Nur254 Peds Exam 4

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

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,  Used when there is a poor response to chemotherapy
 During treatment
 Monitor WBCs (they are elevated with leukemia)
 Common side effects: nausea, vomiting, infection, anemia, mucosal ulcerations, hair loss
 Nurse teaching- rinse mouth often; hair loss w/ chemo (regrows 3-6m)
o Patient care
 Sickle cell crisis- hemoglobin S (sensitive to low O2 levels)
 Managing a crisis
 #1 Priority Establish an IV site for HYDRATION
 Pain management- OPIOD
 Bed rest; HOB 30 degrees, extremities extended (don’t elevate knee Gatch)
 Prevent infection
 O2 as a PRN – NOT the 1st priority
 Nurse teaching= (avoid triggers) illness, stress, dehydration, high altitude
 * Remember after repeated sickling = cells become perm sickled
 Meds- Hydroxyurea antimetabolite= makes RBCs rounder/ flexible
 Keeping hospitalized child entertained during sickle cell crisis= watch movie, read book
 Complications- Vaso-oclusive events, splenic sequestration; hyper hemolytic crisis, Aplastic crisis
 Care of patient following a surgical procedure
 Monitoring for s/s of infection
 Preventing complications
 Pain management
o Priority
 Actions based on patient’s status
 Caring for a patient being treated for a sickle cell crisis
 Always remember what comes next…
 Patient getting blood transfusion
 1. 2 Rn verify Order ( blood type and Rh ) and # of unit
 2.VS every 15mins for 1 hour
 3. 18G IV cath
 Y tubing w/ filter and 0.9 Normal Saline
 4. During- stay @ bedside 1st 15mins
 5. Assess for reactions
 Remember= max 4hours to run blood; 2 hours between transfusion;
 Patient with hemolytic reaction S/S Subjective S/S= headache; Objective Hypertension
 1. Priority: STOP infusion
 2. new tubing and flush w/ normal saline
 3. Report to HCP
 4. Assess Vs (BP, HR, RR)
 5. Assess urine and blood specimens for Hemolyzed (ruptured RBCs)
 Patient w/ Circulatory Overload S/S lung crackles, restlessness
 1. Slow infusion (max 4 hours)
 2. HOB sit up
 3. Oxygen
 4. Push Diuretics
 5. end all IV fluids
 Education
o What to include in teaching
 How do age groups view/deal with death or loss?
 Toddler (1-3)= Death is reversible
 Egocentric – think everything revolves around them
 May act like the deceased is still alive
 Most affected by changes in THEIR routine
 React to the emotions of others
 Preschoolers (3-6)= Death temp & reversible

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