Cancer Book

Question 1

** look at table 24-1, understand the different tests for childhood cancer. what are the nursing responsibilities for each

Answer 1

biopsy: pain
bone marrow aspiration: pain, anxitey
CT/CAT: anxiety/allergies to contrast
lumbar puncture: pain, anxiety
MRI: anxiety, implants
PET/SPECT: anxiety
XR: anxiety
nuclear: anxiety
ultrasound: anxitey
lab: pain, blood, anxiety

Question 2

** lukemia s/s, onset, underlying path, how is it dx’d, how is it treated, complications, long term prognosis for ALL, what findings at time of diagnosis indicate a worse prognosis

Answer 2

s/s: fever, pallor, over s/s of bleeding, anorexia, petechiae, frank bleeding
onset: peak 2-3 ALL, <2 or adol AML
underlying path: chromosomal predisoption, radiation, chemo, occurs when bone marrow produce immature WBC which fill the marrow
dx’d: blood counts (anemia, thrombocytopenia, neutropenia) and bone marrow aspiration
complications: realpse
long term prognosis for ALL: high, less sequealla than AML
worse prognosis: initial WBC, higher then WBC worse prognosis

Question 3

** lukemia treatment duration

Answer 3

2-3 years
- longer than adults

Question 4

** leukemia what lab values do you anticipate

Answer 4

high WBC, low platelets, low hbg

Question 5

** brain tumors: s/s, onset, underlying pathology, how is it dx’d, how is it treated, complications

Answer 5

s/s: behavioral or neural = HA, N/V, abnormal gait, dizziness, change in vision or hearing
onset: all the way until 19
patho: usually occur below roof od cerebellum and involve the cerebellum, mid brain, and brain stem
dx? CT/MRI/PET/SPECT
treated: depends on type, surgery ration chemo
complicaitons: severe infections, seizures, sensiormotor defect, hydrocephalus, and growth problems

Question 6

** when you look at post op complications what are you looking for. what changes in neuro exam and vital signs

Answer 6

s/s of increased ICP and infection
- tachycardia, irregular resp
s/s of seizures and DI
DI = low blood pressure and increase output

Question 7

** wilms tumor
what are the s/s

Answer 7

asymptomatic, firm, lobulated to one side of the midline in the abdomen, hypertension, hematuria, abdominal pain

Question 8

**wilms tumor dx

Answer 8

ultrasound

Question 9

** wilms tumor complications with the mass and after treatment

Answer 9

w mass: hypertension, bleeding, spread of cancer
tx: liver damage, portal hypertension, mild cirrhosis, kyphosis, socloiosis, glomular damage, 2nd malignancies

Question 10

** wilms tumor what are some important nursing considerations

Answer 10

don’t palpate the mass

Question 11

**osteosarcoma, what age of onset is common
what physical findings might the patient present with

Answer 11

peak indigence is during rapid growth years: G 12, B 13
pain, swelling, limp
- pain may be referred to hip or back

Question 12

** osteosarcoma how is it treatmed , complications of treatment, how might complications arise, how would we treat them

Answer 12

chemo/surgery = amputaiton or salvage
salvage is removal of tumor and place bone graft

Question 13

** osteosarcoma what major psychosocial considerations are there

Answer 13

body apperence due to ampuation

Question 14

**lymphoma and non Hodgkin lymphoma who is at risk and what is the etiology

Answer 14

NHD: geographic, decrease immune, viral infection. malignant tumors of lymphoreticular origin
HD: genetics, viral infection, enviornmental. lymphoid system

Question 15

** retinoblastoma how does this present, what is the treatment

Answer 15

first sign is a white pupil (leukokoria, or cats eye reflect) fixed strabismus, glaucoma, heterchomia
removal of the eye, cryotherapy, photocoagulation, radiation, chemo (sometimes)

Question 16

**know all oncologic emergencies and how they are treated
- most common

Answer 16

tumor lysis, septic shock, bone marrow suppression, GI and CNS bleeding, DIC

Question 17

** why is febrile neutropenia an emeegrncy

Answer 17

possible infection and patient has now neutrophils so not able to fight off infection

Question 18

** what is hyperleukocytosis and how is this related to prognosis

Answer 18

increased production of WBC
higher WBC = worse prognosis

Question 19

** what lab values are you going to see for tumor lysis syndrome? who is the highest risk for TLS?

Answer 19

hypo cal, hyperkal, hyper uric, hyperphos
increase risk with high tumor burden (big tumor =big risk

Question 20

** what are some discharge considerations and home teaching

Answer 20

education: adequate nutritional intake, s/s of infection, decrease exposure to illness, admin meds, N/V
if a port: clean, install heparin
be as normal as possible, play, cancer support group, view child as normal

Question 21

process of stem cell transplant

Answer 21

administer a Letha dose of chemo and radition that will kill cancer cells and then resupply with donor cells

Question 22

what are the most commonly occurring solid tumors

Answer 22

brain

Question 23

risk factor for Brian tumor

Answer 23

radiation

Question 24

neuroblastoma

Answer 24

solid tumor occurring outside of cranium

Question 25

when is wilms tumor often discovered

Answer 25

during a bath

Question 26

treatment of wilms

Answer 26

removal of affected kidney

Question 27

most common tumor of the skeletom

Answer 27

osteosarcoma

Question 28

what kind of metastasis occurs with osteosarcoma

Answer 28

lung

Question 29

cardinal signs of marrow failure

Answer 29

petechiae
frank bleeding
joint pain

Question 30

electrolytes during leukemia

Answer 30

increase uric acid, pot, phos
decrease cal

Question 31

chemo stage
- indiuction

Answer 31

max cell death

Question 32

chemo stage
- consolidation

Answer 32

certain type of chemo

Question 33

chemo stage
- delayed intensification

Answer 33

additional drugs to kill cells that have survival

Question 34

chemo stage
- mainentence

Answer 34

destroy remaining cells

Question 35

Hodgkin s/s

Answer 35

contender, firm, lymphadenopathy
- reed Sternberg cells

Question 36

non HD s/s

Answer 36

fever
wt loss
enlarged/nodular lymph glands

Question 37

intraocular malignancy of retina

Answer 37

retinoblastoma

Question 38

s/s of retinoblastoma

Answer 38

white pupil is first sign
red reflex is absent
fixed stabismus
ortibial inflammation
glaucoma
heterchomia

Question 39

treatment of retinoblastoma

Answer 39

removal of the eye