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PEDS Unit 3 > Oncological Disorders: PT1 > Flashcards

Oncological Disorders: PT1 Flashcards

Leukemia, Lymphoma, Brain Tumors, Wilms Tumor, DX tests/labs

1
Q

Brielfy describe normal cellluar life.

A
  • Cells divide to make new cells in order to replace damaged or old cells
  • DNA is coded to direct the cell when to divide or when to die
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2
Q

Brifely describe a how a cell becomes cancerous.

A
  • DNA becomes damaged
  • Gives wrong instructions to the cell
  • Mutation allows for cells to replicate uncontrollably and stay alive longer
  • Cancer cells can crowd out normal cells
  • A lump of cancer cells is called a tumor
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3
Q

What are five common diagnostic tests for cancer?

A
  • Bone marrow biopsy
  • Bone Scintigraphy
  • Gallium Scan
  • PET Scan
  • SPECT Scan
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4
Q

How does a bone marrow biopsy help us diagnose cancer?

A
  • liquid marrow samples & a bone core segment
  • Uses:
    • Diagnosis
    • Evaluates DNA/Chromosomes
    • Prognosis/Risk
    • Treatment and response to therapy
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5
Q

How does bone scintigraphy help us diagnose cancer?

A

We use it to ID areas of increased cellular turnover (rapid growth)

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6
Q

How does Gallium Scan help us diagnose cancer?

A
  • a nuclear medicine scan;
  • uses gallium to look for cancer in the body
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7
Q

How does a PET scan help us diagnose cancer?

A
  • IDs differences in metabolism in tissues
    • (tumor cells have faster metabolism)
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8
Q

How does a SPECT scan help us diagnose cancer?

A
  • a nuclear medicine scan
  • examines the function of organs
  • looks at organs from different angles
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9
Q

Where is a bone marrow biopsy taken from?

A
  • < 2, tibia
  • > 2, iliac crest
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10
Q

What position is a patient in for a bone marrow biopsy?

A
  • Prone or on side,
  • usually on side
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11
Q

What is the nursing care after a bone marrow biopsy?

A
  • put on dressing (possibly pressure to stop in bleeding if present)
  • Monitor for bleeding, bruising, infection
  • Pain management
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12
Q

Leukemia and Lymphoma are cancers of…

A

the blood and lymph

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13
Q

What kind of tumor is a Wilms tumor?

A

organ tumor (kidney)

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14
Q

Neuroblastoma and brain tumors are tumors that effect…

A

the nervous system

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15
Q

Osteosarcoma and Ewing Sarcoma are…

A

bone tumors

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16
Q

Rhabdomyosarcoma is a…

A

muscle tissue sarcoma

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17
Q

What is a sarcoma?

A

tumor of connective or other nonepithelial tissue.

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18
Q

Retinoblastoma is a cancer of…

A

the eye

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19
Q

Why is education and emotional support so important in cases of child cancers?

A

Child cancers are fast growing, which is stressful for family

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20
Q

What is leukemia and where does it originate

A
  • Cancer of the blood-forming cells that are produced in the Bone Marrow
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21
Q

What is the most common childhood cancer?

A

Leukemia

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22
Q

What age is the peak onset of leukemia?

A

2-5yrs

(though it is rare, it can happen outside of that age range)

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23
Q

What are the two types of leukemia and which is more common?

A
  • Acute Lymphocytic Leukemia (ALL)
    • most common
  • Acute Myelogenous Leukemia (AML)
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24
Q

What is occuring with ALL?

A
  • Lymphoblast mutates and proliferates crowding out the healthy cells and using up nutrients
  • Will crowd out RBCs, WBCs and platelets -
  • s/s will relate accordingly
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25
Q

When screening for Leukemia, what will x-rays and a CBC show?

A
  • X-Rays/Imaging
    • Show enlarged liver and spleen
      • abnormal cells are building up in liver/spleen
  • CBC
    • HIGH WBC (With greater % of blasts/immature cells)
      • Low WBC of healthy type
    • Low H&H
    • Low Platelet count (<50,000 admitted to hospital)
26
Q

What are the first steps taken for a pt w/ a new dx of Leukemia?

Briefly explain each

A
  • Symptom management
    • Get the stable
  • Bone marrow biopsy
    • confirm dx/type of Leukemia
  • Lumbar Puncture
    • to assess CSF involvement
  • Central line placement
    • prep for chemo
  • Chemo
    • prophylactic treatment in case CSF involvement
    • focused chemo later in tx
27
Q

Why is chemo given so quickly after dx of Leukemia?

A

Not going to take a chance of missing CNS involvement, so chemo will be done to make sure if there are any cancer cells starting, they’re eliminated asap

28
Q

Explain why education and support are so crucial with a new leukemia dx pt.

A
  • Process happens SUPER fast
  • As soon as DX is confirmed the process starts.
  • w/in 24hrs of dx, they’ll already be in for central line placement and chemo
  • Very scary for family and pt and can be overwhelming
  • Support and education key!
29
Q

A lumbar puncture is done to evaluate for leukemic presense in the CNS. Explain the process.

A
  • Patient will be side-lying with head flexed and knees drawn up
  • Patient may be sedated
  • Provider will take 3-4 vials of CSF
  • Pressure will be held and an elastic bandage placed to puncture site
  • Monitor site for Bleeding, Hematoma, & Infection
  • Child should remain in bed for 4-8 hours flat to prevent leakage, which can lead to spinal headache
30
Q

Explain the three phases of chemo therapy for Leukemia.

A
  • Chemotherapy: three phasesInduction therapy
    • 4 to 5 weeks
    • Goal: “remission”
  • Intensification/Consolidation
    • 6 months of “bursts” of treatment
    • Goal: make sure it doesn’t come back
  • Maintenance therapy
    • 2-3 years
    • Goal: To preserve remission
31
Q

Why would cranial irradiation be used?

A

If the cancer has crossed the blood/brain barrier

32
Q

Why is a leukemia pt at risk for infection?

A
  • due to the destruction of health WBCs
33
Q

Why is a leukemia pt at risk for anemia?

A

Due to the destruction of RBCs

34
Q

Why is a leukemia pt at risk for Bleeding?

A

Due ot the destruction of platelets

35
Q

Why do we not do rectal temps for a Leukemia pt?

A

may tear the rectum and they are at risk for bleeding

36
Q

What are some indicators that the Leukemia has metastasized?

A
  • Bone pain and/or fractures
  • Liver/spleen enlargement
37
Q

True or False

One of the main places a cancer can matastesize is in the lungs.

A

True

38
Q

What is lymphoma?

A

Cancer of the lymphocytes

39
Q

What is the difference between hodgkins and non-hodgkins lymphoma?

A
  • Hodgkins = If lymphocyte has Reed-Sternberg cell
  • Non-Hodgkins = If lymphocyte does NOT have Reed-Sternberg cell
40
Q

What is worse, Hodgkins or non-Hodgkins lymphoma? Why?

A
  • Non-hodgkins
    • Because it can appear in the same places as Hodgkins as well as others and when it is discovered, it is usually at an advanced stage
  • Hodgkins has a 90% survival rate for ≥ 5yrs
41
Q

What is Wilms Tumor?

A
  • Tumor on the kidneys, usually unilateral
  • Most often diagnosed at 3-5 yrs of age
  • 90% survival rate
  • If untreated, the mass will block the vena cava/other organs and death will follow
42
Q

What are the s/s of Wilms Tumor?

A
  • Firm, non-tender abdominal mass
  • Fatigue
  • Weight loss
  • Fever
  • Hematuria
43
Q

How is Wilms Tumor confirmed?

A
  • Intravenous pyelogram
    • dye is injected and observed
44
Q

What is THE key thing to make sure of once a Wilms Tumor is confirmed?

A
  • That NOBODY palpates the mass
    • It is encapsulated and keeps the cancer cells in one spot.
    • Palpation can burst the tumor and the cells would then be released into the body
45
Q

What is the medical treatment for Wilm’s Tumor?

A
  • Tumor AND kidney resection
  • Post op chemo and radiation for to eliminate anything missed, and prevent recurrance and metastasis.
46
Q

What is our Nursing Care for Wilms Tumor?

A
  • Family education/support
  • Monitor central line
  • Post surgical/chemo care
47
Q

What is a Neruoblastoma and whom does it affect?

A
  • A cancer that arises from neural crest cells
  • Only occurs in babies
48
Q

What are the dx tests for Neuroblastoma?

A
  • CT scan
  • Chest x-ray
  • Skeletal scintigraphy
  • Biopsy of tumor
49
Q

What is scintigraphy?

A

A technique in which a scintillation counter or similar detector is used with a radioactive tracer to obtain an image of a bodily organ or a record of its functioning.

50
Q

What is the Medical tx for Neuroblastoma?

A
  • Surgery
  • Chemo
  • Radiation
  • BMT (Bone Marrow Transplant)
51
Q

Where can Neuroblastomas occur?

A
  • Adrenal glands
  • Retroperitenal area
  • Head/neck/pelvis/chest
  • Can happen anywhere along the neural pathways
52
Q

What are the s/s of Neuroblastomas?

A
  • s/s are based on where it happens
    • If in spine, child may have leg weakness, balance issues
    • May have bowel and bladder issues not present before
  • If in face
    • May see bruising/swelling around the eyes
53
Q

True or False

Very commonly the kids will have metastastes somewhere else (bone marrow, lympnodes, bone or skin, etc) before they’re even dx’d w/ neuroblastoma

A

True

54
Q

What is the recovery rate for Neuroblastomas?

A
  • 30-90% recovery rate
    • Lower numbers are with metastasis at time of dx
    • Higher number is when its caught prior to any metastasis
55
Q

What are some general points to remember in regards to Brain Tumors?

A
  • Most common solid tumor
  • Second most common cancer after leukemia
  • Tumors that are confined to brain and spine, mostly brain
  • There are benign and malignant
  • Benign wouldn’t kill a person, but they still need to be removed because they take up space
56
Q

What are the s/s of Brain Tumors?

A
  • s/s based on where it is in the brain
    • Occiptal tumor = vision issues
    • Frontal lobe = irritable, poor decision making, behavior/memory issues
    • Parietal = hearing, speech, etc
57
Q

In addition to s/s due to location of Brain Tumor, what are some other manifestations to keep an eye out for?

A
  • Irritability
  • lethargy
  • increased head circumferance (infants),
  • headache
  • loss/delay of milestones (waking, crawling, etc)
58
Q

Dx tests for Brain Tumors?

A
  • MRI
  • CT Scan
  • PET (to eval tx)
  • LP
  • Biopsy
  • Labs
59
Q

What is the Medical tx for Brain tumors?

A
  • Resection of tumor
  • Possible chemo and radiation
60
Q

What is the number one concern regarding brain tumors?

A
  • ICP, stroke, herniation (out the skull hole)

PEDS Unit 3 (9 decks)

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