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Who has a high likelihood of getting Leukemia?
What lab will dx leukemia?
High amounts of immature WBC-Blasts
But bone marrow dysfunction showing decreased WBC, RBC, platelets
S/S that you have leukemia....
- Nose bleeds
- Wt. loss
- Bone pain
DX of Leukemia
- Bone Marrow Aspiration
- Lumbar Puncture
S/S of Lymphomas
painless enlarged lymph node, tonsils and adenoids
How do you treat Leukemia?
- If relapse..redo chemo then move to bone marrow transplant and stem cell transplant
How do treat Lymphomas?
- Bone Marrow Transplant
- Stem Cell Transplant
What cancer is at risk for tumor lysis?
Two types of bone tumors
Osteosarcoma and Ewings Sarcoma
Osteosarcoma is usually found where? and is mistaken for what?
femur, tibia, humurus
growing pains....may limp
Ewing's sarcoma is usually found where? and is mistaken for what?
femur, vertebra, pelvis, ribs
infection-pain, fever and a soft tissue mass around affected bone
Which bone cancer is most likely to result in amputation
How is Osteosarcoma treated?
Chemo before and after surgery
Radiation only for pain control/palliative care
How is Ewing's Sarcoma treated
Chemotherapy before surgery to debulk the tumor and then resect the tumor
What is Nueroblastoma?
it is a solid tumor that is typically found in the abdomen and on adrenal glands
What can Neuroblastoma be mistaken for?
cold or flu
S/S of Neuroblastoma
- Myoclonic/Rotational eye movements
- *Mass across midline of abdomen
- Respiratory distress
- Swallowing Difficulty
- Abnormal Gait
2 cancers you don't want to palpate
Neuroblastoma and Wilm's Tumor (Nephroblastoma)
How do you treat Neuroblastoma?
- Chemo and Radiation and Bone Marrow Transplant
Name a Neprhroblastoma cancer
What is Wilm's Tumor?
S/S of Wilm's tumor
- firm abdominal mass on one side
- abdominal pain
How do you treat Wilm's Tumor?
- Chemo and Radiation
What do you monitor closely on a patient with Wilm's Tumor?
Blood pressure....increases prior to surgery and can go either way after surgery
S/S of brain tumor
- Vomiting in AM
- change in LOC
- Increased head circumfrence
- Change in balance
- Change in mood
- Vision changes
Treatment for brain tumors
- supportive care
Post op for a child after brain surgery
- raise HOB
- monitor ICP
- prevent infection
- protect airway
- watch for seizures, vomiting, facial edema
Complications of brain tumors/surgery
- neuro deficits
- learning disabilities
- developmental delays
- Bell's Palsy
- Respiratory/airway compromise
- 1,500-2,000 low risk for infection
- 500-1,000 Moderate risk for infection
- <500 severe risk for infection
Bleeding precautions when a kid has thrombocytopenia
- soft toothbrush
- no rectal temps
- avoid trauma, punctures and invasive procedures when possible
What is given prophylactically with chemo?
antibiotics to prevent infection
How do you calculate ANC?
WBC x Segs x Bands
What does chemo wipe out?
immune system-bone marrow
treatment of areas not caught during induction
longest phase with a goal of maintaining remission and preventing relapse
- Autologous-own marrow
- Allogenic-donated by family member or stranger
What sort of vaccines don't you give to a person on chemo?
Only sign of infection
fever....no immune response so wont see normal signs of infection
If patient has a fever what will I do?
- antibiotics for T>38
- cultures-blood, urine and sputum
What childhood illness can be deadly for a chemo patient
Antibiotic that prevents opportunistic infections
Central Line Care
- Need to teach patient impeccable care
- routine flushes
- dressing changes
- cap and tubing changes
- s/s of infection
- culture blood from line and site
Early Septic Shock s/s/
- bounding pulses
- warm extremities
Late Septic Shock s/s
- lethargy to coma
- widened pulse pressure
- tachycardia-bradycardia episodes
- weak pulses
- cold extremities
- increased cap. refill time
- peripheral cyanosis
Problem with reverse isolation
cant go to play room or outside of room....get child life to help with diversional needs
How do we care for stomatitis
- routinely check mouth for signs of infection
- mouthwash for cleaning and pain relief
- oral Nystatin for candida
What's tumor lysis?
when the cancer cells are killed they dump their intracellular contents in to the extracellular fluids
What are the lytes dumped in to extra cellular fluids with tumor lysis? Weird one?
Complication from K and P being dumped during tumor lysis?
can cause acute renal failure
Who gets tumor lysis a lot?
leukemias and non hodgkins lymphoma
How do you treat tumor lysis syndrome?
- treat hyperkalemia
- intensive hydration
2 meds given to a person experiencing tumor lysis syndrome to decrease urine acidity