Caring for the Child with an Alteration in

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Caring for the Child with an Alteration in Cellular Function

Caring for the Child with an Alteration in Cellular Function

Life lessons from cancer survivors Things You Learn. . .

Life lessons from cancer survivors Things You Learn. . .

Neoplasia l Refers to “______” ¡Generally abnormal growth l Can be benign or malignant

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

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

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)

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

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

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

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 – Central Line

Chemotherapy – Implanted Port

Chemotherapy – Implanted Port

General Side Effects of Chemotherapy l Alopecia:

General Side Effects of Chemotherapy l Alopecia:

Mucositis

Mucositis

Philadelphia Mouthwash l Antibiotic l Antihistamine - anesthetic l Antifungal l Steroid – reduce

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

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

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/

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

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

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

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

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

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 Hematologic Emergencies ¡ Bone marrow suppression = anemia & thrombocytopenia (TX? )

Oncologic Emergencies l Space-Occupying Lesions (extensive tumor growth) ¡Spinal Cord compression ¡IICP ¡Brain herniation

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

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

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%

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,

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

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

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

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:

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

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:

Alterations in Platelet Production l Petechiae and purpura:

Diagnostic Workup: CBC l WBC: may be elevated, decreased or normal l Platelets l

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

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

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

Hodgkin’s Lymphoma

Lymphomas l Hodgkins l Diagnosis of Hodgkin’s disease o Biopsy of affected node o

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

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,

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

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

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

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

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

Retinoblastoma: Presentation l Leukocoria – “cats eye reflex” l Esotropia l Strabismus l Inflamed or painful eye

Retinoblastoma

Retinoblastoma

FIGURE 29– 17 Retinoblastoma is characterized by leukocoria, a white reflection in the pupil.

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 in Childhood l Leukocoria, red reflex and esotropia

Retinoblastoma: Diagnosis, Treatment and Survival l Treatment ¡Ophthalmology referral ¡Local therapy ¡Enucleation ¡Chemotherapy ¡Radiation

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

Questions? l https: //youtu. be/g 2 Zu. FZABrq. U