MB4 peds cancer Forsythe

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mthompson17
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214675
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MB4 peds cancer Forsythe
Updated:
2013-04-20 21:02:56
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pediatrics cancer nursing
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Pediatric Cancer
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  1. #1 type of cancer
    leukemias
  2. What is leukemia?
    abnormal WBC proliferation that crowds out normal cells

    very elevated WBC count with most of them being immature WBC
  3. Second most common type of cancer?
    brain tumors - solid tumor
  4. 3rd most common cancer in children?
    non-Hodgkins lymphoma - cancer of lymph system
  5. Onset of leukemia?

    Consideration?
    insidious

    may not take them to the MD until s/s get bad
  6. 7 S/S of leukemia?
    • 1. fever - WBC up
    • 2. pallor - low RBC
    • 3. malaise - low RBC
    • 4. bruising
    • 5. bone or joint pain- WBC content growing causes pain esp in long/flat bones
    • 6. lympadenopathy
    • 7. hepatosplenomegaly
  7. 3 abnormal labs with leukemia?
    • 1. WBC increased
    • 2. RBC decreased
    • 3. platelets decreased
  8. Tx of leukemia?

    How long is the Tx?
    chemotherapy for 2 to 3 years
  9. S/S of brain tumors?
    • 1. altered LOC
    • 2. HA
    • 3. NV upon arising with no nausea preceding
  10. 3 Tx for brain tumors?
    surgery, radiation, chemo
  11. Important consideration before giving chemo in Ommaya reservoir?

    Who else is this important in?
    read the label and make sure it is not multidose or benzyl alcohol included

    should not give any multi-dose / benzyl to newborns ever
  12. What age can radiation be used?

    Why?
    not used if < 5 years old

    toxic effects on developing brain
  13. Goal of surgery for brain tumor?
    remove as much as possible with minimal disturbance to brain to preserve function
  14. How is chemo admin to pt with brain cancer?
    through Ommaya reservior
  15. Important considerations when admin chemo through Ommaya reservoir?
    • 1. give with small gauge needle
    • 2. withdraw CSF in = amnt to dose to be admin
    • 3. DO NOT inject med if CSF is bloody or cloudy
    • 4. Use only preservative free solutions
    • 5. no benzyl alcohol
  16. 3 complications that could occur if a large gauge needle is used for an Ommaya reservoir?
    • 1. infection - brain
    • 2. bleeding
    • 3. destroyed & havbe to do new surgery to replace it
  17. What size needle should be used for an Ommaya reservoir?
    25 g
  18. What can occur if CSF is not removed prior to admin of chemo into Ommaya reservoir?
    hydrocephalus and increased ICP
  19. What should CSF normally look like?
    clear
  20. What types of solutions contain preservatives/benzyl alcohol?
    multi-dose vials
  21. Why is benzyl alcohol dangerous in an Ommaya reservoir?
    it can act as an anticoagulant
  22. Onset of Non-Hodgkins lymphoma?

    Involvement?
    rapid onset

    widespread involvement at diagnosis
  23. 6 S/S of non-hodgkin lymphoma?
    • 1. widespread involvement a Dx
    • 2. abd cramping
    • 3. constipation
    • 4. anorexia & weight loss
    • 5. ascites
    • 6. lymphadenopathy
  24. Why GI s/s with non-hodgkin lymphoma?
    enlarge nodes press on GI structures
  25. Where is main lymphadenopathy located in non-hodgkins lymphoma?

    S/S & complications?
    mediastinal lymph nodes are esp swollen

    presses on bronchi ->  cough, chest tightness, & edema of the face
  26. Why does edema of face occur in non-hodgkin lymphoma?
    nodes press on veins returning blood from the head
  27. Tx of non-hodgkins lymphoma?
    radiation and chemo
  28. How long will chemo be done for non-hodgkins lymphoma?
    6 mo to 2 years
  29. When is radiation used for non-hodgkins lymphoma?
    in emergencies only:  when there is CNS involvement or respiratory obstruction
  30. Most common form of infant cancer?
    NEUROBLASTOMA
  31. Neuroblastoma?
    cancer that arises from the nervous tissue that will develop into the SNS & the adrenal medulla
  32. What causes S/S of neuroblastoma?
    tumor will have tissue similar to that of SNS and affects kidneys (adrenal medulla)
  33. Neuroblastoma s/s?
    1. abd mass that is protruberant and firm

    huge abd
  34. 4 tx for neuroblastoma?
    • 1. radiation
    • 2. chemo
    • 3. stem cell transplant for advanced disease
  35. Most common bone cancer in CH?
    osteosarcoma or osteogenic sarcoma
  36. What is osteosarcoma?
    bone tumor
  37. Osteosarcoma higher incidence in _____.

    3 places it usually occurs/
    adolescents

    • 1. distal femur
    • 2. prox. tibia
    • 3. prox. humerus
  38. Why might osteosarcoma not be found early?
    s/s in early stage are almost always attributed to extremity injury or normal growing pains
  39. 5 s/s of osteosarcoma?
    • 1. pain at tumor site
    • 2. palpable mass
    • 3. limited ROM
    • 4. limping
    • 5. pathologic fracture at site
  40. 3 char of pain at tumor site of osteosarcoma?
    • 1. progressive
    • 2. insidious
    • 3. intermittent
  41. Diff b/t osteosarcoma and Ewing sarcoma?
    • 1. Ewing sarcoma has fever
    • 2. Ewing sarcoma can be treated with radiation (not just for palliative care)
  42. Tx of osteosarcoma?
    • 1. chemo then surgical resection of tumor then chemo again
    • 2. non-weight bearing on affected limb - crutches

    will be very tired
  43. Can radiation be used for osteosarcoma?
    is not used to Tx

    may be used at end of life for palliative pain control
  44. Ewing sarcoma?

    AKA?
    bone tumor

    AKA prmitive neuroectodermal tumor of the bone (PNET)
  45. Incidence of Ewing sarcoma is higher in _____.
    adol
  46. 4 s/s of Ewing sarcoma?
    • 1. fever
    • 2. pain
    • 3. soft tissue swelling around the affected bone
    • 4. pathologic fracture at site
  47. Tx of Ewing sarcoma?
    combination fo chemo and surgical resection or radiation
  48. Rhabdomyosarcoma?
    malignancy of sriated or skel muscles, tendons, bursa, and fascia that occurs in head & neck especially the eye orbit
  49. Incidence of rhabdomyosarcoma?
    <5years of age
  50. Important char of rhabdomyosarcoma?
    highly malignant with metastasis
  51. Clinical manifestations of rhabdomyosarcoma?
    • 1. mass:  soft-hard, nontender, relatively immobile
    • 2. periorbital
    • 3. ptosis - drooping upper or lower lid
    • 4. exopthalmos - bulging of the eye
  52. Ptosis?
    drooping upper or lower eyelid
  53. Tx of rhabdomyosarcoma?
    combo of chemo, radiation, and possible surgery
  54. Most common renal tumor?
    wilms tumor
  55. Wilms tumor?   AKA?
    nephroblastoma

    renal tumor
  56. Char of wilms tumor?
    • 1. very vascular
    • 2. double in size overnight
    • 3. asymptomatic, movable mass
  57. Why may parents not bring child to the MD for wilms tumor?
    may thing the child is constipated
  58. Nursing consideration with wilms tumor?
    NO abd palpation b/c very vascular

    put a sign above the bed an tell all visitors
  59. Retinoblastoma?
    rare tumor of the eye/retina
  60. 2 clinical manifestations of retinoblastoma?
    • 1. leukocoria
    • 2. strabismus
  61. Tx of retinoblastoma?
    combination therapy with goal to save life and preserve eye

    • 1. 1st chemo
    • 2. 2nd focal therapies:  cryotherapy or photocoagulation (laser to retina)
    • 3. 2nd radiation
    • 4. last resort -
  62. Therapeutic management of retinoblastoma enucleation surgery?
    • 1. post-op care of enucleated orbit
    • 2. assess for s/s infection, hemorrhage, and edema
    • 3. conformer is placed in orbit for 5 to 6 weeks to preserve shape of orbit for prosthesis
    • 4. remove, clean, and reinsert
  63. Tx of wilms tumor?
    combo of surgical resection (nephrectomy) & chemo

    OR

    radiation, surgical resection, and chemo
  64. Leukocoria?
    white reflex- light shined in eye makes pupil glow white instead of red
  65. Strabismus?
    eyes point in different directions - not focused on same thing
  66. Cryotherapy?
    freeze tumor to destroy microcirculation to the tumor -> no nutrients
  67. Enucleation ?
    removal of the eye
  68. Photocoagulation?

    Used for?
    laser beam to retinal blood supply to stop nutrition to retinoblastoma tumor
  69. Common radiation and chemo SE?
    • 1. fatigue
    • 2. anorexia
    • 3. NV
    • 4. skin irritation:  erythema and tenderness
  70. Purpose of radiation and chemo?
    destroy cells:  will destroy cancer and normal body cells
  71. Biggest prob with radiation therapy?
    area being radiated will be red, swollen, and tender
  72. Important consideration for pt who is undergoing radiation therapy ongoing?
    do not remove radiation markings
  73. Radiation effect on skin?
    can cause radiation burns and can cause scarring

    goes all the way through the body
  74. Baths with radiation?
    do not need to take long tub baths - no more than 10 minutes

    no perfumed soaps - mild soaps only

    if it is radiation on scalp - mild shampoos
  75. Skin integrity with radiation therapy?

    Intervention?
    skin can be broken r/t numerous radiation therapy

    pat dry & avoid dry towels

    loose fitting clothes

    No creams and lotions b/c have metal in them & will block some of the radiation from the tumor (are some that can use)
  76. Why no perfumes or creams and lotions with radiation?

    Where can they use these things?
    have metal that will block the radiation from the tumor

    can put it on areas away from radiation area
  77. ______ is essential to healing and making blood cells when undergoing radiation.
    nutrition
  78. 2 drugs that are given to cancer pt for NV?'

    When are they given?
    antiemetics - zofran and atarax

    30 minutes before then q 4 to 8 h during
  79. Change in appetite during radiation?

    Intervention?
    don't want high calorie or high sugar food - don't tolerate very well

    can sprinkle wheat bran on food to increase calories or put a lot of butter in their food

    Main thing is to get as much calories as possible:  let them eat whatever they will eat
  80. Important consideration for the consistency of foods in cancer treatment pt?
    don't need sharp foods b/c can break lining of GI tract and cause bleeding that they are at risk for already b/c they have low platelets & chemo kills the MM lining already -> stomatitis
  81. Intervention to prevent N r/t smell of foods?
    take the top off the food outside the room so the smell won't be so strong
  82. Temp of food for cancer pt tx?
    they usually prefer cold or room temp foods esp meats
  83. What will occur if radiation is done on the gut area?

    Interventions?
    bowel will get edematous, erythematous, irritated

    high cellulose veg/fruits will stick to the gut and can cause infection - don't give these
  84. 4 high cellulose foods?
    whole wheat, carrots, celery, sunflower seeds
  85. If radiation and chemo destroys RBC and they are low what will be s/s?

    Interventions?
    tired and fatigued

    allow to rest and provide sedentary activities that don't tire and/or stress bones
  86. Intervention for when child is doing radiation or chemo?
    distraction - teach parent

    • 10 friends to take camping
    • 10 activities to do
    • 10 favorite games to play
  87. Alopecia occurs mostly with _____.

    When else will it occur?
    chemo

    will also occur with radiation to the scalp
  88. Cushingoid appearance?
    moon face/weight gain caused by chemo augmented with steroids
  89. Why give steroids with chemo?
    • augments action of chemo
    • decreases nausea
    • stops body from rejecting stuff
  90. GI probs caused by chemo?
    mucocitis, diarrhea, constipation
  91. Myelosuppression?
    kills WBC, RBC, and platelets
  92. Nadir of chemo drug?
    peak of when will suppress all blood cells

    usually occurs 2 weeks after starting therapy
  93. Risks ass. with nadir of chemo and radiation?
    risk for bleeding and infection
  94. Good food choices for cancer Tx pt?
    • chicken over beef/pork
    • brown sugar over white
    • high calories snacks
  95. 3 interventions for alopecia?
    • 1. wigs/scarfs
    • 2. playing with dolls with no hair
    • 3. family/friends cutting their hair
  96. Interventions for stomatitis/impaired MM?
    • 1. soft foods
    • 2. non acidic
    • 3. local anesthetics (lozengers) before meals
    • 4. meticulous mouth care qid - mix 1 quart lukewarm water, tsp baking soda, tsp salt and give after eating and in b/t eating qid
    • 5. 1/2 str peroxide rinse tid or lukewarm water
    • 6. viscous lidocaine swab (not rinse)
    • 7 no alcohol containing mouthwash
  97. Why don't rinse with lidocaine with stomatitis?
    can decrease gag reflex
  98. Interventions to prevent infection in cancer Tx pt?
    • 1. wash hands
    • 2. provide meticulous oral hygiene
    • 3. no visitors with infections
    • 4. no fresh fruits or veg - can have processed only
    • 5. no honey - botulism
    • 6. no live virus vaccinations- MMR, varicella, nasal flu
    • 7. monitor temp - no rectal temps
    • 8. may use profilactic abx
    • 9. neupogen
  99. Neupogen?

    Why is it used?
    colony stimulating factor - stim WBC to be produced

    filgrastim

    When chem destroys WBC this will replace them so they can keep getting TX
  100. Interventions for risk for bleeding?
    • 1. soft toilet paper
    • 2. no sharp foods
    • 3. avoid IM & rectal if poss.
    • 4. do not give NSAIDS
    • 5. soft toothbrush
    • 6. stool softeners
    • 7. check urine and stool for blood
    • 8. eval menstrual flow in adol girls
  101. Teaching for nosebleed?
    lean forward and pinch nose together and breathe through nose

    leaning back can cause aspiration
  102. Purpose of bone aspiration?
    determines type and quantity of cells
  103. Diff in aspiration sites in ch and infants?
    CH- iliac crest or spines

    infants - anterior tibia
  104. Nursing care pre-bone marrow aspiration biopsy?
    • 1. assess platelet count - under 20,000 will give platelets before procedure
    • 2. - apply cream and leave on 30 min-h to numb
  105. Nursing care during bone marrow aspiration biopsy?
    • 1. treatment table not hospital bed
    • 2. prone position
    • 3. conscious sedation and local anesthesia to reduce pain
    • 4. instruct they will feel considerable pressure when needle inserted and then sharp pain when marrow is aspirated
    • 5. apply pressure dressing to puncture site to prevent bleeding and hold pressure
  106. Nursing care post bone marrow aspiration biopsy?
    • 1. monitor vs and pressure dressing q 15 minutes for the first hour
    • 2. assess: pain, bleeding, and infection
    • 3. keep child quiet - may play quiet games
    • 4. allow young CH to play with a doll and syringe to help them express their feelings aobut such a painful, invasive procedure
  107. What will be done frequently to tx thrombocytopenia r/t chemo/radiation?

    How often?
    will need frequent platelet transfusion r/t platelets having a short life

    q 1 to 3 days
  108. 3 interventions for activity intolerance r/t radiation/chemo?
    • 1. provide frequent rest periods b/t care
    • 2. provide stimulating but not physically tiring activities
    • 3. cluster care to prevent exhaustion
  109. 9 interventions for altered nutrition, anorexia, NV, mucocitis r/t radiation and chemo?
    • 1. antiemetics
    • 2. high calorie, high protein, high Fe
    • 3. provide fave foods
    • 4. room temp food
    • 5. extra fluids
    • 6. small frequent snacks
    • 7. chicken instead of beef or pork - chicken is less bitter
    • 8. sprinkle brown sugar on food - tolerated better than white
    • 9. daily weights
  110. 4 interventions for altered skin integrity r/t radiation and chemo?
    • 1. use only approved lotions/creams
    • 2. avoid excessive scrubbing of skin
    • 3. DO NOT remove radiation marks
    • 4. loose clothing, soft material
    • 5. turn q 2 h if immobile

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