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28 Cards in this Set
- Front
- Back
Where do pediatric tumors arise?
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embryonal and neuroectodermal tissues VS adults which comes from Epithelial cells and are Carcinomas.
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What is important teaching about managing remission of pediatric cancer?
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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 |
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When looking at Hx what is puts a pt at risk for pediatric cancer?
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chromosomal disorders (esp for leukemia)
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What are usually the presenting problems of cancer in pediatrics?
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Fever, pain, bleeding
Abdominal mass Night sweats, weight loss Hematuria, hypertension |
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What is important to identify on physical exams for cancer?
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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 |
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What are important nursing considerations in dx cancer?
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CBC important
be sure to sedate per AAP before LP and Bone Marrow Aspiration |
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What are the goals of cancer management?
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Child will be free from infection and pain
Optimum developmental level will be achieved Family will develop effective coping strategies |
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Name the types of tx for cancer?
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Surgery (dx, palliative, & curative)
Radiation Chemo Bone Marrow Transplant |
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What is the goal of radiation?
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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) |
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What are the complications of radiation?
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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 |
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Why is chemo a good option for pediatric cancer patients?
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peds cancer responds better to chemo vs adult cancer
Childhood cancers tend to metastasize early and systemic tx is needed with local tx. |
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What is bone marrow transplant used for?
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Excellent Tx 4:
Acute leukemia severe aplastic anemia immunodeficiencies malignant infantile osteoporosis Good Tx 4: Chronic leukemia Solid Tumors & some hematologic disorders metabolic disorders |
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What are the types of bone marrow transplants?
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Autologous: patients own harvested marrow
Syngeneic: Transplant between identical twins Allogeneic: (Most common) Transplant from a genetically nonidentical donor (i.e. sibling) |
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What is the procedure for bone marrow transplant?
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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 |
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WHat are the complications of the bone marrow transplant?
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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. |
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What are the nursing interventions for bone marrow treatment?
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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 |
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What side effects need to be minimized for bone marrow transplant?
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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 |
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What are the types of leukemia?
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ALL
AML |
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What is ALL leukemia?
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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 |
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What is AML leukemia?
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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) |
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What is a lymphoma?
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Tumors of the lymph tissue: Lymph nodes, thymus, spleen
Non-Hodgkins and Hodgkins |
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What is hodgkins lymphoma?
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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 |
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What is Non-hodgkins lymphoma?
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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 |
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What are the s/s of a brain tumor?
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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 |
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What is a wilm's tumor?
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Large, encapsulated tumor in the renal parenchyma: Frequently in the left kidney
Age 1-3 |
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What is the dx and sx of wilms tumor?
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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 |
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What is the treatment for bone tumors?
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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 |
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What are the assessment findings of bone tumors?
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: insidious pain, increasing with activity, gradually becoming more severe. Tender mass, warm to touch and limited ROM as well as pathologic fractures
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