6-health problems common in preschooler

7/31/2019 6-Health Problems Common in Preschooler

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Leukemia

Wilm’s Tumor

(Nephroblastoma)

Asthma

Urinary Tract Infection (UTI)



Acute Lymphocytic (lumphoblastic)leukemia

Is a disorder of white blood cells

Is the distorted and uncontrolledproliferation of white blood cells

Frequently occurring type of cancer inchildren accounts to 75% of leukemias

Slightly higher in boys than in girls



The malignant cell involved is thelymphoblast (immature lymphocyte)

Rapid proliferation of lymphocytes,the production of RBC and plateletsfalls, and invasion of body organs by

the rapidly increasing WBC elementsbegins

Abnormally proliferating cells are so

immature, they may be identifiableonly at the immature “blast cell” or

“stem cell” stage



Unknown

Radiation

Exposure to chemicals

Genetic factors

Children with Down Syndrome

A twin with leukemia



First symptoms: pallor, low grade fever, andlethargy

Petechiae and bleeding from oral mucous

membranes, may bruise easily Spleenomegaly and hepatomegaly (due to

infiltration of abnormal cells

Abdominal pain

Vomiting

Anorexia

Bone and joint pain (invasion of lymphocytes tobone periosteum)

Headache and unsteady gait ( invasion in the CNS)



Painless, generalized lymphadenopathy,(submaxillary or cervical nodes)

Laboratory studies: normal or slightly

decrease but includes very immature blastcells, low platelet and hematocrit, normalsize and color of RBC (normocytic andnormochromic)

Bone marrow aspiration (iliac crest) Radiograph of the long bone (reveal lesions Lumbar puncture (presence of blast cells in

the CSF)



Induction Phase – (Chemotherapy program)achieving a complete remission or absence ofleukemia cells

Sanctuary or Consolidation Phase – preventing leukemia cells from invading orgrowing in the CNS

Administering delayed intensive therapy

Maintenance Phase – maintaining the originalremission



Vincristine

Prednisone

L-asparaginase

Doxorubicin

Methotrexate

Allopurinol – for increase uric acid

Given over a period of 1 month



Induction Phase – vincristine, prednisone, L-asparaginase, doxorubicin and methotrexate(given over a period of 1 month) Give allopurinol

Sanctuary or Consolidation Phase - Intrathecal administration – injection of drugs

into the CSF by LP (methotrexate and oraladministration of 6-mercaptopurine

- Cranial Radiation

Third Phase – chemotherapeutic agents pluscyclophosphamide, cytosine arabinoside (ARA-C)

or 6-thioguanine



Maintenance chemotherapy – aims to eliminatecompletely any remaining leukemic cells

Immune system can complete the eradication

Combination include a combination of 6-mercaptopurine, weekly methotrexate

Continued for 2-3 years

Leucovorin – given after systemic methotrexate to

neutralize its action and protect normal cells from theeffect of the drug

Monitored the child’s blood values once a month

Blood transfusion if needed



Bone marrow transplantation orimmunotherapy – for not responding

children



CNS disorders - blindness, hydrocephalus,and recurrent seizures, nuchal rigidity,

headache, irritability, vomiting andpapilledema

Renal disorders - enlarge kidney

Reproductive system disorder --sterilization



Risk for infection r/t nonfunctioning WBC andimmunosuppressive effects of therapy

- prophylactic antibiotics

- limit visitorsRisk for deficient fluid volume r/t increasechance of hemorrhage from poor platelet

Production- digital pressure (Gelfoam soaked intopical thrombin), postnasal packing,transfusion,



Pain r/t invasion of leukocytes

-assess pain using a standard scale for accuracy

- handled legs and arms gently- used alternating mattress deviceunderneath body joints

- give analgesia

Ineffective health maintenance r/t long term therapy forleukemia

- allowed normal activity and should attend regularschool

- encourage parents to report propmtly any signs

of infection so that antibiotic will be given early- follow up visits

- great deal of support to the child



A malignant tumor that rises from themetanephric mesoderm cells of the upper poleof the kidney

It accounts to 20% of solid tumor in children

Occurs in association of congenital anomalies(aniridia, cryptorchidism, hypospadias,

pseudohermaphrodism, cystic kidneys,hemangioma, and talipes disorders)

Metastatic to the lungs, regional lymph nodes,

liver, bone and brain



STAGE DESCRIPTION

ITumor confined to the kidney and completely removedsurgically

II Tumor extending beyond the kidney but completelyremoved surgically

III Regional spread of disease beyond the kidney with

residual abdominal disease postoperatively

IV Metastases to lungs, liver, bone, distant lymph nodesor other distant sites

V Bilateral disease



Nephroblastomas distort the kidneyanteriorly – tumor is felt as firm, nontender

abdominal mass Hematuria and low grade fever

Hypertension – excessive renin production

Anemic –

lack of erythropoietin formation Ct scan and sonogram – primary tumor

NO ABDOMINAL PALPATION!!!



Nephrectomy – removal of tumor byexcision of the affected kidney

Radiation therapy Chemotherapy

Second surgical procedure – for

remaining tumor in the kidney



Small and large bowel obstruction from fibroticscarring and hepatic damage from radiation

Nephritis Sterility – due to radiation to reproductive

organ

Interstitial pneumonia – radiation to the lungs

Scoliosis – radiation to the spine



An immediate hypersensitivity response Most common chronic illness in children

Tends to occur after exposure to

allergens(pollen, house dust, molds, andfoods, cold air, irritating odors, cigarettesmoke)

Mast cells release histamine andleukotrienes that results obstructive andrestrictive airway disease



Triad of asthma: inflammation,bronchoconstriction, and increasedmucus production

Occurs initially before 5 years of age

Intermittent with symptom free periods orchronic with continuous symptoms

Increase incidence if parent has asthma



Dry cough often at night –

bronchoconstriction begins Difficulty exhaling

Wheezing and dyspnea - narrowed lumen of the inflamedbronchioles filled with mucus. Air pushed forcibly to theobstructed bronchioles

Copious mucus containing white casts bearing the shape ofthe bronchi from which it was dislodge

Cyanosis Elevated eosinophil counts Decrease oxygen saturation Feels frightening Shield-like or barrel chest Clubbing of the fingers – growth of excess capillaries

initiated when oxygen deprivation is sensed in distal parts



Fear r/t sudden onset of asthma attack

Health seeking behaviors r/t prevention

of and treatment of acute asthma attack;child demonstrate breathing exercise,use of inhaler and peak expiratory flow

rate



3 goals of allergic disorders:

> avoidance of the allergens by environmentalcontrol

> skin testing and hyposensitization- to identifythe allergen

> relief of symptoms by pharmacological

agents (oral and inhaled anti-inflammatorycorticosteroids, short acting and long-actingbronchodilator, leukotriene receptorantagonist,)



Encourage to drink fluids, avoid milk/milkproducts – cause thick mucus anddifficulty swallowing

Emergency setting: an intravemous linewill be inserted for continuous fluidtherapy and a route for emergency drugadministration



Occurs often in females than in males

Most common pathogens is gram-negative rods; E.coli

Also are a common cause of nosocomial

or health care acquired infections



Infection confined to the bladder (cystitis)

>Low-grade fever, Mild abdominal pain,

enuresis

Pyelonephritis

> high fever, abdominal/flank pain,vomiting and malaise



Urine Culture

Supra-pubic aspiration

Catheterization

Urinalysis (proteinuria, hematuria) Preand Post antibiotic therapy

Presence of RBC and WBC causes theurine to be more alkaline



Oral administration of antibiotic specificto the causative agent

Drink large quantity of fluid Cranberry juice – effective in acidifying

urine

Sits in a bath tub or warm water and voidinto the water

Mild analgesic



Leukemia is cancer of the bone marrow,the stuff in the center of our bones that

makes the three kinds of blood cells. Redblood cells carry oxygen to your body,white blood cells fight infection, andplatelets help your blood to clot. Part ofthe white blood cell is called alymphocyte.



> Fever

> Anemia or pale appearance

> Weight loss

> Abnormal bruising, especially in places wherechildren wouldn't normally "bump"themselves, like on the trunk

> Bone pain, especially if your child startscomplaining that his legs hurt too much to walk andwants to be carried everywhere



with leukemia during a routine screening.For example, a blood test at a regular

checkup uncovers anemia, and thedoctor decides to investigate the cause.More often, though, persistent parentswhose child is simply not getting betterlead the pediatrician to do the necessarytests.



Thank you!!!

6-health problems common in preschooler

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