The Child with Cancer Flashcards
Leukemia Acute Lymphocytic Leukemia (ALL)
- Leukemia is the unrestricted proliferation of immature white blood cells and is the most common type of childhood cancer (lymphoblasts)
- 2-5 cases per 100,000 children
- Peak onset is between 2 and 3 years of age
- Up to 90% survival rate
Leukemia Acute Lymphocytic Leukemia (ALL)
S/S
***Petechiae, Fever, Fatigue
Decreased RBC= anemia
- tired, fatique, pallor, headache, SOB, lethargy, hypoxia
Decreased normal wbc = infection
- fever that won’t go away with meds/ cooling measures, high WBC/ low neutrophil (neutropenia) , don’t have white discharge
Decreased Platelet= Hemorrhage
- decreased amount of PLT: bruising/ epistaxis/ blood in stool or urine/ petechiae
Increased pressure = bone and joint pain/ thinning and weakening of bone
- pathologic faracture: bone breaks from inside outward
Extra medullary infiltration= enlarged spleen, liver, lymph nodes
- Splenomegaly, hepatomegaly, lymphadenopathy
Increased metabolism= starvation of cells, hypoglycemia
Meningitis
-
- Minor infection, such as a cold, fails to completely disappear
- Continues to be pale, listless, irritable, febrile, and anorexic
- Most frequent signs & symptoms are result of infiltration of bone marrow
- Fever, pallor, fatigue, anorexia
- Hemorrhage (usually petechiae), bone and joint pain
- With neutropenia body’s normal bacterial flora can become aggressive pathogens
- Vague abdominal pain
- ***Petechiae, Fever, Fatigue
Leukemia Acute Lymphocytic Leukemia (ALL)
Nursing intervention:
- anemia: Iron, PRBC transfusion, O2, monitor Hct/ Hgb, administer EpiGen: given once lukoblasts are under control
- Infection: neutropenia isolation/ reverse (pressurized) isolation: wear everything except google
— No live plants, no fresh fruits and veggies, no yogurt, no unpasteurized meat/ dairy,
— monitor WBC (CBC w/ dif), absolute neutrophil count (ANC): 500 or < : severely neutropenic/ 1500 or >: safe
Leukemia Acute Lymphocytic Leukemia (ALL)
Pathologic and Related Clinical Manifestations
Tumor Lysis Syndrome (hyperuricemia,
When you use radiation to kill cancer cells you kill healthy cells so you get: hyperphosphotemia, hyperkalemia, hypocalcemia)
Hyperleukocytocis >100,000 WBC
Capillary obstruction
***Petechiae, Fever, Fatigue
Leukemia Acute Lymphocytic Leukemia (ALL):
Diagnostic evaluation
- Suspected from the history, physical manifestations, and a peripheral blood smear that contains immature forms of leukocytes, frequently in combination with low blood counts.
- Definitive diagnosis: *bone marrow aspiration or biopsy. Lumbar Puncture to determine CNS involvement
Leukemia Acute Lymphocytic Leukemia (ALL):
Treatment & Side Effects of Treatment
- Chemotherapy: 1st option
— Induction phase: 4-5 types of chemo agents for 1 month
— Intensification phase: give a new type of stronger med in case there are tumor cells that are hiding/ got missed
— Delayed intensification phase: give a lower dose of chemotherapy/ CNS prophylactic Therapy: give chemo intrathecally
— Maintenance phase: should be in remission: bone marrow aspiration is (-) for leukoblasts. Given for 3 years - High dose Steroids: prednisone: immunosuppressant
- Radiation therapy: if really concentrated in a specific area (like the spleen)
- Infection/neutropenia: fever
- ANC- segs+bandsx1000
- Hemorrhage
- Cystitis: s/s of chemotherapy (hemorrhagic cystitis)
- Anemia
- Nausea/Vomiting: ondansetron (Zofran)
- Altered nutrition: High calorie/ High Protein
- Mucosal Ulceration: entire GI tract
- Neurologic problems
- Alopecia: hair loss (help adolescent with body image issues; help find wig)
- Steroid Effects
Wilms’ tumor
- Is a fast growing solid tumor that is asymptomatic. It is a firm lobulated mass on or inside the kidney
- Peak incidence between 2-3 years
Wilms’ tumor
Treatment/ nursing considerations
- Treatment & prognosis based on stage
— Stage is based on size and how much it has metastasized
— Grading based on abnormalities of the cells; mutations/ genetic markers; do a biopsy - Requires surgical removal (outside of kidney) inside kidney= remove entire kidney), Chemotherapy, and possibly radiation
— Radiation is last choice: because you can develop secondary type of cancer from radiation - **Do not palpate Abdomen.
— Pushing on the tumor can break off pieces of tumor because it is fragile and could spread - Preserve kidney function
— BUN/Cr, strict I&O, Foley cath, don’t give meds that are nephrotoxic (some antibiotics; measure peak and trough)
— Kidneys release renin; increased renin = increased BP; monitor BP
— Releases erythropoietin: stimulates RBC production; decrease kidney function= anemia
Retinoblastoma
Intraocular malignancy of the retina
40% of cases are hereditary- autosomal dominant gene.
Peak incidence 2 years old
Retinoblastoma S/S
**leukokoria- white pupil and absent red reflex
Retinoblastoma treatment
- radiation, surgery, laser therapy and possibly chemotherapy, remove eye.
- 90% survival rate.
Neuroblastoma
- Any solid tumor occurring outside of the cranium.
- Most commonly in the abdomen
- Location of the mass determines the symptoms
- Most common tumor in infants to 12 months old
- Treatment- radiation, chemotherapy and surgery
Bone Tumors:
OSTEOSARCOMA
- Malignant tumor of long bone near the growth plate involving rapidly growing bone tissue
- Occurs mostly in male teens
- Peak incidence during (puberty) rapid growth
- Treatment- surgical - amputation, chemotherapy
- Pain, swelling, decreased ROM, limp, pathologic fracture
Bone Tumors:
EWING SARCOMA
- occurring in the bone marrow of diaphyseal seal
- Occurs in older school age and young adolescents
- Treatment- radiation & chemotherapy. Amputation last resort
- Pain, swelling, decreased ROM, limp, pathologic fracture
