HEALTH PROBLEMS COMMON IN PRESCHOOLERS

Leukemia Wilms Tumor (Nephroblastoma) Asthma Urinary Tract Infection (UTI)

Leukemia
Acute Lymphocytic (lumphoblastic) leukemia Is a disorder of white blood cells Is the distorted and uncontrolled proliferation of white blood cells Frequently occurring type of cancer in children accounts to 75% of leukemias Slightly higher in boys than in girls

 The malignant cell involved is the lymphoblast (immature lymphocyte) Rapid proliferation of lymphocytes, the production of RBC and platelets falls, and invasion of body organs by the rapidly increasing WBC elements begins Abnormally proliferating cells are so immature, they may be identifiable only at the immature blast cell or stem cell stage

Contributing Factors:
Unknown Radiation Exposure to chemicals Genetic factors Children with Down Syndrome A twin with leukemia

Assessment
First symptoms: pallor, low grade fever, and lethargy 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 to bone periosteum) Headache and unsteady gait ( invasion in the CNS)

Physical Assessment
Painless, generalized lymphadenopathy, (submaxillary or cervical nodes) Laboratory studies: normal or slightly decrease but includes very immature blast cells, low platelet and hematocrit, normal size and color of RBC (normocytic and normochromic) Bone marrow aspiration (iliac crest) Radiograph of the long bone (reveal lesions Lumbar puncture (presence of blast cells in the CSF)

Therapeutic Management
Induction Phase (Chemotherapy program) achieving a complete remission or absence of leukemia cells Sanctuary or Consolidation Phase preventing leukemia cells from invading or growing in the CNS Administering delayed intensive therapy Maintenance Phase maintaining the original remission

Chemotherapeutic Agents
Vincristine Prednisone L-asparaginase Doxorubicin Methotrexate Allopurinol for increase uric acid Given over a period of 1 month

Therapeutic MAnagement
Induction Phase vincristine, prednisone, Lasparaginase, 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 oral administration of 6-mercaptopurine - Cranial Radiation
Third Phase chemotherapeutic agents plus cyclophosphamide, cytosine arabinoside (ARA-C) or 6-thioguanine

Maintaining and MOnitoring

Maintenance chemotherapy aims to eliminate completely any remaining leukemic cells Immune system can complete the eradication Combination include a combination of 6mercaptopurine, weekly methotrexate Continued for 2-3 years Leucovorin given after systemic methotrexate to neutralize its action and protect normal cells from the effect of the drug Monitored the childs blood values once a month Blood transfusion if needed

 Bone marrow transplantation or immunotherapy for not responding children

Complications
CNS disorders - blindness, hydrocephalus, and recurrent seizures, nuchal rigidity, headache, irritability, vomiting and papilledema Renal disorders - enlarge kidney Reproductive system disorder -sterilization

Nursing Diagnoses and related interventions

Risk for infection r/t nonfunctioning WBC and immunosuppressive effects of therapy - prophylactic antibiotics - limit visitors Risk for deficient fluid volume r/t increase chance of hemorrhage from poor platelet Production - digital pressure (Gelfoam soaked in topical 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 device underneath body joints - give analgesia Ineffective health maintenance r/t long term therapy for leukemia - allowed normal activity and should attend regular school - 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

Wilms Tumor
A malignant tumor that rises from the metanephric mesoderm cells of the upper pole of 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

Staging Nephroblastoma (Wilms Tumor)

STAGE I II III IV V DESCRIPTION
Tumor confined to the kidney and completely removed surgically Tumor extending beyond the kidney but completely removed surgically Regional spread of disease beyond the kidney with residual abdominal disease postoperatively Metastases to lungs, liver, bone, distant lymph nodes or other distant sites Bilateral disease

Assessment
Nephroblastomas distort the kidney anteriorly 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!!!

Therapeutic MAnagement
Nephrectomy removal of tumor by excision of the affected kidney Radiation therapy Chemotherapy Second surgical procedure for remaining tumor in the kidney

Complications
Small and large bowel obstruction from fibrotic scarring and hepatic damage from radiation Nephritis Sterility due to radiation to reproductive organ Interstitial pneumonia radiation to the lungs Scoliosis radiation to the spine

Asthma
An immediate hypersensitivity response Most common chronic illness in children Tends to occur after exposure to allergens(pollen, house dust, molds, and foods, cold air, irritating odors, cigarette smoke) Mast cells release histamine and leukotrienes that results obstructive and restrictive airway disease

 Triad of asthma: inflammation, bronchoconstriction, and increased mucus production Occurs initially before 5 years of age Intermittent with symptom free periods or chronic with continuous symptoms Increase incidence if parent has asthma

Mechanism of the Disease

Affects the small airways and involves three separate process:
1. bronchospasm - occurs due to stimulation of the parasympathetic nervous system 2. inflammation of the bronchial mucosa and increased bronchial secretions - mast cell activation to release leukotreines, histamine and prostaglandins >All three acts to reduced the size of the airway lumen, leading to acute respiratory distress

Assessment
Dry cough often at night bronchoconstriction begins Difficulty exhaling Wheezing and dyspnea - narrowed lumen of the inflamed bronchioles filled with mucus. Air pushed forcibly to the obstructed bronchioles Copious mucus containing white casts bearing the shape of the 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

Nursing Diagnoses and Related Interventions

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

Therapeutic MAnagement
3 goals of allergic disorders: > avoidance of the allergens by environmental control > skin testing and hyposensitization- to identify the allergen > relief of symptoms by pharmacological agents (oral and inhaled anti-inflammatory corticosteroids, short acting and long-acting bronchodilator, leukotriene receptor antagonist,)

 Encourage to drink fluids, avoid milk/milk products cause thick mucus and difficulty swallowing Emergency setting: an intravemous line will be inserted for continuous fluid therapy and a route for emergency drug administration

Urinary Tract Infection

Occurs often in females than in males Most common pathogens is gramnegative rods; E.coli Also are a common cause of nosocomial or health care acquired infections

Assessment
Infection confined to the bladder (cystitis) >Low-grade fever, Mild abdominal pain, enuresis
Pyelonephritis > high fever, abdominal/flank pain, vomiting and malaise

Laboratory Studies
Urine Culture Supra-pubic aspiration Catheterization Urinalysis (proteinuria, hematuria) Pre and Post antibiotic therapy Presence of RBC and WBC causes the urine to be more alkaline

Therapeutic Management
Oral administration of antibiotic specific to the causative agent Drink large quantity of fluid Cranberry juice effective in acidifying urine Sits in a bath tub or warm water and void into the water Mild analgesic

LEUKEMIA

LEUKEMIA
Leukemia is cancer of the bone marrow, the stuff in the center of our bones that makes the three kinds of blood cells. Red blood cells carry oxygen to your body, white blood cells fight infection, and platelets help your blood to clot. Part of the white blood cell is called a lymphocyte.

Clinical Manifestations
> Fever
> Anemia or pale appearance > Weight loss > Abnormal bruising, especially in places where children wouldn't normally "bump" themselves, like on the trunk

> Bone pain, especially if your child starts complaining that his legs hurt too much to walk and wants to be carried everywhere

Clinical Manifestations
with leukemia during a routine screening. For example, a blood test at a regular checkup uncovers anemia, and the doctor decides to investigate the cause. More often, though, persistent parents whose child is simply not getting better lead the pediatrician to do the necessary tests.

Thank you!!!