New Material - Final
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| Malignant disease of bone marrow and lymphatic system | Leukemia
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| What does decreased production of RBCs lead to with leukemia? | Anemia
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| What does decreased WBC count (neutropenia) lead to with leukemia? | Infection
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| What does decreased production of platelets lead to with leukemia? | Bleeding tendencies
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| How is leukemia classified? | Based on morphology
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| Which type of leukemia comprises 80% of all leukemias? | ALL - Acute lymphoblastic leukemia
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| Which type of leukemia comprises 20% of all leukemias? | AML - Acute myelogenous leukemia
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| Under what type of sedation is bone marrow aspiration done? | Conscious sedation
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| What is the most common location for bone marrow biopsy on children? | Iliac crest
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| What are the five (5) phases of treatment for leukemia? | (1) Induction therapy, (2) Intensification or consolidation therapy, (3) CNS prophylactic therapy, (4) Maintenance therapy, and (5) Remission/relapse/prognosis
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| What is the goal of the induction therapy phase of leukemia treatment? | Achieve remission or absence of leukemic cells
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| How long does the induction therapy phase of leukemia treatment last? | 4-6 weeks
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| What three classes of medications are used in the combination therapy treatment of the induction phase of leukemia treatment? | Corticosteriods, vincristine, and L-asparaginase
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| How would the three classes of medication in the induction phase of combination treatment of leukemia treatment be administered? | Via central line access
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| What is the goal of the intensification/consolidation phase of leukemia therapy? | To further decrease invasion of leukemic cells in CNS
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| What three medications are used in intrathecal (into spinal theca) chemotherapy in the CNS prophylactic phase of leukemia treatment? | Methotrexate, cytarabine, and corticosteroids
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| What is the goal of the maintenance phase of leukemia treatment? | To preserve remission
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| What percentage of children achieve remission from leukemia? | 90 to 95%
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| How is the prognosis of leukemia determined? | By staging
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| What percentage of children suffer from relapse from leukemia? | 16%
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| What are side effects of long-term use of corticosteroids? | Cushing syndrome - Moon face, buffalo hump, obesity in the trunk, mood swings
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| What are side effects of vincristine? | Numbness, foot drop, N/V, bone marrow depression, alopecia
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| What are side effects of L-asparaginase? | N/V, weight loss, and anorexia
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| When does hair generally return after leukemia treatment? | 3-6 months
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| What immunizations need to be avoided when children are undergoing leukemia treatment? | MMR and flu mist - live viruses - immunosuppressed, so don't want to introduce live viruses
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| What four interventions are not recommended to treat mouth ulcers? | Lemon glycerin swabs, hydrogen peroxide, viscous lidocaine, and milk of magnesia
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| How many nurses (or trained personnel) need to double check the type/crossmatch of a patient before a blood transfusion? | Two
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| Within how much time must the blood for a blood transfusion be hung? | Within 30 minutes
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| Within how much time must the blood for a blood transfusion be administered? | Within 4 hours
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| What is an autologous bone marrow transplant? | Patient gives own bone marrow
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| What is an allogenic bone marrow transplant? | Comes from donor
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| What are two possible sources of donated bone marrow? | Peripheral blood stem cell (PBSC) and umbilical cord blood
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| What is the first sign of graft-vs-host disease (GVHD)? | Skin rash
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| Which organs are most often affected by graft-vs-host disease? | Skin, stomach, intestines, and liver
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| Prior to a bone marrow transplant, what does the patient undergo? | Large doses of chemotherapy and total body irradiation
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| Based on what are suitable donors determined for bone marrow transplant? | HLA matching - human leukocyte antigen
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| When is the right time to talk about palliative care? | At the time of diagnosis
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| What sensations, thoughts, feelings are part of acute grief? | Sensations of somatic distress, images of diseased, feelings of guilt and hostility, and loss of usual patterns of conduct
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| When does the process of mourning occur in regards to death? | Mourning occurs well before the actual death
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| What are the four phases of mourning? | (1) Shock and disbelief, (2) Expression of grief, (3) Disorganization and despair, and (4) Reorganization
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| Which is the last sense to go at the time of death? | Hearing
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| What temperature sensation does someone who is dying feel? | Sensation of heat but they're cool to the touch
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| What tool is used to assess children's percentage of body surface area affected? | Lund and Browder
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| What percentage of total body surface area (TBSA) is classified as a minor burn? | < 10%
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| What percentage of total body surface area (TBSA) is classified as a moderate burn? | 10-20%
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| What percentage of total body surface area (TBSA) is classified as a major burn? | > 20%
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| What type(s) of burns are described as partial thickness burns? | Minor and moderate
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| What type(s) of burns are described as full thickness burns? | Major
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| Describes a depth of burn that is partial thickness, affects the epidermis only, has erythema and pain, and heals by itself in 5-10 days | Superficial (1st degree)
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| Describes a depth of burn that is partial thickness, looks wet and shiny, can have weeping, blisters, and edema, are very painful to touch and airflow/temperature changes, and take 3+ weeks to heal | Partial thickness (2nd degree)
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| Describes a depth of burn that involves the epidermis, dermis, and subcutaneous tissue (nerve endings, hair follicles, sweat glands), can be red, waxy, brown and leathery, involves a lack of sensation | Full thickness (3rd degree)
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| Describes a depth of burn that can impact bone and muscle | 4th degree
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| Burn shock affects what system of the body? | The circulatory system
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| Decreased cardiac output, increased fluid loss through burned skin, and increased capillary permeability describe what process after a burn injury? | Burn shock
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| What is the life-threatening result of burn shock? | Dramatic reduction of circulating blood volume
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| What is the best indicator of fluid status after a burn injury? | Urine output
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| What is the priority intervention with burn injury treatment? | Fluid resuscitation
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| Are enteral feedings contraindicated because of a paralytic ileus in a burn patient? | No - need to keep gut moving to prevent translocation of gut bacteria that can cause infection
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| Describes a stress response to a severe burn that results in increased caloric needs of the body | Hypermetabolism
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| Because of hypermetabolism, what will happen to a burn victim's body temperature? | It will be elevated
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| What hormone is released as a result of the body's stress response? | Cortisol
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| In the immediate care after a burn, what is the first step? | Stop the burning process - stop, drop and roll; remove burning clothing, jewelry
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| What are the three (3) zones of injury in the local response to a burn? | (1) coagulation, (2) stasis, and (3) hyperaemia
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| Where is the coagulaion zone of injury located? | Closest to the injury
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| Describes a zone of injury where there is no capillary flow, no blood supply, and necrotic, dead tissue | Coagulation zone
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| Describes a zone of injury where there is damaged tissue, decreased blood flow, and the tissue can be saved if perfusion is restored | Stasis zone
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| Describes a zone of injury that is metabolically active, and has a normal, good response to tissue injury | Hyperaemia zone
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| What nursing assessments are important in monitoring a circumferential burn? | Pain, pallor, pulse, paresthesias, and paralysis
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| This can put someone at risk for the development of compartment syndrome | Eschar
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| During this stage of burn care, ineffective airway clearance related to mucosal edema and deficient fluid volume related to increased capillary permeability are major concerns | Acute stage
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| During this stage of burn care, risk for infection, impaired skin integrity, risk for ineffective thermoregulation, pain related to the burn injury, imbalanced nutrition, and impaired physical mobility are major concerns | Management and rehabilitative stage
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| This burn treatment aids in debridement of wounds and cleansing, aids in range of motion, and helps loosen things to make debridement less painful | Hydrotherapy
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| What medication is commonly used directly on wounds? | Silvidine
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| This type of graft is taken from cadavers and is temporary (lasts 14 days) | Allograft
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| This type of graft is taken from different species and is temporary (< 14 days to rejection) | Zenograft
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| What is the ultimate goal in the long-term care of a burn survivor? | Adapt to the burn injury and get them back into the community
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| Fruity breath, N/V, dehydration, ketones in blood/urine, mental confusion, electrolyte imbalance, dyspnea, and weight loss are signs/symptoms of this disease | Diabetic ketoacidosis
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| To be classified as a diabetic, the patient would have this 8-hour fasting blood glucose level | Greater than or equal to 126 mg/dL
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| To be classified as a diabetic, the patient would have this random blood glucose level | Greater than or equal to 200 mg/dL
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| To be classified as a diabetic, the patient would have this OGTT (oral glucose tolerance test) level | Greater than or equal to 200 mg/dL in 2-hour sample
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| Describes a type of insulin that has an onset of 15 minutes, a peak of 30-60 minutes, and a duration of 3-4 hours | Rapid-acting insulin (clear)
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| Describes a type of insulin that has an onset of 30-60 minutes, a peak of 2-4 hours, and a duration of 5-7 hours | Fast-acting insulin (clear)
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| Describes a type of insulin that has an onset of 1-2 hours, a peak of 4-12 hours, and a duration of 18-24 hours | Intermediate insulin (cloudy)
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| Describes a type of insulin that has an onset of 3-4 hours, no peak, and a duration of 24+ hours | Long-acting insulin (clear)
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| These tonsils are referred to as the adenoids | Pharyngeal tonsils
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| These tonsils are the ones removed during a surgical procedure | Palatine tonsils
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| Difficulty swallowing and breathing, mouth breathing that causes dry mucous membranes, mouth odor and impaired taste/smell describe signs and symptoms of this disease process | Tonsilitis
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| This intervention can be used post-tonsilectomy, to treat pain | Icepack around the neck for 24 hours
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| This is a sign, post-tonsilectomy, that can indicate narrowing of the airway | Increased swallowing or difficulty swallowing
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| Post-tonsilectomy, this intervention facilitates drainage of secretions and decreases swelling | Elevating the head of the bed 30 to 45 degrees
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| This can be used to increase visualization of the throat after a tonsilectomy | Flashlight
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