MB4 peds cancer Forsythe
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#1 type of cancer
What is leukemia?
abnormal WBC proliferation that crowds out normal cells
very elevated WBC count with most of them being immature WBC
Second most common type of cancer?
brain tumors - solid tumor
3rd most common cancer in children?
non-Hodgkins lymphoma - cancer of lymph system
Onset of leukemia?
may not take them to the MD until s/s get bad
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
3 abnormal labs with leukemia?
- 1. WBC increased
- 2. RBC decreased
- 3. platelets decreased
Tx of leukemia?
How long is the Tx?
chemotherapy for 2 to 3 years
S/S of brain tumors?
- 1. altered LOC
- 2. HA
- 3. NV upon arising with no nausea preceding
3 Tx for brain tumors?
surgery, radiation, chemo
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
What age can radiation be used?
not used if < 5 years old
toxic effects on developing brain
Goal of surgery for brain tumor?
remove as much as possible with minimal disturbance to brain to preserve function
How is chemo admin to pt with brain cancer?
through Ommaya reservior
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
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
What size needle should be used for an Ommaya reservoir?
What can occur if CSF is not removed prior to admin of chemo into Ommaya reservoir?
hydrocephalus and increased ICP
What should CSF normally look like?
What types of solutions contain preservatives/benzyl alcohol?
Why is benzyl alcohol dangerous in an Ommaya reservoir?
it can act as an anticoagulant
Onset of Non-Hodgkins lymphoma?
widespread involvement at diagnosis
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
Why GI s/s with non-hodgkin lymphoma?
enlarge nodes press on GI structures
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
Why does edema of face occur in non-hodgkin lymphoma?
nodes press on veins returning blood from the head
Tx of non-hodgkins lymphoma?
radiation and chemo
How long will chemo be done for non-hodgkins lymphoma?
6 mo to 2 years
When is radiation used for non-hodgkins lymphoma?
in emergencies only: when there is CNS involvement or respiratory obstruction
Most common form of infant cancer?
cancer that arises from the nervous tissue that will develop into the SNS & the adrenal medulla
What causes S/S of neuroblastoma?
tumor will have tissue similar to that of SNS and affects kidneys (adrenal medulla)
1. abd mass that is protruberant and firm
4 tx for neuroblastoma?
- 1. radiation
- 2. chemo
- 3. stem cell transplant for advanced disease
Most common bone cancer in CH?
osteosarcoma or osteogenic sarcoma
What is osteosarcoma?
Osteosarcoma higher incidence in _____.
3 places it usually occurs/
- 1. distal femur
- 2. prox. tibia
- 3. prox. humerus
Why might osteosarcoma not be found early?
s/s in early stage are almost always attributed to extremity injury or normal growing pains
5 s/s of osteosarcoma?
- 1. pain at tumor site
- 2. palpable mass
- 3. limited ROM
- 4. limping
- 5. pathologic fracture at site
3 char of pain at tumor site of osteosarcoma?
- 1. progressive
- 2. insidious
- 3. intermittent
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)
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
Can radiation be used for osteosarcoma?
is not used to Tx
may be used at end of life for palliative pain control
AKA prmitive neuroectodermal tumor of the bone (PNET)
Incidence of Ewing sarcoma is higher in _____.
4 s/s of Ewing sarcoma?
- 1. fever
- 2. pain
- 3. soft tissue swelling around the affected bone
- 4. pathologic fracture at site
Tx of Ewing sarcoma?
combination fo chemo and surgical resection or radiation
malignancy of sriated or skel muscles, tendons, bursa, and fascia that occurs in head & neck especially the eye orbit
Incidence of rhabdomyosarcoma?
<5years of age
Important char of rhabdomyosarcoma?
highly malignant with metastasis
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
drooping upper or lower eyelid
Tx of rhabdomyosarcoma?
combo of chemo, radiation, and possible surgery
Most common renal tumor?
Wilms tumor? AKA?
Char of wilms tumor?
- 1. very vascular
- 2. double in size overnight
- 3. asymptomatic, movable mass
Why may parents not bring child to the MD for wilms tumor?
may thing the child is constipated
Nursing consideration with wilms tumor?
NO abd palpation b/c very vascular
put a sign above the bed an tell all visitors
rare tumor of the eye/retina
2 clinical manifestations of retinoblastoma?
- 1. leukocoria
- 2. strabismus
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 -
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
Tx of wilms tumor?
combo of surgical resection (nephrectomy) & chemo
radiation, surgical resection, and chemo
white reflex- light shined in eye makes pupil glow white instead of red
eyes point in different directions - not focused on same thing
freeze tumor to destroy microcirculation to the tumor -> no nutrients
removal of the eye
laser beam to retinal blood supply to stop nutrition to retinoblastoma tumor
Common radiation and chemo SE?
- 1. fatigue
- 2. anorexia
- 3. NV
- 4. skin irritation: erythema and tenderness
Purpose of radiation and chemo?
destroy cells: will destroy cancer and normal body cells
Biggest prob with radiation therapy?
area being radiated will be red, swollen, and tender
Important consideration for pt who is undergoing radiation therapy ongoing?
do not remove radiation markings
Radiation effect on skin?
can cause radiation burns and can cause scarring
goes all the way through the body
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
Skin integrity with radiation therapy?
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)
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
______ is essential to healing and making blood cells when undergoing radiation.
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
Change in appetite during radiation?
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
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
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
Temp of food for cancer pt tx?
they usually prefer cold or room temp foods esp meats
What will occur if radiation is done on the gut area?
bowel will get edematous, erythematous, irritated
high cellulose veg/fruits will stick to the gut and can cause infection - don't give these
4 high cellulose foods?
whole wheat, carrots, celery, sunflower seeds
If radiation and chemo destroys RBC and they are low what will be s/s?
tired and fatigued
allow to rest and provide sedentary activities that don't tire and/or stress bones
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
Alopecia occurs mostly with _____.
When else will it occur?
will also occur with radiation to the scalp
moon face/weight gain caused by chemo augmented with steroids
Why give steroids with chemo?
- augments action of chemo
- decreases nausea
- stops body from rejecting stuff
GI probs caused by chemo?
mucocitis, diarrhea, constipation
kills WBC, RBC, and platelets
Nadir of chemo drug?
peak of when will suppress all blood cells
usually occurs 2 weeks after starting therapy
Risks ass. with nadir of chemo and radiation?
risk for bleeding and infection
Good food choices for cancer Tx pt?
- chicken over beef/pork
- brown sugar over white
- high calories snacks
3 interventions for alopecia?
- 1. wigs/scarfs
- 2. playing with dolls with no hair
- 3. family/friends cutting their hair
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
Why don't rinse with lidocaine with stomatitis?
can decrease gag reflex
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
Why is it used?
colony stimulating factor - stim WBC to be produced
When chem destroys WBC this will replace them so they can keep getting TX
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
Teaching for nosebleed?
lean forward and pinch nose together and breathe through nose
leaning back can cause aspiration
Purpose of bone aspiration?
determines type and quantity of cells
Diff in aspiration sites in ch and infants?
CH- iliac crest or spines
infants - anterior tibia
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
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
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
What will be done frequently to tx thrombocytopenia r/t chemo/radiation?
will need frequent platelet transfusion r/t platelets having a short life
q 1 to 3 days
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
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
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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