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Child Health Nursing > Lecture 11 Life threatening illness and end of life > Flashcards

Lecture 11 Life threatening illness and end of life Flashcards

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1
Q

Childhood vs. adult cancer

A

Childhood cancer is not usually epidemiological (unlike adult cancer); instead it may be genetic inheritance, chromosomal disorders, immunodeficiency, environmental carcinogens, or drug exposure.

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2
Q

Health promotion

A

Giving people the resources to determine their own health.

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3
Q

Health maintenance

A

The prevention of injury (e.g., immunizations, safety).

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4
Q

Care of the pediatric patient is influenced by _

A

Community, culture, and family.

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5
Q

Signs and symptoms of cancer

A

Will be influenced by the type of cancer and where it is located:

  1. Pain.
  2. Cachexia (syndrome of decreased appetite, feeling of being full, and marked weight loss).
  3. Anemia.
  4. Infections.
  5. Bruising.
  6. Neurological signs.
  7. Palpable mass.
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6
Q

Diagnostic evaluation of cancer

A

Labs (including tumor markers in blood samples); biopsies; imaging studies; review of systems and physical examination.

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7
Q

The preferred site of bone marrow aspiration and bone biopsy is the _

A

Iliac crest. (Can also use the sternum or long bones.)

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8
Q

A radiographic exam is used for assessment of _

A

The chest cavity and bones.

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9
Q

A definitive diagnosis of osteosarcoma (bone cancer) is made through _

A

Radiographic examination.

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10
Q

Because an MRI (magnetic resonance imaging) and CT scan (computed tomography) requires the child to be completely still, the use of _ may be necessary.

A

General anesthesia.

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11
Q

An ultrasound is used for assessment of _

A

Organs and tissues.

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12
Q

Three goals of cancer therapy

A
  1. Curative - curing the cancer.
  2. Supportive - extending life expectancy.
  3. End of life.
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13
Q

Nursing care for the child with cancer

A
  1. Child and family educated on disease and treatment.
  2. Treatment administered on schedule with appropriate drug doses.
  3. Side effects of treatment managed.
  4. Treatment complications prevented.
  5. Child and family coping skills supported.
  6. Quality of life during treatment maintained.
  7. Child and family adjusted to chronic illness.
  8. Growth and development maintained during treatment.
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14
Q

Modes of therapy for pediatric cancer

A
  1. Surgery (more conservative).
  2. Chemotherapy - systemic (usually a combination of drugs via oral, IV, or intrathecal routes). Also: Wafers placed directly at the site of the tumor, which dissolve to release chemo.
  3. Radiation therapy - localized.
  4. Biologic response modifiers (BRMs) - getting the body itself to fight the cancer cells.
  5. Bone marrow transplantation.
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15
Q

Intrathecal chemotherapy is more likely to be used when the cancer has _

A

CNS involvement.

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16
Q

Induction chemotherapy

A

Used when the patient has active cancer and the goal is remission.

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17
Q

Consolidation chemotherapy

A

Used when the patient is in remission and the goal is to prevent relapse due to nondetectable cells.

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18
Q

Maintenance chemotherapy

A

Used when the patient is in remission and the goal is to maintain remission through low-dose treatments.

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19
Q

Common side effects of chemotherapy

A
  1. Gastrointestinal.
  2. Nutrition (use small, frequent meals to ensure the child continues to eat).
  3. Mucosal/GI tract ulcerations.
  4. Constipation.
  5. Pain.
  6. Alopecia.
  7. Myelosuppression (bone marrow suppression).
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20
Q

Three effects of myelosuppression

A
  1. Anemia - decrease in RBC and oxygen carrying capacity - treatment with packed red blood cell transfusion possible.
  2. Thrombocytopenia - decrease in platelets - pad the side rails, put bed in lowest position, no contact sports.
  3. Neutropenia - teach good hand washing, keep away from people who are sick, no vaccinations.
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21
Q

If a child has a platelet count below _, this is defined as thrombocytopenia; the child is at risk for bleeding and should not floss.

A

50,000.

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22
Q

Two vaccines that should not be administered to a child receiving chemotherapy

A

MMR and varicella (as these are live vaccines) - the child can receive varicella-zoster immunoglobulin or inactivated vaccines.

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23
Q

Biotherapy (anti-cancer immunotherapy)

A
  1. Retools parts of the body that are programmed to destroy cells and applies them to the cancer cells - directing antitumor activity.
  2. Anti-cancer immunotherapy types: Monoclonal antibodies, growth factors/vaccines, gene therapy.
  3. Modifies the relationship between tumor and host by therapeutically changing the host biologic response to tumor cells.
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24
Q

Autologous stem cell transplantation

A

Removing stem cells from the patient, freezing them, administering high-dose chemotherapy to the patient, then re-infusing the thawed stem cells.

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25
Q

Allogenic bone marrow transplantation

A

Using donor bone marrow cells to repopulate the patient’s bone marrow.

26
Q

Oncologic emergencies

A
  1. Metabolic - tumor lysis syndrome - arrhythmias, renal failure, seizures; hypo- or hypercalcemia; septic shock.
  2. Hematologic - myelosuppression, anemia, thrombocytopenia.
  3. Those involving space-occupying lesions - increased ICP, brain herniation, superior vena cava syndrome, spinal cord compression.
27
Q

Types of childhood cancers

A
  1. Leukemia.
  2. Lymphomas (cancer of lymphoid tissue).
  3. Brain tumors.
  4. Neuroblastoma.
  5. Wilms tumor (nephroblastoma).
  6. Bone tumors.
  7. Soft tissue tumors.
  8. Cancers involving the eye.
28
Q

Leukemia

A
  1. Cancer of the blood; develops in bone marrow. Most common cancer in children.
  2. Dysfunctional bone marrow causes proliferation of immature white blood cells, which crowd the bone marrow and create myelosuppression; child may present with shortness of breath, tiredness, and frequent bleeding.
29
Q

Leukemia - diagnostic evaluation

A
  1. History.
  2. Blood counts (peripheral blood count with differential).
  3. Bone marrow aspiration - definitive.
  4. Lumbar puncture - sometimes there is CNS involvement.
30
Q

Leukemia - treatment/nursing considerations

A
  1. Combination chemotherapy (oral, IV, intrathecal, depending on what they need).
  2. Bone marrow/hematopoietic transplantation.
  3. Prepare for procedures.
  4. Provide emotional support.
  5. Teach parents when to seek medical attention.
31
Q

Carcinomas

A
  1. Cancer arising from the body’s glandular and epithelial cells which line body tissue.
  2. This is not a common cancer in children; most cancer in children is non-epithelial.
32
Q

Hodgkin’s and non-Hodgkin’s lymphoma

A
  1. Hodgkin’s lymphoma is associated with the presence of Reed-Sternberg cells and is more likely to begin the upper body - tonsillar lymph nodes (Waldeyer ring); cervical and supraclavicular lymph nodes. Adolescents.
  2. Non-Hodgkin’s lymphoma has different abnormal cells, is more common, more aggressive, and associated with poorer outcomes. Symptoms include fever and weight loss. Younger children.
33
Q

Radiation is usually used for _ lymphoma.

A

Hodgkin’s.

34
Q

Lymphoma - diagnosis and treatment

A
  1. Diagnosis requires biopsy of lymphoid tissue.

2. Treatment may include radiation (Hodgkin’s), surgery, chemotherapy, or biotherapy.

35
Q

_ tumors are the most common type of solid tumors in children.

A

Brain.

36
Q

A _ is considered the “gold standard” for brain tumor diagnosis.

A

MRI.

37
Q

Clinical manifestations of brain tumors

A

Seizures; morning headaches; vomiting; infants may have a bulging fontanel or increased head circumference; irritability or behavioral problems; loss of coordination; change in eating habits (FTT).

38
Q

Brain tumors are classified based on _

A

Location, rate of growth, and tissue of origin.

39
Q

Corticosteroids can be used for the treatment of _ tumors.

A

Brain.

40
Q

For pain control after brain tumor surgery, _ is usually sufficient.

A

Tylenol or codeine (few muscles in this area so usually not a lot of post-surgical pain - opioids may be used but they are disfavored because they can interfere with neuro checks).

41
Q

Nursing care after brain tumor surgery

A
  1. NPO until gag and swallow reflex returns - while absent, may need to suction.
  2. Assess for emesis.
  3. IV fluids, but assess for cerebral edema - can use mannitol or dextrose to draw the fluid away from the brain.
  4. May need helmet, especially if a portion of the skull is left out.
42
Q

Osteosarcoma - clinical manifestations

A

Localized pain, swelling at site, limping, decreased range of motion, activity intolerance, pathological fractures.

43
Q

Psychosocial considerations regarding osteosarcoma

A

Amputation may be required - prepare the patient emotionally; phantom pain may occur; prosthetic replacement and stump care; physical therapy.

44
Q

Nephroblastoma/Wilms tumor

A
  1. Usually localized to one side - more often in the left kidney; often encapsulated (encapsulation is good); 90% survival rate if caught early.
  2. Symptoms: Firm, non-tender mass in the abdomen that is confined to one side; decrease in urinary output.
  3. Secondary manifestations: Anemia, pain, hematuria, weight loss, hypertension.
  4. Treatment: Surgery (removal of the kidney), radiation, chemotherapy, possibly irradiation.
45
Q

A Wilms tumor should not be _

A

Palpated - due to encapsulation, palpation risks breaking off part of the tumor.

46
Q

An abdominal ultrasound and intravenous pyelogram would be used to diagnose _

A

Wilms tumor.

47
Q

Neuroblastoma

A
  1. Nerve tissue tumor usually located in the abdomen that arises from neural crest cells of the sympathetic nervous system, often from the adrenal glands.
  2. Manifests as a smooth, hard, non-tender mass, accompanied by fever, fatigue, and pain (late sign). Diagnosis involves a CBC and tumor markers.
  3. Usually crosses the midline (difference from nephroblastoma), may cause disruption in bowel and bladder functions.
48
Q

Retinoblastoma - signs and symptoms

A

Vague; may have “cat’s eye” reflex, strabismus (crossing of eyes), or blindness.

49
Q

Retinoblastoma - treatment

A
  1. Enucleation (removal of the eye).
  2. Cryotherapy or photocoagulation.
  3. Radiation is nearly always used.
50
Q

HIV/AIDS - horizontal transmission

A

Transmission from person to person within the same generation - sex and drugs.

51
Q

HIV/AIDS - vertical transmission

A
  1. Transmission from mother to child - childbirth and breastfeeding.
  2. Child will usually show signs by 18 to 24 months; more rapid progression in prenatal transmission.
52
Q

HIV/AIDS - clinical manifestations

A

Diarrhea, repeated infections, malabsorption, failure to thrive, pneumocystis carnii pneumonia (PCP) - classic for HIV/AIDS.

53
Q

HIV/AIDS - medical management

A
  1. Antiretroviral therapy - uses multiple combinations of drugs, usually at least 3 drugs from at least 2 different classes.
  2. Trimethoprim-sulfamethoxazole (Bactrim) - usually an anti-bacterial and anti-fungal agent - used to treat PCP; prophylaxis against opportune infections.
  3. Immunizations - regular schedule for HIV, not for AIDS (especially live).
54
Q

Influence of developmental stages on the child’s concept of death

A
  1. Effect on understanding of death, behavioral response to death, and ability to communicate about death.
  2. Infants and toddlers are non-verbal and will likely perceive their parents’ emotional state. Greatest stressor is separation from their parents.
  3. Preschoolers may have difficulty with the concept of something being permanent and irreversible; magical thinking.
  4. School-aged children can comprehend death but may be more afraid of it.
  5. Adolescents have a mature understanding of death and better coping skills; body image issues may complicate handling of illness.
55
Q

Physical signs of impending death

A

Inability to regulate temperature, decrease in cardiac output, decrease in urinary output.

56
Q

Stages of grief

A

DABDA:

  1. Denial.
  2. Anger.
  3. Bargaining.
  4. Depression.
  5. Acceptance.
57
Q

Nurse’s reaction to patient’s death

A
  1. Denial.
  2. Anger and depression (no bargaining).
  3. Guilt.
  4. Ambivalence.
58
Q

Hodgkin’s lymphoma is generally associated with _, while non-Hodgkin’s lymphoma is generally associated with _

A

Adolescents; children.

59
Q

End of life condition

A

A condition that presents a considerable likelihood of death.

60
Q

Rhabdomyosarcoma

A

Cancer of the extraocular muscles.

61
Q

The first sign of retinoblastoma is often a _

A

White pupil.

62
Q

Wilms tumor is associated with an increase in _, due to an increase in renin.

A

Blood pressure.

Child Health Nursing (16 decks)

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