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56 Cards in this Set

  • Front
  • Back
Brain tumors
(1) Most common__________
(2) Strong link between tumors and ___________
(1) Solid tumor in children
(2) Radiation
Brain tumors
(1) Symptoms depend on _______________
(2) Infant brain tumors are found ____________
(3) Why?
(1) Location
(2) Later in life
(3) head can expand with the tumor because the fontanels are not closed
Brain tumor
(1) Looking for changes in ________________
(2) S/S of intracranial pressure
(3) When does the vomiting usually occur?
(1) Intracranial pressure
(2) Headache, changes in vision (cross eyed, blurry, edema), personality changes, vomiting NOT related to a meal
(3) Occurs in the morning, ask if they ate or not
Brain tumor
(1) At risk for ___________
(2) Depending on location, may not ______ and/or ______
(3) Diagnose with?
(1) Seizures
(2) Grow, walk
(3) MRI, CT, Radiographic studies with IV contrast, Biopsy to determine type of cell
Brain Tumor
(1) Priority Nursing diagnosis
(1) Pain
Risk for imbalanced nutrition, impaired physical mobility depending on place, anxiety, risk for impaired family coping
Brain Tumor
(1) Treatment
(2) Post op monitor:
(3) How?
(1) Surgery for debulking or removal, Chemo or radiation therapy
(2)Monitor Intracranial pressure
(3) Bolt in head, sunsetting eyes (looking down), seizures (non violent, rhythmic)
Brain Tumor
(1) Assess surgical site for ____________&___________
(2) Raise HOB
(3) Maintain __________so fluid can run down hill
(4) Be careful with ___________
(1) Infection and Hemorrhage
(2) 30 degrees at least
(3) Good body alignment
(4) Eyes, provide good eye care because of swelling
Brain Tumor: Family Education
-Reinforce neurosurgeon teaching
-Make sure family understands treatment plan by VERBALIZING AND DEMONSTRATING
-Teach to watch for increased swelling and bruising around eyes (s/s of hemorrhage)
-Pain management pre and post op
- Discuss diabetes insipidus and what to look for and to push fluids if they have it
Brain Tumor Evaluation:
-Make sure they are growing
-Record height and weight
- May have pain and migraines forever
-Need to know how to monitor for infections with shunt
- is the shunt working?
-Safety precaution procedures
Brain tumor complications
-Hydrocephalus- fluid stays in the head may need a VP shunt to get rid of the fluid by sending it to the stomach and abdomen
-Seizures (need management)
-Endocrine disorders
----major one- diabetes insipidus-has to do with water- they pee alot- not sugar
Brain tumor VP shunt
- Sends fluid from the brain to the stomach
-Measure abdominal circumference as well because that is where it drains
- Measure how much fluid the shunt is releasing
Difference between brain tumor and neuroblastoma
Neuroblastoma:
Prognosis

Tumor is often _________ leading to________
Neuroblastoma- outside the brain
--cells originate in the brain but grows outside brain

-based on when they find it (better before one year of age )

-silent....late diagnosis and poor prognosis
Neuroblastoma
symptoms depend on where they are
(1)peritoneal tumor symptoms
(2)Mediastinal tumors
(1)in abdomen, bowel and bladder dysfunction, constipation or diarrhea, incontinence or retention,
(2)in the chest, SOB, neck and facial edema, can metastasis to the bone- legs- difficulty with gait, bruise easily around eyes
Neuroblastoma
(1)Typical signs you will see no matter where it is
(2) Diagnosis
(1)weight loss, irritability, fatigue and fever
(2) Full body CT to find the tumors, Bone marrow aspiration to determine type of cells that are growing
Neuroblastoma
(1) Priority Nursing Diagnosis
(2) Treatment
(3) Chemotherapy uses
(1)Deficient knowledge, Acute pain, Ineffective family coping
(2) Surgery- tumor removal following biopsy , radiation therapy, chemotherapy (after surgery for the therapy)
(3) Uses multiple drugs need to manage side effects
Neuroblastoma
(1) Need a....
(2) When using a central line make sure you have good ________
(3) Also use central line to
(1) Central line to receive chemo
(2) blood return
(3) blood draws if needed
Neuroblastoma
(1) If had radiation make sure to monitor _____
(2) Once skin is broken ______
(3) Post op monitor surgical site for_____&_____
(4) Most accurate measure of infection?
(1) skin integrity- radiation burns the skin, if getting it in the summer need to wear extra sun protection
(2) can not do radiation anymore
(3) hemorrhage and infection
(4) Temperature
Neuroblastoma
(1) Minimize exposure to infection by?
(2) What kind of precautions are they placed on?
(1) Hand washing, private room, limit visitors , avoid live vaccines
(2) Neutropenic precautions - no fresh fruits, no flowers, what goes in the room stays in the room, child cannot go to play room
Neuroblastoma
(1) When is a fever a fever for patients receiving chemo?
(2) When can you give live vaccines
(3) Watch for _______
(4) Limit _____, use ________, recommend ______for sports
(1) 99 degrees
(2) Can give live vaccines 3 months out with a high white count
(3) bleeding, stool, hematuria, anywhere
(4) IM injections, soft toothbrushes, golf and swimming
Neuroblastoma
(1) Teach parents about
(2) Information about:
(3) Evaluation
(1) disease process, treatment plan
(2) Nutrition, when to eat, may need meds so they can eat,
(3) Show they can cope, can manage side effects of chemo, can manage keeping family members that are sick away, keep them apart of school
Nephroblastoma (Wilm's Tumor)
(1) Located where?
(2) If metastasizes where does it go?
(3) Usually __________ but there will be a _______ on the _________
(4) Occurs between what ages?
(5) Most common between what ages?
(1) Kidneys
(2) Lungs and the Liver
(3) Asymptomatic, lump, abdomen
(4) 1- 5 years of age
(5) 18 months to 3 years
Nephroblastoma (Wilm's Tumor)
(1) Can be ________or ________
(2) Worse prognosis?
(3) 75% of children survive until what age?
(1) Unilateral or bilateral
(2) Bilateral
(3) 5 years
Nephroblastoma (Wilm's Tumor)
(1) Abdomen may be __________ if unilateral
(2) Child may complain of ______
(3) Diagnosed by?
(4) Metastasis detected by?
(1) Assymetric
(2) Pain, hematuria
(3) Ultra sound or CT scan of abdomen
(4) CT scan and MRI of lungs
Nephroblastoma (Wilm's Tumor)
(1) 25% Will experience hypertension why?
(2) DO NOT do what?
(3) What will happen if you do?
(1) increased renin production- fluid can not get filtered and goes back into circulatory system
(2) palpate abdomen
(3) Rupture the tumor and cause severe hemorrhaging causing death
Nephroblastoma (Wilm's Tumor)
(1) Priority Nursing diagnosis?
(2) Treatment
(1) Risk for impaired urinary elimination, acute pain, ineffective cardio pulmonary tissue perfusion why?- hypertension, Risk for impaired family coping
(2) Surgery to remove kidney if unilateral, radiation and chemotherapy before and after surgery
Nephroblastoma (WIlm's tumor)
(1) Main focus postop?
(2) How?
(3) If increase oral fluid intake
(4) Make sure to assess____
(1) Monitor Kidney function
(2) I/O, daily weight, urine specific gravity, fluid levels, IV infusions, and BP, fluid and electrolytes
(3) Have to drop IV rate
(4) Pain- provide pain relief with meds and nursing interventions
Nephroblastoma (Wilm's Tumor)
(1) Pain may result from:
(2) Assess
(3) Monitor for _________
(1) incision and shift of internal organs
(2) bowel sounds, abdominal distention, and bowel movements
(3) Infection (temp of 99 call doc)
Nephroblastoma (Wilm's Tumor)
(1) Explain to the family not to
(2) What is not an option?
(3) Evaluation
(1) Poke or touch the abdomen pre or post op, they could kill the kid
(2) Contact sports- they need to protect the good kidney
(3) Family can describe disease process, treatment
client denies pain, means of protecting the kidney
Bone Tumors: Osteogenic Sarcoma
(1) Most frequently affected bone?
(2) other main bones that can be affected?
(1) Femur
(2) Humerus, tibia, pelvis
Bone Tumors: Osteogenic Sarcoma
(1) First 2 signs?
(2) Usually identified by?
(3) Diagnosed further with?
(1) Pain and swelling
(2) Some type of traumatic injury and x-ray shows the tumor
(3) CT and MRI
Bone Tumors: Osteogenic Sarcoma
(1) Priority Nursing Diagnosis
(2) Treatment
(3) Treatment of metastasis to the lungs?
(1) Acute pain, anxiety, ineffective health mainenance- why? amputation- don't do anything because they are upset about it, Risk for disturbed body image, Anticipatory grieving
(2) Amputation, chemo therapy pre and post
(3) thoracotomy- cut open chest and pull out tumor
Bone tumors: Osteogenic Sarcoma
(1) Family needs _______
(2) Use a _______________ approach when ___________ is indicated
(3) Allow the parent and child to ____
(1) Counseling
(2) straightforward, amputation
(3) Vent
Bone tumors: Osteogenic Sarcoma
(1) Post op care amputation care?
(2) Maintain proper ________
(3) Perform _______ to joints ________ amputation
(4) Assist with early _________; Assist with _________
(1) Keep elevated for first 24 hours and elevate periodically throughout the day , dressing changes as ordered
(2) Body alignment
(3) ROM, above
(4) ambulation, temporary prosthesis use
Bone tumors: Osteogenic Sarcoma
(1) Teach appropriate use of _________
(2) Encourage early ____________
(3) Teach client and family about
(1) Assistive devices
(2) Interaction with peers
(3) disease process, treatment options, residual limb care
Bone tumors: Osteogenic Sarcoma
(1) Teach the client and family management of
(2) Demonstrate what 2 things?
(3) Evaluation
(1) Limb pain
(2) Safe use of prosthesis, how to monitor condition of the limb
(3) Client demonstrates appropriate limb care, ambulates safely with prosthesis and assistive devices, appropriate coping strategies, demonstrates positive body image, maintains relationships with peers
Bone tumors: Ewing's Sarcoma
(1) Commonly found in?
(2) Tends to occur between what ages
(3) Highly __________ tumor that metastasizes to ______
(1) femur, pelvis, tibia, fibula, ribs, scapula, humerus, and clavicle
(2) 4-25
(3) Malignant, lung
Bone Tumors: Ewing's Sarcoma
(1) S/s
(2) Diagnosis
(3) Diagnosis of metastasis
(4) Priority nursing diagnosis
(1) Pain, soft tissue mass, fever, fatigue, weight loss, anorexia, malaise
(2) x-rays of affected area
(3) Radionuclide bone scan and CT scan
(4) Pain, Anxiety, Ineffective coping, risk for injury, impaired physical mobility cuz it hurts, self care deficit, anticipatory grieving, ineffective health maintenance, disturbed body image
Bone Tumors: Ewing's Sarcoma
(1) Treatment
(2) Teach patient that radiation can cause
(3) Promote
(4) Allow the patient to vent
(1) Radiation and chemotherapy
(2) Changes in skin color, redness first, may affect mobility
(3) Movement as tolerated
(4) Vent, open communication
Bone Tumors: Ewing's Sarcoma
(1) Teach family
(2) Evaluation
(1) Disease process, treatment options, skin care
(2) client and family can cope, skin remains intact, client maintains mobility of extremity
Leukemia
(1) Genetical link means
(2) 3 categories of assessment
(3) Blood counts may reveal that the child is
(4) Diagnosis of what type of cells
(1) Identical twins have higher risk of getting it
(2) - History - Peripheral blood smear -Physical
(3) anemic, thrombocytopenia, neurtopenia
(4) Bone marrow aspiration
Leukemia
(1) Best place to take bone marrow from?
(2) Other diagnostic tests
(3) Watch these things
(1) Illiac crest
(2) Spinal tap & lumbar puncture to determine CNS involvment
(3) Monitor temp, look for new episodes of bleeding, bruising, bleeding gums, blood in stool, blood in urine, watch for CNS involvement, change in LOC do infants sleep more, are they irritable, are they vomiting without food,
Leukemia
(1) Priority Nursing Dx
(2) Aim of treatment is to ________
(1) Risk for infection, Risk for injury, activity intolerance, Anxiety, Risk for ineffective family coping, Pain r/t bone marrow aspiration and bone involvement
(2) Reduce admission using combos of chemo
Leukemia
(1) Monitor for ___________throughout child's life if treatment is successful
(2) Which symptom would you watch closely for
(3) Treatment option to avoid readmission
(1) Relapse
(2) Blood levels
(3) Bone marrow transplant may be used, radiation therapy, chemotherapy that do NOT cross blood brain barrier
Leukemia
(1)Nursing care is directed at ______and _________
(2) Supportive care for anemia
(3) How do you know anemia is improving
(1) managing symptoms of leukemia, side effects of treatment
(2) Protecting child from harm
(3) Reticulocyte count
Leukemia
(1) Make sure to use
(2) Platelet deficiencies how dealing with that?
(3) To avoid injury
(4) where will they bleed internally
(1) Frequent rest periods , provide nutrition that will help with RBC production
(2) Bleeding precautions: soft toothbrush, maybe gauze around the finger, avoid alcohol containing mouth wash
(3) Keep floor clear
(4) head, usually in joints
Leukemia
(1) Type of precautions
(2) Nursing interventions
(3) Monitor pain that is coming from?
(1) Neutropenic
(2) Vital signs, Daily weights, specific gravity, mucous membranes- no open sores, neuro status, degrees of irritability, include parents
(3) Bones
Leukemia
(1) Education
(1) Integrate the parents into care, teach side effects of chemo therapy, how to manage pain, nutritional status promotion with nausea control, good hygiene to avoid infection, free from complications of chemo, managing side effects, back in normal lab ranges
Leukemia
(1) Three phases of Leukemia treatment
(1) Induction- achieve remission (1 month)
- Intensification - serves to maintain remission
- Maintenance- lasts 2-3 years, if leukemia cells are detected in bone marrow process is started all over again
Chemotherapy Nursing considerations
(1)Have to understand
(2) If given orally watch for?
(3) IV complains of pain what do you do?
(4) Side effects education
(1) why chemo is important- why are we destroying cells that fight infection? Think of simple ways you can explain it (ON TEST)
(2) GI irritation
(3) STOP infusion
(4) Monitor height and weight, maintain nutrition, likes and dislikes, may have to talk to parents about tube feeding at night when they are sleeping then it doesn't disturb normal activities, vomiting very common with chemo treat them with zofran before chemo
(1) Med therapy for side effects of chemo
(2) what is mucositis
(3) Interventions
(1) Zofran, phenegran
(2) Ulcers in the mouth
(3) get baseline assessment before starting chemo then teach better oral hygiene, look for cavities in teeth, ask when last dental exam was, educate on appropriate oral hygiene, soft bristle toothbrush, no alcohol mouth wash
Chemotherapy side effects
(1) Constipation treatment
(2) Diarrhea look at?
(3) Hair loss
(1) stool softener, increased fiber, push fluids, promote activity,
(2) assess for signs of dehydration, how many episodes in a 24 hour period
(3) Need to be taught about it before it happens , will not be same color, texture when it grows back, take them to wig maker before losing hair, meed to wear hat or scarf over head so it doesn't burn
Chemotherapy Pyschosocial group
- Get them in a peer group
-Teenagers will communicate more clearly when parents are not around
Hodgkin's Disease
(1)Originates where?
(2) often metastizes where?
(3) Life expectancy
(4) Higher in?
(5) Prognosis
(1) In the lymph nodes
(2) spleen, liver, bone marrow, lungs, and other tissues
(3) 15 to 30 years
(4) Males
(5) Excellent cure rates
Hodgkin's Disease
(1) Two Types
(2) How do you determine staging
(1) Classification A- asymptomatic- enlarged, firm lymph nodes, Usual location supraclavicular or cervical lymph nodes
- classification B- temp of 100.4 or higher for 3 days, night sweats, unexplained weight loss of 10% or more over previous 6 months, malaise, painless, firm nodes
(2) Lymphnobiopsy looking for Reedsternberg cells
Hodgkin's Disease
(1) Treatmetn
(1) Radiation and chemotherapy
Non-Hodgkin's Disease
(1) Clinical Presentation
(2) Diagnosis
(3) Treatment
(1) Fever, weight loss, enlarged lymph nodes
(2) CBC, Bone marrow aspiration, biopsy
(3) Chemo, radiation, surgery