Oncological Disorders: PT2 Flashcards
What is an Osteosarcoma and what are the key items to keep in mind regarding it?
- Tumor arises from bone forming cells
- Occurs in long bones, often femur
- Often diagnosed when child fractures the bone
- X-ray - Sunburst appearance
- Peak age: 15-16 yrs
What are some clues in a pt hx that may point to Osteosarcoma?
- Pain in bones for a few months
- Thought it was growing pains
- Change of gate, etc
What is a Ewing’s Sarcoma and where does it commonly occur?
- Bone tumor that arises in the marrow spaces of the bone or soft tissue around the bone
- Commonly occurs in the femur, tibia or spine
What is the Codman Triangle?
- It is a periosteal reaction
- triangular area of new subperiosteal bone that is created when the tumor, raises the periosteum away from the bone.
- Its surface manifestation is swelling in the effected area
What is a Rhabdomyosarcoma and where does it occur?
- It is a tumor in a muscle
- It can grow anywhere in the body, but it’s most common in the
- Arms and legs
- Head and neck
- Urinary and reproductive organs
- and even the EYE
What are the key points to keep in mind re: Rhabdomyosarcoma?
- Most often found in teenagers
- S/S: soft or hard “lump” in muscle that doesn’t move
- may move as a whole, but doesn’t “squish” like a typical muscle injury
- Poor prognosis
What is the Medical Treatment for Rhabdomyocarcoma?
- Chemo
- Radiation
- Resection or Amputation
How does the medical team assist the family with deciding between limb saving or amputate procedures?
- Med team may make recommendation based on case, but otherwise
- We present data and numbers and support the family in making the choice
If amputation is going to occur, what post op condition do we need to prepare our pt for?
- Phantom pain syndrome
- Its real, it’s a neuro reaction and its treatable
If a patient is being treated for muscle or bone cancer and is compliaining of SOB, what could be the problem?
- The cancer has matastasized in the lungs
- SOB is the first sign of this
What is a Retinoblastoma?
- intraocular malignancy of the retina only found in children
- It can be unilateral or both
What are the s/s of retinoblastoma?
- Leukoria (cat’s eye)
- a whitish glow in the pupil
- Strabismus
- lazy eye
- Eye pain
- Blindness (late sign)
Why is it hard to pick up on visual changes with kids?
- Kids won’t say they’re not seeing well out of one eye, for them they just can’t see well.
What is the Medical treatment for retinoblastoma?
- Chemo
- Can be used in combination with
- Photocoagulation
- Cryotherapy
- Radiation
- Enucleation
How is retinoblastoma treated w/ photocoagulation?
Laser to destroy the retinal blood vessels that are feeding the tumor
How is retinoblastoma treated w/ cryotherapy?
Freeze the tumor to destroy vessels which will stop growth
How is retinoblastoma treated w/ enucleation and what do we keep in mind with it?
- Enucleation is eye removal
- shouldn’t keep the eye in if vision can’t be salvaged
- Kids tend to roll with it, but it can be traumatizing for parents, will go through grieving process
- Kids learn to accommodate (get used to the challenges of one eye) rather easily
How do we support parents of kids going through enucleation?
- Help them get used to seeing it and caring for it Educate how to monitor incision
- Educate that kid will wear an eyepatch for a week or so and then, after healed, will get artificial eye
What is the goal of chemotherapy?
Kill malignant cells, prevent metastasis
What is a metastsis?
the development of secondary malignant growths at a distance from a primary site of cancer.
True or False
Chemo goes through the body and will affect ANY cell that is rapidly reproducing regardless if it is the target cell or not.
True
What are some examples of non-cancerous cells that are affected by chemo?
- hair folicles rapidly grow, thus why peeps lose their hair
- FX mucous membranes and blood producing cells in marrow so they’ll have less RBC, Platelets, WBCs and be more @risk for infection, bleeding and fatigue
Chemo dosage, method of admin, and length of tx will be determined by…
its effect on the pt’s body
True or False
All registered nurses can admin chemo.
False, only certified RNs can
What are items we need to keep in mind re: admin of chemo?
- Need to know how to take care of yourself and pt
- Special gloves worn, all mats used are thrown away in special radioactive bags and desposed w/ toxic waste
- Chemo is peed out about 48 hrs after chemo treatment, so have to take safety precautions at home for radioactive pee.
- Diapers will go in that med waste - the special gloves are used for changing diapers or emptying a pee bin, etc
- If staff or family is pregnant, they don’t take care of the patient at all
What two methods are used for central line access for chemo?
- Broviac
- w/ external tube hanging
- more maintenance and behavior mod
- no swimming, showering, etc
- Portocath
- Internal
- No maintenance/behavioral mods
- Just the puncture pain during admin/access
What are three areas have common complications to chemo?
- Hair
- GI
- GU
What is the chemo complication for hair and how do we address it?
- Alopecia
- loss of hair
- Need to consider psychosocial impact
- Support and Educate that it will come back
What are the chemo complications for GI and how do we address them?
- Nausea/vomiting
- common but manageable w/ anti-emetics
- give cool or bland foods
- Change in appetite
- some kids lose sense of taste
- This was the storry about flaming hot cheetos being popular cause they can actually taste those
- Mucositis- Mucosal irritation/Mouth sores
- Provide good oral hygeine
- “Magic mouthwash” - has benadryl, lydocane and an antacid - that helps them feel better for mouth care and inflammation and acids in stomach that add to pain
- Constipation
- stool softeners
How does chemo effect the GU system?
- Chemo is gonna be in bladder
- Problem is it just sits there against the bladder tissue and can cause hemorrhagic cystitis
- Will give lots of fluids, up to TWICE their proper maintenance dose - trying to flush that out
- MESNA is med protects the bladder tissues
How is radiation treatment delivered?
- In divided treatments (about 5mins ea), every day, over weeks
- Delivered to exact location of cancer cells (unlike chemo)
SFX of radiation?
- fatigue
- skin damage
- hair loss
- n/v
- low blood counts
Why can radiation treatment be taxing on a family?
Where they live, type of transportation they need to take (public can expose to infection), etc
Why might surgery be necessary after chemo or radiation therapy?
- to get anything missed (or to make tumor smaller prior to resection), or vise verse
Key things to remember about pre-op care?
- Consent/assent
- Fam/Pt education on what’s about to happen
- developmentally appropriate for kid
- Parents stay with kid until the last second and parent brought back in for the wake up
Key things to remember post-op?
Usual. Watch for:
- bleeding,
- respiratory issues,
- infection,
- pain
How do we deal with our kiddos re: body issues from procedures?
- communicate at developmental level
- Educate on care
- Support emotions
- Connect w/ support groups w/ peers
Where do stem cells come from?
- bone marrow,
- umbilical cord blood,
- peripheral blood
Is it possible to purposefully wipe out a pt’s bone marrow, if so, why?
- Yes
- In the case of diseased bone marrow, you’d want to wipe it out so it can be replaced by stem cells
How are stem cells administered?
into the blood stream where they will migrate to the marrow.
What is Graft vs Host disease?
- biggest concern w/ stem cell and bone marrow transplants
- When body rejects replacement
- We want to suppress the body’s response to this
What are Bio agent treatments?
- Naturally occurring substances that are in the body that influence the immune system functions
- May give “monoclonal antibodies” (a synthesized protein) for specific types of cancer
- usually used in conjunction with some other type of tx
What are CAM therapies and what is our responsibility with them?
- Complementary Alternative Medical Therapies
- Family/religious/spiritual/cultural traditions
- We need to build a trusting relationship w/ family so that they feel safe discussing and we can ensure safety
What is Tumor Lysis Syndrome?
- It is when the tumor ruptures and its contents are spread throughout the body
- Can cause metabolic abnormalities/electrolyte imbalances - ex. hyperkalemia, hypocalcemia
How is Tumor Lysis Syndrome managed?
- Hydration
- Serial labs
- Monitor I/Os
- Meds for specfic abnromality/imbalance
- ex. if hyperkalemia, reduce potassium
What is the Nadir of treatment?
The point after treatment when blood counts are very very low and the pt is @ highest risk for infections
Why do parents need to know the nadir of treatment?
So they can take extra precautions to keep their kid at home and safe from infections.
To know the nadir, we need to know the Absolute Neutrophil Count.
What is its formula and what level triggers neutropenic precautions?
- ANC = neutrophils X WBCs
- or
- ANC = (%segs + %bands) x WBCs
- an ANC < 500 is the trigger point for neutropenic precautions
What are neutropenic precautions?
- Neutropenic precautions are steps you can take to prevent infections if you have moderate to severe neutropenia.
- Neutropenia is a condition that causes you to have low neutrophils in your blood.
What is tumor compression, where can it occur and why do we care?
- Tumor compression is when a tumor grows and pushes against tissues, organs, vessels, etc
- It can occur anywhere in the body
- We care because if it compress the spinal cord, esophagus, airway, etc - its bad news bears
- s/s will manifest according to location
Why do some kids that have faced trauma have a hard time relating to other kids and their problems and what do we do about it?
- Other kids typical problems are just nothing compared to almost losing your life or limb.
- This can lead to isolation
- We should connect w/ support groups/programs
