NUR 254
EXAM IV
Maternal and
Pediatrics
, NUR 254 EXAM IV Maternal and Pediatrics
Child Caring Exam #4 Study Guide
Nur 254 Pediatric Exam 4
Galen College of nursing
Unit 9: Oncology, Hematology, Grief, and Loss
• Nursing management
o Communication
▪ Appropriate responses following death of a child (therapeutic communication)
• Stay with the family
• Accept the family’s grief reactions and avoid judgmental statements
• Avoid “rationalizing” (She isn’t suffering anymore)
• Avoid artificial consolation (“I know how you feel”)
• Do everything possible to ensure comfort
• Express personal feelings of loss or frustration (you can cry!)
• Allow family to stay with child as long as needed
• Refer to the dead child by name
o Recognizing signs/symptoms
▪ Impending death (everything slows down)
• Loss of sensation and movement in lower extremities – progresses towards upper body
• Sensation of heat, although body is cold
• Loss of senses (photosensitivity, tactile sense decreases)
• Confusion, loss of consciousness, slurred speech
• Muscle weakness
• Loss of bowel and bladder control
• Decreased appetite and thirst
• Difficulty swallowing
• Change in respiratory pattern (Cheyne-Stokes respirations)
• Weak, slow pulse
• Decreased BP
o Creating care plans
▪ Leukemia= (involves blood cells and bone marrow) too much WBC Not enough RBC for clotting
• Acute lymphocytic leukemia (ALL)
▪ Most common (2-5year old)
• Acute myelogenous leukemia (AML)
▪ Higher rate in infants
• S/S: generally, there are few “dramatic” signs and symptoms
▪ Diagnosis can occur when a cold fails to go away
▪ Weight loss, petechia, bruising, complaints of bone or joint pain, fatigue, anemia, unsteady gait,
thrombocytopenia
▪ Immature “baby” WBC
▪ Labs: low H&H and low Platelets
• Neutropenic precautions and bleeding precautions
▪ Private room
▪ All visitors wear a mask – NO sick visitors
▪ Hand hygiene
▪ WE are a threat to the child, not the other way around
▪ No fresh flowers
▪ Thoroughly cooked foods
• Treatment= radiation & chemo
▪ Induction phase
▪ Low level chemo for 4-5 weeks
▪ Intensification phase
▪ “pulses” of chemo over 6 months
▪ Maintenance therapy
▪ Combined drugs to keep in remission for 2-3 years
▪ Bone marrow transplant
EXAM IV
Maternal and
Pediatrics
, NUR 254 EXAM IV Maternal and Pediatrics
Child Caring Exam #4 Study Guide
Nur 254 Pediatric Exam 4
Galen College of nursing
Unit 9: Oncology, Hematology, Grief, and Loss
• Nursing management
o Communication
▪ Appropriate responses following death of a child (therapeutic communication)
• Stay with the family
• Accept the family’s grief reactions and avoid judgmental statements
• Avoid “rationalizing” (She isn’t suffering anymore)
• Avoid artificial consolation (“I know how you feel”)
• Do everything possible to ensure comfort
• Express personal feelings of loss or frustration (you can cry!)
• Allow family to stay with child as long as needed
• Refer to the dead child by name
o Recognizing signs/symptoms
▪ Impending death (everything slows down)
• Loss of sensation and movement in lower extremities – progresses towards upper body
• Sensation of heat, although body is cold
• Loss of senses (photosensitivity, tactile sense decreases)
• Confusion, loss of consciousness, slurred speech
• Muscle weakness
• Loss of bowel and bladder control
• Decreased appetite and thirst
• Difficulty swallowing
• Change in respiratory pattern (Cheyne-Stokes respirations)
• Weak, slow pulse
• Decreased BP
o Creating care plans
▪ Leukemia= (involves blood cells and bone marrow) too much WBC Not enough RBC for clotting
• Acute lymphocytic leukemia (ALL)
▪ Most common (2-5year old)
• Acute myelogenous leukemia (AML)
▪ Higher rate in infants
• S/S: generally, there are few “dramatic” signs and symptoms
▪ Diagnosis can occur when a cold fails to go away
▪ Weight loss, petechia, bruising, complaints of bone or joint pain, fatigue, anemia, unsteady gait,
thrombocytopenia
▪ Immature “baby” WBC
▪ Labs: low H&H and low Platelets
• Neutropenic precautions and bleeding precautions
▪ Private room
▪ All visitors wear a mask – NO sick visitors
▪ Hand hygiene
▪ WE are a threat to the child, not the other way around
▪ No fresh flowers
▪ Thoroughly cooked foods
• Treatment= radiation & chemo
▪ Induction phase
▪ Low level chemo for 4-5 weeks
▪ Intensification phase
▪ “pulses” of chemo over 6 months
▪ Maintenance therapy
▪ Combined drugs to keep in remission for 2-3 years
▪ Bone marrow transplant
