UNIT 9 PEDIATRIC ONCOLOGY Flashcards
Side effects of cancer
Infection
Hemorrhage
Anemia
Nausea/vomiting
Altered nutrition
Mucosal ulceration
Neurologic problems
Hair loss
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. Malignant diseases of bone marrow and lymphatic system
Which type of Leukemia is most common
ALL- Acute Lymphocytic Leukemia
or
AML – Acute Myelogenous Leukemia (acute
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
S/S of leukemia
Manifestations
Anemia
Infection
Bleeding
Enlarged organs
Fever, lethargy, malaise
Petechiae
Weight loss
Diagnostic of Leukemia
Peripheral blood smear
Bone marrow aspiration
LP
IS there stages where leukemia is treated
Yes
No
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
What i the final stage of treatment is leukemia isn’t treated by chemotherapy
Bone marrow transplant
Reserved for poor response to chemotherapy
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
C. Private room one bed
Private room
Hand hygiene
No sick visitors
What is Neuroblastoma ?
(STOMACH CANCER)
Most common cancer
diagnosed in infancy
Primary site: abdomen
“silent” tumor- poor
prognosis
Often mestataizes
S/S of Neuroblastoma(
- Firm, nontender, irregular mass in the abdomen that crosses the midline
- Urinary frequency or retention from compres-
sion of the kidney, ureter, or bladder - Lymphadenopathy, especially in the cervical and
supraclavicular areas - Bone pain if skeletal involvement
- Supraorbital ecchymosis, periorbital edema, and
exophthalmos as a result of invasion of retrobul-
bar soft tissue - Pallor, weakness, irritability, anorexia, weight loss
- Signs of respiratory impairment (thoracic le-
sion) - Signs of neurological impairment (intracranial
lesion) - Paralysis from compression of the spinal cord
Neuroblastoma treatment
Treatment
Surgery, chemo
What is osteosarcoma?
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.
S/S OF OSTEROSARCOMA
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)
Treatment of Osteosarcoma
Treatment may include surgical resection (limb salvage procedure) to save a limb remove affected tissue, or amputation.
- Chemotherapy is used to treat the cancer and may be used before and after surgery.
What is Ewing Sarcoma
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)
Treatment for Ewing Sarcoma
Radiation
Chemo
Possible limb salvage/amputation
What is Wilms tumor (Nephroblastoma)(kidney)
Most common kidney tumor
Peak incidence between 2-3 years of age
UNILATERAL
Is Wilms tumor bilateral or unilateral?
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)
- Swelling or mass within the abdomen (mass is
characteristically firm, nontender, confined to one side, and deep within the flank) - Urinary retention or hematuria, or both
- Anemia (caused by hemorrhage within the tumor)
- Pallor, anorexia, and lethargy (resulting from anemia)
- Hypertension (caused by secretion of excess amounts of renin by the tumor) 6. Weight loss and fever
Nursing considerations for Wilms Tumor
Nursing considerations
DO NOT PALPATE ABDOMEN
Monitor BP
Management of Wilms Tumor
Management
Surgery combined with chemo
Best prognosis of all childhood cancers- 90% chance of cure (localized tumors)
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?
- Palpating the abdomen for a mass
- Assessing the urine for the presence of hematuria
- Monitoring the temperature for the presence of fever
- Monitoring the blood pressure for the presence of hypertension
- 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.
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.”
- “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.
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.
- Initiate bleeding precautions.
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.”
- “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.
Platelet count LAB VALUES
150,000-500,000
What is Retinoblastoma
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.
S/S of Retinoblastoma
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)
Management and treatment of retinoblastoma
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
