Peds Test # 3 Cancer Flashcards
Mutation results in which 3 outcomes?
1) Lack of differentiation
2) Unregulated growth
3) Cellular immortality
What does it mean when cancer is referred to as “well-differentiated”?
It means you can tell where the cancer metastasized from.
Which 2 types of cancers are classified as Hematological Malignancies?
1) Leukemia - Cancner of the blood/bone marrow
2) Lymphoma - Cancer of the lymph
Which 3 cancers are classified as Solid Tumors?
1) Wilm’s Tumor - Nephroblastoma
2) CNS Tumors - Cancer of the brain/spine
3) Retinoblastoma - Cancer of the eye
What are the 5 characteristics of childhood cancers?
1) Usually affects deep tissues
2) Usually very responsive to therapy
3) Sometimes related to peak growth periods
4) No screening or early detection available
5) Often disseminated at diagnosis (75% cure rate)
Why are childhood cancers usually very responsive to therapy?
Because kids usually don’t have other health problems like older people. also kids don’t have bad habits like drinking and smoking that further complicate the problem.
What is the most common type of childhood cancer?
Leukemia
What are the 2 classifications of Leukemia covered in lecture and what is the survival rate for both?
1) Lymphoid - Includes Acute Lymphoid Leukemia (ALL) has a 80% survival rate.
2) Myeloid - Includes Acute Myeloid Leukemia (AML) & Acute Nonlymphoid Leukemia (ANL). Has a 50% survival rate.
What are the 6 different etiologies/causes of Leukemia?
1) Combination of genetic and environmental agents
2) Chemical agents
3) Chemotherapeutic agents
4) Radiation
5) Viruses
6) Immunologic deficiencies
What are the 4 noted pathophysiological effects of Leukemia on the body?
1) Genetic damage to bone marrow
2) Uncontrolled proliferation of blasts
3) ⬇ Production of normal cells
4) Accumulation of blasts in organs & tissues
What are the 8 SxS of Leukemia?
1) Weakness & fatigue
2) Bruising & bleeding
3) Fever and infection
4) Bone & joint pain
5) Abdominal pain & vomiting
6) Pallor & tachycardia
7) Petichiae & purpura
8) Lymphadenopathy & Hepatosplenomegaly
What is the etiology of the weakness and fatigue that accompanies Leukemia?
Anemia
What are the 4 methods used to diagnose Leukemia?
1) Bone marrow aspiration and biopsy
2) Lumbar puncture
3) CXR to look at lungs
4) Other tests to ID cell subtype and stage
Can you use a CBC to diagnose Leukemia?
No
When is the prognosis favorable for a child with Leukemia? When is it unfavorable?
1) Favorable when diagnosed > 1yr and < 10 yrs.
2) Unfavorable when WBC > 50,000 at diagnosis.
What are the 3 nursing diagnoses covered in lecture that are appropriate for a Leukemia patient?
1) Risk for infection
2) Fear
3) Deficient Knowledge related to disease process or related to chemotherapy.
Define Induction
The first large dose of chemotherapy
What are the 3 phases of therapy for Leukemia?
1) Induction - Goal is to induce remission
2) Consolidation/Intensification - Goal is to maintain remission and prevent disease in extramedullary “sanctuary sites” such as the testes and CNS where systemic therapy is not easily delivered.
3) Maintenance/Continuation - Maintenance chemotherapy consisting of lower doses, are given orally or IV on a regular basis over 2 to 3 yrs to maintain remission.
Define Intrathecal Chemotherapy
Chemotherapy given prophylactically to prevent relapse in the CNS.
What is the typical length of treatment (all 3 phases) for Leukemia (ALL)?
2 to 3 years
What are the 4 characteristics of ALL (Leukemia) remission?
1) Absence of SxS
2) Blasts < 5% in marrow
3) Absolute Neutrophil Count (ANC) > 500
4) Platelets > 100,000
A fever is considered a medical emergency when it is a side effect of Chemotherapy. What should be done about it?
Get blood C&S and start IV antibiotics within 1 to 2 hours.
Define Thrombocytopenia. How is is associated with Leukemia?
1) Thrombocytopenia - A reduction in platelet count (normal is 150,000 - 450,000) resulting in increased risk for bleeding and bruising.
2) Leukemia causes suppressed bone marrow production which results in Thrombocytopenia.
What are 4 important Nursing Interventions to be implemented for a patient with Thrombocytopenia?
1) Avoid NSAIDs and aspirin
2) Assess for bleeding: including bruising, petechiae, epistaxis, and heavy menses.
3) Do not take rectal temps or give suppositories
4) Avoid constipation (because it causes bleeding).
Define Anemia
Anemia - A deficiency in RBC and as a result a ⬇ in Hbg as well.
What are the 6 SxS of Anemia?
1) Pallor
2) Shortness of breath
3) Dizziness
4) Syncope
5) Headaches
6) Tachycardia
What are the 8 SxS of Chemotherapy?
1) Fever
2) Thrombocytopenia
3) Anemia
4) Mucositis
5) N & V
6) Constipation or diarrhea
7) Alopecia
8) Anaphylaxis
What are the 4 appropriate nursing interventions for Mucositis when it is a side effect of chemotherapy?
1) Oral care (i.e., rinses)
2) Pain management
3) Hydration
4) Maintain nutrition
What are the 4 appropriate nursing interventions for N & V when they are side effects of chemotherapy?
1) Pre-medicate before chemo with antiserotonins such as Zofran for N & V
2) Adminster Substance P Antagonists for N & V
3) Administer steroids and anti-anxiolytics
4) Pre-hydrate before chemo
What are 5 nursing interventions appropriate for a patient suffering from constipation as a side effect of chemotherapy?
1) Use laxatives and stool softeners
2) ⬆ fiber in diet
3) ⬆ fluids
4) ⬆ activity
5) Do not take rectal temp or give rectal meds
What are 5 appropriate nursing interventions for a patient suffering from diarrhea as a side effect from chemotherapy?
1) Get stool cultures (potential infection)
2) Assess stools for blood
3) Start a low residue diet
4) Protect from skin breakdown (i.e., use sitz baths and barrier creams)
5) Use Antispasmodic therapy (meds that prevent the spasms of tubular organs like the intestines)
Define Alopecia as it relates to being a side effect of chemotherapy.
Hair loss within 2 to 3 weeks post chemo. Not all Chemotherapeutic agents produce hair loss, but most do.
What are the 4 SxS of Anaphylaxis as a side effect of chemotherapy?
1) Cyanosis
2) Hypotension
3) Wheezing
4) Uticaria
Why should the patient be closely observed for 20 minutes after the infusion of chemotherapy?
Because Anaphylaxis is a life threatening side effect of chemotherapy.
What should be done if Anaphylaxis happens while infusing Chemo?
1) Discontinue the chemo immediately
2) Give emergency meds
What are the 5 types of emergency medications given to a patient suffering from Anaphylaxis as a result of chemotherapy?
1) Epinephrine
2) Antihistamine
3) Aminophylline
4) Corticosteroids
5) Vassopressors
What are the 2 Infant/toddler perceptions of death?
1) They have no understanding of death
2) They have fear and anxiety over the separation cause by death
What are the 4 Preschooler’s perceptions of death?
1) They think it’s not permanent (reversible)
2) They think it’s just something that happens to others
3) They have magical thinking (they think their bad thoughts might come true)
4) They are curious about things and people that have died
What are the 4 School-age perceptions about death?
1) They think death is final
2) They believe they may die but only in the distant future
3) they understand death occurs and suspects that parents will die some day
4) They fear pain associated with death
What are the 6 Preadolescent & Adoloscent perceptions of death?
1) They think death is permanent and universal
2) They understand death in a logical manner
3) They fear disfigurement
4) They fear isolation from peers
5) They often believe death won’t happen to them
6) They have invincibility beliefs which leads to high-risk behaviors
What 5 specific things should be avoided a patient on Neutropenic Precautions?
1) Raw fruits and veges
2) Fresh flowers and plants
3) Standing water (i.e., pitcher water)
4) Chicken pox exposure
5) Live virus or bacterial vaccines
How is neutropenia calculated?
1) ANC < 500 (ANC %) + Bands % = total %
2) Change total % into decimal form ( 55% = .55)
3) Multiply decimal form times WBC
