peds mini test

deficiency of neutrophils (less than 1,000 for infants, less than 1,500 for child over 1 year of age)

1: less than 2,000

2: less than 1,500

3: less than 1,000

fever, lymphadenopathy, organomegaly, pallor, bruising, petechiae

neutropenic precautions

hand washing, check temperature regularly (never rectal), seek medical attention for fever, oral hygiene (soft toothbrush, rinse well), avoid crowds/sick people, no fresh flowers/raw meat/raw honey/fresh produce

microcytic, hypochromic anemia caused by inadequate supply of iron, with diminished hemoglobin production

decreased iron supply, increased iron demands, blood loss, inability to form hemoglobin, impaired absorption

3 mg/kg per day (don’t give with milk, may stain teeth or cause dark stools)

condition characterized by significant difficulties forming emotional attachments with others, usually related to early life trauma or loss

marked disturbance in ability to relate socially

• emotional withdrawal or inhibition

• inability to seek or accept warmth from others

• inability to show or respond to affection

marked disinhibition

• indiscriminate willingness to seek comfort even from strangers

• excessive trust of strangers

physical abuse, sexual abuse, emotional abuse, & neglect

anxiety disorder that occurs in response to real or perceived trauma or threat to one’s life/safety

re-experiencing the trauma through flashbacks/nightmares/sensations, avoiding reminders of anything or any place that triggers memories, physiological symptoms of anxious arousal

the nurse can discern: does the child have a plan? is that plan possible (is the means accessible)? has the child attempted suicide before?

• if any of those factors for suicidal ideation are present, the nurse must refer the child to a mental health professional or for immediate hospitalization

identify school-based programs that target students at risk for dropping out of school & assist children to remain involved

cognitive-behavioral techniques may be used by conducting exercises, activities, & discussions that help the student connect their thoughts & behaviors

only use bed for sleeping, avoid caffeine late in the day, avoid taking naps late in the day, avoid large meals right before bedtime, dim household lights at night, create a healthy sleep environment, turn off screens 30 minutes before bedtime, develop a bedtime routine to help you relax, go to bed at the same time every night, discuss ongoing sleep problems with parent/doctor

it is important to distinguish developmentally expected anxiety vs. anxious temperament vs. symptoms of anxiety disorder

anxiety disorders include separation anxiety disorder, panic disorder, agoraphobia, specific phobias, social anxiety disorder, generalized anxiety disorder, substance-induced anxiety disorder, & PTSD

anxiety that does not abate or gets worse over time (persistent)

anxiety that pervades more than one aspect of the child’s life, significant distress or avoidance or feared situations, impaired functioning or development in response to the anxiety

be aware of the need for early intervention

early language development, interventions that address social competence, help the family with coping skills, be aware of physical boundaries

 ALARM acronym as a means of understanding ASD & treatment

• autism is prevalent

• listen to patients

• act early

• refer

• monitor

third most common pediatric cancer

tumor of nerve tissue, usually developing in the abdomen within the tissues of the adrenal gland (but it can develop elsewhere), that can spread to the lymph nodes, liver, bones, & bone marrow

palpable tumor usually crossing the midline (hard, painless mass in neck or abdomen), mass upon radiograph, edema related to vascular compression (if tumor is large enough)

bone pain & swelling/bruising around the eyes can present if the tumor has metastasized

extravasation, ulceration, cellulitis

hemorrhagic cystitis (bloody or painful urination caused by cyclophosphamide/Cytoxan or ifosfamide/Ifex), tumor lysis syndrome, septic shock

others include superior vena cava syndrome, superior mediastinum syndrome, pericardial effusion, pleural effusion, abdominal emergencies, neurological conditions, shock, & hyperleukocytosis

offer plain/bland foods, avoid spicy/heavy/fatty foods, serve cold or room-temperature foods to avoid food smells, serve liquids & solids 30 to 60 minutes apart

offer liquids as well as bananas/rice/applesauce/toast/tea, decrease dietary fiber

offer liquids & caffeine, increase dietary fiber, encourage increased activity

offer small amounts throughout the day, offer liquids between meals, serve “power-packed” foods, start with small portions & gradually increase, serve foods/beverages that the child especially likes

offer soft foods, avoid acidic/spicy/chewy foods, encourage good oral hygiene

avoid high-fat foods/spicy foods/citrus/cinnamon/peppermint/pepper, keep child upright for 1 hour after eating

offer soft/moist foods, encourage sips of liquids while eating, avoid hard foods, cut food into small pieces, use butter/sauces/gravies, offer hard candy

avoid gas-forming foods, encourage child to eat slowly, avoid chewing gum

nephroblastoma (tumor originating in one or both kidneys)

*do not palpate once diagnosed (can cause rupture or further metastasis

palpable abdominal tumor that does not cross the midline

hematuria, hypertension, & pain occur infrequently

other symptoms may include aniridia (absence of iris), hemihypertrophy (increased size of half of the body), & urinary defects such as cryptorchidism & hypospadias

normal bone marrow elements are replaced by large amounts of blast cells, causing pancytopenia (low levels of all blood cells)

*ALL is most common type in children

health situation that persists over time, usually longer than 3 months, or one in which recovery progresses slowly

IDEA, regular check-ups, including siblings, coping mechanisms

parents often experience renewed & intense grief on occasions that would have been significant benchmarks in the life of the deceased child such as birthdays, holidays, anticipated graduations, etc.

presents as feelings of tightness in throat/chest, SOB, preoccupation with the image of the deceased, inability to focus on anything other than the loved one who died, emotionally distancing self from others, feelings of guilt/responsibility, hostile reactions, inability to complete daily tasks

denial/isolation, anger, bargaining, depression, acceptance

1 = numbness & shock; 2 = intense grief; 3 = reorganization

meant to provide the best quality of life possible for the child & family by supporting the bereaving child & family, relieving distressing symptoms, & providing respite

separation from peer group is a difficult consequence, possible anger due to interrupted independence & little peer interaction, increased awareness but may not understand the consequences of the condition

not fitting in with pediatric unit or adult floor, may be required to accept help from others when previously independent (this also may cause maladaptive coping behaviors), can show regression when overwhelmed, may be affected by concern about burden & strain on parents

rocking/holding/comforting, soothing voice, provide auditory & visual stimulation when one-on-one intervention is not possible, group care measures, designated treatment room, minimize pain & discomfort

jeopardizes initiation of autonomy, frightening aspects including pain, anxiety, & separation, hinders speech & motor development

most common coping mechanisms is regression (this is expected & will subside in time after returning home)

leucovorin (recovery drug for prevention of HC from medications)

mesna (prevents ifosfamide-induced HC)