Neuroblastoma, Leukemia, Osteosarcoma

What are early clinical manifestations of neuroblastoma

Firm, non-tender irregular mass that crosses midline

urinary retention or frequency

periorbital edema and ecchymosis

Exophthalmos

What are late clinical manifestations of neuroblastoma

lymphadenopathy

hepatomegaly

what is treatment for neuroblastoma

surgery

radiation

chemotherapy

What are the interventions for neuroblastoma

routine post-op cares

provide emotional support

What is the most common cancer diagnosed in infancy

neuroblastoma

Where does neuroblastomas affect the body

head

neck

chest

pelvis

what is neuroblastomas nicknamed

silent tumor

poor prognosis

What is the goal of leukemia treatment

eliminate leukemic cells

What are some s/s of leukemia

bone pain

joint swelling

enlarged liver and spleen

weight loss

Overgrowth of leukemic cells prevents the growth of what other blood components

mature leukocytes

platelets

What can happen if mature leukocytes are not present in the body

immunosuppression

infection

death

what can happen in the body if there is no platelet growth

increases bleeding risk

Leukemia _______ and __________ bone marrow

invade

destroy

What is the most common cancer in children and young adults

osteosarcoma

what are the clinical manifestations of osteosarcoma

nonspecific bone pain

weakness, swelling, decreased movement

palpable lymph nodes

anemia, generalized infection, unexplained weight loss

limpness or inability to hold a heavy object

What are nursing interventions for osteosarcoma

follow prescribed weight bearing restrictions

routine pre and post-op care after amputation

reactions of anger and depression are normal

encourage attendance at a support group

refer to mental health counseling as needed

where can you take stem cells from

umbilical cord

bone marrow

peripheral circulation

Harvesting Bone Marrow:

Happens in the __________

Procedure takes ________

Donor is discharged ____________

__________ are given for comfort

OR

1-2 hours

several hours after procedure

analgesics

Harvesting Peripheral blood:

__________ procedure

Procedure takes ______________

May take more than ________ session

outpatient

2-4 hours

one

when will the donor replenish bone marrow and peripheral blood

couple weeks

How do you prepare a patient before they receive bone marrow or stem cells

High dose of chemo to completely eradicate bone marrow and malignant cells

what are the side effects of a bone marrow transplant

life-threatening pancytopenia

Tumor lysis syndrome

what is tumor lysis syndrome

tumor cells get released into blood cells

When is a patient cleared to get a stem cell infusion

48 hours after last dose of chemo

What is important to remember about engraftment

takes 2-4 weeks sometimes longer

requires hospitalizations due to pancytopenia

what are side effects of stem cell infusion

fever

chills

flu like symptoms

What are stem cell transplant complications

infection: bacterial, viral, fungal, protozoan

Graft-versus-host disease

what is graft-versus-host disease (GVHD)

donor initiates an immune response against recipients tissue

How can you prevent graft-versus-host disease (GVHD)

recipient receives immunosuppressant drugs

what are the skin s/s of GVHD

diffuse rash

blistering

desquamation

What are GI tract s/s of GVHD

mucosal inflammation

diarrhea

malabsorption

What are liver s/s of GVHD

hepatomegaly

elevated liver enzymes

jaundice

hepatic coma

what is the treatment of GVHD

none

What are short term devices central vascular access devices

non-tunneled percutaneous

PICC

What are short term CVAD used for

Chemo treatment

Short term CVAD:

Put in at ____________ using _______________

High risk for __________

Nurse wears ________, _______________, sterile ___________, and _____________

Have patient look ________ from __________________

bedside, sterile technique

infection

cap, mask, glove, gown

away, sterile field

What are long term central vascular access devices

Hickman, Broviac, Groshong

port

where are long term CVAD placed

at bedside unless child then OR

what is long term CVAD used for

long-term chemo

Ports:

considered ____________

placed in the _________

accessed using a ____________ through the skin

permanent

OR

non-coring needle

what are irritant interventions for an IV

remove IV and restart

apply warmth

what are vesicant interventions for an IV device

Monitor for infiltration (extravasation)

order for antidote

What are the s/s of extravasation

pain

absence of blood return

burning, swelling, redness, vesicles

what are extravasation interventions

stop administration

follow drug-specific extravasation protocols to minimize further tissue damage

What is external radiation frequency

daily (Monday - Friday) for 2-8 weeks

Each radiation treatment lasts only about 1 minute

What are clothing skin protection interventions for external radiation

lightweight NOT harsh fabrics

Avoid tight fitting clothing

What should be avoided in order to protect the skin during external radiation

direct sun

excess heat or cold temperatures

anything that will further dry out and damage treatment area

How should you clean the skin in order to protect it during external radiation

Rinse with saline solution

expose to air

cleanse with mild soap, rinse, pat dry

If someone gets wet desquamation what is the goal of treatment

to prevent infection

facilitate wound healing

what is the treatment if someone has wet desquamation

normal saline compresses

Hydrocolloid dressings

What are internal radiation precautions

Nothing leaves the room

30 minute visit limit

maintain a distance of 6 feet

No one pregnant or <16 years old

What are at home internal radiation precautions

flush the toilet twice after each use

drink extra fluids

use separate utensils and towels

no kissing or sexual contact

Limit contact with infant children

When are chemotherapy precautions instituted

during infusion

48- hours after last drop infused

What are chemotherapy precautions

Double flush toilet

Chemo spill kit

waste receptacle

clean and protect skin