lOMoARcPSD|44532475
EXAM 4
Hematology and Oncology
Assessment, analysis, planning, implementation, and evaluation
- CBC, H&P, energy level of child, food diary, iron sources, frequent infections,
bleeding, skin assessment: pallor, petechiae, and/or bruising
Blood smear – blood cells should be normal in size, shape, color, number – if any
irregularities can indicate blood disorder
Blood Transfusion Reminders:
o Blood within 30 mins of arrival
o Infuse over 4 hours maximum
Hematology
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Anemia – characterized by decrease in # of RBCs and/or Hgb which decreases
O2 carrying capacity – reduces O2 available to tissues – when anemia develops
slowly in children the child adapts with growth defects (Hgb less than 10) -
anemia causes increased cardiac workload; may cause murmur
Nursing Care:
o Treat underlying cause (transfusion after hemorrhage and/or
nutritional intervention)
o Provide supportive care (IV fluids, O2, bed rest)
o Prepare child & Family for lab tests: consider pain management
interventions due to sequential lab draws (use of topical anesthetic
agents, distractions, etc.)
o Decrease tissue O2 needs: assess child’s energy levels & minimize
excess demands – allow self-care, cluster care to allow rest periods
o Prevent complications- prevent exposure to infections
o Support Family
o Iron rich foods: dark leafy greens
o Iron supplements
Causes:
o Decrease in production of RBCs
o Increase blood loss
o Increases destruction of RBCs in the body
Symptoms/Other causes/TX:
1. SOB
2. Cool skin/pallor
3. Drugs/toxic substances
4. Immune conditions
5. Bone marrow failure
6. Epistaxis
7. Hemophilia
8. Pica
9. Weakness
10. Icteric Sclera
11. Low iron, low folate, low B12
12. Decreased peripheral pulses
13. Sickle Cell Disease
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14. Dark urine
15. DIC
16. Low BP
17. Stop bleeding
18. B12 injections
19. Headache
20. Trauma
21. Malignancy
22. Splenomegaly/Hepatomegaly
23. Increase iron in diet
24. Folic acid supplements
25. Systolic heart murmur
26. Tachycardia
Iron Deficient Anemia – inadequate supply of dietary iron – usually preventable
through dietary changes – plays a role in muscle function, energy creation, &
brain development. Preemies and breast-fed babies have reduced iron supply,
give iron fortified formulas to infants, 12-36 months at high risk due to cow’s
milk, adolescents at risk due to rapid growth, poor eating habits, menses,
obesity, and/or strenuous activities. SX: tired/weak, pale skin (hands, nails,
eyelids), low appetite, frequent infections/bleeding Signs: behavioral problems &
repeat infections, lethargy & breathlessness, failure to grow at expected rate &
pica. **
Sickle cell disease (SCD) OR Sickle Cell Anemia – sickling of RBCs causes
obstruction of vessels, vascular inflammation, & RBC destruction – newborn
screening in every state in US (not mandatory in all countries)
o Causes: infection, stress, dehydration, trauma
o Types of crises:
- Vaso-occlusive – “painful episode”
- Splenic sequestration – pooling of blood in the spleen (may
need splenectomy)
- Aplastic – decreased production of RBCs
- TX of crises: Oral/IV hydration (enuresis possible),
Pain management, Naloxone/Narcan, Increase admin.
of O2
o Complications: acute chest syndrome, CVA (stroke)
o Prevention/TX:
- Oral/IV hydration (enuresis possible)
- Decrease O2 demands
- Pain management
- Naloxone/Narcan
- Administer O2
- Prevent infections (immunizations, PCN prophylaxis,
hydroxyurea)
- Splenectomy
- Blood Transfusions
- Stem Cell Transplant (considered curative)
- Teaching: S/S of infection, acute chest syndrome, CVA
(stroke)
Hemophilia – bleeding disorder resulting from deficiency or dysfunction of
factors (proteins) needed for clotting – PATHO: deficiency of factor VIII (clotting
factor produced by liver)
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o Manifestations (S/SX):
- Prolonged/excessive bleeding (could bleed out)
- Hemorrhage
- Bruising
- Hemarthrosis (bleeding in the joints – cannot be seen
– treat with RICE)
- Spontaneous hematuria
- Subcutaneous hemorrhage – bleed under skin
o Diagnostics:
- HX of bleeding episodes
- Evidence of inheritance
- LABS: clotting factors, DNA
o TX:
- Prevent bleeding
- Replace clotting factor
- MEDS: corticosteroids (especially if there’s hematuria),
NSAIDs (use cautiously due to bleed risk), DDAVP (used for
mild hemophilia – stimulates factor 8 activity)
- Regular exercise and PT – no contact sports
- Control bleeding: Rest, Ice, Compression, Elevation –
vasoconstrict – (especially hemarthrosis)
- Support/Educate family – signs of stroke, no contact sports
(swimming, golf, bowling), black tarry stools = rectal bleed,
no suppository, no rectal temp
Oncology
Etiology of cancer – unknown – could contribute to genetic
alterations/chromosomal abnormalities, lifestyle factors in adult cancers not
usually present in childhood cancers
o Diagnostics:
- LABS: CBC, CMP, LFT, Coags (PT/INR/PTT)
- LP – leukemia, brain tumors, METS to CNS
- Radiology: x-ray, CT, MRI, PET
- Biopsy (bone marrow)
o Cardinal SX of cancer:
- Mass/swelling
- Fever (cause unknown)
- Easily bruised
- Gained/lost a lot of weight
- Headache
o Management/TX:
- Surgery
- Chemo
- Radiation
- Bone marrow transplant (BMT)
o Side Effects of TX:
- Infection (Neutropenia – decreased WBCs – Neutropenic
precautions = no fresh fruit/flowers)
- Hemorrhage
- Anemia
- N/V (Med: Zofran)
Downloaded by madiba South Africa stuvia ()
EXAM 4
Hematology and Oncology
Assessment, analysis, planning, implementation, and evaluation
- CBC, H&P, energy level of child, food diary, iron sources, frequent infections,
bleeding, skin assessment: pallor, petechiae, and/or bruising
Blood smear – blood cells should be normal in size, shape, color, number – if any
irregularities can indicate blood disorder
Blood Transfusion Reminders:
o Blood within 30 mins of arrival
o Infuse over 4 hours maximum
Hematology
Downloaded by madiba South Africa stuvia ()
, lOMoARcPSD|44532475
Anemia – characterized by decrease in # of RBCs and/or Hgb which decreases
O2 carrying capacity – reduces O2 available to tissues – when anemia develops
slowly in children the child adapts with growth defects (Hgb less than 10) -
anemia causes increased cardiac workload; may cause murmur
Nursing Care:
o Treat underlying cause (transfusion after hemorrhage and/or
nutritional intervention)
o Provide supportive care (IV fluids, O2, bed rest)
o Prepare child & Family for lab tests: consider pain management
interventions due to sequential lab draws (use of topical anesthetic
agents, distractions, etc.)
o Decrease tissue O2 needs: assess child’s energy levels & minimize
excess demands – allow self-care, cluster care to allow rest periods
o Prevent complications- prevent exposure to infections
o Support Family
o Iron rich foods: dark leafy greens
o Iron supplements
Causes:
o Decrease in production of RBCs
o Increase blood loss
o Increases destruction of RBCs in the body
Symptoms/Other causes/TX:
1. SOB
2. Cool skin/pallor
3. Drugs/toxic substances
4. Immune conditions
5. Bone marrow failure
6. Epistaxis
7. Hemophilia
8. Pica
9. Weakness
10. Icteric Sclera
11. Low iron, low folate, low B12
12. Decreased peripheral pulses
13. Sickle Cell Disease
Downloaded by madiba South Africa stuvia ()
, lOMoARcPSD|44532475
14. Dark urine
15. DIC
16. Low BP
17. Stop bleeding
18. B12 injections
19. Headache
20. Trauma
21. Malignancy
22. Splenomegaly/Hepatomegaly
23. Increase iron in diet
24. Folic acid supplements
25. Systolic heart murmur
26. Tachycardia
Iron Deficient Anemia – inadequate supply of dietary iron – usually preventable
through dietary changes – plays a role in muscle function, energy creation, &
brain development. Preemies and breast-fed babies have reduced iron supply,
give iron fortified formulas to infants, 12-36 months at high risk due to cow’s
milk, adolescents at risk due to rapid growth, poor eating habits, menses,
obesity, and/or strenuous activities. SX: tired/weak, pale skin (hands, nails,
eyelids), low appetite, frequent infections/bleeding Signs: behavioral problems &
repeat infections, lethargy & breathlessness, failure to grow at expected rate &
pica. **
Sickle cell disease (SCD) OR Sickle Cell Anemia – sickling of RBCs causes
obstruction of vessels, vascular inflammation, & RBC destruction – newborn
screening in every state in US (not mandatory in all countries)
o Causes: infection, stress, dehydration, trauma
o Types of crises:
- Vaso-occlusive – “painful episode”
- Splenic sequestration – pooling of blood in the spleen (may
need splenectomy)
- Aplastic – decreased production of RBCs
- TX of crises: Oral/IV hydration (enuresis possible),
Pain management, Naloxone/Narcan, Increase admin.
of O2
o Complications: acute chest syndrome, CVA (stroke)
o Prevention/TX:
- Oral/IV hydration (enuresis possible)
- Decrease O2 demands
- Pain management
- Naloxone/Narcan
- Administer O2
- Prevent infections (immunizations, PCN prophylaxis,
hydroxyurea)
- Splenectomy
- Blood Transfusions
- Stem Cell Transplant (considered curative)
- Teaching: S/S of infection, acute chest syndrome, CVA
(stroke)
Hemophilia – bleeding disorder resulting from deficiency or dysfunction of
factors (proteins) needed for clotting – PATHO: deficiency of factor VIII (clotting
factor produced by liver)
Downloaded by madiba South Africa stuvia ()
, lOMoARcPSD|44532475
o Manifestations (S/SX):
- Prolonged/excessive bleeding (could bleed out)
- Hemorrhage
- Bruising
- Hemarthrosis (bleeding in the joints – cannot be seen
– treat with RICE)
- Spontaneous hematuria
- Subcutaneous hemorrhage – bleed under skin
o Diagnostics:
- HX of bleeding episodes
- Evidence of inheritance
- LABS: clotting factors, DNA
o TX:
- Prevent bleeding
- Replace clotting factor
- MEDS: corticosteroids (especially if there’s hematuria),
NSAIDs (use cautiously due to bleed risk), DDAVP (used for
mild hemophilia – stimulates factor 8 activity)
- Regular exercise and PT – no contact sports
- Control bleeding: Rest, Ice, Compression, Elevation –
vasoconstrict – (especially hemarthrosis)
- Support/Educate family – signs of stroke, no contact sports
(swimming, golf, bowling), black tarry stools = rectal bleed,
no suppository, no rectal temp
Oncology
Etiology of cancer – unknown – could contribute to genetic
alterations/chromosomal abnormalities, lifestyle factors in adult cancers not
usually present in childhood cancers
o Diagnostics:
- LABS: CBC, CMP, LFT, Coags (PT/INR/PTT)
- LP – leukemia, brain tumors, METS to CNS
- Radiology: x-ray, CT, MRI, PET
- Biopsy (bone marrow)
o Cardinal SX of cancer:
- Mass/swelling
- Fever (cause unknown)
- Easily bruised
- Gained/lost a lot of weight
- Headache
o Management/TX:
- Surgery
- Chemo
- Radiation
- Bone marrow transplant (BMT)
o Side Effects of TX:
- Infection (Neutropenia – decreased WBCs – Neutropenic
precautions = no fresh fruit/flowers)
- Hemorrhage
- Anemia
- N/V (Med: Zofran)
Downloaded by madiba South Africa stuvia ()
