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ABSN > Peds Exam 3a - Onc > Flashcards

Peds Exam 3a - Onc Flashcards

1
Q

peds vs adult cancer

A

peds is not organ cancers
-born with it like blood and bone cancers
-kids respond well to chemo

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2
Q

how are tumors named & symptoms

A

type and location, symptoms are based on size, location & age

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3
Q

when will we start to do radiation

A

once they are over 2 years old d/t how it affects growth

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4
Q

nursing considerations for post opt glioblastoma tumor removals

A

-do not want to position on the side it was taken out of
-reduce ICP
-neck flexion
-NPO
-comfort measures
-eye care (moist & covered)

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5
Q

neuroblastoma

A

the most common malignant extracranial solid tumor in childhood (most common during infancy)
chest, neck, pelvis

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6
Q

s/s of neuroblastoma

A

depends on location and stage of disease

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7
Q

therapeutic mgt of neuroblastoma

A

-if they can remove them, they will
-chemo & radiation

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8
Q

lymphomas

A

hodgkin & non hodgkin
tumors that arise in the lymphatic system
-hod: more prevalent in 15 to 19 yr olds
-non: most prevalent in <14

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9
Q

hodgkin disease has which type of cell

A

reed-sternbery cells

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10
Q

hodgkin disease treatment

A

-chemo (does well for hod & non)
-radiation maybe
-HSCT (stem cell transplant)

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11
Q

S/s hodgkin disease

A

-painless
-enlarged lymph nodes
-fever
-night sweats

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12
Q

bone tumor: osteosarcoma

A

-seen in the long bones w/ pain, limping & decreased ROM
-spreads & hard to remove
-amputation of leg
work w/ child on body image

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13
Q

bone tumor: ewing sarcoma

A

not seen in young kids
intermittent pain that worsens + redness & swelling + systemic symptoms like a fever -> treated with chemo and radiation

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14
Q

rhabdomyosarcoma

A

specific to kids
-tends to mimic other things going on w/ vague non specific symptoms often overlooked, example: ear ache
-often spreads
-chemo & radiation

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15
Q

wilms tumor (nephroblastoma)

A

young person cancer
an encapsulated tumor that attaches itself around 1 or both kidneys, often caught during routine physical when we palpate the mass

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16
Q

once you palpate a mass, what is the next step

A

immediately stop palpation because we are at risk of rupturing the tumor -> get imaging and confirm or disprove

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17
Q

wilms tumor clinical manifestations

A

either no symptoms or abdominal pain, not eating well, and possibly blood in urine

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18
Q

treatment of wilms tumor

A

immediate nephrectomy w/ removal of all regional lymph nodes and chemo with or without radiation
good prognosis

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19
Q

retinoblastoma

A

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

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20
Q

retinoblastoma dx

A

cats eye reflex instead of red eye reflux

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21
Q

retinoblastoma treatment

A

removal of the eye
very important to protect the good eye

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22
Q

post opt care for eye removal

A

-large pressure dressing
-wash out eye socket during dressing change
-antibiotic ointment

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23
Q

if a sibling has retinoblastoma, how often should siblings be screened after the dx

A

every 1-3wk for the first year after

24
Q

testicular tumors

A

not common but need to teach the importance of testicular self examinations (same w/ breasts)

25
Q

what should you not see on a CBC w/ diff

A

blasts, if seen or high not good because it indicates marrow is making cell prematurely

26
Q

leukemia

A

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

27
Q

what do stem cell produce

A

RBCs & platelets

28
Q

consequences of leukemia

A

-anemia
-more frequent infections
-bleeding
-spleen, liver and lymph glands show marked infiltration, enlargement & fibrosis

29
Q

presenting symptoms of leukemia

A

-fever
-pallor
-bleeding
-malaise
-anorexia
-large joint & bone pain
-bone marrow failure

30
Q

cardinal signs of bone marrow failure

A

-petechiae
-frank bleeding
-joint pain
-fatigue

31
Q

how do you dx leukemia

A

bone marrow biopsy

32
Q

therapeutic mgt of leukemia

A

-treatment of symptoms
-combination chemotherapy (specific for each pt)
-cranial irradiation (in some cases)
do not want it to spread to brain

33
Q

nursing considerations for child w/ cancer

A

-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

34
Q

4 phases of chemotherapy

A

-remission induction
-consolidation (CNS prophylaxis)
-intensification
-maintenance

35
Q

chemo: remission induction

A

rapid induction of complete remission, lasts 3-4 wks, oral steroids & IV chemo

36
Q

chemo: consolidation

A

strengthen remission. introduce CNS prophylaxis. intrathecal & IV administration

37
Q

chemo: intensification

A

destroy remaining or resistant cells

38
Q

chemo: maintenance

A

prevent relapse, treat metastasis

39
Q

can chemo cross the blood brain barrier

A

no

40
Q

what is our main concern for a child w/ cancer and what will we watch for

A

spread to the brain esp leukemia
headache, persistent nausea & vomiting, irritability, dizziness, seizures, behavioral changes, lateral eye movement

41
Q

short term side effects of chemo

A

-immunosuppression
-infection
-myelosuppresion
-nausea
-vomiting
-oral mucositis
-alopecia

42
Q

long term effects of chemo

A

-microdontia & missing teeth
-hearing & vision changes
-hematopoietic
-immunologic or gonadal dysfunction
-endocrine dysfunction
-alts in cardiorespiratory & GI/GU
-increase risk of adult cancers

43
Q

bone marrow suppression

A

-admin of blood products
-anemia & thrombocytopenia interventions (low RBC & platelets)
-admin of colony-stimulating factors
-interventions for neutropenia

44
Q

alopecia

A

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

45
Q

tricks for N/V

A

-zofran <3
-avoid strong smells
-SFM w/ largest being before chemo
-cold foods rather than hot
-admin chemo early

46
Q

stomatitis

A

mouth sores

47
Q

stomatitis prevention

A

-keep oral mucosa and teeth clean
-use anti fungal & antibacterial mouth wash QID

48
Q

stomatitis treatment

A

-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

49
Q

if you swallow a swish and sip anesthetic mouth wash, why are we concerned

A

can numb the airway and we can lose it

50
Q

oncologic emergencies: hemorrhagic cystitis

A

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

51
Q

oncologic emergencies: tumor lysis syndrome

A

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

52
Q

clinical manifestations of tumor lysis syndrome

A

flank pain, lethargy, N/V, oliguria, pruritus, cardiac arrhythmias, impaired renal function, tetany, & neuro changes red alert

53
Q

what drug can we give for tumor lysis syndrome

A

allopurinol -> reduces the conversion of metabolic byproducts to uric acid
lots of fluids, good I&Os, urine specific gravity <10, urine pH & neuro

54
Q

what to watch for in septic shock

A

-drop in BP
-change in pulse
-hypercalcemia
give fluids & phos

55
Q

short adverse effects of radiation

A

lots of effect to the skinn
tired, N/V, oral mucositis, myelosuppression

56
Q

pain mgt of cancer kids

A

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

57
Q

immunization & chemotherapy

A

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

ABSN (118 decks)

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