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peds 331 > cancer > Flashcards

cancer Flashcards

1
Q

differences

A

arise from primitive tissues (embryonic), result in leukemias, lymphomas, sarcomas, CNS tumors, not from lifestyle factors, respond well to treatment

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2
Q

general cm

A

mass/swell, pale and energy loss, easily bruise, persistant and localized pain/limp, prolonged unexplained fever/illness, HA freq with vomit, eye/vision change, excessive rapid weight loss

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3
Q

CNS tumors cm

A

based on location, size, stage
HA, v, clumsy, unsteady, cranial nerve neuropathy (blurred or double vision), head tilt, seizure, motor abnormality, weak, behavior or personality change, ftt, irritable, VS disturbance

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4
Q

CNS tumors tm

A

based on type
sx, radiotherapy >2yr, chemo, prognosis varies

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5
Q

CNS tumors nc

A

post op: position to decrease pressure where tumor was - midline, off operative site, reduce ICP (decrease stimulation), neck flexion, NPO (gag and swallow), comfort (NPO), eye care (cover or moist, may not be able to close)
promote return to optimal functioning

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6
Q

neuroblastoma cm

A

based on location and stage
often metastasize before diagnosis

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7
Q

neuroblastoma tm

A

based on stage
sx, biopsies, radiation, chemo, transplant (bone or stem cell), prognosis varies

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8
Q

lymphoma - hodgkin cm

A

painless enlargement of lymph, fever, night sweats, reed sternberg cells
complications: liver failure, secondary cancers, delayed puberty

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9
Q

lymphoma - hodgkin tm

A

radiation, long term chemo, hsct, transplant

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10
Q

lymphoma - hodgkin nc

A

significant pain in effected node following alcohol

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11
Q

lymphoma - nonhodgkin cm

A

diffused rather than nodular, poorly differentiated (B and T lymphocytes, uncontrolled growth), dissemination (fast), mediastinal involve and invasion of meninges (CNS)
complication: metastasis, secondary malignancy
pain, lymph swell (deeper - abd), d or c, cough, dyspnea, orthopnea, facial edema or venous engorgement (emergency)

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12
Q

lymphoma - nonhodgkin tm

A

chemo 3/4 stage

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13
Q

osteogenic sarcoma cm

A

long bones (legs) - metaphysis
pain, limp, decreased ROM
complications: metastasis, recurrence within 3 years
can mimick growing pains

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14
Q

osteogenic sarcoma tm

A

surgical resection or amputation, prosthetic, and chemo

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14
Q

osteogenic sarcoma nc

A

preop crucial, support, body image, pain (phantom limb)

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15
Q

ewing sarcoma cm

A

intermittent pain - worses to constant/severe, swell/red
systemic: fever, spinal cord compression, respiratory distress

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16
Q

ewing sarcoma tm

A

radiation, chemo (myeloblative, stem cell, surgical resection, avoid active play or weight bearing with treatment - fractures

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17
Q

rhabdomyosarcoma cm

A

vague s that are often common to childhood (ear ache)
very malignant

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18
Q

rhabdomyosarcoma tm

A

remove, radiation, chemo (long term)

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19
Q

wilms tumor (nephroblastoma) cm

A

abd mass (pain), malaise, anorexia, fever, gross hematuria, htn
long term survival

20
Q

wilms tumor (neproblastoma) tm

A

nephrectomy and regional lymph nodes, chemo with or without radiation

21
Q

wilms tumor (nephroblastoma) nc

A

handle and bathe careful (dont palpate), monitor BP and I+O

22
Q

retinoblastoma cm

A

cats eye reflex (white eye), strabismus, red painful eye with glaucoma, blind (late)
may regress, secondary tumors, spread to brain and other eye, lymph, bone, liver, others

23
Q

retinoblastoma tm

A

early and uni: irradiation, cryotherapy
bilateral: preserve useful vision in least affected
advanced: enucleation, chemo

24
Q

retinoblastoma nc

A

post op - enucleation: large pressure dressing, dressing change - saline, abx)
family support - screen siblings q1-3 wks first year, protect other eye

25
Q

testicular

A

not common, usually malignant
self examine!
tm: orchiectomy - chemo/radiation

26
Q

leukemia complications

A

anemia, infection, bleeding (decrease platelets), spleen, liver and lymph - infiltration to enlarge

27
Q

leukemia cm

A

stem cells produce immature wbc, fill bone marrow and lead to decreased rbc and platelets causing anemia, thrombocytopenia, and neutropenia
fever, pallor, bleed, lethargy, malaise, anorexia, large joint and bone pain
bone marrow failure: petechiae, frank bleeding, joint/bone pain, fatigue
CNS involvement: HA, persistant n/v, irritable, dizzy, seizure, behavior change, 6th cranial nerve palsy (eye tract)

28
Q

leukemia tm

A

diagnose with bone marrow biopsy
treat s, combo chemo, cranial irradiation

29
Q

leukemia nc

A

educate, treatment schedule, manage SE, prevent complications, coping skills, QOL, g+d maintain

30
Q

chemo - remission induction

A

rapid, 3-4 weeks, oral steroids and IV chemo, kill active, sickest

31
Q

chemo - consolidation

A

strengthen, remission, CNS prophylaxis, intrathecal and IV

32
Q

chemo - intensification

A

destroy remaining

33
Q

chemo - maintenance

A

prevent relapse, treat spread

34
Q

chemo causes

A

kills normal and cancerous
short term: immunosuppression, infection, myelosuppression, n/v, oral mucositis, alopecia
long term: microdontia and missing teeth, hearing and vision changes, hematopoietic, immunologic or gonadal dysfunction, various alterations of systems, 2nd cancer

35
Q

chemo - bone marrow suppression

A

admin blood safely, nc for anemia, nc for thrombocytopenia, colony stimulating factors, nc for neutropenia

36
Q

chemo - alopecia

A

most adjust well, hat, scarves, wigs, will grow back (different color/texture)

37
Q

chemo - n/v

A

antiemetics before chemo and q3-4 hours until drugs clear, avoid strong smells, small and freq, cool, chemo early in day

38
Q

chemo - stomatitis

A

multiple ulcers
prevent: oral mucosa and teeth clean, antifungal and bacterial mouthwash, avoid acidic
treat: rinse with NS, magic mouth wash, avoid local anesthetics (cant swallow)

39
Q

chemo - fear and anxiety

A

inform, plan of care with family, assess coping, optomistic, no false hope, resources, diversional activities

40
Q

oncologic emergencies

A

hemorrhagic cystitis
tumor lysis syndrom
septic shock (monitor for circulatory failure)
hyperCa from large bone destruction (hydrate and P supplement)

41
Q

hemorrhagic cystitis

A

bladder pain and blood in urine
increase fluid intake, void frequently, mesna to protect bladder

42
Q

tumor lysis syndrome

A

tumors release high uric acid, k, P into blood leading to metabolic acidosis, renal failure, death
rf: large tumor/lots, sensitive to chemo, increased proliferation rate, high wbc at diagnosis

43
Q

tumor lysis syndrome - cm

A

flank pain, lethargy, n/v, oliguria, pruritus, arrythmias, impaired renal, tetany, neuro change

44
Q

tumor lysis syndrome - tm and nc

A

fluid before therapy (3-4x maintenance), i+o, daily weight, urine specific gravity <1.01, e and meds to decrease conversion of metabolic by products to uric acid, urine pH (7-7.5), monitor for tetany and mental change, collect labs

45
Q

SE of radiation therapy

A

short: fatigue, n/v, oral mucositis, myelosupression, skin integrity at site
long: growth alter, hormone dysfunction, hearing and vision, learning problem, heart dysfunction, pulmonary fibrosis; hepatic, sexual, or renal dysfunction; osteoporosis, development of secondary sex characteristics

46
Q

cancer - pain management

A

oral or IV, dose with weight, titrated for SE, pain scale appropriate

47
Q

cancer - nutrition

A

normal w+h, pref (shake/pudding), antiemetics, weigh daily or weekly and h, high cal meals when appetite high, vit and min supplements, TPN and IV lipids

48
Q

cancer - health promo

A

dental: floss, dentist, soft
vaccine: 2 weeks before or during = inactivated, 3 months after = good

peds 331 (28 decks)

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