6-health problems common in preschooler
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7/31/2019 6-Health Problems Common in Preschooler
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Leukemia
Wilm’s Tumor
(Nephroblastoma)
Asthma
Urinary Tract Infection (UTI)
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Acute Lymphocytic (lumphoblastic)leukemia
Is a disorder of white blood cells
Is the distorted and uncontrolledproliferation of white blood cells
Frequently occurring type of cancer inchildren accounts to 75% of leukemias
Slightly higher in boys than in girls
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The malignant cell involved is thelymphoblast (immature lymphocyte)
Rapid proliferation of lymphocytes,the production of RBC and plateletsfalls, and invasion of body organs by
the rapidly increasing WBC elementsbegins
Abnormally proliferating cells are so
immature, they may be identifiableonly at the immature “blast cell” or
“stem cell” stage
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Unknown
Radiation
Exposure to chemicals
Genetic factors
Children with Down Syndrome
A twin with leukemia
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First symptoms: pallor, low grade fever, andlethargy
Petechiae and bleeding from oral mucous
membranes, may bruise easily Spleenomegaly and hepatomegaly (due to
infiltration of abnormal cells
Abdominal pain
Vomiting
Anorexia
Bone and joint pain (invasion of lymphocytes tobone periosteum)
Headache and unsteady gait ( invasion in the CNS)
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Painless, generalized lymphadenopathy,(submaxillary or cervical nodes)
Laboratory studies: normal or slightly
decrease but includes very immature blastcells, low platelet and hematocrit, normalsize and color of RBC (normocytic andnormochromic)
Bone marrow aspiration (iliac crest) Radiograph of the long bone (reveal lesions Lumbar puncture (presence of blast cells in
the CSF)
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Induction Phase – (Chemotherapy program)achieving a complete remission or absence ofleukemia cells
Sanctuary or Consolidation Phase – preventing leukemia cells from invading orgrowing in the CNS
Administering delayed intensive therapy
Maintenance Phase – maintaining the originalremission
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Vincristine
Prednisone
L-asparaginase
Doxorubicin
Methotrexate
Allopurinol – for increase uric acid
Given over a period of 1 month
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Induction Phase – vincristine, prednisone, L-asparaginase, doxorubicin and methotrexate(given over a period of 1 month) Give allopurinol
Sanctuary or Consolidation Phase - Intrathecal administration – injection of drugs
into the CSF by LP (methotrexate and oraladministration of 6-mercaptopurine
- Cranial Radiation
Third Phase – chemotherapeutic agents pluscyclophosphamide, cytosine arabinoside (ARA-C)
or 6-thioguanine
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Maintenance chemotherapy – aims to eliminatecompletely any remaining leukemic cells
Immune system can complete the eradication
Combination include a combination of 6-mercaptopurine, weekly methotrexate
Continued for 2-3 years
Leucovorin – given after systemic methotrexate to
neutralize its action and protect normal cells from theeffect of the drug
Monitored the child’s blood values once a month
Blood transfusion if needed
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Bone marrow transplantation orimmunotherapy – for not responding
children
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CNS disorders - blindness, hydrocephalus,and recurrent seizures, nuchal rigidity,
headache, irritability, vomiting andpapilledema
Renal disorders - enlarge kidney
Reproductive system disorder --sterilization
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Risk for infection r/t nonfunctioning WBC andimmunosuppressive effects of therapy
- prophylactic antibiotics
- limit visitorsRisk for deficient fluid volume r/t increasechance of hemorrhage from poor platelet
Production- digital pressure (Gelfoam soaked intopical thrombin), postnasal packing,transfusion,
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Pain r/t invasion of leukocytes
-assess pain using a standard scale for accuracy
- handled legs and arms gently- used alternating mattress deviceunderneath body joints
- give analgesia
Ineffective health maintenance r/t long term therapy forleukemia
- allowed normal activity and should attend regularschool
- encourage parents to report propmtly any signs
of infection so that antibiotic will be given early- follow up visits
- great deal of support to the child
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A malignant tumor that rises from themetanephric mesoderm cells of the upper poleof the kidney
It accounts to 20% of solid tumor in children
Occurs in association of congenital anomalies(aniridia, cryptorchidism, hypospadias,
pseudohermaphrodism, cystic kidneys,hemangioma, and talipes disorders)
Metastatic to the lungs, regional lymph nodes,
liver, bone and brain
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STAGE DESCRIPTION
ITumor confined to the kidney and completely removedsurgically
II Tumor extending beyond the kidney but completelyremoved surgically
III Regional spread of disease beyond the kidney with
residual abdominal disease postoperatively
IV Metastases to lungs, liver, bone, distant lymph nodesor other distant sites
V Bilateral disease
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Nephroblastomas distort the kidneyanteriorly – tumor is felt as firm, nontender
abdominal mass Hematuria and low grade fever
Hypertension – excessive renin production
Anemic –
lack of erythropoietin formation Ct scan and sonogram – primary tumor
NO ABDOMINAL PALPATION!!!
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Nephrectomy – removal of tumor byexcision of the affected kidney
Radiation therapy Chemotherapy
Second surgical procedure – for
remaining tumor in the kidney
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Small and large bowel obstruction from fibroticscarring and hepatic damage from radiation
Nephritis Sterility – due to radiation to reproductive
organ
Interstitial pneumonia – radiation to the lungs
Scoliosis – radiation to the spine
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An immediate hypersensitivity response Most common chronic illness in children
Tends to occur after exposure to
allergens(pollen, house dust, molds, andfoods, cold air, irritating odors, cigarettesmoke)
Mast cells release histamine andleukotrienes that results obstructive andrestrictive airway disease
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Triad of asthma: inflammation,bronchoconstriction, and increasedmucus production
Occurs initially before 5 years of age
Intermittent with symptom free periods orchronic with continuous symptoms
Increase incidence if parent has asthma
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Dry cough often at night –
bronchoconstriction begins Difficulty exhaling
Wheezing and dyspnea - narrowed lumen of the inflamedbronchioles filled with mucus. Air pushed forcibly to theobstructed bronchioles
Copious mucus containing white casts bearing the shape ofthe bronchi from which it was dislodge
Cyanosis Elevated eosinophil counts Decrease oxygen saturation Feels frightening Shield-like or barrel chest Clubbing of the fingers – growth of excess capillaries
initiated when oxygen deprivation is sensed in distal parts
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Fear r/t sudden onset of asthma attack
Health seeking behaviors r/t prevention
of and treatment of acute asthma attack;child demonstrate breathing exercise,use of inhaler and peak expiratory flow
rate
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3 goals of allergic disorders:
> avoidance of the allergens by environmentalcontrol
> skin testing and hyposensitization- to identifythe allergen
> relief of symptoms by pharmacological
agents (oral and inhaled anti-inflammatorycorticosteroids, short acting and long-actingbronchodilator, leukotriene receptorantagonist,)
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Encourage to drink fluids, avoid milk/milkproducts – cause thick mucus anddifficulty swallowing
Emergency setting: an intravemous linewill be inserted for continuous fluidtherapy and a route for emergency drugadministration
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Occurs often in females than in males
Most common pathogens is gram-negative rods; E.coli
Also are a common cause of nosocomial
or health care acquired infections
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Infection confined to the bladder (cystitis)
>Low-grade fever, Mild abdominal pain,
enuresis
Pyelonephritis
> high fever, abdominal/flank pain,vomiting and malaise
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Urine Culture
Supra-pubic aspiration
Catheterization
Urinalysis (proteinuria, hematuria) Preand Post antibiotic therapy
Presence of RBC and WBC causes theurine to be more alkaline
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Oral administration of antibiotic specificto the causative agent
Drink large quantity of fluid Cranberry juice – effective in acidifying
urine
Sits in a bath tub or warm water and voidinto the water
Mild analgesic
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Leukemia is cancer of the bone marrow,the stuff in the center of our bones that
makes the three kinds of blood cells. Redblood cells carry oxygen to your body,white blood cells fight infection, andplatelets help your blood to clot. Part ofthe white blood cell is called alymphocyte.
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> Fever
> Anemia or pale appearance
> Weight loss
> Abnormal bruising, especially in places wherechildren wouldn't normally "bump"themselves, like on the trunk
> Bone pain, especially if your child startscomplaining that his legs hurt too much to walk andwants to be carried everywhere
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with leukemia during a routine screening.For example, a blood test at a regular
checkup uncovers anemia, and thedoctor decides to investigate the cause.More often, though, persistent parentswhose child is simply not getting betterlead the pediatrician to do the necessarytests.
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Thank you!!!