NEED antibiotics STAT Try to pull out bacteria you can draw first and send for

Need antibiotics stat try to pull out bacteria you

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**NEED antibiotics STAT** **Try to pull out bacteria you can – draw first and send for culture, then start antibiotics, give Tylenol LAST Absolute Neutrophil Count o (% Neutrophils + % Bands) (WBC x 10) = ANC o Normal ANC >1000 o If less than 500 Cannot give chemo Have patient wear mask Cannot go to school o **Slide 46 pic** WBC of 9.2, 22% Neuts, and 4% bands (22+4) (9.2 x 10) = 2,392 Side Effects: Acute Tumor Lysis Syndrome o Life threatening o S/sx: anorexia, vomiting, weakness, lethargy o **Usually with ALL and (something) Lymphoma o 4 metabolic abnormalities – all released at the same time & hard for kidneys to handle Hyperphosphatemia Hypocalcemia – binds with extra phosphate so Ca+ gets depleted = will see: Positive Trousseaus' sign Positive Chvostek sign Treat with calcium gluconate IV – must give SLOW Hyperuricemia – tumors release nucleaic acids which break down and body makes uric acid Crystalizes in kidneys = acute kidney failure Hyperkalemia Dysrhythmias **Needs cardio/respiratory monitoring** o Metabolites are released too quickly for kidney to excrete them o Prevention of Tumor Lysis IV hydration Urinary alkalinization Monitor urine pH Hypouricemic agents Allopurinol: decreases formation of uric acid Monitor I & Os Monitor Serum Electrolytes Treatment: Supportive Care Steroids o Relieve sickness associated with chemotherapy o Increase appetite o Immunosuppressant o Reduce inflammation o Increase erythropoiesis o Increase neuts o Decrease lymphs
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Radiation – DON’T do on kids less than 3 because of developmental mess-ups o Side Effects Skin Alopecia Dry or moist skin GI o N/V/D o Anorexia o Mucosal ulceration GU o Cystitis Hematologic o Myelosupporession Types X-rays, gamma rays and charged particles Systemic radiation vs. directed radiation Damages cell DNA and cells cannot divide Bone Marrow Transplant o Kill original bone marrow = TONS OF CHEMO to wipe out o Transplant with donor marrow = given to receiver via IV o At risk for GVHD – graft vs host disease Body reacting to host marrow = HEMMORRAGE EVERYWHERE, Clots everywhere **TONS OF PAIN** - usually do not survive o At risk for infection o May change blood type Nursing Interventions o Pain Management – Opioids scheduled & sometimes OVER dose range o Pharmacological management – monitor ALL side effects o Decrease anxiety – Ativan sometimes o IV hydration o Nutrition o Developmental care – usually delayed after chemo o Family care & Child Life support o **Immunizations have to start from ground zero** Leukemia o Group of malignant diseases of the bone marrow and lymphatic system o ALL: most common form of childhood cancer Boys>girls Caucasians>African Americans Peak age 2-5 years 90% survival rates o AML (Acute myelocytic leukemia) 15-20% of leukemia Boys=girls Higher rates during first year of life 65% survival rate o Leukemia Unrestricted proliferation of immature WBC (could be super low or super high) Not a “tumor” SUPER THICK BLOOD
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