Nursing 2Nd Semester: Peds Exam 3: The Child With Cancer

Front 1

True or False: Childhood cancer is a rare disease, yet is the leading cause of death in childhood from disease.

Back 1

True. Childhood cancer represents about 1% of all new cancers diagnosed annually.

Front 2

True or False: Over 3,000 children die from cancer yearly in the US, more than from AIDS, asthma, diabetes, and cystic fibrosis combined.

Back 2

True

Front 3

Early _____ and ____ can drastically impact the outcome of a child with cancer. It is recommended that a child with cancer go to a specialized ______ cancer center for the best treatment.

Back 3

diagnosis, referral
pediatric

Front 4

Doctor's don't like to say cancer is "cured" but rather in a state of _______.

Back 4

remission

Front 5

What is the most common childhood cancer? The 2nd most common? The 3rd? 4th?

Back 5

1. leukemia
2. brain tumors
3. lymphomas
4. solid tumors outside the CNS

Front 6

Solid tumors outside the CNS include neuroblastomas, which are neural _____ derived; Wilms tumor, which is a ____ tumor and syndrome; bone tumors; and rhabdomyosarcomas, which are ____ tissue sarcomas.

Back 6

Solid tumors outside the CNS include neuroblastomas, which are neural crest derived; Wilms tumor, which is a renal tumor and syndrome; bone tumors; and rhabdomyosarcomas, which are soft tissue sarcomas.

Front 7

The etiology of childhood cancer but there are theories about ____ alterations. What are some risk factors?

Back 7

genetic
Risk Factors:
environmental agents
drug exposure
inherited genetic tendency
viral connection
Trisomy 21 children
Failure of immune system to detect "self" from "non-self"

Front 8

A ______ is any tumor arising from abnormal growth. (Describe an example)

Back 8

neoplasm

ex- tumor in pancreas

Front 9

_____ is when malignant cells invade and destroy normal tissue
(Describe an example)

Back 9

invasion

ex- spreads to liver

Front 10

_____ is when cancer is spread through lymph system or blood to distant sites. (Describe an example)

Back 10

matastasis
ex- spread to lungs
(It left the original area, traveled somewhere else in the body through lymph or blood)

Front 11

It is ominous sign if cancer spreads to the _____ or _____.

Back 11

liver, lungs

Front 12

Name some examples of environmental damage that are linked or may be linked with causing cancer.

Back 12

Sun
cell phones
power lines
radiation
viruses- HPV, epstein barr

Front 13

Staging describes the extent of the cancer process or disease. What do T, N, and M mean?

Back 13

T- locally
N- regionally
M- systematically
ex- T3 N2 M1
means that cancer is present at 3 large sites, at least 2 lymph nodes, and 1 new area of cancer

Stage I-V, higher number is more advanced stage

Front 14

The diagnosis for cancer is based on ____ _____ aspiration from the _____ _____. Some children may need conscious ______ for this procedure. Other tests involve with the diagnosis of cancer iinclude CBC, serum chemistry, urinalysis, and scans such as CT scans. There are over 45 different cancer lab markers.

Back 14

bone marrow
iliac crest
sedation

Front 15

What are the overt (obvious, not subtle) signs of cancer in children?

Back 15

a mass or tumor
purpura
weight loss (unintended)
white reflex in eye (photo)
vomiting upon arising (brain issue)
recurrent or persistent fever (at same time every day not associated with acute infection)

Front 16

What are the covert (subtle) signs of cancer in children?

Back 16

bone pain (may be confused with growing pains)
headache
persistent lympadenopathy
change in balance, gait, or personality (was coordinated, now not so graceful)
fatigue
malaise

Front 17

What is lymphadenopathy?

Back 17

enlarged lymph nodes

Front 18

What is the therapeutic management for cancer?

Back 18

Surgery
-cure
-palliative (takes away pain, not cured)
Chemotherapy
Radiation
-cure or
-palliative (helps pain)
Biotherapy
Bone marrow Transplant
Supportive therapy
-imagery & meditation

Front 19

What is involved with biotherapy?

Back 19

Interferons or Interleukins (cytokines that trigger immune response)
introduce medication to stimulate immune system to fight infection instead of chemo/radiation

Front 20

True or False: Chemo and radiation basically wipe out all the bone marrow and a child is pushed nearly to death, then they wait for a match for a bone marrow transplant, which is a difficult process.

Back 20

true

Front 21

Two other types of treatment for cancer include ___ ___ transplantation and ____ ___ blood.

Back 21

stem cell, umbilical cord

Front 22

Stem cells can differentiate into any type of ____ cell. Umbilical cord blood can be transfused into ____ _____, and make RBC's etc.

Back 22

blood

bone marrow

Front 23

Chemo kills _____ ______ cells, which is why many lose their hair. What are some side effects of chemotherapy?

Back 23

rapidly dividing
s/s:
↓ Bone marrow production
-anemia
-neutropenia
-thrombocytopenia
GI Tract Complications
-nausea & vomiting
-anorexia
-sloughing of mucousal tissue
(sores in mouth)
Hair Loss
Psychological Factors
-

Front 24

Often times, _____ care more about the child's hair loss or appearance than the child does. The child may act out as a way of coping.

Back 24

parents

Front 25

True or False: Side effects of radiation are dose and treatment site specific.

Back 25

true

Front 26

True or False: Radiation kills healthy and unhealthy slowly dividing cells.

Back 26

false, rapidly dividing

Front 27

When do side effects of radiation begin to present?

Back 27

7-10 days after starting tx

Front 28

_______ are often given 30 min prior to chemo and radiation to prevent _____

Back 28

antiemetics
nausea/vomiting

Front 29

What are some side effects of radiation?

Back 29

erythema of radiated area
fatigue
anorexia
nausea & vomiting
Cell growth may be be altered
-brain tissue
-bone cells
-development of a 2nd malignancy

Front 30

Side effects of chem on bones include skeletal _______ and uneven _____, especially when on the ____ ____.

Back 30

malformations
growth
growth plate

Front 31

If there is erythema at the radiated area, avoid...

Back 31

lotions, scratching, perfumed soaps

Just using water is best. It will feel sore.

Front 32

Radiation on the brain is avoided if the child is what age?

Back 32

< 3 y

Front 33

________ is unrestricted proliferation of immature WBC in the blood forming tissues of the body and affects all types of blood cells. The WBC's grow like crazy, take over, fight for space and push away healthy WBCS, RBCs, and thrombocytes. This causes what 3 things?

Back 33

leukemia

anemia
risk for infection
risk for bleeding

Front 34

What are the clinical manifestations of leukemia?

Back 34

pallor (anemia)
fatigue (anemia)
fever (low WBC)
infections (low WBC)
hemorrhage (low platelets)
brusing (low platelets)
purpura
petechiae
pain- especially in late stages, especially painful in bones
weight loss

Front 35

What is the tx for leukemia?

Back 35

Chemotherapy
Remission induction- "hard & heavy" chemo daily or every other day for 4-6 days
After remission- 1x week- 1x month etc.
maintenance- 1x a month, every 3 weeks, or every 6 months etc.

Front 36

Treatment for leukemia and most cancers usually involves about ____ years of therapy and then lifelong followup.

Back 36

2

Front 37

Nursing considerations for the management of leukemia

Back 37

monitor CBC
excellent handwashing!
Inspect mouth daily for ulcers
Inspect perineum daily for fissures
Meticulous oral hygiene

Front 38

Watch for _____ changes in ________ with leukemia, which can be a big deal due to their immunocompromised state.

Back 38

subtle
temperature

Front 39

If a child with leukemia is neutropenic, what are some implications?

Back 39

no fresh flowers, plant, fruit
Don't go in the yard, stay inside.

Front 40

A child with leukemia should not get ___ virus or ____ bacterial vaccinations.

Back 40

live, live

Front 41

True or False: A child going through chemo who had a recent vaccine will still be immunized and does not need to repeat the vaccine.

Back 41

false, the chemo will wipe out the vaccine and any recent immunizations will need to be repeated.

Front 42

What is the normal platelet count? When does spontaneous bleeding occur?

Back 42

150,000-400,000

<20,000

Front 43

Nursing implications for a child with leukemia who is thrombocytopenic

Back 43

avoid punctures
(probably will have CVC)
meticulous hygeine
limit activities that can cause injury
gentle nose blowing
soft toothbrush

Front 44

What should we use to rinse the mouth of a young child after a period of emesis?

Back 44

saline, don't want them to swallow alcohol, etc.

Front 45

What can we do to help with periods of nausea, vomiting, and mucositis?

Back 45

antiemetics
clear, cool liquids
small, frequent meals
allow family to bring food
no fresh food
mouth analgesics (older child)
daily weight (monitor wt. loss)

Front 46

what is mucositis

Back 46

Mucositis involves the inflammation of the lining of the mouth and digestive tract, effects people with cancer.

Front 47

In treating pain for a child with cancer, explain procedures in an ___-appropriate manner, monitor for signs and symptoms of ____, administer _______ and ______, which are very appropriate for these children.

Back 47

age
pain
analgesics
antianxiety

Front 48

Signs of a brain tumor

Back 48

sings of increased ICP
headache- worse in AM
vomiting- worse in AM
neuromuscular deterioration
-hemiparesis
behavioral changes

Front 49

what is hemiparesis?

Back 49

one sided weakness

Front 50

True or False: Children with brain tumors usually present signs of its development before the critical threshold is reached?

Back 50

false, often asymptomatic until threshold reached

Front 51

Increased ICP can obstruct ___ flow and can cause hydrocephalus

Back 51

CSF

Front 52

A _______ is a brain tumor than can grow very large before detection.

Back 52

medulloblastoma

Front 53

Diagnostic tests for a brain tumor include scans such as a ____ and a ____. ____ is analyses but is not a confirmatory diagnosis.

Back 53

CT
MRI
CSF

Front 54

Therapeutic management for brain tumors includes _____, a ____ to relieve ______ and ______, _______ medications, ______ and _______.

Back 54

surgery
shunt
pressure
symptoms
antiseizure
chemo
radiation

Front 55

S______ can be sign of a brain tumor. ______ is avoided before age 3 if possible because of the toxic effects on brain cells.

Back 55

seizures
radiation

Front 56

A _______ is a nerve tumor and can easily _____ without being noticed. It is a tumor of the ____ ____ system.

Back 56

neuroblastoma
advance

sympathetic nervous system

Front 57

Neuroblastomas can be tumors of the .... (5)

Back 57

chest
neck
head
adrenal glands
abdominal mass

Front 58

a neuroblastoma, abdominal mass often _____ ______.

Back 58

cross midline

Front 59

Symptoms of neuroblastomas may include ____ _____ compression due to a thoracic or abdominal tumor.

Back 59

spinal cord

Front 60

Cervical or high thorac mass may present with ____ syndrome, which includes ______, _____, and ____.

Back 60

miosis- constricted pupil
ptosis- drooping eyelid
anhydrosis- absence of sweating

Front 61

True or False: neuroblastomas are very painful.

Back 61

false, not painful, often go unnoticed

Front 62

Neuroblastomas are known as the "____ tumor." What are some manifestations?

Back 62

"silent tumor"
firm, non-tender mass
non painful
urinary retention or frequency (depending on location, i.e. kidneys)
loss of appetite
anemia

Front 63

True or False: Neuroblastomas are more common in children than adults.

Back 63

true

Front 64

Signs of metastasized neuroblastomas

Back 64

irritability (brain involvement)
weight loss
bone pain
fever
proptosis
bone lesions
periorbital ecchymoses

Front 65

What is proptosis?

Back 65

protruding eye, like it's coming out of socket

Front 66

What is the prognosis of neuroblastomas?

Back 66

poor, poor survival rates.

Front 67

Therapeutic management for neuroblastomas

Back 67

surgery may be an option

chemo & radiation followed by a bone marrow transplant

Front 68

True or False: the treatment for neuroblastoma is so vigorous and aggressive, much more than most adults would be willing to tolerate in hopes that the child will survive. It's pretty much their only shot. Many die of PNA or a cold because the WBC's are destroyed in the process.

Back 68

true

Front 69

Bone tumors in children include what 2 types?

Back 69

osteogenic sarcoma
Ewing's sarcoma

Front 70

Osteogenic sarcoma is cancer of the bones. What bones are usually affected? Manifestations include what 4?

Back 70

long bones, mainly the femur
also the tibia, fibula, humerus

Pain at site
limp
refusal to walk
spontaneous fracture

Front 71

The therapeutic management for osteogenic sarcomas includes what 3 options?

Child will have ____ after tx.

Back 71

chemotherapy- to kill microscopic cancer cells
possible amputation
possible resection- limb salvage operation

Child will have deficits after tx.

Front 72

What is involved with a resection for an osteogenic sarcoma?

Back 72

limb salvage operation-
bone grafts or orthopedic deficits installed.

Front 73

Nursing considerations for the management of osteogenic sarcoma include management of chemo ____ ____, pain control, support parents, and help child adjust to change in ___ ____.

Back 73

side effects
body image

Front 74

Ewing's sarcoma is bone cancer arising from the ______ spaces of bones. It is often found in the ____ and ____.

Back 74

marrow
legs, ribs

Front 75

What are the manifestations of Ewings Sarcoma initially?
If metastasized what are the s/s?

Back 75

***PAIN***
soft tissue swelling
If metastasized:
anorexia
fatigue
weight loss
malaise

Front 76

What is the therapeutic management for Ewing's Sarcoma?

Back 76

Chemo to decrease tumor size
Radiation (usually successful)
Surgery to remove expendable bone tissue
Amputation NOT commonly needed

Front 77

Nursing care for Ewing's Sarcoma is similar to that of _____ _____.

Back 77

osteogenic sarcoma.

Front 78

Rhabdomyosarcoma is a tumor originating from cells of ____, ____, and/or _____.

Back 78

muscles
bursae
fascia

Front 79

The clinical manifestations of Rhabdomyosarcoma vary depending on their site. What are the manifestations of the orbital type?

Back 79

ptosis- droopy eye
proptosis- props outward
conjunctivitis
swelling of eye
loss of extraoccular movements
(can't move eye)

Front 80

The clinical manifestations of Rhabdomyosarcoma vary depending on their site. What are the manifestations of the nasopharyngeal type?

Back 80

stuffy nose
nasal obstruction
epistaxis
palpable neck nodes

Front 81

The clinical manifestations of Rhabdomyosarcoma, the pelvic tumor type, affect ____ function _____, such as the ______ and _____.

Back 81

organ
nearby
kidneys
intestines

Front 82

The clinical manifestations of Rhabdomyosarcoma of the extremities cause...

Back 82

limited ROM

Front 83

The clinical manifestations of Rhabdomyosarcoma, the parameningeal type cause...

Back 83

cranial palsies
hearing loss
chronic aural (ear) or sinus drainage

Front 84

True or False: Rhabdomyosarcoma can show up at any site and any age.

Back 84

true

Front 85

The therapeutic management for Rhabdomyosarcoma is very aggressive because the the tumor competes and wins. They are very _____ and rich in ____ and ____.

Back 85

vascular, blood & nutrients

Front 86

Treatment for Rhabdomyosarcoma involves ____, _____, and ______. Unfortunately, there is ___ ____ with frequent ____.

Back 86

chemo
radiation
surgery
poor prognosis
relapses

Front 87

Wilm's tumor is a _________, also known as a ____ tumor.

Back 87

nephroblastoma
renal

Front 88

Manifestations of Wilms Tumor

Back 88

firm mass in abdomen
weight loss
hematuria
fatigue
fever
anemia

Front 89

Therapeutic Management for Wilms Tumor (don't do what?)

Back 89

Don't palpate the abdomen

surgery
chemo
radiation

Front 90

Treatment for Wilm's tumor is started right away. Child and parents need to be prepared for surgery and following treatment. What does the surgery usually involve? What risk does this present?

Back 90

removal of kidney
risk of fluid volume imbalance

Front 91

Post op care for a Wilms tumor includes a ___ and a ____. They will go through ______ chemo.

Back 91

ng tube
catheter

outpatient

Front 92

True or False: Adults tumor can affect adults and children.

Back 92

false, just kids

Front 93

Retinoblastoma is a tumor arising from the _____. What are some s/s?

Back 93

retina

whitish "glow" in pupil
leukokoia "cat's eye"
painful red eye
strabismus (cross eyed)

Front 94

Management of retinoblastoma includes .....
What is the prognosis?

Back 94

radiation
surgery---
enucleation if no chance for normal vision after removal of tumor (usually eye must be removed)

good. 90% survival rate

Front 95

Nursing care after retinoblastoma includes supportive care and teach about...

Back 95

caring for artificial eye
They will come out of surgery with a spacer/placement
and a patch or dressing cover.
Coordinate with ophthalmologist.