Learning Guide
Module 9
Nursing Care of the Pediatric Individual with a Hematologic
Disorder or Soft Tumor Cancers
Hematologic System:
1. Compare the differences between neonatal and adult hematologic
system:
a. What is life cycle of the RBC for each?
b. How does age affect hemoglobin and hematocrit values? (what
are normal values for each infant, child, adult?)
c. How does blood cell production change throughout the lifespan?
Iron deficiency anemia:
2. What is the cause of iron-deficiency anemia?
3. What diagnostic tests confirm iron-deficiency anemia?
4. Discuss the two main treatments:
a. Oral iron supplements – know side effects, how to give, etc.
b. Dietary teaching
Sickle Cell Diseases:
5. What is sickle cell disease? What is sickle cell anemia?
6. What are precipitating factors that will cause red blood cells to begin
severe sickling? Explain.
7. There are three types of sickle cell crisis. Which type is more common?
8. Compare and contrast the four types of sickle cell crisis.
9. What is the most common reason for admission to the hospital for a child
with sickle cell disease?
10. What organs experience complications as a result of chronic sickling
crises? What causes these complications?
11. What diagnostic tests/lab tests would the healthcare provider order to
diagnose sickle cell disease?
12. Can the newborn have a diagnosis of sickle cell disease? What is the
rationale for this answer?
13. Why are blood transfusions ordered for the client in sickle cell crisis?
14. What are potential complications of frequent blood transfusions and what
are the nursing interventions for these complications?
15. Develop a plan for insuring hydration in the child with sickle cell.
Remember to incorporate teaching for the child/family that includes
explanations to emphasize the importance of hydration.
16. When providing instruction for long-term care of the child with sickle cell,
what medications should the nurse include regarding potential for
infection?
a. Antibiotic therapyb. Immunizations-
Hemophilia:
17. Explain the Pathophysiology of hemophilia including:
a. What is an X-linked recessive disorder?
b. What factor is missing or defective?
c. Who is the carrier and who is affected by the disorder?
18. When is hemophilia most commonly diagnosed?
19. The classic sign of hemophilia is bleeding anywhere from, or in the body.
During the nurses assessment, what manifestations are commonly seen
in each body system?
20. What laboratory tests would the nurse anticipate when the client is
suspected of having hemophilia? What are the normal values for this
test?
21. Discuss is the basis for the following lab results: Normal PT with a
prolonged PTT.
22. What is the most commonly used form of Factor VIII. How does the
nurse prepare and administer this medication?
23. What is the primary nursing goal for hemophiliac and what are specific
nursing interventions to achieve this goal?
24. Hemarthrosis is a serious complication of hemophilia. What instruction
should the nurse include to prevent this complication?
25. What is the major cause of death of a child with hemophilia?
Childhood Cancer:
26. What are the warning signs of childhood cancer?
27. What are signs and symptoms in a child that would alert a healthcare
provider to suspect a diagnosis of leukemia?
28. What results from a CBC would support a diagnosis of leukemia?
29. Where is the most common site for bone marrow aspiration in a child?
a. How does the nurse prepare the child/family for this procedure?
b. What are the nursing responsibilities for this procedure?
30. Chemotherapy is the most common treatment modality of leukemia.
Explain the three phases of chemotherapy treatment:
a.
b.
c.
31. Develop a plan of care with nursing interventions for the five major side
effects/toxic effects of chemotherapy:
a.
b.
c.
d.
e.
32. What does intrathecal administration of medication mean? What are the
nursing responsibilities with regards to this route of medication
administration?
33. In addition to chemotherapy, cranial radiation is often ordered. What is
the rationale for this additional treatment?
34. What is the cause of tumor lysis syndrome? What are the signs and
symptoms of this complication? What nursing interventions apply to this
situation?
35. Explain the purpose of bone marrow and stem cell transplantation in a
child with leukemia.
36. What is a major side effect of a bone marrow transplant?
37. What teaching must the nurse include concerning safety for the child
with leukemia throughout treatment?
38. Why would the nurse not want to palpate the abdomen of a child
diagnosed with Wilm's tumor/Nephroblastoma?
39. Nephrectomy is used in the treatment of Wilm's tumor. What are priority
nursing interventions in the post-operative period?
40. What are the manifestations of neuroblastoma?
41. Describe the nursing management, planning and teaching of the child
with neuroblastoma.
Death and Dying:
42. Describe the child's understanding of death according to age:
a. Children under 3 yearsb. Preschool to 5 yearsc. School age or 5-9 yearsd. Older school age to adolescent43. What nursing interventions are appropriate in caring for the child and
family undergoing the death and grief process?