Pediatric Cancer

Question 1

What is the leading cause of death by disease for children

Answer 1

Cancer

Question 2

What is the most common form of cancer in children?

Answer 2

Leukemia (ALL)

Question 3

True or False: Lifestyle factors can impact the likelihood of all age groups acquiring cancer?

Answer 3

False. Lifestyle factors are NOT a cause of childhood cancers

Question 4

What is the most promising theory as to the cause of childhood cancer?

Answer 4

A genetic alteration that leads to uncontrolled proliferation

Question 5

What are the usual labs acquired for childhood cancer?

Answer 5

CBC, CMP (complete metabolic panel), UA (urine analysis)

Question 6

Name some of the cardinal symptoms of cancer (8):

Answer 6

1. ) Unusual mass or swelling
2. ) Unexplained paleness and loss of energy
3. ) Sudden tendency to bruise
4. ) Persistent, localized pain or limping
5. ) Prolonged, unexplained fever or illness
6. ) Frequent headaches, often with vomiting
7. ) Sudden eye or vision change
8. ) Excessive, rapid wt loss

Question 7

When should sedation be used with children during a bone marrow aspiration?

Answer 7

Always! May use conscious or unconscious, but must always use something.
Adults may only receive local anesthetics.

Question 8

How do biologic response modifiers (a.k.a. monoclonal antibodies) work on cancer cells?

Answer 8

They change the host’s biologic response to cancer cells.

Question 9

How are clinical trials conducted to test new treatments?

Answer 9

Control group receives the best available therapy currently known, while the experiment group receives treatment that is thought to be even better.

Question 10

Why must the IV site be carefully watched when chemotherapy is being administered?

Answer 10

Chemo is very vesicant (sclerosing) and can cause serious damage to local tissue if allowed to infiltrate.

Question 11

Why does chemo cause baldness and what other types of cells/sites may be affected by chemo?

Answer 11

It will affect all cells that have a high proliferation rate. Cells (aside from tumor cells) that have a high proliferation rate include hair, mucosal, GI tract, bone marrow, and skin).

Question 12

What are potential hypersensitivity reactions that may be observed with chemo?

Answer 12

Urticaria, angioedema, flushing, rashes, difficulty breathing, hypotension, and N/V.

Question 13

What steps does a nurse immediately take if a hypersensitivity reaction to chemo is suspected?

Answer 13

1. ) D/C the drug
2. ) Flush IV line with NS
3. ) Monitor vital signs

Question 14

What is an “allogenic” bone marrow transplant?

Answer 14

Bone marrow received from a donor.

Question 15

Why is umbilical cord blood an option for bone marrow transplant?

Answer 15

It is a rich source for hematopoietic stem cells

Question 16

What is an “autologous” bone marrow transplant?

Answer 16

Uses the patient’s own marrow from disease-free tissue

Question 17

How does Bone Marrow Transplant differ from Peripheral Stem Cell Transplant?

Answer 17

Differs in how the collection is performed.
BMT is done by aspirating bone marrow.
PSCT is done by administering a colony stimulating factor to encourage proliferation of stem cells, that are collected by a filtering (apherisis) machine from the blood and later transfused back to the patient
Both methods infused through a Central line.

Question 18

What is the cause of abnormalities in tumor lysis syndrome?

Answer 18

Mass release of intracellular contents into bloodstream when malignant cells die.

Question 19

What abnormal changes are found in the bloodstream from tumor lysis syndrome?

Answer 19

Hyperuricemia, Hypocalcemia, Hyperphosphatemia, Hyperkalemia

Question 20

What are the potential serious complications of tumor lysis syndrome?

Answer 20

Acute renal failure and death

Question 21

How is tumor lysis syndrome prevented?

Answer 21

Prevented with IV hydration and medication to decrease uric acid levels (Allopurinol)

Question 22

What are the risk factors for acute tumor lysis syndrome?

Answer 22

Large tumor burden, sensitivity to chemotherapy, and high proliferative rate.

Question 23

What are the clinical symptoms of acute tumor lysis syndrome?

Answer 23

Flank pain, lethargy, N/V, oliguria, pruritus, tetany, and altered level of consciousness.

Question 24

How is neutropenia treated?

Answer 24

Administering colony-stimulating factors (Neupogen).

Question 25

What temperature warrants being brought to the ER?

Answer 25

100.5 or greater

Question 26

What common OTC meds for fevers should be avoided and which one is allowed (*Test question)

Answer 26

Aspirin and Ibuprofen. May take Tylenol.

Question 27

What is the best way nurses can take care of kids with N/V from treatment?

Answer 27

Administer zofran as scheduled. Also will give other antiemetics such as emend prior to chemo as preventive

Question 28

Aside from IMMEDIATELY notifying MD, what can nurses do if mouth ulcers develop?

Answer 28

Administer magic mouth wash, Allow children to select foods they can eat (soft bland foods may feel best, avoid hot, cold, and spicy foods)

Question 29

How should nurses advise parents regarding alopecia?

Answer 29

Hair will grow back within 3-6 months after completing treatment, may have a different texture.
Protect from sunlight.

Question 30

What are potential side effects to chemo treatment?

Answer 30

1. ) Infection/Neutropenia
2. ) Hemorrhage
3. ) Anemia
4. ) N/V
5. ) Altered nutrition
6. ) Mucosal ulceration
7. ) Neuropathy
8. ) Hemorrhagic cystitis
9. ) Alopecia
10. ) Steroid effects (Moon face, mood swings)