Caring for the Child with an Alteration in
- Slides: 51
Caring for the Child with an Alteration in Cellular Function
Life lessons from cancer survivors Things You Learn. . .
Neoplasia l Refers to “______” ¡Generally abnormal growth l Can be benign or malignant
Pediatric Differences l _____ in body tissues l _____ growing l Child’s immune system
Clinical Manifestations l Pain l Cachexia l Anemia l Infection l Bruising l Neuro symptoms l Palpable mass
Diagnostic Tests l CBC with diff – most common l Absolute neutrophil count (ANC) ¡ %segs +%bands x WBC ¡ _____ = risk of infection l Bone marrow aspiration (where? ? ) l Bone marrow biopsy l LP (? ? ) l Urinalysis l Biopsy
Overview of treatment of childhood cancer – Managed by Oncology l Surgery ¡Staging ¡Resection ¡Biopsy ¡Palliation
Overview of treatment of childhood cancer l Surgery ¡Nursing Considerations l. Purpose of surgery l. Pre-operative baseline vitals and labs l. Postoperatively for complications l. Maintain careful aseptic technique with all care
Overview of treatment of childhood cancer l Chemotherapy ¡Protocols - based on staging ¡Side effects and toxic responses l. GI alterations l. Cushingoid appearance l. Immunosuppression l. Tissue necrosis l. Malaise l. Mucositis
Chemotherapy – Central Line
Chemotherapy – Implanted Port
General Side Effects of Chemotherapy l Alopecia:
Mucositis
Philadelphia Mouthwash l Antibiotic l Antihistamine - anesthetic l Antifungal l Steroid – reduce inflammation l Local anesthetic - pain l Antacid – coats ingredients on mouth l Use Q 4 -6 h; hold in mouth 2 min, spit or swallow. No food or drink for 30 min.
Overview of treatment of childhood cancer l Chemotherapy ¡Nursing Considerations l. Anti-emetics l. Diet l. Careful oral care l. Self-image l. Monitor absolute neutrophil count l. Assure patency of IV
Reportable events for receiving chemo l Fever l Bleeding/bruising l Pain with urination or defecation l Mouth sores l GI distress l Headache l Infection-respiratory, CVL, l Exposure to C-pox, etc.
Chemotherapy – OVER!! https: //www. facebook. c om/Alessa ndra. RSchu tte/videos/4 815036987 07033/
Overview of treatment of childhood cancer l Radiation (ex: Hodgkins, Wilms Tumor, Retinoblastoma) ¡Side effects may be systemic or localized ¡Short term: Radiation sickness ¡Long term l. Skeletal l. Head l. Reproductive l. CNS l. Gastrointestinal l. Secondary malignancies later in life
Overview of treatment of childhood cancer l Radiation ¡Nursing Considerations l. DO NOT REMOVE MARKINGS! l. No lotions on skin l. Shield other organs l. Sedation or distraction l. No concerns with radioactivity after treatment l. Explain side effects to patient & family
Overview of treatment of childhood cancer l Hematopoietic Stem Cell Transplantation ¡Leukemia, neuroblastoma, aplastic anemia ¡Autologous or allogeneic donor ¡Chemo & radiation ¡New cells in 2 -8 weeks
Overview of treatment of childhood cancer l Hematopoietic Stem Cell transplant ¡Nursing considerations l Strict isolation l Anti-reaction drugs as ordered l Monitor for complications l Provide emotional support
Oncologic Emergencies l Metabolic Emergencies ¡ Tumor lysis syndrome (most often in Non. Hodgkin’s Lymphoma) ¡ Septic Shock (TX? ) ¡ Hypercalcemia
Oncologic Emergencies l Hematologic Emergencies ¡ Bone marrow suppression = anemia & thrombocytopenia (TX? )
Oncologic Emergencies l Space-Occupying Lesions (extensive tumor growth) ¡Spinal Cord compression ¡IICP ¡Brain herniation ¡Seizures ¡Massive hepatomegaly/GI obstruction ¡Cardiac and respiratory complications (Super. Vena Cava Syndrome d/t obstruction by tumor)
Nursing concerns in childhood cancers l Growth and development l Cancer Survivors l Effect on family
Nursing Care l Family assessment l Education l Payment l Support systems l Developmental assessment l Body image
Neuroblastoma – nerve tissue l Blastoma – developing or immature cells l 8 -10% of childhood CA l Outside of cranium l Dx-under age of 5 (most often dx around 17 -22 months) l Most common tumor in infants during 1 st year of life l Lymph node metastasis common l Usually starts in adrenal glands OR ganglia in the abdomen
Neuroblastoma l Abdominal fullness, discomfort l Bone pain, refuses to walk-metastasis l Fever, diarrhea, increased BP, flushing, sweating-hormones l Patches on skin l Blueberry muffin spots – (infants) l Don’t palpate tumor!!
Prognosis/Treatment l Depends on staging l Chemotherapy l Surgery l Radiation l Neuroblastoma can reoccur
Wilms Tumor: Signs and Symptoms l Malignant renal tumor l Congenital anomalies-aniridia, hemihypertrophy, genituourinary (*most kids have no other anomalies) l Nontender, firm flank mass not crossing midline, in healthy appearing child l May be asymptomatic or have: ¡ Abdominal pain ¡ Vomiting ¡ HTN (r/t renal damange – 25%) ¡ 25 -30% microscopic/gross hematuria ¡ Fever ¡ Fatigue
Wilms Tumor: Treatment and Prognosis l. NO PALPATION l Surgery ¡Unilateral – complete nephrectomy ¡Bilateral – nephrectomy of more involved kidney and partial nephrectomy of contralateral kidney l Chemotherapy l Radiation (if applicable) l Survival – overall 90%
Leukemia Most common cancer of childhood l Myeloid and Lymphoid cell:
Acute Leukemia: Clinical Presentation l Symptoms l Fatigue, pallor, anorexia l Bruising, bleeding, petechiae or purpura l Fever, infection l Bone/joint pain l Abdominal distention, hepatosplenomegaly l Headache, vomiting, visual disturbances l Lymphadenopathy
Alterations in Platelet Production l Petechiae and purpura:
Diagnostic Workup: CBC l WBC: may be elevated, decreased or normal l Platelets l Hemoglobin l Differential l 10% of patients have “normal” CBC l Usually cannot diagnose type of leukemia from CBC – BONE MARROW BIOPSY
l In a child receiving treatment for leukemia, which of the following conditions poses the greatest risk of death? ¡A. Bleeding ¡B. Infection ¡C. Electrolyte imbalance ¡D. Chronic anemia with heart failure
Lymphomas(lymph nodes/lymphatic system) Hodgkin’s Disease l From single node (CERVICAL) or anatomical group l Occurs in ages 20 -30 – usually l Peak occurrence in teen boys l Possible genetic link ( & infectious agents: EBV, herpes, viruses) l Non-tender, firm node l Respiratory problems (d/t mediastinal growth; pressure on trachea) l Fever, Night sweats, Weight loss l Elevated ESR & leukocyte count l Reed Sternberg cells
Hodgkin’s Lymphoma
Lymphomas l Hodgkins l Diagnosis of Hodgkin’s disease o Biopsy of affected node o Staging of the disease • Chest X-ray • CT of the chest, abdomen, and pelvis • Possible gallium scan and bone marrow biopsy
Lymphomas l Hodgkin’s Treatment o Chemotherapy o Radiation o Combination l Nursing management l 80% survival rate
Lymphomas l Non-Hodgkin's Lymphoma l. People over 60 – usually l. Enlarged lymph nodes, especially cervical or axillary (inguinal & femoral also) l. Pain or swelling with acute onset and progression l. Cough or c/o tightness in chest (Mediastinal mass, pleural effusion, lymphadenopathy) l. GI symptoms (Abdominal mass) l. Confirmed by biopsy of affected nodes
Lymphomas l Non-Hodgkin’s Dx: l Biopsy o Bone marrow o Pleural effusion o Ascites o Affected nodes
Lymphomas l Dx of Non-Hodgkin’s l Staging o Bone marrow biopsy o Lumbar puncture o Radiological studies: CT of affected area and chest, abdomen, pelvis o Nuclear studies: Bone and gallium scans o Laboratory evaluation
Lymphomas – Non-Hodgkin’s l Treatment: Aggressive chemotherapy l Nursing management l Approx. 16 variations – prognosis and tx depend on type
Retinoblastoma l Tumor that occurs in the retina l 90% diagnosed by age 5 years l 20 -30% of cases bilateral involvement l Genetic component identified (autosomal dominant; arises from embryonic retinal cells)
Retinoblastoma: Presentation l Leukocoria – “cats eye reflex” l Esotropia l Strabismus l Inflamed or painful eye
Retinoblastoma
FIGURE 29– 17 Retinoblastoma is characterized by leukocoria, a white reflection in the pupil. From Hathaway, W. E. , Hay, W. W. , Jr. , Groothuis, J. R. , & Paisley, J. W. (1993). Current pediatric diagnosis and treatment(11 th ed. ). Norwalk, CT: Appleton & Lange.
Retinoblastoma in Childhood l Leukocoria, red reflex and esotropia
Retinoblastoma: Diagnosis, Treatment and Survival l Treatment ¡Ophthalmology referral ¡Local therapy ¡Enucleation ¡Chemotherapy ¡Radiation ¡Genetic counseling l Overall 90% curative
Questions? l https: //youtu. be/g 2 Zu. FZABrq. U
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