NURS356 Exam 3 Study Guide Care of Children with Chronic Life Threatening Disease Cancer Overview Alteration in cell function resulting from overproduction of immature nonfunctional cells Can be life threatening Can metastasize to distant locations Goal of treatment is to achieve remission a 5 year remission is considered a cure play therapy guided imagery traumatic to child and family family centered care is key Pediatric Cancers Second to accidents as the greatest cause of death in children incidence increases with age frequency of occurrence leukemia brain tumors lymphomas neuroblastomas Wilms tumor bone tumors occur primarily in rapidly differentiating tissues such as bone marrow all tumors in children are considered malignant until histology has said that they are not if they find a tumor they assume its cancer all tests done in surgery some cancers developed in utero Pediatric cancers grow faster because body tissues are in a state of rapid growth high metabolic rate Primarily grow from bone marrow Child are more responsive to tx better long term survival rate Assessment Diagnostics Symptoms vary with type of cancer observe for pain abnormal skin lesions fatigue fever night sweats weight loss acute or dull pain that gets worse look at family history and child s history Diagnostics include selected lab work such as a CBC w differential x rays such as bone studies ultrasounds CT scans MRI We do multifaceted tx regimes that prolong survival and decrease side effects We anticipate side effects and tx them ahead of time before they appear Brain Tumors Diagnosed between the ages of 3 and 7 1 NURS356 Exam 3 Study Guide 2nd most prevalent childhood cancer Gliomas are common tumor Prognosis depends on location in brain 2 3 are infratentorial involving the cerebellum or brain stem brain stream incredibly provoking symptoms may not be able to cure Symptoms arise from the tumor pressure on adjacent neural tissues This pressure increase ICP decline in school work r t IICP or when kids wake up with headaches c o visual acuity problems Neurological Assessment Review Assessment history and physical examination Behavior reported observed Cognitive perceptual development sensory motor function has something changed in school Disability related to cerebellar function coordination LOC posturing reflexes Assessment Considerations Behavior changes Cognition functional screening Motor abilities age specific milestones Coordination i e finger nose Reflexes hyperactivity vs loss Soft signs gray area look to the developmental assessment what has changed with this particular child Assessing IICP In Children Infants changes of cry irritability Children early morning headache behavior changes 2 NURS356 Exam 3 Study Guide sleeping more Adolescents personality behavior signs that must be differentiated Initial Nursing Interventions Prepare child for CT or MRI scan Prepare family for radiation treatments expect facial edema when they shrink tumor with radiation this will decrease symptoms but the child will lose hair with this Support the family with information Provide emotional support for child family Postoperative Nursing Care Position on nonoperative side to minimize pressure with any skull surgery infratentorial lie flat supratentorial elevate HOB 15 20 either way ordered by physician Monitor ICP and LOC VS Relieve eye edema b c you have facial edema Cold compress on eye Eye lubricant Seizure precautions Could chance of seizure depending on where tumor lies Monitor for diabetes insipidus typically use vasopressin Antidiuretic hormone release High volume urine output renal failure Not at all related to blood sugars Related to dehydration and vast changes in electrolytes High volume renal failure kidneys could shut down Neuroblastoma Tumors mainly arise from adrenal gland Highly malignant Usually metastasizes before diagnosis Staged by size involvement Staged from 1 to 4 depending on metastasis Look at lymph and organ involvement to determine Usually by the time they come in to be diagnosed they have already metastasized Poor prognosis if diagnosed beyond the age of 1 year b c this tumor is usually part of the formation of the fetus Symptoms vary widely d t tumor pressure of adjacent structures 3 NURS356 Exam 3 Study Guide Nephroblastoma or Wilms Tumor Tumor of the kidney formed during fetal average age of diagnosis is 2 to 4 years good prognosis is diagnosed early typically mom will notice lump on the backside of child during bathing non tender midline mass near the liver encapsulated unilateral tumor with good prognosis in early diagnosis favors left kidney can remain encapsulated for a very long time appears as a nontender midline mass ON LEFT firm mass in the abdomen DO NOT PALPATE Loose clothing no elastic IVP to assess kidney function Look at blood pressure Dip urine for hematuria Monitor abdominal pain and or constipation Treatment nephrectomy Done in children within 24 48 hours of diagnosis After this chemotherapy is done Sometimes chemo is done before surgery but not always Osteogenic Sarcoma Most common bone cancer of children Arises from long bones 50 in femur Peak age is adolescent sometimes late adolescent Think growth Long bones grow the most during this time Highly malignant metastasizes to lungs Survival rate of 60 X ray exam shows a sunburst effect Pain and swelling at the site Hx of trauma they will think this is why this is happening Ask did pain happen before or after the trauma Treatment amputation chemotherapy Amputation bone proximal joint And then they receive chemotherapy Happens more in boys very difficult to come away with a good attitude Ewings Tumor or Sarcoma Arises from the cells within the bone marrow occurs between ages 4 and 25 years 4 NURS356 Exam 3 Study Guide highly malignant to lungs and bone Noted for pain swelling at site and moth eaten appearance of xray Cancer of the bone marrow so amputation doesn t help and tumor just spreads rapidly Treated with radiation chemotherapy Trying bone sparing and limb sparing surgeries Hodgkin s Disease Malignant neoplasm of the lymph tissue Common in lower cervical area Staged according to involvement adolescents young adults originates as a localized lymph nodes then proliferates via lymphocytes Painless firm persistently enlarge lymph Appears insidiously not r t a disease Complains of night sweats weight loss fever If treated early excellent prognosis Diagnosed with lymphangiogram Dye injected via IV to the bilateral feet X