The Child with a Condition of the Blood, Blood-forming Organs, or Lymphatic System
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Questions and Answers

Which blood component is primarily responsible for transporting oxygen and carbon dioxide?

  • Erythrocytes (correct)
  • Plasma
  • Leukocytes
  • Thrombocytes

What is the main role of leukocytes in the immune system?

  • Transporting nutrients
  • Fighting infection (correct)
  • Oxygen transport
  • Clot formation

Which of the following is a common manifestation of iron deficiency anemia?

  • Pallor (correct)
  • Cyanosis
  • Fever
  • Hypotension

What factor can trigger sickling in sickle cell disease?

<p>Emotional stress (D)</p> Signup and view all the answers

What is the significance of the thymus gland in newborns?

<p>Develops immune response (B)</p> Signup and view all the answers

Which treatment is commonly used for iron deficiency anemia?

<p>Ferrous sulfate (C)</p> Signup and view all the answers

What condition is characterized by the clumping of sickle cells due to low oxygen levels?

<p>Sickle cell disease (D)</p> Signup and view all the answers

Which of the following is a potential complication of sickle cell anemia?

<p>Organ infarction (A)</p> Signup and view all the answers

Which anemia is noted as the most common nutritional deficiency in children in the US?

<p>Iron deficiency anemia (C)</p> Signup and view all the answers

Which of the following is NOT a part of the lymphatic system?

<p>Bone marrow (D)</p> Signup and view all the answers

What is a significant risk for preterm and term infants in relation to T-cell activity?

<p>Higher infection rates (C)</p> Signup and view all the answers

What dietary sources are recommended for toddlers at risk of iron deficiency anemia?

<p>Iron-rich solid foods (D)</p> Signup and view all the answers

Which symptom is commonly associated with anemia due to decreased hemoglobin levels?

<p>Shortness of breath (D)</p> Signup and view all the answers

What can significantly interfere with the absorption of iron supplements?

<p>Whole cow’s milk (D)</p> Signup and view all the answers

Which treatment strategy is essential for managing children with hemophilia during episodes of bleeding?

<p>Using RICE (Rest, Ice, Compression, Elevation) (B)</p> Signup and view all the answers

What is a key clinical manifestation of Idiopathic Thrombocytopenic Purpura (ITP)?

<p>Spontaneous bruising (A)</p> Signup and view all the answers

Which of the following is considered a life-threatening risk in children with hemophilia?

<p>Intracranial bleeding (B)</p> Signup and view all the answers

Which medication is considered the first-line treatment for Idiopathic Thrombocytopenic Purpura (ITP)?

<p>Steroids (D)</p> Signup and view all the answers

What is crucial to maintain during the management of a child with ITP?

<p>Monitoring for signs of bleeding (B)</p> Signup and view all the answers

Which dietary recommendation is appropriate for a child with hemophilia?

<p>Increased intake of citrus fruits (B)</p> Signup and view all the answers

What can indicate the presence of Henoch-Schönlein purpura?

<p>Petechiae and purpura (D)</p> Signup and view all the answers

What is a core aspect of managing children with bleeding disorders?

<p>Encouraging independence and decision-making (D)</p> Signup and view all the answers

What risk factor is associated with the pathophysiology of Henoch-Schönlein purpura?

<p>Respiratory illness (A)</p> Signup and view all the answers

Which of the following would NOT be a recommended activity for a child with hemophilia?

<p>Contact sports (A)</p> Signup and view all the answers

How does leukemia primarily impact the body?

<p>It inhibits the formation of RBCs from the marrow. (B)</p> Signup and view all the answers

What is NOT a characteristic of ITP?

<p>High platelet count (A)</p> Signup and view all the answers

Which of the following is vital in differentiating bruises from ITP and signs of abuse?

<p>Neurologic assessments (A)</p> Signup and view all the answers

What type of joint bleeding is especially common in children with hemophilia?

<p>Hemarthrosis (C)</p> Signup and view all the answers

What is one important aspect of nursing care for the dying child?

<p>Providing support and facilitating the grieving process (A)</p> Signup and view all the answers

How should nurses approach a child's communication about death?

<p>Use simple language and be honest (C)</p> Signup and view all the answers

What emotional reaction might siblings of a dying child experience?

<p>Frustration and a sense of neglect (A)</p> Signup and view all the answers

Why is it essential for nurses to be aware of their own attitudes toward life and death?

<p>It affects their nursing practice and empathetic response (C)</p> Signup and view all the answers

What is a common characteristic of children's understanding of death under the age of 5?

<p>They may believe that death is reversible (C)</p> Signup and view all the answers

What might indicate that a terminally ill child is aware of their condition?

<p>Changes in their drawings and play (B)</p> Signup and view all the answers

How should nurses respond when parents are visibly grieving in a child's room?

<p>Listen and allow them to express their emotions (B)</p> Signup and view all the answers

What is a typical physical change an individual may exhibit as they approach death?

<p>Cool and mottled skin (D)</p> Signup and view all the answers

What role does hospice care play in the context of terminal illness in children?

<p>It provides support before and after death for the child and family (C)</p> Signup and view all the answers

Why is it important for children to express their feelings about death?

<p>It helps them cope and process their emotions (C)</p> Signup and view all the answers

What is an essential nursing intervention for a child undergoing chemotherapy to prevent skin irritation?

<p>Use PABA sunscreen before going outdoors. (A)</p> Signup and view all the answers

Which of the following actions helps support a child with cancer who is expressing anger?

<p>Provide safe outlets for the safe direction of anger. (B)</p> Signup and view all the answers

What might be a common concern for a child undergoing cancer treatment related to growth?

<p>Appearance of secondary sexual characteristics may be delayed. (A)</p> Signup and view all the answers

Why is education especially important for patients receiving care at home?

<p>Most patients have to manage their own care after treatments. (B)</p> Signup and view all the answers

What should be done regarding immunizations for a child with leukemia who is not up to date?

<p>Delay active immunization during chemotherapy. (D)</p> Signup and view all the answers

What is typically the first symptom seen in children with Hodgkin's disease?

<p>Painless cervical neck lump. (A)</p> Signup and view all the answers

An adolescent with cancer who is refusing treatment should primarily be managed by:

<p>Allowing them to have a say in their treatment options. (C)</p> Signup and view all the answers

What is a significant psychological benefit of school programs for hospitalized children?

<p>They help maintain peer relationships and social skills. (A)</p> Signup and view all the answers

What is an effective method for managing behavior problems in chronically ill children?

<p>Encouraging verbalization of specific concerns. (B)</p> Signup and view all the answers

Which service is designed to relieve parents of caregiving responsibilities temporarily?

<p>Respite Care. (C)</p> Signup and view all the answers

How can home health care positively impact a child with developmental disabilities?

<p>It emphasizes what the child can do. (C)</p> Signup and view all the answers

Which of the following symptoms can be associated with advanced cases of Hodgkin’s disease?

<p>Night sweats and unexplained weight loss. (B)</p> Signup and view all the answers

What is an appropriate action when a child expresses reluctance to adhere to treatment protocols?

<p>Take steps to understand their perspective and engage them. (D)</p> Signup and view all the answers

Which emotional response should nurses be prepared to support in children diagnosed with chronic illnesses?

<p>Strong feelings of anger and frustration. (B)</p> Signup and view all the answers

At what stage of gestation does blood formation primarily occur in the yolk sac?

<p>Around the second week (D)</p> Signup and view all the answers

Which organ is primarily responsible for blood formation in the fetus until the last trimester of pregnancy?

<p>Liver (A)</p> Signup and view all the answers

What is the function of erythropoietin in the hematological system?

<p>Regulates red blood cell production (A)</p> Signup and view all the answers

Why is vitamin K administered immediately after birth to newborns?

<p>To aid in the development of blood clotting factors (C)</p> Signup and view all the answers

Which component of blood is responsible for transporting oxygen throughout the body?

<p>Erythrocytes (D)</p> Signup and view all the answers

Which statement about white blood cell (WBC) levels in newborns is true?

<p>WBC levels are stable immediately after birth. (D)</p> Signup and view all the answers

What does the lymphatic system primarily do?

<p>Drains regions of the body to lymph nodes (D)</p> Signup and view all the answers

By what age does hematopoiesis mainly occur in the marrow of the ribs, sternum, and pelvis?

<p>By adolescence (B)</p> Signup and view all the answers

Which of the following symptoms is NOT commonly associated with thalassemia major?

<p>Frequent respiratory infections (B)</p> Signup and view all the answers

Which treatment is specifically aimed at reducing the iron overload in patients with thalassemia?

<p>Chelating agents (A)</p> Signup and view all the answers

What is the primary function of hydroxyurea in sickle cell disease treatment?

<p>Enhance fetal hemoglobin production (D)</p> Signup and view all the answers

What is a common consequence of hyperhemolytic crises in sickle cell disease?

<p>Reduced spleen function (B)</p> Signup and view all the answers

What type of inheritance pattern is seen in beta-thalassemia minor?

<p>Heterozygous (C)</p> Signup and view all the answers

Which of the following vaccines is recommended for preventing infections in children with sickle cell disease?

<p>Pneumococcal vaccine (A)</p> Signup and view all the answers

What is the typical clinical presentation of aplastic crises in children with sickle cell disease?

<p>Severe anemia (D)</p> Signup and view all the answers

Which medication is used to relieve severe pain in children during a sickle cell crisis?

<p>Morphine (B)</p> Signup and view all the answers

Which of the following is a recommended nursing intervention for managing sickle cell crises?

<p>Maintain venous thrombosis prophylaxis (C)</p> Signup and view all the answers

Which diagnostic method helps in distinguishing between sickle cell trait and sickle cell disease?

<p>Hemoglobin electrophoresis (C)</p> Signup and view all the answers

In children with thalassemia major, which physical change is often observed as a result of bone marrow expansion?

<p>Facial and skull contour changes (A)</p> Signup and view all the answers

Which of the following assessments is crucial for monitoring potential complications in a child undergoing frequent blood transfusions?

<p>Temperature monitoring for infections (A)</p> Signup and view all the answers

What is the primary goal of screening for sickle cell disease in newborns?

<p>To prevent complications of the disease (A)</p> Signup and view all the answers

What is considered a common manifestation of leukemia in children?

<p>Skin has a lemon-yellow appearance (C)</p> Signup and view all the answers

What diagnostic procedure is commonly used to confirm leukemia?

<p>Bone marrow biopsy (A)</p> Signup and view all the answers

Which symptom is most commonly associated with thrombocytopenia in leukemia patients?

<p>Petechiae and ecchymosis (C)</p> Signup and view all the answers

What is a crucial nursing intervention for a child undergoing chemotherapy?

<p>Obvious hydration to prevent kidney damage (C)</p> Signup and view all the answers

Which of the following is a primary treatment method for Hodgkin’s Disease?

<p>Chemotherapy and radiation therapy (B)</p> Signup and view all the answers

Which of the following medications is commonly included in the COPP regimen for Hodgkin’s Disease?

<p>Cyclophosphamide (A)</p> Signup and view all the answers

What is the main characteristic of Reed-Sternberg cells?

<p>They are multinucleated giant cells (B)</p> Signup and view all the answers

What complication is commonly associated with neutropenia in a child receiving chemotherapy?

<p>Infection risk (B)</p> Signup and view all the answers

In the context of leukemia treatment, why is nutritional support critical?

<p>To combat the side effects of chemotherapy (A)</p> Signup and view all the answers

What is the preferred method for obtaining a bone marrow biopsy in children?

<p>From the iliac crest as a common practice (B)</p> Signup and view all the answers

Which of the following describes the prognosis of Stage IV Hodgkin’s Disease?

<p>Least favorable (D)</p> Signup and view all the answers

Which symptom would most likely indicate central nervous system involvement in leukemia?

<p>Headache (A)</p> Signup and view all the answers

What is a common side effect of prednisone used in leukemia treatment?

<p>Moon-shaped face appearance (B)</p> Signup and view all the answers

What is the recommendation for providing iron-fortified formula to infants?

<p>Until they are 12 months old (C)</p> Signup and view all the answers

Which statement is true regarding individuals with sickle cell trait?

<p>They carry hemoglobin S but show no symptoms (B)</p> Signup and view all the answers

What nursing intervention is appropriate for a child in sickle cell crisis?

<p>Monitor response to analgesics (B)</p> Signup and view all the answers

Frequent blood transfusions in children with thalassemia major primarily maintain which level?

<p>Hemoglobin levels above 9.5 g/dL (C)</p> Signup and view all the answers

What is a classic symptom of hemophilia?

<p>Hemarthrosis (D)</p> Signup and view all the answers

Which treatment option aims to replace missing clotting factors in hemophilia patients?

<p>Recombinant antihemophilic factor (C)</p> Signup and view all the answers

Why should nursing staff delay heel sticks and IM injections for newborns with hemophilia?

<p>To reduce blood loss risks (D)</p> Signup and view all the answers

What is the function of desmopressin acetate (DDAVP) in hemophilia treatment?

<p>It promotes the production of factor VIII (C)</p> Signup and view all the answers

Which of the following is NOT a symptom associated with severe hemophilia?

<p>Ineffective immune response (D)</p> Signup and view all the answers

When does spontaneous hematuria typically occur in hemophilia patients?

<p>Without any apparent cause (D)</p> Signup and view all the answers

What percentage of children born to both parents who are carriers of sickle cell trait will inherit the disease?

<p>25% (C)</p> Signup and view all the answers

What type of hemophilia is associated with Factor IX deficiency?

<p>Hemophilia B (A)</p> Signup and view all the answers

When is cow's milk typically introduced into an infant's diet?

<p>At 1 year (C)</p> Signup and view all the answers

Which of the following interventions should be avoided during a sickle cell crisis?

<p>Applying ice to painful areas (D)</p> Signup and view all the answers

Flashcards

Hematological System

The system responsible for blood and blood cell production.

Blood Dyscrasias

A condition where blood components are not formed properly or where blood values are outside the normal range.

Plasma

The liquid part of blood that contains water, proteins, and other substances.

Erythrocytes

Red blood cells (RBCs), responsible for carrying oxygen.

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Leukocytes

White blood cells (WBCs) that fight infection.

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Thrombocytes

Platelets that help with blood clotting.

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Hematopoiesis

The process of blood cell formation.

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Lymphatic System

The network of vessels and nodes that helps circulate lymph fluid, containing lymphocytes and fighting infections.

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Aplastic Crisis

A condition where the bone marrow stops producing red blood cells, often triggered by viral infections.

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Hyperhemolytic Crisis

A rare and severe complication of sickle cell disease, characterized by rapid breakdown of red blood cells. It often occurs alongside overwhelming infection or functional hyposplenism.

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Sickledex Screening

A diagnostic test used to determine if a person has sickle cell disease or just the trait.

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Hemoglobin Electrophoresis

A lab test that distinguishes between sickle cell trait and sickle cell disease.

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Small Blood Transfusion

A treatment that helps increase hemoglobin levels and reduce the percentage of abnormal red blood cells.

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Hydroxyurea (HU)

The only FDA-approved drug for sickle cell disease, oral hydroxyurea increases fetal hemoglobin, decreases red blood cell adhesion, and improves blood flow.

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Hemopoietic Stem Cell Transplantation

A potential treatment for sickle cell disease, but not always without complications.

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Splenectomy

A surgery that removes the spleen, often recommended for children who experience severe sickle cell crises.

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Hemolysis

The process of red blood cells becoming abnormally shaped and destroyed.

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Thalassemia

A genetic disorder where the body cannot produce sufficient adult hemoglobin, resulting in abnormal red blood cells.

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Thalassemia Major

Also known as Cooley anemia, this is a severe form of thalassemia where individuals inherit the thalassemia gene from both parents.

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Thalassemia Minor

A milder form of thalassemia, where individuals inherit the affected gene from only one parent.

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Deferasirox (Exjade)

A medication used to remove iron deposits from the tissues in patients with thalassemia.

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Deferiprone (Ferriprox)

Another medication used to remove iron deposits from the tissues in patients with thalassemia.

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Lymph

A fluid that circulates throughout the body, carrying white blood cells, and filtering waste products.

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Lymphocytes

Specialized white blood cells that are responsible for the immune response.

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Lymphatic Vessels

A network of thin vessels that collect and transport lymph fluid throughout the body.

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Lymph Nodes

Small, bean-shaped organs that filter lymph fluid and house immune cells.

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Spleen

A large organ that filters blood, stores white blood cells, and removes old red blood cells.

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Tonsils

Lymphoid tissues located at the back of the throat, protecting against inhaled and ingested pathogens.

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Adenoids

Lymphoid tissues located in the nasopharynx, protecting against airborne pathogens.

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Thymus Gland

A gland located in the chest that plays a crucial role in the development and maturation of T-cells, a type of immune cell.

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Lymphatic System in Children: Tonsils and Adenoids

The lymphatic system in children has larger tonsils and adenoids compared to adults. This is a normal defense mechanism.

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Thymus Gland in Newborns

The thymus gland plays a significant role in developing a healthy immune system in newborns.

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Infants' Immune System

Premature and full-term infants are more susceptible to infections due to their immature immune system.

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Anemia

A condition characterized by a lower than normal amount of red blood cells or hemoglobin, affecting the body's ability to carry oxygen.

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Iron Deficiency Anemia

The most common type of nutritional deficiency in children in the US, caused by low iron levels.

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Sickle Cell Anemia

An inherited blood disorder that affects the shape of red blood cells, causing them to sickle or clump.

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Vasoocclusive Sickle Cell Crisis

A specific type of sickle cell crisis characterized by the obstruction of blood flow in blood vessels, leading to pain and inflammation.

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Splenic Sequestration Sickle Cell Crisis

A specific type of sickle cell crisis where a large amount of blood pools in the spleen, causing enlargement and pain.

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Hemophilia

A condition where blood does not clot normally, even with minor injuries, due to a deficiency in clotting factors.

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Hemophilia A

The most common type of hemophilia, caused by a deficiency in Factor VIII, which is essential for blood clotting.

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Hemophilia B (Christmas Disease)

A rarer type of hemophilia caused by a deficiency in Factor IX, another crucial clotting factor.

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Hemarthrosis

A type of bleeding into a joint, often experienced by individuals with hemophilia.

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Prolonged bleeding

Prolonged bleeding from injuries or internal bleeding, often a characteristic symptom of hemophilia.

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Prophylactic factor replacement

A treatment approach for hemophilia involving regular infusions of the missing clotting factor to prevent bleeding episodes.

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Recombinant antihemophilic factor

A synthetic product used to replace missing clotting factors in hemophilia, reducing the need for blood transfusions.

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Desmopressin acetate (DDAVP)

A nasal spray that increases Factor VIII levels, sometimes used in the treatment of Hemophilia A.

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Hemosiderosis

A condition where iron accumulates in tissues due to repeated blood transfusions, often seen in patients with thalassemia major.

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Frequent blood transfusions

A life-saving treatment for thalassemia major, involving regular blood transfusions to maintain adequate hemoglobin levels.

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Hemoglobin levels above 9.5g/dL

The target hemoglobin level in patients with thalassemia major, maintained through frequent blood transfusions.

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Iron-rich foods

Foods high in iron, often recommended for individuals with iron deficiency anemia.

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Iron-fortified formula

A special formula for infants that contains extra iron to meet their needs.

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Desmopressin (DDAVP)

Used to treat mild forms of hemophilia, this medication replaces the missing clotting factor.

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Aminocaproic Acid (Amicar)

An antifibrinolytic agent that helps control bleeding, especially during dental procedures.

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Prednisone

A medication used to treat ITP, an autoimmune disorder affecting platelets.

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IV Gamma Globulin (IVIG)

A second-line treatment for ITP, using intravenous immunoglobulin to elevate platelet count.

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Idiopathic Thrombocytopenic Purpura (ITP)

An autoimmune disorder affecting platelets, leading to easy bruising and bleeding.

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Henoch-Schönlein Purpura

A medical condition characterized by inflammation of blood vessels, often triggered by infections, NSAIDs, or food allergies.

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Leukemia

A group of cancers affecting bone marrow and lymphatic system, leading to uncontrolled growth of immature white blood cells.

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Thrombocytopenia

A reduction in platelet count caused by leukemia, increasing bleeding risk.

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Pathological Fractures

A condition where the bone marrow is infiltrated by leukemia cells, leading to weakening of bone and potential fractures.

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Leukemia Classification

A classification system used to categorize leukemia based on the type of white blood cell affected and the speed of the disease's progression.

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Acute Lymphoblastic Leukemia (ALL)

The most common type of leukemia in children.

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Low-Grade Fever

A common symptom of leukemia characterized by a low-grade fever that is often unexplained.

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Lemon-Yellow Skin

A sign of leukemia where the skin takes on a pale, yellowish appearance.

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Leukemia Diagnosis

The process of diagnosing leukemia involves a combination of medical history, bloodwork, and imaging.

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Bone Marrow Biopsy

A key diagnostic test for leukemia, where a sample of bone marrow is extracted and examined under a microscope.

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Spinal Tap

A specialized procedure that involves extracting a sample of cerebrospinal fluid from the spinal canal to assess for leukemia's presence in the central nervous system.

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Leukemia Treatment Team

The process of treating leukemia often involves a multidisciplinary team of healthcare professionals.

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Neutropenia

A common side effect of leukemia treatment, where the body produces very few white blood cells, increasing the risk of infections.

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Chemotherapy

A crucial aspect of leukemia treatment that involves administering various medications to target and kill cancerous cells.

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Chemotherapy-Induced Nausea and Vomiting

A common side effect of chemotherapy characterized by nausea, vomiting, and intestinal discomfort.

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Bone Marrow Transplant

A treatment option for leukemia that involves replacing the diseased bone marrow with healthy cells.

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Autologous Transplant

A type of bone marrow transplant where the donor is the patient themselves.

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Hemolytic Transfusion Reaction

A potentially dangerous complication of blood transfusions where the recipient's body reacts negatively to the donated blood, leading to a range of symptoms.

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What are the key nursing care considerations for a child with cancer?

Caring for a child with cancer involves managing side effects of chemo and radiation, promoting growth and development, and providing emotional support.

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How is skin protected during cancer treatment?

Protecting sensitive skin from sun exposure and irradiation is crucial, using sunscreen with PABA.

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How is anger managed in children with cancer?

Anger is a common emotion for children with cancer, so providing safe outlets for anger expression is important.

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What kind of emotional support is provided?

Provide emotional support during cancer treatment, especially when the child is going through anger.

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How does cancer treatment affect puberty?

Secondary sexual characteristics and menstruation may be delayed due to cancer treatment.

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What are the reproductive implications for a child with cancer?

Sterility is a possible side effect of cancer treatment, and it is essential to discuss it with the child and family.

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Why is education important for children with cancer?

Educate the child and family about cancer treatment, tests, procedures, and home care management.

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Why are immunizations delayed during chemotherapy?

Active routine immunizations should be delayed during chemotherapy to avoid interfering with the body's ability to form antigens.

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What is a common symptom of Hodgkin's disease?

Hodgkin's disease often presents with a painless lump in the neck.

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How should a nurse approach an adolescent refusing cancer treatment?

Allowing the adolescent to make some choices during treatment can increase cooperation and a sense of control.

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How does chronic illness affect a child's growth and development?

Chronic illness in childhood can affect growth and development, emphasizing the need for programs fostering security and independence.

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Why is it important for children with chronic illness to express their concerns?

Behavioral problems can be lessened when children can verbalize their concerns to someone who understands them.

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Why are hospital school programs important for children with chronic illness?

Hospital school programs allow children with chronic illness to keep pace with their classmates and maintain a sense of normalcy.

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What is the role of a recreational therapist in caring for a child with chronic illness?

Recreational therapists help combat boredom and provide outlets for tension in children with chronic illness.

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What is respite care, and why is it helpful for families of children with chronic illness?

Respite care provides trained workers to relieve parents of caring for a child with chronic illness, allowing them to take breaks.

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Understanding the Grieving Process

Nurses must understand how individuals and cultures view death and grieve, and how a parent might process losing a child.

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Nursing Priorities in End-of-Life Care

Nurses are patient advocates, providing support and aiding families through the grieving process.

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Honesty with Children Facing Death

Honest communication with children about their illness and upcoming procedures, using age-appropriate language, is crucial.

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Understanding Child's Communication

Recognizing that children express emotions differently, through play, drawings, or interactions with others, is essential in understanding their response to death.

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Child's Cognitive Development and Death

The concept of death develops through a child's cognitive stages, with younger children typically experiencing separation anxiety and fearing abandonment.

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Awareness of Terminal Illness

While terminally ill children often understand their condition, their awareness may be expressed indirectly through drawings, behavior, and play.

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Physical Changes of Impending Death

These signs signal the impending death of a child and require careful monitoring and pain management.

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Nurse's Role in Family Support

Open communication, active listening, and support for the family's needs are crucial for providing effective care during a child's terminal illness.

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Providing Privacy for Grieving Families

Offering privacy for grieving families allows them to express their emotions and comfort one another without feeling judged or pressured.

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Communication Strategies for Families

Open-ended questions and concrete statements encourage families to express their feelings and concerns about the child's condition and their own grief.

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Study Notes

Hematological System in Pediatrics

  • The hematological system comprises the blood and blood-forming organs, vital for all bodily functions.
  • Blood disorders (dyscrasias) occur when blood components form incorrectly or blood values deviate from normal ranges.
  • Blood cell formation (hematopoiesis) begins in the yolk sac during gestation.
  • Fetal blood formation is primarily in the liver until the last trimester.
  • During childhood, red blood cells (RBCs) form in the marrow of long bones.
  • During adolescence, hematopoiesis occurs in various bone marrow sites (ribs, sternum, vertebrae, pelvis, skull, clavicle, scapulae).
  • Erythropoietin regulates RBC production.
  • Blood components include plasma and formed elements: erythrocytes, leukocytes, thrombocytes.

Blood Component Differences in Infancy

  • Newborns have high hemoglobin and RBC counts due to high erythropoietin levels, placental blood shift, and low extracellular fluid volume.
  • High white blood cell (WBC) count at birth decreases to a stable level by one week.
  • Newborns have low vitamin K levels, requiring immediate administration for proper blood clotting factor development.

Lymphatic System in Pediatrics

  • The lymphatic system includes lymphocytes, vessels, nodes, spleen, tonsils, adenoids, and thymus.
  • It drains bodily regions to lymph nodes, where pathogens are destroyed and antibodies produced.
  • Enlarged tonsils and adenoids in preschool and school-aged children are normal defense mechanisms.
  • The thymus, crucial for newborn immune response development, is essential for proper immunity
  • Preterm and term infants are at higher risk for infections due to reduced T-cell activity.

Anemia in Children

  • Anemia arises from various causes and reduces the blood's oxygen-carrying capacity.
  • Hemoglobin levels below 8 g/dL increase cardiac output and redirect blood to vital organs..
  • Common manifestations include pallor, weakness, tachycardia, and shortness of breath; and potentially, congestive heart failure.

Iron Deficiency Anemia

  • The most common nutritional deficiency in US children, particularly during rapid growth spurts (infancy and adolescence).
  • Causes include severe hemorrhage, impaired absorption, excessive growth demands, and inadequate diet.
  • Feeding whole cow’s milk can cause GI bleeding, and maternal iron deficiency can contribute.
  • Manifestations include pallor, irritability, anorexia, decreased activity, and, with long-standing anemia, growth retardation and cognitive changes.
  • Treatment involves iron supplements (usually ferrous sulfate), taken between meals with vitamin C for absorption.
  • Liquid iron should be administered via a straw to prevent tooth staining.
  • Breastfeeding and iron-fortified formulas are crucial.
  • Treatment may require intramuscular or intravenous iron-dextran for non-responders.
  • Parents need education on diet, iron supplementation, and follow-up care.

Sickle Cell Anemia

  • An inherited hemoglobin disorder, mainly affecting African Americans (1 in 365 births), with Mediterranean descent carriers also present.
  • Decreased blood oxygen triggers sickling (clumping) of red blood cells.
  • Causes include dehydration, infection, stress, or cold exposure.
  • These abnormal cells (hemoglobin S) cause slowed blood flow & clots (thrombosis), leading to tissue damage (infarcts)—commonly in spleen; but potentially in other organs.
  • Acute pain in affected regions.
  • Sickle cell trait does not lead to the disease; but genetic counseling is recommended.
  • Inheritance involves a one-in-four chance of an offspring inheriting the disease if both parents are carriers.
  • Types of crises include: vaso-occlusive, splenic sequestration, aplastic, and hyperhemolytic.
  • Treatment involves supportive care (hydration, rest, pain management, blood transfusions), and hydroxyurea (HU).
  • Nursing care includes preventing dehydration, infection, and crises.

Thalassemia

  • Hereditary disorders impairing adult hemoglobin production, leading to abnormal, fragile RBCs.
  • Body attempts to increase fetal hemoglobin by compensating.
  • Types include α- and β-thalassemia.
  • β-thalassemia is a common form.
  • Thalassemia minor (β-thalassemia trait) is a milder form with a heterozygous inheritance.
  • Thalassemia major (Cooley anemia) is a severe form with a homozygous inheritance.
  • Symptoms include pallor, hypoxia, poor appetite, fever, muddy bronze jaundice (from tissue iron deposition), enlarged liver/spleen, and skeletal deformities.
  • Diagnosis involves family history, hematologic tests, x-rays, and hemoglobin electrophoresis.
  • Treatment methods include blood transfusions to maintain hemoglobin levels, chelating medications (deferasirox, deferiprone), splenectomy, and potential hematopoietic stem cell transplantation.

Bleeding Disorders

  • Hemophilia: Inherited blood clotting disorders (Factor VIII or IX deficiency) characterized by prolonged bleeding & hemarthrosis (bleeding into joints).
  • Treatment and Nursing: Factor replacement therapy (recombinant factors or DDAVP). Minimize injuries and ensure adequate rest.
  • Idiopathic Thrombocytopenic Purpura (ITP): Acquired platelet disorder, the cause is unknown but suspected to be an autoimmune response to a virus.
  • Treatment: Recognizing possible intracranial bleeding is essential in treatment. This includes neurologic assessments, distinguishing bruises from abuse, restricting activities during the acute stage, and avoiding any medications that affect platelets.
  • Henoch-Schönlein Purpura (HSP): Multi-organ autoimmune inflammation of blood vessels.
  • Treatment: General supportive care, hydration, nutrition, and pain control.

Disorders of White Blood Cells

  • Leukemia: Malignant bone marrow and lymphatic system cancers, characterized by uncontrolled growth of immature white blood cells.
  • Treatment options include a multidisciplinary team, chemotherapy, supportive care, and hematopoietic stem cell transplantation (autologous or allogeneic).
  • Hodgkin’s Disease: Lymphatic system malignancy, characterized by unique Reed-Sternberg cells.
  • Treatment involves radiation and chemotherapy regimens (like COPP).
  • Nursing care focuses on symptom management, supporting growth and development, protecting the skin from radiation, and providing emotional support.

Nursing Care of the Chronically Ill Child

  • Chronic illness can impact growth and development.
  • Providing a supportive environment is vital.
  • Behavior problems lessen when children can express concerns.
  • Hospital school programs help maintain normalcy.
  • Recreational therapy and respite care can be beneficial.
  • Home healthcare supports the child and family holistically.
  • Maintaining normality, inclusion, and control are essential in treatment.

Nursing Care of the Dying Child

  • Nurses must understand grieving and cultural views.
  • Hospice care can provide crucial support.
  • Honesty, emotional support, and allowing child control are important components.
  • Children express grief and needs symbolically.
  • Nurses must acknowledge the grieving process of the family as well as the child.

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Explore the key components and functions of the hematological system in pediatrics. Understand blood disorders, hematopoiesis across different life stages, and the differences in blood components in infancy. This quiz will guide you through the intricacies of pediatric hematology.

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