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Pediatrics > Nursing Assessment of Child with Cancer > Flashcards

Nursing Assessment of Child with Cancer Flashcards

1
Q

Childhood Cancer: Symptom Onset

A

May be rapid or insidious
Diagnosis often delayed
Symptoms often vague
There are no classic or universal symptoms of cancer, but instead there are often vague and nonspecific complaints, which are usually consistent with very common, benign childhood illnesses. Because it is rare there may be delayed diagnosis.

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2
Q

S&S of Cancer

A

Pallor, bleeding, bruising
Fatigue
Infection/Persistent fever
Headache, visual changes
Lymphadenopathy
Bone pain, joint pain, limp
Abdominal mass
Cough, respiratory difficulties
Cachexia (anorexia)
Anemia
Wide variation in the symptoms and intensity of symptoms that occur in a child with cancer. Vague and nonspecific and often be thought to be attributed to the flu or a viral syndrome initially. Cancer in children is rare, and vague symptoms do not automatically mean cancer but sustained or more serious illness often does initiate more in-depth testing and evaluation. Headaches should also be looked into.

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3
Q

Diagnostic Tests for Childhood Cancer

A

Bone marrow aspiration
Lumbar puncture
Complete blood count and differential
Absolute neutrophil count (ANC)
CT

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4
Q

Cancer Treatment

A

Multimodal treatment (come at it from different angles)
Goal is to cure and/or prolong survival
Aimed at reducing or stopping cells from reproducing/growing
Chemo, surgery, biopsy or removal, radiation, steriods)

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5
Q

Surgery

A

Resection, debulking, diagnosis (biopsy)

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6
Q

Chemotherapy

A

Shrink the tumor
Stop cells from dividing

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7
Q

Radiation

A

To shrink tumor
cause cell death; wait until older than 5 years if possible (affects growth & mental ability -> an irradiated brain will not grow further)

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8
Q

Hematopoietic Stem Cell Transplant (Bone Marrow Transplant)

A

Given via IV (HIGHLIGHTED)
give mega doses of chemo and rescue patient with own stored stem cells or allogeneic.
Wipe out cancer and marrow first to make room for donor. want to get to the point where they have almost no WBC, RBC, or platelets. Require platelet infusion and blood transfusions. very immunocompromised. Giving packed RBC and platelets and waiting and watching the numbers

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9
Q

Treatment Protocols

A

Every child with cancer is on a treatment protocol
Plan of action for treatment (chemo/radiation) based on staging of the cancer (type of cancer, location, and particular cell type)
A recipe or roadmap outlining drugs, timing, schedule, dosages, modifications due to toxicity

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10
Q

Chemotherapy

A

Goal = CURE
Given IV, po, sc, intrathecal (into the CNS system - IT), IM
Benefits must outweigh the side effects
Attacks cells a different points in cell cycle

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11
Q

Principles of Combination Chemotherapy (HIGHLIGHTED)

A
  • Intermittent therapy: several different drugs
  • better response rates, longer remissions
  • provides optimum cell destruction
  • least toxic effects
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12
Q

Intrathecal Chemotherapy

A

Children with leukemia are given IT to prevent metastasis to the brain
Bypasses blood brain barrier; prevents relapse in CNS -> sanctuary site. Will give even if CSF clear. into the CNS
Chemo placed in the CSF space to prevent cancer form spreading to the brain (HIGHLIGHTED)

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13
Q

Chemo is Selective to Rapidly Dividing Cells

A
  • cancer cells
  • bone marrow
  • hair follicles
  • GI tract
  • oral mucosa
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14
Q

Chemotherapy Side Effects

A

Numerous and can be life threatening:
- nausea/vomiting
- constipation/diarrhea
- anorexia
- mucositis/stomatitis (sores inside the mouth)
- alopecia
- organ damage
- myelosuppression

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15
Q

Myelosuppression

A

Immune system, RBC, WBC, platelet goes down
Can be life-threatening

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16
Q

Nadir

A

Period after chemotherapy when your blood counts are at their lowest point
usually 7-14 days after chemotherapy
-can vary depending on your treatment regimen

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17
Q

Nausea and Vomiting

A

Due to stimulation of the chemoreceptor zone and the vomiting center in the brain
From mucositis and damage to GI tract from Chemo
Prevention is key - give meds before !!! (HIGHLIGHT)
Antiemetic regime individualized to patient needs and desires

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18
Q

Constipation/Diarrhea

A

Constipation: due to neurotoxic effects of some chemo agents on autonomic nervous system. Bowel assessment daily, prophylactic stool softeners
Diarrhea: due to destruction of epithelial cells lining GI tract and/or infection

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19
Q

Anorexia Causes:

A

nausea/vomiting
taste alterations (due to disease, chemotherapy, radiation or surgery to the oral cavity or surrounding areas)
mucositis/stomatitis
psychological/sociocultural factors
abdominal mass
DO NOT PRESSURE THE CHILD TO EAT (HIGHLIGHTED)

20
Q

Anorexia: Nursing Care

A
  • Managing treatment toxicities
  • Manage alteration in taste sensation problems
  • Patient/family teaching
  • Provide diet supplements
  • Enteral or parenteral feeding
  • Offer frequent small meals/snacks
  • Deal with control issues
    Quick to start NG feeds -> maintain integrity of GI tract, therefore even 5 ml/hr is helpful.
21
Q

Mucositis/Stomatitis

A
  • From cytotoxic effects on the rapidly dividing epithelial cells causing Myelosuppression
  • Occurs within 2-7 days of chemo
  • As WBC decreases, risk of microbial infections in the mouth increase from myelosuppression
  • Also affects nutritional status
22
Q

Mucositis/Stomatitis: Nursing Care

A

Frequent assessment of oral mucosa (at least once per shift)
In patients with myelosuppression: frequent and meticulous mouth care is essential to avoid mucositis
Bicarb rinses, Chlorhexidine rinses, magic mouthwash
Use of antifungal agents to prevent oral condidiasis
Pain management

23
Q

Oral care with Mucositis/Stomatitis

A

MUST brush teeth 4x/day even if not eating -> brush & rinse
In patients with myelosuppression: frequent and meticulous mouth care is essential to avoid mucositis (HIGHLIGHTED)

24
Q

Alopecia

A

Usually temporary
Thinning to complete baldness
Regrowth may occur while still on therapy
Areas that have been irradiated are usually permanently bald

25
Q

Organ Toxicity

A

Many chemo agents are toxic to certain organs
Commonly affected are the kidneys, liver, skin, heart, bladder and sense of hearing
Screening pre each course of chemo via GFRs, LFTs, audiology exams, ECHOs
Organ protective agents

26
Q

WBC Differential: Types of cells

A

Neutrophils (infection-fighters)
- Segs or polys (mature)
- bands or stabs (young)
- myelocytes, metamylocytes (very young)
Lymphocytes (immunity)
Monocytes (phagocytosis)
Eosinophils (allergy, parasites)
Basophils (hypersensitivity)
Blasts (very immature)
BLASTS SHOULD ALWAYS BE CONSIDRED ABNORMAL

27
Q

Myelosuppression 3 components

A
  1. Anemia (RBC)
  2. Neutropenia (WBC)
  3. Thrombocytopenia (platelets)
28
Q

What is Myelosuppression

A

Rapidly dividing cells affected by chemo
Severity depends on dosage, schedule, individual response
Most drugs cause myelosuppression resulting:
- Neutropenia
- Thrombocytopenia
- Anemia
Patients at increase risk of infection: HAND HYGIENE is important (HIGHLIGHTED)
Signs of infection may be very subtle because unable to mount infectious process (swelling, warmth, pus)

29
Q

Evaluating the Neutrophil Count

A

Patients with low neutrophil counts are at high risk of developing bacterial infections
The lower the neutrophil count, and the longer it stays low, the higher the risk of infection
Patients with very low neutrophil counts may not be able to mount a response (show an increase in WBC) in the presence of infection
NEUTROPHILS FIGHT BACTERIAL INFECTIONS

30
Q

Absolute Neutrophil Count (ANC) levels

A

> 1.500 = normal (in oncology patients)
< 1.000 = impaired ability to fight infection (myelosuppression is occurring)
< 0.500 = at risk for serious infection

31
Q

What is ANC

A

Absolute Neutrophil Count
- indicator of the child’s ability to right bacterial infections.
For healthy people the ANC is generally over 2.500 but for practical purposes, an ANC of > 1.500 is considered normal
ANC: adding the neutrophil counts with the bands (immature)
May got to school if >0.5: depends on type of cancer and treatment to determine discharge and return to school

32
Q

Neutropenia

A

Add Neutrophils + Band Cells = ANC
ANC < 1.000 = neutropenia
Fever in a child with neutropenia is an emergency
Infection is the #1 cause of death in children with cancer (infection leads to sepsis or septic shock)

33
Q

Neutropenia: S&S only appear if infection present

A

FEVER (> 38.5 PO or > 38 C axilla)
- cough, sore throat, redness @ wounds, subtle signs of inflammation, prolonged healing
- children with cancer have something else that puts them at higher risk for septicemia: CENTRAL LINES
There will always be fever
Prompt intervention is KEY

34
Q

Evaluating Children with Neutropenia

A

Usual signs of infection may be absent (patients vital signs, report of pain, and overall appearance may be the only way to gauge their status and response to treatment measures)
- erythema
- warmth
- drainage/pus
- crackles
Pain/tachycardia/fever may be only signs of infection
Fever or shaking chills require immediate intervention.
Assessment of the febrile neutropenic patient should include routine visualization of the oral mucosa or perianal area

35
Q

Fever/Neutropenia Nursing Care

A

q4h vital signs including BP (temp q2h if febrile)
Assess for S/S of sepsis
Blood cultures
Broad spectrum antibiotics STAT
Hydration
Tylenol - wait before giving (check with oncologist first; all cultures done & antibiotics started. dont want to mask fever and delay treatment)

36
Q

Platelets

A

important for blood clotting
life span is 72 hrs to 10 days
low platelets = thrombocytopenia
S&S:
- easy or excessive bruising
- prolonged bleeding
- bleeding from gums or nose
- blood in urine or stool
- fatigue
- pale skin color
TX: platelet transfusion

37
Q

Nursing Consideration (Thrombocytopenia) - highlighted

A

encourage parents to avoid contact sports and activities that could cause the child bodily injury including using a soft toothbrush

38
Q

Red Blood Cells (anemia)

A

Transport oxygen and carbon dioxide
Lifespan = 120 days
Low RBCs = anemia
S/S
- increased HR, increased RR, fatigue, pallor, listlessness, cranky, tissue anoxia, flank pain
TX: blood transfusion

39
Q

Evaluating Vital Signs

A

Know norms for age
Measure precisely using correct technique and equipment
Weights are very important aspect of assessment

40
Q

Temperature Considerations

A

No rectal temperatures for oncology patients because the rectal mucosa is fragile and easily injured. (bleeed because of thrombocytopenia and risk for infection because of neutropenia)
Fever is an emergency:
- in patients with neutropenia
in patients with central lines or other implanted apparatus
- in immunodeficiency or asplenia

41
Q

Fever Considerations

A

Shaking chills
- may occur before onset of fever
- also considered an emergency
Check capillary refill and other perfusion parameters
- normal = brisk
- report if delayed
Notify MD immediately
- urgent evaluation/intervention required

42
Q

Evaluating Vital Signs: Tachycardia

A

Potential Causes:
- anxiety, anemia, hypovolemia, shock, fever, pain

43
Q

Evaluating Vital Signs: Tachypnea

A

Evaluate: retractions, nasal flaring, colour (dusky, cyanotic), breath sounds, O2 sats
Potential Causes: anxiety, hypoxia, fever, pain, respiratory compromise

44
Q

Evaluating Vital Signs: Hypotension

A

Hypotension is an emergency - report immediately
LATE SIGN
- potential causes: septic shock (can be rapidly fatal) and hypovolemia (dehydration, bleeding)
Fluid resuscitation is the immediate treatment

45
Q

Evaluating Vital Signs: Hypertension

A

Requires prompt assessment and intervention
Potential etiology:
- steroids
- renal
- increased intracranial pressure - report!
May require routine medication

46
Q

Nursing Assessment

A

Thorough Physical Assessment
Special Attention to:
- mouth
- skin
- perianal area
- vital signs
- fluid balance
- lab results

47
Q

Family Centered- Care

A

Parents as partners in their child’s care
Family: the constant in the child’s life
Nursing strategies to promote the family’s role
Honoring diversity
Recognizing family strengths and individuality

Pediatrics (25 decks)

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