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