The Child with a Condition of the Blood, Blood-Forming Organs, or Lymphatic System

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Questions and Answers

What is the primary role of the lymphatic system?

Produce red blood cells

Transport blood to the heart

Facilitate oxygen exchange in the lungs

Drain regions of the body to lymph nodes (correct)

What condition is indicated by the term lymphadenopathy?

Reduction of red blood cells

Deterioration of hemoglobin

Enlargement of lymph nodes (correct)

Inflammation of blood vessels

What is the most common pathological condition of the spleen?

Splenic rupture

Spleen abscess

Splenomegaly (correct)

Spleen infarction

What characterizes iron deficiency anemia in children?

Inadequate hemoglobin levels Signup and view all the answers

Which of the following is a typical treatment for iron deficiency anemia?

Oral iron supplements, often ferrous sulfate Signup and view all the answers

Which blood component primarily acts in the body's defense against infection?

Leukocytes Signup and view all the answers

What is the consequence of neglecting treatment for severe iron deficiency anemia?

Weakening of the heart muscle leading to possible failure Signup and view all the answers

What is one of the main functions of the spleen within the lymphatic system?

Bringing blood into contact with lymphocytes Signup and view all the answers

What is a common early objective symptom of leukemia?

Petechiae Signup and view all the answers

Which diagnostic test is used to check for central nervous system involvement in leukemia?

Spinal tap Signup and view all the answers

Which of the following is NOT a treatment component for leukemia?

Surgical removal of tumors Signup and view all the answers

What side effect is characterized by the child's face appearing moon-shaped due to steroid use?

Moon facies Signup and view all the answers

What is the main focus of nursing care for patients with Hodgkin Lymphoma?

Symptomatic relief of radiation and chemotherapy side effects Signup and view all the answers

What is a characteristic of Reed-Sternberg cells?

Giant multinucleated Signup and view all the answers

Which chronic illness-related behavior should nurses encourage in children to reduce behavioral problems?

Verbalize specific concerns Signup and view all the answers

During which stage of dying is a person likely to exhibit anger?

Anger Signup and view all the answers

What type of reactions to death are influenced by cognitive development rather than chronological age?

Reactions to death Signup and view all the answers

What is an essential nursing intervention when supporting a family dealing with the death of a child?

Show compassion and be nonjudgmental Signup and view all the answers

Which approach is important for nurses when addressing an adolescent's fears related to chronic illness?

Promoting self-determination Signup and view all the answers

What physical sign may be observed as a child approaches death?

Cyanotic skin Signup and view all the answers

Which of the following effects of treatment for Hodgkin Lymphoma can delay puberty?

Sterility Signup and view all the answers

What nursing intervention can help children with cancer verbalize their feelings?

Provide opportunities for open discussions Signup and view all the answers

Which of the following is a common symptom of sickle cell anemia during the first year of life?

Unusual swelling of the fingers and toes Signup and view all the answers

What is the primary cause of chronic anemia in thalassemia?

Ineffective production of red blood cells Signup and view all the answers

What characterizes hemophilia A?

Deficiency in factor VIII Signup and view all the answers

What is a classic symptom of Idiopathic Thrombocytopenic Purpura (ITP)?

Easy bruising Signup and view all the answers

Which treatment is typically avoided in patients with Idiopathic Thrombocytopenic Purpura (ITP)?

Aspirin Signup and view all the answers

What complication can arise from a vaso-occlusive sickle cell crisis?

Risk for stroke Signup and view all the answers

In which condition is there a deficiency in coagulation factor IX?

Hemophilia B Signup and view all the answers

What is the most common type of leukemia in children?

Acute lymphoid leukemia (ALL) Signup and view all the answers

What is one of the first symptoms of leukemia in children?

Leg and joint pain Signup and view all the answers

What is the aim of therapy for patients with hemophilia?

To increase levels of factor VIII Signup and view all the answers

Which type of thalassemia involves impaired production of beta chains?

Beta-thalassemia Signup and view all the answers

What is a common laboratory finding in hemophilia?

Prolonged partial thromboplastin time (PTT) Signup and view all the answers

Which symptom is NOT typically associated with sickle cell disease?

High appetite Signup and view all the answers

What is an expected effect of leukemia on the body’s blood-forming organs?

Uncontrolled growth of immature WBCs Signup and view all the answers

Study Notes

Lymphatic System

Drains body regions to lymph nodes, where infectious organisms are destroyed and antibody production is stimulated.
Lymphadenopathy is enlarged lymph nodes, indicative of infection or disease.
The spleen, the largest lymphatic organ, brings blood into contact with lymphocytes.
Splenomegaly (enlarged spleen) occurs during infections, congenital and acquired hemolytic anemias, and liver malfunction.

Circulating Blood

Blood consists of plasma and formed elements (red blood cells [RBCs], white blood cells [WBCs], and platelets).
Erythrocytes transport oxygen and carbon dioxide.
Leukocytes defend against infection.
Lymphocytes are produced in lymphoid tissues.

Anemias

Diverse causes can result in reduced circulating hemoglobin, impacting blood's oxygen-carrying ability.
Hemoglobin (Hgb) below 8 g/dL causes increased cardiac output and blood shunting from the periphery to vital organs.
Symptoms can include pallor, weakness, rapid breathing (tachypnea), shortness of breath (SOB), and congestive heart failure (CHF).

Iron Deficiency Anemia

Most common nutritional deficiency in children, highest incidence in infancy (9-24 months) and adolescence.
Causes may include severe hemorrhage, impaired iron absorption, high growth needs, or poor diet (e.g., excessive cow's milk).
Manifestations: pallor, irritability, anorexia, decreased activity. Infants may be overweight from excessive milk consumption.
Diagnostics: red blood cell count, hemoglobin and hematocrit levels, morphological cell changes, iron concentration; stool test for occult blood.
Untreated, anemia progresses slowly; severe cases can cause heart weakness; long-standing cases may lead to growth and cognitive issues.
Treatment: oral iron supplements (usually ferrous sulfate), two to three times daily, with Vitamin C to aid absorption.

Sickle Cell Disease

Two types:
- Sickle cell trait (asymptomatic): Mixed hemoglobin A and sickle (S) with low S proportion. Normal Hgb and RBC counts.
- Sickle cell anemia (more severe): Symptoms appear in late infancy, possibly with finger and toe swelling. Results from enlarged marrow sites and vessel obstructions, causing ischemia.
Manifestations:
- Hemoglobin levels are 6-9 g/dL or lower.
- Pallor, fatigue, and poor appetite.
- Painful crises (vaso-occlusive, splenic sequestration, aplastic, hyperhemolytic) can be fatal. Symptoms include abdominal pain, muscle spasms, leg pain, painful swollen joints, fever, vomiting, or neurological issues.
- Risk for stroke.

Thalassemia

Hereditary blood disorders causing insufficient adult hemoglobin production.
Abnormal RBC size and shape lead to rapid destruction, resulting in chronic anemia. The body compensates by producing fetal hemoglobin.
Categorized by affected polypeptide chains.
- Beta-thalassemia is the most common type, affecting beta chains.
- Two forms: thalassemia minor and major (Cooley anemia).
Can result from spontaneous mutations.

Hemophilia

Inherited sex-linked recessive trait on the X chromosome.
Diagnosed via fetal blood samples.
Two main types:
- Hemophilia B (Christmas disease): factor IX deficiency.
- Hemophilia A: factor VIII deficiency.
Deficiency in any factor interferes with blood clotting.
Hemophilia A: factor VIII deficiency; severity depends on factor VIII level. Minor injuries can pose significant risk for some. Treatment aims to increase factor VIII for clotting, monitored by partial thromboplastin time (PTT) test.

Idiopathic (Immunological) Thrombocytopenic Purpura (ITP)

Acquired childhood platelet disorder, most common type of purpura.
Cause unknown; suspected autoimmune reaction to a virus, resulting in antiplatelet antibodies that are seen as "foreign". Platelets are destroyed by the spleen.
Affects all ages, with highest incidence between 2-4 years of age.
Manifestations: easy bruising (petechiae, purpura); recent history of rubella, rubeola or viral infections; 2 week interval between exposure and onset; a platelet count below 20,000/mm3 (normal range 150,000-400,000/mm3).

Treatment of ITP

Neurologic assessment is primary.
Treatment is usually not needed initially; prednisone, IV gamma globulin, anti-D antibody, or splenectomy for chronic cases.
Avoid aspirin, phenylbutazone, phenacetin, caffeine during acute states.
Avoid activity that increases bruising risk. Platelets are usually not directly given.
Complications include GI bleeding, hemarthrosis, intracranial hemorrhage.

Leukemia

Most common childhood cancer, malignant blood disorder causing uncontrolled growth of immature white blood cells (WBCs) in the bone marrow.
Classified according to WBC type affected.
- Acute lymphoid leukemia (ALL)
- Acute non-lymphoid (myelogenous) leukemia (AML)
Disrupts bone marrow function, reducing RBCs and platelets.
Bone weakening and pathological fractures.

Manifestations of Leukemia

Common symptoms: low-grade fever, pallor, bruising, leg/joint pain, listlessness, abdominal pain, and enlarged lymph nodes.
Progress: liver/spleen enlargement, lemon-yellow skin, early petechiae/purpura; anorexia, vomiting, weight loss, and dyspnea.

Diagnosis of Leukemia

Based on history, symptoms, blood tests, and the presence of leukemic blast cells in blood, bone marrow, or tissue.
Radiographs show bone changes, and spinal taps assess CNS involvement.
Kidney/liver function studies are needed.

Treatment of Leukemia

Radiation and chemotherapy target specific cells.
- Induction
- CNS prophylaxis
- Maintenance
- Reinduction (relapse)
- Extramedullary disease therapy

Side Effects of Chemotherapy

Steroids mask infection, cause fluid retention, induce personality changes, and affect facial appearance.
Other chemotherapy agents cause nausea, diarrhea, rash, hair loss, fever, anuria, anemia, and bone marrow depression.
Peripheral neuropathy may present with severe constipation.

Nursing Care of a Child with Leukemia

Encourage emotional expression.
Observe frequently for infection.
Monitor vital signs and bleeding tendencies.

Hodgkin Disease (Hodgkin Lymphoma)

Lymph system malignancy, primarily in lymph nodes.
Possible metastasis to spleen, liver, bone marrow, lungs, or other sites.
Diagnosed by Reed-Sternberg cells.
Rare before 5, peaks in adolescence and early adulthood. Twice as common in boys.

Treatment of Hodgkin Lymphoma

Radiation and chemotherapy, tailored to disease stage.
Cure primarily related to diagnosis stage, improving long-term outlook.

Nursing Care of Patients with Hodgkin Lymphoma

Focus on symptomatic relief of radiation/chemotherapy side effects.
Patient and family education.
Malaise, fatigue, anorexia, and skin sensitivity are common.

Emotional Support of Hodgkin Lymphoma Patients

Age-appropriate support.
Activity regulation based on patient's tolerance.
Potential for delayed puberty and sterility.

Chronic Illness in Children

Behavior issues lessen with open communication and understanding.
Adolescents may fear forced dependence, body invasion, mutilation, rejection, or loss of face.
Support their self-determination.

Developmental Disabilities

Overprotection, limited peer relationships, and potential family crisis surrounding emerging sexuality.

Care of the Chronically Ill Child

Focus on abilities, successful experiences, family involvement.
Integration into community. Wellness is central.

Nursing Care of the Dying Child

Understanding cultural, personal views of grief, parents' loss, and children's perceptions.
Sensitivity, nonjudgmental approach, compassion, and open communication about grief processes are needed.

Stages of Dying (and the nurse's role)

Stages: denial, anger, bargaining, depression, acceptance
Nurse's role: listening, providing privacy, therapeutic interventions, and information using sensitive phrases.

Physical Changes of Impending Death

Cool, mottled, cyanotic skin; slowing body processes.
Loss of consciousness, but possible hearing retention.
Rales (lung congestion) are possible.
Decreasing movement/neurologic signs.

Child's Reaction to Death

Cognitive development, not age, influences response.
Children <5 have separation and abandonment concerns.
Preschool children use fantasy, while older children begin to develop a more realistic concept of death.

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Description

Test your knowledge on the lymphatic system, blood composition, and anemias. This quiz covers essential concepts such as lymphadenopathy, the function of spleen and blood components, including erythrocytes and leukocytes, as well as conditions like splenomegaly and anemia.