Pediatric Nursing: Oncological Problems Flashcards

1
Q

Leukemia: Description

A
  • is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow.
  • proliferating immature WBCs depress the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia).
  • cause is unknown; it seems to involve genetic damage of cells, leading to the transformation of cells from a normal state to a malignant state.
  • risk factors: genetic, viral, immunological, and environmental factors and exposure to radiation, chemicals, and medications.
  • acute lymphocytic leukemia is the most frequent type of cancer in children.
  • more common in boys than girls after 1 year of age.
  • prognosis depend on various factors such as age at diagnosis, initial WBC count, type of cell involved, and sex of the child.
  • treatment involves chemotherapy and possibly radiation and hematopoietic stem cell transplantation.
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2
Q

Leukemia: Assessment

A
  • infiltration of the bone marrow by malignant cells causes fever, pallor, fatigue, anorexia, hemorrhage (usually petechiae), and bone and joint pain; pathological fractures can occur as a result.
  • signs of infection occur as a result of neutropenia.
  • child experiences hepatosplenomegaly and lymphadenopathy.
  • child has a normal, elevated, or low WBC count, depending on the presence of infection or of immature versus mature WBCs.
  • child has decreased Hb, Ht, and platelet levels.
  • a positive bone marrow biopsy specimen identifies leukemic blast (immature) - phase cells.
  • signs of increased intracranial pressure (IPC) occur as a result of CNS involvement.
  • child shows signs of cranial nerve or spinal nerve involvement (clinical manifestations relate to the area involved).
  • clinical manifestations indicate the invasion of leukemic cells to the kidneys, testes, prostate, ovaries, GI tract, and lungs.
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3
Q

Leukemia: Infection

A
  • can occur through self-contamination or cross-contamination.
  • most common sites are the skin, respiratory tract, and GI tract.
  • initiate protective isolation procedures, in private room with high-efficiency particulate air filtration or laminar air flow system if possible.
  • room needs to be cleaned daily, use strict aseptic technique for all nursing procedures, limit the number of care givers, and ensure everyone wears a mask.
  • keep supplies for the child separate and reduce exposure to environmental organisms. Daily bath with antimicrobial soap, oral hygiene frequently.
  • monitor WBC, neutrophil counts, VS, auscultate lungs, change wound dressing daily, assess urine and the skin and oral mucous for signs of infection.
  • encourage deep-breathe and cough.
  • child should not receive immunization with a live virus (measles, mumps, rubella, polio) or varicella.
  • avoid invasive procedures and initiate a bowel program to prevent constipation.
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4
Q

Leukemia: Bleeding

A
  • platelet transfusions are generally reserved for active bleeding episodes that do not respond to local treatment and that may occur during induction or relapse therapy.
  • packed red blood cells may be prescribed for a child with severe blood loss.
  • handle the child gently, measure abdominal girth (an increase can indicate internal hemorrhage), instruct use of soft toothbrush and avoid dental floss. Provide soft food.
  • avoid injections and apply firm and gentle pressure to a needle-stick site for at least 10 min. Pad side rails and sharp corners of the bed and furniture, discourage child from engaging in activities, and contact sports. Avoid constrictive or tight clothing, use caution when taking BP. Avoid blowing the nose, count the number of pads or tampons if menstruating.
  • avoid use of enemas, examine all body fluids.
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5
Q

Leukemia: Fatigue and Nutrition

A
  • assist parents and child in selecting a well-balanced diet.
  • provide small meals that require little chewing and are not irritating to the mucosa.
  • if child can not take oral feedings, parental nutrition or enteral feedings may be prescribed.
  • assist the child in self-care and mobility.
  • allow adequate rest periods.
  • do not perform nursing care activities unless they are essential.
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6
Q

Leukemia: Chemotherapy

A
  • Induction phase: achieves a complete remission or disappearance of leukemic cells;
  • intensification or consolidation therapy: decreases the tumor burden further;
  • CNS prophylactic therapy: prevents leukemic cells from invading the CNS;
  • maintenance phase: serves to maintain the remission phase.
  • monitor for severe bone marrow suppression; during the period of greatest bone marrow suppression (the nadir), blood cell counts are extremely low.
  • monitor for infection and bleeding, nausea, vomiting, and alteration in bowel function (adm stool softeners to prevent constipation as prescribed), provide rectal hygiene as gently as needed.
  • adm antiemetics before chemotherapy.
  • monitor for dehydration, hemorrhagic cystitis, peripheral neuropathy, oral mucous membranes for mucositis.
  • hair loss may occur (regrows in 3-6m and may be different).
  • instruct parents on signs and symptoms, when to notify PHCP, and about the care of a central venous access.
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7
Q

Hodgkin’s disease: description

A
  • a type of lymphoma
  • is a malignancy of the lymph nodes that originates in a single lymph node or a single chain of nodes.
  • the disease predictably metastasizes to nonnodal or extralymphatic sites, especially the spleen, liver, bone marrow, lungs, and mediastinum.
  • characterized by the presence of Reed-Sternberg cells noted in a lymph node biopsy.
  • peak incidence is in mid-adolescence.
  • possible causes include viral infections and previous exposure to alkylating chemical agents.
  • prognosis is excellent, with long-term survival rates depending on the stage of the disease.
  • primary treatment modalities are radiation and chemotherapy (alone or in combination).
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8
Q

Hodgkin’s disease: assessment

A
  • painless enlargement of lymph nodes.
  • enlarged, firm, nontender, movable nodes in the supraclavicular area; in children, the “sentinel” node located near the left clavicle may be the first enlarged node.
  • nonproductive cough as a result of mediastinal lymphadenopahty.
  • abd pain as a result of enlarged retroperitoneal nodes.
  • advanced lymph node and extralymphatic involvement that may cause systemic symptoms, such as a low-grade or intermittent fever, anorexia, nausea, weight loss, night sweats, and pruritus.
  • positive biopsy specimen of a lymph node and positive bone marrow biopsy.
  • CT scan of the liver, spleen, and bone marrow may be done to detect metastasis.
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9
Q

Hodgkin’s disease: Interventions

A
  • for early stages without mediastinal node involvement, the treatment of choice is extensive external radiation of the involved lymph node regions.
  • with more extensive disease, radiation and miltidrug chemotherapy are used.
  • monitor for medication induced pancytopenia and an abnormal depression of all cellular components (which increases the risk of infection, anemia, and bleeding).
  • monitor for adverse effects.
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10
Q

Nephroblastoma (Wilms’ Tumor)

A
  • most common intraabdominal and kidney tumor of childhood; manifests unilaterally and localized or bilaterally, sometimes with metastasis to other organs.
  • peak incidence is 3y and is associated with genetic inheritance and with several congenital anomalies.
  • therapeutic management includes a combined treatment of surgery and chemotherapy (depending on clinical stage and pattern).
  • presents with a swelling or mass within the abd (usually firm, nontender, confined to 1 side, and deep within the flank).
  • urinary retention and/or hematuria. Anemia, pallor, anorexia, and lethargy. Hypotension, weight loss, and fever.
  • symptoms of lung involvement, such as dyspnea, shortness of breath, and chest pain, if metastasis occur.
  • monitor VS, AVOID palpation of the abd (place a sign beside the bed because rupture of the tumor can spread the cancer cells), measure abd girth at least once daily.
  • post-op: monitor for signs of hemorrhage or infection, VS, strict intake and output, and abd distension.
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11
Q

Neuroblastoma: description

A
  • a tumor that originates from the embryonic neural crest cells that normally give rise to the adrenal medulla and the sympathetic ganglia.
  • most tumors develop in the adrenal gland or the retroperitoneal sympathetic chain; other sites may be within the head, neck, chest, or pelvis.
  • most children present with neuroblastoma before 10 years of age.
  • most presenting signs are caused by the tumor compressing adjacent normal tissue and organs.
  • diagnostic evaluation is aimed at locating the primary site; analyzing the breakdown products excreted in the urine (vanillylmandelic acid, homovanillic acid, dopamine, and norepinephrine, permits detection of suspected tumor before and after medical-surgical intervention).
  • prognosis is poor because of the frequency of invasiveness of the tumor and because, in most cases, a diagnosis is not made until after metastasis has occurred; the younger the child at diagnosis, the better the survival rate.
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12
Q

Neuroblastoma: therapeutic management

A
  • surgery is performed to remove as much of the tumor as possible and to obtain biopsy ; in the early stages, complete surgical removal is the treatment choice.
  • surgery usually is limited to biopsy in the later stages because of metastasis.
  • radiation is used commonly with later-stage disease and provides palliation for metastatic lesions in bones, lungs, liver, and brain.
  • chemotherapy is used for extensive local or disseminated disease.
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13
Q

Neuroblastoma: Assessment

A
  • firm, nontender, irregular mass in the abd that crosses the midline.
  • urinary frequency or retention from compression of the kidney, ureter, or bladder.
  • lymphadenopathy, especially in the cervical and supraclavicular areas.
  • bone pain if skeletal involvement.
  • supraorbital ecchymosis, periorbital edema, and exophthalmos as a result of invasion of retrobulbar soft tissue.
  • pallor, weakness, irritability, anorexia, weight loss.
  • signs of respiratory impairment (thoracic lesion)
  • signs of neurological impairment (intracranial lesion).
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14
Q

Osteosarcoma (Osteogenic Sarcoma): description

A
  • most common bone cancer in children.
  • usually is found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur.
  • peak age of incidence is between 10 and 25 years.
  • symptoms in the earliest stage are most always attributed to extremity injury or normal growing pains.
  • treatment may include surgical resection to save a limb or remove affected tissue, or amputation.
  • chemotherapy is used to treat the cancer and may be used before and after surgery.
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15
Q

Osteosarcoma: assessment

A
  • localized pain at the affected site (often relieved by a flexed position).
  • palpable mass, limping if weight-bearing limb is affected.
  • progressive limited range of motion and the child’s curtailing of physical activity.
  • child may be unable to hold heavy objects.
  • pathological fractures occur at tumor site.
  • phantom limb pain after amputation.
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16
Q

Brain Tumors: description and assessment

A
  • an infratentorial tumor, the most common, is located in the posterior third of the brain (primarily in the cerebellum or brainstem) and accounts for the frequency of symptoms resulting from increased IPC.
  • a supratentorial tumor is located within the anterior two-thirds of the brain (mainly the cerebrum).
  • signs and symptoms depend on its anatomical location and size, and to some extent, the age of the child.
  • most common diagnostic procedure is MRI.
  • therapeutic management includes surgery, radiation, and chemotherapy; the treatment of choice is total removal of the tumor without residual neurological damage.
  • assessment: headache (worse on awakening and improves during the day), vomiting, ataxia, seizures, behavioral changes, clumsiness, awkward gait or difficulty walking, diplopia, facial weakness.
  • monitor for signs of increased IPC.
17
Q

Brain tumors: Preoperative interventions

A
  • perform neurological assessment at least every 4h.
  • institute seizure precautions.
  • assess weight loss and nutritional status.
  • shave the child’s head as prescribed (may be done in the OR) provide a cap or hat.
  • prepare the child as much as possible.
18
Q

Brain tumors: postoperative interventions

A
  • assess neurological, motor function, and level of consciousness.
  • monitor temp closely, signs of respiratory infection, signs of meningitis, signs of increased IPC, for hemorrhage (do not change dressing without a specific prescription).
  • assess pupillary response, monitor colorless drainage on the dressing, ears or nose (report immediately), assess surgeon’s prescription for positioning, including degree of neck flexion.
  • monitor IV fluids closely and adm analgesics as prescribed.
  • promote measures that prevent vomiting (because increases IPC and risk for incisional rupture).
  • provide quite environment and emotional support.
  • if large tumor, not positioned on the operative side.
  • if infratentorial, usually positioned flat on either side.
  • if supratentorial, usually head elevated above heart.