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43 Cards in this Set

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  • Back
What are two difficult-to-treat major forms of childhood cancers derived from neural tissue?
brain tumor
neuroblastoma
Brain tumors are the most common ____ tumors in children and are the ____ most common childhood cancer.
solid
second
The majority of tumors (60%) are _____
infratentorial (below the tentorium cerebelli), which means they occur in the posterior third of the brain, primarily in the cerebellum or brainstem
About 40% of brain tumors are ____, or within anterior two thirds of brain, mainly cerebrum
supratentorial
It is not until ___ ____ ____causes markedly increased
head size that a lesion may be suspected, clinical manifestions are usually ____
spinal fluid obstruction
nonspecific
The most common symptoms of brain tumors is 1______, especially on 2____ and 3____ that's not related to feeding
1 headache
2 awakening
3 vomiting
Diagnosis of brain tumor is based _____ on presenting clincial signs and ____ on neurologic tests and histologic diagnosis via surgery
subjectively
objectively
The most common diagnostic test for brain tumor is?
MRI

other tests are:
CT
angiography
electroencephalography
lumbar puncture
1 What is dangerous in presence of ICP (increased cranial pressure)?

2. If a lumbar puncture occurs, there may be a ___ ____ following a sudden release of pressure.
1. lumbar puncture
2. brainstem herniation
Treatment for brain tumors is surgery, chemo, and radiation in any combination.
okay
Vital signs, including b.p. and pulse pressure are taken routinely, especially when?
during or after diagnostic procedures
Besides vital signs, nurse should assess neurologic and measure?
head circumfence
Nurse should observe child for evidence of (3)?
headache
vomiting
seizure
What symptoms might a child display if feeling uncomfortable?
lying flat and facing away
from light
refusing to engage in play
unusual gait
head tilt and other changes
in posturing
Nurse should deliver information in ____ ___ and let child pursue additional answers.
small amounts
Nurse should be sensitive to shaving child's head day before surgery by saving a braided swatch if possible...provide cap or scarf...provide wig
okay
Tell child about size of dressing...sleepiness and headache is considered normal following surgery...it's not uncommon for child to be lethargic or comatose following surgery
okay
Postop, VS are taken every?
15 to 30 minutes
What type of measurement is particularly important because of hyperthermia resulting from surgical intervention in the hypothalamus or brainstem and from some types of general anesthesia.
temperature
Due to HYPERthermia postop, a ___ ____ should be placed on bed BEFORE child returns to unit...monitor for HYPOthermia following that.
cooling blanket
Recognizing signs of other complications such as (3) is IMPERATIVE.
increased ICP
meningitis
respiratory tract infection
Nursing Alert!
When temperature is elevated, an infectious process must always be suspected, particularly if the febrile state occurs ___ to ____ days after surgery.
1 to 2
Postop, assess patient's LOC, sleep patterns, pupillary reaction, response to stimuli following comatose condition...regression to lethargic, irritable state may indicate?
increasing pressure, possibly caused by meningitis and cerebral edema
Nursing Alert!
Sluggish, dilated, or unequal pupils are reported immediately because they indicate _____ ____ and potential brainstem herniation, a medical emergency.
increased ICP
Nursing Alert!
To keep an accurate account of 1 _____, the soiled area is circled with a pen every hour or so. In this way, continuous 2_____ is easily recognized. The presence of 3_____ drainage is reported immediately, since it most likely is 4____ from incisional area. A foul odor from dressing may indicate an 5____. Such a finding is reported, and a 6____ is taken
1 drainage
2 bleeding
3 colorless
4 CSF
5 infection
6 culture
Nursing Alert!
The 1_____ position is contraindicated in both 2____ and 3_____ surgeries because it increases ICP and the risk of hemorrhage. If 4____ is impending, the practitioner is notified immediately, before the head is lowered.
1 Trendelenburg
2 infratentorial
3 supratentorial
4 shock
Explain headache for brain tumors?
recurrent and progressive
frontal or occipital
dull and throbbing
worse on arising, less during
day
intensified by lowering head
and straining, such as
during bowel movement,
coughing, sneezing
Assessment for headache?
record description of pain,
location, severity, and
duration
use pain rating scale to
assess severity of pain
note changes in relation to
time of day and activity
observe changes in behavior
in infants
(persistent irritability,
crying, head rolling)
Explain vomiting for brain tumors?
with or without nausea or
feeding
progressively more projectile
more severe in morning
relieved by moving about and
changing position
Assessment for vomiting?
record time, amount, and
relationship to feeding, nausea, activity
Explain neuromuscular changes for brain tumors?
incoordination or clumsiness..
loss of balance (use of wide-
based stance, falling, tripping, banging into objects)
poor fine motor control
weakness
hyporeflexia or hyperreflexia
positive Babinski sign
spasticity
paralysis
Assessment for neuromuscular changes?
test muscle strength, gait, coordination, and reflexes
Explain behavioral changes for brain tumors?
irritability
decreased appetite
failure to thrive
fatigue (frequent naps)
lethargy
coma
bizarre behavior (staring, automatic movements)
Assessment for behavioral changes?
observe behavior regularly
compare observations with
parental reports of normal
behavioral patterns
monitor growth and food
intake
monitor activity and sleep
Explain cranial nerve neuropathy for brain tumors?
cranial nerve involvement varies according to tumor location
most common signs:
head tilt
visual defects (nystagmus,
diplopia, strbismus,
episodic "graying out"
of vision, visual field
defects)
Assessment for cranial nerve neuropathy?
Assess cranial nerves, esp.:
VII (facial)
IX (glossopharyngeal)
X (vagus)
V (trigeminal, sensory
roots)
VI (abducens)

Assess visual acuity, binocularity, and peripheral vision
Explain vital sign disturbances for brain tumors?
decreased pulse and respiration...
increased blood pressure...
decreased pulse pressure...
hypothermia or hyperthermia..
Assessment for vital sign disturbances?
measure vital signs frequently...
monitor pulse and respirations for 1 full minute...
record pulse pressure (difference between systolic and diastolic blood pressure)
Other signs of brain tumors?
seizures
cranial enlargement
tense, bulging fontanel at
rest
nuchal rigidity
papilledema (edema of optic
nerve)
Assessment for other signs of brain tumor?
record seizure activity
measure head circumference
daily (infant and young
child)
perform funduscopic exam if
skilled in procedure
Clinical Manifestations of
Neuroblastoma
Abdominal Tumors
firm, nontender, irregular mass...
crosses the midline...
compression of kidney, ureter, or bladder may cause urinary frequency of retention...
Clinical Manifestations of Neuroblastoma
Distant Metastasis
Ocular:
supraorbital ecchymosis
periorbital edema
proptosis (exophthalmos)
from invasion of retro-
bulbar soft tissue
lymphadenopathy, esp.
cervical and supraclav-
icular
skeletal: bone pain may or
may not be present
intracranial: neurological
impairment
thoracic: respiratory
obstruction
spinal cord: varying degrees
of paralysis
adrenal:
increased catecholemine
excretion
flushing
hypertension
tachycardia
diaphoresis
Clinical manifestations of neuroblastoma
Widespread metastasis?
pallor
weakness
irritability
anorexia
weight loss