Ch. 19 Flashcards
cardinal signs of cancer in children
Unusual mass or swelling
Unexplained paleness and loss of energy
Sudden tendency to bruise
Persistent, localized pain or limping
Prolonged, unexplained fever or illness
Frequent headaches, often with vomiting
Sudden eye or vision changes
Unexplained excessive, rapid weight loss
care of child with cancer (immune system)
- want to depress the immune system so that cancer does not regenerate/can kill the cancer with chemo/radiation
Risk for infection related to depressed body defenses: expected outcomes
The child exhibits no evidence of infection.
The child will not come in contact with infected persons.
Risk for infection related to depressed body defenses: interventions
- Place child in private room and screen all visitors and staff for signs of infection to minimize exposure to infective organisms.
- Teach child and family about good hygiene and careful handwashing techniques to prevent spread of infection.
- Use good handwashing for all contacts with child and scrupulous aseptic technique for all invasive procedures to minimize exposure to infection.
- Encourage a nutritionally complete diet to support body´s natural defenses.
- Administer antibiotics and G-CSF per HCP order to prevent infection.
- Monitor vital signs (esp. T) and observe skin and mucosa to detect signs of infection.
- Do not administer live attenuated virus vaccines (i.e., measles-mumps-rubella, oral polio, varicella zoster) to child with depressed immune system to prevent overwhelming the system and introducing an infectious disease; use inactivated virus vaccines as prescribed (i.e., chickenpox, Salk polio, influenza) to prevent common childhood illnesses.
- Screen all visitors and staff for signs of infection to minimize exposure to infective organisms.
- Evaluate needle puncture sites, mucosa, and minor abrasions for possible signs of infection to detect possible infection/sources of infection.
Risk for injury (hemorrhage, hemorrhagic cystitis) related to interference with cell proliferation: expected outcome
The child exhibits no evidence of bleeding or hematuria.
Risk for injury (hemorrhage, hemorrhagic cystitis) related to interference with cell proliferation: interventions
- Monitor platelet counts and administer platelets per physician order to raise platelet count and minimize bleeding tendencies.
- Do not administer aspirin products because they interfere with platelet function.
- Teach child and family to limit activity when platelet count drops to minimize chances of accidental injury.
- Use care in the administration of therapy (e.g., avoid grabbing with fingers and friction with clothing and bedclothes when turning; keep skin clean and dry and sheets clean and wrinkle free; use soft sponge for oral care) to reduce bruising and injury.
- Turn and reposition frequently, use pressure-relieving mattresses to prevent pressure ulcers.
Implement only essential skin puncturing procedures; monitor puncture site carefully; apply gentle pressure, ice to bleeding sites to minimize bleeding. - Teach child and parents how to manage nosebleeds to reduce blood loss.
- Administer ordered drugs that are irritating to the bladder mucosa early in day to allow sufficient fluid intake and voiding for flushing of irritants.
- Ensure increased oral intake as ordered and encourage frequent voiding to flush metabolites from system and prevent irritation.
- Observe for and report signs of cystitis (burning and pain on urination) to ensure prompt medical treatment.
Risk for fluid volume deficit related to chemotherapy-induced nausea and vomiting: expected outcome
The child is adequately hydrated.
Risk for fluid volume deficit related to chemotherapy-induced nausea and vomiting: interventions
- Administer initial dose of antiemetic before starting chemotherapy to reduce incidence of nausea and vomiting.
- Administer regular doses of antiemetic as ordered for the duration of expected cycle of nausea and vomiting to decrease or prevent nausea and vomiting episodes.
- Administer IV fluids as ordered to maintain hydration; encourage oral fluids and foods in small amounts to increase tolerance. Popsicles.
- Monitor child’s response to antiemetic because reactions are idiosyncratic and adjustments in drugs or dose may be needed.
- Monitor intake and output to ensure adequate hydration.
- Avoid foods with strong odors because they may induce nausea and vomiting.
- Encourage frequent intake of fluids in small amounts because small portions are usually better tolerated.
Impaired Nutrition (less than body requirements) r/t chemotherapeutically induced anorexia: expected outcome
The child will have adequate nutritional intake.
Impaired Nutrition (less than body requirements) r/t chemotherapeutically induced anorexia: interventions
- Encourage parents to reduce pressure placed on eating to promote acceptance of anorexia as a consequence of treatment.
- Allow child any food tolerated to promote nutrition, knowing that the quality of food selections can improve once appetite resumes.
- Explain anticipated increase in appetite with steroid use to prepare the child and family for changes.
- Fortify foods with nutritious supplements to maximize the quality of intake.
- Allow the child to become involved in food prep and selection to increase intake and tolerance.
- Monitor the child’s weight to track his/her status.
- Make food appealing to encourage eating.
- Take family history to assess any food issues that may require intervention (e.g., use of food as control mechanism or reward and punishment).
Altered mucous membranes related to administration of chemotherapeutic agents: expected outcome
The child exhibits no evidence of oral mucositis or rectal ulceration.
Altered mucous membranes related to administration of chemotherapeutic agents: interventions
- Institute meticulous oral hygiene (e.g., soft-sponge toothbrush to avoid trauma; frequent mouthwashes to promote healing; lip balm to keep lips moist). Do not use lemon glycerin swabs, which irritate eroded tissue and induce tooth decay; hydrogen peroxide, which delays healing of ulcers; and milk of magnesia, which dries oral mucosa.
- Inspect oral mucosa daily for ulcers and report immediately to ensure early treatment.
- Apply local anesthetics as ordered to ulcerated areas before meals to relieve pain and increase food intake. - Do not use viscous lidocaine in young children because it may depress gag reflex.
- Serve a bland, moist, soft diet; avoid juices with ascorbic acid; use a straw for fluids; avoid oral and rectal temperature-taking to decrease pain and injury to ulcerated areas.
- Administer prescribed anti-infective agents to prevent or treat mucositis, analgesics to control pain.
Wash perianal area after stools to lessen irritation. - Use warm sitz baths to ease pain and promote healing.
- Expose reddened mucosal areas to air; apply protective skin barriers to perianal area to protect mucosa and promote healing.
- Use stool softeners, bulk laxatives to prevent constipation.
- Track frequency and description of bowel movements to assess for constipation.
Disturbed body image r/t changes caused by disease process and treatment: expected outcome
The child will exhibit positive coping skills.
Disturbed body image r/t changes caused by disease process and treatment: interventions
- Encourage child to decide how he/she will cope with alopecia (ex. Wig, cap, nothing) to promote early adjustment and preparation for anticipated body changes.
- Provide adequate covering during exposure to sunlight, wind, or cold to provide protection, since natural hair protection is lost.
- Explain that hair begins with regrowing in 3-6 months and may be a different color and texture to prevent anxiety about alopecia.
- Encourage rapid return to peer group and friends to promote peer support.
- Encourage visits from friends before discharge to prepare the child for anticipated reactions from others.
- Depending on age of patient, may need to discuss egg harvest or sperm banking before treatment
common dx procedures for cancer
Injections (IM, intradermal)
Bone marrow aspiration
Lumbar puncture
Implanted port access
Needle sticks (venipuncture)
possible interventions for dx procedure prep
Parents’ and caretakers’ presence
Developmentally appropriate non-pharmacological approaches
Pharmacological treatment
Proper timeline for pre-procedure preparation (age specific p. 681-682)
- infants/toddlers: not much prep needed
- school age: little bit of lee-way
- teenagers: as much time as possible
sedation may be used if child has to lay completely still
common, anticipated fears in children with heme/onc dx
fear of leaving parents: toddlers, preschoolers
fear of pain: school-age, adolescents
body image: adolescents
mild pain mngmnt (1, 2, 3 level)
- nonopioid analgesics: acetaminophen, ibuprofen, naproxen
- +/- adjuvants: anticonvulsants for neuropathic pain, antidepressants ir anxiolytics for coexisting disturbances
moderate pain mngmnt (4, 5, 6)
- opioid analgesics for step 2: codeine, oxycodone, hydrocodone, morphine
- nonopioid analgesics: acetaminophen, ibuprofen, naproxen
- +/- adjuvants: anticonvulsants for neuropathic pain, antidepressants or anxiolytics for coexisting disturbances
severe pain mngmnt (7, 8, 9, 10)
- opioid analgesics from step 3: higher doses of morphine; fentanyl, hydromorphone; PCA delivery of IV opioid
- nonopioid analgesics: acetaminophen, ibuprofen, naproxen
- +/- adjuvants: anticonvulsants for neuropathic pain, antidepressants ir anxiolytics for coexisting disturbances
