TABS

An illness in a child is a stress, especially if it includes hospitalization.

Depends on their:

• Cognitive ability

• Past experiences

• Level of knowledge

What is the meaning of illness to children?

Mostly has IV lines for hydration and nutrients supply

In pedia ward, mostly has ______ for hydration and nutrients supply

❖ Very young children do not have the vocabulary to describe symptoms.

❖ Children younger than 5 have great deal of difficulty describing a headache, dizziness.

❖ “Crying” is their way out to express their symptoms

Inability to communicate

Correct Answer: C

Rationale: Young children, especially those under 5, lack the vocabulary and cognitive development to articulate specific symptoms. Crying and behavioral changes are their main communication tools.

A 2-year-old child presents to the emergency department with a fever and irritability. Which of the following is the MOST accurate statement regarding the child's ability to communicate their symptoms?

A. The child can accurately describe the location and intensity of their pain.

B. The child can use complex vocabulary to explain their discomfort.

C. The child's primary way of expressing symptoms is through crying and behavioral changes.

D. The child can easily differentiate between a headache and abdominal pain.

Correct Answer: C

Rationale: Children under 5 struggle with abstract concepts like numerical pain scales and complex medical terms. Observing behavior (e.g., rubbing their head, irritability) and asking simple questions (e.g., "Does your head hurt?") are more effective.

Question 2:

A nurse is assessing a 4-year-old child who is suspected of having a headache. Which of the following assessment techniques is MOST appropriate?

A. Directly asking the child to rate their pain on a numerical scale.

B. Asking the child to describe the quality of the headache using medical terminology.

C. Observing the child's behavior and asking simple, directed questions about discomfort.

D. Relying solely on parental reports of the child's symptoms.

Correct Answer: B

Rationale: The core concept presented is the communication barrier in young children.

Which of the following is a key difference between how children and adults respond to illness?

A. Adults are more likely to express their symptoms through crying.

B. Children often lack the ability to articulate specific symptoms due to limited vocabulary.

C. Adults are less likely to experience fever as a symptom of infection.

D. Children typically have a higher pain tolerance than adults.

Correct Answer: C

Rationale: This reinforces the concept of limited communication abilities in young children.

When assessing a child younger than 5 years old, what is the most important factor to remember regarding their ability to describe their symptoms?

A. They are able to use advanced medical terminology.

B. They can accurately describe the intensity of their pain.

C. They have a limited vocabulary and rely on nonverbal cues.

D. They are always able to differentiate between different types of pain.

Inability to monitor care and manage fear

❖ Children have fears that adults do not experience.

❖ Infants – separation anxiety

❖ Toddlers & Preschoolers – fear of intrusive procedures, body mutilation

❖ School & Adolescent – loss of body parts, body image disturbance

Correct Answer: C

Rationale: Infants primarily experience separation anxiety when hospitalized.

An infant is admitted to the hospital. Which of the following fears is MOST prominent during this developmental stage?

A. Fear of body mutilation.

B. Fear of loss of body parts.

C. Separation anxiety.

D. Fear of intrusive procedures.

Rationale:

• B. Demonstrating separation anxiety. This is the correct answer. Infants in this age range experience separation anxiety, which is a normal developmental phenomenon. They have formed strong attachments to their primary caregivers and become distressed when separated from them.

• A. Expressing fear of body mutilation. This fear is more characteristic of toddlers and preschoolers, not infants.

• C. Verbalizing concerns about body image. This is a concern typically seen in school-aged children and adolescents.

• D. Exhibiting fear of intrusive procedures. While infants may react negatively to procedures, the primary fear at this age is separation from caregivers.

Question 1:

A 10-month-old infant is admitted to the pediatric unit for observation after a fall. Which of the following behaviors would the nurse anticipate based on the infant's developmental stage?

A. Expressing fear of body mutilation.

B. Demonstrating separation anxiety.

C. Verbalizing concerns about body image.

D. Exhibiting fear of intrusive procedures.

Rationale:

• C. Use simple language and explain that the procedure will help them feel better, focusing on sensory experiences. This is the best approach. Toddlers and preschoolers have limited understanding of complex medical concepts. Explaining the procedure in simple terms and focusing on what they will feel, see, and hear can help reduce their fear of intrusive procedures and body mutilation.

• A. Explain the procedure using anatomical diagrams and detailed medical terminology. This would likely increase the child's anxiety, as they would not understand the information.

• B. Encourage the child's parents to leave the room to minimize distractions. Parental presence is crucial for providing comfort and support to young children during procedures. Separation from parents would increase the child's anxiety.

• D. Tell the child that the procedure will be quick and painless, regardless of the actual experience. This is dishonest and can erode trust between the child and the healthcare provider. It's important to be truthful while still providing reassurance.

Question 2:

A 3-year-old child is scheduled for a lumbar puncture. Which nursing intervention is most appropriate to address the child's likely fears?

A. Explain the procedure using anatomical diagrams and detailed medical terminology.

B. Encourage the child's parents to leave the room to minimize distractions.

C. Use simple language and explain that the procedure will help them feel better, focusing on sensory experiences.

D. Tell the child that the procedure will be quick and painless, regardless of the actual experience.

Rationale:

• D. Body image disturbance. Adolescents are highly concerned about their physical appearance and how they are perceived by their peers. A brace can significantly impact their body image, leading to anxiety and self-consciousness.

• A. Separation from parents. While adolescents still value parental support, separation anxiety is primarily seen in infants.

• B. Fear of intrusive procedures. While medical procedures can cause anxiety, the primary concern for an adolescent with scoliosis and brace fitting is related to their body image.

• C. Loss of body parts. This fear is more common in younger children and those facing major surgeries or traumatic injuries.

A 14-year-old adolescent with scoliosis is scheduled for a brace fitting. Which of the following fears is most likely to be a primary concern for this patient?

A. Separation from parents.

B. Fear of intrusive procedures.

C. Loss of body parts.

D. Body image disturbance.

Children have greater metabolic demand, breathe in more air per pound of body weight than adults do, have a higher surface to body mass ratio, and are at greater risk of insensible fluid loss when they are sick

Nutritional needs of the children?

In a newborn ECF is 40% of total body pf water

In a newborn ECF is __________ of total body pf water

Because child’s body is continually growing, young children tend to respond to disease systematically rather than locally

Because child’s body is continually growing, young children tend to respond to disease__________ rather than ______.

Fever, vomiting, and diarrhea occur so frequently in children with any type of illness

____________ and _______ occur so frequently in children with any type of illness

measles, chicken pox, mumps, etc.

Children are more susceptible to illness, such as:

Ill infant

encourage development of trust.

False: Breastfeeding should be continued if possible.

T/F: Breast feeding should be minimize if the infant is ill for it is known to cause allergic reactions, exacerbating the condition.

Toddler & Preschooler

promote autonomy in toddlers and initiative in preschoolers.

School-age Child

continue to work on a sense of industry by involving them as much as possible in planning their care

Adolescent

encourage them to maintain self-care activities and good hygiene practices to help preserve self-esteem.

• MIO (Monitoring Intake and Output):

• IV hydration:

• Providing enteral feedings (NGT, TPN):

A child with a chronic illness is experiencing decreased oral intake and is at risk for malnutrition. List three (3) nursing interventions that are essential for promoting the child's nutritional health and maintaining optimal nutritional status.

❖ Placed side rails up at all times.

❖ Follow standard infection precautions to prevent spread of infections.

prime nursing interventions is to keep children safe during illness care

Answer: C. Provide a quiet, dimly lit environment and read a bedtime story.

Rationale: Option C directly addresses creating a conducive sleep environment by minimizing stimulation (dim lights, quiet) and incorporating a calming routine (bedtime story). Options A, B, and D are counterproductive to promoting sleep.

A nurse is caring for a 6-year-old child hospitalized with pneumonia. Which of the following interventions is most appropriate to promote restful sleep?

A. Encourage the child to watch television until they fall asleep.

B. Maintain a brightly lit room to monitor the child closely.

C. Provide a quiet, dimly lit environment and read a bedtime story.

D. Allow the child to play video games until late in the evening.

Answer: B. Providing a consistent bedtime routine and minimizing interruptions.

Rationale: A consistent routine, including quiet activities and minimal interruptions, helps regulate the child's sleep-wake cycle. Options A, C, and D are detrimental to sleep.

An 8-year-old child, hospitalized for a febrile illness, is having difficulty sleeping. Which nursing intervention is most effective in promoting sleep?

A. Administering a stimulant medication to counteract the fever.

B. Providing a consistent bedtime routine and minimizing interruptions.

C. Allowing the child to have caffeinated beverages before bed.

D. Encouraging the child to engage in vigorous physical activity before bedtime.

skip ko rikta cancer dayon ah

FEBRUARY 15

when is the International Childhood Cancer Day

Cancer

is a collective term describing a large group of diseases characterized by uncontrolled growth and spread of abnormal cells.

Dysplasia

A term used to describe abnormal cells that are not yet cancerous.

Rhabdomyosarcoma

It's a type of sarcoma, which is cancer that begins in the body's connective tissues.

• GO PHASE – resting phase

• G1 PHASE – RNA and Protein synthesis

• S PHASE – DNA Synthesis

• G2 PHASE – cell prepares to divide

• M PHASE – mitosis

Predictable Cell Life Cycle

Our body has regulatory growth mechanism that tells the body when the cycle will begin. It will now go to G1, mRNA synthesis will occur and protein (needed for cellular growth)

Our body has _______________ that tells the body when the cycle will begin. It will now go to G1, mRNA synthesis will occur and protein (needed for cellular growth)

Lymphatic Spread

tumor emboli enter lymphatic channels via interstitial fluid and lodge to lymph nodes or pass by lymphatic or venous circulations.

Without protein, it could cause death to the cell.

The cell will now decide whether to continue the process, it can tell if the cell is defective that’s why it won’t continue anymore.

Without______________, it could cause death to the cell.

The cell will now decide whether to continue the process, it can tell if the cell is defective that’s why it won’t continue anymore.

APOPTOSIS

A type of cell death in which a series of molecular steps in a cell lead to its death

There’s a gene here that stops the process if it detects abnormalities or the cell would have this programmed cell death or what we call ________________

DIFFERENTIATION

The process of development where cells become more specialized or committed to a more particular cell line as they mature.

False

T/F: Cell differentiation results in cells having a uniform look and function.

When we do the biopsy, the one we look for is the degree of differentiation

When we do the biopsy, the one we look for is the ______________

CONTACT INHIBITION

the restraint in cell growth and division which normally follows contact between tissue cells.

Answer: False

Explanation:

This statement is false because normal cells exhibit a phenomenon known as contact inhibition or density-dependent inhibition. This means that when normal cells grow in a culture dish (or within a tissue), they will continue to divide until they form a single layer and come into contact with each other. Once this contact occurs, they receive signals that inhibit further cell division.

In normal cells, cell division continues indefinitely, regardless of cell density or contact with neighboring cells.

In cancer, they would continue to divide and grow in number. That’s why you can see the patients have presence of lump or there would be swelling or there would be tumor because it continues to divide even if it’s already piling up.

In cancer, they would __________ and grow in number. That’s why you can see the patients have presence of lump or there would be swelling or there would be tumor because it continues to divide even if it’s already piling up.

falsea: Growth Rate is = to death rate

In a scenario where growth rate exceeds cell death, there will be a net increase in the number of cells.

In biopsy, there’s grading like grade 1, grade 2, grade 3, grade 4. Grade 4 is tolly different from the tissue of origin or what we call dysplastic cell.

In biopsy, there’s grading like grade 1, grade 2, grade 3, grade 4. Grade 4 is tolly different from the tissue of origin or what we call _______________.

Uncontrolled growth

Cancer cells disregard the signals that normally regulate cell growth.  They continue to divide even when they are surrounded by other cells, resulting in the formation of tumors

No contact inhibition.

The uncontrolled growth of cancer cells, resulting in the formation of disorganized masses or tumors, is largely due to a defect in the signaling pathways that normally regulate cell growth. What specific characteristic is lost in cancer cells, allowing them to grow over and on top of each other instead of forming a single layer?

• Vary in size, shape and appearance

• NO CONTACT INHIBITION

• UNCONTROLLED GROWTH

• Ability to grow and survive even in adverse condition

• Serves no function

• Metastasize

Characteristics of canccer cells

LYMPHATIC SPREAD

most common form of metastasis penetrating by invasion.

Metastasis

is a complex process by which cancer cells spread from their original location (primary tumor) to distant sites in the body, forming secondary tumors.

ANGIOGENESIS

growth of new capillaries from host tissue by release of growth factors and enzymes

VEGF – vascular endothelial growth factor

What does VEGF mean

Vascular Endothelial Growth Factor

is a crucial protein that plays a significant role in angiogenesis, the formation of new blood vessels

HEMATOGENOUS SPREAD

dissemination via the blood stream directly related to the vascularity of the tumor

How does Hematogenous spread occur

INTRINSIC FACTORS (Genetic Predisposition)

In childhood cancer, normally we focus on this area.

Viruses

Unhealthy lifestyle

smoking

poor diet

physical agents

Chemical agents

PROMOTERS

Virus

− Oncogenic viruses; Hepa B can be a risk factor in hepatic cancer (liver)

− Cervical cancer- HPV (human papillomavirus)

− Lymphomas- Epstein-Barr virus

Rationale:

• C. Hepatic cancer is the correct answer. Chronic hepatitis B infection is a significant risk factor for hepatocellular carcinoma (liver cancer).

• A. Cervical cancer is associated with HPV, not hepatitis B.

• B. Lung cancer has various risk factors, but not primarily hepatitis B.

• D. Lymphoma is associated with Epstein-Barr virus, not hepatitis B.

A patient diagnosed with chronic hepatitis B is receiving education about potential long-term complications. Which of the following cancers is most strongly associated with chronic hepatitis B infection?

A. Cervical cancer

B. Lung cancer

C. Hepatic cancer

D. Lymphoma

Poor diet

− Red meat is carcinogenic

− Processed foods everyday

✓ Stress

✓ Chronic disease

✓ Depressed immune system

ENVIRONMENTAL FACTORS

Carcinogenesis

The process by which normal, healthy cells transform into cancer cells

Rationale:

• C. Anorexia-cachexia syndrome. is the correct answer. This syndrome is characterized by severe weight loss, tissue wasting, and debilitation, commonly seen in advanced cancer.

• A, B, and D are potential complications of cancer but do not directly explain the severe weight loss and wasting.

A patient with advanced pancreatic cancer has lost a significant amount of weight and appears emaciated. The nurse recognizes that this is consistent with which of the following cancer-related syndromes?

A. Hypercalcemia.

B. Disseminated intravascular coagulation (DIC).

C. Anorexia-cachexia syndrome.

D. Edema.

Rationale:

• B. Obstruction and pressure on surrounding tissues. is the correct answer. Malignant cells proliferate uncontrollably, leading to tumor growth that can obstruct airways and compress surrounding tissues, causing pain and breathing difficulties.

• A. Anemia, not increased RBC production, is a common issue.

• C. Malignant cells often produce abnormal enzymes.

• D. Malignant cells disrupt, not improve, tissue function.

A client with metastatic lung cancer reports experiencing significant pain and difficulty breathing. The nurse understands that this is likely due to which of the following mechanisms related to malignant cell proliferation?

A. Increased production of red blood cells.

B. Obstruction and pressure on surrounding tissues.

C. Decreased enzyme production.

D. Improved tissue function.

Rationale:

• B. Production of hormones and other substances by tumor cells. is the correct answer. Paraneoplastic syndromes, such as hypercalcemia, occur when tumor cells produce substances that disrupt normal physiological processes.

• A, C, and D are related to cancer complications but do not explain paraneoplastic hypercalcemia.

A patient with small cell lung cancer develops hypercalcemia. Which of the following mechanisms best explains this complication?

A. Increased red blood cell destruction.

B. Production of hormones and other substances by tumor cells.

C. Obstruction of blood flow.

D. Ulceration of surrounding tissues.

Rationale:

• C. Disseminated intravascular coagulation (DIC). is the correct answer. Invasion of blood vessels by malignant cells can trigger DIC, a life-threatening condition involving abnormal clotting and bleeding.

• A, B, and D are potential complications but are not as directly linked to vascular invasion as DIC

A nurse is caring for a client with a malignant tumor that has invaded the surrounding blood vessels. Which of the following complications is the client at the highest risk for?

A. Anemia.

B. Effusion.

C. Disseminated intravascular coagulation (DIC).

D. Pain.

Rationale:

• B. Obstruction of lymphatic or venous flow. is the correct answer. Tumor growth can obstruct lymphatic or venous drainage, leading to fluid accumulation and edema.

• A, C, and D are not directly related to the development of edema in cancer patients.

A client with cancer is experiencing significant edema in the lower extremities. Which of the following mechanisms could contribute to this finding?

A. Increased production of digestive enzymes.

B. Obstruction of lymphatic or venous flow.

C. Decreased hormone production.

D. Increased red blood cell production.

• Tissue wasting

• Severe weight loss

• Severe debilitation

ANOREXIA AND CACHEXIA SYNDROME symptomps

Malignant cells

- produce enzymes, hormones and other substances (Paraneoplastic Syndrome)

• Anemia

• Hypercalcemia

• Edema

• DIC

Malignant Cell factors

Cellular Transformation and Derangement Theory

Healthy cells are transformed, by unknown mechanisms, into malignant cells upon exposure to certain etiologic agents resulting in uncontrolled cell growth, size.

1. Mutation of genes resulting in hyperactivity of growth-related gene products such genes are called oncogenes.

2. Mutation of genes resulting in loss or inactivity of gene products that normally would inhibit growth such genes are called tumor suppressor genes.

3. Mutation of genes resulting in overexpression of products that prevent normal cell death or apoptosis, thus allowing continued growth of tumor.

3 MAIN GENETIC MECHANISMS HAVE A ROLE IN CARCINOGENESIS

Mutation of genes resulting in overexpression of products that prevent normal cell death or ___________________, thus allowing continued growth of tumor.

Mutation of genes resulting in overexpression of products that prevent normal cell death or apoptosis, thus allowing continued growth of tumor.

Mutation of genes resulting in loss or inactivity of gene products that normally would inhibit growth such genes are called __________________________.

Mutation of genes resulting in loss or inactivity of gene products that normally would inhibit growth such genes are called tumor suppressor genes.

1. Mutation of genes resulting in hyperactivity of growth-related gene products such genes are called _________________.

1. Mutation of genes resulting in hyperactivity of growth-related gene products such genes are called oncogenes.

NORMAL IMMUNE RESPONSE

recognized foreign on antigen on cell membrane of cancer cells. (Macrophages and T lymphocytes

Lymphokines

kills, damage malignant cells

Interferons

which has anti-viral/tumor growth

Natural Killer Cells (NK cells)

directly destroy, produce lymphokines and enzyme for cancer destruction