nancy pares, rn, msn metro community college. identify pathophysiology and nursing process of...

NURS 2410 Unit 6 and 7

Nancy Pares, RN, MSNMetro Community College

Identify pathophysiology and nursing process of selected sensory/neurological system alterations inclusive of:◦ Visual, hearing, retinoblastoma (covered in onco

unit), hydrocephalus, cerebral palsy, spina bifida, muscular dystrophies, spinal cord injuries and systemic lupus

Objective 1

Visual disorders◦ Myopia◦ Astigmatism◦ Strabismus◦ Amblyopia

Disorders of Eye

Visual disorders◦ Cataracts◦ Glaucoma◦ Retinoblastoma◦ Color blindness◦ Retinopathy of prematurity (ROP)

Disorders of Eye

Otitis media Otitis externa Hearing impairment

Disorders of Ear

Figure 24-2 Of the three anatomic differences in the eustachian tube between adults and small children (shorter, wider, more horizontal), which do you think could cause more problems for the child and why? Answer: More horizontal. Small children who are bottle fed in a supine position have a greater probability of developing otitis media because the eustachian tube opens when the child sucks and the horizontal angle provides easy access to the middle ear. In older children the greater angle helps keep foreign substances and germs away from the middle ear.

Epistaxis Nasopharyngitis Sinusitis Pharyngitis Tonsillitis

Disorders of Nose and Throat

20/20 by age 6 or 7 (visual acuity) Screening starts at well-child exams when

cooperative (screening timing and frequency)

Vision Screening

Infant in hospital◦ Screening timing and frequency◦ Many states mandate

Observation for cues to hearing Clinical manifestations

Hearing Screening

Chronic ear infections Chronic fluid/effusion Follow-up needed for hearing deficit

Risk Factors

Conjunctivitis◦ Bacterial

Antibiotic eye drops◦ Viral and allergic

Supportive care Periorbital cellulitis

◦ Oral or intravenous antibiotics

Abnormalities of Eyes

Other disorders◦ Multiple types of treatments based on etiology

Occlusion therapy Compensatory lenses Surgery Vision therapy

◦ Refer to eye specialist

Abnormalities of Eyes

Otitis media◦ Antibiotic usage◦ Supportive care

Abnormalities of Ears

Figure 24-7 Acute otitis media is characterized by abrupt onset, pain, middle ear effusion, and inflammation. Note the injected vessels and altered shape of cone of light. See Chapter 7for a normal tympanic membrane. Source: Courtesy of Kevin Kavanagh, MD, FACS.

Figure 24-8 Otitis media with effusion is noted on otoscopy by fluid line or air bubbles. Pneumatic otoscopy or tympanometry shows a nonmobile tympanic membrane. Note that the light reflex is not in the expected position due to a change in tympanic membrane shape from air bubbles. Where would you expect to see the light reflex? (See Chapter 7 for a description of normal findings.) Source: Courtesy of Kevin Kavanagh, MD, FACS.

Recurrent otitis media or effusion◦ ENT referral for possible tympanostomy tube

placement Otitis externa

◦ Antibiotic ear drops


Hearing loss◦ Sensorineural

Cochlear implant


Box 24-7 (continued) Cochlear Implants

Collaborative care includes antibiotics if bacterial in etiology◦ Nasopharyngitis◦ Pharyngitis◦ Tonsillitis

Tonsillectomy Criteria for surgery

◦ Sinusitis

Abnormalities of Nose and Throat

Primary intervention is prevention◦ ROP interventions and prevention strategies

Protective eyewear

Eye Abnormalities

Prevention focus◦ Decrease otitis media◦ Increase access to care◦ Increase frequency of hearing screens◦ Reduce noise-induced hearing loss

Ear Abnormalities

Prevention measures Education to prevent communicable

diseases Home care for common communicable

diseases Injury prevention Dental emergencies

◦ Tooth avulsion

Nose, Throat, and Mouth Abnormalities

Avoid triggers Long-term planning for chronic illness Maintain fluid balance Promote adequate and appropriate nutrition

Nursing Management of Systemic Lupus Erythematosus

Promote skin integrity Promote rest and comfort Emotional support Community activities and support groups

Nursing Management of Systemic Lupus Erythematosus

Plan care◦ Age and developmentally appropriate

Medication regimen◦ Education on importance of regimen◦ Education on side effects

Promotion of general health◦ Avoid infectious individuals

Collaborate with Family of a Child with Human Immunodeficiency Virus (HIV)

Promotion of growth and development◦ Proper food◦ Proper atmosphere, toys, friends

Emotional support◦ Caregiver◦ Child

Support groups

Collaborate with Family of a Child with Human Immunodeficiency Virus (HIV)

Increasingly common Children at risk for allergy Testing for latex allergy Latex allergy questionnaire

Latex Allergy

Alternative products Medical-alert ID bracelet Epinephrine kit at home and school Education of caregivers related to

hypersensitivity reactions◦ Preparation to provide care

Nursing Care for Child with Latex Allergy

Type I◦ Definition

Type II◦ Definition

Type III◦ Definition

Type IV◦ Definition

Hypersensitivity Reactions in Children

History Assessment

◦ Type I and Type II carry EpiPen

Nursing Management

Cranial bones are not completely ossified◦ Allows for brain growth

The posterior fontanel closes at 3-4 months The anterior fontanel closes at 18 months Increases risk for brain and spinal cord

injury

Neurological Anatomic Differences in Children

Figure 33-2 The skull and brain grow and develop rapidly during early childhood. Infants and young children are at higher risk for injury to the brain and spinal cord because of developing anatomic structures.

Levels of consciousness—most important indicator of neurological dysfunction

Consciousness—receptiveness to stimuli Alertness—arousal, ability to react Cognitive power—ability to process data

and respond Altered levels of consciousness

◦ Causes

Nursing Assessment of Altered Levels of Consciousness and Other Neurological Conditions

Levels of consciousness assessment◦ Categories: confusion, delirium, lethargy,

obtunded, stupor, and coma◦ Decorticate and decerebrate posturing


Figure 33-3 A, Decorticate posturing, characterized by rigid flexion, is associated with lesions above the brainstem in the corticospinal tracts.

Figure 33-3 (continued) B, Decerebrate posturing, distinguished by rigid extension, is associated with lesions of the brainstem.

Increased intracranial pressure ◦ Scales for responsiveness


Increased intracranial pressure ◦ Glasgow coma scale


Figure 33-4 Pupil findings in various neurological conditions with altered consciousness. A, A unilateral dilated and reactive pupil is associated with an intracranial mass. B, A fixed and dilated pupil may be a sign of impending brainstem herniation. C, Bilateral fixed and dilated pupils are associated with brainstem herniation from increased intracranial pressure.

An acute seizure that lasts over 30 minutes Electrolytes, glucose, blood gases,

temperature, and blood pressure need monitoring if a seizure occurs for longer than 10 minutes

Status Epilepticus

Maintain airway Ensure safety Administer medications Provide emotional support Provide education

Nursing Management for Seizures

Malformation of the spinal cord and canal Impaired physical mobility related to

neuromuscular impairment Impaired urinary elimination related to

sensory impairment Risk for latex allergy response related to

multiple surgical procedures

Myelodysplasia

Imbalance between production and absorption of CSF

Leads to increased CSF volume in brain Commonly associated with

myelomeningocele (spinal-fluid-filled sac protruding through vertebrae)

Treatment may include placement of a shunt

Hydrocephalus

Risk for infection related to the presence of shunt

Risk for caregiver role strain related to care of a child with a chronic condition

Risk for delayed development related to compression of brain tissue with excess cerebral spinal fluid

Nursing Diagnosis for Myelodysplasia and Hydrocephalus

Group of permanent disorders of movement and posture

Causes activity limitations Nonprogressive in nature May have additional sensory, cognition,

communication and behavior problems

Cerebral Palsy

Community care◦ Case manager◦ Early intervention◦ Financial needs◦ School assistance and IEP needed

Children with Cerebral Palsy

Figure 33-19 A child with cerebral palsy has abnormal muscle tone and lack of physical coordination.

Multidiscipline care◦ Orthopedic surgeon care◦ Speech therapy◦ Regular eye exams◦ Pediatric nurse practitioner or pediatrician◦ Support groups

Children with Cerebral Palsy

Traumatic brain injuries◦ Falls are a major cause◦ Primary vs. secondary◦ Cushing’s triad

Nursing management of mild vs. severe brain injury◦ Emergency care◦ Long-term care

Mild, Moderate, and Severe Brain Injury

Figure 33-20 Child having baclofen pump filled.

Explain the pathophysiology and nursing process of congenital defects of the musculoskeletal system inclusive of:◦ Cranial malformations, club foot,

kyphosis/scoliosis, hip dysplasia, Bone tumors covered in oncology (unit 7)

Objective 2

Child’s bones◦ More porous and pliable◦ Less dense

Infant skull◦ Fontanel closure: 18 months◦ Overall growth completion: 2 years

Child bone growth from epiphyseal plate

Musculoskeletal Differences

Muscles◦ Number same as adult◦ Only length and circumference grow

Ligaments and tendons◦ Stronger than bone until puberty

Musculoskeletal Differences

Figure 35-3 Skeletal and muscle development throughout childhood.

Figure 35-3 (continued) Skeletal and muscle development throughout childhood.

Feet and legs◦ Metatarsus adductus (intoeing)

Structural Deformities

Figure 35-4 Metatarsus adductus is characterized by convexity (curvature) of the lateral border of the foot. The child’s right foot demonstrates the disorder. Note that the forefoot turns inward and appears out of alignment with the remainder of the foot.

Feet and legs◦ Talipes equinovarus (clubfoot)


Figure 35-5 Parents of a child with clubfoot will have many questions. Can the condition be treated? Will the child be able to walk normally after surgery? Will they need help caring for the infant? How much will surgery and other care cost? Will any subsequent children have a clubfoot? Source: Modified from Staheli, L. T. (1992). Fundamentals of pediatric orthopedics (p. 5.10). New York: Raven Press.

Feet and legs◦ Genu valgum (knock-knees)◦ Genu varum (bowlegs)


Figure 35-8 A, Genu valgum, or knock-knees. Note that the ankles are far apart when the knees are together. B, Genu varum, or bowlegs. The legs are bowed so that the knees are far apart as the child stands.

Hip◦ Dysplasia◦ Legg-Calvé-Perthes◦ Slipped capital femoral epiphysis (SCFE)


Figure 35-9 The asymmetry of the gluteal and thigh fat folds is easy to see in this child with developmental dysplasia of the hip.

Figure 35-10 The most common treatment for DDH in a child under 3 months of age is a Pavlik harness. A shirt should be worn under the harness to prevent skin irritation (it was omitted for clarity in this photograph).

Figure 35-13 In slipped capital femoral epiphysis, the femoral head is displaced from the femoral neck at the proximal epiphyseal plate.

Spine◦ Scoliosis, kyphosis, lordosis◦ Torticollis


Figure 35-14 A child may have varying degrees of scoliosis. For mild forms, treatment will focus on strengthening and stretching. Moderate forms will require bracing. Severe forms may necessitate surgery and fusion. Clothes that fit at an angle, such as this teenage girl’s shorts, and anatomic asymmetry of the back provide clues for early detection.

Prevent complications of immobility Assist coping with treatment

◦ Support long-term adaptation Facilitate pain control

Deformities: Nursing Care

Bone infection Etiology: idiopathic or nosocomial

◦ Due to trauma, pins Symptoms

◦ Bone pain◦ Edema◦ Joint pain◦ Fever

Osteomyelitis

Skeletal tuberculosis◦ Pain, spasms, muscle atrophy◦ “Doughy” swelling over joints, limited mobility

Septic arthritis◦ Pain, fever, local inflammation, joint tenderness,

loss of spontaneous movement

Rarer Bone Infections

Figure 35-17 This boy from Kenya had surgery to correct severe kyphosis and scoliosis, caused by tuberculosis of the spine. A Risser cast has been applied to maintain stability of the spine and thoracic cage during healing. Notice the area cut out of the cast to allow for auscultation of the abdomen, as well as to facilitate the child’s comfort and adequate intake of food.

Pain relief Maintain joint mobility Prevent deformities Promote self-care Well-balanced diet Hydration Medication management

Nursing Management of Juvenile Arthritis

Achondroplasia◦ Short stature, prominent forehead

Marfan syndrome◦ Connective tissue disorder◦ Skeletal changes◦ Cardiac, respiratory, vision changes

Chronic Conditions

Osteogenesis imperfecta◦ Brittle-bone disease, collagen defect◦ Thin, soft skin; increased flexibility; short

stature;weak muscles; hearing loss

Chronic Conditions

Muscular dystrophies◦ Muscle degeneration and wasting◦ Early signs:weakness and hypotonia◦ Life-threatening

Chronic Conditions

Figure 35-18 Because the leg muscles of children with muscular dystrophy are weak, they must perform the Gowers maneuver to raise to a standing position. A and B, The child first maneuvers to a position supported by arms and legs.

Figure 35-18 (continued) Because the leg muscles of children with muscular dystrophy are weak, they must perform the Gowers maneuver to raise to a standing position. A and B, The child first maneuvers to a position supported by arms and legs.

Figure 35-18 (continued) Because the leg muscles of children with muscular dystrophy are weak, they must perform the Gowers maneuver to raise to a standing position. C, The child next pushes off the floor and rests one hand on the knee.

Figure 35-18 (continued) Because the leg muscles of children with muscular dystrophy are weak, they must perform the Gowers maneuver to raise to a standing position. D and E, The child then pushes himself upright.

Figure 35-19 This young boy with muscular dystrophy needs to receive tube feedings and home nursing care. He attends school when possible and is able to use an adapted computer.

Limit movement◦ Snug but do not impair circulation◦ No direct contact with skin◦ Assess neurovascular and skin status

Braces

Figure 35-15 In severe scoliosis, the child may wear a halo brace, shown here, to hold the body in position after surgery.

Figure 35-12 Although the Toronto brace used for treatment of Legg-Calvé-Perthes disease may seem formidable for a child to wear, you can see by this photograph that, as usual, children adapt quite well to it.

Prevention◦ Greater risk for children◦ Teach use of protective equipment, safe play

Types◦ Closed

Casting◦ Open

Surgery and casting

Fractures (review)

Describe pathophysiology and nursing process of inflammatory diseases of childhood◦ Meningitis, Reyes syndrome, tetanus, Kawasaki

disease

Objective 3

An inflammation of the meninges covering the brain and spinal cord

Caused by either viral or bacterial agents

Meningitis

Acute inflammation of the brain Symptoms include nuchal rigidity or

positive Kernig or Brudzinski Symptoms depend on the causative

organism

Encephalitis

Discuss the psychopathology and nursing process of alterations in the psycho-social functions of the childrearing period◦ Learning disabilities◦ ADHD◦ Mental health

Objective 4

Developmental and behavioral disorders◦ Pervasive developmental disorders◦ Nursing management

Stabilize environmental stimuli Provide supportive care Enhance communication Maintain a safe environment Provide anticipatory guidance

Nursing Management of Children and Adolescents with Mental Health Disorders

Attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD)◦ Nursing management

Administer medication Minimize environmental distractions Implement behavior management plans Provide emotional support Promote self-esteem


Attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD)◦ School issues


Suicide◦ Nursing management:

Safety 24-hour monitoring Medication Care in community


Effects up to 5 of school children Children do not process information

correctly

Learning Disabilities

Individual education plan (IEP)◦ Developed through an interdisciplinary approach◦ Specific goals are included

Learning Disabilities

Limitations in adaptive and intellectual functioning

Conditions associated:◦ Down syndrome◦ Fragile X syndrome◦ Fetal alcohol syndrome

Mental Retardation

Nursing management◦ Maintain safe environment◦ Provide assistance with adaptive functioning

Mental Retardation

Evaluation depends on needs and developmental level

First evaluation needs to assess the family’s understanding of the disorder

Mental Retardation

Discuss pathophysiology and nursing process associated with blood dyscrasias inclusive of:◦ Sickle cell anemia, iron deficiency anemia, von

willenbrand disease, thalassemias Objective 2

◦ Describe nursing process and procedure for pediatric blood transfusions (covered in NURS 2520)

Unit 7- Objective 1

Iron deficiency anemia◦ Lack of iron◦ Anemia of prematurity◦ Affects production of RBCs◦ RBCs appear hypochromic, decreased hemoglobin

synthesis

Anemia

Iron deficiency anemia◦ Manifestations based on severity

Pallor Fatigue Irritability Pica

Anemia

Normocytic anemia◦ Decreased number of RBCs◦ Normal size with pale center◦ Associated with multiple causes◦ Manifestations similar to iron deficiency anemia

Anemia

Sickle-cell anemia◦ Genetic mutation◦ Hemoglobin S replaces normal hemoglobin◦ RBCs lose doughnut shape, become sickleshaped

Anemia

Figure 28-4 Many of these red blood cells show an elongated crescent shape characteristic of sickle cell anemia.Source: Courtesy of Dr. Ed Wong, Laboratory Medicine, Children’s National Medical Center, Washington, DC.

Sickle-cell anemia◦ Manifestations appear in multiple body systems◦ Severity based on pathologic changes

Anemia

Figure 28-5 The etiology, pathophysiology, and disease process of sickle cell anemia.

Thalassemias◦ Groups of hereditary disorders◦ Hemoglobin synthesis abnormal◦ Range from mild to severe◦ Three types

Anemia

Thalassemias◦ Clinical manifestations based on type and severity

Pallor Fatigue Failure to thrive

◦ Severe anemia leads to chronic hypoxia

Anemia

Hereditary spherocytosis◦ Congenital hemolytic anemia◦ No abnormality of hemoglobin◦ Cells have unusual structure◦ Manifestations appear in neonatal period or

infancy◦ Severity varies

Anemia

Goals of Care◦ Adequate nutrition◦ Hydration and fluid balance◦ Promotion of adequate tissue perfusion◦ Promotion of growth and development◦ Family and patient education

Anemia

Failure of bone marrow to produce blood cells

Disorder is idiopathic or acquired Clinical presentation varies depending on

degree Most common is bleeding secondary to

thrombocytopenia

Aplastic Anemia

Hereditary bleeding disorder X-linked—expressed in males, females have

carrier status

Hemophilia

Manifestations range from mild to moderate to severe◦ Spontaneous bleeding◦ Hemarthrosis◦ Deep tissue hemorrhage◦ Nosebleeds◦ Hematuria◦ Easy bruising

Hemophilia

Autosomal dominant trait Equal expressivity in males and females Manifestations

◦ Easy bruising◦ Epistaxis

von Willebrand Disease

Disseminated intravascular coagulation (DIC)◦ Complication from another illness◦ Most common following infection in children◦ Manifestation range

Minor oozing Frank hemorrhage

Bleeding Disorders: Clotting Disorders

Idiopathic thrombocytopenic purpura (ITP)◦ Autoimmune disorder◦ After a viral illness


Idiopathic thrombocytopenic purpura (ITP)◦ Manifestations

Ecchymoses Petechiae Purpura Bleeding from gums Nosebleeds Blood in urine Blood in stools


HSP◦ Vasculitis

Raised purpuric lesions Joint pain Colicky abdominal pain GI bleeding Renal involvement


RBCs◦ Oxygenation◦ Circulation◦ Fluid◦ Nutrition◦ Pain management

Nursing Care of a Child with a Hematologic Disorder Is Based on the Disorder

WBCs◦ Infection◦ Oxygenation◦ Nutrition


Platelets and bleeding disorders◦ Bleeding◦ Oxygenation◦ Circulation◦ Injury prevention


Team approach Family involved

◦ Decisions with family and child

Collaborative Care Approach for a Child with a Hematologic Disorder

Discuss the pathophysiology and nursing process of pediatric oncology◦ Leukemia, Hodgkins disease, Wilm’s tumor

Objective 3

Therapy may be singular or combination of treatments◦ Surgery◦ Chemotherapy◦ Radiation◦ Biotherapy◦ HSCT◦ Complementary therapies◦ Palliative care

Clinical Therapy

Based on type of cancer and therapy◦ Infection control◦ Pain◦ Nutrition◦ Growth and development◦ Emotional needs◦ Spiritual needs

Nursing Care Plan

Metabolic◦ Tumor lysis syndrome◦ Septic shock◦ Hypercalcemia

Hematologic◦ Caused by bone marrow suppression◦ Require transfusion and careful RBC and WBC

assessment

Three Types of Oncological Emergencies

Space-occupying lesions: tumors with extensive growth◦ Spinal cord compression◦ Increased ICP◦ Brain herniation◦ Seizures


Space-occupying lesions: tumors with extensive growth◦ Hepatomegaly◦ Gastrointestinal obstruction◦ Cardiac and respiratory complications◦ SVC syndrome


Brain and central nervous system◦ Most common malignancy in children, next to

leukemia◦ Treatment depends on type and location of tumor◦ Surgery◦ Radiation◦ Chemotherapy

Solid Tumors

Figure 29-13 Approximately 1,700 children under the age of 14 years are diagnosed annually as having tumors of the brain and central nervous system. The four most common brain tumors in children are medulloblastoma, cerebral astrocytoma, ependymoma, and brainstem glioma.

Neuroblastoma◦ Definition◦ Treatment based on protocol

Surgical Chemotherapy Radiation HSCT

Solid Tumors

Wilms’ tumor◦ Define◦ Treatment based on stage

Requires surgical removal Radiation Chemotherapy

Solid Tumors

Table 29-8 (continued) National Wilms Tumor Study Staging System

Bone tumors (osteosarcomas)◦ Definition◦ Treatment

Surgery required Chemotherapy Radiation

Ewing’s sarcoma◦ Similar to osteosarcoma

Solid Tumors

Most commonly diagnosed malignancy in children under 14

Definition

Leukemia

Difficult due to multisystem effect Long period of treatment required Assessment complete and thorough

◦ Observe for signs of bleeding◦ Observe for signs of infection

Nursing Management

Monitor for toxic side effects of chemotherapy or tumor cell lysis◦ Renal function◦ Special attention for children on

cyclophosphamide

Nursing Management

Nutrition CNS infiltration Pain Bone marrow suppression

◦ Isolation and transmission precautions

Nursing Management

Education of family and child◦ Careful handwashing◦ Prevention of spread of infection◦ Oral care

Nursing Management

Hodgkin’s disease◦ Definition◦ Treatment based on staging

Outpatient setting Chemotherapy

Soft Tissue Tumors

Figure 29-16 Lymph nodes and organs affected in Hodgkin disease in children.

Non-Hodgkin lymphoma◦ Definition◦ Three types◦ Treatment tailored to stage

Stages I and II treat with drugs Stages III and IV treat with additional drugs and

longer period

Soft Tissue Tumors

Rhabdomyosarcoma◦ Definition◦ Locations◦ Treatment

Surgical when possible Widefield radiation Chemotherapy

Soft Tissue Tumors

Figure 29-17 Rhabdomyosarcoma is characterized by ptosis and swelling. Source: From Vaughn, D., Asbury, T., & Riordan-Eva, P. (1995). General opthalmology (14th ed.). Norwalk, CT: Appleton & Lange.

Retinoblastoma◦ Definition◦ Treatment

Radiation almost always used Chemotherapy sometimes used, but often ineffective Removal of eye if other treatment fails

Soft Tissue Tumors

Figure 29-18 Retinoblastoma is characterized by leukokoria, a white reflection in the pupil. Source: From Hathaway, W. E., Hay, W. W., Jr., Groothuis, J. R., & Paisley, J. W. (1993). Current pediatric diagnosis and treatment (11th ed.). Norwalk, CT: Appleton & Lange.

Similar to other cancers Physiologic assessment Psychosocial assessment Collaboration with family Collaboration with medical team Intervention based on assessment and side

effects of therapy

Nursing Management

Cancer affects all areas of function Effects of therapy

◦ Surgery External and internal body changes

◦ Radiation Long-term effects Growth Secondary cancers

Psychological and Physiological Problems of Cancer Survival

Effects of therapy◦ Chemotherapy

Effects immediate May present years later


Long-term planning◦ Family stressors

Questions regarding outcomes Financial concerns

◦ Frequent follow-up Physical Physiological Developmental Cognitive Interventions started as soon as deficit noted


Team members◦ Nurses◦ Primary and specialty care providers◦ Social workers◦ Case managers◦ Child life therapist◦ Psychologist

Collaboration to Provide Family-Centered Care

For the school-age child◦ Encourage maintenance of learning◦ Involvement of school appropriate with

permission Spiritual and emotional needs

◦ Encourage participation in support groups

Collaboration to Provide Family-Centered Care

Treatment for disorders unresponsive to other therapy

Pretransplant phase◦ Total body irradiation◦ Strict isolation

Transplant phase◦ Intravenous transfusion of donor stem cells◦ Transplant starts to grow in 2 to 4 weeks

Hematopoietic Stem Cell Transplant (HSCT)

Posttransplant phase◦ Lasts several weeks◦ Major risk is infection◦ Immunosuppressive agents prevent graftversus-

host disease


Nursing care◦ Prevent infections◦ Injury prevention◦ Growth and development◦ Nutrition◦ Physical activity limits◦ Oral health◦ Mental and spiritual health◦ Family and social relationships


nancy pares, rn, msn metro community college. identify pathophysiology and nursing process of...

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