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43 Cards in this Set
- Front
- Back
What are two difficult-to-treat major forms of childhood cancers derived from neural tissue?
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brain tumor
neuroblastoma |
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Brain tumors are the most common ____ tumors in children and are the ____ most common childhood cancer.
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solid
second |
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The majority of tumors (60%) are _____
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infratentorial (below the tentorium cerebelli), which means they occur in the posterior third of the brain, primarily in the cerebellum or brainstem
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About 40% of brain tumors are ____, or within anterior two thirds of brain, mainly cerebrum
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supratentorial
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It is not until ___ ____ ____causes markedly increased
head size that a lesion may be suspected, clinical manifestions are usually ____ |
spinal fluid obstruction
nonspecific |
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The most common symptoms of brain tumors is 1______, especially on 2____ and 3____ that's not related to feeding
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1 headache
2 awakening 3 vomiting |
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Diagnosis of brain tumor is based _____ on presenting clincial signs and ____ on neurologic tests and histologic diagnosis via surgery
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subjectively
objectively |
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The most common diagnostic test for brain tumor is?
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MRI
other tests are: CT angiography electroencephalography lumbar puncture |
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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 |
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Treatment for brain tumors is surgery, chemo, and radiation in any combination.
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okay
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Vital signs, including b.p. and pulse pressure are taken routinely, especially when?
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during or after diagnostic procedures
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Besides vital signs, nurse should assess neurologic and measure?
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head circumfence
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Nurse should observe child for evidence of (3)?
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headache
vomiting seizure |
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What symptoms might a child display if feeling uncomfortable?
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lying flat and facing away
from light refusing to engage in play unusual gait head tilt and other changes in posturing |
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Nurse should deliver information in ____ ___ and let child pursue additional answers.
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small amounts
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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
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okay
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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
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okay
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Postop, VS are taken every?
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15 to 30 minutes
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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.
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temperature
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Due to HYPERthermia postop, a ___ ____ should be placed on bed BEFORE child returns to unit...monitor for HYPOthermia following that.
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cooling blanket
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Recognizing signs of other complications such as (3) is IMPERATIVE.
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increased ICP
meningitis respiratory tract infection |
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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
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Postop, assess patient's LOC, sleep patterns, pupillary reaction, response to stimuli following comatose condition...regression to lethargic, irritable state may indicate?
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increasing pressure, possibly caused by meningitis and cerebral edema
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Nursing Alert!
Sluggish, dilated, or unequal pupils are reported immediately because they indicate _____ ____ and potential brainstem herniation, a medical emergency. |
increased ICP
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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 |
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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 |
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Explain headache for brain tumors?
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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 |
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Assessment for headache?
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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) |
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Explain vomiting for brain tumors?
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with or without nausea or
feeding progressively more projectile more severe in morning relieved by moving about and changing position |
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Assessment for vomiting?
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record time, amount, and
relationship to feeding, nausea, activity |
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Explain neuromuscular changes for brain tumors?
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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 |
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Assessment for neuromuscular changes?
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test muscle strength, gait, coordination, and reflexes
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Explain behavioral changes for brain tumors?
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irritability
decreased appetite failure to thrive fatigue (frequent naps) lethargy coma bizarre behavior (staring, automatic movements) |
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Assessment for behavioral changes?
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observe behavior regularly
compare observations with parental reports of normal behavioral patterns monitor growth and food intake monitor activity and sleep |
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Explain cranial nerve neuropathy for brain tumors?
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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) |
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Assessment for cranial nerve neuropathy?
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Assess cranial nerves, esp.:
VII (facial) IX (glossopharyngeal) X (vagus) V (trigeminal, sensory roots) VI (abducens) Assess visual acuity, binocularity, and peripheral vision |
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Explain vital sign disturbances for brain tumors?
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decreased pulse and respiration...
increased blood pressure... decreased pulse pressure... hypothermia or hyperthermia.. |
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Assessment for vital sign disturbances?
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measure vital signs frequently...
monitor pulse and respirations for 1 full minute... record pulse pressure (difference between systolic and diastolic blood pressure) |
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Other signs of brain tumors?
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seizures
cranial enlargement tense, bulging fontanel at rest nuchal rigidity papilledema (edema of optic nerve) |
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Assessment for other signs of brain tumor?
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record seizure activity
measure head circumference daily (infant and young child) perform funduscopic exam if skilled in procedure |
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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... |
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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 |
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Clinical manifestations of neuroblastoma
Widespread metastasis? |
pallor
weakness irritability anorexia weight loss |