NCLEX 요약정리 (+NGN 포함) - 아동간호 Hematological & Oncological

문서 내 토픽

1. Sickle cell crisis (SCC)

겸상 적혈구 위기는 낫 모양 세포가 혈관을 막아 혈류를 차단하는 증상이다. 급성 비장 폐쇄 위기는 생명을 위협할 수 있는 응급 상황으로, 많은 수의 낫 모양 세포가 비장에 갇혀 비장이 빠르게 비대해지는 것이 특징이다. 정상 적혈구는 120일 생존하지만 겸상 적혈구는 20일 내에 죽기 때문에 항상 빈혈이 있다. 혈관폐쇄 위기는 극심한 통증이 있어 연령에 맞는 통증 척도를 사용하고 진통제를 투여해야 한다. 손과 발의 부종(지염)도 겸상 적혈구 질환의 첫 징후로 나타날 수 있다.
2. Acute lymphoblastic leukemia (ALL)

급성 림프구성 백혈병은 백혈병 세포의 빠른 증식과 과밀화로 인해 발생하는 혈액암이다. 백혈병 세포가 다른 골수 성분(적혈구, 백혈구, 혈소판)을 억제하여 범혈구감소증이 발생한다. 증상으로는 피로, 발열, 출혈, 타박상, 골관절통, 체중감소 등이 있다. 진단을 위해 골수 천자와 생검을 하며, 과세포성 골수는 ALL을 시사한다. 수혈 시 백혈구 감소 및 방사선 조사된 혈액을 사용하여 합병증을 줄인다.
3. Hemophilia

혈우병은 응고 인자 결핍으로 인한 유전성 출혈 장애이다. 주요 증상은 장기간 출혈, 관절 내 출혈(혈관절증), 타박상 등이다. 치료는 결핍된 응고 인자를 대체 투여하는 것이며, 치과 위생, 응급 의료 식별 팔찌 착용, 비스테로이드성 소염진통제 금기, 비접촉 스포츠 등의 교육이 필요하다. 장기적으로 관절 파괴, 심장판막 손상, 지적 장애 등의 합병증이 발생할 수 있다.
4. Disseminated intravascular coagulation (DIC)

파종성 혈관 내 응고는 비정상적인 혈전 형성과 출혈이 동반되는 생명을 위협하는 상태이다. 기저 질환(패혈증, 암, 산과적 출혈 등)에 의해 발생하며, 응고 검사(PT/INR, aPTT)에서 이상 소견이 나타난다. 치료는 출혈 조절, 출혈 위험 최소화, 기저 원인 치료, 혈액 제제 투여 및 응고 검사 모니터링 등이 포함된다.
5. Aplastic anemia (AA)

재생불량성 빈혈은 골수에서 새로운 혈액 세포 생성이 적절하지 않아 범혈구감소증이 발생하는 혈액 장애이다. 면역 장애, 바이러스 감염, 방사선/화학요법 등으로 인해 선천적 또는 후천적으로 발생할 수 있다. 증상으로는 피로, 창백, 쉬운 타박상/출혈, 감염 등이 있다. 진단을 위해 골수 생검을 하며, 수혈, 감염 및 출혈 징후 모니터링이 필요하다.
6. Epistaxis (nosebleed)

코피는 건조한 점막, 국소 손상, 이물질 삽입, 비염 등으로 인해 흔히 발생할 수 있다. 가정에서 직접 압박, 냉찜질, 안정을 취하는 등의 관리를 하며, 지속되거나 과다 출혈, 호흡 곤란 등의 경우 응급실 방문이 필요하다.
7. Trismus

트리스무스는 저작근의 강직성 수축으로 인한 개구 불능 증상으로, 편도주위 농양이나 인두 뒤 농양의 더 심각한 합병증일 수 있다. 특징으로는 '감자 목소리', 침 고임, 목젖 편위 등이 있으며, 응급 기도 유지가 필수적이다. 수술적 중재(편도 절제술, 절개 및 배농)이 필요하다.
8. Palliative care

완화 치료에서는 비언어적 아동의 통증 평가를 위해 FLACC 척도와 COMFORT-B 척도를 사용한다. 통증 징후로는 찡그린 표정, 눈썹 돌출, 신음, 훌쩍거림, 구부린 자세 등이 있다.
9. Adolescent chemotherapy education

청소년 환자에게 화학요법 교육 시, 탈모에 대한 두려움을 표현하는 경우 현재의 위기를 해결하는 것에 초점을 맞추고 미래에 대한 개념화가 어려울 수 있음을 이해해야 한다. 또래와의 상호작용 기회를 제공하여 불안을 완화시키는 것이 도움이 될 수 있다.

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1. Sickle cell crisis (SCC)

Sickle cell crisis (SCC) is a severe and potentially life-threatening complication of sickle cell disease, a genetic disorder that affects the shape and function of red blood cells. During an SCC, the abnormal sickle-shaped red blood cells can become stuck in small blood vessels, blocking blood flow and oxygen delivery to tissues. This can cause excruciating pain, organ damage, and other serious complications. Managing SCC requires prompt medical intervention, including pain management, hydration, and sometimes blood transfusions or other treatments to address the underlying causes. Patients and their caregivers must be vigilant in recognizing the signs of an impending crisis and seeking immediate medical care. With proper management and preventive measures, the frequency and severity of SCC episodes can be reduced, improving the quality of life for those living with sickle cell disease.
2. Acute lymphoblastic leukemia (ALL)

Acute lymphoblastic leukemia (ALL) is a type of blood cancer that affects the lymphoid cells, specifically the immature lymphocytes called lymphoblasts. It is the most common type of childhood cancer, but can also occur in adults. ALL is characterized by the rapid proliferation of these abnormal lymphoblasts, which can crowd out healthy blood cells and impair the body's ability to fight infection, control bleeding, and transport oxygen. Prompt and aggressive treatment is crucial, often involving a combination of chemotherapy, targeted therapies, and in some cases, stem cell transplantation. While the prognosis for ALL has improved significantly in recent decades, it remains a challenging and complex disease that requires specialized care and ongoing monitoring. Continued research into the underlying mechanisms of ALL and the development of more effective and less toxic treatments are essential to further improving outcomes for patients of all ages.
3. Hemophilia

Hemophilia is a rare genetic disorder characterized by a deficiency or dysfunction of certain blood clotting factors, primarily factor VIII (hemophilia A) or factor IX (hemophilia B). This leads to an increased risk of uncontrolled bleeding, both internally and externally, which can be life-threatening if not properly managed. Individuals with hemophilia require lifelong specialized care, including regular infusions of the missing clotting factors, to prevent and control bleeding episodes. Advances in treatment, such as the development of recombinant clotting factors and gene therapy, have significantly improved the quality of life and life expectancy for those living with hemophilia. However, access to these treatments remains a challenge in many parts of the world, highlighting the need for continued research, education, and advocacy to ensure that all individuals with hemophilia receive the comprehensive care and support they require.
4. Disseminated intravascular coagulation (DIC)

Disseminated intravascular coagulation (DIC) is a complex and potentially life-threatening condition characterized by the widespread activation of the body's blood clotting system, leading to the formation of small blood clots throughout the body. This can deplete the body's clotting factors, resulting in an increased risk of uncontrolled bleeding. DIC is often a secondary complication of an underlying condition, such as severe infection, trauma, or certain types of cancer. Prompt recognition and treatment of the underlying cause, along with supportive care to manage the clotting and bleeding abnormalities, are crucial to preventing organ damage and improving outcomes. DIC can be a challenging condition to manage, as the delicate balance between clotting and bleeding must be carefully monitored and adjusted. Continued research into the pathophysiology of DIC and the development of more targeted therapies are essential to improving the prognosis for patients.
5. Aplastic anemia (AA)

Aplastic anemia (AA) is a rare and serious condition characterized by the failure of the bone marrow to produce sufficient numbers of healthy blood cells, including red blood cells, white blood cells, and platelets. This can lead to a variety of life-threatening complications, such as increased risk of infection, bleeding, and organ damage. The underlying causes of AA can be genetic, acquired through exposure to certain toxins or medications, or idiopathic (unknown). Treatment typically involves immunosuppressive therapy, stem cell transplantation, or, in some cases, supportive care with blood transfusions and growth factors. While the prognosis for AA has improved in recent years, it remains a challenging condition that requires specialized care and close monitoring. Continued research into the pathogenesis of AA and the development of more effective and targeted therapies are crucial to improving outcomes for patients.
6. Epistaxis (nosebleed)

Epistaxis, or nosebleed, is a common and often benign condition that can occur due to a variety of factors, including dry air, trauma, underlying medical conditions, or the use of certain medications. While most nosebleeds are minor and can be managed with simple first-aid measures, some cases can be more severe and require medical intervention. Persistent or recurrent nosebleeds may be a sign of an underlying condition, such as a bleeding disorder, vascular malformation, or nasal/sinus pathology, and should be evaluated by a healthcare provider. Prompt and appropriate treatment, which may include cauterization, nasal packing, or the use of topical medications, is essential to control bleeding and prevent complications. Educating patients and the public on the proper management of nosebleeds and the importance of seeking medical attention for persistent or severe cases can help improve outcomes and reduce the burden of this common condition.
7. Trismus

Trismus, also known as lockjaw, is a condition characterized by the involuntary contraction or spasm of the muscles responsible for opening the mouth, resulting in a limited ability to open the jaw. It can be a symptom of various underlying conditions, such as tetanus, trauma, or certain neurological or musculoskeletal disorders. Prompt recognition and treatment of the underlying cause are crucial, as trismus can lead to difficulties with eating, drinking, and maintaining proper oral hygiene, which can further exacerbate the condition and increase the risk of complications. Treatment may involve a combination of muscle relaxants, physical therapy, and, in some cases, surgical intervention. Educating healthcare providers and the public on the recognition and management of trismus is important, as early intervention can help prevent long-term complications and improve the quality of life for those affected by this condition.
8. Palliative care

Palliative care is a comprehensive approach to the management of individuals with serious or life-threatening illnesses, with the goal of improving quality of life for both the patient and their family. This multidisciplinary approach focuses on the relief of symptoms, such as pain, anxiety, and depression, as well as addressing the emotional, social, and spiritual needs of the patient. Palliative care can be provided alongside curative or life-prolonging treatments, and it is particularly important for individuals with advanced or terminal illnesses, as it can help alleviate suffering and improve the overall quality of life. Increased awareness and access to palliative care services, as well as the integration of palliative care principles into the broader healthcare system, are crucial to ensuring that all individuals with serious or life-limiting conditions receive the comprehensive and compassionate care they deserve.
9. Adolescent chemotherapy education

Providing comprehensive education and support for adolescents undergoing chemotherapy is essential to ensuring the best possible outcomes and quality of life during this challenging time. Adolescents face unique physical, emotional, and social challenges during cancer treatment, and tailored education and support can help them navigate these changes and maintain a sense of normalcy and independence. Key components of adolescent chemotherapy education should include information on the treatment process, potential side effects and how to manage them, the importance of adherence to the treatment plan, and strategies for coping with the emotional and social impacts of the disease and its treatment. Additionally, providing resources and support for maintaining academic progress, social connections, and age-appropriate activities can help adolescents feel empowered and in control during their cancer journey. Collaboration between healthcare providers, educators, and community organizations is crucial to delivering a comprehensive and holistic approach to adolescent chemotherapy education and support.

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