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64 Cards in this Set

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  • Back
What is main difference between adult cancer and childhood cancer?
childhood cancer is embryonal in cell type....adult cancers are epithelial in origin.

Child - embryonal, mechanism of apoptosis is not developed
What determines the treatment plan for cancer?
type of cancer

site of primary tumor

sites of metastasis
What is the goal of curative cancer treatment?

What is the goal of palliative cancer treatment?
curative - rid the child's body of cancer

palliative - make the child as comfortable as posible when no cure is possible
What is the schedule of chemotherapy determined by?
cell's cycle of replication....specific drugs at specific times. Kills fast growing cells in different phases of cell cycle
What is very important to remember in chemo therapy as a nurse?
Always follow OSHA guidelines when handling chemo drugs...some need gloves,etc.
What does radiation do?

Major side effect?
breaks down DNA molecule in cell and destroys cell

FATIGUE
What is common duration/frequency for radiation?
once a day for 4-5 days for 2-7 weeks
After treatment (not sure if just radiation), what is often given?
colony stimulating factors, which increase production of baby cells
What are the examples of colony stimulating factors?
Epoetin alfa - RBC
Filgrastim - WBC
Oprelvekin - platelets

*these treat or prevent bone marrow suppression
What should normal platelets be for a four year old?
150,000-400,000
What is normal WBC for child?
WBC greater than ?????
What is normal hemoglobin for child?
hgb normal is 12-16

Hg of 7 would be low
What do you want the ANC (absolute neutrophil count) to be for a child who is normal?
normal is greater than 1500. If this is too low, your own flora will turn on you. An ANC of 500 has an increase for infection
What do you want your glucose and protein to be for a normal child?

IN URINE
not present in urine
What do you want SG to be for urine for normal?
specific gravity around 1.010 is good. one of 1.030 is high, means dehydration
What is the type of leukemia that is present for 75% of all childhood leukemias?
ALL - Acute lymphocytic leukemia
What is ALL?
cancer of blood forming tissues

primarily bone marrow

stems cells produce immature white blood cells calls blasts
If you have a high level of blasts, high being greater than 5%, what is most likely the cause?
ALL...25% blasts in CBC
What is the patho of leukemia?
uncontrolled replication of immature WBC's called blasts

(higher than 5%)
What is the problem with producing tons of blasts?
crowd out normal cell growth in marrow....they take over and clog everything
With leukemia, you get that flower word. What is it?
Pancytopenia

low everything.

anemia - low RBC
infection - low WBC
bleeding - low platelets
What are the presenting symptoms for leukemia?
fever
pallor
bruising
bone pain
How do they diagnose leukemia?
physical assessment
CBC results (increased WBC (Blasts)
Bone marrow aspiration for ***DEFINITIVE DX****

Lumbar puncture to determine if cells have made it to CNS
What is result if blasts are found in CNS?
if immature WBC found in CNS, then it has spread through body
What are some lab values that are important for leukemia?
leukocytes will be raised. Normal is below 10,000. With leukemia it will be above 10,000

Plateletes decreased. Normal is 150,000-400,000. Leukemia will be 20,000-100,000

Hemoglobin will be down
normal is 12-16. Leuk will be 7-10
What is tx for leukemia?
chemotherapy and radiation

Bone marrow transplant if fail to maintain remission with standard treatment
What is the process of chemotherapy with leukemia?
four phases wipes out blast cells, then continue chemo, then target certain stuff, then maintance phase
What is syndrome that happens after chemo for leukemia?
tumor lysis syndrome - occurs when large numbers of cancer cells are killed. Kidneys clog up
What is percentage of relapse expected after chemo tx?
10%
If relapse after chemo, what is next step?
bone marrow transplant
What are some common things to expect as symptoms or side effects from chemo treatment?
poor appetite
mouth care
nausea/vomiting (Zofran)
Alopecia/body image issues
Constipation
What is big side effect of chemo treatment?
most agents cause bone marrow depression
Where are there rapidly growing cells other than hair and nails?
GI tract
What are some side effects of corticosteroids?
body image (moon face)
mood swings
appetite voracious
diabetes (short term)
osteoporosis
acne, cushingfoid features
high blood pressure
immunosuppression
weight gain
With bone marrow transplant, what is main problem?
you wiped out their immune system, so they are low in WBC, platelets, RBC, pancypenia
How long does the prolonged pancytopenia last? What is happening during this time?
3 weeks....stem cells are navitating to the bone marrow to settle in

then it takes 3 months to get normal before they can go home
What is the main rejection with bone marrow transplants called?
graft vs host disease - the graft has the white blood cells and the immune system. It fights the new host
What is bone marrow transplant process?
cytoreduction - wipe out bone marrow with new lethal doses of chemo agents

day of rest

administer stem cells via IV infusion
What is number 1 neutropenic precaution?
handwashing

then avoid contact with ill individuals
monitor temp at least BID
If temp is monitored BID, what is treatment if febrile status found?
Temp of 101.5 will be treated like sepsis....big reaction to slightly raised temperature
After chemo, the body does not display normal signs of infection if it gets sick...why is this?
because it doesn't have WBC so can't react normal
What is something to NOT have on a chemo ward?
plants - fungus is horrible

food precautions vary

chicken pox from a sick person can wipe out entire ward
What should you worry about with a ANC of less than 500?
your own body flora may cause the infection
Bump under skin. It is cancer. What will it feel like?
cancer mass is hard and not tender. infection is soft
What is the most common tumor in children found outside the brain?
Neuroblastoma. Prognosis is best in infants with localized disease
What does Wilm's tumor look like?
Usually encapsulated. Membrane around it, so decreased metastasis
What type of tumor is Wilm's tumor?
nephorblastoma - kidney
What is presenting symptom of Wilm's tumor?
abdominal swelling
What is dx of Wilm's tumor?
ct, mri, cxr, cbc, u/a...evaluate good kidney for function since you are going to surgically remove the bad kidney.
What is VIP in regard to patient care for a patient with Wilm's Tumor?
No palpating the belly - put a sign up. Palpation could rupture capsule and cause metastasis. Very Good Survival Rate
A osteogenic sarcoma is what type of tumor?
bone tumor
When does an osteogenic sarcoma usually present itself?
teens, mid 20's
What are main presenting symptoms?
pain, limp...may be diagnosed with fracture near site and no previous issues
Where are most likely sites for osteogenic sarcoma?
distal femur, proximal tibia, proximal humerus
Where does bone cancer go to?
lung
What is treatment of osteosarcoma?
surgical resection plus chemo...if you don't do chemo, good chance you will die. if you do do chemo, most likely you will recover
What is amputation's role with osteosarcoma?
amputation no longer only procedure of choice - limb sparing surgeries available: donor bone can't grow tho
What is main problem with donor bone?
doesn't grow....
Ewing's Sarcoma is very ____________.
Malignant

Ewing's Sarcoma is very maglignant.
What bones does Ewing's Sarcoma like?
any bone may be effected, especially pelvis, tib, fib, femur.
What is main concern with diagnosis of Ewing's Sarcoma?
Staging Eval - CT the lungs, bone scan, MRI of primary site....since this is very malignant, you want to make sure it hasn't metastasized. Look at Staging b/4 anything else.
What is treatment for Ewing's Sarcoma (remember that it is very malignant).
Chemo prior to surgery

Radiation if tumor can't be removed

Resection where possible
Interesting about Retinoblastomas
-40% hereditary
-may be BOTH eyes
-white glow in pupil instead of red reflex
-blindness w/ late dx
-PIRATES - take out eye
What does radiation do to the body over time?
growth retardation
cognitive deficits
scoliosis
atrophy
avascular necrosis
osteoporosis
sterility
hypothyroidism
dental problems
pulmonary fibrosis