PEDS Exam 2 Review Questions and Answers
Leukemia Treatment - Answer-*Four phases of chemo:
1. Induction
2. CNS prophylaxis
3. Consolidation (then delayed intensification)
4. Maintenance (prevent remission)- can last a LONG time, 18 months - 2 years
Radiation to brain may or may need
*...
Leukemia Treatment - Answer-*Four phases of chemo:
1. Induction
2. CNS prophylaxis
3. Consolidation (then delayed intensification)
4. Maintenance (prevent remission)- can last a LONG time, 18 months - 2 years
Radiation to brain may or may need
*HSCT:
AML in FIRST remission (check for a match right away)
ALL in SECOND remission (only go to transplant if they relapse)
Leukemia Prognosis Factors - Answer-1. WBCs @ diagnosis = (ALL) white cell <
50,000 usually do better
2. Age = less than 1 OR older than 10 HIGH RISK
3. Response to initial treatment = if in remission after first 4 weeks, move on to easier
treatment plan/ lower risk (if not responding, will need more intense chemo)
Iron Deficient Anemia Screening Lab Studies - Answer-*Hbg < 11 (if slightly low, may be
no S/S- dietary teaching)
*MCV = microcytic = small cells
*MCH = hypochromic = pale color
Reticulocyte count LOW
TIBC HIGH
Sickle Cell Disease - Answer-Abnormal sickle cell Hgb S replaces normal Hgb A
Both parents have to have trait (autosomal recessive)
Many people just have trait = might see mild anemia
(Babies may have delayed onset of symptoms for 4-6 months due to fetal Hgb)
SCD Lab Tests - Answer-All babies screened @ birth!
*Hemoglobin electrophoresis = definitive test. Tells if you have disease or trait and what
TYPE of Hgb
*Sickledex = screening tool (not able to tell if have disease or just trait)
,CBC- to detect anemia
Vaso-Occlusive Crisis - Answer-PAIN crisis of SCD. Most common crisis
*TRIGGERS- dehydration, temp extremes, high altitude, infection, stress
*Extreme pain- Ischemia is causing pain! Usually in bones, joints, sometimes abdomen.
Swelling of joints. Can develop blood in urine, avascular necrosis
Sickle cells block blood vessels in spleen
Blood is not able to get out, spleen gets larger
Spleen can't do job (filter blood/ get infections OUT)
*One of main reasons why SCD high risk of infections!!!
Child usually has functional asplenia by 5 years old
Prophylactic antibiotics
Many children have spleen removed
Cardiac Cath - Answer-PRE:
-NPO 4-6 hours (sometimes clear liquids)
-Allergies- esp. iodine/ shellfish (dye), prior sedation history
-Baseline circulation + patient teaching
POST:
-*pressure for 5 mins, then pressure dressing placed
-LAY FLAT and bedrest for 6 hours- difficult for kids
-Encourage fluids = get dye out
-Minimal activity for 24 hours
-Prevent vomiting- don't want increased pressure
General Heart Defects S/S - Answer-*Heart murmur
*Cyanosis (as soon as cord is cut)
*Tachycardia - heart tries to compensate by beating faster
*Diaphoresis- classic sign of heart issue
*Poor weight gain (too tired to feed)
Delayed cap refill
Diminished pulses
Patent Ductus Arteriosus (PDA) - Answer-INCREASED PULM BLOOD FLOW
LEFT to RIGHT SHUNT- more blood to lungs
Patent = DA stays open, pressure on LEFT side higher, more blood to lungs
*Machinery murmur, wide pulse pressures, BOUNDING pulses, HIGH risk for
respiratory infections
, *IV Indomethacin (decreases need for surgery)
Cardiac cath or surgery
Arterial Septal Defect (ASD) - Answer-INCREASED PULM BLOOD FLOW
HOLE in atrium = L to R shunt = more blood to lungs
Small = can resolve by 4 yo (do nothing)
Severe = patch/ occlude (CC, surgery)
Ventricular Septal Defect (VSD) - Answer-INCREASED PULM BLOOD FLOW
HOLE in ventricle = L to R shunt = more blood to lungs
*most common defect
*Loud, harsh murmur @ LEFT STERNAL BORDER
Most small close within 6 months
Closure surgery usually > 1 yr
Pulmonary Stenosis - Answer-OBSTRUCTIVE SYSTEMIC BLOOD FLOW
Pulm valve NARROWS = OBSTRUCTS blood flow to pulm artery
-DECREASED volume in RV
-DECREASED cardiac output (low pressure AFTER narrowing)
-HYPERTROPHY of RV (high pressure BEFORE narrowing)
*MURMUR, thrill, CYANOSIS (decreased CO)
Range from asymptomatic to cardiomegaly/ HF
Corrections depend on severity
Mild = do nothing
Moderate = cardiac cath, balloon
Severe = surgical valvotomy or resection
Coarctation of the Aorta (COA) - Answer-OBSTRUCTIVE SYSTEMIC BLOOD FLOW
NARROWING of Aorta- heart has to pump harder to force blood through narrow portion.
*Obstructed blood to LOWER extremities- more S/S here
*4 Quadrant BPs- lower BP distally, in lower extremities (hypotension in general)
S/S: cool skin, weak/ absent femoral pulses
Usually prefer to do surgery- high rate of reoccurrence
Hypoplastic Left Heart Syndrome (HLHS) - Answer-OBSTRUCTIVE SYSTEMIC
BLOOD FLOW
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