NUR 402 Pediatric Nursing Exam Four Guaranteed A+
What is NADIR and its implications on an oncology patient? ✅-This refers to the "low point" of the
blood cells and is known as a chemotherapy side effect. The immune system is really weak during the
NADIR.
-WBCs and Platelets are the lowest at 7-14 days after the last day of treatment. RBCs live longer and
reach nadir after several weeks after treatment
What is ANC and its implications in care of an oncology patient? ✅-Actual Neutrophil Counts, the lower
is the higher the risk for infection as it measures the percentage of neutrophils in your white blood
count.
-ANC is derived from multiplying WBC count x the % of neutrophils in the differential WBC count, the %
of neutrophils compiles segmented (mature) and bands (almost mature).
*Normal ANC range is above 1500*
What is Mucositis and management in a patient? ✅-Inflammation/infections mouth sores are painful,
soft white patches in mouth. Can cause difficulty swallowing or taking, feeling of dryness, mild burning,
pain when eating, etc.
-Management: Medication mouth rinse/warm saline (Before and after meals, at bedtime), Pain
medication and antiemetic prior to meals to encourage adequate nutrition intake, use a soft bristle
toothbrush, do not floss with platelets below 40,000, do not use lemon/glycerin swabs, high protein
foods, avoid spicy/hot/greasy foods, avoid toothpastes, keeps lips moist, etc.
What are Neutropenic precautions and management? ✅-Precautions for patients who are highly
susceptible to infection
, -*Precautions: include keeping equipment for that patient only, no pain medications with Tylenol or
ibuprofen due to masking of fevers, no rectal temps (sometimes no oral temps depending on policy), no
tampons, no injections, daily weights to calculate ANC to guide isolation level*
-Complications/Dangers: Fever with low ANC=sepsis protocol, Low platelets=Bleeding precaution
What is Leukemia and the labs we look at? ✅-Leukemia is a group of malignancies that affects the bone
marrow and lymphatic system.
-Labs: CBC (Blood count) for presence of leukemic blasts, LP (check if spread to CSF), bone marrow
aspiration, immunophenotyping (Identify cancer cells based on the types of antigens or markers on the
surface of the cells), Cytogenic analysis (Blood/bone marrow check for chromosomal changes)
What are the signs and symptoms of leukemia? ✅Low grade fever, pallor and increasing
bruising/petechiae, enlarged liver/lymph nodes/kidneys/testicles/joints, abdominal/leg/joint pain,
headaches, lightheadedness, vomiting, anorexia, weight loss
What is the management of leukemia? ✅Chemotherapy, Radiation therapy, Stem cell transplant,
Targeted therapy. Treatment is generally done in 3 phases (Remission, Consolidation, Maintenance).
(Common side effects of chemo are mucositis, N/V/D, constipation, enlarged lymph nodes, low blood
counts, low grade fevers, body chills, body sweats, etc.)
What is Neuroblastoma and the labs we would complete? ✅-Tumor from the embryonic neural crest
cells, genetic mutation (most common cancer in babies). Most commonly starts in the adrenal glands or
in the abdomen, anywhere along the paravertebral sympathetic chain in the chest or retroperitoneum.
*Metastasis occurs before it is diagnosed*.
-Labs: CBC and coagulation studies
What is the management of Neuroblastoma? ✅Surgical removal of the tumor and chemotherapy or
radiation for metastasis and residual disease.
