Peds Exam 3a - Onc Flashcards
peds vs adult cancer
peds is not organ cancers
-born with it like blood and bone cancers
-kids respond well to chemo
how are tumors named & symptoms
type and location, symptoms are based on size, location & age
when will we start to do radiation
once they are over 2 years old d/t how it affects growth
nursing considerations for post opt glioblastoma tumor removals
-do not want to position on the side it was taken out of
-reduce ICP
-neck flexion
-NPO
-comfort measures
-eye care (moist & covered)
neuroblastoma
the most common malignant extracranial solid tumor in childhood (most common during infancy)
chest, neck, pelvis
s/s of neuroblastoma
depends on location and stage of disease
therapeutic mgt of neuroblastoma
-if they can remove them, they will
-chemo & radiation
lymphomas
hodgkin & non hodgkin
tumors that arise in the lymphatic system
-hod: more prevalent in 15 to 19 yr olds
-non: most prevalent in <14
hodgkin disease has which type of cell
reed-sternbery cells
hodgkin disease treatment
-chemo (does well for hod & non)
-radiation maybe
-HSCT (stem cell transplant)
S/s hodgkin disease
-painless
-enlarged lymph nodes
-fever
-night sweats
bone tumor: osteosarcoma
-seen in the long bones w/ pain, limping & decreased ROM
-spreads & hard to remove
-amputation of leg
work w/ child on body image
bone tumor: ewing sarcoma
not seen in young kids
intermittent pain that worsens + redness & swelling + systemic symptoms like a fever -> treated with chemo and radiation
rhabdomyosarcoma
specific to kids
-tends to mimic other things going on w/ vague non specific symptoms often overlooked, example: ear ache
-often spreads
-chemo & radiation
wilms tumor (nephroblastoma)
young person cancer
an encapsulated tumor that attaches itself around 1 or both kidneys, often caught during routine physical when we palpate the mass
once you palpate a mass, what is the next step
immediately stop palpation because we are at risk of rupturing the tumor -> get imaging and confirm or disprove
wilms tumor clinical manifestations
either no symptoms or abdominal pain, not eating well, and possibly blood in urine
treatment of wilms tumor
immediate nephrectomy w/ removal of all regional lymph nodes and chemo with or without radiation
good prognosis
retinoblastoma
congenital malignant tumor that arises from the retinal cells ( usually one sided), high chance of this being hereditary so if one kid has it then the others are at risk and need to be screened frequently
retinoblastoma dx
cats eye reflex instead of red eye reflux
retinoblastoma treatment
removal of the eye
very important to protect the good eye
post opt care for eye removal
-large pressure dressing
-wash out eye socket during dressing change
-antibiotic ointment
if a sibling has retinoblastoma, how often should siblings be screened after the dx
every 1-3wk for the first year after
testicular tumors
not common but need to teach the importance of testicular self examinations (same w/ breasts)
what should you not see on a CBC w/ diff
blasts, if seen or high not good because it indicates marrow is making cell prematurely
leukemia
stem cells in the bone marrow produce immature WBCs -> these cells proliferate rapidly by cloning filling the bone marrow -> leukemia cells enter circulation replacing normal WBC then they rapidly fill the bone marrow replacing stem cells resulting in anemia, thrombocytopenia & neutropenia
what do stem cell produce
RBCs & platelets
consequences of leukemia
-anemia
-more frequent infections
-bleeding
-spleen, liver and lymph glands show marked infiltration, enlargement & fibrosis
presenting symptoms of leukemia
-fever
-pallor
-bleeding
-malaise
-anorexia
-large joint & bone pain
-bone marrow failure
cardinal signs of bone marrow failure
-petechiae
-frank bleeding
-joint pain
-fatigue
how do you dx leukemia
bone marrow biopsy
therapeutic mgt of leukemia
-treatment of symptoms
-combination chemotherapy (specific for each pt)
-cranial irradiation (in some cases)
do not want it to spread to brain
nursing considerations for child w/ cancer
-educate family on disease & treatment
-treatment schedule & drug doses
-side effects & how to manage
-how to prevent complication
-support coping skills & offer resources
-maintain quality QOL
-adjust to chronic illness
-support G&D
4 phases of chemotherapy
-remission induction
-consolidation (CNS prophylaxis)
-intensification
-maintenance
chemo: remission induction
rapid induction of complete remission, lasts 3-4 wks, oral steroids & IV chemo
chemo: consolidation
strengthen remission. introduce CNS prophylaxis. intrathecal & IV administration
chemo: intensification
destroy remaining or resistant cells
chemo: maintenance
prevent relapse, treat metastasis
can chemo cross the blood brain barrier
no
what is our main concern for a child w/ cancer and what will we watch for
spread to the brain esp leukemia
headache, persistent nausea & vomiting, irritability, dizziness, seizures, behavioral changes, lateral eye movement
short term side effects of chemo
-immunosuppression
-infection
-myelosuppresion
-nausea
-vomiting
-oral mucositis
-alopecia
long term effects of chemo
-microdontia & missing teeth
-hearing & vision changes
-hematopoietic
-immunologic or gonadal dysfunction
-endocrine dysfunction
-alts in cardiorespiratory & GI/GU
-increase risk of adult cancers
bone marrow suppression
-admin of blood products
-anemia & thrombocytopenia interventions (low RBC & platelets)
-admin of colony-stimulating factors
-interventions for neutropenia
alopecia
children mind it less than adults do, adolescence care more than other kids (hair can grow back in a different color & texture)
biggest complaint is getting cold
tricks for N/V
-zofran <3
-avoid strong smells
-SFM w/ largest being before chemo
-cold foods rather than hot
-admin chemo early
stomatitis
mouth sores
stomatitis prevention
-keep oral mucosa and teeth clean
-use anti fungal & antibacterial mouth wash QID
stomatitis treatment
-rinse mouth w/ NS
-“magic mouth wash” as prescribed
-avoid local anesthetics (“ocaines”) in small children bc they have to be able to spit it back out
if you swallow a swish and sip anesthetic mouth wash, why are we concerned
can numb the airway and we can lose it
oncologic emergencies: hemorrhagic cystitis
chemo is affecting the bladder leading to blood in the bladder
-give lots of fluids w/ chemo to flush it
-want them to void frequently pH <7
-mesma medication to help bladder mucosa
oncologic emergencies: tumor lysis syndrome
when you have a large tumor burden w/ tumor cell destruction release -> produced is high levels of uric acid, potassium and phos in blood leading to hyperuricemia, hyponatremia, hypocalcemia & metabolic acidosis which can result in renal failure and death
clinical manifestations of tumor lysis syndrome
flank pain, lethargy, N/V, oliguria, pruritus, cardiac arrhythmias, impaired renal function, tetany, & neuro changes red alert
what drug can we give for tumor lysis syndrome
allopurinol -> reduces the conversion of metabolic byproducts to uric acid
lots of fluids, good I&Os, urine specific gravity <10, urine pH & neuro
what to watch for in septic shock
-drop in BP
-change in pulse
-hypercalcemia
give fluids & phos
short adverse effects of radiation
lots of effect to the skinn
tired, N/V, oral mucositis, myelosuppression
pain mgt of cancer kids
take very seriously bc we dont want them in pain
-oral or IV dosinng preferred
-appropriate dosage based on body wt
-titrated to increase analgesia & minimize side effects
-use age appropriate pain scales
immunization & chemotherapy
vaccines given 2 weeks before or during chemo should be considered inactivated. child should be revaccinated or receive live virus vaccines 3 months after chemo has stopped
