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Nur 216 Exam 3 Impaired Cellular Regulation
Terms in this set (142)
The ________________ is the basic unit of life and the working unit of all living systems.
Cell reproduction, proliferation, and growth are all regulated by the _____________
What are the two methods of cellular transportation?
What is Passive Transportation?
Transportation that happens through
diffusion or osmosis
What is Active Transportation?
Transportation that requires
Common problems associated with cellular regulation include (4)
Stress and coping
Characteristics associated with abnormal cellular regulation include
-Changes in bowel or bladder habits
- Sores that don't heal
-Unusual bleeding or discharge
-Any lumps or thickening
-Loss of Appetite
-Changes in warts or moles
-Hoarseness, persistant cough
-Changes in developmental milestones
-Changes in activity tolerance
-Tired, pale, short of breath
Diagnostic testing associated with finding the cause of abnormal cellular regulation include
-Bone Marrow aspiration
-Biopsy and Staging
-Blood work (CBC)
Meds: ALKYLATING AGENTS (Antineoplastic Agents)-
They interfere with DNA production, causing cellular death. Not cell specific so both the cancerous cells and non cancerous cells are destroyed
Nursing considerations for ALKYLATING agents
-Monitor CBC w/ differential
-Uric acid levels
-Kidney and Liver functions
-Monitor Neuro status
-CONTRAINDICATIONS with concurrent med administration with drugs that are toxic to kidney and liver
-CONTRAINDICATIONS with clients who already have kidney/liver or GI problems
Meds: ANTI-TUMOR ANTIBIOTICS (Antineoplastic agents)
They interfere with the production and action of nucleic acids to inhibit DNA and RNA replication
Nursing considerations for Anti-tumor antibiotics
-Monitor CBC with differential
-monitor neuro status
-monitor for bleeding and protect from injury
-monitor s/s of infection
-CONTRAINDICATED with patients with liver, kidney, cardiac, pulmonary, GI or lung diseases.
Meds: ANTIMETABOLITES (antineoplastic agents)
They interfere with pyrimidine and purine synthesis which are essential for DNA production
Nursing considerations for Anti-metabolites
-Monitor CBC with differential
-monitor kidney and liver functions
-monitor for bleeding and protect from injury
-Monitor for s/s infection
-Monitor for dyspnea and cough
Meds: HORMONES AND HORMONE ANTAGONISTS
Help block cancerous cells from utilizing the hormones that promote their growth and inhibit the body's natural production of hormones that promote growth of cancerous cells.
Nursing Considerations for hormones and hormone antagonist
-CBC with differential
-signs of bleeding and protect from injury
ADVISE client to discontinue this medication only when directed to do so by a HCP
Meds: BIOLOGIC RESPONSE MODIFIERS
Stimulate immune function or block tumor growth. They also block cellular replication
Nursing considerations for biologic response modifiers
Monitor the following:
-assess for dehydration
-capillary leak syndrome (hypotension, generalized edema, decreased urine output)
Meds: natural products VINCA ALKALOIDS
Causes immediate cellular death by inhibition of mitosis
nursing considerations for Vinca Alkaloids
Monitor the following:
-CBC with diff.
-bleeding and protect from injury
Med: Anti-anemic agents IRON SUPPLEMENTS
Provide additional iron intake for the purpose of correcting RBC abnormalities caused by iron deficiency. Do not stimulate RBC production (erythropoiesis)
nursing considerations for Iron supplements
Monitor the following:
To avoid staining of the teeth thoroughly dilute the liquid preparations and administer while using a straw or a dropper to apply the medication to the back of the tongue
Advise the client of the potential side effects including black, or dark green stools, and constipation
Meds- Anti-anemic agents
(folic acid, vitamin B12)
Folic acid stimulates production of RBCs, WBCs, and PLTs, in clients with megaloblastic anemia.
Vitamin B12 is necessary for the production of RBCs and is used to treat vitamin B12 deficiency and pernicious anemia
Interventions for clients with impaired cellular regulation
-increased rest needed
(need to balance nutrition, activity and rest to maintain homeostasis)
Pediatric considerations when dealing with impaired cellular regulation
-Kids are at a higher risk for dehydration
-Should be offered small frequent feedings (SFF)
-Keep citrus fruits to a minimum
-need accurate I/O's
-Pain control is a challenge
-Need psychosocial support
-never forget the impact it also has on the parents, and siblings
-School still needs to be considered
Why is it necessary to keep citrus fruits to a minimum?
It can exacerbate complications from the chemotherapy (Stomatits)
Why must we maintain accurate I/O's?
Meds are excreted by the kidneys
Pain meds should be administered at what dose?
The lowest dose possible because the liver and kidneys are still immature and there may be excretion issues (concern for toxicity)
What is Leukemia?
p. 826: A broad term given to a group of malignant diseases of the bone marrow and lymphatic system.
Leukemia is an unrestricted proliferation of immature white blood cells in the blood-forming tissues of the body.
-Cancer of the blood forming tissues
-Chronic malignant disorders of the WBC's and WBC precursors
abnormal and immature
the liver, spleen and lymph nodes throughout the body.
What sex and ethnicity is Leukemia more common in?
What is the peak onset of Leukemia?
between 2 and 5 years of age
What is the estimated survival rate of Leukemia?
What is one of the main concerns when dealing with Leukemia?
relapse or secondary cancer.
What is the Pathophysiology of Leukemia?
power-point: Stem cells in the bone marrow produce immature (bands) WBC's that don't function as normal WBC's should.
They multiply rapidly by cloning instead of normal mitosis
The malignant WBC's fill the bone marrow and decrease the production of RBC's and PLT's.
p. 828: A complete remission is determined by the absence of clinical signs and symptoms of the disease and the presence of less than 5% blast cells in the bone marrow.
What are the 4 types of Leukemia?
(chronic lymphocytic leukemia)
(acute lymphocytic leukemia)
(Acute myeloid leukemia)
(Chronic myeloid leukemia)
Characteristics of CLL
-Primarily affects older adults
-has an insidious (slow) onset and slow chronic course
Characteristics of ALL
-Primarily affects children and young adults
-Has a rapid onset and disease progression
has an unknown cause
Characteristics of AML
-Common in older adults and is rarely seen in children
Characteristics of CML
Risk Factors for ALL
-children with immunodeficiency states
-Chromosomal defects (higher incidence)
-Environmental factors (second-hand smoke)
-Exposure to radiation (nuclear reactor)
Clinical Manifestations of Leukemia result from....
-S/S result from anemia, infection and bleeding
Clinical Manifestations of Leukemia include..
-Infections: fever, night sweats, URI, UTI
-Bleeding: bruising, petechiae, bleeding gums, bleeding into organs and tissues
-Meningeal infiltration: HA, decreased LOC, increased ICP, N/V
-Kidney infiltration: Decreased U/O, increased BUN and Creatinine.
Diagnostic testing for leukemia
"Leukemia is usually suspected from an H&P and a peripheral blood smear that contains immature forms of leukocytes, frequently in combination with low blood counts. Definitive diagnosis is based on the bone marrow aspiration or biopsy.
-CBC w/ diff. (shows size and shape of WBC's)
-Bone marrow analysis
Potential surgical procedures for Leukemia
-Bone Marrow Transplant
-Stem Cell Transplant
notes: might be considered for the child who didn't stay in remission too long. This is the "end-all"
Medication/Therapeutic management for Leukemia
-Chemotherapy (may use a combo of meds) (goes after all cells not just cancerous)
-Pain Medication (start on low doses)
-Steroids (taper off, tons of S/E's, used as anti-inflammatory)
-Complementary therapy (massage, play)
What are the goals of Leukemia treatment?
-child will meet developmental milestones
-child will express emotions
Continued nursing interventions for working with the leukemia patient
-monitor meds and their S/E's
-Check for infiltration of meds
-Check reactions to meds
-protect from injury
-promote healthy grieving
Teaching regarding Alopecia
-May come out in clumps
-Can happen after only one treatment
-Protect the head! Can develop sores
-typically regrows in 3 to 6 months
-May grow back differently (darker, thicker, curlier)
What is Epistaxis and who is more prone to it?
A child with leukemia is more prone to this due to the decreased PLT count
How should you treat Epistaxis?
-Sit up and lean forward
-Apply pressure (minimum 10 mins)
-insert cotton soaked in epinephrine (vasoconstrictor)
-Keep calm/decrease crying (CRYING will increase bleeding!!)
-Appl ice/cold therapy to the bridge of the nose (constriction)
Possible etiology of epistaxis
-in a dry environment
How might epistaxis be treated if it can't be controlled?
Cauterization with silver nitrate (usually reserved for adults)
What is Hodgkin's Lymphoma?
Malignancy that originates in the lymphoid system and primarily involves the lymph nodes
Painless enlargement of the lymph nodes is associated with Hodgkin's lymphoma or Non-Hodgkin's lymphoma?
Overall the prognosis of Hodgkin's Lymphoma is ...good or bad?
Non-Hodgkin's lymphoma is more commonly seen in what age group?
Characteristics of Non-hodgkin's lymphoma are...
-Disease is more diffuse
-Cell type is poorly differentiated
-Occurs early and rapidly (more diffuse)
- Meninges are more commonly involved
Clinical Manifestations of Lymphoma (both types per Mrs. Foster)
-Lymph node enlargement
-pressure on organs (heart, lungs, kidneys)
-nodes are firm, movable, non-tender, and often located in the Left clavicular region
Where are the enlarged nodes typically located with lymphoma?
in the Left clavicular region
Most common treatment for lymphoma includes
Chemotherapy and Radiation
The most common side effect of radiation is
Fatigue (think how this might affect the child... might not be able to keep up with the other kids)
A concern for adolescents receiving chemotherapy and radiation is the high risk for ______________________
Sterility (Think about sperm banking)
and can also cause delayed sexual maturation
Pediatric Considerations (This is repeated.... hint ;) ..... )
-Impact on Growth and Development
-Parental compliance with therapy
What is anemia
an indication or manifestation of an underlying pathological process-not a disease (p. 786)
-Occurs when oxygen delivery is inadequate
-Due to low volume of RBCs or a defect in the structure or function of the RBC's.
-Less oxygen to the tissues and cells causes tissue hypoxia
Patho: we need RBC's to transfer O2 to the tissues and organs. With anemia the number of RBC's or the quality of the RBC's is insufficient
Clinical Manifestations of Anemia
-Increased HR & RR (body's trying to keep up)
-Pallor (nail beds, conjunctiva)
Diagnostic for Anemia
-Iron binding capacity
-Bone marrow examination
What is a schillings test?
This test measures how well the body absorbs vitamin B12 from the gastrointestinal (digestive) tract. This test is performed using a 24-hour urine sample, and certain medications are given during the testing period. This test is used to confirm vitamin B12 deficiency. (google)
Medications/treatments for anemia
-Parental Vitamin B12
Oral intake of Iron S/E's to teach
When is parenteral vitamin B12 used?
if there is a malabsorption or lack or intrinsic factor that leads to a deficiency of vitamin B12
When is Folic Acid used?
Where there is a deficiency of Folic acid or in those with sickle cell anemia (this helps with the demands for bone marrow)
How is Erythropoietin given and when is it indicated?
It's given SQ and is indicated when the anemia is caused by chronic diseases
When is a blood transfusion indicated?
in hemorrhage or Aplastic Anemia
Iron deficiency is most commonly found in what age group?
What other disorder is associated with Iron deficiency anemia?
What needs to be evaluated with the patient who has iron deficiency anemia?
(WIC may help with this)
teaching about lifestyle changes for the patient with anemia
-Decrease normal activities
-Frequent periods of rest
-No strenuous play
-No activities that result in dyspnea or fatigue
Anemia leads to tissue __________________
What happens with the blood during anemia?
gets shunted to the vital organs
What is Menorrhagia?
A heavy period
What is chronic occult blood loss? What are some conditions that can result in occult blood loss?
Hidden blood loss that is chronic
Risk Factors for anemia include
-Pt's not consuming a well balanced diet
Amemias that are GENETIC in origin: Can or Cannot be prevented?
When talking about foods high in iron you need to teach to eat foods high in ...
Foods high in iron include
Green leafy veggies
When administering iron to kids it is important to teach them to ....
Use a straw to prevent staining of the teeth and also to NOT take it with an empty stomach as it can cause an upset stomach
Types of Anemia include
Blood Loss Anemia
Nutritional Anemias: Iron defieciency, Vitamin B 12 deficiency, and Folic acid deficiency
Hemolytic Anemia- Sickle Cell and Thalassemia
Vitamin B12 Deficiency Anemia results from
Failure to absorb dietary B12
Vitamin B12 deficiency anemia can result in
Folic Acid deficiency anemia is seen when
-In Neuro tube defects
-Seen with alcohol and drug abuse
-seen in those that are chronically malnourished
What is Hemolytic Anemia?
A defect in the RBC membrane or Hemoglobin structure
includes: Sickle Cell Anemia and Thalassemia (Cooley)
What is Thalassemia (Cooley)
An inherited disorder of the hemoglobin synthesis
Patients with Thalassemia may require life long..... what?
For every One unit of blood that you loose or gain you will loose or gain _____________ point(s) in the Hgb/Hct
One point in the Hgb or Hct (class notes)
Acquired Hemolytic Anemia results from __________________________ and examples of this are...
Trauma to the RBC
Bacterial or Protozoal infections
What is Aplastic Anemia?
Results when the bone marrow fails to produce RBC, WBC and PLT
This condition is RARE
What may trigger Aplastic Anemia?
A viral infection
Which medication (Ferrous or Ferric) help absorb iron faster?
Ferrous (U want this one)
Interventions for Aplastic Anemia...
-Medication Management (Ferrous/Ferric)
Goals for Aplastic anemic patient
-make appropriate dietary choices
-Parental compliance with drug therapy
-Maintain blood work within acceptable range
-Teach ways to conserve energy
-No smoking or 2nd hand smoke
-Check skin and MM's
-Play therapy- play w/ equipment
-Teach to administer iron with a straw and brush teeth to minimize staining
-Give iron to small children in a dropper in the back of the mouth.
-Explain child stools will be greenish in color
Large amounts of Iron ingested are toxic and can be fatal
You should take Iron with _______________________ to increase absorption
Vitamin C (asorbic acid)
Foods high in Iron
-Green leafy veggies
Foods high in Folic Acid
-Green leafy veggies
Foods high in Vitamin B12
Blood Transfusion reactions that were talked about in class
S/S of Allergic reaction in blood transfusion
S/S of circulatory overload in blood transfusion
-JVD (distended neck veins)
Do you ever use a warmer for blood transfusions
NO more than likely you will not. The only time you might use this is during an emergency when the blood needs to be infused rapidly
If there is every any question of reaction during a blood transfusion you should....
Stop the transfusion (even if it's the 3rd unit/hour)
Sickle Cell Anemia is...
A group of diseases where the normal Hgb A is partially or completely replaced by Hgb S (S like Sickle)
It is a common genetic disease that primarily affects the African American ethicity
When is Sickle Cell Anemia commonly diagnosed? Why this age?
around 4 to 6 moths ... and it isn't diagnosed at birth because the fetus has maternal RBC's still circulating
Sickle Cell Anemia prognosis is...
Guarded - Can potentially be fatal
Is Sickle Cell Anemia a chronic or acute condition?
Sickle Cell crisis can be triggered by what?
decreased oxygen level and decreased pH
(causes the hemoglobin to change and sickle which can obstruct the vessels causing thrombosis... which causes more Sickling and decreased blood flow)
Primary intervention with Sickle Cell Anemia
Keep the child
at all times
Diagnostic Test for Sickle Cell Anemia
Sickledex - a drop of blood placed on a slide, When covered, the O2 will leave the cell and the cell will sickle.
Other interventions for Sickle Cell anemia
-Electrolyte replacement (Pedialyte)
Why is electrolyte replacement needed for sickle cell anemia
Because the hypoxia results in metabolic acidosis which causes further sickling
Why are analgesic used is Sickle cell anemia
The hypoxia causes pain in the joints and muscles.
Why are antibiotics used for sickle cell anemia?
These patients are more susceptible to infections and antibiotics will be given sooner than normal to prevent further sickle cell crisis
Clinical Manifestations of Sickle Cell anemia
-Moderate to severe lethargy due to vascular occlusion
-May lie on their left side with their knees flexed
-Liver enlargement (due to congestion and engorgement of SC)
-Physical and sexual maturation are delayed in adolescents
Treatment for sickle cell crisis is primarily _____________
What medication must you avoid with sickle cell anemia?
meperidine (Demerol) as it may induce seizures
Evidence Based Practice shows that if you prophylactically administer _________________ to infants at 2 mos. of age it can decrease pneumococcal infections
_______________ will decrease the need for O2 in the body
Does oxygen help in a sickle cell crisis?
power-point: Oxygen therapy has little value
What medication might you give to a sickle cell patient?
Folic Acid to stimulate RBC synthesis
During a sickle cell crisis episode the nurse should....
promote rest, help the client decrease their O2 need and provide pain management
What might the sickle cell patient benefit from
a transfusion. (take some out and put some new back in )
What types of medication are given to the sickle cell patient for pain management?
May need to add codeine
Is there a cure for Sickle Cell Anemia?
No the patient needs to learn how to live with it
What ethnicity is sickle cell normally found in?
African American or whites of Mediterranean descent (Spanish)
What is the abbreviation for normal hemoglobin (no.. not Hgb)
What is the abbreviation for a sickle hemoglobin
How to monitor hydration status in an infant/child
# of diapers
Teach to increase fluid consumption during the summer months due to increased loss in sweat
With Sickle cell you should check for enlargement of which organ?
The Sickle cell patient should avoid __________altitudes
High due to the need for increased oxygenation
If a sickle cell patient has an injury should you apply ice?
No because it will cause vasoconstriction and increase their risk for sickle cell crisis
What risk does surgery pose to the sickle cell patient?
Risk for O2 depletion which can place the patient at risk for sickle cell crisis
What can infection do to the sickle cell patient?
It can put them at risk for sickle cell crisis
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