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NUR 230 MATERNITY & PEDIATRICS > UNIT 9 PEDIATRIC ONCOLOGY > Flashcards

UNIT 9 PEDIATRIC ONCOLOGY Flashcards

1
Q

Side effects of cancer

A

 Infection
 Hemorrhage
 Anemia
 Nausea/vomiting
 Altered nutrition
 Mucosal ulceration
 Neurologic problems
 Hair loss

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2
Q

What is the definition of leukemia?

A. Malignant diseases of bone marrow and lymphatic system
B. long bone cancer
C. Cancer in eye
D. Cancer in nephrons

A

A. Malignant diseases of bone marrow and lymphatic system

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3
Q

Which type of Leukemia is most common

ALL- Acute Lymphocytic Leukemia

or

AML – Acute Myelogenous Leukemia (acute

A

 ALL- Acute Lymphocytic Leukemia
 Most common type of childhood cancer
 Peak onset: 2-5 years

 AML – Acute Myelogenous Leukemia (acute
nonlymphoid)
 20% of leukemia cases
 Higher rates seen in infants

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4
Q

S/S of leukemia

A

Manifestations
 Anemia
 Infection
 Bleeding
 Enlarged organs
 Fever, lethargy, malaise
 Petechiae
 Weight loss

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5
Q

Diagnostic of Leukemia

A

Peripheral blood smear
 Bone marrow aspiration
 LP

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6
Q

IS there stages where leukemia is treated

Yes
No

A

Induction phase
 Begins at diagnosis, lasts 4-5 weeks

 Intensification therapy
 Further decreases leukemia cells in body
 “pulses” of chemo over 6 months

 Maintenance therapy
 Combined drug regimen to keep in remission
 Used for 2-3 years

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7
Q

What i the final stage of treatment is leukemia isn’t treated by chemotherapy

A

Bone marrow transplant
 Reserved for poor response to chemotherapy

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8
Q

You just received a new admission. The child is diagnosed with Leukemia . What room assignment owed be most appropriate for this patient?

A. droplet precautions two bed
B. Airborne precaution - negative air flow room
C. Private room one bed
D. Contact precaution double room

A

C. Private room one bed

Private room
Hand hygiene
No sick visitors

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9
Q

What is Neuroblastoma ?

A

(STOMACH CANCER)

 Most common cancer
diagnosed in infancy
 Primary site: abdomen
 “silent” tumor- poor
prognosis

Often mestataizes

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10
Q

S/S of Neuroblastoma(

A
  1. Firm, nontender, irregular mass in the abdomen that crosses the midline
  2. Urinary frequency or retention from compres-
    sion of the kidney, ureter, or bladder
  3. Lymphadenopathy, especially in the cervical and
    supraclavicular areas
  4. Bone pain if skeletal involvement
  5. Supraorbital ecchymosis, periorbital edema, and
    exophthalmos as a result of invasion of retrobul-
    bar soft tissue
  6. Pallor, weakness, irritability, anorexia, weight loss
  7. Signs of respiratory impairment (thoracic le-
    sion)
  8. Signs of neurological impairment (intracranial
    lesion)
  9. Paralysis from compression of the spinal cord
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11
Q

Neuroblastoma treatment

A

Treatment
 Surgery, chemo

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12
Q

What is osteosarcoma?

A

Most common bone tumor, arises from osseous tissue

BONE CANCER (TUMOR)

 Peak age 15 years; boys > girls
 Most commonly found in the metaphyseal region of long
bones in lower extremities

Symptoms in the earliest stage are almost always attributed to extremity injury or normal growing pains.

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13
Q

S/S OF OSTEROSARCOMA

A

 Pain at the affected site- SEVERE or dull

 Limps; may interfere with normal activity

 Progressive limited range of motion and the child’s curtailing of physical activity’

 Child may be unable to hold heavy objects because of their weight and the resultant pain in the affected extremity.

 Pathological fractures occur at the tumor site.

 May have a palpable mass

Symptoms in the earliest stage are almost always attributed to extremity injury or normal growing pains. (MAY BE MISTAKEN FOR GROWTH SPURTS)

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14
Q

Treatment of Osteosarcoma

A

Treatment may include surgical resection (limb salvage procedure) to save a limb remove affected tissue, or amputation.

  1. Chemotherapy is used to treat the cancer and may be used before and after surgery.
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15
Q

What is Ewing Sarcoma

A

 Arises from the marrow
 Originates in the shaft of long bones in extremities and trunk
 Almost always occurs in people younger than 30 years of age
(long bone cancer)

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16
Q

Treatment for Ewing Sarcoma

A

Radiation
 Chemo
 Possible limb salvage/amputation

17
Q

What is Wilms tumor (Nephroblastoma)(kidney)

A

 Most common kidney tumor
 Peak incidence between 2-3 years of age

UNILATERAL

18
Q

Is Wilms tumor bilateral or unilateral?

A

Manifestations
 Painless, firm mass in abdomen, deep in flank
area
 Confined to one side
 Weight loss
 Fever
 Hypertension (occasionally)
 Anemia
 Lymphadenopathy (swelling of lymph nodes)

  1. Swelling or mass within the abdomen (mass is
    characteristically firm, nontender, confined to one side, and deep within the flank)
  2. Urinary retention or hematuria, or both
  3. Anemia (caused by hemorrhage within the tumor)
  4. Pallor, anorexia, and lethargy (resulting from anemia)
  5. Hypertension (caused by secretion of excess amounts of renin by the tumor) 6. Weight loss and fever
19
Q

Nursing considerations for Wilms Tumor

A

Nursing considerations
 DO NOT PALPATE ABDOMEN
 Monitor BP

20
Q

Management of Wilms Tumor

A

Management
 Surgery combined with chemo
 Best prognosis of all childhood cancers- 90% chance of cure (localized tumors)

21
Q

The parent of a 4-year-old child tells the pediatric nurse that the child’s abdomen seems to be swol- len. During further assessment, the parent tells the nurse that the child is eating well and that the activ- ity level of the child is unchanged. The nurse, suspecting the possibility of Wilms’ tumor, would plan to avoid which during the physical assessment?

  1. Palpating the abdomen for a mass
  2. Assessing the urine for the presence of hematuria
  3. Monitoring the temperature for the presence of fever
  4. Monitoring the blood pressure for the presence of hypertension
A
  1. Palpating the abdomen for a mass

Wilms’ tumor is the most common intra- abdominal and kidney tumor of childhood. If Wilms’ tumor is suspected, the tumor mass would not be palpated by the nurse. Excessive manipulation can cause seeding of the tumor and spread of the cancerous cells. Hematuria, fever, and hyper- tension are clinical manifestations associated with Wilms’ tumor.

22
Q

The nurse provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for further instruction?
1. “The femur is the most common site of this sarcoma.”
2. “The child does not experience pain at the primary tumor site.”
3. “Limping, if a weight-bearing limb is affected, is a clinical manifestation.”
4. “The symptoms of the disease in the early stage are almost always attributed to normal growing pains.”

A
  1. “The child does not experience pain at the primary tumor site.”

Osteosarcoma is the most common bone cancer in children. Cancer usually is found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur. Osteosarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site. By the time these children receive medical attention, they may be in considerable pain from the tumor. Options 1, 3, and 4 are accurate regarding osteosarcoma.

23
Q

The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 mm3 (19.5 × 109/L). On the basis of this laboratory re- sult, which intervention would the nurse include in the plan of care?
1. Initiate bleeding precautions.
2. Monitor closely for signs of infection.
3. Monitor the temperature every
4 hours.
4. Initiate protective isolation precautions.

A
  1. Initiate bleeding precautions.
24
Q

A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandparent of the child visits and brings a fresh bouquet of flowers picked from the garden and asks the nurse for a vase for the flowers. Which response would the nurse provide to the grandparent?
1. “I have a vase in the utility room, and I will get it for you.”
2. “I will get the vase and wash it well before you put the flowers in it.”
3. “The flowers from your garden are beautiful, but cannot be placed in the child’s room at this time.”
4. “When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible.”

A
  1. “The flowers from your garden are beautiful, but cannot be placed in the child’s room at this time.”

Rationale: Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). For a hos- pitalized neutropenic child, flowers or plants would not be kept in the room, because standing water and damp soil har- bor Aspergillus and Pseudomonas aeruginosa, to which the child is susceptible. In addition, fresh fruits and vegetables harbor molds and need to be avoided until the white blood cell count increases.

25
Q

Platelet count LAB VALUES

A

150,000-500,000

26
Q

What is Retinoblastoma

A

Retinoblastoma, so named because it arises from the retina, is the most common intraocular malignancy of childhood, with approximately 300 new cases diagnosed annually in the United States (Leahey, Gom- bos, & Chevez-Barrios, 2021). Retinoblastoma can be present at birth, can have single or multiple foci in one or both eyes, and occurs in a heritable form.

27
Q

S/S of Retinoblastoma

A

Retinoblastoma has few grossly obvious signs. Typically parents or relatives are the ones who first observe a whitish “glow” in the pupil, known as the cat’s eye reflex, or leukocoria

 Cat’s eye reflex- whitish
“glow” of the pupil
 Strabismus( crossed eyes )
 Heterochromia ( the presence of different colored eyes in the same person)

28
Q

Management and treatment of retinoblastoma

A

Management
 Radiation
 Chemo
 Cryotherapy
 Enucleation(REMOVAL OF EYE) for advanced stages with optic nerve involvement

 Nursing considerations: enucleation
 Family support
 After enucleation, face will be edematous and bruised
 Surgically implanted sphere keeps facial symmetry
 Socket covered in mucosal lining resembling oral cavity
 Fitted for prosthesis in 3-4 weeks

NUR 230 MATERNITY & PEDIATRICS (40 decks)

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