Pediatrics Test 2: Cancer and Dying Flashcards
What types of children are more prone to cancer?
After treatment of chemotherapy and radiation
Children with AIDS
certain genetic syndromes
Down syndrome is more likely for leukemia
What are the most common types of childhood cancer?
Leukemia
cancer of brain and CNS
What are the cardinal symptoms of cancer?
Unusual mass or swelling Unexplained paleness and loss of energy Sudden tendency to bruise Persistent localized pain or limping (osteosarcoma) Prolonged, unexplained fever or illness Frequent headaches, often with vomiting Sudden eye or vision change Excessive, rapid weight loss
List the treatment options for cancer?
Surgery
Chemotherapy
Radiotherapy
How is surgery an option for chemotherapy
Biopsies
Excision of tumor
- palliative: reduce bulk to decrease pain
- curative
What is chemotherapy treatment?
Primary option
Interfere with production of nucleic acids, DNA or RNA
Given in combination
Very toxic to cell tissue
What is radiotherapy treatment?
Come a long way in 30 years
List the adverse reactions of cancer treatment?
Bone marrow suppression GI suppression Alopecia Fatigue Infertility
What is bone marrow suppression?
Anemia (don’t develop hemoglobin or hematocrit in normal amounts. Decreased oxygen carrying capacity)
Neutropenia : decrease neutrophils which is a indicator that chemo is working
Thrombocytopenia : decreased platelet count if get below 100,000. At risk for bleeding so enforce bleeding risk.
- such as invasive procedures, soft toothbrush, electric shavers, avoid aspirin and NSAIDS
What are the GI disturbances of cancer?
Anorexia : small frequent meals, increase calorie and protein, good oral care
Nausea and vomiting
Diarrhea : keep hydrated. Good hair and skin care. Fiber, limit fat and spice food. Avoid anti-diarrhea
Stomatitis : ulceration in mouth, get paradex mouthwash for pain relief
What is alopecia?
Loss of hair.
It will regrow but color and texture will change
Give them choices on how to use it and what the want to do when they are bald
How is fatigue and adverse reaction?
Exercise them
Allow more time for activities
Balanced meals
What is extravasation signs and symptoms?
Blister
Ulceration
Tissue necrosis
Extravastion nursing interventions?
Stop infusion
Notify MD
moist compress
-cold except Vinca alkaloids then use warm
What are the signs and symptoms of Anaphylaxis?
Urticaria Angioedema Flushing Rashes Difficulty breathing Hypotension Nausea and vomiting
What are the radiotherapy adverse effects?
GI : nausea, vomiting, diarrhea, and anorexia
Skin : alopecia, dry or moist desquamation
Head : mucositis, parotitis, sore throat, loss of taste, dry mouth
Urinary bladder : rarely cystitis
Bone marrow : myelosuppression
Bone marrow transplantation, when it is chosen
Treatment of childhood cancer that is not curable via other means
How does one use a bone marrow transplant
Utilizes lethal doses of chemotherapy to rid body of malignant cells
What do bone marrow transplants require
Suppression of immune system to prevent rejection
What are the types of bone marrow transplant?
Autologous bone marrow transplant
Allogenic bone marrow transplant
Umbilical cord blood transplant
What is retinoblastoma
Unilateral or bilateral
Causes blindness in eyes
Last resort is enuclieation (removal of eye)
What is palliative care?
Focus on preventing or relieving child’s symptoms and support child and family
What can children understand about death by the age of 7?
Universality : all living things die, it is inevitable, timing is unknown
Irreversibility : once the physical body dies it does not become alive again
Non functionality : once a living thing dies, all life-defining capabilities to cease
Causality : external and internal events can cause death
No corporal continuation : some from of personal continuation exists after death
What is the principle of double effect?
An action that has one good (intended) and one bad effect is permissible if there must be a compelling or proportionate reason for permitting the foreseeable bad effect to occur.
What are some symptoms that dying children may experience?
Pain
GI : anorexia, n/v, constipation and diahrrea
GU : UTI, urinary retention
Hematologist : anemia, bleeding
Respiratory : cough, congestion, SOB, wheezing
CNS : fever, chill, sleep disturbance, seizures
Integumentary : dry skin, rash, itching, edema, pressure sores
Emotional : fear, anxiety and depression
What are physical signs of approaching death?
Loss of sensation in lower extremities Sensation of heat: body feels cold Loss of senses : hearing is last to fail Confusion, LOC, slurred speech Loss of bowel and bladder control Decreased appetite and thirst Difficulty swallowing Change in respiratory pattern Weak, slow pulse, decreased blood pressure
What care can be provided during death?
Frequent mouth care Good physical hygiene Continue medications to manage symptoms Discontinue unnecessary medications Encourage family to discus death Encourage family to speak with child in calm, reassuring voice Provide family surrounding and objects Allow spiritual and cultural rituals Allow Family to be alone with child after death
What. Are symptoms of grief
Sensations of somatic distress Preoccupation with image of deceased Feelings of guilt Feelings of hostility Loss of usual patterns of conduct
How do you support e grieving families
Stay with them, listen, cry
Avoid judgmental statement, rationalizationz, artificial consolation
Refer to help groups
Attend funeral or visitation
Refer to dead children by name, share memories
Emphasize that grief is a painful process that can take years
