HEALTH PROBLEMS COMMON IN PRESCHOOLERS
MATERNAL AND CHILD HEALTH NURSING
L E C T U R E
LEUKEMIA • PE reveals painless, generalized
swelling of lymph nodes
Leukemia is the distorted and uncontrolled (submaxillary or cervical LN)
proliferation of WBC’s and is the most • WBC count is markedly elevated but
frequently occurring type of cancer in in some, normal or decreased but
children composed almost entirely of
immature blast cells
ACUTE LYMPHOCYTIC • Platelet count and hematocrit are
(LYMPHOBLASTIC) LEUKEMIA (ALL) low, but RBC’s are normochromic
and normocytic
• 75% of leukemias • BM aspiration is necessary to ID type
• involves lymphoblasts or immature of WBC or type of leukemia (if >
WBC’s 29%blast cells present, leukemia is
• With rapid proliferation of the diagnosis)
lymphoblasts, RBC and platelet
• BM aspiration is through the iliac
production fall and invasion of body
crest because it is less frightening
organs by the WBC’s begins
and yields more marrow
• highest incidence is between 2 to 6
• Radiograph of long bones reveals
years old
lesions
• prognosis in those <1 is not as good
• Lumbar puncture reveals evidence of
as in those from 2-6 years old
blast cells in the CSF
• more common in boys and in white
children, children with Down’s
syndrome or Fanconi syndrome
ASSESSMENT
• 1st symptoms: pallor, w-grade
fever, lethargy (symptoms of
anemia), petechiae and bleeding
from oral mucous membranes and
may bruise easily because of low
platelet count
• As spleen and liver enlarge due to
THERAPEUTIC MANAGEMENT
infiltration of abnormal cells,
abdominal pain, vomiting and • Up to 95% will have a first remission
anorexia occur but if a child experiences a relapse,
• As abnormal lymphocytes invade the chances of long-term survival are
bone periosteum, bone and joint pain reduced to 70%
• CNS invasion leads to headache or
unsteady gait Disease Classification and Prognosis
• B-lymphocyte involvement accounts
for 85% of instances of ALL
• 15% to 20% have T-lymphocyte cell
involvement
Cure as a Goal
• Induction phase of chemotherapy-
complete remission or absence of
leukemia cells
• Sanctuary or consolidation phase -
preventing leukemia cells from
invading or growing in the CNS
1
HEALTH PROBLEMS COMMON IN PRESCHOOLERS
MATERNAL AND CHILD HEALTH NURSING
L E C T U R E
• 3rd, administering delayed intensive MAINTENANCE AND MONITORING
therapy
• Maintenance phase-maintaining the • Standard maintenance therapy
original remission includes a combination of daily 6-
mercaptopurine, weekly
CHEMOTHERAPY IN CHILDREN methotrexate, and sporadice
vincristine and prednisone, and
It involves administration via central venous intrathecal methotrexate.
catheter or port to prevent irritation of vessel • This is continued for 2 to 3 years
walls; also they can be clamped or trapped • Leucovorin is usually given after
so the child ca be ambulatory between methotrexate to neutralize its action
treatments and protect normal cells from the
effect of the drug
• Blood values must be monitored at
least monthly
• Children who are free of the disease
for 4 years are considered cured and
their maintenance therapy can be
stopped
COMPLICATIONS:
• CNS involvement-blindness,
hydrocephalus, recurrent seizures,
nuchal rigidity, headache, irritability
• Renal Involvement- from invasion of
leukemia cells; kidneys enlarge and
function impaired
• Testicular Invasion- leukemic cells in
the testes will not be destroyed by
chemotherapy therefore irradiation is
done leading to sterility
Drugs: ACUTE MYELOID LEUKEMIA
• vincristine, • It involves the overproliferation of
• prednisone, granulocytes (neutrophils, basophils
• L- asparaginase, and eosinophils)
• doxorubicin and • Accounts for only 20% in childhood
• methotrexate leukemias
*****given over a period of about 1 • More frequent in late adolescence
month • Granulocytes grow so rapidly they
• Cell destruction due to chemotherapy are often forced out into the
results in increased uric acid levels bloodstream while still in the blast
which may destroy glomeruli and stage. It results in limited production
leads to loss of kidney function. To of RBC and platelets
prevent this, allopurinol is often
administered to reduce UA
production. Hydration also helps UA
excretion
• Intrathecal administration of drugs
may be included to bypass the blood-
brain barrier
2
HEALTH PROBLEMS COMMON IN PRESCHOOLERS
MATERNAL AND CHILD HEALTH NURSING
L E C T U R E
ASSESSMENT • Nephroblastomas distort the kidney
so that the tumor is felt as a firm,
• Same symptoms as ALL nontender abdominal mass
• Susceptible to infection (sometimes mistaken as hard stool
by the parents)
THERAPEUTIC MANAGEMENT • Fathers often discover the tumor
when they toss their child in the air
• BM aspiration and Biopsy; cells are and catch him or her by the abdomen,
typed to determine prognosis (M1 to and feel the mass.
M6) • Parents sometimes feel that the
• 1 to 2 months of Cytarabine and tumor grew overnight.
anthracycline (daunorubicin) to • It may manifest with hematuria and
achieve full remission low- grade fever
• During maintenance phase, • Hypertension may occur due to
additional chemotherapeutic agents excessive rennin production
like cyclophosphamide and 6- • Anemic due to lack of erythropoietin
thioguanine are used usually for 6 to formation by the diseased kidney
9 months • CT scan reveals the tumor and points
• Remission is difficult to achieve and of metastasis
is often brief • GFR, BUN tests are done to assess
• BM transplantation is recommended the kidney before the surgery
• DO NOT palpate the child’s abdomen
WILM’S TUMOR because handling appears to aid
metastasis
• Place a sign reading “No abdominal
palpation” over the child’s crib
WILM’S TUMOR / NEPHROBLASTOMA
A. Malignant cancer of the kidney;
usually unilateral; encapsulated at C. TREATMENT
the time of diagnosis 1. Nephrectomy
B. INCIDENCE: most frequent 2. Chemotherapy
abdominal tumor and most common 3. Radiation therapy
type of renal cancer; 1:200,000 to 4. Thoracotomy
250,000 children; peak – 3 years;
increased incidence among siblings - D. PROGNOSIS - better prognosis if no
→evidence of genetic inheritance metastasis and with younger age of
the child; among all childhood
cancers, highest survival rates
ASSESSMENT
ASTHMA
• Discovered early in life (6 months to
5 years), although it arises from an
• Immediate hypersensitivity (Type I)
embryonic structure present before
response and is the most common
birth
chronic illness in children
3
HEALTH PROBLEMS COMMON IN PRESCHOOLERS
MATERNAL AND CHILD HEALTH NURSING
L E C T U R E
• It tends to occur initially before 5
years of age
The condition may be intermittent,
with symptom-free periods, or
chronic, with continuous symptoms
• It tends to occur in children with atopy
or those hypersensitive to allergens.
• Mast cells release histamine and
leukotrienes that result in diffuse
obstructive and restrictive airway
disease because of a triad of • This causes the typical dyspnea and
inflammation, wheezing (sound caused by air
bronchoconstriction and forcibly pushed past obstructed
increased mucus production bronchioles) heard primarily upon
• Most are sensitive to: pollens, molds, expiration
house dust, cigarette smoke, cold • If the child coughs up mucus, it is
weather, irritating odors like usually white and has the shape of
turpentine or smog the bronchi from which it was
• Increased incidence in cold weather dislodged.
though some may experience the • Cyanosis, clubbing of fingers (for
symptoms all year long chronic cases)
• Aspirin can be a trigger • Tripod position to ease breathing
MECHANISM OF DISEASE HISTORY
• Bronchospasm, inflammation of • Include history of the attack, and ask
bronchial mucosa and increased parents to describe the home
bronchial secretions all act to reduce environment
the airway lumen, leading to
respiratory distress PHYSICAL ASSESSMENT
• Bronchial constriction is due to
stimulation of parasympathetic • Auscultate for wheezing
nervous system which initiates • Cyanosis and eosinophilia may be
smooth muscle constriction
present
ASSESSMENT • Pulmonary function studies
THERAPEUTIC MANAGEMENT
• After exposure to an allergen or
trigger, an episode begins with a dry
3 GOALS:
cough, often at night and
bronchoconstriction begins
• avoidance of allergen by
• Since bronchiole lumen are larger on
environmental control,
inspiration than on expiration, there is
• skin testing and
little difficulty in inhaling. They later
on develop difficulty exhaling due to • hyposensitization to identified
the narrow lumen and more so as allergens, and relief of symptoms by
mucus is produced causing plugging pharmacologic agents
4
HEALTH PROBLEMS COMMON IN PRESCHOOLERS
MATERNAL AND CHILD HEALTH NURSING
L E C T U R E
• Most are caused by gram-negative
• Cough suppressants are rods (usually E. coli)
contraindicated to prevent • Girls should be taught to wipe from
accumulation and formation of thick the front to back after voiding and
mucus plugs defecating to avoid contaminating the
• Inhaled anti-inflammatory urethra
corticosteroid such as fluticasone • Minimize use of feminine hygiene
(Flovent) daily sprays, bubble baths and hot tubs
• Long-acting bronchodilator at • Encourage voiding after sexual
bedtime in addition to inhaled anti- intercourse
inflammatory daily corticosteroid
• For severe and persistent asthma, ASSESSMENT
combination of oral and inhaled
corticosteroid daily Symptoms:
• Short-acting beta-2 agonist
bronchodilator such as albuterol or • pain on urination,
terbutaline to use if an attack should • frequency,
begin • burning
• Cromolyn sodium is a mast cell • hematuria, l
stabilizer is given by a nebulizer or • low-grade fever,
metered-dose inhaler to prevent • mild abdominal pain,
bronchoconstriction and prevent • enuresis
symptoms (not effective once **Urine for culture is obtained by a
symptoms have begun) clean-catch technique
• Leukotriene receptor antagonists
such as montelukast (Kastair, MANAGEMENT
Singulair) for prophylaxis and chronic
treatment of asthma in children over • Antibiotic therapy. Make sure to
6yo. Not effective in an attack. instruct the parents to complete the
• Encourage drinking of fluids during regimen to prevent recurrence
attack to prevent dehydration but • Increase fluid intake to flush out the
avoid milk and milk products because organisms
they thicken the mucus • Cranberry juice to acidify the urine
• Repeat clean-catch sample is
STATUS ASTHMATICUS obtained after 72 hours of antibiotic
therapy to assess effectiveness of
• It occurs when children fail to treatment
respond to medications during an
attack
• It is an extreme emergency because
a child may die of heart failure due to
a combination of exhaustion,
atelectasis and acidosis from
bronchial plugging
• It is managed by Oxygen therapy,
continuous nebulizing with beta-2
antagonist, IV corticosteroids and
careful monitoring
URINARY TRACT INFECTION
• It occurs more often in females as an
ascending infection from the
perineum because the urethra is
shorter in girls
