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PEDI | Hematology P1 (NO Drugs)
1. Major Hematologic Disorders
• Iron Deficiency Anemia: The most common anemia in children, often caused by excessive milk intake (>24 oz/day) displacing iron-rich foods.
◦ Management: Administer iron supplements (give with Vitamin C/juice, avoid milk) and limit milk intake. Stools may turn tarry green.
• Sickle Cell Disease (SCD): Genetic disorder where HgbS replaces normal HgbA, causing RBCs to sickle, obstructing blood flow.
◦ Crisis Management: Prioritize hydration (1.5–2x maintenance), oxygenation, and pain control (opioids, NSAIDs). Medical emergency: Acute chest syndrome or splenic sequestration.
• Hemophilia: X-linked recessive clotting deficiency (A=Factor VIII, B=Factor IX).
◦ Safety: Prevent bleeding (no contact sports, soft toothbrush). Treat bleeds with RICE (Rest, Ice, Compression, Elevation) and factor replacement.
2. Pediatric Oncology
Unlike adult cancers (epithelial/environmental), childhood cancers are largely embryonal (tissue-based), grow rapidly, and are highly responsive to treatment.
• Leukemia (ALL/AML): The malignancy of bone marrow/blood. ALL is the most common. Diagnosis via bone marrow biopsy; lumbar puncture checks CNS involvement.
• Solid Tumors:
◦ Wilms Tumor: Renal tumor. Never palpate the abdomen pre-op to prevent rupture/metastasis.
◦ Neuroblastoma: Neural crest tumor, often presents as an abdominal mass crossing the midline.
◦ Retinoblastoma: Signaled by "cat's eye reflex" (whitish glow in pupil).
3. Critical Pharmacology & Safety
Chemotherapy requires specialized handling due to toxicity.
• Vincristine: A mitotic inhibitor.
◦ FATAL WARNING: For IV use only. Fatal if given intrathecally.
◦ Side Effects: Peripheral neuropathy (foot drop), constipation, vesicant (extravasation risk).
• Methotrexate: Folate antimetabolite.
◦ Risks: Myelosuppression, hepatotoxicity, mucositis, renal failure (requires hydration/alkalinized urine).
◦ Rescue Agent: Leucovorin is used to neutralize toxic effects.
• Daunorubicin/Doxorubicin: Anthracyclines.
◦ Risks: Severe cardiotoxicity (lifetime cumulative dose limits apply) and red/orange urine.
• Etoposide: Topoisomerase inhibitor.
◦ Admin: Watch for hypotension during rapid infusion (infuse over 30–60 mins).
• Prednisone: Corticosteroid used for induction/palliation.
◦ Side Effects: Hyperglycemia, mood changes, immunosuppression, Cushing’s syndrome. Must taper to avoid adrenal insufficiency.
• Mesna: A cytoprotectant agent.
◦ Use: Must be given with Ifosfamide or Cyclophosphamide to prevent hemorrhagic cystitis (bladder bleeding).
4. Nursing Priorities
• Neutropenia: Infection is the leading cause of death. Calculate ANC; implement protective isolation if ANC <500. No fresh flowers/fruit; monitor temp closely.
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By Regular Guy1. Major Hematologic Disorders
• Iron Deficiency Anemia: The most common anemia in children, often caused by excessive milk intake (>24 oz/day) displacing iron-rich foods.
◦ Management: Administer iron supplements (give with Vitamin C/juice, avoid milk) and limit milk intake. Stools may turn tarry green.
• Sickle Cell Disease (SCD): Genetic disorder where HgbS replaces normal HgbA, causing RBCs to sickle, obstructing blood flow.
◦ Crisis Management: Prioritize hydration (1.5–2x maintenance), oxygenation, and pain control (opioids, NSAIDs). Medical emergency: Acute chest syndrome or splenic sequestration.
• Hemophilia: X-linked recessive clotting deficiency (A=Factor VIII, B=Factor IX).
◦ Safety: Prevent bleeding (no contact sports, soft toothbrush). Treat bleeds with RICE (Rest, Ice, Compression, Elevation) and factor replacement.
2. Pediatric Oncology
Unlike adult cancers (epithelial/environmental), childhood cancers are largely embryonal (tissue-based), grow rapidly, and are highly responsive to treatment.
• Leukemia (ALL/AML): The malignancy of bone marrow/blood. ALL is the most common. Diagnosis via bone marrow biopsy; lumbar puncture checks CNS involvement.
• Solid Tumors:
◦ Wilms Tumor: Renal tumor. Never palpate the abdomen pre-op to prevent rupture/metastasis.
◦ Neuroblastoma: Neural crest tumor, often presents as an abdominal mass crossing the midline.
◦ Retinoblastoma: Signaled by "cat's eye reflex" (whitish glow in pupil).
3. Critical Pharmacology & Safety
Chemotherapy requires specialized handling due to toxicity.
• Vincristine: A mitotic inhibitor.
◦ FATAL WARNING: For IV use only. Fatal if given intrathecally.
◦ Side Effects: Peripheral neuropathy (foot drop), constipation, vesicant (extravasation risk).
• Methotrexate: Folate antimetabolite.
◦ Risks: Myelosuppression, hepatotoxicity, mucositis, renal failure (requires hydration/alkalinized urine).
◦ Rescue Agent: Leucovorin is used to neutralize toxic effects.
• Daunorubicin/Doxorubicin: Anthracyclines.
◦ Risks: Severe cardiotoxicity (lifetime cumulative dose limits apply) and red/orange urine.
• Etoposide: Topoisomerase inhibitor.
◦ Admin: Watch for hypotension during rapid infusion (infuse over 30–60 mins).
• Prednisone: Corticosteroid used for induction/palliation.
◦ Side Effects: Hyperglycemia, mood changes, immunosuppression, Cushing’s syndrome. Must taper to avoid adrenal insufficiency.
• Mesna: A cytoprotectant agent.
◦ Use: Must be given with Ifosfamide or Cyclophosphamide to prevent hemorrhagic cystitis (bladder bleeding).
4. Nursing Priorities
• Neutropenia: Infection is the leading cause of death. Calculate ANC; implement protective isolation if ANC <500. No fresh flowers/fruit; monitor temp closely.