CARE OF PRESCHOOLERS WITH HEALTH PROBLEMS  Objective of therapy is complete remission, in which there is no

Definition of terms residual leukemia in the bone marrow

 Prognosis- predicts the outcome of the disease; the expected
course of a disease
 Cancer- is a class of diseases in which a group of cells display
uncontrollable growth invasion and sometimes metastasis
 Metastasis- is the spread of disease from one organ or part to
another non-adjacent organ part
 Reversible- capable of going though a series of actions (as
changes) either backward or forward
 Administration of Chemotherapy called inductive therapy
 Supportive care consist of administration of blood products
(RBCs and platelets) and promptly treating infections
CHRONIC MYELOID LEUKEMIA (CML)
- arises from a mutation in the myeloid stem cell, there is a
pathologic increase in the production of forms of blast cells
- common in people younger than 20 year old
-have an overall median life expectancy of 3 to 5 years

LEUKEMIA CLINICAL MANIFESTATIONS

-“white blood”, is a neoplastic proliferation of one particular cell
type.  Leukocyte commonly exceeds 100,000/mm3 which causes
-defect originates from the hemapoietic stem cell shortness of breath or slightly confused due to decrease
capillary perfusion to the lungs and brain
CLASSIFICATION ACCORDING TO STEM CELL IINVOLVED:  May have enlarged, tender spleen; liver may also be enlarged
 May have insidious symptoms such as malaise, anorexia and
 ACUTE MYELOID LEUKEMIA (AML) weight loss
 CHRONIC MYELOID LEUKEMIA (CML)
 ACUTE LYMPHOCYTIC LEUKEMIA (ALL) MEDICAL MANAGEMENT

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 CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)

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 Oral formulation of a tyrosine kinase inhibitor (imatinib
ACUTE MYELOID LEUKEMIA (AML) mesylate) which works by blocking signals with in the leukemia

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- results from a defect in the hemapoietic stem cell that cells, thus preventing a series of chemical reactions that cause

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differentiates into all myeloid cells: monocytes, granulocytes cell to grow and divide

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(eosinophils, basophils, and neutrophils), erythrocytes and platelets.  Can be potentially cured with BMT (Bone Marrow Transplant)

CLINICAL MANIFESTATIONS rs e LYMPHOCYTES

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Normal Function Other Characteristics
 Fever and infection result from neutropenia
value
 Weakness and fatigue from anemia  Initiates the immune  Major
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 Bleeding tendencies from thrombocytopenia response types; t

 Pain from an enlarged liver or spleen  Fights viral infection cells, B
aC s

 Hyperplasia of gums, and bone pain from expansion of marrow 20-35%  Responsible for cells,
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humoral and cell Natural

COMMON SIGNS OF LEUKEMIA mediated immune killer cells
response
Systemic- weight loss, fever, frequent infections
Lungs- easy shortness of breath
MONOCYTES
Muscular- weakness
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Bones or joints- pain or tenderness Normal Function Other Characteristics

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Psychological- fatigue, loss of appetite Value

Lymph nodes- swelling 1-6%  Phagocytic  Moves to the site of
Spleen and/or liver- enlargement  Fights injury within 3-7 days
chronic  Differentiate into
Skin- night sweats, easy bleeding and bruising, purplish patches or infection macrophages and
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spots dendritic to elicit an

immune response
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DIAGNOSTIC FINDINGS
ACUTE LYMPHOTIC LEUKEMIA (ALL)
 CBC shows a decrease both in erythrocytes and platelets
-results from an unconscious proliferation of immature cells
 Total leukocytes count can be low, normal and high
(lymphoblasts)
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 The percentage of normal cells vastly decreased

-common in young children, boys are more affected than girls; peak
 Bone marrow analysis shows an excess of immature blast cells
of incidence is 4 years of age
(more than 30%)

COMPLICATIONS CLINICAL MANIFESTATIONS

 Bleeding and infection are the major cause of death  Reduced number of leukocytes, erythrocytes, and platelets
 The low platelet count can result into ecchymosis (bruises) and  Pain from an enlarged liver or spleen or bone pain
petechiae (pinpoint red or purple hemorrhagic spots on the  Exhibit headache and vomiting because meningeal involvement
skin)

MEDICAL MANAGEMENT MEDICAL MANAGEMENT

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  Corticosteroids and Vinka alkaloids are the medication of choice - Balance activity and rest
for the initial induction therapy (blast cells are sensitive to these 6. Maintaining fluid and electrolyte balance
drugs) - Monitor intake and output
 Because it invades the CNS, prophylaxis with cranial irradiation - Daily weight monitoring
or intrathecal chemotherapy (eg. Methotrexate) or both is also - Replacement of electrolytes
a key part of the treatment plan 7. Improving self-care
8. Managing anxiety and grief
CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) - Providing emotional support and discussing concerns
- common malignancy for older adults 9. Encouraging spiritual well-being
- 2/3 are older than 60 years at diagnosis 10. Monitoring and managing potential complications
- average survival ranges from 14 years (early stage) and 2 years (late
stage) WILM’S TUMOR/ NEPHROBLASTOMA
- more often in males
- Survival tends to be shorter in males  Intraabdominal and kidney tumor of childhood
 80%- diagnosed under 5 years of age
PATHOPHYSIOLOGY  Peak inside between 3 to 4 years of age
 Increase incidence among siblings and identical twins
 Most cells- fully mature  It is an autosomal dominance inheritance disease
 Resulting in an excessive accumulation of the cells in the
marrow and circulation CLINICAL MANIFESTATIONS
 In early stage, an elevated lymphocyte count is seen; it can  Swelling or mass within the abdomen
exceed in 100,000/mm3  Mass if firm, nontender, confined to one side, and deep within

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 Develop lymphadenopathy- painful

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the flank
 Hepatomegaly and splenomegaly  Metabolic alteration due to compression from tumor mass

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 Later stage- anemia, thrombocytopenia may develop  Hematuria

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CLINICAL MANIFESTATIONS:  Anemia which is secondary to bleeding within the tumor

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 Weight loss

 rs e
An increase lymphocyte count is always present
Lymphadenopathy, this can be severe and sometimes painful
 Fever
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 The spleen can also be enlarged (splenomegaly) DIAGNOSTIC EVALUATION
 Develop “B symptoms” a constellation of symptoms including  History and physical assessment for the presence of congenital
fever, drenching sweats (especially at night), and unintentional anomalies
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weight loss  Abdominal ultrasound

Infections are common
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  CT scan
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MEDICAL MANAGEMENT  MRI (Magnetic Resonance Imaging)

 Hematologic studies (CBC)
 Chemotherapy with fludarabine (fludara)  Biochemical studies and urinalysis
 Corticosteroids or rambucil (Leukeran)
 The use of monoclonal antibodies are effective and less toxic THERAPEUTIC MANAGEMENT
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agents (Rituximab)  Surgery and chemotherapy

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 Prophylaxis- antibiotics and antiviral agents  Large transabdominal incision is performed

 Continue for at least 2 months after the treatment ends  Great care is taken to keep the encapsulated tumor intact
GENERAL NURSING INTERVENTIONS because rupture can seed cancer cells
 If both kidney are involved, radiotherapy or chemotherapy
is

1. Preventing or managing infection and bleeding preoperatively to shrink the tumor

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2. Managing mucositis  Agents for treatment: Actinomycin D and Vincristine

- Due to prolonged administration of antibiotics
- Assess oral mucosa thoroughly NURSING MANAGEMENT
- Oral hygiene is very important Preoperative Care
3. Improving Nutritional Intake
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 The nurse need to take into account the parents feeling

- Small frequent feeding of foods that are soft in texture and
moderate in temperature may be better tolerated
- Avoid uncooked foods and vegetables and those without a
peelable skin
- Weigh daily
4. Easing pain and discomfort
- Sponging with cool water to decrease fever
- Gentle back and shoulder massage may provide comfort
- Promote rest and sleep
5. Decreasing fatigue and deconditioning
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 Prepare the parents and the child for all laboratory and
preoperative procedures (within 24 to 48 hours of admission)
 Keep explanations simple and repeated often with attention to
what the child will experience
 Explain to parents the benefits and side effects of the drug
Postoperative care
 Monitors gastrointestinal activity such as bowel movement,
bowel sounds, distention and vomiting

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  Frequent evaluation of BP and observation for signs of infection
Support the family
 To assure them of the child’s recovery after surgery
 To assess their understanding of the pathology report
ASTHMA
-chronic inflammatory disorder of the airways
-common chronic disease of childhood
-80% to 90% of children have their first symptoms before 4 to 5 years
of age
- Episodes of progressively worsening shortness of breath,
cough, wheezing, or chest tightness or some combination of
these changes
Characterized by:
 Decrease in expiratory airflow
 Airways narrow due to bronchospasm, mucal edema, mucous
plugging, with air being trapped behind occluded or narrowed
airways
 Hypoxemia can occur because of mismatching of ventilation and
perfusion

RISK FACTORS FOR ASTHMA IMMUNOLOGIC FACTORS

 Age  Deposits of antigenic substance

 Heredity  While lysozymes immediately digest its outer coating releasing
 Gender fragment of protein that initiate immune sequence
 Mother under age 20 years  IgE mediates the immediate hypersensitive reaction in the
 Smoking bronchial mucosa that leads to specific tissue binding
 Ethnicity (African-Americans at greatest risk)  IgE attaches ---- mast cells, basophils react with specific antigen
 Previous life threatening attack  Mediators effect ---- increased permeability of the blood
 Lack of access to medical care vessels, contractions of smooth muscles, and stimulation of

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 Psychologic and psychosocial problems mucus secretions.

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PRECIPITATE OR AGGRAVATE ASTHMATIC EXACERBATION: Allergens VAGAL STIMULATION

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 OUTDOOR- trees, shrubs, weeds, grasses, molds, pollens, air  Infant receptors in the mucosa stimulated by various antigenic

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pollution, spores or nonantigenic stimuli trigger a reflex bronchospasm that

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 INDOOR- dust or dust mites, mold, cockroach antigen narrows the airway. In asthma, bronchial constrictions is
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 IRRITANTS- tobacco smoke, wood smoke, odors, sprays abnormally severe
- Exposure to occupational chemicals
- Exercise, cold air, changes in weather and temperature VENTILATION
- Colds and infections
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 The smooth muscle, causes narrowing and shortening of the

- Animals (cats, dogs, rodents, horses) airway, which significantly increases airway resistance to
aC s

 Medications (Aspirin, NSAIDs, antibiotics, and beta blockers) airflow.

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 Strong emotions (fear anger, laughing, crying)
 Conditions (gastroesophageal reflux, tracheoesophageal fistula)
 Food additives (Sulfite preservatives)
 Foods (nuts, milk, and dairy products)
 Endocrine factors- menses, pregnancy, thyroid disease
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 Increase resistance in the airway causes forced expirations
through the narrowed lumen. The volume of air trapped in the
lungs increases
 Because gas trapping forces the individual to breath at higher

and higher lung volumes, the work of breathing increases.

 Hyperinflation of alveoli increases the diameter of the airways
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PATHOPHYSIOLOGY
exerting lateral traction on bronchiolar walls.
 Release of inflammatory mediators from bronchial mast cells,
macrophages, and epithelial cells GAS EXCHANGE
 Migration and activation of other inflammatory cells
is

 when the number of poorly ventilated alveoli increases, the

 Alterations in epithelial integrity and autonomic neural control degree of hypoxemia also increases.
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of airway tone  as the severity of obstruction increases, there is a reduced

 Increase in the airways smooth muscle responsiveness, which alveolar ventilation with carbon dioxide retention, hypoxemia,
then results in several physiologic manifestations, such as respiratory acidosis, and eventually respiratory failure.
wheezing and dyspnea with eventual obstruction
CLINICAL MANIFESTATIONS
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Mechanism responsible for the obstruction symptoms include:

 Inflammation and edema of the mucous membrane
 Accumulation of tenacious secretions from mucous glands
 Spasm of smooth muscle of the bronchi and bronchioles which
decreases the caliber of the bronchioles
EXACERBATIONS
 dyspnea, wheezing and coughing
 children may experience symptoms that range from acute
episodes of shortness of breath, wheezing and cough
 children may experience a prodromal itching localized at the
front of the neck or over the part of the neck
 coughing in the absence of respiratory secretion

DIAGNOSTIC EVALUATION

 history; physical assessment; and laboratory tests

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  Pulmonary Functions Test- provide an objective method of
evaluating the presence and severity of the lung disease and
the response to medication therapy
 Peak Expiratory Flow Meter (PEFM)- measures peak expiratory
flow rate or the maximum flow of air that can be forcefully
exhaled in 1 second.
 PEFM is measured in liter per minute.
 Bronchoprovocation testing, direct exposure of the mucous
membranes to a suspected antigen in increasing concentrations,
helps to identify inhaled allergens.
 Skin testing is useful in identifying specific allergens, and those
obtained by the puncture technique correlate better than
intracutaneous tests with symptoms and measurement of
specific IgE antibody.
 Laboratory test such as CBC with differential, chest radiographs.
GENERAL THERAPEUTIC MANAGEMENT
The overall goal of asthma management are:
1. To maintain normal activity levels
2. Maintain normal pulmonary function
3. Prevent chronic symptoms and recurrent exacerbations
 Obtain information how asthma affects the child’s everyday
activities and self-concept, the child and family’s adherence to
the prescribed therapy, and their personal treatment goals.
 Out patient management: parents are taught on how to avoid
allergens, to recognize and respond to symptoms of
bronchospasm, to maintain health and prevent complications,
and to promote normal activities.
GENERAL CARE
 Avoid allergens
 Relieve bronchospasm
 Maintain health and prevent complications
 Promote normal activities
 Child and family support
URINARY TRACT INFECTION
- A condition that involves urethra and bladder (lower urinary
tract) and the ureters, renal pelvis, calyces, and renal
parenchyma (upper urinary tract).
- Peak incidence occurs between 2-6 years old.

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4. Provide optimum drug therapy with the minimum or no adverse ETIOLOGY

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effects

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5. Assist the child in living a normal happy life  Escherichia coli- 80% of cases

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 Gram negative enteric organisms and other organism (proteus,
TREATMENT PRINCIPLES TO BE FOLLOWED: klebsiella etc)

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Other factors:
1.
2.
ALLERGEN CONTROL
DRUG THERAPY rs e 1. Anatomic and physical factors
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2. Altered urine and bladder chemistry
- Long term control
- Quick relief medications CLINICAL MANIFESTATIONS
a. CORTICOSTEROIDS
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b. CROMOLYN AND NEDOCROMIL SODIUM  Classic symptoms of UTI

c. BETA ADRENERGIC AGENTS  Enuresis or daytime incontinence
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d. METHYLXANTHINES  Fever
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e. LEUKOTRIENE MODIFIERS  Strong or foul smelling urine

3. CHEST PHYSICAL THERAPY (CPT)  Increased frequency of urination
4. HYPOSENSITIZATION  Dysuria or urgency
5. EXERCISE  Abdominal pain
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 Costovertebral angle tenderness (flank pain)

NURSING CARE OF A CHILD WITH ASTHMA  Hematuria
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ACUTE CARE  Vomiting

 Monitored closely for relief of respiratory distress and signs of DIAGNOSTIC EVALUATION
side effects after administration of beta-antagonists and
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corticosteroids  Microscopic examination of the urine, which often reveals

 May be more comfortable in sitting upright or learning slightly pyuria (5 to 8 WBC/mL of uncentrifuged urine)
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forward  Urine culture and sensitivity

 Avoid fatigue  UTI screening
 Assure children that they will not be left alone and that their Additional notes: pyuria- puss in urine
parents will be allowed to remain with them
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 Parents need reassurance and information about the child’s THERAPEUTIC MANAGEMENT
condition and therapies Objectives of treatment:
GENERAL CARE A. Eliminate the current infection
 Physical assessment including chest configuration posturing and B. Identify contributing factors to reduce the risk of occurrence
type of breathing C. Preserve renal function
 History or the current and previous episodes and precipitating
factor or events provides important information Common infective agents:

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  Penicillins, sulfonamide, the cephalosphorins, nitrofurantoin
and tetracyclines
 Antibiotics per IV for a minimum of 48 hours
 Blood and urine culture- repeated at monthly intervals for 3
months and at 3 month intervals for 6 months.

PROGNOSIS

 Prompt treatment – excellent

 The hazard of renal injury is greatest when infection occurs in
young children (esp. under 2 years of age) and is associated
with congenital renal malformations and reflux.
 Early diagnosis is important at this stage.

NURSING CARE MANAGEMENT

Objectives:

a. Identification of children with UTI and

b. Education of parents and children regarding prevention and
treatment of infection
 Annual examination- routine analysis
 Health history regarding voiding habits, episodes of
unexplained irritability

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 Collecting appropriate specimen
 Adequate preparation if surgery of children is indicated

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 Teach the parents the appropriate dosage and scheduling

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 Adequate fluid intake – drink 100mL/kg, or approximately

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50mL/lb of body weight daily

effect on the bladder mucosa rs e
Avoid caffeinated or carbonated beverages- with irritative
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 If febrile and unable to drink liquids- IV hydration

PREVENTION
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 Ordinary hygienic habits that should be a routine part of daily

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care
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 Increase fluid intake

 Treat signs of intestinal parasites
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is
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