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NSG 434 - Peds > Peds with Cancer > Flashcards

Peds with Cancer Flashcards

1
Q

Risk Factors for Cancer

A

▪Radiation exposure
▪Carcinogenic drugs
▪Immunosuppressive therapy
▪Infections
▪Race
▪Genetic conditions

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2
Q

Diagnostic for cancer

A

▪History and physical
▪CBC, LFTs, coagulation studies, urinalysis
▪Lumbar puncture, bone marrow aspiration
▪CT, MRI, PET, MIBG
▪Surgery
▪Biopsy

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3
Q

Multimodal therapy

A

▪Combination surgery, chemotherapy, and radiotherapy

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4
Q

surgery for cancer

A

▪Remove traces of tumor, restore normal function

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5
Q

what is the primary form of treatment for childhood cancer

A

chemotherapy

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6
Q

Radiotherapy

A

▪In conjunction with chemotherapy
Side effects related to lethal damage to tissue

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7
Q

Signs and Symptoms of Cancer in Children

A

▪Fever and pain, common in childhood, leading to easily missed problem
▪Unexplained loss of energy
▪Sudden vision changes
▪Excessive, rapid weight loss

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8
Q

side effects of cancer treatment

A

▪Damage occurs to normal tissues as well as malignant tissues
▪Infection—Monitor for septic shock
▪Hemorrhage
▪Anemia
▪Nausea and vomiting
▪Altered nutrition
▪Mucosal ulceration
▪Neurological problems
▪Alopecia
▪Steroid effects

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9
Q

management for infection

A

Monitor for septic shock
▪Fever with absolute neutrophil count (ANC) lower than 500/mm3
▪Prevention of infection is a priority

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10
Q

management for hemorrhage

A

▪Prevented or controlled with platelet infusions
▪Teach to avoid activities that may cause injury: riding a bike or skate boards; contact sports

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11
Q

management for anemia

A

▪Common during induction therapy
▪Limits tolerance of physical activity

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12
Q

management for altered nutrition

A

▪Monitor intake and nutritional status
▪Monitor height and weight routinely

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13
Q

management for nausea and vomiting

A

▪Antiemetics used to manage side effect
▪Synthetic cannabinoids are being used in children
▪Administer antiemetic 30 minutes BEFORE chemotherapy begins and routinely for 24 hours after chemotherapy

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14
Q

management for mucosal ulceration

A

▪Red, eroded, painful in mouth; may extend to rectal area (sitz baths)
▪Increase anorexia due to pain
▪Use bland, moist, soft food, and soft sponge toothbrush

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15
Q

management for neurological problems

A

▪Severe constipation- stool softners
▪Foot drop, weakness and numbness lead to difficulty walking
▪Severe jaw pain

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16
Q

management for alopecia

A

anticipatory guidance
-Warn the child and the family of possible side effect early in the treatment to allow them time for preparation
-Explain that hair falls out in clumps, leads to patchy baldness
-Explain that hair regrows in 3 to 6 months but may be a different texture (now curly when it was straight before treatment) or a different color

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17
Q

management for steroid effects

A

▪Cushingoid appearance (Can be distressful for older children due to weight gain; moon face appearance)
▪Avoid salt intake to reduce fluid retention

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18
Q

what is the most common form of childhood cancer

A

Acute lymphoid leukemia (ALL)

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19
Q

Types of acute leukemia

A

▪Acute lymphoid leukemia (ALL)
▪Acute myelogenous leukemia (AML)

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20
Q

Acute Leukemia

A

A broad group of malignant diseases of bone marrow and lymphatic system
▪Leukemia is an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body

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21
Q

Although leukemia is an overproduction of WBCs, often acute form causes..

A

low leukocyte count
▪Greatly elevated immature cells or blasts
▪Immature cells do not attack and destroy normal blood cells

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22
Q

three primary consequences of leukemia

A

▪Anemia
▪Infection and neutropenia
▪Bleeding

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23
Q

S/S of Leukemia

A

▪Fever, pallor, fatigue, anorexia, hemorrhage, bone, joint pain
▪Bones weaken and are prone to fractures
▪Bone pain from increased pressure

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24
Q

Diagnostic Evaluation of Leukemia: Based on history and physical manifestations

A

▪Minor infection does not disappear
▪Pale, listless, irritable, febrile, anorexia

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25
Q

Diagnostic Evaluation of Leukemia: peripheral blood smear

A

▪Immature leukocytes
▪Frequently low blood cell counts

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26
Q

Lumbar puncture to evaluate

A

▪central nervous system (CNS) involvement of leukemia

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27
Q

diagnosis for leukemia

A

▪Bone marrow aspiration or biopsy

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28
Q

Therapeutic Management of Leukemia

A

IV and chemotherapy, Bone marrow transplantation

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29
Q

Three phases of therapy for leukemia

A

▪Induction
▪Intensification (consolidation) therapy
▪Maintenance therapy: To preserve remission

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30
Q

induction phase for leukemia treatment

A

▪4 to 5 weeks, begins almost immediately

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31
Q

Intensification (consolidation) therapy:

A

To eradicate residual leukemic cells
▪Chemotherapy given periodically over 6 months

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32
Q

Maintenance therapy:

A

To preserve remission
▪Weekly or monthly CBCs
▪Treatment usually stops after 2 to 3 years
▪Monitor for relapse

33
Q

after relapse of leukemia

A

-Reinduction after relapse
-Each relapse means poorer prognosis
-Testes are resistant to chemotherapy and may lead to relapse
-Relapse in testes leads to intensive chemotherapy and irradiation

34
Q

Hodgkin disease (lymphoma) age

A

More prevalent among children 15 to 19 years of age

35
Q

Non-Hodgkin Lymphoma age

A

More prevalent among children <14 years of age

36
Q

Hodgkin Lymphoma

A

▪Neoplastic disease originating in lymph system
▪Primarily involves lymph nodes

37
Q

Hodgkin Lymphoma often metastasizes to

A

▪spleen, liver, bone marrow, lungs, or other tissues

38
Q

Clinical manifestations of Hodgkin disease

A

▪painless enlarged cervical or supraclavicular lymphadenopathy
▪Cough, abdominal discomfort, anorexia
▪Fever, weight loss, night sweats

39
Q

Diagnostic evaluation for hodgkin disease

A

▪History and physical, CBC, uric acid, liver function, CRP or ESR, alkaline phosphatase, urinalysis, radiological tests
▪Lymph node biopsy, presence of Sternberg-Reed cells

40
Q

Lymph node biopsy for hodgkin disease

A

presence of Sternberg-Reed cells

41
Q

what is measured in your blood and increases when there’s inflammation in your body

A

CRP = C-Reactive Protein

42
Q

An ESR blood test is usually done to check

A

understand the degree of inflammation in the body such as cancers, various kinds of infections as well as autoimmune disorders and diseases.

43
Q

clinical appearance of Non-Hodgkin Lymphoma

A

▪Disease usually diffuse rather than nodular
▪Classification is based on the cell type
▪Mediastinal involvement and invasion of meninges

44
Q

clinical manifestations of Non-Hodgkin Lymphoma

A

▪Depends on anatomic site involved
▪Metastasis to bone marrow or CNS may appear like leukemia

45
Q

Diagnostic evaluation for Non-Hodgkin Lymphoma

A

▪Surgical biopsy for confirmation of disease
▪Bone marrow aspiration
▪Radiologic studies, CT scans of the lungs and GI

46
Q

s/s of brain tumors

A

▪Hydrocephalus
▪Headache
▪Vomiting
▪Nystagmus
▪Ataxia
▪Dysarthria
▪Diabetes insipidus
▪Growth failure

47
Q

Therapeutic Management of Brain Tumors

A

▪Surgery, radiotherapy, chemotherapy
▪Treatment of choice is removal of tumor without neurological damage
▪Radiation to shrink tumor before removal
▪Chemotherapy alone or in combination

48
Q

Neuroblastoma

A

malignant tumor composed mainly of cells resembling neuroblasts that occurs most commonly in infants and children
-“silent tumor”

49
Q

primary site of neuroblastoma

A

primary site is within the abdomen; other sites include the head and neck region, chest and pelvis

50
Q

clinical manifestations of neuroblastoma

A

▪Depend on location and stage
▪Firm, non-tender, irregular mass in the abdomen
▪Neurological impairment
▪Respiratory obstruction
▪Paralysis
▪Periorbital edema
▪Exophthalmos
Supraorbital ecchymosis

51
Q

diagnostic fro neuroblastoma

A

CT scan of abdomen, pelvis or chest to located primary tumor
Bone scan to evaluate for skeletal metastasis
Bone marrow biopsies

52
Q

staging and prognosis of neuroblastoma

A

▪Diagnosis often made after metastasis occurs
▪Age and stage of disease impacts prognosis
▪Younger age = more likely survival

53
Q

therapeutic management for neuroblastoma

A

▪Surgery to remove as much as possible
▪Irradiation postoperatively
▪Chemotherapy

54
Q

most common type of bone tumor

A

Osteosarcoma

55
Q

clinical manifestations of Osteosarcoma

A

▪Localized pain at affected site (severe/dull sometimes attributed to growing pains)
▪Limping, decreased physical activity, unable to hold heavy objects
▪Palpable mass
▪Fever
▪Respiratory distress

56
Q

prognosis of Osteosarcoma

A

▪Most can be cured

57
Q

diagnosis of Osteosarcoma

A

Thorough history and physical
Rule out trauma or infection
Functional status of affected area
Signs of inflammation
Size of mass
Anemia
Weight loss
Infections
X-ray, CT, MRI
Biopsy

58
Q

Osteosarcoma likely arises from

A

▪bone-forming mesenchyme

59
Q

Osteosarcoma found mostly in

A

lower extremities near growth plate

60
Q

Osteosarcoma therapeutic management

A

▪Surgery and chemotherapy
▪Surgery for biopsy and to save or amputate limb
▪Limb salvage includes prosthetic bone placement
▪Chemotherapy to decrease tumor size

61
Q

Ewing Sarcoma

A

rare malignant tumor arising in bone; arise in marrow spaces most often occurring in children

62
Q

Ewing sarcoma originates from:

A

bone marrow;
▪shaft of long and trunk bones
▪Pelvis, femur, tibia, fibula, humerous, ulna, vertebrae, scapula, ribs, skull

63
Q

Ewing sarcoma therapeutic management

A

▪Limb salvage or amputation depending on situation
▪Radiation
▪Chemotherapy

64
Q

Wilms Tumor

A

nephroblastoma
▪Most common kidney tumor of childhood

65
Q

clinical manifestations of wilms tumor

A

▪Painless swelling or mass in abdomen
▪Firm, nontender, confined to one side, deep within flank area
▪Often discovered during routine bathing/dressing

66
Q

Wilms Tumor therapeutic management

A

-In surgery, the tumor, affected kidney and adjacent adrenal gland are removed
-Radiation and chemo usually started right after surgery

67
Q

If the wilms tumor ruptures it can

A

send cancer cells throughout the abdomen, lymph channel, and bloodstream

68
Q

pre-op care for wilms tumor

A

▪Surgery usually occurs within 24 to 48 hours of diagnosis
▪DO NOT palpate tumor—Careful bathing and handling of child important
▪Tell parents what to expect; keep terms simple

69
Q

Rhabdomyosarcoma

A

▪Most common soft-tissue sarcoma in children
▪Most common in children 9 years and under
-Found in striated (rhabdo) muscle throughout the body - the most common for this cancer is head and neck, especially the eye orbit - thus the myo [meaning eye] in the name
-The tumor tends to compress the adjacent organs

70
Q

clinical manifestations of Rhabdomyosarcoma

A

▪Signs and symptoms related to site of tumor and compression of organs
▪Earache or runny nose

71
Q

Rhabdomyosarcoma treatment

A

-Complete removal of primary tumor whenever possible
-Chemotherapy effective and radiation may also be used

72
Q

Retinoblastoma

A

tumor arising from a retina

73
Q

Retinoblastoma clinical manifestations

A

▪Whitish “glow” in the pupil
▪Strabismus
▪Blindness (late)

74
Q

diagnosis Retinoblastoma

A

▪Detailed family history
▪Ophthalmoscopy
▪Ultrasound
▪CT and MRI

75
Q

therapeutic management for retinoblastoma

A

▪Radiation
▪Chemotherapy
▪Surgical implantation of iodine-125 for radiation
▪Photocoagulation
▪Cryotherapy

76
Q

what is used to treat advanced disease with optic nerve invasion in which there is no hope for salvage of vision

A

Enucleation

77
Q

Photocoagulation

A

use of a laser beam to destroy retinal blood vessels that supply nutrition to the tumor

78
Q

Cryotherapy

A

freezing of the tumor

79
Q

The Childhood Cancer Survivor

A

▪Late effects are of concern
▪Radiotherapy can decrease growth in bones or reproductive organs
▪Treatments may cause hormonal dysfunction
▪Growth and Tanner stages are important to document
▪Assess all body areas for abnormalities based on treatment used

NSG 434 - Peds (17 decks)

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