Peds Test # 3 Cancer

Question 1

Mutation results in which 3 outcomes?

Answer 1

1) Lack of differentiation
2) Unregulated growth
3) Cellular immortality

Question 2

What does it mean when cancer is referred to as “well-differentiated”?

Answer 2

It means you can tell where the cancer metastasized from.

Question 3

Which 2 types of cancers are classified as Hematological Malignancies?

Answer 3

1) Leukemia - Cancner of the blood/bone marrow

2) Lymphoma - Cancer of the lymph

Question 4

Which 3 cancers are classified as Solid Tumors?

Answer 4

1) Wilm’s Tumor - Nephroblastoma
2) CNS Tumors - Cancer of the brain/spine
3) Retinoblastoma - Cancer of the eye

Question 5

What are the 5 characteristics of childhood cancers?

Answer 5

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)

Question 6

Why are childhood cancers usually very responsive to therapy?

Answer 6

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.

Question 7

What is the most common type of childhood cancer?

Answer 7

Leukemia

Question 8

What are the 2 classifications of Leukemia covered in lecture and what is the survival rate for both?

Answer 8

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.

Question 9

What are the 6 different etiologies/causes of Leukemia?

Answer 9

1) Combination of genetic and environmental agents
2) Chemical agents
3) Chemotherapeutic agents
4) Radiation
5) Viruses
6) Immunologic deficiencies

Question 10

What are the 4 noted pathophysiological effects of Leukemia on the body?

Answer 10

1) Genetic damage to bone marrow
2) Uncontrolled proliferation of blasts
3) ⬇ Production of normal cells
4) Accumulation of blasts in organs & tissues

Question 11

What are the 8 SxS of Leukemia?

Answer 11

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

Question 12

What is the etiology of the weakness and fatigue that accompanies Leukemia?

Answer 12

Anemia

Question 13

What are the 4 methods used to diagnose Leukemia?

Answer 13

1) Bone marrow aspiration and biopsy
2) Lumbar puncture
3) CXR to look at lungs
4) Other tests to ID cell subtype and stage

Question 14

Can you use a CBC to diagnose Leukemia?

Answer 14

No

Question 15

When is the prognosis favorable for a child with Leukemia? When is it unfavorable?

Answer 15

1) Favorable when diagnosed > 1yr and < 10 yrs.

2) Unfavorable when WBC > 50,000 at diagnosis.

Question 16

What are the 3 nursing diagnoses covered in lecture that are appropriate for a Leukemia patient?

Answer 16

1) Risk for infection
2) Fear
3) Deficient Knowledge related to disease process or related to chemotherapy.

Question 17

Define Induction

Answer 17

The first large dose of chemotherapy

Question 18

What are the 3 phases of therapy for Leukemia?

Answer 18

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.

Question 19

Define Intrathecal Chemotherapy

Answer 19

Chemotherapy given prophylactically to prevent relapse in the CNS.

Question 20

What is the typical length of treatment (all 3 phases) for Leukemia (ALL)?

Answer 20

2 to 3 years

Question 21

What are the 4 characteristics of ALL (Leukemia) remission?

Answer 21

1) Absence of SxS
2) Blasts < 5% in marrow
3) Absolute Neutrophil Count (ANC) > 500
4) Platelets > 100,000

Question 22

A fever is considered a medical emergency when it is a side effect of Chemotherapy. What should be done about it?

Answer 22

Get blood C&S and start IV antibiotics within 1 to 2 hours.

Question 23

Define Thrombocytopenia. How is is associated with Leukemia?

Answer 23

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.

Question 24

What are 4 important Nursing Interventions to be implemented for a patient with Thrombocytopenia?

Answer 24

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).

Question 25

Define Anemia

Answer 25

Anemia - A deficiency in RBC and as a result a ⬇ in Hbg as well.

Question 26

What are the 6 SxS of Anemia?

Answer 26

1) Pallor
2) Shortness of breath
3) Dizziness
4) Syncope
5) Headaches
6) Tachycardia

Question 27

What are the 8 SxS of Chemotherapy?

Answer 27

1) Fever
2) Thrombocytopenia
3) Anemia
4) Mucositis
5) N & V
6) Constipation or diarrhea
7) Alopecia
8) Anaphylaxis

Question 28

What are the 4 appropriate nursing interventions for Mucositis when it is a side effect of chemotherapy?

Answer 28

1) Oral care (i.e., rinses)
2) Pain management
3) Hydration
4) Maintain nutrition

Question 29

What are the 4 appropriate nursing interventions for N & V when they are side effects of chemotherapy?

Answer 29

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

Question 30

What are 5 nursing interventions appropriate for a patient suffering from constipation as a side effect of chemotherapy?

Answer 30

1) Use laxatives and stool softeners
2) ⬆ fiber in diet
3) ⬆ fluids
4) ⬆ activity
5) Do not take rectal temp or give rectal meds

Question 31

What are 5 appropriate nursing interventions for a patient suffering from diarrhea as a side effect from chemotherapy?

Answer 31

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)

Question 32

Define Alopecia as it relates to being a side effect of chemotherapy.

Answer 32

Hair loss within 2 to 3 weeks post chemo. Not all Chemotherapeutic agents produce hair loss, but most do.

Question 33

What are the 4 SxS of Anaphylaxis as a side effect of chemotherapy?

Answer 33

1) Cyanosis
2) Hypotension
3) Wheezing
4) Uticaria

Question 34

Why should the patient be closely observed for 20 minutes after the infusion of chemotherapy?

Answer 34

Because Anaphylaxis is a life threatening side effect of chemotherapy.

Question 35

What should be done if Anaphylaxis happens while infusing Chemo?

Answer 35

1) Discontinue the chemo immediately

2) Give emergency meds

Question 36

What are the 5 types of emergency medications given to a patient suffering from Anaphylaxis as a result of chemotherapy?

Answer 36

1) Epinephrine
2) Antihistamine
3) Aminophylline
4) Corticosteroids
5) Vassopressors

Question 37

What are the 2 Infant/toddler perceptions of death?

Answer 37

1) They have no understanding of death

2) They have fear and anxiety over the separation cause by death

Question 38

What are the 4 Preschooler’s perceptions of death?

Answer 38

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

Question 39

What are the 4 School-age perceptions about death?

Answer 39

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

Question 40

What are the 6 Preadolescent & Adoloscent perceptions of death?

Answer 40

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

Question 41

What 5 specific things should be avoided a patient on Neutropenic Precautions?

Answer 41

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

Question 42

How is neutropenia calculated?

Answer 42

1) ANC < 500 (ANC %) + Bands % = total %
2) Change total % into decimal form ( 55% = .55)
3) Multiply decimal form times WBC