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44 Cards in this Set

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  • Back
Clinical manifestations of retinoblastoma?
cat's eye reflex (most common sign)...
strabismus (second most common sign)...
red, painful eye, often with
glaucoma...
blindness (late sign)
Staging of retinoblastoma?
Group 1
very favorable
solitary tumor, less than 4
disc diameters (DD), at or
behind the equator
multiple tumors, none
greater than 4 DD, all at
or behind the equator
Staging of retinoblastoma?
Group II
favorable
solitary tumors, 4 to 10 DD,
at or behind the equator
multiple tumors, 4 to 10
DD, behind the equator
Staging of retinoblastoma?
Group III
doubtful
any lesion anterior to the
equator
solitary tumors larger than
10 DD, behind the equator
Staging of retinoblastoma?
Group IV
unfavorable
multiple tumors, some larger
than 10 DD
any lesion extending anter-
iorly to the ora serrata
Staging of retinoblastoma?
Group V
very unfavorable
massive tumors involving
more than half the retina
vitreous seeding
Retinoblastoma, which arises from the retina, is the most common _____ ______ _____ tumor of childhood
congenital malignant intraocular
Retinoblastoma occurs primarily in children younger than ____
5 years old
Caused by mutation in a gene and may occur ______ or be _____.
sporadically
inherited
Develops when mutated gene is unable to produce the natural signals to stop growth of _____ _____
retinal cells
Of all cases, the majority are 1_______ and 2______, with the remainder divided between hereditary and unilateral, and hereditary and 3______
1 nonhereditary
2 unilateral
3 bilateral
Hereditary retinoblastomas are transmitted as an _______ dominant trait with a 90% penetrance
autosomal
What is the cat's eye reflex?
white reflex...a "whitish" glow in the pupil also called leukokoria
What is leukokoria?
represents visualization of the tumor as the light momentarily falls on the mass
Eye abnormalities that the nurse can be listening for from family members includes?
cat's eye reflex
strabismus
decreased vision
persistent painful
erythematous eyes
Definitive diagnosis is usually based on ophthalmoscopic exam under ____ ____
general anesthesia
The aim of therapy is to preserve useful _____ and _____ the tumor.
vision
eradicate
What is the commonly used standard for intraocular disease?
Reese-Ellsworth (RE) classification
Some of the common focal therapies are (4)?
plaque brachytherapy
laser photocoagulation
cryotherapy
thermotherapy
What is plaque brachytherapy?
surgical radioactive implant on the sclera until maximum dose has been delivered to the tumor
What is laser photocoagulation?
laser beam to coagulate blood supply to the tumor
What is cryotherapy?
freezing the tumor by destroying the micro-circulation to the tumor through microcrystal formation
What is thermotherapy?
uses microwaves or infrared radiation to deliver heat to the tumor
Chemotherapy has been used for several years to prevent metastatic disease in the RE groups IV and V and relapsed patients
chemoprevention
chemoprophylaxis
Chemoreduction and chemoprevention include two to six courses of?
vincristine
etoposide
carboplatin with or without
cyclophosphamide
Retinoblastoma is chemosensitive but not yet _____
chemocurable
What is enucleation?
removal
Enucleation of the affected eye is the ___ of ___ with advanced tumor growth into the optic nerve, choroid, orbit, and anterior chamber
treatment of choice
After enucleation, the orbital implant is placed to provides 3 things?
a more natural cosmetic appearance...
minimizes sinking of the
prosthesis...
enables motility of prosthesis
Enucleation may be prevented by treating with the following procedures?
chemotherapy
external beam
radiotherapy
cryotherapy
laser
plaque brachytherapy
thermotherapy
Overall prognosis is very favorable with survival rate of?
90%
(for both bilateral and unilateral tumors)
Retinoblastoma is one of the tumors that may spontaneously _____
regress
Of major concern in long-term survivors is the development of decreased?
visual acuity
facial disfiguration
secondary tumors
esp. osteogenic sarcoma
other sarcomas
melanoma
Secondary tumors are (3)?
osteogenic sarcoma
other sarcomas
melanoma
Children with bilateral disease (hereditary form) are more likely to develop secondary cancers than are children with _____ ______
unilateral disease
It is thought that children who develop bilateral disease (hereditary) are ______ to developing cancer and that radiation increases their risk
predisposed
Nurse should pay close attention when parents report a strange light in the child's ____ or _____
eye
expression
After indirect ophthalmoscopy, the child may not see very clearly, or the eyes may be sensitive to light because of ______ _____.
pupillary dilation
Treatment plan may include ___ ____ ____ with or without chemotherapy, external beam radiation, and, if necessary, enucleation.
focal intraocular therapy
_______ is the treatment of choice if there is extensive disease threatening metastasis or no chance for useful vision.
Enucleation
The nurse may show the parent a photo of another child with an artificial eye to help them adjust.
okay
After surgery, an eye patch is in place, and the child's face may be 1_______ or 2_______. Parents often fear seeing the surgical site because they imagine a
3 ____ in the skull. A surgically implanted sphere maintains the shape of the eyeball, and the implant is covered with 4____ When the lids are open, the exposed area resembles the _____ lining of the mouth. After the child is fitted for a 6_____, usually within 3 weeks, the facial appearance returns to normal. Initial instructions for care of the prosthesis are given by the 7____ who fits and manufactures the device
1 edematous
2 ecchymotic
3 cavity
4 conjunctiva
5 mucosal
6 prosthesis
7 ocularist
Care of the socket is 1 _____
and easily accomplished. The wound itself is clean and has little or no 2_____.
If an antibiotic ointment is prescribed, it is applied in a thin line on the surface of the tissues of the socket.
To cleanse site, an 3____ solution may be ordered and is instilled daily or more frequently, before application of the antibiotic ointment. The dressing consists of an eye pad taped over the surgical site and is changd dialy. After the socket has healed completely, a dressing is no longer necessary, although it is a preventive measure against infection.
1 minimal
2 drainage
3 irrigating
Families with a history of the disorder may feel great ____ for transmitting defect to offspring. If not hereditary, then parents feel _____.
guilt
shock