NUR 145 STUDY
GUIDE PRACTICE
CHEAT SHEET
, NUR 145
Diagnosis
Physical Exam
Bone marrow aspiration
LEUKEMIA Radiograph of long bones reveals lesions
o X-ray, CT scan, and Ultrasound
Distorted and uncontrolled proliferation of Lumbar puncture
WBCs
Therapeutic Management
ACUTE LYMPHOCYTIC LEUKEMIA (ALL)
Up to 95% will have a first remission but if a child
Develops from lymphoblasts or immature WBC experiences a relapse, chances of long-term survival are
With rapid proliferation of lymphoblasts, RBC and reduced to 70%
platelet production fall and invasion of body organs
by the WBCs begins Chemotherapy (Intrathecal)
Common in children between 2-6 years old o Induction phase – kill all the leukemia
Idiopathic (Unknown cause) cells in the bone marrow
Common in male, white children, and children o Sanctuary phase – preventing leukemia
with Down Syndrome or Fanconi Syndrome cells from invading or growing in the
CNS
CHRONIC LYMPHOID LEUKEMIA (CLL) o Administer delayed intensive therapy
o Maintenance phase – maintaining the
Same with ALL but CLL is slow-growing. original remission
Common in adults, rare in children Bone marrow transplant
Nursing Interventions
o Maintain positive room pressure
Assessment o Methotrexate
Chemotherapy in Children
1st Symptoms
o Pallor Administration via central venous catheter or
o Low-grade fever port to prevent irritation of vessel walls
o Lethargy Drugs (Given over 4 weeks)
o Petechiae o Vincristine, Prednisone, L-asparaginase,
o Bleeding Doxorubicin, and Methotrexate
o Bruise easily Cell destruction due to chemotherapy results in
As spleen & liver enlarge due to infiltration of
increased uric acid level which may destroy
abnormal cells, abdominal pain, vomiting,
glomeruli and leads to loss of kidney function
anorexia occurs
o Allopurinol – reduce UA production
As abnormal lymphocytes invade bone
Hydration helps UA excretion
periosteum, bone and joint point pain
Intrathecal administration of drugs may be
CNS invasion leads to headache, unsteady gait
included to bypass the blood-brain barrier
Physical exam reveals painless, generalized
swelling of lymph nodes Maintenance and Monitoring
WBC count is markedly elevated
Combination of daily Mercaptopurine, weekly
Platelet and hematocrit are low
Methotrexate, Sporadic Vincristine and
RBCs are normochromic and normocytic
Prednisone, and Intrathecal Methotrexate and
Disease Classification & Prognosis may be continued for 2 to 3 years.
Leucovorin (given after Methotrexate)
Can affect lymphocytes o To protect normal cells
o T-lymphocytes cells – 85% Blood values must be monitored monthly
o B-lymphocytes cells – 15-20%
P a g e 1 | Manuel, R.N, M.D
, Complications Hypertension may occur
Anemic (due to lack of erythropoietin formation)
CNS involvement
o Blindness Do not palpate child’s abdomen
o Hydrocephalus o Place a sign “No abdominal palpation”
o Recurrent seizures Diagnosis
o Nuchal rigidity
o Headache CT scan reveals the tumor and points of
o Irritability metastasis
Renal Involvement GFR, BUN tests are done
o Kidney enlarges and function impaired o To assess the kidney before surgery
Testicular Invasion
STAGE DESCRIPTION
o Leads to sterility
I Tumor confined to 1 kidney
(Unilateral) & completely removed
ACUTE MYELOID LEUKEMIA (AML) surgically
II Tumor extending beyond the kidney
Involves the over proliferation of granulocytes but completely removed surgically
(Neutrophils, Basophils, and Eosinophils) III Regional spread of the disease
Granulocytes grow so rapidly they are often beyond the kidney with residual
forced out into the bloodstream while still in the abdominal disease postoperatively
blast stage. It results in limited production of IV Metastases to lung, live, bone, distant
RBC and platelets lymph nodes, or other distant sites
V Bilateral disease (Both kidneys)
Assessment
Same symptoms with ALL Treatment
Susceptible to infection
Nephrectomy
Diagnosis Chemotherapy
Radiation therapy
Bone marrow aspiration & Biopsy
o To determine prognosis (M1 to M6) Thoracotomy
Management Complications
1-2 months of Cytarabine and Anthracycline Nephritis
o To achieve full remission Small bowel obstruction
6-9 months of Cyclophosphamide and 6- Hepatic damage
thioguanine Sterility (girls) – radiation related damage
Remission is difficult and brief to achieve Interstitial pneumonia – radiation to the lungs
Bone marrow transplantation is recommended
Prognosis: Highest survival rate among all childhood
cancer
WILM’S TUMOR/ NEPHROBLASTOMA
Malignant cancer of the kidney
ASTHMA
Assessment Narrowing of airway
Discovered early in life (6 months to 5 years) Occur in children with atopy or hypersensitive to
Tumor felt as a firm, nontender abdominal allergens
mass Triggers: pollens, molds, house dust, cigarette
Manifest with hematuria and low-grade fever smoke, cold weather, cold weather, irritating
odor
P a g e 2 | Manuel, R.N, M.D
, Aspirin can be trigger
Mast cells release histamine and leukotrienes
Cough suppressants are contraindicated
that result in diffuse obstructive and restrictive
Inhaled anti-inflammatory corticosteroid such as
airway disease because of a triad of
Fluticasone daily
Inflammation, Bronchoconstriction, and
Long-acting bronchodilator at bedtime
Increased mucus production
For severe and persistent asthma, oral and
Cause inhaled corticosteroid daily
Short-acting beta-2 antagonist bronchodilator
Environmental and genetic factors
such as Albuterol or Terbutaline
Mechanism of the Disease o If attack begins
Cromolyn sodium
Bronchospasm – inflammation of bronchial
Leukotriene receptor antagonists
mucosa and increased bronchial secretions all
Encourage drinking of fluids during attacks
act to reduce the airway lumen, leading to
respiratory distress
Bronchial constriction – due to stimulation of STATUS ASTHMATICUS
parasympathetic nervous system which initiates
smooth muscle constriction Occurs when children fail to respond to
Inflammation and mucus production - occurs medication during attack
because of mast cell activation to release An extreme emergency because child may die of
leukotrienes, histamines, and prostaglandins heart failure
Managed by oxygen therapy, continuing
Assessment nebulizer with beta-2 antagonist, IV
corticosteroid, and careful monitoring
Dry cough (after exposure to an allergen)
Difficulty in breathing
Typical dyspnea and wheezing upon expiration URINARY TRACT INFECTION
Mucus – white and has the shape of the bronchi
Occurs more in females due to shorter urethra
Cyanosis
Caused by gram-negative rods (usually E. coli)
Clubbing of fingers
Tripod position - to ease breathing Symptoms
History Pain on urination and frequency
Burning
Include history of the attack
Hematuria
Ask parents to describe home environment
Low-grade fever
Physical assessment Mild abdominal pain
Enuresis
Auscultate for wheezing
Cyanosis & Eosinophilia may be present Urine culture is obtained by a clean-catch technique
Pulmonary function studies
Management
Antibiotic therapy
Therapeutic Management
Increased fluid intake
3 goals: Cranberry juice
Avoidance of allergen Repeat clean-catch sample after 72 hours of
antibiotic therapy
Skin testing
Hypo sensitization & relief of symptoms by
pharmacologic agents
P a g e 3 | Manuel, R.N, M.D
GUIDE PRACTICE
CHEAT SHEET
, NUR 145
Diagnosis
Physical Exam
Bone marrow aspiration
LEUKEMIA Radiograph of long bones reveals lesions
o X-ray, CT scan, and Ultrasound
Distorted and uncontrolled proliferation of Lumbar puncture
WBCs
Therapeutic Management
ACUTE LYMPHOCYTIC LEUKEMIA (ALL)
Up to 95% will have a first remission but if a child
Develops from lymphoblasts or immature WBC experiences a relapse, chances of long-term survival are
With rapid proliferation of lymphoblasts, RBC and reduced to 70%
platelet production fall and invasion of body organs
by the WBCs begins Chemotherapy (Intrathecal)
Common in children between 2-6 years old o Induction phase – kill all the leukemia
Idiopathic (Unknown cause) cells in the bone marrow
Common in male, white children, and children o Sanctuary phase – preventing leukemia
with Down Syndrome or Fanconi Syndrome cells from invading or growing in the
CNS
CHRONIC LYMPHOID LEUKEMIA (CLL) o Administer delayed intensive therapy
o Maintenance phase – maintaining the
Same with ALL but CLL is slow-growing. original remission
Common in adults, rare in children Bone marrow transplant
Nursing Interventions
o Maintain positive room pressure
Assessment o Methotrexate
Chemotherapy in Children
1st Symptoms
o Pallor Administration via central venous catheter or
o Low-grade fever port to prevent irritation of vessel walls
o Lethargy Drugs (Given over 4 weeks)
o Petechiae o Vincristine, Prednisone, L-asparaginase,
o Bleeding Doxorubicin, and Methotrexate
o Bruise easily Cell destruction due to chemotherapy results in
As spleen & liver enlarge due to infiltration of
increased uric acid level which may destroy
abnormal cells, abdominal pain, vomiting,
glomeruli and leads to loss of kidney function
anorexia occurs
o Allopurinol – reduce UA production
As abnormal lymphocytes invade bone
Hydration helps UA excretion
periosteum, bone and joint point pain
Intrathecal administration of drugs may be
CNS invasion leads to headache, unsteady gait
included to bypass the blood-brain barrier
Physical exam reveals painless, generalized
swelling of lymph nodes Maintenance and Monitoring
WBC count is markedly elevated
Combination of daily Mercaptopurine, weekly
Platelet and hematocrit are low
Methotrexate, Sporadic Vincristine and
RBCs are normochromic and normocytic
Prednisone, and Intrathecal Methotrexate and
Disease Classification & Prognosis may be continued for 2 to 3 years.
Leucovorin (given after Methotrexate)
Can affect lymphocytes o To protect normal cells
o T-lymphocytes cells – 85% Blood values must be monitored monthly
o B-lymphocytes cells – 15-20%
P a g e 1 | Manuel, R.N, M.D
, Complications Hypertension may occur
Anemic (due to lack of erythropoietin formation)
CNS involvement
o Blindness Do not palpate child’s abdomen
o Hydrocephalus o Place a sign “No abdominal palpation”
o Recurrent seizures Diagnosis
o Nuchal rigidity
o Headache CT scan reveals the tumor and points of
o Irritability metastasis
Renal Involvement GFR, BUN tests are done
o Kidney enlarges and function impaired o To assess the kidney before surgery
Testicular Invasion
STAGE DESCRIPTION
o Leads to sterility
I Tumor confined to 1 kidney
(Unilateral) & completely removed
ACUTE MYELOID LEUKEMIA (AML) surgically
II Tumor extending beyond the kidney
Involves the over proliferation of granulocytes but completely removed surgically
(Neutrophils, Basophils, and Eosinophils) III Regional spread of the disease
Granulocytes grow so rapidly they are often beyond the kidney with residual
forced out into the bloodstream while still in the abdominal disease postoperatively
blast stage. It results in limited production of IV Metastases to lung, live, bone, distant
RBC and platelets lymph nodes, or other distant sites
V Bilateral disease (Both kidneys)
Assessment
Same symptoms with ALL Treatment
Susceptible to infection
Nephrectomy
Diagnosis Chemotherapy
Radiation therapy
Bone marrow aspiration & Biopsy
o To determine prognosis (M1 to M6) Thoracotomy
Management Complications
1-2 months of Cytarabine and Anthracycline Nephritis
o To achieve full remission Small bowel obstruction
6-9 months of Cyclophosphamide and 6- Hepatic damage
thioguanine Sterility (girls) – radiation related damage
Remission is difficult and brief to achieve Interstitial pneumonia – radiation to the lungs
Bone marrow transplantation is recommended
Prognosis: Highest survival rate among all childhood
cancer
WILM’S TUMOR/ NEPHROBLASTOMA
Malignant cancer of the kidney
ASTHMA
Assessment Narrowing of airway
Discovered early in life (6 months to 5 years) Occur in children with atopy or hypersensitive to
Tumor felt as a firm, nontender abdominal allergens
mass Triggers: pollens, molds, house dust, cigarette
Manifest with hematuria and low-grade fever smoke, cold weather, cold weather, irritating
odor
P a g e 2 | Manuel, R.N, M.D
, Aspirin can be trigger
Mast cells release histamine and leukotrienes
Cough suppressants are contraindicated
that result in diffuse obstructive and restrictive
Inhaled anti-inflammatory corticosteroid such as
airway disease because of a triad of
Fluticasone daily
Inflammation, Bronchoconstriction, and
Long-acting bronchodilator at bedtime
Increased mucus production
For severe and persistent asthma, oral and
Cause inhaled corticosteroid daily
Short-acting beta-2 antagonist bronchodilator
Environmental and genetic factors
such as Albuterol or Terbutaline
Mechanism of the Disease o If attack begins
Cromolyn sodium
Bronchospasm – inflammation of bronchial
Leukotriene receptor antagonists
mucosa and increased bronchial secretions all
Encourage drinking of fluids during attacks
act to reduce the airway lumen, leading to
respiratory distress
Bronchial constriction – due to stimulation of STATUS ASTHMATICUS
parasympathetic nervous system which initiates
smooth muscle constriction Occurs when children fail to respond to
Inflammation and mucus production - occurs medication during attack
because of mast cell activation to release An extreme emergency because child may die of
leukotrienes, histamines, and prostaglandins heart failure
Managed by oxygen therapy, continuing
Assessment nebulizer with beta-2 antagonist, IV
corticosteroid, and careful monitoring
Dry cough (after exposure to an allergen)
Difficulty in breathing
Typical dyspnea and wheezing upon expiration URINARY TRACT INFECTION
Mucus – white and has the shape of the bronchi
Occurs more in females due to shorter urethra
Cyanosis
Caused by gram-negative rods (usually E. coli)
Clubbing of fingers
Tripod position - to ease breathing Symptoms
History Pain on urination and frequency
Burning
Include history of the attack
Hematuria
Ask parents to describe home environment
Low-grade fever
Physical assessment Mild abdominal pain
Enuresis
Auscultate for wheezing
Cyanosis & Eosinophilia may be present Urine culture is obtained by a clean-catch technique
Pulmonary function studies
Management
Antibiotic therapy
Therapeutic Management
Increased fluid intake
3 goals: Cranberry juice
Avoidance of allergen Repeat clean-catch sample after 72 hours of
antibiotic therapy
Skin testing
Hypo sensitization & relief of symptoms by
pharmacologic agents
P a g e 3 | Manuel, R.N, M.D
