module 13

Question 1

neoplastic disorders

Answer 1

Cells that abnormally proliferate
Cancers account for most deaths from disease in children over 1
The 5-year survival rate is 80%
Chemotherapy decreases immunity → worried about socialization
Pallor, fatigue, frequent/severe infection, or easy bruising

Question 2

chemotherapy

Answer 2

Destroys cancer and healthy cells
Adverse effects: infection, myelosuppression, nausea, vomiting, constipation, alopecia & pain
Oral mucositis → nutrition and dehydration
Long-term effects: dental impact, hearing & visual changes, hematopoietic, immunologic dysfunction, gonadal dysfunction, endocrine dysfunction, cardiorespiratory issues, GI issues, GU issues, development of secondary cancers

Question 3

radiation

Answer 3

High energy radiation to damage or kill cancer cells → more targeted
Skin integrity
Long-term effects are related to the area
Alterations in growth, hormone dysfunction, vision/hearing alterations, learning issues, cardiac dysfunction,pulmonary fibrosis, hepatic/sexual/renal dysfunction, osteoporosis, and development of secondary cancers

Question 4

Hematopoietic stem cell transplantation autologous

Answer 4

from the self
Higher risk of relapse
Will not give them their own stem cells because they’ve got the issue
Don’t bank stem cells if you’re only going to have one kid

Question 5

Hematopoietic stem cell transplantation allogenic

Answer 5

from a donor and requires matching for antigen specific sites on leukocytes
Graft vs. host, infection, electrolyte imbalance, bleeding, organ/skin/mucous membrane toxicities can occur
Long-term effects include impaired growth and fertility related to endocrine dysfunction, developmental delay, cataracts, pulmonary/cardiac disease, avascular necrosis of bone, development of secondary cancers

Question 6

treatment nursing management

Answer 6

Palliative care
Use tylenol over NSAIDs due to risk of bleeding
Ginger helps with nausea
Foot massage can decrease pain
Use of a cooling cap may minimize hair loss

Question 7

Leukemia

Answer 7

Primary disorder of the bone marrow where normal elements are replaced by abnormal WBCs
Most common are ALL and AML

Question 8

acute lymphoblastic leukemia

Answer 8

More common 2-10
T cell, B cell, early B cell, or pre-B cell
70% overall cure rate

Question 9

acute lymphoblastic leukemia treatment

Answer 9

Induction
Consolidation
Maintenance

Question 10

acute lymphoblastic leukemia assessment

Answer 10

Know if the child has a fever, look for petechiae, purpura, or unusual bruising due to decreased platelet levels. Inspect skin for signs of infection.
Auscultate lungs, note adventitious breath sounds that can indicate pneumonia either present at diagnosis or from treatment.
Note location and size of enlarged lymph nodes and palpate liver/spleen for enlargement

Question 11

acute lymphoblastic leukemia management

Answer 11

Focus is on managing complications such as infection, pain, anemia, bleeding, hyperuricemia and other adverse effects of treatment. May require blood transfusions. Reducing pain is also a major focus as child has pain due to both disease and treatment - most commonly experience pain of the head, neck, legs and abdomen
Distraction techniques
EMLA cream to numb before IV and blood work
Gate-control theory is back bitches
Narcotics

Question 12

acute myeloid leukemia

Answer 12

More resistant to treatment
50% cure rate
Worried about headache → metastasis to brain

Question 13

Hodgkin lymphoma

Answer 13

Large B lymphocytes
Reed-sternberg cells
Possible link to Epstein Barr (mono)
Starts in one general area and multiplies
B symptoms (fever, night-sweats, over 10% weight loss)
Palpate lymph nodes

Question 14

non hodgkin lymphoma

Answer 14

Mutation in B & T cells
Spreads very fast
Very responsive to treatment
90% will survive
2 years of maintenance chemo

Question 15

brain tumor

Answer 15

Most common solid tumor
Second most common type of cancer in children
Increased ICP, blocks cerebrospinal fluid, edema
Blood pressure may decrease
Avoid straining
NV, blurred vision, motor abnormality, behavior change, irritability
Hyperreflexive

Question 16

brain tumor post op

Answer 16

Check neuro every 15 min
Minimize stimuli
Position child on unaffected side and head of bed flat or with neurologist order
Do not elevate foot of bed

Question 17

neuroblastoma

Answer 17

Arise from embryonic neural crest cells
Most common extracranial tumor in children
Happens usually in the first year
If picked up later, it may metastasize and prognosis is poorer
Can occur anywhere in the paravertebral sympathetic chain
Not initially operative because of positioning → need chemo and radiation
Nerve compression → neurologic deficits
Neck or facial
Bruising around the eyes is really bad (metastasis to skull)

Question 18

Bone tumor (sarcomas)

Answer 18

Bone tumor is usually diagnosed in adolescence
Soft tissue tumor is usually diagnosed in young children
Surgical removal is required
Radical amputation may be necessary
Commonly metastasizes to lungs and other bones
Recurrence within 3 years showing in lungs
Wound care is important

Question 19

Ewing sarcoma

Answer 19

Most frequently in pelvis or femur
25% of children will show in lungs, bone, and bone marrow
May get myeloablative chemo and stem cell transplant
Do they wake from sleep? → if yes, further evaluation

Question 20

Wilms tumor

Answer 20

Most common renal tumor
Usually between 2-5
Generally unilateral but can affect both kidneys
Treated with surgical removal of affected kidney
Metastasis is most often is to perineal tissue, liver, diaphragm, lungs, abdominal tissue, and lymph nodes
Complications include metastasis or complications from radiation such as liver or renal damage, female sterility, bowel obstruction, pneumonia, or scoliosis
25% of children may have hypertension
Assess abdomen and lungs
Assessment of remaining kidney function