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128 Cards in this Set

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When are brain cells fully matured?
5-6 years of age (due to myelination).
What is important re: confidentiality?
Cannot keep life threatening issues confidential.
Developmental Milestone at 1 year?
1 year, 1 word
What is important to remember about vital signs and clinical status?
Clinical status can worsen before vital signs show it.
Which conditions put a child at increased risk for cancer?
Li Fraumeni Syndrome (Loss of P-53 Cancer gene inhibition. Also retinoblastoma and Down Syndrome.
From which germ cell layer do most childhood cancers arise?
Ectoderm or Mesoderm (Tissues deep within the body).
What year was COG formed?
2000-Children's Oncology Group
APHON's Mandate
Training Nurses
Childhood Cancer Diagnosis
Vague Symptoms. Could take days to weeks to get diagnosed.
Findings r/t Alterations in Blood Cell Production
Fever, Infection, Fatigue, Pallor
Mediastinum Includes:
Thymus, Thyroid, Esophagus, Lymph Nodes, Trachea, Bronchi, Heart/Pericardium, Great Vessels, Nerves.
Mediastinal Mass/Safety
Never Force to lie down or and never sedate unless prepared to intubate.
Most Common Chidlhood Cancer
ALL-Acute Lymphoblastic Leukemia
How are Childhood Leukemias Classified?
Onset/Course
ALL % of Cancers
75% of Childhood Leukemias and 25% of Childhood Cancers
Chem Panel Changes
K, Phos, Uric Acid, Creat, LDH all up, Ca+ is down
What is diagnostic of leukemia?
>25% Blasts in bone marrow
Cytogenic Types (Fav/Unfav)
(12:21) - Favorable
(9:22) - Unfavorable
ALL
WBC Count
Age at Dx
Response
Treatment
>=50K Unfavorable
>1<10 Favorable
Rapid Early Resp.-Favorable
Appropriate for Risk Factor-Fav
ALL Bone Marrow Rating
M1 <5% Blasts
M2 5-25%
M3 >25%
M1=Remission ***
M2=Partial Response
M3=Frank Leukemia ***
Goal of 1st Phase of Therapy
Induction of Remission
AML Morphology / FAB Classification
# Subtypes??
8 Subtypes
AML
WBC Count
Down Syndrome
FAB Subtype
Etiology
>=100K Unfavorable
Present=favorable
M3=Favorable
Treatment related=Unfav.
Juvenile Myelomonocytic Leukemia (JMML) Features
Leukocytosis (>10K)
Monocytosis (>1000/mm3)
Prognosis Generally Poor
Allogeneic HCT is only cure
Where do Lymphomas arise from?
From Cells of Immune System (Lymphocytes)
Peak age of Hodgkin's Lymphoma.
Teens/Young Adulthood
Hallmarks of Hodgkin's Disease Cytology
Reed-Sternberg Cells
(multinucleated giant cell)
(Owl's Eye appearance)
(Characteristic architecture)
Hodkin's Clinical Presentation
Painless Lymphadenopathy (Often firm, rubbery. 60-90% lower cervical)
Unexplained fever
Drenching Night Sweats
Weight loss >10% in 6 months
Procarbazine Teaching (Given for Hodgkin's)
Low Tyramine Diet
Wilm's Tumor Peak Age
2-3 years
Safety for Wilm's Tumor
Do not palpate. Can be easily ruptured
Rhabdomyosarcoma Staging
TNM Staging
Tumor
Node
Metastasis
Treatment for Stage 2-4 Rhabdomyosarcoma
Radiation in addition to surgery
Osteogenic Sarcoma derived from?
Mesenchyme (bone forming connective tissue) generally long large bones
Peak for Osteogenic Sarcoma
Adolescence
Risk Factor for Osteogenic Sarcoma
Alkylating Agent Exposure (such as Cyclophosphamide)
Ewing's Tumors sensitive to?
Radiation
Ewing's most common Metasteses
Lung
Bone Marrow
Other Bones
Retinoblastoma 8th most common can lead to??
Osteosarcoma
Germ Cell Tumors Tumor Markers?
Serum Beta-HCG
AFP
Langerhans Cell Histiocytosis common presentation
Skin-scaly, erythematous, seborrhea like papules behind ears, scalp, axila
3 Major divisions of the brain
Forebrain
Midbrain
Hind brain
Occipital Lobe??
Visual
Brainstem=
midbrain
medulla
pons
Infratentorium=
Cerebellum
Pons
Medulla
S/S increased ICP
Initially Subtle
Decreased LOC
Restlessness Irritability
Bradycardia/HTN
Brain Tumor Grading for Benign
Typical of Cells of Origin
Lower mitosis & necrosis
Slow growing
Localized
May be malignant by location
Hallmarks of Infratentorial Tumors
AM Vomiting
Visual Disturbances
r/t Increase in ICP while sleeping
General Treatment for Childhood Brain Tumors
Surgery
XRT >3yo
Chemo
Immune/biotherapy
HCT/Stem Cell Therapy
Neuroblastoma arise from? Occurs in what age group?
Neural Crest Tissue (Primitive neuroblasts of the Parasympathetic) Occurs in Infants/Toddlers
Neuroblastoma Clinical Presentation
- Opsoclonus/Myoclonus -(Dancing Eyes/Dancing Feet) Nystagmus and ataxia. Does not resolve - High Intellectual impairment.
- Orbital Swelling/Ecchymosis r/t bony erosion of orbit.
- Blueberry muffin spots
Neuroblastoma - Paraspinal Mass result
Not walking
Neuroblastoma - Best prognosis Age
Under 1 year
Two congenital types of anemia
- Diamond Blackfan-RBC Only
- Fanconi's Anemia-All 3 lines
ITP Treatment
Steroids
IgG
WinRhO
Splenectomy (rare)
Hemophilia-Tingling
Can be blood trickling under the skin
Sickle Cell - When both parents have the trait
1:4 chance for child to have SCD
Evidence of engraftment after stem cell transplant
ANC>500
Platelets>20K s/ transfusion
Major source of morbidity/mortality first 100 days post stem cell
Infection
GVHD Damages ??
3 target organs
-skin
-GI
-Liver
GVHD Chronic complications
Mouth ulcers
Hair loss
Thickening of skin
malabsorption
Goals of clinical trials
- Determine effectiveness of new treatments
- Maintain Pt. Safety
- Improve outcomes
-increase cure, decrease tox
COG formed when?
2000
% of Peds Pt's c/ cancer on clinical trials
75%
Phase II Trial requirements
Requires measurable disease response
Phase III Trial details
- Compares new to standard treatment
- Stratification ensures balanced representation
Phase IV Evaluates approved treatment for
Impact on Quality of life. Rarely done in Peds Onc
Nursing Role in Clinical Trials
Provide Patient and Family Education.
Neoadjuvant Chemo
Used preop to decrease tumor bulk
Cell Kill Max?
Repeated Doses for Max Cell Kill
Granulocyte Colony Stimulating Factor
Stims proliferation/ differentiation of neutrophils.
Monoclonal antibodies
Cause cell death thru interaction c/ immune responses/recognize tumor associated antigens
Patient's Meter Squared
Very thin or obese base on ideal body wt. Square root of HtxWt/3600
Dauno/Doxorubicin To know
Idarubicin
Teach re: reddish orange discoloration of urine. Ida Also
Cumulative Max dose (550mg/m2)
Etoposide
Hypotension
Liver Tox
Asparaginase
Systemic Allergic Rxn (may be delayed)
Mesna
Rescue Drug for Ifos or Cyclafos protect bladder
For VAD Occlusion
TPA 1/2 to 1 mL, Leave for 60 mins, can repeat
What does Chemo do to bone marrow
Does not destroy existing cells, but stops making new cells.
ANC Calc
WBC *(Segs+Bands)
Severe Neutropenia
AND<500
With Surgically implanted devices/Dental care
Requires Cardiac prohylaxis
Protozoa Prophylaxis
PCP-Bactrim 6-12 mo's post-therapy
Fever and VADs
Alternate lumens for Abx
Thrombocytopenia-what to avoid
Avoid NSAIDs and ASA
Anemia Cardiac Assessment
May hear a gallop murmur
Transfusion guidelines
Irradiated leukopore filtered (irradiate kills T-cells)
Vestibular System/NV
Motion Sickness Incr. N/V
Cisplatinum-
90% of N/V
Antiserotonins
Revolutionized N/V Mgmt
When supplemental feeding?
At 5-10% Weight Loss
C-Diff Meds
Vanco or Flagyl
Photo/sun sensitivity
Methotrexate and Retinoids
Hyperleukocytosis
Maintain hydration for urine output 1-2 MLs/KG/Hour
Greatest Risk Hypoerleukocytosis
AML/ALL
Greatest Cause of DIC
Gram (-) Sepsis
Spinal Cord Compression Med Mgmt
Steroids
Superior Vena Cava Syndrome Nursing Mgmt
O2 and Put up head of bed
SIADH
Dilutional Hyponatremia
Too rapid correction can cause cerebral edema
Anaphylaxis risk drugs
Aspariginase
Bleomycin
Epipodophyllotoxins
Carboplatins
Addiction
Voluntary psychological behavioral pattern-drug seeking
Drug tolerance
Physiological adaptation requires larger doses
Physical dependence
Physiological withdrawal symptoms. Requires weaning
Nociceptive pain
Inflammatory response that is perceived as pain.
Polyneuropathic pain
Associated with many nerve centers
Scheduled pain med dosing
Promotes steady state blood level.
Oral route for drugs
Must undergo first pass effect in liver
IV Pain Meds Best results
Basal Rate with PRN Boluses/PCA
Epidural requirements
Preservative free solution
Demerol/Mepiridine
CNS side effects include seizures. Limit use to rigors
Antihistamines as Adjuvant
Not-co-analgesic. Controls side effects
Best chance of pain control
Multiple drugs or multiple modalities
Which patients have more significant late effects?
Younger patients
Cognitive dysfunction risk
Younger patients
Hearing loss drugs
Platinum
Aminoglycosides
XRT
Rad to brain, eye, or TBI can cause which occular problem?
Cataracts
Cardiac effect drugs
Anthracyclines and cyclophosphamide
Cause of Lung fibrosis
Bleomycin
Drugs and hepatotoxicity
Methotrexate
6-MP
AMD
Thyroid problems
Hypothyroid is most common problem
Growth hormone replacement
Cardiac health, controversial treatment
Renal effects of Platinum
Kidney failure
Renal effects of Ifos/cyclophosph
Bladder fibrosis, malignancy, hemorrhagic cystitis
Long time steoir use effect on bone
Avascular necrosis
Late effect of Rad. to HP axis
Fertility problems
Core concepts of palliative care
- Respect
- comprehensive caring
- building support
- addressing caregiver concerns
Addressing death
Should be addressed at diagnosis with goal of cure in most cases
Pain treatment
Most pain undertreated