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235 Cards in this Set
- Front
- Back
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What are 3 causes of childhood cancer?
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1. Genetic
2. Failure of immune system to distinguish between normal and abnormal cells 3. Carcinogens |
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Children from which ethnic background have the highest incidence of cancer?
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White
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Describe the incidence and mortality trends of invasive childhood cancers over the last 30 years.
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incidence has increased, mortality has declined by 50%
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What are 3 reasons why mortality rates have decreased in terms of invasive childhood cancers?
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1. Better protocols
2. Better early detection methods 3. Kids generally healthier |
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What are the 3 most common cancers in children?
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1. leukemia
2. brain & spinal tumors 3. lymphoma |
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What is the Children's Oncology Group?
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An international society for pediatric oncology that meets 2x/year to come up with and review cancer protocols
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What are 3 areas that are delineated in cancer treatment protocol?
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1. Treatment
2. Diagnostic tests 3. Follow-up tests |
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What are 6 treatments that are used for cancer?
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1. Chemo
2. Surgery 3. Radiation 4. BMT 5. Stem cell transplant 6. Biological response modifiers (used more in adults) |
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Which types of drugs are used in chemotherapy and what is the goal for treatment?
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Antineoplastic drugs
Goal: to destroy abnormal tissue |
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Why do we need to use multiple/combo antineoplastic drugs in chemotherapy?
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Tumors possess the ability to develop resistance to chemotherapy
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Before one begins treatment with chemotherapy, what must happen?
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Pretreatment evaluation
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What does a pretreatment evaluation entail?
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Physiological & psychological preparation
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Why does one need to be physiologically evaluated before chemo treatment initiates?
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To check for any conditions that can conflict with chemo [i.e. septic infections must be cleared, hold if child is febrile, do a blood/urine culture]
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What routes of delivery can be used to administer chemo drugs? Which is most common? Which is least common?
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1. Oral
2. IM (rare) 3. IV (*most) 4. SubQ (rare) 5. Intrathecal |
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Why would intrathecal delivery be a preferred method of chemo delivery?
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In intrathecal administration, the medicine is delivered directly into the spinal fluid. This is done to prevent metastases into the CNS
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Why is chemo primarily delivered to children via central lines?
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central lines are preferred because nearly all chemo drugs damage peripheral veins
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Name 6 types of chemotherapy drugs
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1. alkylating agents
2. antimetabolites 3. plant alkoids 4. antitumor antibiotic 5. hormones 6. enzymes |
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Give an example of an alkylating agent.
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cytoxan
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Give an example of an antimetabolite.
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methotrexate
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Give an example of a plant alkoid
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vincristine
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Give an example of an atitumor antibiotic
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adriamycin
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Give an example of a hormone
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prednisone- may bind to DNA to alter transcription (inhibits mutation)
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Give an example of an enzyme
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L-aspariginase
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What are 7 major side effects that are caused by chemotherapy?
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1. killing of normal cells
2. bone marrow suppression 3. gastrointestinal esophagitis & C 4. alopecia 5. organ-specific damage 6. mucositis 7. oral candidiasis |
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Why do normal cells get killed in adition to abnormal cells?
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Chemotherapy nonselectively targets rapidly-dividing cells
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What lab results indicate that bone marrow suppression has occurred?
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1. neutropenia
2. anemia 3. thrombocytopenia |
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What are 2 major risks that are associated w/ bone marrow suppression?
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1. infection
2. bleeding |
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In which phase of chemo treatment is a child most at risk for developing bone marrow suppression?
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7-10 days after chemo has begun
(if their WBC is incredibly low--0 or .5 for ex--they may need to be put in isolation during this time) |
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How do we counteract the nausea and vomiting GI side effects of chemo?
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Give antiemetics 30 min prior to tx + throughout tx
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What are 2 antiemetics that are used to reduce N,V?
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1. Zofran
2. Kytrel |
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Which pharmalogical methods can be used to treat mucosal ulcerations?
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1. PCA pumps (morphine, dilaudid)
2. Magic mouthwash (benedryl + malox + (lidocane)) |
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What nonpharmalogical methods can be used to assist eating?
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Give an ice pop or ice prior to eating to numb the ulcerated area
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Why should you never take a rectal temperature on a child that is receving chemo?
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ulcerations can extend all the way from the mouth to the anus, so rectal temps might induce bleeding
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Which taste effect from chemo might decrease a child's desire to eat?
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metallic taste
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Which pharmaceutical factors increase ones risk for becoming constipated during cancer tx?
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Chemo + opioids
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If a patient is constipated and has thrombocytopenia, what is the danger of bearing down?
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May cause bleeding
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What is alopecia?
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Hair loss: head, eyebrows, body
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In addition to ulceration, which 2 side effects decrease ones desire to eat and drink?
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1. mucositis
2. oral candidiasis |
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Where can candidiasis occur in a cancer patient?
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throughout the GI tract
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What does radiation do?
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slows tumor cell growth & kills rapidly dividing cells
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At which phase in radiation therapy is the patient maximally immune-suppressed?
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7-10 days after the radiation has begun
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How can we alleviate a child's fears about receiving radiation?
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Show them the radiation suite prior to their tx time and prepare them to expect getting tattooed
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Which 2 methods are used to help keep a child still during radiation tattooing?
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1. contrasedation
2. papoosing |
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What are 3 specific uses for radiation?
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1. curative
2. palliative (assists w/pain management) 3. prep for BMT or stem cell transplant |
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Why is it important for one to receive full body radiation prior to a BMT or stem cell transplant?
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to prevent graft-vs-host disease
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What are radiation side effects that are not seen in chemo (4)?
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1. erythema @ site of radiation
2. cognitive delays from cranial radiaition in children below 3 3. secondary malignancy 4. alterations in bone growth & skeletal malformation |
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What are 5 common surgical procedures that may be performed in cancer patients.
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1. biopsy
2. tumor debulk & resect 3. Broviac placement 4. Portacath 5. VP shunt |
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What information does a tumor biopsy reveal?
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What stage of cancer one is in
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What is debulking? Why is it useful?
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Debulking makes the tumor smaller, which may make it more susceptible to chemo & radiation
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What is resecting?
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Removal of the whole tumor
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What type of broviac is normally placed in a cancer patient?
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Double lumen: one to give meds, one to draw blood
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How should you approach dressing changes on a broviac?
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a few weeks after it is placed, change 1x/week---use sterile technique!!
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What route does the broviac catheter take within the body?
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from the R-subclavian vein to the R-atrium
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What is the difference between a broviac and a portacath?
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a portacath is under the skin in the same location, but it too has a purpose for drawing blood and giving chemo
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When is a portacath preferred over a broviac?
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if a kid has repeated broviac infections & adolescents
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Describe a portacath in a hospital vs home setting.
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the needle stays in during hospitalization, but it gets taken out when one goes home
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What is a VP shunt?
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A ventricular peritoneal shunt that drains CSF
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What does a VP shunt prevent?
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hydrocephalus from tumor occlusion--enables CSF to get reabsorbed
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Are BMT and SCT preferred treatments?
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No, usually not first line
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When is BMT and SCT usually used?
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1. in cancers w/no other tx
2. in cancers known to relapse |
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What is the reason for putting BMT & SCT candidates on chemo first?
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treatment in the meantime, while they work on receving bone marrow or stem cells
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5 types of cancer/diseases that call for transplants
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1. ALL
2. Stage IV Neuroblastoma 3. Hodgkins disease 4. Non-hodgkin's lymphoma (5. sickle-cell disease) *these cancers usually fail conventional treatments, so matches are automatically searched for upon diagnosis |
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When are other cancers/diseases treated with a BMT or SCT?
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if other tx fail or if the cancer reoccurs
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At which developmental stage is the risk for infertility from chemo/radiation the highest? What can be done to counteract this side effect?
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pre-puberty or beginning of puberty; offer egg harvesting
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What are 3 possible types of transplants that can be done?
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1. syngeneic
2. autologous 3. allogenic |
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Where does syngeneic transplant tissue come from?
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identical twin
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What is the origin of an autologous transplant?
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Tissue comes from self (ie child's own stem cells or bone marrow)
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Why is radiation used for an autologous transplant?
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affected cells are purged via radiation before a sample of cells is taken up to reduce the likelihood of receiving affected cells; NOT for preventing rejection
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What is the origin of an allogenic transplant?
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donor
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Why is radiation used in an allogenic transplant?
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to prevent rejection
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After a BMT or a SCT, how long does it take for the immune system to return to normal? What is the tx during this time?
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1-2 years Immunosuppressants
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Which phase occurs before a transplant? How is it identified?
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Conditioning, when one receives chemo &/or radiation
-3,-2,-1 |
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How is a BMT or SCT administered? How is it identified?
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via IV infusion (cells go directly to the bone marrow to produce RBCs, WBCs, platelets)
Day 0 |
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Which phase are we looking for post transplant? How is it identified?
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Engraftment,
+1,+2,+3 |
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What is engraftment?
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when the patient starts producing their own RBC, WBC, and platelets
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When does engraftment usually occur?
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2-4 weeks post transplant
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When is there a good indication that engraftment will not take place?
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if it has not occurred by 20-30 days
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What is a major post-transplant side effect that we are worried about?
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Graft vs. Host disease (GVHD): #1 cause of death with stem cell or bone marrow transplants
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How does GVHD occur?
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When the DONOR WBCs recognize the patient's body as foreign and attack it
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When are you most at risk for GVHD?
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2 weeks after the transplant
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What are 2 major signs of GVHD?
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1. Skin rash (v. painful, whole body)
2. Organ damage (i.e. liver, intestines) |
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What is a sign that GVHD has damaged the intestines? The liver?
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intestines=vomiting
liver=elevated liver enzymes |
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Which drugs suppress GVHD?
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corticosteroids
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How do biological response modifiers work?
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therapeutically changes the host response to tumor cells
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In biological response modification, what naturally occurring substances are boosted to treat the cancer?
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Substances that enhance our immunen system: interferon, interleukin, monoclonal antibodies, activated T cell antigens
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6 other supportive therapies for cancer tx
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1. pain management (PCA)
2. antiemetics 3. Nutrition (TPN) 4. GFs 5. blood products (whole blood, platelets, blood cells) 6. psycho/social support |
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What is the purpose of administering growth factors?
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Boosts the RBC and WBC count, which prevents you from missing a med cycle due to too low of a count
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Give 2 examples of GF-boosting meds
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Neupogin (boots WBCs)
Epigen (boosts RBCs) |
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What are 3 uses for an ANC (absolute neutrophil count)?
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1. determine necessity for isolation
2. if child can be discharged 3. determines when certain meds are needed |
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Define ANC
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Determines the total % of neutrophils in "polys/segs" and "bands"
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What are polys or segs?
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mature neutrophils
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What are bands?
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immature neutrophils
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Formula for ANC?
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WBC x %All neutrophils
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What is the range for a normal ANC?
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500-1500
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What is the minimum ANC one must have in order to return to school?
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500
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What would an ANC below 500 indicate?
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isolation
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LEUKEMIA
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LEUKEMIA
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What is the most common type of cancer in children?
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leukemia
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What is leukemia?
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the proliferation of immature WBCs in the blood-forming tissues of the body
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Which gender is affected more and what is the typical age of onset?
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Males 2-6 y/o
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When are you considered "cured" of leukemia?
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after 8 years of remission
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What is the most common type of leukemia? What is the survivor rate?
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ALL 80% long term, disease-free survival rate
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ALL makes up 85% of leukemia cases, so this is the one the remaining flashcards refer to
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ALL makes up 85% of leukemia cases, so this is the one the remaining flashcards refer to
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Although the cause of ALL is unknown, what is the geographical distribution?
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occurs more in industrial areas--- possible link with ionizing radation & chemical toxins (ie alkylating agents for chemo)
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What percentage of leukemic cells have a chromosomal abnormality?
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90%
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What population has an insanely high risk for development of leukemia?
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Downs Syndrome pts are 15x more likely to develop leukemia.
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What does genetic alteration in a leukemic WBC cause?
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prevented maturation of the WBC
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The quick replication of immature (blast cells) in the bone marrow casues what?
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crowding & cell competition
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What effect does blast cell overcrowding have on RBC and platelet production?
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they get crowded out, so their production gets altered-->manifests as thrombocytopenia and anemia
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What does cell competition do to normal cells?
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It deprives them of essential nutrients of metabolism, so they undergo cellular destruction
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What are 5 signs and symptoms of bone marrow infiltration?
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1. anemia
2. infection 3. bleeding 4. fractures 5. bone pain |
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Blast cells can get released into circulation and infiltrate extramedullary sites. What is an extramedullary site? Give examples
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Sites other than the original site lymph node, spleen, liver, testes, CNS
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How do you classify types of leukemia?
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According to the cell type that is involved: T, B, early pre-B, pre-B
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What clinical manifestations are shown based on what is happening in the bone marrow?
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1. fever
2. pallor 3. petechiae 4. excessive bruising 5. joint and bone pain 6. lymphadenopathy 7. splenomegaly 8. malaise/tired |
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When is peticihie indicative of leukemia?
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if it occurs nipple down. If nipple up, often due to coughing/vomiting
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What blood properties would be revealed in a lab test for leukemia+?
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1. anemia
2. thrombocytopenia 3. increased WBC (differential would reveal that the increased WBC are blast cells) |
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List the most important prognostic indicators in determining long-term survival in children with ALL.
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1. initial WBC count (below 50,000)
2. age at dx (>2, <10) 3. cytogenetics (50+ chromosomes) 4. sex (F) 5. immunological subtype (CALLA +) |
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What do you look for when assessing cytogenetics?
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1. number of chromosomes
2. types of chromosomal abnormalities (ie translocations tend to have poorer prognoses) |
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What is CALLA?
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A leukocytic antigen on a pre-B WBC
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What is the order and purpose of diagnostic lab tests for leukemia?
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1. CBC w/ differential (shows immature leukocytes)
2. bone marrow aspiration (definitive dx based on # of blast cells) 3. lumbar puncture (checks for CNS infiltration) |
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Where does the bone marrow aspiration take place?
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iliac crest
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What is the treatment for leukemia?
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Chemo w/ or w/o cranial radiation
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What is the purpose of cranial radiation? What is it's downfall?
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to prevent CNS involvement; the younger you are, the more at risk you are for developmental delays
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What does rapid cell turnover of leukemic cells increase?
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uric acid levels--- in combo w/ chemo, this could have damaging effects on the kidneys
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What 2 meds are often given before chemo tx and what is their purpose?
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1. allopurinol: reduce uric acid levels
2. IV sodium bicarb: alkynizes urine *prevents kidney damage thatcan occur w/ chemo |
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In some cases, they get CNS prophylaxis. In what forms?
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cranial radiation + intrathecal therapy
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What are the 3 phases of leukemia tx?
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1. induction phase
2. intensification or consolidation phase 3. maintenance phase |
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What is the duration & goal of the induction phase?
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duration: 1st month of chemo
goal: to induce remission (blast cells below 5%) ***90% of kids go into remission after this phase |
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What is the duration & goal of the intensification/consolidation phase?
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duration: several months
goal: target residual leukemic cells & prevent resistant leukemic clones ***often done outside of hospital (unless something goes wrong) |
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What is the duration & goal of the maintenance phase?
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duration: over 2 yrs
goal: preserve remission (receiving less chemo than before) |
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In which 2 phases are they receiving CNS prophylaxis?
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2nd and 3rd
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How long does the entire tx course for leukemia take?
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~3 yrs
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What are 2 common long-term effects from leukemia tx?
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1. cognitive delays (fm radiation)
2. osteoporosis (huge doses of steroids like prednisone) |
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When are immunosuppressed children at risk for chicken pox and measles?
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1. if they have not received MMR vaccine
2. if they have received MMR vaccine (Igs get killed from chemo) |
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How can you prevent complications from varicella or measles exposure?
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Give an Ig specific to the virus they have been exposed to
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What are 2 major effects of myelosuppression? How can they be minimized?
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1. thrombocytopenia (use a soft toothbrush to prevent bleeding)
2. constipation (stool softener) |
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How long should you observe the patient when administering the drug?
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for the first 20 min to observe for anaphylaxis
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What is Vincristine notorious for causing?
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neuropathies such as foot drop; reversible if tx early
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BRAIN TUMORS
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BRAIN TUMORS
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What is the most common tumor in children and where is it confined?
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brain tumors; confined to brain and spine
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What is the cause of brain tumors?
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unknown-possibly radiation
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How are brain tumors classified?
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1. according to cell histology
2. rate of tumor proliferation |
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Where are 60% of brain tumors found?
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infratentorial (ie below tentorium, an extension of grey matter)
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Of the infratentorial tumors, 50% are…
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cerebellar astrocytomas
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What do symptoms of brain tumors depend on?
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1. tumor size
2. tumor location |
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What is the hallmark symptoms of a brain tumor?
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headache + morning vomiting upon rising
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What are infant-toddler-specific symptoms of a brain tumor?
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developmental delays
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What are 5 other common signs of brain tumors?
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1. ataxia
2. fatigue 3. visual disturbances 4. loss of milestones 5. poor school performance |
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How do you dx a brain tumor?
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CT or MRI
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What are 3 tx methods for brain tumors?
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1. surgery
2. radiation 3. chemo |
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In which age group should you avoid radiation?
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children under 3
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S/p to brain tumor surgery, is it abnormal for a child to be so lethargic that they are almost comatose for a few days?
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no
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Post-op, high T can mean 2 things within the first 24-48 hr:
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1. hypothalamus area operated on
2. fm anasthesia |
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If after 48 hr, high T can mean:
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infection
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What fluid are you concerned about leaking into dressing? Why?
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clear fluid, could be CSF
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Which neuro checks are particularly important to do post-op?
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1. measure head circumference
2. look for change in level of consciousness |
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Which drainage should you circle to see if it enlarges?
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serosanguinous
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How should you position a patient post-op?
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in perfect alignment w/ careful turning
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Why is it important to regulate fluid intake?
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to prevent cerebral edema
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What type of feedings might a post-op pt need?
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NG
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What are 4 med to give to a pt s/p brain tumor operation.
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1. pain meds
2. Abs to prevent infection 3. mannitol 4. steroids (decadron) |
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Which position should you avoid in a pt s/p brain tumor surgery?
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trandalenberg position (head down, used for shock to increase blood flow to the brain)
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Which position should you use in a pt s/p brain tumor surgery?
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reverse trandalenberg (head up)
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NEUROBLASTOMA
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NEUROBLASTOMA
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What is the most common malignant extracranial solid tumor of childhood?
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neuroblastoma--NOT a brain tumor, occurs outside of brain and spinal cord
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What is the most common cancer in infants? What causes it?
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neuroblastoma….thought to be present at birth and NOT environmental
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If a child gets a neuroblastoma under 12 mo, what might they experience? Why?
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Spontaneous remission embryotic cells in the immune system are starting to mature
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Which gender and race is most susceptible to neuroblastoma?
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M White
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Which percentage of cases of neuroblastoma are below 2?
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50%
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What percentage of neuroblastoma cases above 2 y/o metastasize?
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80% - often misdiagnosed
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Symptoms occur in non-primary sites such as…
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Lymph nodes, skin, liver, bone marrow, skeletal system
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What are 2 primary sites for neuroblastoma?
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1. retroperitoneal sympathetic chain
2. adrenal medulla |
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Neuroblastoma originates in which cells?
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Neural crest cells (precursors to SNS and adrenal medulla)
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Which chromosome is typically abnormal in neuroblastoma?
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Chromosome #1 w/ a deletion or rearangement on the short arm
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Which oncogene is amplified from this mutation?
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MYCN, even though it is not found on chromosome 1
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What does MYCN amplification cause?
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uncontrolled cell growth
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20% of neuroblastoma cases follow which mutation pattern?
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1 mutation before birth, 1 mutation after birth-->initiate uncontrolled cell growth
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80% of neuroblastoma cases follow which mutation pattern?
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2 mutations after birth
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65% of neuroblastoma cases display which symptoms?
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1. abdominal mass
2. protuberant, firm abdomen |
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Besides the abdominal mass, what are 3 other signs and symptoms that are seen in non-metastatic neuroblastoma?
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1. impaired ROM & mobility
2. pain & limping (fm retroperitoneal chain) 3. impaired bowel & bladder function |
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If neuroblastoma has spread to the chest, which symptoms would manifest?
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cough & respiratory compromise
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If neuroblastoma has spread to the neck, which symptoms would manifest?
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facial, periorbital edema & bruising (Racoon eyes)
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If neuroblastoma has spread to the spinal cord (in retroperitoneal chain), which symptoms would manifest?
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inability to walk
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If neuroblastoma has spread to the adrenal gland, which symptoms would manifest?
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fever & HTN
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20% of children with stage IV neuroblastoma display what?
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Racoon eyes--oribital & skull metastases
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What is the probable cause of racoon eyes and skull metastases in neuroblastoma?
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obstruction of the palpebral vessels (branches of the ophthalmic and facial vessels) by tumor tissue in and around the orbits
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What are 5 tests to see if the neuroblastoma has metastasized?
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1. CXR
2. CT of chest, abdomen, pelvis 3. Bone marrow aspiration & IVP 4. skeletal survey 5. IVP to see for kidney effect |
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What do you examine in tumor samples?
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1. tumor's genetic make-up
2. stages of disease |
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2 catecholamines that are excreted in the urine and are elevated in pts with neuroblastoma
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1. Vanillylmandelic Acid (VMA)
2. Homovanillic Acid (HVA) *the higher the elevation, the poorer the prognosis |
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How is neuroblastoma stages?
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I-IV (localized - distant spread)
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How do you treat neuroblastoma?
|
it depends on the stage….
1. surgery (removes tumor) 2. may also need chemo & radiation 3. autologous BMT (most) |
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If a child is under 12 mo, what do they require to remove the tumor?
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Only surgery---even if some tumor remains, it becomes benign, disappears on it's own, and will not become malignant
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Which age group has the best prognosis for neuroblastoma?
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90% of kids below 12 mo are cured
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What criteria must be met for an infant to be considered cured?
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disease free for 1 year after tx
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What 2 criteria help determine the prognosis?
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age & stage of the disease
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6 nursing dx for children w/ neuroblastoma
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1. pain
2. anxiety 3. nutrition (dept on tumor size, might not be hungry) 4. GI obstruction 5. immobility 6. support |
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HODGKIN'S DISEASE
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HODGKIN'S DISEASE
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Which age group does Hodgkin's Disease (HD) most commonly effect?
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adolescents and young adults (15+), not commonly seen in young children
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Where doe's HD originate?
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Lymphoid system
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Which sits can HD spread to?
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Non-nodular sites:
1. liver 2. spleen 3. bone marrow 4. lungs |
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What are 2 possible causes of HD?
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1. EBV
2. CMV (2 causes of mono) |
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What 3 criteria is HD staging based upon?
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1. # of lymph node sites
2. extranodular disease 3. hx of symptoms: A- absence of B symp B-presence of B symp |
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What symptoms do ALL asymptommatic Hodgkin's patients exhibit?
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firm, nontender cervical or supraclavicular lymphadenopathy
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If someone with HD has mediastinal lymphadenppathy, which symptom do they exhibit?
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persistent, non-productive cough
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If someone w/ HD has metastases to the liver and spleen, which symptom do they exhibit?
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abdominal pain
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What are the B symptoms of HD?
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1. low, intermittent fever
2. night sweats 3. weight loss exceeding 10% BW over the 6 mo prior to dx |
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What are 2 other general symptoms seen in HD?
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Pruritis (dry, itching) Nausea
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How do you dx HD?
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Biopsy of lymph nodes: Sternberg-Reed Cells (owl's cells) indicate +
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What are 3 methods that you can use to check for HD metastasis to extramedullary sites?
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1. CT scan & gallium scan
2. X-ray (chest, ab, pelvis) 3. Bone marrow |
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What method of staging is used to classify HD? Describe it
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Ann Arbor Staging: Stage is based on the site of involvement ((extra: Number/Letter is based on the # of involved lymph nodes and the presence or absence of systemic symptoms))
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What is management/prognosis for HD based upon?
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1. disease stage
2. age 3. histological type |
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What forms of tx are available for HD?
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chemo and/or radiation
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What is the typical prognosis for HD?
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long term survival typicaly very good; very curable
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Due to the age of the people with HD, what option should they be given prior to chemo/radiation tx?
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egg/sperm harvesting due to infertility side effects
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OSTEOGENIC SARCOMA
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OSTEOGENIC SARCOMA
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What is the most common bone cancer?
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Osteogenic sarcoma (OS)
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What is the peak age of onset for OS?
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10-23 y
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What is the primary site in which half of all OS occurs?
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metaphysis of the femur (often occurs in long bones)
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Which disease, often found in the same primary site as OS, is OS often confused with?
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osteomyelitis
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Where does osteosarcoma have a tendency to spread?
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lungs
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4 symptoms of OS?
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1. Progressive, insidious or intermittent pain at tumor site, relieved by position change
2. Palpable mass 3. Limited ROM 4. Pathologic fracture at tumor site |
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Which other causes do you want to rule out before dx OS?
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1. infection
2. trauma |
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Why do you need to take a pain hx if you suspect OS?
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want to figure out how long the tumor has been there
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Which 3 methods can you order to look for a suspect OS tumor?
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1. CT
2. MRI 3. Bone Scan (also shows extent) |
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Once a tumor is found, what tests do you do to dx the tumor?
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Needle or surgical bone biopsy
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Which blood test could you order if you suspect OS? Why?
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CBC: If OS+, shows an increase in the enzymes
ALP (serum alkaline phosphate) and LDH (lactate dehydrogenase). The higher these enzyme levels, the poorer the px |
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Which test allows you to visualize the tumor?
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X-ray
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Why would you do a CXR in a pt w/ OS?
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to see if it has spread to the lungs
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How do you manage OS?
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1. surgery
2. chemo |
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What are the surgical options for OS?
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1. amputation
2. limb salvaging procedure that replaces defected area w/ metal prosthesis |
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Is radiation an option for OS?
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NO, OS is unresponsive to radiation
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What is OS px dept on?
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1. extent of dz at dx
2. levels of ALP and LDH |
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Phantom limb pain may accompany amputation. What are the signs?
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Neuropathic pain: itching, tingling, cramping, spasms
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What pharmalogical tx can you prescribe for phantom limb pain?
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Elavil
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What non-pharmalogical tx can you use to tx phantom limb pain?
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mirror box: tries to fool the brain to think that the hand is still there-->reduces pain symptoms by visualizing unclenching
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