Children's Cancer Flashcards
The etiologies of childhood cancer
1) External stimuli that cause genetic mutations
2) Immune system and gene abnormalities
3) Chromosomal abnormalities
What is an example of external stimuli that can cause childhood cancer?
Radiation
What is an example of immune and gene abnormalities that can cause childhood cancer?
Down’s Syndrome can get leukemia, rabdo, etc
Leukemia secondary to chemo for Brian cancer
What is an example of chromosomal abnormalities that can cause childhood cancer?
Down’s Syndrome and familial.
With a cancer diagnosis, what is the first reaction from a parent?
Disbelief, shock. The parents like to blame the nurse.
With a cancer diagnosis, what are the reactions of the parents?
1) Disbelief, shock.
2) Must gather resources, make treatment decisions.
3) Travel often required for treatment
4) Financial strain, potential job loss
5) Adaptation
How can the nurse help the parents gather resources?
Suggest ways that others can help them such as religious organizations. let them know that it is ok to accept help from others.
The reaction of a child to cancer depends on what?
Depends on the child’s age.
How would an infant and/or a toddler handle a cancer diagnosis?
They would have a limited understanding. They don’t know that it is not normal.
When does a child develop a conscious?
Preschool age.
How would a preschooler handle a cancer diagnosis?
They may believe that they caused the illness. Assure them that it is not their fault. They are also going to be concerned with pain.
How would a school-age child handle a cancer diagnosis?
They have an improved understanding and like to talk about it. Such as with the doctor who told them, the nurses, etc.
How would an adolescent handle a cancer diagnosis?
They would like to talk to other adolescent teens that have cancer, NOT to the doctors, nurses, parents, etc.
What psychosocial area would an adolescent, possibly a school age child be concerned with?
Body image.
What can a toddler use to deal with stress and how to cope?
They can use a doll.
What are some common presenting symptoms of childhood cancer?
1) PAIN
2) Cachexia
3) Anemia
4) Infection
5) Bruising
6) Neurologic symptoms
7) Palpable mass
What does cachexia mean?
The child looks like they are wasting away due to the illness.
What would be the reasons for pain in a child with cancer?
Result of neoplasm either directly of indirectly affecting nerve receptors through obstruction, inflammation, tissue damage, stretching of visceral tissue, or invasion of susceptible tissue.
How does the book define cachexia?
Syndrome characterized by anorexia, weight loss, anemia, asthenia, and early satiety.
What does asthenia mean?
weakness
When would a child with cancer experience anemia and why?
Experienced during times of chronic bleeding or iron deficiency. In chronic illness the body uses iron poorly. Anemia is also present in cancers of the bone marrow when the number of red blood cells id reduced, in part because of the presence of large numbers of other bone marrow products. Treatment of cancer often promotes further anemia.
Why would child with cancer get an infection?
Result of altered or immature immune system. Occurs when bone marrow cancers inhibit maturation of normal immune system cells. Infection may also occur in children treated with corticosteriods. Because their immune response is altered, the normal signs of infection may not occur.
Why does bruising occur in children with cancer?
If the bone marrow cannot produce enough platelets; bleeding after even a minor trauma can lead to ecchymosis.
Why would a child with cancer have neurological symptoms?
Result from impingement on the brain or nervous system. Signs of ICP, decreased or altered consciousness, eye abnormalities, or other neurologic or behavior changes may be evident.
Where would a palpable mass be in children with cancer?
Most commonly in abdomen but may be mediastinal, in the neck, or at other sites.
Subcutaneous nodules may appear why?
If leukocytosis is present.
What can occur with mediastinal tumors (neuroblastomas)?
Superior vena cava syndrome or respiratory difficulty.
What are common with lymphomas?
Enlarged lymph nodes.
What are some common diagnostic tests for childhood cancer?
1) Laboratory tests - WBC count, ANC, etc
2) Imaging Studies - MRI, x-ray, CT
3) Tumor biopsy
Bone Marrow Aspiration - Purpose, Normal Lab Value, Diagnostic Value
Purpose - Examines bone marrow
Normal Lab - Less than 5% blast cells (immature)
Diagnostic Values - Greater than 25% blast cells in acute lymphoblastic leukemia, most with hyper cellular marrow
Lumbar puncture - Purpose, Normal Lab Value, Diagnostic Value
Purpose - Examines cerebrospinal fluid
Normal Lab - Cell count (microliters)
Polymorphonuclear leukocytes 0
Monocytes 0-5
RBCs 0-5
Diagnostic Values - Presence of malignant cells indicates CNS involvement
Complete blood count and differential - Purpose, Normal Lab Value, Diagnostic Value
Purpose - Examine cellular components of blood
Normal Lab - WBC less than 10,000/microliter
Platelets 150,000 - 400,000/microliter
Hemoglobin 12 - 16 g/dL
Diagnostic Values - WBC greater than 10,000/microliter
Platelets 20,000 - 100,000/mL
Hemoglobin 7-10 g/dL
Absolute Neutrophil Count (ANC) - Purpose, Normal Lab Value, Diagnostic Value
Purpose - Blood component ratio: % of segmental neutrophils times % of bands (immature neutrophils) times WBC count
Normal Lab - ANC greater than 1000
Diagnostic Values - ANC less than 500 = risk of infection
Staging a cancer refers to what?
Labeling type of cancer cells, severity, and spread.
What are some Lab tests that can be done for childhood cancer?
Blood work, Bone marrow aspiration/biopsy, and lumbar puncture.
What are some Imaging Studies that can be done for childhood cancer?
CT, MRI, Ultrasound, Nuclear medicine scans, and PET.
What does an ultrasound allow the viewer to see?
The function of the organ.
What are the 3 things to know about a tumor biopsy?
1) Invasive test
2) May be done during surgery to remove or debunk tumor
3) Section of tumor examined microscopically
What are the purposes of diagnostic tests?
1) Identify initial source of cancer (primary site)
2) Determine if cancer has metastasized
3) Stage cancer
What are some options for clinical therapy for cancer?
1) Surgery
2) Chemotherapy
3) Radiation
4) Biotherapy
5) Bone marrow/stem cell transplantation
What are some considerations in choice of therapy for cancer?
1) Type of cancer
2) Location
3) Degree of metastasis
4) Goal of therapy
What are the three types of goals for therapy?
1) Curative - Look for a cure.
2) Palliative - Get treatment in hopes of extending life, but not curing.
3) Supportive - The cancer is too bad. Look to keep child comfortable til death.
What are the reasons for surgery?
1) Remove or debulk tumor
2) May determine stage and type of cancer
What is an example of a tumor that would require surgery?
Wilms’ tumor
Chemotherapy
1) Drugs that kill both normal and cancerous cells
2) Must be chemo certified before giving chemotherapy drugs
3) CPON - Certified Pediatric Oncology Nurse
4) Timed for maximum cellular destruction
5) Different drugs work on different phases of cell growth
What are the potential Long-Term effects of chemotherapy? (5 years)
1) Cardiomyopathy
2) Lung, renal toxicity
3) Neurological changes
4) Infertility
5) Hearing loss, vision changes
Radiation.
1) Energy destroys DNA and cells
2) Used for local and regional control of cancer
- may be used in combination with surgery and chemotherapy
3) May be curative or palliative
What would be an example of a cancer that would receive radiation?
Hodgkin’s disease.
What are the nursing care considerations with radiation therapy?
1) Assessing skin were radiation occurs.
2) Possible sedation during radiation therapy
3) Wash irradiated area daily with mild soap and water or only water.
4) No powders, ointments, lotions, or creams unless prescribed by radiologist.
What does the child and/or parent need to be educated on about radiation therapy?
1) Dont wash of indelible marks
2) Children cannot go into the sun after radiation therapy.
3) If they are going to go outside, MUST wear sun protective clothing.
What are CoolMagic Hydrogel Sheets?
Light-weight, see-through polymer sheet provides instant cooling to burns, abrasions, skin tears, radiation reactions and sensitive wounds, effectively reducing pain.
What does a CoolMagic Hydrogel Sheet do?
1) This sterile hydrogel polymer sheet consists of 90% water, 10% inactive cross-linked polyethylene oxide matrix and it transfers heat away from the wound, providing a cooling effect.
2) Cooling action relieves pain of burning, itching, or sore throat.
3) Allows oxygen flow while preventing bacteria or foreign material from entering wound.
Can the CoolMagic Hydrogel Sheet be refrigerated?
Yes. This allows it to have greater cooling capacity.
What are the potential long-term effects of radiation?
1) Impairs growth of bones and teeth - can lead to scoliosis, dental problems.
2) Hypothyroidism
3) Delayed puberty, sterility
4) Secondary cancers
What is the goal of bone marrow/stem-cell transplant?
Kill cancer with chemotherapy or radiation, then resupply the body with stem cells.