Oncological Conditions / Death

Question 1

Describe the pathophysiology of leukemia (2)

Answer 1

• Overproduction of WBCs
• Immature cells compete causing destruction of normal cells

Question 2

What are the manifestations of ALL? (3)

Answer 2

• Bone pain
• Bruising
• Pallor

Question 3

What are the manifestations of AML? (2)

Answer 3

• Anorexia
• Hemorrhage

Question 4

What complications are associated with leukemia? (3)

Answer 4

• Anemia (decreased RBCs)
• Infection (decreased WBCs)
• Bleeding (decreased platelets)

Question 5

______ is used for a definitive diagnosis of leukemia

Answer 5

Bone marrow biopsy

Question 6

______ is used after diagnosis of leukemia to determine CNS involvement

Answer 6

Lumbar puncture

Question 7

Describe the 3 phases of chemotherapy for leukemia

Answer 7

• Induction - induce complete remission (< 5% of immature cells in bone marrow)
• Consolidation - systemic chemotherapy to eliminate CNS involvement
• Maintenance - maintain remission

Question 8

______ is used for management of leukemia in addition to chemotherapy

Answer 8

Bone marrow transplantation

Question 9

Describe the nursing considerations associated with chemotherapy (3)

Answer 9

• Oxygen for hypoxia - prevent anemia
• Neutropenic precautions - prevent infection
• Soft toothbrush, no rectal temps, no needle sticks - prevent bleeding

Question 10

When is the peak incidence of osteosarcoma?

Answer 10

Adolescent growth spurt - most common near growth plate

Question 11

What are the manifestations of osteosarcoma? (3)

Answer 11

• Swelling / palpable mass
• Pain with activity / weight bearing
• Limping

Question 12

What is usually the first clinical manifestation of osteosarcoma?

Answer 12

Fracture

Question 13

Why is diagnosis of osteosarcoma often late?

Answer 13

Manifestations are similar to normal growth pains

Question 14

Describe the treatment of osteosarcoma (3)

Answer 14

• Chemotherapy
• Surgical resection
• Amputation - last resort

Question 15

Metastasis of Wilm’s tumor is most likely to ______

Answer 15

The lung

Question 16

Describe presentation of Wilm’s tumor

Answer 16

Presentation on one side - usually does not cross the midline

Question 17

What are the manifestations of Wilm’s tumor? (3)

Answer 17

• Firm / non-tender flank mass
• Hematuria
• Hypertension

Question 18

What is the primary nursing consideration associated with Wilm’s tumor?

Answer 18

DO NOT palpate the tumor mass - risk of rupture

Question 19

Describe the treatment of Wilm’s tumor (2)

Answer 19

• Chemotherapy
• Nephrectomy

Question 20

Where are the most common sites of neuroblastoma? (2)

Answer 20

• Medulla
• Adrenal gland

Question 21

Why is neuroblastoma known as the “silent tumor”?

Answer 21

Metastasis is common and typically advanced before diagnosis

Question 22

Treatment of neuroblastoma is dependent on ______

Answer 22

Stage (size, location, metastasis)

Question 23

Describe the treatment of neuroblastoma (2)

Answer 23

• Chemotherapy / radiation
• Surgical resection

Question 24

Children of what age are most responsive to treatment of neuroblastoma?

Answer 24

< 1 year old

Question 25

______ are the basis for understanding death as a child

Answer 25

Age and developmental level

Question 26

What are the 4 main concepts of death for children?

Answer 26

- Irreversibility - death is permanent - Finality - all functioning stops - Inevitability - death is universal to all living things - Causality - different causes of death

Question 27

Describe the concept of death for infants / toddlers

Answer 27

No understanding of death - can sense what caregiver is feeling

Question 28

Which age group has the following grief response: - Anxiety due to separation - Constant crying - Change in eating / sleeping habits

Answer 28

Infants / toddlers

Question 29

Describe the concept of death for preschoolers

Answer 29

View death as temporary - must use literal / clear language

Question 30

Which age group has the following grief response: - Frightening dreams - Night agitation - Regression

Answer 30

Preschoolers

Question 31

Describe the concept of death for school age children

Answer 31

Understand death as final but may not understand as universal

Question 32

Which age group has the following grief response: - Feeling guilty - Act out sadness / anger - Difficulty in school - Indifference / hiding feelings - Use of play to act out feelings - Personify death (ghosts, boogyman)

Answer 32

School age

Question 33

Describe the concept of death for adolescents

Answer 33

Understand death on same level as adults

Question 34

Which age group has the following grief response: - Engaging in risky behavior to gain control - Anger outbursts / irritability / moodiness - Difficulty in school - Change in eating / sleeping habits - Questioning religious beliefs / meaning of life

Answer 34

Adolescents