Study topic
Paediatric blood and cancer
NCLEX pediatric hematology-oncology: sickle cell crisis care, hemophilia bleeds, iron teaching by age, leukemia marrow suppression, and Wilms tumor handling.
Pediatric blood and cancer items turn on three maps: sickled pain and hydration, bleeding versus infection precautions after marrow suppression, and never kneading a Wilms mass.
Sickle cell disease
| Situation | Priority |
|---|---|
| Vaso-occlusive crisis | Pain meds, IV/oral fluids, O2 if hypoxic, rest |
| Prevention teaching | Hydration, avoid cold extremes, infection vigilance |
| Sudden massive splenomegaly + shock cues | Emergency sequestration pathway |
Hemophilia and iron deficiency
- Joint bleed: factor replacement as ordered, immobilize/compress/ice, elevate — early treatment beats watching it swell.
- Safety: padded play, no contact sports as advised, avoid IM/aspirin-type drugs unless cleared.
For toddlers, excess cow’s milk can crowd out iron-rich foods. Liquid iron: dose with a syringe toward the back of the mouth, offer vitamin C–containing fluids if taught, warn about dark stools and teeth staining, keep locked away (iron overdose is toxic).
Leukemia, chemo effects, Wilms tumor
| Problem | Nursing focus |
|---|---|
| Neutropenia | Hand hygiene, avoid crowds/sick contacts, no fresh flowers per protocol; fever = emergency |
| Thrombocytopenia | Bleeding precautions; report petechiae/bleeding/headache |
| Mucositis | Soft diet, gentle oral care, pain control |
| Wilms tumor mass | Do not palpate; careful handling; prep for nephrectomy pathway |
Safety
A child on chemo with a temperature around 38.5°C and severe neutropenia needs urgent evaluation — not acetaminophen and “see how the night goes.”
- Protect from infection when ANC is critically low.
- Protect from bleeding when platelets are critically low.
- Never repeatedly palpate a suspected Wilms abdomen.
- Support the child and family through hair loss and isolation rules with clear, kind teaching.
Priority map
| Picture | First move |
|---|---|
| SCD crisis pain 9/10 | Analgesia + fluids/O2 supports |
| Hemarthrosis in hemophilia | Factor now |
| Toddler anemia + 36 oz milk/day | Iron teaching + milk limits |
| Chemo + fever | Febrile neutropenia pathway |
| Flank mass labeled Wilms | Do not palpate |
Must know
- 1Vaso-occlusive crisis (any age with SCD): prioritize pain control, hydration, oxygen when hypoxic, rest. Treat pain as the emergency it is.
- 2Crisis prevention teaching: fluids, avoid extreme cold, treat infections early, meds/vaccines as ordered.
- 3Rapidly enlarging spleen with pallor/shock cues: sequestering crisis — emergency.
- 4Hemophilia: early factor replacement for bleeds; RICE for joints; no IM when avoidable; soft toothbrush; medical alert.
- 5Iron-deficiency anemia (toddlers often): limit excessive cow’s milk (classic over-intake pattern), liquid iron via syringe (stains teeth — behind teeth), vitamin C aids absorption; expect dark stools.
- 6Leukemia/chemo marrow suppression: neutropenia → infection precautions; thrombocytopenia → bleeding precautions; fever in neutropenia is an emergency at pediatric thresholds (often ≥38.0–38.3°C per protocol).
- 7Wilms tumor (young child abdominal mass): do NOT palpate the abdomen repeatedly — risk of rupture/spread. Handle gently; signage as ordered.
- 8Mucositis: gentle oral care, soft foods, report pain/infection. Alopecia teaching is supportive, not optional silence.
Memory hooks
Pain, fluids, oxygen for VOC
Sickle cell vaso-occlusive crisis care starts with analgesia and hydration, plus oxygen when sats fall.
Hands off the Wilms belly
A suspected Wilms tumor mass is not for repeated deep palpation.
Factor first for the bleed
In hemophilia, replace the missing factor promptly — do not wait through a long observation for a joint bleed.
How it's tested
Stems ask VOC priorities, whether to palpate a flank mass, liquid iron teaching for a toddler on too much milk, or what to do with fever in neutropenia. Distractors massage a Wilms abdomen or withhold opioids in crisis.