Sample Answer for NURS 6501 Knowledge Check Pediatrics Included After Question
Pediatric disorders can present unique challenges to patients, families, and healthcare providers. Disorders in these areas are complicated by the fact that young patients can have difficulties communicating symptoms. Furthermore, the manner in which disease and disorders manifest in children may be unique.
APRNs working to support these patients and their loved ones must demonstrate not only support and compassion, but expertise to communicate and guide understanding of diagnoses and treatment plans. This includes an understanding of disease and disorders at the pediatric level.
This week, you examine pathophysiology in pediatrics. You apply key terms, concepts, and principles in this area to demonstrate an understanding of the impact they have on altered physiology in children.
NURS 6501 Knowledge Check Pediatrics
Learning Objectives
Students will:
Analyze concepts and principles of pathophysiology across the lifespan
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
Chapter 14: Cancer in Children, including Summary Review
Chapter 20: Alterations of Neurologic Function in Children (stop at Childhood tumors); Summary Review
Chapter 34: Alterations of Cardiovascular Function in Children (stop at Defects decreasing pulmonary blood flow); Summary Review
Chapter 37: Alterations of Pulmonary Function in Children (stop at Congenital malformations); Summary Review
Chapter 40: Alterations of Renal and Urinary Tract Function in Children, including Summary Review
Chapter 43: Alterations of Digestive Function in Children, including Summary Review
Chapter 46: Alterations of Musculoskeletal Function in Children (stop at Avascular diseases); (start at Cerebral palsy) (musculoskeletal tumors in children); Summary Review
Chapter 48: Alterations of the Integument in Children, including Summary Review
Chapter 50: Shock, Multiple Organ Dysfunction Syndrome, and Burns in Children, including Summary Review
Dr. Tara Harris reviews the structure of Module 8 as well as the expectations for the module. Consider how you will manage your time as you review your media and Learning Resources throughout the module to prepare for your Knowledge Check and your Final Exam. (3m)
Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children
In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapter 20, 34, 37, 40, 43, and 46 that relate to alterations in hematological function in children. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at https://evolve.elsevier.com/
Knowledge Check: Pediatrics
In this exercise, you will complete a 5-essay type question Knowledge Check to gauge your understanding of this module’s content.
Possible topics covered in this Knowledge Check include:
Growth and development
Normal growth patterns
Scoliosis (ortho)
Kawasaki
Alterations in children
Congenital (heart syndrome)
PDAs
Sudden Infant Death Syndrome (SIDS)
Asthma
Lead poisoning and effects on neurological functioning
Sickle cell
Hemophilia
Photo Credit: laflor / E+ / Getty Images
(Note: It is strongly recommended that you take the Knowledge Check at least 48 hours before taking the Final Exam.)
Complete the Knowledge Check By Day 5 of Week 11
To complete this Knowledge Check:
Module 8 Knowledge Check
A Sample Answer For the Assignment: NURS 6501 Knowledge Check Pediatrics
Title: NURS 6501 Knowledge Check Pediatrics
Question 1
4 out of 4 points
Scenario 1: Acute Lymphoblastic Leukemia (ALL)
An 11-year-old boy is brought to the clinic by his parents who states that the boy has not been eating and listless. The mother also notes that he has been easily bruising without trauma as he says he is too tired to go out and play. He says his bones hurt sometimes. Mother states the child has had intermittent fevers that respond to acetaminophen.
Maternal history negative for pre, intra, or post-partum problems.
PE: reveals a thin, very pale child who has bruises on his arms and legs in no particular pattern.
LABS: CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%, and platelet count of 80,000/mm3. The CMP demonstrated a blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9 mg/dl.
DIAGNOSIS: acute leukemia and renal failure and immediately refers the patient to the Emergency Room where a pediatric hematologist has been consulted and is waiting for the boy and his parents.
CONFIRMED DX: acute lymphoblastic leukemia (ALL) was made after extensive testing.
Question
1.Explain what ALL is?
Selected Answer:
Acute lymphocytic leukemia (ALL) is also called acute lymphoblastic leukemia. Acute means that leukemia can progress quickly and, if not treated, would probably be fatal within a few months. Lymphocytic means it develops from immature forms of lymphocytes, a type of white blood cell. ALL is a malignant, clonal disease of the bone marrow in which early lymphoid precursors proliferate and replace the normal hematopoietic cells of the marrow. In most cases, the leukemia cells invade the blood quickly. They can also sometimes spread to other parts of the body, including the lymph nodes, liver, spleen, central nervous system, and testicles (in males). Acute lymphocytic leukemia is the most common type of cancer in children, and treatments result in a good chance of a cure. Acute lymphocytic leukemia can also occur in adults, though the chance of a cure is greatly reduced. Signs and symptoms of acute lymphocytic leukemia may include: bleeding from the gums, bone pain, fever, frequent infections, frequent or severe nosebleeds, lumps caused by swollen lymph nodes in and around the neck, armpits, abdomen or groin, pale skin, shortness of breath, weakness, fatigue or a general decrease in energy.
Correct Answer:
Acute lymphoblastic leukemia (ALL) is a malignant (clonal) disease of the bone marrow in which early lymphoid precursors proliferate and replace the normal hematopoietic cells of the marrow. ALL is the most common type of cancer and leukemia in children in the United States. The malignant cells of acute lymphoblastic leukemia (ALL) are lymphoid precursor cells (ie, lymphoblasts) that are arrested in an early stage of development. This arrest is caused by an abnormal expression of genes, often as a result of chromosomal translocations or abnormalities of chromosome number. These aberrant lymphoblasts proliferate, reducing the number of the normal marrow elements that produce other blood cell lines (red blood cells, platelets, and neutrophils). Consequently, anemia, thrombocytopenia, and neutropenia occur, although typically to a lesser degree than is seen in acute myeloid leukemia. Lymphoblasts can also infiltrate outside the marrow, particularly in the liver, spleen, and lymph nodes, resulting in enlargement of the latter organs.
Response Feedback:
[None Given]
Question 2
4 out of 4 points
Scenario 1: Acute Lymphoblastic Leukemia (ALL)
An 11-year-old boy is brought to the clinic by his parents who states that the boy has not been eating and listless. The mother also notes that he has been easily bruising without trauma as he says he is too tired to go out and play. He says his bones hurt sometimes. Mother states the child has had intermittent fevers that respond to acetaminophen.
Maternal history negative for pre, intra, or post-partum problems.
PE: reveals a thin, very pale child who has bruises on his arms and legs in no particular pattern.
LABS: CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%, and platelet count of 80,000/mm3. The CMP demonstrated a blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9 mg/dl.
DIAGNOSIS: acute leukemia and renal failure and immediately refers the patient to the Emergency Room where a pediatric hematologist has been consulted and is waiting for the boy and his parents.
CONFIRMED DX: acute lymphoblastic leukemia (ALL) was made after extensive testing.
Question
1.Why does ARF occur in some patients with ALL?
Selected Answer:
Renal injury in ALL is common and can occur through many different mechanisms, including prerenal acute kidney injury, acute tubular necrosis, reno-vascular disease, obstruction, glomerulonephritis, and parenchymal infiltration of tumor cells. Although renal involvement is not uncommon in ALL, renal failure is rarely a presenting symptom in ALL and is thought to be a poor prognosis indicator. Leukemic may lead to significant impairment of renal function if it is bilateral and diffuse, particularly involving the cortical region. Acute renal failure in patients with acute leukemia is usually a consequence of a chemotherapeutic regimen, leading to tumor lysis syndrome—the tumor lysis syndrome results in acute uric acid and calcium phosphate nephropathy. The most common form of kidney injury in leukemia is related to prerenal AKI in the setting of volume depletion. When infiltration is suspected, kidney biopsy is typically recommended as the extent of infiltration can give prognostic information regarding the malignancy as the rate of infiltration parallels the stage and grade of the disease
Correct Answer:
Renal failure as a result of hyperuricemia can be associated with ALL, particularly at diagnosis or during active treatment. Uric levels rise as an end product of purine metabolism from cellular destruction. Because the major excretory pathway is through the kidneys, urates can precipitate
Response Feedback:
[None Given]
Question 3
4 out of 4 points
Scenario 2: Sickle Cell Disease (SCD)
A 15-year-old male with known sickle cell disease (SCD) present to the ER in sickle cell crisis. The patient is crying with pain and states this is the third acute episode he has had in the last 10-months. Both parents are present and appear very anxious and teary eyed. A diagnosis of acute sickle cell crisis was made.
Question
1.Explain the pathophysiology of acute SCD crisis. Why is pain the predominate feature of acute crises?
Selected Answer:
The term “sickle cell crisis” describes several acute conditions such as the vaso- occlusive crisis (acute painful crisis), aplastic crisis, splenic sequestration crisis, hyperhemolytic crisis, hepatic crisis, dactylitis, and acute chest syndrome. Sickle cell disease is an autosomal recessive disorder of a gene mutation. On chromosome 11, nucleotide mutation substitutes glutamic acid for valine at position six on the beta-globin subunit. A sickle cell crisis occurs when sickle-shaped red blood cells clump together and block small blood vessels that carry blood to certain organs, muscles, and bones. This causes mild to severe pain. The pain can last from hours to days. “Painful event” and “painful crisis” are other terms used to describe these episodes. Some people with sickle cell disease have many painful events, while others have few or none. The pain can happen in any part of the body. Nevertheless, the most common areas include the: bones of the spine, arms, and legs; chest; and abdomen. Inflammatory mediators such as plasma cytokines lead to a pro-inflammatory state, causing further complications of vaso-occlusion. It is postulated that the intestinal microbiome may be a potential trigger for the vaso-occlusive crisis. While some triggers (cold temperature, dehydration, low humidity, stress) for pain are identifiable, most episodes do not have an identifiable cause.
A 15-year-old male with known sickle cell disease (SCD) present to the ER in sickle cell crisis. The patient is crying with pain and states this is the third acute episode he has had in the last 10-months. Both parents are present and appear very anxious and teary eyed. A diagnosis of acute sickle cell crisis was made.
Question
1.Discuss the genetic basis for SCD.
Selected Answer:
Sickle Cell Disease is inherited and involves an autosomal recessive pattern which means both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition carry one copy of the mutated gene, but they typically do not show signs and symptoms. Hemoglobin (Hb), a gene that determines how red blood cells are made and how they work, is inherited from both parents. Each birth parent provides one hemoglobin (Hb) gene. Normal hemoglobin is called HbA. HbS is a change to the normal Hb gene. An abnormal HbS gene causes red blood cells to become sickle-shaped, limiting the amount of oxygen the red blood cells can carry through the body.
8-month infant is brought into the office due to a swollen right knee and excessive bruising. The parents have noticed bruising about a month ago but thought the bruising was due to the attempts to crawl. They became concerned when the baby woke up with a swollen knee. Infant up to date on all immunizations, has not had any medical problems since birth and has met all developmental milestones.
FH: negative for any history of bleeding disorders or other major genetic diseases.
PE: within normal limits except for obvious bruising on the extremities and right knee. Knee is swollen but no warmth appreciated. Range of motion of knee limited due to the swelling.
DIAGNOSIS: hemophilia A.
Question
1.What is the pathophysiology of Hemophilia
Selected Answer:
Hemophilia is the most prevalent severe hereditary bleeding disorder and is characterized by the inability to form thrombi in response to injury, resulting in continuous bleeding. Both hemophilia A and B result from mutations in the F8 gene and F9 gene. Changes or mutations of the genes result in deficiency or dysfunction of clotting factors VIII and IX, respectively. Specifically, “inversions in introns 1 and 22 of the factor VIII gene are the most frequently observed mutations and account for most severe cases of hemophilia A” . Another type of mutation that may result in hemophilia is a point mutation. In this instance, a single nucleotide in the DNA is added, deleted, or changed. When these alterations take place, the amino acid chain is typically destroyed. Otherwise, the protein chain can disrupt protein function, inhibit intracellular processing, or result in protein clearance.
A Sample Answer 2 For the Assignment: NURS 6501 Knowledge Check Pediatrics
Title: NURS 6501 Knowledge Check Pediatrics
Scenario 1: Acute Lymphoblastic Leukemia (ALL)
An 11-year-old boy is brought to the clinic by his parents who states that the boy has not been eating and listless. The mother also notes that he has been easily bruising without trauma as he says he is too tired to go out and play. He says his bones hurt sometimes. Mother states the child has had intermittent fevers that respond to acetaminophen.
Maternal history negative for pre, intra, or post-partum problems.
PE: reveals a thin, very pale child who has bruises on his arms and legs in no particular pattern.
LABS: CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%, and platelet count of 80,000/mm3. The CMP demonstrated a blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9 mg/dl.
DIAGNOSIS: acute leukemia and renal failure and immediately refers the patient to the Emergency Room where a pediatric hematologist has been consulted and is waiting for the boy and his parents.
CONFIRMED DX: acute lymphoblastic leukemia (ALL) was made after extensive testing.
Question
Explain what ALL is?
Your Answer:
Acute Lymphoblastic Leukemia (ALL) is a type of cancer that primarily affects the blood and bone marrow. It is characterized by the uncontrolled proliferation of immature white blood cells, specifically lymphoblasts, which are a type of white blood cell involved in the immune system. In a healthy individual, these cells mature into different types of lymphocytes that play crucial roles in defending the body against infections.
In ALL, the abnormal lymphoblasts accumulate in the bone marrow, interfering with the production of normal blood cells, including red blood cells, white blood cells, and platelets. As a result, the bone marrow becomes overcrowded with cancerous cells, leading to a decrease in the production of healthy blood cells.
The symptoms described in the scenario, such as fatigue, paleness, bruising, bone pain, and fever, are common manifestations of ALL. The reduced number of red blood cells (anemia) leads to fatigue and pallor, while the decreased platelet count contributes to easy bruising and bleeding. The bone pain could be a result of the overcrowding of the bone marrow with cancerous cells.
