Neoplastic, hematologic, endocrine Flashcards
Nearly half of all childhood cancers involve _____
Blood or blood forming agents
How does childhood cancer differ from adult cancer?
Children grow faster and therefor their cancer does as well
What are the negative implications of the fast growing nature of cancer in children?
Very high rates of metastatic cancers. Rapid spread throughout the body
How do children respond to cancer treatment compared to adults?
They respond much better and have a much higher cure rate
What is the patho of a brain tumor?
- Caused of them is unknown
- Usually a solid tumor below the roof of the cranium
How do brain tumors manifest in children?
They cause behavioral and neurological changes.
These can be from tissue loss or damage or increased ICP
What are some common s/s of brain tumors in children?
- Headache
- Vomiting
- Ataxia
- Seizures
- Visual disturbances
- Increased ICP
- Nystagmus
What is a neuroblastoma? (patho)
- A solid tumor outside of the cranium
- Often diagnosed after it metastasizes
- Unknown causes
What determines the clinical manifestations of a neuroblastoma?
The location of the mass
What are the s/s of a retro-peritoneal neuroblastoma?
- Bowel and bladder alterations
- Weight loss
- Abdominal fullness
- Fatigue
- fever
What are the s/s of a Mediastinal neuroblastoma?
- Dyspnea
- infection
- neck or facial edema
What are the s/s of a intracranial neuroblastoma?
Periorbital ecchymosis
What is the patho of Osteosarcoma
- Cancer of the soft bone tissue
- Affected bone tissue never matures into compact bone
- peaks during puberty
What is the most common location for osteosarcoma?
The metaphysis of the distal femur, prox tibia or prob humerus
What are the clinical manifestations of osteoscarcoma?
- Pain and swelling of the affected limb (sometimes the pain moves to hip/back
- Causes a limp
What is a major risk of osteoscarcoma?
The chance of it metastasizing to the lungs
What is the ESR test? What does it measure?
Erythrocyte Sedimentation rate
-Meansures the rate at wich RBC’s precipitate in 1 hour
What does the ESR test determine? What does it indicate?
- It is a nonspecific measure of inflammation
- Sed rate is affected by an alteration in blood proteins by inflammation and necrosis
- Indicates infection or autoimmune disorder
What is the CRP test? what is it not?
It is the C-reactive protein test.
It is not a liver function test
What does CRP measure?
The livers response to inflammation and infection
-also the risk for atherosclerosis
What is the benefit to a CRP test?
Changes faster than ESR
What is a unique treatment for osteoscarcoma?
Rotationplasty
What is the most common congenital malignant intraocular tumor of childhood?
Retinoblastoma
What are some characeristics of retinoblastoma?
- Uni or bilateral
- May have a genetic proponent
What are the main s/s of retinoblastoma?
- Cat eye reflex
- Strabismus
- Pain
- Dec. vision
What is retinoblastoma usually diagnosed?
1-2 years old
What family gene should alert the the chance of retinoblastoma? What other cancer is this gene associated with?
RB1
Osteogenic sarcoma
What is Nephroblastoma (aka Wilms tumor)
A malignant renal and/or intra-abdominal tumor
When is the peak growth for nephroblastoma?
3 years
What s/s lead to the diagnosis of nephroblastoma?
- Abdominal swelling or mass with no other symptoms
- Hx of congen. anomalies
- Signs of malignancy
How is a nephroblastoma treated?
- Surgery/chemo
- Removal of affected kidney
What is the biggest nursing con. when treating a child with nephroblastoma?
DO NOT PALPATE TUMOR PRe-OP
What are some other nursing cons for a child after treatment for a nephroblastoma?
- Post op treatment/care
- Family support
- Education on living with one kidney
- High risk for F and E imbalance
What is the function of surgery in the treatment of cancer?
- To remove all malignant cells
- Reconstruction
- Palliative care
What is the function/considerations for chemotherapy?
- Many body systems are negativley affected by the treatment (Hematopoietic, GI, Hep., renal, integ, reproductive)
- Venous access sites need to be maintained
- Hair will grow back different
What are some considerations for a patient going through radiation treatment?
- Xerostomia (dry mouth)
- Skin breakdown
- Pneumonia
- reduced growth rate and bone integrity
Bone marrow transplants are now called what?
HSCT
Hematopoietic stem cell transplantation
What is the function of Biological response modifiers?
To stimulate the bodies immune system to destroy cancer cells
What are some examples of Biological response modifiers?
- Colony stimulation factors (CFS)
- interleukins
- monoclonal antibodies
- interferons
What is the patho. of iron deficiency anemia?
-inadequate supply of iron leads to smaller RBC’s, less RBC’s, lower oxygen carrying capacity of blood.
What are the s/s of acute iron def. anemia?
Pallor, fatigue, irritability
What are the two main assessments for iron def. anemia?
- Nutritional intake
- Low ferritin levels
Chronic iron def. anemia can cause…..
Nail changes. growth and development delays, PICA
What is a side effect of iron supplements?
Black or green stick poop
What is a consideration when taking liquid iron supplments?
they can stain teeth
What are the main teaching points when a pt is taking iron suppliments?
- Take with protein, vit c, and folic acid and NOT calcium. better on an empty stomach
- Begin iron fortification at 4-6 months
- Brest milk does not have a good supply of iron
- High iron diet, limit dairy
- the fetus will begin to store iron in the third trimester and will use those stores for the first few months of life
What are some caused of iron deficiency anemia?
- Bleeding
- Poor diet
- Heavy Flo
- Growth spurts
What is the patho of sickle cell anemia?
- Autosomal recessive blood disorder
- One amino acid replaces another causing a change in the shape of RBC’s r/t a change in hgb
- these RBC’s are short lived and unable to pass through micro circulation and can clump together
What are the three ways that sickle RBC’s affect the body?
- Distruction of RBC’s
- Clumping of RBC’s causing clogs in micro circulation
- Pooling of RBC’s in spleen
Explain how sickle cell anemia presents in a patient.
It goes through periods of exacerbation and dormancy.
The patient will experience a crisis when their cells begin to sickle
Along with the individual aspect of the crisis, what are some general s/s of sickle cell anemia during an exhaserbation
- Pallor
- Fatigue
- SOB
- Irritable
When a pt is in a sickle cell anemia crisis they will always be in ____
Pain
What are the three types of sickle cell anemia crisis?
- Vaso-occlusive (hand and foot)
- Sequestration (spleen and liver pooling)
- Aplastic (fifth’s disease)
What is an aplastic crisis?
A massive RBC death
What are the interventions for a sickle cell anemia crisis?
- PCA (morphine)(control pain)
- PROM (promote circulation)
- Hydration (to dilute) via IV or oral
- Heat (open capillaries)
- O2
- Infection prevention
What is the number 1 intervention for a sickle cell anemia crisis?
O2 (helps reverse some of the sickling)
Why is Demerol not given to children?
It causes seizures
What is one treatment for sickle cell anemia (not for the crisis)
-Stem cell or bone marrow transplant
What are some common triggers for a sickle cell anemia crisis?
- Fever
- Infection
- Acidosis
- Dehydration
- Constricting clothing
- Exposure to cold
What is B-Thalassemia (cooley anemia)
- Often inherited in Mediterranean families
- Anemia that is caused by defective Hgb.
- Causes fragile RBC’s and leads to anemia and hypoxia
- Iron from broken RBC’s accumulates in the body and may need to be treated
What are the s/s of B-Thalassemia?
- Darkening or bronzing of the skin
- Skeletal changes
- CHF
- Hepatomegly
- Splenomegaly
How is B Thalassemia treated?
Blood transfusion and chelating agents
What is Hemophilia?
-Several Hereditary bleeding disorders
What is the patho of Hemophilia?
Bleeding disorder causes excessive bleeding after minor falls, loss of teeth, circumcision, and immunizations.
How is Hemophilia treated?
When bleeding is active, the PT will use DDAVP is the form of a nasal spray. This will constrict blood vessels and help control the bleedin
-Long term, treated with clotting factors
What are some nursing considerations for children with hemophilia?
- Help them to be kids
- Maintain a safe environment
- Encourage activity
- Non-contact sports
- Home care administration of factors
When are most children diagnosed with Type 1 DM
after a hospital visit for DKA
What is the main goal in childhood DM management?
To empower the child to perform self care
By ____ years old, a child with DM should be able to ____ under heavy supervision
9
administer their own insulin
A ___ year old with DM can be empowered to assist in car by ____
Being allowed to retrieve glucometer and other supplies
SIADH is AKA ___
water intoxication
What is SIADH?
A condition when ADH is secreted in the presence of low serum osmolarity
What caused SIADH?
- Brain tumor
- Trauma
- CF
- pneumonia
- Ventilator
What is the main symptom of SIADH? How does that symptom present?
Water retention
- Decreased output
- Weight gain
- Decreased Na
- increased ECF causing Neuro and GI symptoms
How is SIADH treated?
- Fluid restriction
- IV NaCl
- Treating the underlying disorder
What is hypopituitarism?
a growth hormone deficiency that causes stunted growth and a proportionate skeleton
What causes hypopituitarism?
The body fails to produce growth hormone because of injury, tumor or it can be idiopathic
-can be genetic
How is hypopituitarism diagnosed?
a deteriorating rate of growth over one year
How is hypopituitarism treated?
Growth hormone injections
What is a major nursing consideration for a child with hypopituitarism?
- This condition requires a large about of family and financial support
- The treatment is long term
- Development can be affected
What is hyperpituitarism?
Accessive growth hormone
How is the body affected if it develops hyperpituitarism before the closure of the epiphyseal plates?
An average height of over 8 feet
How is the body affected if it develops hyperpituitarism after the closure of the epiphyseal plates?
Acromegaly
What is one of the major negative effects of Acromegaly?
The internal organs don’t match the growth of the body and eventually fail to maintain homeostasis
How is hyperpituitarism treated?
- Surgery
- Irradiation
- Radioactive implants
Why is hyperpituitarism often misdiagnosed?
Because we place a high value on height
How is precocious puberty?
- The appearance of secondary sex characteristics before 8-9 years old
- Also caused advanced bone growth and maturation
What can cause precocious puberty?
-Disorders of the gonads, adrenal, tumor, or unknown causes
In terms of growth, what is the biggest concern with precocious puberty
Growth stops early and can cause stunted height
What are the social and developmental implications of precocious puberty
- High sex drive at a very young age
- Social isolation
How is precocious puberty treated?
LHRH analogs are given to slow down but not stop the precocious puberty
What is congenital hypothyroidism?
-Deficiency in thyroid hormone
An infant with congenital hypothyroidism will present as____
Sleepy, easy, and quiet
What are the s/s of congenital hypothyroidism
- Decline in growth
- Dry skin
- Puffy eyes
- sparse hair
- constipation
- Mental decline
- Decreased appetite
- Bradycardia
- Goiter
How do the s/s of congenital hypothyroidism differ from adults with hypothyroidism?
-s/s are the same but occur along side a change in past growth patterns with increased weight and decline in height
How is congenital hypothyroidism treated?
Thyroxine therapy
What are the 2 big nursing considerations for a child with congenital hypothyroidism?
- Keep them warm
- treat constipation
How does the outward appearance of a child with hypo]erthyroidism present?
- possible goiter
- Exophthalmos
- may be underweight
children with hyperthyroidism often have a concurrent _____disorder
auto-immune
What are the s/s of a child with hyperthyroidism
Emotional Lability, restless, decline in school work, tachycardia, accelerated linear growth, behavioral problems, trouble concentrating
hyperthyroidism is aka ___
graves disease
What are the key nursing interventions for a child with hyperthyroidism
- increase caloric intake
- Keep quiet
- rest
- monitor for thyroid storm (fever, sweating, tachycardia, palpations, tremors) this is an emergent situation
What is the treatment for hyperthyroidism?
- Antithyroid drugs
- Subtotal thyroidectomy
- ablation with radioiodine
What is Addison disease?
A chroninc adrenocortical insufficiency.
The body cant make stress hormones!
This is an auto-immune disease that caused destruction of the adrenal glands
-Can be caused by trauma or infection
What are the s/s of addison’s disease?
Gradual
-Muscle weakness, mental fatigue, irratable, pigment changes at pressure points, general bronzing, dehydration, weight loss, hypotension, syncope, hypoglycemia, GI distress
What is the Tx for Addison’s disease?
monthly injections of Cortisol and aldosterone
What is the main nursing consideration for Addison’s disease?
Monitor for a crisis that comes from dehydration. can lead to coma, shock, and circulatory collapse
