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Children with Cancer
CSM Pediatrics Cancer
73
Nursing
Undergraduate 3
03/12/2016

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Cards

Term
What is the leading cause of death in children under 15?
Definition
Cancer
Term
What are some external stimuli that cause genetic mutations?
Definition
1. Diethylbesterol
2. Steroids
3. Chemotherapy agents
4. Benzene (leukemia)
5. Immunosuppressants
6. Radiation exposure (thyroid, leukemia)
7. UV from the sun
Term
What cancers are tied to viruses?
Definition
Burkitts lymphoma, Leukemia
Term
What chromosomal abnormalities are linked to cancer?
Definition
Chromosome 21 -> leukemia
Chromosome 11 -> Wilm's tumor
Chromsome 13 -> Retinoblastoma
Term
What are symptoms of cancer?
Definition
Pain: tumor presses on nerve; cry & tell you
Cachexia: weight loss
Anemia: Leukemia
Repeated infections: Leukemia
Bruising: pettichaie
Neuro problems: nystagmus etc
Papable mass: may take nutrition from regular cells causing weight loss
Term
What are you looking for in CBC panel when looking for cancer?
Definition
Decrease RBCs, Decrease PLT, Increased WBC (leukemia, lymphoma)
Term
How do you determine the differences in leukemia and lymphoma?
Definition
Bone marrow aspiration
Term
What can a lumber puncture show in regards to cancer?
Definition
Brain tumor, Leukemia
Term
What Labs should you monitor in a cancer patient?
Definition
CBC, Electrolytes, Liver function test, ANC
Term
What imaging tools are used for cancer?
Definition
CT, MRI, Ultrasound, Nuclear Medicine scans, PET (cancer cells need more glucose) scans, SPECT
Term
What are the diagnostics used for?
Definition
1. Identify source of cancer (primary site)
2. Determined if the cancer has metastasized
3. Stage cancer (1 in-situ, 4 metastasized)
Term
What are considerations for cancer therapy?
Definition
1. Type of Cancer
2. Location
3. Degree of Metastasis
Term
How is surgery used to treat cancer?
Definition
1. Remove or debulk tumor
2. May determine stage & type of cancer
Ex: Wilm's Tumor (encapsulated)
Term
What is important to know about chemotherapy?
Definition
1. Drugs kill both normal & cancer cells
2. Timed for maximum destruction
3. Different
Term
What is adriamycin?
Definition
Chemo drug that causes cardiac damage
Term
What is methotrexate?
Definition
Anti-metabolite chemo drug
Term
What are 3 different ways chemotherapy drugs work?
Definition
1. Inhibit RNA or DNA
2. Block reproduction
3. Deplete key ingredient
4. Substitute building block that prevents reproduction
Term
What are the effects of suppressing bone marrow?
Definition
1. Anemia
2. Low WBC- risk for infections
3. Low HCT
Term
How does radiation therapy work?
Definition
1. Unstable isotopes are used to destroy DNA and the cell
2. Used for local & regional control of cancer
3. Can be used in combo with Chemo & surgery
4. May be curative or palliative
Ex: Hodgkin's
Term
What are drugs are used to stimulate WBC & RBC production?
Definition
Epogen-> RBC
Nuepogen -> WBC
Term
What is Sorafenib?
Definition
Oral chemo kinase inhibitor that creates apoptosis in the cells. Much more tolerated.
Term
How often is radiation therapy used?
Definition
5-7 weeks 5 days per week
Term
Why is important to pre hydrate & empty a bladder while a patient is on chemo?
Definition
To prevent cell lysis syndrome and to prevent damage to the bladder
Term
How does biotherapy work?
Definition
Uses parts of the body already programmed to destroy the cells to target cancer cells (Apoptosis)
Term
What is a problem with radiation in pediatrics?
Definition
Kids move, sometimes need sedation. Also radiation therapy is not done on kids under 2 because it causes too much damage
Term
What is XRT?
Definition
X-ray radiation therapy where the patient comes in prior to the procedure and lines are drawn to triangulate several radiation points onto the cancer.
Term
What type of cancers use radiation therapy?
Definition
Hodgkin's, Wilm's, retinoblastoma, rhabdomyosarcoma, metastasis to the brain (ex: leukemia)
Term
What are some different types of biotherapy for cancer?
Definition
Antibodies that are specific to certain cancers (Adjuvant)
Vaccines (stimulate stronger immune response)
Interferon
Tumor necrosis factor (TNF)
Term
What is the goal for bone marrow stem cell transplant?
Definition
Kill cancer with chemotherapy or radiation, then resupply the body with stem cells
Term
What are the sources for stem cell's?
Definition
Child's own bone marrow (autologous transplant) not ideal b/c of possible cancer
Compatible donor (allogenic transplant)
Umbilical cord blood
Term
What are bone marrow transplants used for?
Definition
Neuroblastoma, Severe complicated immune disease (SKIDS), Aplastic anemia
Term
What are the most abundant cells in the blood?
Definition
Red blood cells 40-45% of blood volume,
Term
What is erythropoiesis?
Definition
The process of forming new RBCs
Term
What triggers the production of new red blood cells?
Definition
Tissue hypoxia
Term
Where are RBCs formed?
Definition
The bone marrow
Term
What is the function of the RBCs?
Definition
To carry oxygen from the lungs to tissues via hemoglobin, and return carbon dioxide to the lungs
Term
What does polycythemia mean?
Definition
above average increase in RBCs
Term
What does anemia mean?
Definition
Reduction in number of RBCs
Term
Why do babies have higher levels of RBCs at birth?
Definition
The fetus shares oxygenated blood with the mother so each RBC has less total oxygen. The fetus then produces more RBCs to ensure enough oxygen is delivered to the body. Once the baby is born, the extra RBCs are no longer needed and start to break down causing the newborn to turn jaundice color
Term
What is another name for white blood cells?
Definition
Leukocytes
Term
Where are WBCs created?
Definition
Bone marrow, Lymph tissue
Term
What are the 5 types of WBCs?
Definition
Eosinophils, Neutrophils, Basophils, Monocytes, Lymphocytes
Term
What do platelets (thrombocyte) do?
Definition
Stick to the surface of a torn vessel and signal other cascade factors to stop bleeding
Term
Where are platelets stored?
Definition
Spleen
Term
How big are platelets?
Definition
1/10 the size of RBCs
Term
What forms from myeloid stem cells?
Definition
Eosinophils, Neutrophils, Basophils, Monocytes, RBCs, PLTs
Term
What forms from Lymphoid stem cells?
Definition
Lymphocytes -> T & B lymphocytes, Natural killer cells
Term
What is leukemia?
Definition
The most common type of childhood cancer that results from the proliferation of white blood cells. Highest risk (Caucasian)
Term
What are the two main types of Leukemia?
Definition
Acute lymphoblastic leukemia (ALL) (Most common)
Acute myelogous Leukemia (AML)
Term
What does leukemia do?
Definition
Stem cells in the bone marrow produce large numbers of immature WBC blast cells that do not function properly. These cells replace the RBCs & PLTs and increase the risk for infection.
Term
What does leukemia cause?
Definition
Anemia- Fatigued
Thrombocypetenia- Bruising immunosuppression
Term
What lab values indicate leukemia?
Definition
>10,000/µL WBC (Leukocytes) Norm <10K
<150K/µL PLT Norm 150K-400K
7-11 Hb Norm 12-16
Term
What are signs & symptoms of Leukemia?
Definition
Fever, Pallor, Overt signs of bleeding, lethargy & malaise, Joint or bone pain, Enlarged: liver, spleen, nymph node (infiltrates: WBC clusters)
Term
What are signs of CNS infiltration?
Definition
Headache, Vomiting, Papilledema
Signs of rising ICP
Term
What are signs of testicular infiltration?
Definition
Painless enlargement of the testicles
Term
What is it important to sample the bone marrow for Leukemia patients?
Definition
It is the only way to identify the type of leukemia
Term
What is the treatment for leukemia?
Definition
Radiation & chemotherapy
Term
What are the four phases of cancer treatment?
Definition
Induction- (1st month) Hit the cancer hard with full force/1st line drugs 95% will go into remission
Consolidation-
Delayed intensification- to take out small pieces
Maintenance- Less frequent not as harsh
Term
What is the criteria for receiving BMT?
Definition
10 HLA facts; 2/3 must match donor
Term
What is Mozabil?
Definition
Drug to promote more stem cells
Term
Why are BMTs used?
Definition
Chemotherapy is very harsh and destroys circulating blood cells & diseased bone marrow. It takes 4-12 days to destroy the cells. Children become high risk for infection. BMT is used to help promote new healthy cells but takes 2-4 weeks to proliferate.
Term
How do you prevent infections in neutropenic patients?
Definition
Protective isolation, Avoid fresh fruits & flowers
Term
How can you prevent bleeding in chemo patients?
Definition
Limit invasive procedures, No IM injections or rectal temps, Maintain pressure on injection site for 5 minutes, transfuse RBCs or PLTs as needed
Term
What is the prognosis for ALL and ALL + AML?
Definition
85% if under 15 for ALL
50% for both
10% relapse after 1st year of Tx
Initial WBC count- Higher=worse prognosis
Term
What are favorable factors for leukemia patients?
Definition
Age of onset is usually 2-10 years old
Initial hemoglobin less than 10 g/dL
Rapid response to Chemo
Term
What are significant assessment findings for leukemia patients?
Definition
Signs of bleeding, bruising, or infections
Renal function
Mucosal sores in mouth
CNS infiltration
-Decreased LOC
-Irritability
-Vomiting
-Lethargy
Term
What are some nursing interventions for Cancer patients?
Definition
Prevent infection
Skin & mouth care
Attention to renal function
Monitor IV site for extravasation
RBC & PLT Admin
Chemo Admin
Psychosocial interventions
Term
What are common Rxns from parents of kids who receive a cancer diagnosis?
Definition
Shock, disbelief
Must gather resources, make tx decisions
Travel often required for tx
Financial strain, potential job loss
Adaptation
Term
What are common Rxns from children who receive a cancer diagnosis?
Definition
infants & toddlers: limited understanding
Preschooler: limited understanding
School age? improved understanding
Adolescent: like to talk with other adolescents
Term
What are lung term effects of surgery?
Definition
1. Adhesions from abdominal sugery can lead to intestinal obstruction
2. Visual impairment
3. Neurological changes
4. Sterility- radiation, chemo
Term
What are long term effects from radiation?
Definition
Impairs growth of bones & teeth- can lead to scoliosis, dental problems
Hypothyroidism
Delayed puberty, sterility
Secondary cancers
Term
Long term effects of chemotherapy?
Definition
Cadiomyopathy (adriamycin)
Lung, renal toxicity
Neurological changes
Infertility
Hearing los, Vision changes
Term
What are affects from vincristine?
Definition
Chemo drug can cause jaw pain and loss of reflexes
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