characterized by ptosis and swelling. Source: From Vaughn, D., Asbury, T., &
Riordan-Eva, P. (1995). General opthalmology (14th ed.). Norwalk, CT: Appleton & Lange.
Soft Tissue Tumors
• Retinoblastoma
– Definition
– Treatment
• Radiation almost always used
• Chemotherapy sometimes used, but often ineffective
• Removal of eye if other treatment fails
Figure 29-18 Retinoblastoma is characterized by leukokoria, a white reflection in the pupil. Source: From Hathaway,
W. E., Hay, W. W., Jr., Groothuis, J. R., & Paisley, J. W. (1993). Current pediatric diagnosis and treatment (11th ed.).
Norwalk, CT: Appleton & Lange.
Nursing Management
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Similar to other cancers
Physiologic assessment
Psychosocial assessment
Collaboration with family
Collaboration with medical team
Intervention based on assessment and side
effects of therapy
Psychological and Physiological
Problems of Cancer Survival
• Cancer affects all areas of function
• Effects of therapy
– Surgery
• External and internal body changes
– Radiation
• Long-term effects
• Growth
• Secondary cancers
Psychological and Physiological
Problems of Cancer Survival
• Effects of therapy
– Chemotherapy
• Effects immediate
• May present years later
Psychological and Physiological
Problems of Cancer Survival
• Long-term planning
– Family stressors
• Questions regarding outcomes
• Financial concerns
– Frequent follow-up
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Physical
Physiological
Developmental
Cognitive
Interventions started as soon as deficit noted
Collaboration to Provide
Family-Centered Care
• Team members
– Nurses
– Primary and specialty care providers
– Social workers
– Case managers
– Child life therapist
– Psychologist
Collaboration to Provide
Family-Centered Care
• For the school-age child
– Encourage maintenance of learning
– Involvement of school appropriate with
permission
• Spiritual and emotional needs
– Encourage participation in support groups
Neurological Anatomic Differences
in Children
• Cranial bones are not completely ossified
– Allows for brain growth
• The posterior fontanel closes at 3 months
• The anterior fontanel closes at 4 months
• Increases risk for brain and spinal cord injury
Figure 33-2 The skull and brain grow and develop rapidly during early childhood. Infants and young children are at
higher risk for injury to the brain and spinal cord because of developing anatomic structures.
Nursing Assessment of Altered Levels of
Consciousness and Other Neurological Conditions
• Levels of consciousness—most important
indicator of neurological dysfunction
• Consciousness—receptiveness to stimuli
• Alertness—arousal, ability to react
• Cognitive power—ability to process data and
respond
• Altered levels of consciousness
– Causes
Nursing Assessment of Altered Levels of
Consciousness and Other Neurological Conditions
• Levels of consciousness assessment
– Categories: confusion, delirium, lethargy,
obtunded, stupor, and coma
– Decorticate and decerebrate posturing
Figure 33-3 A, Decorticate posturing, characterized by rigid flexion, is associated with lesions above the brainstem in
the corticospinal tracts.
Figure 33-3 (continued) B, Decerebrate posturing, distinguished by rigid extension, is associated with lesions of the
brainstem.
Nursing Assessment of Altered Levels of
Consciousness and Other Neurological Conditions
• Increased intracranial pressure
– Scales for responsiveness
Nursing Assessment of Altered Levels of
Consciousness and Other Neurological Conditions
• Increased intracranial pressure
– Glasgow coma scale
Figure 33-4 Pupil findings in various neurological conditions with altered consciousness. A, A unilateral dilated and reactive pupil
is associated with an intracranial mass. B, A fixed and dilated pupil may be a sign of impending brainstem herniation. C, Bilateral
fixed and dilated pupils are associated with brainstem herniation from increased intracranial pressure.
Status Epilepticus
• An acute seizure that lasts over 30 minutes
• Electrolytes, glucose, blood gases,
temperature, and blood pressure need
monitoring if a seizure occurs for longer than
10 minutes
Nursing Management
for Seizures
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Maintain airway
Ensure safety
Administer medications
Provide emotional support
Provide education
Meningitis
• An inflammation of the meninges covering the
brain and spinal cord
• Caused by either viral or bacterial agents
Encephalitis
• Acute inflammation of the brain
• Symptoms do not include nuchal rigidity or
positive Kernig or Brudzinski
• Symptoms depend on the causative organism
Myelodysplasia
• Malformation of the spinal cord and canal
• Impaired physical mobility related to
neuromuscular impairment
• Impaired urinary elimination related to
sensory impairment
• Risk for latex allergy response related to
multiple surgical procedures
Hydrocephalus
• Imbalance between production and
absorption of CSF
• Leads to increased CSF volume in brain
• Commonly associated with myelomeningocele
(spinal-fluid-filled sac protruding through
vertebrae)
• Treatment may include placement of a shunt
Nursing Diagnosis for Myelodysplasia
and Hydrocephalus
• Risk for infection related to the presence of
shunt
• Risk for caregiver role strain related to care of
a child with a chronic condition
• Risk for delayed development related to
compression of brain tissue with excess
cerebral spinal fluid
Cerebral Palsy
• Group of permanent disorders of movement
and posture
• Causes activity limitations
• Nonprogressive in nature
• May have additional sensory, cognition,
communication and behavior problems
Children with Cerebral Palsy
• Community care
– Case manager
– Early intervention
– Financial needs
– School assistance and IEP needed
Figure 33-19 A child with cerebral palsy has abnormal muscle tone and lack of physical coordination.
Children with Cerebral Palsy
• Multidiscipline care
– Orthopedic surgeon care
– Speech therapy
– Regular eye exams
– Pediatric nurse practitioner or pediatrician
– Support groups
Mild, Moderate, and Severe
Brain Injury
• Traumatic brain injuries
– Falls are a major cause
– Primary vs. secondary
– Cushing’s triad
• Nursing management of mild vs. severe brain
injury
– Emergency care
– Long-term care
Figure 33-20 Child having baclofen pump filled.
Nursing Management of Children and
Adolescents with Mental Health Disorders
• Developmental and behavioral disorders
– Pervasive developmental disorders
– Nursing management
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Stabilize environmental stimuli
Provide supportive care
Enhance communication
Maintain a safe environment
Provide anticipatory guidance
Nursing Management of Children and
Adolescents with Mental Health Disorders
• Attention deficit disorder (ADD) and attention
deficit hyperactivity disorder (ADHD)
– Nursing management
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Administer medication
Minimize environmental distractions
Implement behavior management plans
Provide emotional support
Promote self-esteem
Nursing Management of Children and
Adolescents with Mental Health Disorders
• Attention deficit disorder (ADD) and attention
deficit hyperactivity disorder (ADHD)
– School issues
Nursing Management of Children and
Adolescents with Mental Health Disorders
• Suicide
– Nursing management:
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Safety
24-hour monitoring
Medication
Care in community
Learning Disabilities
• Effects up to 5 of school children
• Children do not process information correctly
Mental Retardation
• Limitations in adaptive and intellectual
functioning
• Conditions associated:
– Down syndrome
– Fragile X syndrome
– Fetal alcohol syndrome
Mental Retardation
• Nursing management
– Maintain safe environment
– Provide assistance with adaptive functioning
Learning Disabilities
• Individual education plan (IEP)
– Developed through an interdisciplinary approach
– Specific goals are included
Mental Retardation
• Evaluation depends on needs and
developmental level
• First evaluation needs to assess the family’s
understanding of the disorder
Musculoskeletal Differences
• Child’s bones
– More porous and pliable
– Less dense
• Infant skull
– Fontanel closure: 18 months
– Overall growth completion: 2 years
• Child bone growth from epiphyseal plate
Musculoskeletal Differences
• Muscles
– Number same as adult
– Only length and circumference grow
• Ligaments and tendons
– Stronger than bone until puberty
Figure 35-3 Skeletal and muscle development throughout childhood.
Figure 35-3 (continued) Skeletal and muscle development throughout childhood.
Figure 35-3 (continued) Skeletal and muscle development throughout childhood.
Structural Deformities
• Feet and legs
– Metatarsus adductus (intoeing)
Figure 35-4 Metatarsus adductus is characterized by convexity (curvature) of the lateral border of the foot. The child’s
right foot demonstrates the disorder. Note that the forefoot turns inward and appears out of alignment with the
remainder of the foot.
Structural Deformities
• Feet and legs
– Talipes equinovarus (clubfoot)
Figure 35-5 Parents of a child with clubfoot will have many questions. Can the condition be treated? Will the child be able to walk
normally after surgery? Will they need help caring for the infant? How much will surgery and other care cost? Will any subsequent
children have a clubfoot? Source: Modified from Staheli, L. T. (1992). Fundamentals of pediatric orthopedics (p. 5.10). New York:
Raven Press.
Structural Deformities
• Feet and legs
– Genu valgum (knock-knees)
– Genu varum (bowlegs)
Figure 35-8 A, Genu valgum, or knock-knees. Note that the ankles are far apart when the knees are together. B, Genu
varum, or bowlegs. The legs are bowed so that the knees are far apart as the child stands.
Structural Deformities
• Hip
– Dysplasia
– Legg-Calvé-Perthes
– Slipped capital femoral epiphysis (SCFE)
Figure 35-9 The asymmetry of the gluteal and thigh fat folds is easy to see in this child with developmental dysplasia
of the hip.
Figure 35-10 The most common treatment for DDH in a child under 3 months of age is a Pavlik harness. A shirt should
be worn under the harness to prevent skin irritation (it was omitted for clarity in this photograph).
Figure 35-13 In slipped capital femoral epiphysis, the femoral head is displaced from the femoral neck at the proximal
epiphyseal plate.
Structural Deformities
• Spine
– Scoliosis, kyphosis, lordosis
– Torticollis
Figure 35-14 A child may have varying degrees of scoliosis. For mild forms, treatment will focus on strengthening and
stretching. Moderate forms will require bracing. Severe forms may necessitate surgery and fusion. Clothes that fit at an
angle, such as this teenage girl’s shorts, and anatomic asymmetry of the back provide clues for early detection.
Deformities: Nursing Care
• Prevent complications of immobility
• Assist coping with treatment
– Support long-term adaptation
• Facilitate pain control
Osteomyelitis
• Bone infection
• Etiology: idiopathic or nosocomial
– Due to trauma, pins
• Symptoms
– Bone pain
– Edema
– Joint pain
– Fever
Rarer Bone Infections
• Skeletal tuberculosis
– Pain, spasms, muscle atrophy
– “Doughy” swelling over joints, limited mobility
• Septic arthritis
– Pain, fever, local inflammation, joint tenderness,
loss of spontaneous movement
Figure 35-17 This boy from Kenya had surgery to correct severe kyphosis and scoliosis, caused by tuberculosis of the spine. A
Risser cast has been applied to maintain stability of the spine and thoracic cage during healing. Notice the area cut out of the cast
to allow for auscultation of the abdomen, as well as to facilitate the child’s comfort and adequate intake of food.
Chronic Conditions
• Achondroplasia
– Short stature, prominent forehead
• Marfan syndrome
– Connective tissue disorder
– Skeletal changes
– Cardiac, respiratory, vision changes
Chronic Conditions
• Osteogenesis imperfecta
– Brittle-bone disease, collagen defect
– Thin, soft skin; increased flexibility; short
stature;weak muscles; hearing loss
Chronic Conditions
• Muscular dystrophies
– Muscle degeneration and wasting
– Early signs:weakness and hypotonia
– Life-threatening
Figure 35-18 Because the leg muscles of children with muscular dystrophy are weak, they must perform the Gowers
maneuver to raise to a standing position. A and B, The child first maneuvers to a position supported by arms and legs.
Figure 35-18 (continued) Because the leg muscles of children with muscular dystrophy are weak, they must perform
the Gowers maneuver to raise to a standing position. A and B, The child first maneuvers to a position supported by
arms and legs.
Figure 35-18 (continued) Because the leg muscles of children with muscular dystrophy are weak, they must perform
the Gowers maneuver to raise to a standing position. C, The child next pushes off the floor and rests one hand on the
knee.
Figure 35-18 (continued) Because the leg muscles of children with muscular dystrophy are weak, they must perform
the Gowers maneuver to raise to a standing position. D and E, The child then pushes himself upright.
Figure 35-18 (continued) Because the leg muscles of children with muscular dystrophy are weak, they must perform
the Gowers maneuver to raise to a standing position. D and E, The child then pushes himself upright.
Figure 35-19 This young boy with muscular dystrophy needs to receive tube feedings and home nursing care. He
attends school when possible and is able to use an adapted computer.
Braces
• Limit movement
– Snug but do not impair circulation
– No direct contact with skin
– Assess neurovascular and skin status
Figure 35-15 In severe scoliosis, the child may wear a halo brace, shown here, to hold the body in position after
surgery.
Figure 35-12 Although the Toronto brace used for treatment of Legg-Calvé-Perthes disease may seem formidable for
a child to wear, you can see by this photograph that, as usual, children adapt quite well to it.
LEARNING OUTCOME 6
• Provide nursing care for fractures, including
teaching for injury prevention and nursing
implementations for the child who has
sustained a fracture.
Fractures
• Prevention
– Greater risk for children
– Teach use of protective equipment, safe play
• Types
– Closed
• Casting
– Open
• Surgery and casting
Anemia
• Iron deficiency anemia
– Lack of iron
– Anemia of prematurity
– Affects production of RBCs
– RBCs appear hypochromic, decreased hemoglobin
synthesis
Anemia
• Iron deficiency anemia
– Manifestations based on severity
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Pallor
Fatigue
Irritability
Pica
Anemia
• Normocytic anemia
– Decreased number of RBCs
– Normal size with pale center
– Associated with multiple causes
– Manifestations similar to iron deficiency anemia
Anemia
• Sickle-cell anemia
– Genetic mutation
– Hemoglobin S replaces normal hemoglobin
– RBCs lose doughnut shape, become sickleshaped
Figure 28-4 Many of these red blood cells show an elongated crescent shape characteristic of sickle cell anemia.
Source: Courtesy of Dr. Ed Wong, Laboratory Medicine, Children’s National Medical Center, Washington, DC.
Anemia
• Sickle-cell anemia
– Manifestations appear in multiple body systems
– Severity based on pathologic changes
Figure 28-5 The etiology, pathophysiology, and disease process of sickle cell anemia.
Anemia
• Thalassemias
– Groups of hereditary disorders
– Hemoglobin synthesis abnormal
– Range from mild to severe
– Three types
Anemia
• Thalassemias
– Clinical manifestations based on type and severity
• Pallor
• Fatigue
• Failure to thrive
– Severe anemia leads to chronic hypoxia
Anemia
• Hereditary spherocytosis
– Congenital hemolytic anemia
– No abnormality of hemoglobin
– Cells have unusual structure
– Manifestations appear in neonatal period or
infancy
– Severity varies
Anemia
• Goals of Care
– Adequate nutrition
– Hydration and fluid balance
– Promotion of adequate tissue perfusion
– Promotion of growth and development
– Family and patient education
Aplastic Anemia
• Failure of bone marrow to produce blood cells
• Disorder is idiopathic or acquired
• Clinical presentation varies depending on
degree
• Most common is bleeding secondary to
thrombocytopenia
Hemophilia
• Hereditary bleeding disorder
• X-linked—expressed in males, females have
carrier status
Hemophilia
• Manifestations range from mild to moderate
to severe
– Spontaneous bleeding
– Hemarthrosis
– Deep tissue hemorrhage
– Nosebleeds
– Hematuria
– Easy bruising
von Willebrand Disease
• Autosomal dominant trait
• Equal expressivity in males and females
• Manifestations
– Easy bruising
– Epistaxis
Bleeding Disorders:
Clotting Disorders
• Disseminated intravascular coagulation (DIC)
– Complication from another illness
– Most common following infection in children
– Manifestation range
• Minor oozing
• Frank hemorrhage
Bleeding Disorders:
Clotting Disorders
• Idiopathic thrombocytopenic purpura (ITP)
– Autoimmune disorder
– After a viral illness
Bleeding Disorders:
Clotting Disorders
• Idiopathic thrombocytopenic purpura (ITP)
– Manifestations
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Ecchymoses
Petechiae
Purpura
Bleeding from gums
Nosebleeds
Blood in urine
Blood in stools
Bleeding Disorders:
Clotting Disorders
• HSP
– Vasculitis
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Raised purpuric lesions
Joint pain
Colicky abdominal pain
GI bleeding
Renal involvement
Nursing Care of a Child with a Hematologic
Disorder Is Based on the Disorder
• RBCs
– Oxygenation
– Circulation
– Fluid
– Nutrition
– Pain management
Nursing Care of a Child with a Hematologic
Disorder Is Based on the Disorder
• WBCs
– Infection
– Oxygenation
– Nutrition
Nursing Care of a Child with a Hematologic
Disorder Is Based on the Disorder
• Platelets and bleeding disorders
– Bleeding
– Oxygenation
– Circulation
– Injury prevention
Collaborative Care Approach for a
Child with a Hematologic Disorder
• Team approach
• Family involved
– Decisions with family and child
Hematopoietic Stem Cell
Transplant (HSCT)
• Treatment for disorders unresponsive to other
therapy
• Pretransplant phase
– Total body irradiation
– Strict isolation
• Transplant phase
– Intravenous transfusion of donor stem cells
– Transplant starts to grow in 2 to 4 weeks
Hematopoietic Stem Cell
Transplant (HSCT)
• Posttransplant phase
– Lasts several weeks
– Major risk is infection
– Immunosuppressive agents prevent graftversushost disease
Hematopoietic Stem Cell
Transplant (HSCT)
• Nursing care
– Prevent infections
– Injury prevention
– Growth and development
– Nutrition
– Physical activity limits
– Oral health
– Mental and spiritual health
– Family and social relationships