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64 Cards in this Set
- Front
- Back
What is main difference between adult cancer and childhood cancer?
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childhood cancer is embryonal in cell type....adult cancers are epithelial in origin.
Child - embryonal, mechanism of apoptosis is not developed |
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What determines the treatment plan for cancer?
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type of cancer
site of primary tumor sites of metastasis |
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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 |
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What is the schedule of chemotherapy determined by?
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cell's cycle of replication....specific drugs at specific times. Kills fast growing cells in different phases of cell cycle
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What is very important to remember in chemo therapy as a nurse?
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Always follow OSHA guidelines when handling chemo drugs...some need gloves,etc.
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What does radiation do?
Major side effect? |
breaks down DNA molecule in cell and destroys cell
FATIGUE |
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What is common duration/frequency for radiation?
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once a day for 4-5 days for 2-7 weeks
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After treatment (not sure if just radiation), what is often given?
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colony stimulating factors, which increase production of baby cells
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What are the examples of colony stimulating factors?
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Epoetin alfa - RBC
Filgrastim - WBC Oprelvekin - platelets *these treat or prevent bone marrow suppression |
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What should normal platelets be for a four year old?
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150,000-400,000
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What is normal WBC for child?
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WBC greater than ?????
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What is normal hemoglobin for child?
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hgb normal is 12-16
Hg of 7 would be low |
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What do you want the ANC (absolute neutrophil count) to be for a child who is normal?
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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
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What do you want your glucose and protein to be for a normal child?
IN URINE |
not present in urine
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What do you want SG to be for urine for normal?
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specific gravity around 1.010 is good. one of 1.030 is high, means dehydration
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What is the type of leukemia that is present for 75% of all childhood leukemias?
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ALL - Acute lymphocytic leukemia
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What is ALL?
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cancer of blood forming tissues
primarily bone marrow stems cells produce immature white blood cells calls blasts |
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If you have a high level of blasts, high being greater than 5%, what is most likely the cause?
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ALL...25% blasts in CBC
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What is the patho of leukemia?
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uncontrolled replication of immature WBC's called blasts
(higher than 5%) |
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What is the problem with producing tons of blasts?
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crowd out normal cell growth in marrow....they take over and clog everything
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With leukemia, you get that flower word. What is it?
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Pancytopenia
low everything. anemia - low RBC infection - low WBC bleeding - low platelets |
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What are the presenting symptoms for leukemia?
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fever
pallor bruising bone pain |
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How do they diagnose leukemia?
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physical assessment
CBC results (increased WBC (Blasts) Bone marrow aspiration for ***DEFINITIVE DX**** Lumbar puncture to determine if cells have made it to CNS |
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What is result if blasts are found in CNS?
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if immature WBC found in CNS, then it has spread through body
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What are some lab values that are important for leukemia?
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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 |
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What is tx for leukemia?
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chemotherapy and radiation
Bone marrow transplant if fail to maintain remission with standard treatment |
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What is the process of chemotherapy with leukemia?
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four phases wipes out blast cells, then continue chemo, then target certain stuff, then maintance phase
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What is syndrome that happens after chemo for leukemia?
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tumor lysis syndrome - occurs when large numbers of cancer cells are killed. Kidneys clog up
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What is percentage of relapse expected after chemo tx?
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10%
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If relapse after chemo, what is next step?
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bone marrow transplant
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What are some common things to expect as symptoms or side effects from chemo treatment?
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poor appetite
mouth care nausea/vomiting (Zofran) Alopecia/body image issues Constipation |
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What is big side effect of chemo treatment?
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most agents cause bone marrow depression
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Where are there rapidly growing cells other than hair and nails?
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GI tract
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What are some side effects of corticosteroids?
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body image (moon face)
mood swings appetite voracious diabetes (short term) osteoporosis acne, cushingfoid features high blood pressure immunosuppression weight gain |
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With bone marrow transplant, what is main problem?
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you wiped out their immune system, so they are low in WBC, platelets, RBC, pancypenia
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How long does the prolonged pancytopenia last? What is happening during this time?
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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 |
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What is the main rejection with bone marrow transplants called?
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graft vs host disease - the graft has the white blood cells and the immune system. It fights the new host
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What is bone marrow transplant process?
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cytoreduction - wipe out bone marrow with new lethal doses of chemo agents
day of rest administer stem cells via IV infusion |
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What is number 1 neutropenic precaution?
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handwashing
then avoid contact with ill individuals monitor temp at least BID |
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If temp is monitored BID, what is treatment if febrile status found?
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Temp of 101.5 will be treated like sepsis....big reaction to slightly raised temperature
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After chemo, the body does not display normal signs of infection if it gets sick...why is this?
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because it doesn't have WBC so can't react normal
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What is something to NOT have on a chemo ward?
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plants - fungus is horrible
food precautions vary chicken pox from a sick person can wipe out entire ward |
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What should you worry about with a ANC of less than 500?
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your own body flora may cause the infection
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Bump under skin. It is cancer. What will it feel like?
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cancer mass is hard and not tender. infection is soft
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What is the most common tumor in children found outside the brain?
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Neuroblastoma. Prognosis is best in infants with localized disease
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What does Wilm's tumor look like?
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Usually encapsulated. Membrane around it, so decreased metastasis
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What type of tumor is Wilm's tumor?
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nephorblastoma - kidney
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What is presenting symptom of Wilm's tumor?
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abdominal swelling
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What is dx of Wilm's tumor?
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ct, mri, cxr, cbc, u/a...evaluate good kidney for function since you are going to surgically remove the bad kidney.
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What is VIP in regard to patient care for a patient with Wilm's Tumor?
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No palpating the belly - put a sign up. Palpation could rupture capsule and cause metastasis. Very Good Survival Rate
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A osteogenic sarcoma is what type of tumor?
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bone tumor
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When does an osteogenic sarcoma usually present itself?
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teens, mid 20's
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What are main presenting symptoms?
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pain, limp...may be diagnosed with fracture near site and no previous issues
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Where are most likely sites for osteogenic sarcoma?
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distal femur, proximal tibia, proximal humerus
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Where does bone cancer go to?
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lung
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What is treatment of osteosarcoma?
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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
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What is amputation's role with osteosarcoma?
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amputation no longer only procedure of choice - limb sparing surgeries available: donor bone can't grow tho
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What is main problem with donor bone?
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doesn't grow....
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Ewing's Sarcoma is very ____________.
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Malignant
Ewing's Sarcoma is very maglignant. |
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What bones does Ewing's Sarcoma like?
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any bone may be effected, especially pelvis, tib, fib, femur.
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What is main concern with diagnosis of Ewing's Sarcoma?
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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.
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What is treatment for Ewing's Sarcoma (remember that it is very malignant).
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Chemo prior to surgery
Radiation if tumor can't be removed Resection where possible |
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Interesting about Retinoblastomas
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-40% hereditary
-may be BOTH eyes -white glow in pupil instead of red reflex -blindness w/ late dx -PIRATES - take out eye |
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What does radiation do to the body over time?
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growth retardation
cognitive deficits scoliosis atrophy avascular necrosis osteoporosis sterility hypothyroidism dental problems pulmonary fibrosis |