Download 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...
Neoplasia
Refers to “___________”
Generally abnormal growth
Can be benign or malignant
Pediatric Differences
__________ in body tissues
__________ growing
Child’s immune system
Clinical Manifestations
Pain
Cachexia
Anemia
Infection
Bruising
Neuro symptoms
Palpable mass
Diagnostic Tests
 CBC with diff – most common
 Absolute neutrophil count (ANC)
%segs +%bands x WBC
__________ = risk of infection
 Bone marrow aspiration (where??)
 Bone marrow biopsy
 LP (??)
 Urinalysis
 Biopsy
Overview of treatment of childhood
cancer – Managed by Oncology
Surgery
Staging
Resection
Biopsy
Palliation
Overview of treatment of childhood
cancer
Surgery
Nursing Considerations
Purpose of surgery
Pre-operative baseline vitals and labs
Postoperatively for complications
Maintain careful aseptic technique with all care
Overview of treatment of childhood
cancer
Chemotherapy
Protocols
- based on staging
Side effects and toxic responses
GI alterations
Cushingoid appearance
Immunosuppression
Tissue necrosis
Malaise
Mucositis
Chemotherapy – Central Line
Chemotherapy – Implanted Port
General Side Effects of
Chemotherapy
Alopecia:
Mucositis
Philadelphia Mouthwash
Antibiotic
Antihistamine - anesthetic
Antifungal
Steroid – reduce inflammation
Local anesthetic - pain
Antacid – coats ingredients on mouth
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
Chemotherapy
Nursing Considerations
Anti-emetics
Diet
Careful oral care
Self-image
Monitor absolute neutrophil count
Assure patency of IV
Reportable events for receiving chemo
Fever
Bleeding/bruising
Pain with urination or defecation
Mouth sores
GI distress
Headache
Infection-respiratory, CVL,
Exposure to C-pox, etc.
Chemotherapy – OVER!!
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Overview of treatment of childhood
cancer
Radiation (ex: Hodgkins, Wilms Tumor, Retinoblastoma)
Side effects may be systemic or localized
Short term: Radiation sickness
Long term
Skeletal
Head
Reproductive
CNS
Gastrointestinal
Secondary malignancies later in life
Overview of treatment of childhood
cancer
Radiation
Nursing Considerations
DO NOT REMOVE MARKINGS!
No lotions on skin
Shield other organs
Sedation or distraction
No concerns with radioactivity after treatment
Explain side effects to patient & family
Overview of treatment of childhood
cancer
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
Hematopoietic Stem Cell transplant
Nursing considerations
Strict isolation
Anti-reaction drugs as ordered
Monitor for complications
Provide emotional support
Oncologic Emergencies
 Metabolic Emergencies
Tumor lysis syndrome
(most often in NonHodgkin’s Lymphoma)
Septic Shock (TX?)
Hypercalcemia
Oncologic Emergencies
 Hematologic Emergencies
Bone marrow suppression = anemia &
thrombocytopenia (TX?)
Oncologic Emergencies
 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
Growth and development
Cancer Survivors
Effect on family
Nursing Care
 Family assessment
 Education
 Payment
 Support systems
 Developmental assessment
 Body image
Neuroblastoma – nerve tissue
Blastoma – developing or immature cells
8-10% of childhood CA
Outside of cranium
Dx-under age of 5 (most often dx around17-22 months)
Most common tumor in infants during 1st
year of life
Lymph node metastasis common
Usually starts in adrenal glands OR
ganglia in the abdomen
Neuroblastoma
Abdominal fullness, discomfort
Bone pain, refuses to walk-metastasis
Fever, diarrhea, increased BP, flushing,
sweating-hormones
Patches on skin
Blueberry muffin
spots – (infants)
Don’t palpate
tumor!!
Prognosis/Treatment
Depends on staging
Chemotherapy
Surgery
Radiation
Neuroblastoma can reoccur
Wilms Tumor: Signs and Symptoms
 Malignant renal tumor
 Congenital anomalies-aniridia, hemihypertrophy,
genituourinary (*most kids have no other anomalies)
 Nontender, firm flank mass not crossing midline, in
healthy appearing child
 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
NO PALPATION
Surgery
Unilateral – complete nephrectomy
Bilateral – nephrectomy of more involved
kidney and partial nephrectomy of contralateral
kidney
Chemotherapy
Radiation (if applicable)
Survival – overall 90%
Leukemia
Most common cancer of childhood
Myeloid and Lymphoid cell:
Acute Leukemia: Clinical
Presentation
 Symptoms
 Fatigue, pallor, anorexia
 Bruising, bleeding, petechiae or purpura
 Fever, infection
 Bone/joint pain
 Abdominal distention, hepatosplenomegaly
 Headache, vomiting, visual disturbances
 Lymphadenopathy
Alterations in Platelet Production
Petechiae and purpura:
Diagnostic Workup: CBC
WBC: may be elevated, decreased or
normal
Platelets
Hemoglobin
Differential
10% of patients have “normal” CBC
Usually cannot diagnose type of leukemia
from CBC – BONE MARROW BIOPSY
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
 From single node (CERVICAL) or anatomical
group
 Occurs in ages 20-30 – usually
 Peak occurrence in teen boys
 Possible genetic link ( & infectious agents: EBV, herpes, viruses)
 Non-tender, firm node
 Respiratory problems (d/t mediastinal growth;pressure on trachea)
 Fever, Night sweats, Weight loss
 Elevated ESR & leukocyte count
 Reed Sternberg cells
Hodgkin’s Lymphoma
Lymphomas
Hodgkins
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
Hodgkin’s Treatment
o Chemotherapy
o Radiation
o Combination
Nursing management
80% survival rate
Lymphomas
Non-Hodgkin's Lymphoma
People over 60 – usually
Enlarged lymph nodes, especially cervical or
axillary (inguinal & femoral also)
Pain or swelling with acute onset
and progression
Cough or c/o tightness in chest (Mediastinal
mass, pleural effusion, lymphadenopathy)
GI symptoms (Abdominal mass)
Confirmed by biopsy of affected nodes
Lymphomas
Non-Hodgkin’s Dx:
Biopsy
o Bone marrow
o Pleural effusion
o Ascites
o Affected nodes
Lymphomas
Dx of Non-Hodgkin’s
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
Treatment: Aggressive chemotherapy
Nursing management
Approx. 16 variations – prognosis and tx
depend on type
Retinoblastoma
Tumor that occurs in the retina
90% diagnosed by age 5 years
20-30% of cases bilateral involvement
Genetic component identified (autosomal
dominant; arises from embryonic retinal cells)
Retinoblastoma: Presentation
Leukocoria – “cats eye reflex”
Esotropia
Strabismus
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(11th ed.). Norwalk, CT: Appleton & Lange.
Retinoblastoma in Childhood
Leukocoria, red reflex and esotropia
Retinoblastoma: Diagnosis,
Treatment and Survival
Treatment
Ophthalmology referral
Local therapy
Enucleation
Chemotherapy
Radiation
Genetic counseling
Overall 90% curative
Questions?
https://youtu.be/g2ZuFZABrqU