Peds: Cancer

Front 1

Where do pediatric tumors arise?

Back 1

embryonal and neuroectodermal tissues VS adults which comes from Epithelial cells and are Carcinomas.

Front 2

What is important teaching about managing remission of pediatric cancer?

Back 2

Maintenance of normal relationships
Parents’ marriage may be strained
Siblings may feel neglected or jealous
fear rejection bec of change in looks or fear inability to “keep up.”
Teacher may be unsure as to what/how to tx/say
Classmates need to be prepared for the child’s return. Concerned about it being contagious of if pt will die

Front 3

When looking at Hx what is puts a pt at risk for pediatric cancer?

Back 3

chromosomal disorders (esp for leukemia)

Front 4

What are usually the presenting problems of cancer in pediatrics?

Back 4

Fever, pain, bleeding
Abdominal mass
Night sweats, weight loss
Hematuria, hypertension

Front 5

What is important to identify on physical exams for cancer?

Back 5

o General Appearance
Skin: note color, bruises, or petechiae
Neuro: fatigue, activity level, behavior, headache, dizziness, gait disturbances
Pain: guarding of any body part, change in ROM
Height and Weight
Inspect and palpate abd (liver/spleen enlargement)
Palpate for enlarged lymph nodes
nystagmus

Front 6

What are important nursing considerations in dx cancer?

Back 6

CBC important
be sure to sedate per AAP before LP and Bone Marrow Aspiration

Front 7

What are the goals of cancer management?

Back 7

Child will be free from infection and pain
Optimum developmental level will be achieved
Family will develop effective coping strategies

Front 8

Name the types of tx for cancer?

Back 8

Surgery (dx, palliative, & curative)
Radiation
Chemo
Bone Marrow Transplant

Front 9

What is the goal of radiation?

Back 9

Improve prognosis & achieve max effect on tumor while sparing normal tissue

Dose range varies - 1000rad (relieve bone pain) or 7000 rad (cure Ewing’s sarcoma)

Front 10

What are the complications of radiation?

Back 10

Infants susceptible to developing skeletal deformities later year from this

Cx to growing child:
scoliosis
arrested skeletal development
pulmonary fibrosis – depending on the site radiated

Front 11

Why is chemo a good option for pediatric cancer patients?

Back 11

peds cancer responds better to chemo vs adult cancer
Childhood cancers tend to metastasize early and systemic tx is needed with local tx.

Front 12

What is bone marrow transplant used for?

Back 12

Excellent Tx 4:
Acute leukemia
severe aplastic anemia
immunodeficiencies
malignant infantile osteoporosis

Good Tx 4:
Chronic leukemia
Solid Tumors & some hematologic disorders
metabolic disorders

Front 13

What are the types of bone marrow transplants?

Back 13

Autologous: patients own harvested marrow
Syngeneic: Transplant between identical twins
Allogeneic: (Most common) Transplant from a genetically nonidentical donor (i.e. sibling)

Front 14

What is the procedure for bone marrow transplant?

Back 14

Donor Suitability: Tissue antigen typing: HLA, MLA
Bone Marrow Aspiration: Donor marrow is aspirated along iliac crests w/gen anesthesia
Donor Marrow IV Infusion
Results seen 2wks post procedure

Front 15

WHat are the complications of the bone marrow transplant?

Back 15

Infection: highest risk first 3-4 weeks.
Pneumonias: principal cause of death during first 3 months post transplant.
Graft vs host disease – develops w/in the 1st 100 days post transplant.

Front 16

What are the nursing interventions for bone marrow treatment?

Back 16

Help cope
Allow the child to handle and manipulate the equipment.
Allow the child some control: choose positioning, selection of injection site, etc.
• Frequent clinical conferences to keep informed (tell the truth)
Provide contact with another parent or an organized support group.
Encourage them to keep daily life as normal as possible.
Minimize side effects of treatment

Front 17

What side effects need to be minimized for bone marrow transplant?

Back 17

Skin breakdown (Clean and dry wash only w/warm water, no soaps or creams)
Avoid exposure to sunlight, avoid alcohol, perfumes and powders.
Bone marrow suppression
Dec RBC’s: Allow child to determine the activity, frequent rest periods
Dec WBC’s: Avoid crowds, evaluate potential site of infection, Monitor inc T
Dec platelets: Provide safe environment, Avoid use of salicylates
N/V: antiemetic before chemo, Eat light meal before, PO or administer IV fluids
Stomatitis, Mucositis

Front 18

What are the types of leukemia?

Back 18

ALL
AML

Front 19

What is ALL leukemia?

Back 19

Malignant change in the lymphocyte with Acute onset
High chance of remission and of surviving 5 years or more
•Call MD if: Fever, recurrent infection, fatigue/listlessness, pallor, unusual bleeding, abdominal pain, NV, Bone pain, HA

Front 20

What is AML leukemia?

Back 20

Affects the Myeloid cell precursers Resulting in malignant cells
Cure rate is 50%
Risk Factors: Infection, fever, fatigue, Hispanic race, genetic abnormalities for example Down Syndrome or NF1. (double check this)

Front 21

What is a lymphoma?

Back 21

Tumors of the lymph tissue: Lymph nodes, thymus, spleen

Non-Hodgkins and Hodgkins

Front 22

What is hodgkins lymphoma?

Back 22

Adolescents
Reed Stern-berg cells in Cervical, axillary, inguinal areas (closer to surface)
Cause linked to Epstein-Barr Virus
Tx: Chemo/Radiation, HSCT
Cx: Liver failure and leukemia

Front 23

What is Non-hodgkins lymphoma?

Back 23

Affects deeper lymph nodes and spread through bloodstream rapidly proliferating (aggressive malignancy) -responsive to tx
Diffuse (not nodular)
Cx: Metastasis and secondary malignancy later in life
Tx: Chemotherapy and Autologuous bone marrow transplantation
24mo remission = cure

Front 24

What are the s/s of a brain tumor?

Back 24

Boys 3-7yo
first sign is poor school performance, elasticity of child’s skull and poor coordination
LOTS of AM VOMITING

Cx: Hydrocephalus, ICP, Brain stem herniation

Front 25

What is a wilm's tumor?

Back 25

Large, encapsulated tumor in the renal parenchyma: Frequently in the left kidney
Age 1-3

Front 26

What is the dx and sx of wilms tumor?

Back 26

Dx: IVP reveals the mass that parent notices while bathing/dressing child. DO NOT PALPATE
Sx: present w/HTN and possible hematuria and anemia, mass nontender, midline near liver

Front 27

What is the treatment for bone tumors?

Back 27

Amputation (temp prosthesis right after surgery&permanent1fitted few wks later), Lung surgery for metastases, and Radiation if the tumor is not accessible to surgery.

Age 10-20

Front 28

What are the assessment findings of bone tumors?

Back 28

: insidious pain, increasing with activity, gradually becoming more severe. Tender mass, warm to touch and limited ROM as well as pathologic fractures