1102 Test 3 The Child With Alteration In Cellular Growth

Front 1

Neoplasms are

Back 1

any new of abnormal growth

Front 2

Benign –

Back 2

do not demonstrate anaplasia or metastasis

Front 3

Malignant –

Back 3

have specific properties of anaplasia and metastasis

Front 4

Cancer is

Back 4

an alteration in cell function

Front 5

cancer Signs & Symptoms:

Back 5

fatigue, bone pain, persistent lymphadenopathy, lack of appetite, HA, malaise, and changes in balance, gait or personality

Others: mass, purpura, pallor, weight loss, squint or change in the eye, vomiting, recurrent or persistent fever

Front 6

CBC –

Back 6

increased production of immature cells, and overproduction of others

Front 7

Basic chemistry profile –

Back 7

liver, renal and electrolytes

LP, Bone marrow aspiration, CT and MRI
Biopsy – for TNM
TNM-tissue, nodules, metastisis
Decrease in platelets and increase in bands-something is wrong
Inflammation-increase in platelets
Higher the stage worse the case

Front 8

Chemotherapy

Back 8

Antineoplastic agents
Given IV, must be a patent line. If infiltrates, may cause cell lysis and tissue sloughing; may need central venous access

Anaphylaxis can occur: needs at the bedside – B/P equipment, ambu bag, and Epinephrine

Front 9

Most toxic Chemotherapy:

Back 9

Vincristine
Vinblastine
Cytoxan
Dactinomycin-

some dehydrate cell and shrivel away.
Infiltration stop immediately! Blisters away all tissue involved in infiltration. To give these drugs u need to be certified. Some chemo drugs when exposed to to much light can turn to acid. Have at bed side stethescop, epinephrin,ambu bag, cuff.

Front 10

Chemotherapy

Nausea & Vomiting:

Back 10

give antiemetic (30 minutes to 1 hour before) and around the clock during the next 24 hours after infusion is complete.

Ex: Zofran, Kytril, Anzement
Risk for secondary infection: fever, bleeding and anemias

NANDA-risk for fluid volume defecit

Front 11

Chemotherapy

Alteration in nutrition and oral mucosa-–

Back 11

anorexia and taste changes. Meal time should be pleasant and enjoyable. Allow the child to anything they want and later try to provide nutritious snacks. Bland, soft or light diet, use of soft sponge or toothbrush, rinse mouth with hydrogen peroxide and water, avoid vicous lidocaine and rectal temperatures.

Everything will become bitter.
Coat all of food with sugar
Satisfy diet at all costs

Toothbrush must be soft. Sometimes sponge must be used alone.
Seizure risk when using lidocaine
Recal thermomenter-extra peristylais., and bleed
Mucositis-mucosal ulcerations
Peer group school age thing starts to worry about hair loss
Wigs promote heat which inhibits hair growth and promotes growth of bacteria.

Pain-chronic pain, inermittent analgesics at first, then on pca morpheine or pca daladid, titrate the med. Increase pain does not mean end of life.

Front 12

Radiation Therapy

Common Course:

Back 12

once daily for 4 to 5 days/week for a period of 2-6 weeks.

Side effects: anorexia, N&V, extreme fatigue

Front 13

Highly sensitive tumors:

Back 13

Hodgkin’s disease, Wilm’s tumor, retinoblastoma, rhabdomyosarcoma

Front 14

Nursing Management for Radiation Therapy

Back 14

Prior to treatment: indelible ink marks are applied
After treatment: monitor CBC, WBC, platelet count. Observe for skin integrity

Front 15

Bone Marrow Transplant

Back 15

Aspirate from iliac crests or spines, in newborns from anterior tibia
Conscious sedation
Human leukocyte antigen (HLA) matching
Give IV - monitor for cardiac dysfunction and pulmonary emboli; N&V, fever, and chills – Tylenol, Valium and Benadryl; observe for anaphylasis
Strict Isolation

Match up donor
Get marrow
Give to client
Good HLA (human leukocyte antigen typing) (every antigen on your cells needs to match recipient)
Typing.
ABO typing.97 or 98 % match needed.
Below 93% may not be successful.
Wheezing infusion will stop

Front 16

Hematopoietic Stem Cell Transplantation

Back 16

Stem cells harvested from bone marrow, peripheral blood, or the umbilical vein of the placenta are given to the patient via IV transfusion.

To be successful kill enough bad cells then give patient stem cells.

Conscious sedation
Human leukocyte antigen (HLA) matching
Post-procedure – same as Bone Marrow Transplant

Front 17

Brain Tumors

Most common types

Back 17

Most common types: medulloblastoma, cerebral astrocytoma, brainstem glioma



Related to anatomic location, size and age of the child
In infants it is difficult to see ICP until the tumor is large.
Anterior fontanel has not closed..(closes at 12-18 months) brain tumor doesn’t show up because fontanel has not closed.

S&S: classic HA and vomiting.
DX: CT, MRI, PET scan, neurologic testing
TX: surgery, chemo and radiation
Preop: radiation to shrink tumor
Postop: position on nonoperative side, monitor V/S, check pupils, assess LOC, eye and facial edema from ICP – apply cold compresses, seizure precautions, check drsg, observe fever

Scale 1-4
4-worse
Patient’s first visit is usually diagnosed 3 or 4
Debulking tumor when mass is cut out. Fingers grow faster which go to pons.
Postop-need to lay on unoperative side. No lay on operative side because on suture.
Incision site turns warm look for infection. (red, drainage)

Front 18

Neuroblastoma

Back 18

Originates from embryonic neurocrest cells that normally give rise to the adrenal medulla and the sympathetic ganglia.
S&S: usually in abdomen, firm, nontender, smooth mass in the flank area, weight loss, irritability, fatigue, and fever
DX: radionuclide scan, 24 hour urine for catecholamines and VMA, CT, bone marrow aspiration
TX: surgery and chemo (Vincristine, Cisplatin)

Front 19

Wilm’s Tumor (Nephroblastoma)

Back 19

Intraabdominal tumor Vincristine and Dactinomycin
S&S: asymptomatic, firm mobile mass confined to one side and deep within the flank.
DO NOT PALPATE
DX: abdominal x-rays, US, CT, MRI and blood studies
TX: nephrectomy then radiation and Chemo; if inoperable; Vincristine and Dactinomycin
Prognosis: Excellent, can recur in lungs
Only survive if encapsulated

Front 20

Osteosarcoma or Osteogenic Sarcoma

Back 20

Bone cancer in the long bones, grows rapidly, highly malignant and metastasizes early

S&S: pain and swelling at the tumor site, palpable mass, limping, and limited ROM
DX: CT, bone scans, tumor biopsy, x-ray
TX: single bone removal, amputation
These children and parents need your honesty
Phantom pain
Anger and depression common

Front 21

Ewing’s Sarcoma

Back 21

Malignant small cell tumor, arising in the marrow spaces of the bone, metastasis usually to lungs and bones

S&S: pain, soft tissue swelling at the tumor site and fever

TX: radiation and chemo, surgery

Very sensitive to radiation

Front 22

Leukemia

Back 22

Unrestricted proliferation of immature WBCs. This robs the healthy WBCs nutrition. Bone marrow hypertrophies and then atrophies leading to anemia, bleeding disorders, and immunosuppression

More bands than segs.
90-95% receive their first remission.
70-75% go into 2nd remission

Front 23

ALL

Acute lymphocytic leukemia (ALL)

Back 23

Most common, in children 2 to 5 years

S&S: chronic cold, anemia, fatigue, weakness, pallor, lethargy, lymphadenopathy, hepatospenomegaly, bruising without reason, joint pain, petechiae, nosebleeds and gum bleeding

DX: CBC – neutropenia, thrombocytopenia, decreased Hgb and Hct, + bone marrow aspiration, LP may show CNS involvement

Treatment: chemotherapeutic agents

Induction phase – complete remission or absence of leukemia cells

Consolidation phase – preventing leukemia cells from invading or growing in the CNS

Maintenance phase – maintain remission

Nursing consideration: gentle assessments, close monitoring of renal function, I&O, weights, bone marrow suppression, protective isolation, mouth care, and observation of changes in neurologic functioning

Front 24

AML

Acute myelogenous leukemia (AML)

Back 24

Common in adolescents
Death usually from overwhelming infection

Usually Upper Respiratory

Front 25

Lymphomas

Back 25

Hodgkin’s and non-Hodgkin’s lymphoma
NHL usually younger than 14 years old with early stage disease survival is 90%. Late stage disease survival 65-75%.
HL usually adolescence, 15-19 years old with survival excellent with localized nodal disease, survival after 2 years is cured.
Neoplastic disease that arise from lymphoid and hemopoietic system

NHL-borders of cells are diffuse. Fatigue, nausea, (covert) Menigital involvement.
2nd remission not good.

Front 26

Hodgkin’s Disease

Back 26

S&S: painless enlargement of the cervical or supraclavicular lymph nodes with a firm, movable mass; low-grade fever, night sweats, weight loss, cough, abd discomfort, anorexia, nausea and pruritus
Labs: CT, MRI, lymph node biopsy, bone marrow aspiration and staging
TX: combination of chemo and radiation

Front 27

Non-Hodgkin’s Disease

Back 27

Diffuse, un- or poorly differentiated, dissemination early, mediastinal involvement and invasion of meninges
DX: CT and biopsy
TX: combination of chemo and radiation

Front 28

Rhabdomyosarcoma

Back 28

Malignant soft tissue tumor of striated muscle
Most common in the orbit of the eye
Hard painless mass with poorly defined margins, rhinorrhea, otalgia, swelling, ptosis, discoloration
DX: CT, bone marrow aspiration, biopsy
TX: radiation and chemo; surgical

Front 29

Retinoblastoma

Back 29

Congenital intraocular malignancy of the retina
Leukokoria or cat’s eye reflex, fixed strabismus, red painful eye with glaucoma, blindness
DX: ophthalmologist exam
TX: external beam radiation therapy; best –chemotherapy with cyclosporine therapy, laster therapy and cryosurgery; or enucleation