Pediatric Respiratory Study Guide PDF

PEDIATRIC RESPIRATORY STUDY GUIDE How does the respiratory tract differ in children compared to adults? How does this make them more susceptible to infection? Upper respiratory o Nose o Pharynx o Trachea § Epiglottis and larynx Lower Res...

PEDIATRIC RESPIRATORY STUDY GUIDE How does the respiratory tract differ in children compared to adults? How does this make them more susceptible to infection? Upper respiratory o Nose o Pharynx o Trachea § Epiglottis and larynx Lower Respiratory o Bronchi o Bronchioles o Alveoli Differences in children o Smaller diameter airway o Shorter distance between structures w/in tractà organisms move more rapidly down tract 1  List the signs of respiratory distress in children. Then, list how you would describe each to parents. Sign of Distress Description to Parents Tachypneaà 1st sign of You may notice that your child is breathing much faster than usual. It can respiratory distress seem like they are panting or rushing to catch their breath, even when they aren’t active Nasal flaring Watch for your child’s nostrils widening with each breath. This is often a sign that they are working harder to get air into their lungs. Grunting If your child is making a grunting sound when they breathe out, it could be because they are trying to keep their airways open and are struggling to breath Accessory Muscles Use Look for pulling in of the skin around their ribs, collarbone, or neck when they breathe. This happens when they’re working harder than normal to take breaths Cyanosis If your child’s lips, face, or fingers appear bluish, this is a serious sign that they’re not getting enough oxygen, and you should seek medical help immediately Pallor If your child’s skin looks unusually pale or grayish, it could mean that they aren’t getting enough oxygen or blood flow, which is a sign of respiratory distress. Adventitious sounds Wheezingà If you hear a high-pitched, whistling sound when listen in front, back your child breathes, especially when they breathe out, this could and under axillary+ be a sign that their airways are narrowed down sides Cracklesà Are small popping or crackling sounds you might hear when your child breathes, especially if you listen closely to their chest. It can sound like bubbles popping or rubbing hair between your fingers near your ear. This might mean there’s fluid in the lungs Rhonchià Are low-pitched, rattling sounds that you might hear when your child breathes. It can sound like snoring or a deep rumbling, and it usually means there’s mucus or fluid blocking larger airways What question can you ask to assess their breathing? Are you having trouble breathing or do you feel like it’s hard to catch your breath? For younger children or infants, you might ask the caregiver: “Have you noticed if they are breathing faster than usual, or if their belly and chest are moving in an unusual way when they breathe? 2  AOM-ACUTE OTITIS MEDIA (*most common URI) CHRONIC OTITIS MEDIA w/ EFFUSION Cause Diagnosis: Streptococcus Pneumonia, Haemophilus Influenza, Moraxella - Acute onset of s/sx NOT an infection catarrhalis - Presence of middle ear effusion Fluid persists in middle ear for o Bacterial organisms o Bulging TM weeks or months Noninfectious causesà e.g. allergies o Limited or absent mobility Associated with mild to moderate o Inflammation in the Eustachian tube TM heating lossà if not treated Passive Smoke o Air-fluid level behind TM o Exposureà inflammation o Otorrheaà discharge or Feeding techniques drainage from ear o Breastfeed babies have ¯ incidence due to receiving IgA - S/sx of middle ear inflammation from milk o Distinct erythema of TM OR Most prevalent dz of early childhood o Otalgiaà discomfort clearly o Highest incidence 6month à 2 years referable to ears causing § Incidence gradually decreases expect when entering issues normal activity and school sleep patterns Clinical Manifestations: Physical Exam Findings/Diagnosis: Using Otoscopy Clinical Manifestations: 4  Irritable Intact tympanic membrane, bright red and bulging No complaints of severe pain o Grabbing at ears No landmarksà bony prominences Ears feel full or rubbing on No light reflexà cone of light Ear popping sensation during caregiver shoulder Check for mobility of tympanic membrane swallowing Feverà up 104 o If no mobilityà concerned Otoscopic Exam Lymphadenopathy o Only do at well visit for pt w. chronic infections o Ear has normal appearance Rhinorrhea o Never do this test on picture below ® § TMà dull or opaque, pearly grey o Clear nasal Auditory testing à chronic can cause hearing problems § Pinna and ear discharge canal normal Loss of appetite § Fluid or o Chewing causes bubbles seen changes in behind pressureà PAIN V/D may be present Treatment Acute Otitis Media (Infectious) Chronic OM w/Effusion (Non-infectious) (AAP Recommendations) Chronic à ventilation tubes maybe needed < 6 months Defined as: suspected AOM w/ or w/o severe symptoms with low grade feverà TREAT o ³3 incidences in 6 months or 4 incidences in 1 year 6 monthsà ³2 years: § AND Bilateralà Treat o Bilateral OME that’s unresponsive to tx for ³3 months w/ associated hearing Unilateral w/severe sxà TREAT loss o Persistent otalgia >48hrs and temp 102.2F (39C) Myringotomy required Unilateral w/ mild sxà Observed for 48-72hr if no improvement or symptoms Pt ed: worseningà TREAT o Wax ear plugs are required after surgery for showers, bathing, and swimming o Observation only acceptable if follow-up can be ensured in untreated bodies of water Immunosuppressed and/or Craniofacial Abnormalities o No diving Predisposed for AOMà TREAT Medications: PO Amoxicillinà 1st line tx IM Ceftriaxone o Concerned about compliance or poor absorption due to D/V Pain Management: Analgesics/ Antipyretics o Check temp before admin to make sure afebrile and/or not worsening or resolving Warm soaks Prevention- HIB and Prevnar vaccine for 5  CROUP - Inflammation of upper airways (larynx and trachea) resulting from respiratory illness cause by a viral infection. Characterized by: o Hoarseness o Barking cough (harsh cough) o Varying degrees of inspiratory stridor (high-pitched and noisyà narrowing airway) o Respiratory distress (difficulty breathing depending on severity) o Includes labored breathing or tachypnea o Typically, worsening’s at night - Most prevalent in: o Boys o 6monà 3yr (peaks at 2yr) Seasonalà late autumn to early winter Laryngotracheobronchitis (LTB) *most common Acute Epiglottitis *2nd most common - Caused by a viral infection Caused by a bacterial infectionà Commonly – Haemophiles influenza - Age- 3monthsà 8yrs S/Sx: S/sx: Gradual Onset Abrupt onset Begins with UPI Severe sore throat Barking cough Fever Inspiratory stridor & Suprasternal + Supraclavicular retractions Muffled voice o child’s body is trying to overcome the airway obstruction and maintain Severe pain w/ swallowingà don’t want to swallow airflow Assume upright positionà leaning forward w/ mouth o if retractions become severe or are seen at restàmay need for medical open, drooling and tongue protruding intervention. Irritable Increased RR Restless Distressed and Frightened Frightened Expression May develop hypoxia sx Dz progression o à exhaustionà bradypneaà respiratory acidosis o Respiratory obstruction s/sx Mild fever o W/ froglike croaking sounds o Suprasternal + Supraclavicular retractions o Cyanosis Treatment MILD SEVERE In primary care setting: No stridor at restà can tx at home Requires hospitalization Send to ER Keep comfortable IV fluids NEVER inspect throat → can cause airway spasm Antipyretics Respiratory monitoring and collapse of airway High humidity w/ cool mist O2 if indicated o Cool mist → ↓ inflammation Include parentsà reduces stress In hospital (ICU): o Bundle up & stand outside MEDS: Lateral neck films o Stand front of freezer Corticosteroids (IV or IM) Intubation / tracheotomy Fluids Tx reduces swelling in 3-5 days w/ abx Racemic epinephrine via nebulizer S/sx respiratory distress o Repeat in 2hrs after initial tx if Prevention-HIB vaccine symptoms return 7  BRONCHIALITIS (RSV) RESPIRATORY SYNCTIAL VIRUS Cause: Key Notes: - Virus invades bronchiolar epithelial cellsà inflammation & edemaà lumina fill - Cause of asthma up to 13yrs w/ mucus and exudateà shed epithelial cellsàobstruction of airway passages - Highest incidenceà 2-6months w/ peak @ 2-3months - “A” strain àmore serious cause severe illness - Responsible for ~50% hospitalization for bronchiolitis - Most important respiratory pathogen in infancy and early childhood Transmission - Live on surfaces (skin+ paper)à 1hr - Immunity cannot be acquiredà but incidence and severity ¯ w/ age - Live on cribsà 6hrs - All children by 3yr have had RSV at least once - Incubationà 4-6 days Contact & - Durationà 7-10 days - Usually, only severe for ­risk pts droplet!! - Most contagiousà 2-4 days - Peak Seasonà Winter and Spring - Infectiousà 1-3wks after s/sx subside - RSV (contagious) and asthma (non-contagious) look similarà Make sure to differentiate Risk Factors: S/sx: Diagnostics: Males à more incidences but no increase in severity Starts as URI - Chest X-Ray Prematurity Progression to LRI o Mild peribranchial infiltrates Chronic Lung Dz o ­Cough o Lungs hyperinflatedà air trapped Bronchopulmonary Dysplasia (BPD) o Wheezingà not stridor due to mucous necrotic debris in o Primarily affects premature infantsà lung injury that results from o Retractions airway prolonged use of ventilators and oxygen support àcausing o Crackles o Lowered diaphragmà body inflammation and scarring of the lungs tissue o Dyspnea compensation to try and ­ lung CHD o Tachypnea expansion CF o ¯ breath sounds Immunodeficiency o Prolonged expiratory phaseà Tabacco snoke exposure due to airway obstructions Low grade fever Cough (may be present) Hospitalizations if: Hospitalization Mgmt.à Nursing Care: Homecare Mgmt.: Preventionà ¯55% Hospitalization - Tachypneic - Elevate HOB - Most Common - Marked retractionsà - IV fluids - Cool air humidity - Synagis (Palivizumab) + Preventative Antibodies visible pulling in of o Tachypneicà NPO w/ IV fluids - Fluids - Monoclonal Antibody the chest wall - Suctioning as needed - Antipyretics - IM q4wks muscles - Humidified air - Elevate HOB - Indicationà Prevent RSV in high-risk pts - Listless and/or poor - Monitoring: - Parent ed. à On o Infant born peak season (fallàSpring) and mother PO intake o S/sx of respiratory distress s/sx of respiratory has not gotten RSV o VS distress o Infants born outside peak season 1st s/sx appears before 4-5yr TRIGGERS Pt Educationà How to Remove Triggers - Outdoorsà trees, weeds, mold, pollen - Foods - No rug - Indoorà dust, mold, cockroach dander - Cold Air - Wet mop hardwood floors - Irritantsà perfume Tabacco Snoke Exposureà worst trigger - Cover mattress and pillows w/ hypoallergic coveringàPrevention of dust - Exercise mites - Colds/Infections - Dust frequently - Animalsà Pet dander - Washed stuffed animal in water and then stick in freezerà kills dust mites - Medications - Cautious w/ cleaning products o ASA, Beta-Blockersà Trigger - ¯ use of highly fragrant products exacerbation Key Note: - Emotions - exposure to triggers may work as well as an inhaler SYMPTOMSà Dependent on Severity DX - Barking paroxysmal Nonproductive - Adventitious Sounds May be Present Physical exam, labs, X-ray to r/o other diseases Coughà COMMON o Rhonchi Pulmonary function tests (PFTs) o W/o presence of infection o Wheezing o Determine presence & degree of lung disease & response to therapy o Worsens at nightà> when laying § Mildàonly on expiration Peak expiratory flow rate (PEFR)à unreliable 6 yr only ○ Inhaled ○ Injection q2-4 weeks ○ Cromolyn – most common ○ Xolair 3. Beta adrenergic agents ○ Bronchodilator ○ PO, IV, or inhaled Inhaler Pt ed. ○ Quick relief Albuterol - Use spacerà ¯incidence of thrush Levalbuterol - Rinse mouth after useà¯incidence of thrush - General inhalers use ed. 4. Methylxanthines ○ 3rd line agentà last resort, usually in ICU Prevention: ○ Bronchodilator Avoid triggers ○ IV, PO, IM, or rectal Peak flow & chart ○ Theophylline Recognize s/sx Narrow therapeutic index Breathing exercises 5. Leukotriene Modifiers o Swimming is good! ○ Non-steroidal inflammatory (NSAID) Maintain health ○ Long-term Drug compliance ○ PO only ○ Montelukast Blocks leukotriene receptors → dec inflammation Enhances effects of inhaled corticosteroids 11  Fluid and Electrolytes Study Guide List the three types of fluid loss: - Insensible losses-2/3 through skin and 1/3 through respiratory tract o Can’t track/measure - Urinary - Fecal List the two major fluid compartments in the body: - Intracellular (inside cell) - Extracellular (outside cell) o Intravascular fluid o Interstitial Fluid List 4 reasons why children under age 2 are more susceptible to rapid fluid depletion: - Greater amount of BSA  insensible losses - Kids maintain larger amount of ECF until about 2yrs -  metabolic rate  fluid demand to fuel metabolic process - Greater number of metabolic wastes to be excreted by kidneys - Glomeruli tubules and nephrons of kidney are immature and unable to conserve H20 effectively o Lose fluids + electrolytes more quickly Infants are composed of approximately 65% water, whereas adults are composed of 50-60%. - Newborn 75%TBW=ECF-45% + ICF-30% o Brain and skin occupy a greater proportion of BW and are high in interstitial fluid - Infants 65%TBW= ECF-25% + ICF-30-40% o  BSA promotes fluid loss o 5-6x >fluid exchange daily o  metabolic rate requires  fluid intake - Child/Adolescent 50%TBW= ECF- 10-15% + ICF- 40% o Kidneys are immature until 2yp and unable to conserve water and electrolytes or fully assist in acid-base balance o Decrease risk >2yr How is the daily maintenance for fluid requirements calculated? - Wt (kg) - 100mL/kg for 1st 10kg - 50mL/kg for 2nd 10kg - 20mL/kg for remainder of wt - Divide total amount by 24hrs rate in mL/hr Age Group Standard Urine Output Infants and Toddlers >2-3mL/kg/hr Preschool and Young School Age (6-8yr) >1-2mL/kg/hr Older School Age, Adolescents 0.5-1mL/kg/hr 1  Isotonic Dehydration Hypotonic Dehydration Hypertonic Dehydration - Most common (Hyponatremia) more severe (Hypernatremia) Water vs electrolyte Electrolyte losses= H20 Electrolyte losses > H20 Deficits Electrolyte losses < H20 Deficits losses Deficits ICF vs ECF Mainly ECF ECF #> ICF ECF * < ICF Caused By: - Vomiting - Intake solutions w/ too low solutes - Inadequate fluid intake - Safest fluid - Diarrhea - SIADH excessive ADH - Decrease in ADH for children o E.g. brain tumor/injury, - D/V meningitis - Excessive Sweating excess o Very high specific gravity insensible water loss - Excessive sweating - High solute intake w/o adequate - Burns H20 - Diuretics - Renal Dz - V/D - Osmotic diuresis (T1D) - Renal dz - Heart failure Serum Na+(mEq/L) 130-150 150 Symptoms - Lethargy - Confusion - Tenting - Confusion - HA - Sunken eyes/fontanels - Agitation - Weakness - tachycardia - N/V -  deep tendon reflexes - Agitation - Agitation - Low grade fever - Lethargy - Thirst - Anorexia - Hypotension - N/V/D - Oliguria - Possible seizures (r/t  Na+) - Jaundice in newborns - Change in LOC Observe for Hypovolemic Shock Seizures Change in LOC Treatment options - Isotonic Solution- - Tx underlying cause - Tx underlying cause - Orla Rehydration - Restrict fluids - Restrict Na+ therapy - Administer Na+ - Administer appropriate IV fluid - Appropriate IV solution if needed Tx examples - 0.9% NS - 0.9% NS - 1st line Isotonic (0.9%NS)pt in - Lactic Ringers - 3% NaCl Hypertonic soln shock or significant hypovolemia - Pedialyte - D10 monitor; push slow - 2nd lineHypotonic 0.45% NS - D5 or D5W - are introduced gradually -.225% NS or.45% NS to replace the free water deficit Rationale for tx Treats isotonic The choice /b/ hypertonic and isotonic Isotonic fluids are used initially to choice/Mechanism dehydration by fluids depend on severity of stabilize blood volume, while of action effectively replace lost hyponatremia and the clinical hypotonic fluids are introduced ECF volume w/o causing presentation of the patient. gradually to correct the water deficit osmotic shifts, ensuring Mildmod. cases may only require and lower serum sodium levels safely safe and effective isotonic fluids, while severe cases w/ rehydration. neurological symptoms may necessitate hypertonic saline Overhydration - CauseLarge fluid - Water intoxication or dilutional - CauseIncreased fluid in ECF b/c intake dilutes plasma hyponatremia hypertonic fluid infused too quickly - S/sx Weight gain, - Causes intake large of - S/sx Pulmonary edema Bounding pulses, electrolyte free fluids, fluids lost Solution Decrease intake Circulatory overload, via NGT suction, V/D, or diuresis Edema - S/sxCNS disturbances sign of - Solution Decrease ICP intake - Solution Decreased Fluid intake, slow infusion of hypertonic soln 2  Hypokalemia 80% excreted thru urine Hyperkalemia Serum K+ 5.8 mmol/L Cause -  K+ excretion - Massive cell death K+ released into ECF o Diuretics, osmotic diuretics (e.g. o Crushing injury T1D) o Blood draw from heel (cell injury from o Renal disease milking) o Diarrhea o Sickle cell (RBC lifespan 10 days; o Elevated aldosterone & cortisol whereas normal = 120 days)  Binds to K+ & released in o Leukemia (rapid immature WBC urine turnover) -  K+ intake o Chemotherapy o NPO - Excessive or too rapid K+ IV infusion o Anorexia - Metabolic acidosis o Prolonged IV without K+ o H+ goes in / K+ goes out - Loss of K+ - Diabetes o Vomiting o T1D during diabetic ketoacidosis o NG tube lossesvia suctioning (DKA) o Metabolic alkalosis - K+ excretion  H+ goes out / K+ goes in - Renal disease Symptoms - Skeletal muscle weakness - Abdominal cramping - Leg cramps - D/N - Decrease DTRs - EKG elevated T wave; short QT interval; - EKG changes Flat T wave w/ QT wave widening QRS - Constipation - Irregular pulse - Digoxin Toxicity low K+ risk toxicity - Bradycardia o Bradycardia (auscultate 1 min) - Muscle weakness o N/V -  DTRs o Arrythmia -  Deep Tendon Reflexes - Irregular weak pulse - Cardiac arrhythmias - Orthostatic hypotension Treatment - Mange underlying cause - Manage underlying condition - Monitor cardiac status - Meds -  K+ intake o Meds to EXCRETE K+ - Ensure pt can urinate before administering  K+ wasting diuretic (Lasix) any K+  Kayexalate o B/c 80% of K+ is excreted through o Meds to BRING K+ INTO CELL urine  IV bicarbonate  IV insulin  w/ glucose - Peritoneal dialysis may not get rid of k+ inside case K+ back into cell o Perform as many exchanges as possible at night, so kids have more free day time - Diet CAUTION: Monitor cardiac rhythms—can lead to ventricular Monitor cardiac rhythms peaked T waves, widened tachycardia QRS complexes, or ventricular arrhythmias 3 How do you calculate severity of dehydration by assessing weight loss? What loss indicates mild/moderate/severe dehydration? - Severity= (original wt-present wt)/(original wt) - Mild 5% o All system are normal except there might be a slight  UO - Moderate 10% o Mental Status- Listless, irritable o Tachycardia o Pulses normal to decreased o Capillary Refill >2 seconds o Tachypnea o Eyesslightly sunken o  tears o Sunken Fontanelle o UO o Dry mucus membranes - Severe 15% o Mental Status- Lethargy, Altered mental status o Tachycardia o Pulses  to thready o BP normal to  o Capillary Refill prolonged o Tachypnea + Deep o Eyes sunken and cries w/o tears o Sunken Fontanelle o Oliguric or Anuric Describe the signs and symptoms present in a dehydrated child: 4  Acute Diarrhea Chronic Diarrhea Caused by Caused by abnormal intestinal H20 and electrolyte transport abnormal intestinal > 14 days H20 and electrolyte Causes transport ○ Underlying disease Leading cause of ○ Inflammatory bowel diseases death 14 days Usually self-limited Most common cause: (< 14 days) ○ inadequately managed acute infectious diarrhea Acute infectious diarrhea Chronic non-specific diarrhea (gastroenteritis) **These kids are “healthy” ** Cause of chronic diarrhea in children 6-54 months Loose stools w/ undigested food Grow normally & not malnourished No blood in stool or infection Causes ○ Excessive apple juice consumption ○ Excessive diet soda consumption (artificial sugar) Etiology of diarrhea Diagnosis Management - Fecal-oral route - History - Assessment of fluid and electrolyte imbalance - Contaminated food/water o Diet, current meds, - Rehydration w/ - Organisms duration/frequency of diarrhea, able - Mild  Viral – rotavirus to tolerate fluids? when was last time o 50mL/kg administered over 4hrs 1mL/kg  Bacterial – salmonella, drank fluids? Last time urinated? every 5minutes shigella, campylobacter o Is it unusual from normal? o Measure UO q2hr  Parasite – o Anyone also sick at home? - Moderate cryptosporidium, giardia o Recent travel? o 100mL/kg administered over 4hrs in clinicians’ - TreatmentAntibiotics - Lab data stool specimens office or ED successful child can go home - Urine specific gravity(normal = - Maintenance of fluid therapy 1.005-1.030); high USG = ○ Reintroduction of adequate diet Begin w/ bland dehydrated foods, low fat, low carb, low sugar - CBC ○ Stop formula and pause solid, switch to - Serum Electrolytes Pedialyte - Creatinine ○ Transition to soy-based formula then milk-based - BUN formula ○ If breastfeeding, can continue - 5 6  Hirshsprung's Disease (congenital aganglionic megacolon) Mechanical obstruction caused by inadequate motility by distal intestines rectum; Aganglionic portion; distended sigmoid colon (sometimes into descending colon and rare causes full colon) A defect in neural crest cells causes Hirschsprung’s disease results in the absence of ganglion cells Incidence: Pathophysiology: 1/4 of all neonatal obstruction but Absence of ganglionic cells in 1 segments of colon 75% may not be dx till later in cases involve rectum infancy/childhood Unknown etiology More common in children w/ Downs Syndrome Results in absence of peristalsis → accumulation of intestinal Males - 4x more common contents & distention of bowel proximal to defect (megacolon) 1/5,000 births Internal anal sphincter fails to relax Intestinal distention & ischemia of bowel wall → enterocolitis (inflammation of small bowel & colon) ○ Leading cause of death in children w/ Hirshprung’s S/Sx: Tx: Dx:  Newborn  Surgery  Definitive diagnosis = rectal biopsy o Failure to pass meconium o Bowel resection and o Presence or absence of ganglionic cells within 24-48 hrs. after birth Colostomy → then pull o Annal sphincter will relax if not pt doesn’t o Reluctance to ingest fluids through surgery have Hirshprung’s o Bile-stained vomitus  Remove diseased portion  Alternative Diagnostics o Abdominal distention  No deep of bowel & reconnect o Rectal exam palpation measure bowel to rectum via  Tight internal sphincter distention rectum  Absence of stool  Infancy o Barium enema o Failure to thrive  Avoid contrast enemas if pt has o Constipation enterocolitis o Abdominal distention o Anorectal manometry o Episodes of diarrhea & vomiting  Balloon catheter inflation should o Fever cause sphincter relaxation b/c o Severe exhaustion distention  Childhood o Constipation Irrigations for Enterocolitis in Children w/ Hirshprung’s Disease o Ribbon-like, foul smelling stool Colonic irrigation used to clear bowels when concerned for enterocolitis o Abdominal distention palpate fecal Inject small amounts of saline into rectum using catheter mass in bowels ○ (NOT an enema, which uses large amount of saline w/ stimulant to o Visible peristalsis have large BM) o Fecal masses easily palpable Irrigate 3x or more/day, if needed o Poorly nourished child; anemic No irrigation at least 2-4 weeks after surgery If symptomatic Female - Unknown cause - 2-6 yr - Geographic distribution - Most common form of childhood cancer - Genetic disorder - Excessive radiation / chemical toxins exposure - Alkylating agents - Family hx S/Sx: Dx: Infiltration of Bone marrow DefinitiveBone marrow aspiration - ↓ RBC – anemia - > 30% blast cells=Leukemia - ↓ Platelet - Performed at hip iliac crest o Bruising o Petechiae o Thrombocytopenia risk for bleeding o Epistaxis - ↑ WBC - Fever - Malaise - Bone & joint pain r/t bone marrow expansion due to crowding Other Tests: - Pallor - CBC - Lymphadenopathy - Lumbar puncture - Hepatosplenomegaly Tx: Favorable prognostic factors for ALL: Nursing: - Prepare child & family Chemo w/ or w/o cranial radiation - CBC Leukocyte count < 50,000 - Relieve pain - Age2-10 yr - Prevent complications ○ Cranial radiation not done much anymore - Sex Female (cognitive delays) of myelosuppression - Immunological Subtype: (1) Induction o CALLA (+) - Drug administration ○ 1st month of chemo o Pre-B cell - Drug toxicity ○ Goal: Induce remission (blast cell 38C / 100.4 F) for 3 consecutive days Weight loss w/o trying or >10% of body weight loss over 6 months Drenching night sweats ○ Stage 1-2 - No sx ○ Stage 3-4 - Sx’s - CT scan & gallium scan - X ray chest, abdomen, pelvis - Bone marrow S/sx: Tx: - Hallmark - Depends on age, disease stage, histologic type o Asymptomatic - Chemo, radiation – either alone or combined o Enlarged cervical or supraclavicular lymphadenopathy - Long term survival (non-tender) o Stage 1 & 2 – 90% o Fatigue o Stage III → 80% o Loss of Appetite o Stage 4 → 70% o Purities - Nursing interventions - If other organs involved: o Offer option to harvest sperm/egg o Mediastinal lymphadenopathy → persistent non-productive cough o Abdominal pain - Add. Sx if in B category o Low grade intermittent fever o Weight loss o Night sweat  Osteogenic Sarcoma Cause: Diagnosis: - Develops where bone grows fast (e.g. long - R/O causes  process of ruling out bones) Determine risk factors and evaluating differential diagnosis  to - Most common sites distinguish from other conditions w/ similar presentations o 1) Metaphysis of femur (distal femur, proximal tibia) - Hx regarding pain o 2) Proximal humerus - CT scan - 20% of dx spread by diagnosis - MRI - Bone scan - Needle or surgical bone biopsy - CBC ○ Elevated serum alkaline phosphate (ALP) & lactase dehydrogenase (LDH) Distal femur Highest Incidence: - Adolescence and young adults Most common bone cancer S/sx: Mgmt & Prognosis: - Progressive, insidious, or intermittent pain at - Surgery & chemo tumor site relieved by position change (flexion) o This cancer is unresponsive to radiation - Palpable mass - Limb Salvage Procedure or Amputation - Limed ROM - Pathologic fracture at tumor site o Like the osteoblasts in normal bone cells that form this cancer make bone matrix o But the bone matrix of an osteosarcoma is not as strong as normal bones - Elevated serum alkaline phosphate (ALP) & lactase dehydrogenase (LDH)- high rate of tx failure - Prognosis depends on extent of disease at dx - Alkaline Phosphatase (ALP) & Lactate Dehydrogenase (LDH) levels (higher levels = worse prognosis) - Mirror Box  for phantom limb o Normal hand on one sidelooks into the mirror creating the illusion that the amputated hand has returned allows the patient to visualize the unclenching of the phantom spasm o Promising technique